HomeMy WebLinkAbout2003- April File Copy
• Jefferson County
Board of Health
Agenda
•
Minutes
April 17, 2003
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•
JEFFERSON COUNTY BOARD OF HEALTH
April 17, 2003
2:30-4:30 PM
Main Conference Room
Jefferson County Health and Human Services
AGENDA
I. Approval of Agenda
II. Approval of Retreat Summary of March 20,2003
III. Public Comments
IV. Old Business and Informational Items
1. Board of Health Field Trips
• 2. Jefferson County and Washington State WIC Report
3. State Board of Health Request
V. New Business
1. West Nile Virus Response: A Comprehensive Public Health Approach
2. Severe Acute Respiratory Syndrome: A Test of Global Surveillance and
Communicable Disease Control Systems
3. Board Sponsors for Environmental Health Regulation Development
VI. Activity Update
1. May 13, 2003 "Translating the Data: Moving from Numbers to People"
Jefferson County Elks Club, (9 AM to 3 PM)
(RSVP to Cathy Avery, cavery@co.jefferson.wa.us)
VII. Agenda Planning
VII. Next Meeting: May 15, 2003
• Jefferson County HHS Conference Room
,
JEFFERSON COUNTY BOARD OF HEALTH
• MINUTES
Thursday, February 20, 2003
Board Members: Staff Members:
Dan Titterness,Member-County Commissioner District#1 Jean Baldwin,Nursing Services Director
Glen Huntingford,Member-County Commissioner District#2 Larry Fay,Environmental Health Director
Wendi H. Wrinkle,Member-County Commissioner District#3 Thomas Locke,MD,Health Officer
Geoffrey Masa, Vice Chairman-Port Townsend City Council
Jill Buhler,Member-Hospital Commissioner District#2
Sheila Westerman, Chairman-Citizen at Large(City)
Roberta Frissell,Member- Citien at Large(County)
Vice Chairman Wrinkle called the meeting to order at 2:38 p.m. All Board and Staff members were
present, with the exception of Chairman Geoff Masci. Commissioner Huntingford joined the meeting at
2:40 p.m.
APPROVAL OF AGENDA
• Commissioner Titterness moved to approve the agenda as presented. Member Buhler seconded
the motion,which carried by a unanimous vote.
APPROVAL OF MINUTES
Member Buhler moved to approve the minutes of January 16, 2003. Member Frissell seconded
the motion,which carried by a unanimous vote.
PUBLIC COMMENT-- None
OLD BUSINESS AND INFORMATIONAL ITEMS
Commissioner Wrinkle noted that the Healthy Youth Coalition is meeting this afternoon at the Tri-Area
Community Center to provide the opportunity for Chimacum students to discuss the issue of the recent
teen death.
Member Westerman noted that there has been much publicity in the newspaper about the awarding of
the recycling contract. The newspapers have not reported on the letter from the Developmental
Disabilities Board to the Commissioners in support of awarding the recycling contract to Skookum.
•
, t .
HEALTH BOARD MINUTES -February 20, 2003 Page: 2
NEW BUSINESS •
Community Health Assessment Update (corrected handouts of agenda packet report): Dr. Chris Hale
provided background of data previously reported to the Board: in 1990, the 1990 US Census and school
survey data; in January 2001, 20 years of birth-related health indicators and mortality rates and
preliminary short-form US Census data; and in March 2002, the Behavioral Risk Factor Survey data.
She then prefaced her presentation of the 2000 long-form Census, by noting that a somewhat longer
report looking at socio-demographic data would be offered at a community meeting tentatively planned
for May 13th. The survey primarily focused on six areas: Port Townsend,Port Hadlock/Irondale, Port
Ludlow, Marrowstone Island, Brinnon and Quilcene. She noted that only fragmentary information is
available for the West End. This assessment was guided by Healthy People 2010, an ongoing
international effort to improve health of communities,targeted at improving the number of years people
live and the quality of those years and at reducing disparities. It is unlikely that life expectancy in
Jefferson County can go much higher, having nearly reached the biological limits. Quality of life
conclusions can be drawn from Behavioral Risk Factor Data and other data. She believes the reduction
of disparities is where the community would be focusing its efforts. The report focuses on two classes of
disparity: differences in age composition(which will drive differences in the demand for health care)
and differences in poverty.
In reviewing the data in each of the report's, she offered the following comments:
1. Jefferson County's Population is significantly older than Washington State. Jefferson S
County's percentage of people 65 and over is nearly twice that of the State (21.5% compared
with 11.2%). The implications of this are enormous because half of all health care expenditures
are consumed by this group. As a result, any constraint at the national level in Medicare or other
programs that benefit older people will hit this community twice as hard as it hits Washington
State. The 85+ segment which is nearly twice what it is in the State,has been growing
dramatically since about 1990 and is the most expensive to care for due to healthcare costs and
the assistance they need if they stay in their own homes. Other analyses indicate that this is
almost solely in-migration.
2. Age composition of places within the County are different. The major factors in changes over
the last 20 years are: 1)in-migration of 40-50 year olds and 85+, 2)normal aging of existing
residents, and 3) low birth rate. She noted that Port Townsend, Port Hadlock and Quilcene look
similar to the County overall,whereas Marrowstone,Brinnon and Port Ludlow look similar to
each other,but different from the County. The vastly different age composition within each of the
six communities would argue for different kinds of programs. She then reviewed the map in the
back of the report,which overlays the Census Bureau delineation of these community
populations with the postal zip code boundaries. These differences are important when
considering socio-economic information. Dr. Hale talked further about census tracts and noted
that Cape George,Kala Point and Shine were not represented. In summary, she noted that
Jefferson County, with a median age of about 43, is old, even compared to the State figures.
There are big differences in age composition among the communities, with the highest •
percentage of kids living in Port Townsend,Port Hadlock/Irondale and Quilcene.
HEALTH BOARD MINUTES - February 20, 2003 Page: 3
• 3. Poverty rates in Jefferson County in 1999 were generally higher than in the state,but rates
varied from place to place within the County. She pointed out that while Jefferson County's
Median Household Income (MHI) in 1999 was $37,869, the data from Port Ludlow, representing
10% of the total households and whose MHI is nearly$57K, distorts upward the County's figure.
For the past two decades, Jefferson County's MHI has remained at about 80% of the state
average. Looking at those below 100% of the Federal Poverty Level, the County rate is 11.3%,
which is higher than the State rate. However, when excluding Port Ludlow(1.2%), Marrowstone
(4%), and Brinnon(13.8%), other communities reflect a higher poverty rate than the State. It was
noted that of the 593 people shown as below poverty in the West End, over 300 are on the Hoh
Reservation and some might also be in Queets.
4. The universe of people in poverty consists of three segments: children younger than 18 and
their parents or guardians,people age 18-64, and people age 65+. Nearly one quarter of the 2900
people in the county who qualify as having incomes below poverty are children and female heads
of household, with no spouse present. Nearly one in five are kids in married couple households.
The next largest group is people 18-64 living in non-family households with no children under
18. Together, these groups account for 3/4 of all the people in poverty in Jefferson County. The
other groups that account for the remainder are family households— 18-64 with no children under
18, and two groups of people 65+.
5. Poverty rates among children are higher in Jefferson County than in Washington State, and
rates differ sharply by place. One in six children younger than 18 in Jefferson County lives below
• poverty. This compares with the national rate of one in four. Dr. Hale said that two confounders
in looking at this data are housing costs and the rates of disability in those 65 and older, which
may be a better indicator of program need than their income. The concept of poverty in rural
communities is different. Even though incomes in a certain area may be lower, program
utilization is also lower. People do not necessarily think of themselves as poor. Commissioner
Huntingford noted that at one point there was school information that showed the number of
children in the Brinnon School that are actually living with grandparents.
6. Jefferson County mothers are significantly more likely to be unmarried and to have their
pregnancies and deliveries paid for by Medicaid than in the State. Medicaid pays for 55% of the
births in Jefferson County as opposed to 36% statewide. Dr. Hale said she is concerned about the
dependence in this County on Medicaid as a payment source for deliveries.
7. Adults in Jefferson County households that included children younger than 18 reported
higher rates of health risk behaviors than did adults in households that did not include children.
8. Poverty rates are higher among people age 18-34 and may be associated with the lack of
advanced education. Jefferson County's poverty rate in this age group is about 18%, compared
with 14%in the State. There again is a lot of variability by place, with 0% on Marrowstone and
6.5% in Port Ludlow, whereas in the rest of the county it is about one in four or five, except in
the West End, where it is over half. To look more closely at the poverty rates, they split the
. population into two groups: 18-24 and 25-34. Of the 18-24, about 1/3 have not completed high
school or have a GED (compared to the State's V4), another 1/3 have completed high school or
GED, and another 1/3 have some post secondary education. She believes there is a huge potential
to improve the educational attainment, such as with mentoring programs (youth 14+with an
HEALTH BOARD MINUTES -February 20, 2003 Page: 4
adult to help in transition to adulthood).
9. People age 18-34 have lower rates of healthcare access and higher rates of risk behaviors than
the adult population as a whole. Dr. Hale noted the rates of access to healthcare are lower in the
County than they are in the State for this group.
10. Poverty rates in Jefferson County among people 65-74 are lower than they are in the State
(2.3%vs. 6.5%). However, the poverty rate among people 75+ in the County is higher than in the
State (10.6%vs. 8.6%). She noted that on Marrowstone, out of 152 people, 10.5% are below the
poverty level—the highest rate in the County. She believes we are seeing people with relatively
low incomes but who may be sitting on valuable property, and may qualify for the property tax
exemption program.
11. Healthcare access indicators are better among people age 65+ than the County average,but
this group has significant health risk behaviors. This does not answer other access-related
questions such as how far they have to travel, what is excluded, etc. This group is more likely to
be overweight and less likely to be physically active, but is less likely to smoke. It is most
surprising that there is no difference in the alcohol consumption rates among people 65+and
other adults in this county. The State alcohol consumption rate is a little over 60% for all adults
and 46% for those 65+. Member Frissell asked whether the Census asks question about
prescription coverage,which Dr. Hale said it does not.
12. Poverty rates in Jefferson County probably underestimate need because they are based on an •
assumption that 1/3 of income is for housing, 1/3 for food, and 1/3 is for everything else. Dr.
Hale, in considering the median house price relative to median income,pointed out the
"affordability gap," (the difference between the price of a house people could afford based on
median income and the actual price of the average or median house in the county.) The Census
data on annual income spent on housing revealed that one in five spend more than 35% of their
income on housing, which is about the same as the State. However, in Port Hadlock/Irondale, one
in four spend more than 35%on housing. Statewide, about 1/3 of all renters are spending more
than 35+% of their income on housing,but in the County this is roughly 40%, although no one in
Port Ludlow or Marrowstone falls into this category. Not represented are those who spend more
than 50% of their income on housing. Housing prices are the most likely to affect the younger
segment of the population. Poverty rates are really not a measure of program need.
13. Disability rates for County residents (male and female) age 65-74 and men 75+ are lower
than they are in the State. In women age 75+, the disability rates are higher. However, if you look
at the population of people 65+, one third have some significant disability. The combination of
disability and poverty rates points to a need for increased publicly funded services among people
age 65 and older. Dr. Hale noted the Health Department will be issuing a detailed report on
disabilities. There is relatively little difference in disability rates place by place.
Jean Baldwin noted that the Data Steering Committee,with its various representatives from the hospital,
City Council,Health Department, O3A, OlyCap, WSU, law enforcement, and citizens,has been working •
for two and a half years. This group has discussed making the data available to the public, community
and policy makers by creating a book and a compact disc. They also plan to hold a summit on May 13 to
present the data and indicators to senior managers and community leaders and to confirm whether we
HEALTH BOARD MINUTES - February 20, 2003 Page: 5
• want to track them for the next 15-20 years. They are uncertain what policymakers need to know in order
to support program providers and change or improve services. She also solicited recommendations
who else needs to attend the summit. on
Member Westerman spoke of the specific need for policymakers to attend the summit. She would like to
find a way for summit attendees to focus on the big picture and not just advocate their specific interests.
Member Frissell said she believes managers need to receive the information.
Dr. Hale noted that Jefferson is the first County to have completed this type of detailed analysis. Clallam
and Kitsap are doing identical analysis, in part because of their sense that their demands look similar and
because of their desire for a more regional approach.
Dr. Locke also spoke of the need for a coordinated process to address these `multi jurisdictional
problems."These are not city and county-based problems, but are national problems and are not solvable
by local government alone.
Member Buhler said we might not realize the value of this information until specific needs arise, adding
that the data will have to be indexed and accessible so that the desired information can be found.
Bringing different interests together at a summit provides an opportunity for collaboration.
There was Board support for holding a May summit.
• Legal Opinion Regarding P g ng O&M Inspections on Private Property: Larry Fay reported that after the
last Board meeting, he and Dr. Locke drafted a memorandum to Deputy Prosecuting Attorney David
Alvarez with the five key questions from Mr. Belenski.
Deputy Prosecutor Alvarez said that his written opinion addressed the current regulatory scheme, Mr.
Belenski's objections, the general rules that apply to search and seizure, and Washington State's
protection of privacy as compared to federal courts. He believes the WAC sections related to Operation
and Maintenance supports conditioning an on-site sewage permit on third party monitoring and allows
requiring someone who obtains an on-site sewage permit to sign an operation and maintenance contract.
Mr. Alvarez believes Mr. Belenski is correct about the Fourth Amendment issues raised. There is either
consent to access the property or a warrant is issued. He noted that there is a state statute(70.118.130)
but it only applies in very limited situations. Particularized evidence would be needed to get on the
property. The Board is also faced with what he called a substantial quandary because while there is an
obligation to monitor, a person with private property can refuse entry to the person doing the inspecting.
That is where Bill 5108 comes into play, which he hopes would create an exception to the trespassing
statute for people enforcing a permit. He said the Board might want to support this bill, which recognizes
there are certain times when criminal trespassing should not pertain to the obligation to go on the
property and fulfill a public duty. He then reviewed what changes Thurston County has made regarding
the enforcement regulations for residential on-site sewage systems. He noted that there are points of
Aik view, statutes and aspects of constitutional law that conflict with the WACs as well as public policy that
lip conflicts with the Fourth Amendment. He said he hoped to highlight the issue,
questions and confirm that Mr. Belenski has been heard. answer the Board's
HEALTH BOARD MINUTES -February 20, 2003 Page: 6
Mr. Fay reviewed this issue with the adoption of the On-Site Sewage Ordinance in 2002. The Board has •
followed a set of State directives and regulations,but the County is not in a position to compel someone
to let us onto his/her private property.
Commissioner Titterness stated that Jefferson County's ordinance, adopted per the WAC, is probably
not consistent with the Constitution of either the U.S. or the State of Washington. He then inquired
whether to ask for a court decision on this matter?
Member Westerman noted that the memorandum states that you can also surrender part of your Fourth
Amendment rights in exchange for a privilege. She argued that the privilege of receiving a permit for an
on-site septic system,which comes with the requirement that it be monitored, is similar to the privilege
of obtaining a driver's license and consenting to undergo a breath or blood alcohol content test if
requested while under arrest. Mr. Alvarez said he does not believe anyone has ever used this analogy to
argue his or her point in a Washington court.
Mr. Fay said the ordinance states if you have an on-site sewage permit, you are subject to being on an
inspection schedule.
Mr. Belenski said there has to be probable cause to entangle someone and invade his or her privacy.
While the County may be mandated to enforce public safety, the WACs as written begin to infringe on
people's rights. There is nothing in the WAC that says you have to access someone's property. He said
WACs are rules and the RCW is the law and neither one can step on your constitutional rights. Mr.
Alvarez noted that a WAC also goes through a rule-making process and does have the effect of law,
•
albeit a lesser level than the state statute or federal constitution.
Commissioner Huntingford said he is interested in what Thurston County is doing. He asked Dr. Locke
about a similar bill that failed before the legislature two to three years ago? Mr. Fay noted that in the
early 90s Thurston County adopted an ordinance requiring both installation and operational permits for
on-site sewage systems,permits that are renewable on some frequency depending on the complexity of
the system. Before it could be renewed,they provide proof of passing an inspection by a qualified
person. Rather than mandating an inspection frequency, they attached it to a permit. In practice, they
have found something less than 40% compliance on renewals and they are largely not enforcing it.
Mr. Alvarez said he understands Thurston County has changed their structure for regulating and would
suggest Mr. Fay talk with his counterpart in Thurston County about their regulations. Mr. Fay,being on
the State Board of Health's Rule Development Committee, is currently involved in updating the on-site
sewage code. Among the members of this committee, there is strong interest in prescriptive state
standards on operation and maintenance. He will be sharing with them Mr. Alvarez's opinion,because it
has significant influence on the policy direction for the State.
Dr. Locke noted that while there was an administrative search bill that failed four to five years ago,he
believes three to four years ago another one passed(RCW 70.118.030),which is very specific and says
you have to prove that freshwater or marine water contamination is at risk.
appears that without permission to access property,you have to prove •
Commissioner Huntingford said it pp
just cause. Instead of trying to monitor every system in the County, encourage people to talk to the
County when they have a problem and provide access to the Revolving Loan fund for help. Member
HEALTH BOARD MINUTES - February 20, 2003 Page: 7
• Westerman, referring to the Gaikowski situation, said that while most people do not want to pollute the
environment, there needs to be a mechanism for addressing these situations. Commissioner Huntingford
stated that a mandatory inspection on a regular basis is different than a visible health problem, which the
County should have the authority to fix.
Mr. Belenski cited a case where the City of Seattle police were pulling drivers over and checking them
for intoxication. This practice eventually went to court and was ruled unconstitutional. Neighbors can
fabricate conditions on which the government would base its just cause. If a septic system fails, it is
known 300 feet away. He believes there should be some proof of a hazard before you can invade his
privacy.
Mr. Alvarez said the Board should discuss whether there could be off-site monitoring. Mr. Belenski
pointed out that the smell test helps and he also noted that a person who has a huge monetary investment
in their system is unlikely to let it collapse.
Mr. Fay recommended reviewing the Operation and Maintenance program with the basic operating
principle remaining, which is that the homeowner is responsible for the system. We could also retain the
program around authorizing certified people to work on systems at the homeowner's request. He noted
there is interest across the state and county in operation and maintenance systems. He said onsite sewage
systems have become increasingly complex because we are relying on technology rather than the site to
provide treatment,with the tradeoff being that more systems can now be placed on marginal sites that
would not have been permitted 10-20 years ago. We have recognized that with these systems, operation
and maintenance is necessary to keep them functioning properly over the long run. If they fail, there
would be environmental degradation, public health threat and impacts to shellfish, etc. With the
objective of operation and maintenance being the prevention of failures, maybe the focus of the
ordinance should be on failed systems and having tools in place to correct failures, with the policy goal
of working with individuals to the extent possible to get problems corrected. It may be that the only way
to get proper operation and maintenance in Washington State is to increase outreach and education
around the consequences of failures. Not wait until there is a public health threat or shellfish problem in
order to deal with failed septic systems. He noted that over the years, the strong prevention program has
resulted in several shellfish upgrades.
Member Frissell said if the County was to back down from monitoring, she would less likely vote in
favor of exemptions. To protect public health, she might vote against making exceptions if no one is
going to look at the system after installation.
Member Buhler said a remodel, building permit, or sale of the property could trigger an inspection of the
system.
In response to a question whether the County can ignore the Washington Administrative Code for
monitoring, Mr. Alvarez said the County could allocate resources as they see fit.
Dr. Locke said the requirement to have an operation and maintenance agreement is sound,but what is
• not allowed is an involuntary search of the property. Since the County is not in the business of coercive
searches, the requirement to do operation and maintenance agreements stands,
the ability to refuse access. The consequence may be that their system wod fail and they would have to
bear the expense.
HEALTH BOARD MINUTES -February 20, 2003 Page: 8
The Board recessed into Executive Session at 4:35 p.m. and came back into open session at 5:07 p.m.
Given the discussion with Mr. Alvarez and considering the issues raised by Mr. Belenski, Mr. Fay
recommended the Board take three administrative steps to resolve the problem:
1) Modify a condition of the permit dealing with the contracts to include some language that
recognizes people's constitutional right;
2) Incorporate similar language in the PUD's contract recognizing peoples' right to deny access, and
3) Create a written consent form for these inspections.
Member Westerman moved to approve Staff's recommendation. Commissioner Huntingford
seconded the motion,which carried by a unanimous vote.
ACTIVITY UPDATE—None
AGENDA PLANNING
It was noted that the Board of Health Retreat would be held in lieu of the Board's Regular Meeting on
Thursday, March 20, 2003 at Fort Worden from 9:00 a.m. to 3:00 p.m. Dr. Locke reported that
accountability standards for local health departments would be presented at the retreat, along with •
bylaws information and a possible PUD seat on the Board. Other retreat topics were solicited.
NEXT MEETING
The meeting adjourned at 5:09 p.m. The next regular meeting will be held on Thursday,April 17 at 2:30
p.m. at the Jefferson County Health and Human Services Conference Room.
JEFFERSON COUNTY BOARD OF HEALTH
Geoffrey Masci, Chairman Jill Buhler,Member
Wendi H. Wrinkle, Vice-Chairman Sheila Westerman,Member
Glen Huntingford,Member Roberta Frissell, Member
Dan Titterness,Member •
•
Board of Health
Agenda Item # II.
• Approval of Retreat Summary
Of March 20, 2003
April 17, 2003
•
Jefferson County Board of Health 2003 Retreat Summary
A meeting of the Jefferson CountyBoard and of Health was held at the Fort Worden State
Park Chapel building on March 20, 2002. The meeting was called to order by Board
Chair Goeff Masci at 9 AM. All Board members were in attendance. Staff attendees
include: Jean Baldwin, Larry Fay, Tom Locke, Julia Danskin, Lisa McKenzie, and
Kellie Ragan. Guest include: David Sullivan(PUD Commissioner) and Evan Oakes (U
of W MPH Student).
Topics Covered:
1) Review of 2002 Baseline Assessment Report for Standards of Public Health
2) Review of Standard-specific Jefferson HHS Work Plans
3) Access to Critical Health Care Services and Civic Engagement Grant
4) Legislative Update
5) Board of Health Operational Issues (structure of meetings, board membership,
committee structure, field trips)
A 40 minute videotape of a March 19, 2002 Presentation by Gov. John Kitzhaber
regarding health care access challenges for elected officials and health policy makers was
shown during the lunch break.
Board Actions:
• 1) The Board endorsed the concept of partnering with the Jefferson erson General Hospital
Board of Commissioner to serve as a Joint Health Policy Board under JGH's
Critical Access/Civic Engagement Grant
2) The Board requested additional legal consultation re: quorum rules, ex officio
board membership, State AG office review of 0 &M inspection authority
3) The Board unanimously passed a"sense of the Board"resolution supporting ex
officio membership status for a PUD representative if no legal barriers exist
4) The Board expressed interest in field trips to observe environmental health and
public health activities and requested additional information.
5) The Board expressed interest in individual Board members serving as "sponsors"
for specific rule making initiatives and requested additional information.
6) The Board expressed interest in guidelines for public comment at Board meetings
providing these guidelines did not discourage or restrict citizen access to the Board
The meeting was adjourned at 3:00 PM by Chair Masci. The next scheduled meeting of
the Board is May 17, 2003.
Geoff Masci, Chair
• Tom Locke, Health Officer
•
Board of Health
Old Business
Agenda Item # IV., 1
Board of Health
• Field Trips
April 17, 2003
•
•
\�� _ _"
V•
-f-
, Jefferson County Health &Human Services
f j 1..4 >; ; 615 SHERIDAN • PORT TOWNSEND,WA 98368 • FAX 360-385-9401
M M p R A N p U M
DATE: March 31, 2003
TO: Jefferson County Board of Health
FROM: Larry Fay
Environmental Health Director
RE: Field Trips
During the BOH retreat held in March the Board indicated that it would like to
• know what opportunities there may be for board members to accompany staff
during the course of their work. The following are some suggestions from staff:
Onsite Sewage: This lends itself to a field trip type activity with several board
members. Possible topics include site characterization, technology
Operation and Maintenance/Evaluation of Existing Systems, and redevelopment
problems. This is something that we want to be able to plan ahead on so we will
need to coordinate a date.
Alternatively or additionally, we can always arrange to have one or two board
members accompany Linda or Randy for a day or part of a day to observe their
normal activities.
Drinking Water: There are two main activities that may interest board members.
These are our well construction inspections and sanitary surveys of public water
systems. Because we conduct well construction inspections on short notice it
may be difficult to join staff in that activity. However, sanitary surveys are
scheduled well in advance so we can arrange to have board members join us.
The purpose of the sanitary surveys is to inspect existing operating public water
supply systems and identify operation problems.
Food Service: Accompanying Dana during some of her regularly scheduled
• restaurant inspections may be of interest. Probably no more than one or two
COMMUNITY ENVIRONMENTAL NATURAL
HEALTH HEALTH DEVELOPMENTAL SUBSTANCE ABUSE
360/EALTH 0 RESOURCES DISABILITIES &PREVENTION
360/385-9444 360/385-9444 360/385-9400
360/385-9400
Statement of Agreed Priority
page 2
•
board members should participate at any one time. Let me know if and when you
are available and I will coordinate with Dana.
Solid Waste: This program has two major themes, facility permitting and
complaints/enforcement. Facilities that we permit include the Jefferson County
Solid Waste Facilities (transfer station, recycle center and moderate risk waste
facility), Port Townsend composting operation, Dept. of Correction composting
operation in Clearwater, and the Port Townsend Paper Company limited purpose
landfill. Also inspected, but not permitted are biosolids land application sites on
Pope Resource lands south of Highway 104.
The program regularly responds to complaint and investigates incidents of illegal
dumping and neighborhood nuisances. Individual board members are welcome
to join field staff on individual cases or we could arrange for a "tour" of some of
our more chronic situations.
Let me know if you are interested in putting something together and I will work
• with appropriate staff for scheduling.
•
March 31, 2003
Jefferson
County Health and Human Services
Opportunities for Board of Health members to observe or participate in
Community Health Programs. Home visits, clinics and some classes are limited
to one Board Member at a time.
Program Type of How to arrange
contact
Maternal Child Health programs Home visit Contact Julia to arrange with
including Nurse Family Public Health Nurse
Partnership (Best Beginnings)
In Port Breast Feeding Tea every
Townsend Wed. 1:30 to 3pm contact
office, group Carol Hardy to arrange to
come
At JGH, Child Birth Education Classes,
Class Contact Carol Hardy for
schedule
WIC Out clinic Schedule with Julia:
Brinnon and Quilcene second
Wed. of every month
Tri-area third Tuesday of every
month
In Port Contact Julia to arrange
Townsend
WIC clinic
Foot Care Out clinic Contact Julia to get in touch
with Myrtle Corey, RN
Substance abuse and Tobacco Meeting Healthy Youth Coalition,
Prevention contact Hilary for schedule
School Health Meetings Parent night, Sex Ed Classes,
and classes Contact Hilary to arrange
i
•
Board of Health
Old Business
Agenda Item # IV. , 2
• Jefferson County &
Washington State
WIC Report
April 17, 2003
1
•
Board of Health
Old Business
Agenda Item # IV. , 3
•
State Board of Health
Request
April 17, 2003
r
• STATF OF
,
STATE OWASHINGTON
WASHINGTON STATE BOARD OF HEALTH
1102 SE Quince Street • PO Box 47990
Olympia, Washington 98504-7990
February 4, 2003
RECEIVED
FEB 0 5 2003
Chair Person 42ffergton County
Jefferson County Board of Health � " Services
615 Sheridan Street
Port Townsend WA 98368
Dear Board of Health Members,
For many years, the State Board of Health has held regular meetings in local health
jurisdictions across the state to better understand local concerns, including those of local
boards of health. We believe our efforts should strengthen and support your own, since
you are the prime overseers of public health operations. Now, budget cuts are forcing us
• to reduce the number of times we meet and to meet more frequently in Olympia. These
same budget cuts, however, make it more important than ever that we understand your
perspectives. We are taking several steps we hope will improve information flow and
deepen our partnerships with you who serve on local boards of health.
To begin with, our staff has contacted your office in recent weeks to ask that we be added
to your meeting minutes mailing list if we are not already on it. Starting this month, we
will highlight local board of health minutes in the FYI section of our meeting agendas.
We hope these summaries will improve our members' familiarity with the issues facing
local boards. We will distribute these summaries to those who receive our agendas and
make them available on our Web page so you can to get a glimpse of how your
colleagues at other local boards of health are coping with the very challenges that
confront you.
If you would like us to mail you this information regularly, please ask to be added to our
mailing list. You will receive these summaries as part of monthly announcements about
state board meetings. These mailings also contain a brief summary of the leading public
health, medical and other media articles on health issues and a listing of upcoming state,
regional and national health-related meetings and conferences. These announcements
contain electronic links to our Web page where you can always find up-to-date
summaries of the major developments, work products and decisions at the State Board of
Health together with downloadable versions of most of our major work products. It is
• available on line anytime at our Web page at www.doh.wa.gov/sboh.
Working for the Health of Washington and Its People
® 18 �y
Jefferson County Board of Health
February 4, 2003
Page 2 of 2
While we expect these efforts will help each of us improve our knowledge of the other's •
perspectives, we know there is no substitute for face-to-face discussions. That is why, if
they haven't already, our staff will be calling you in the coming weeks to ask that Don
Sloma, our executive director, and I have a few moments to meet with you or your entire
board at or near the time and place of one of your upcoming board meetings. Our goal for
these talks is to hear your views of how public health activities are faring in your
community.
We know the specter of reductions in state financial support is paramount in many of
your minds. We know you are coping with repeated efforts to audit, survey, measure and
assess your operations. We have been briefed on the results of the recent assessment
against the Public Health Improvement Partnership Standards. We know some of you are
wondering what local public health's role should be in bioterrorism, in emerging
infectious diseases, in regard to West Nile virus and other environmental health
challenges, in the epidemic of obesity, in tobacco control, in the rekindling crisis in
access to and affordability of medical care, and more.
But to do our jobs better, we would like to hear how you are coping with the strengths
(and weaknesses) of both your local public health efforts and the community with which
you work to assure a safer and healthier population. How are you coping with funding
shortages, regulatory and accountability demands, the need for ever better trained and
more widely expert staff, strained community medical resources and social supports, and
divergent community attitudes toward the role of government in health areas? Are there .
messages we can help you bring to Olympia or better ways of doing our business that will
increase state government's usefulness to you?
We do not plan a lengthy presentation about the State Board of Health,the Department of
Health, or state government policy. We have no new program to offer. We simply hope to
hear from you. If you have any questions about this request, or would like to discuss it,
please feel free to call me at(425) 827-8218 or Don Sloma at(360) 236-4102.
Thank you and we look forward to meeting you and hearing your thoughts soon about
your efforts to create a safer and healthier Washington in these difficult times.
Sincerely,
Linda Lake
Chair, Washington State Board of Health
•
•
Board of Health
New Business
Agenda Item # V., 1
• West Nile Virus
Response
April 17, 2003
•
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• West Nile Virus and the Ten Essential Services
A Framework for Understanding and Communicating A Core Public Health Service
April-2003
In 1988 the Institute of Medicine(IOM)produced a report, The Future of Public Health.
Among other findings,the IOM noted that pubic health was fractionated and the public
lacked a clear understanding of the basic or core functions of public health. In 1994, The
Ten Essential Services of Public Health was developed as an alternative means of
organizing and presenting public health services and activities.
The Ten Essential Services provide a means to look at an issue in a comprehensive and
structured manner, addressing all aspects of the issue,not just the interesting or
problematic ones. As applied to West Nile Virus (WNV), one can frame the issue and
the approach of the Washington State Department of Health(DOH)into the 10 essential
services as follows:
1. Monitor status to identify issues of public health importance related to WNV—
• Noted the arrival of WNV in the United States in 1999.
• Noted its arrival in Washington state in late summer,2002,in birds and
horses.
• Noted the magnitude of the epidemic and epizootic in the U.S. during 2002.
• • The full extent of how WNV will manifest in Washington will not be known
until the fall of 2003.
• Monitoring data from the Centers for Disease Control(CDC)and other states
is our primary source of information used to anticipate impacts. These
impacts can range from significant to minor.
2. Diagnose and investigate WNV related health hazards in the community—
• Initiated mosquito trapping to identify potential carriers of WNV, and
confirmed that such carriers exist throughout the state.
• Continue seasonal surveillance to detect WNV infections in dead birds
beginning in April 2003 through the end of the mosquito season.
• Coordinating with the Washington State Department of Agriculture
(WSDA)to receive reports of WNV infection in horses.
• Developed capability and capacity for the DOH Public Health
Laboratories to provide diagnostic testing for suspected cases of WNV
infection in humans.
• Developed case report forms and protocols to facilitate the identification,
diagnosis and reporting of human WNV illness and death.
•
3. Inform, educate and empower people about WNV related health issues in their
community-
• Developed a communication plan for the DOH that will be shared with
local health jurisdictions.
• Developed a brochure and distributed it to all local health jurisdictions and
other state agencies for their use.
• Set up a toll—free telephone number with basic information on WNV
issues.
• Set up a web page with more detailed information on WNV,with links to
various other resources sites,both in state and federal.
• Developed resource packets for use with media and other interested
groups or parties.
• Initiated several media releases and will continue to do so throughout the
summer.
4. Mobilize partnerships to identify and solve WNV related health problems—
• Active working relationships with Washington State Department of
Ecology(DOE) and WSDA to facilitate information and access to
pesticide applications.
• Worked with local health jurisdictions to clarify roles and responsibilities
as now contained in statute for mosquito control efforts.
• Partnered with the U.S. Army at Fort Lewis to prefect mosquito
surveillance techniques.
• Worked with local governments and mosquito control districts on control
efforts, including mosquito surveillance techniques.
• Worked with local health jurisdictions to clarify roles and responsibilities
in communicable disease surveillance and reporting.
• Presented information regarding mosquito control and employee safety
measures to other state agencies-such as Department of Natural
Resources,Washington State Parks and Recreation,Department of
Transportation, and Department of Fish and Wildlife-that may own
mosquito-breeding areas.
• Coordinated with Washington State University for expanded laboratory
capacity to exam dead birds.
• Negotiated with CDC for funding to assist with surveillance activities
within the state.
• Contacted the Washington State Medical Association and the Washington
Veterinary Medical Association to provide current clinical and diagnostic
information to professionals concerning WNV.
• Contacted the Plan Medical Directors and Pharmacy Benefits Managers
for orientation of understanding of potential WNV impacts on their
industry.
•
411 5. Link human resources to needed WNV related health
services and resources—
• Used CDC funding and General Fund State to enhance the agency's vector
control efforts to 2+ full time equivalents (FTEs) since 2001.
• Dedicated a portion of an FTE to serve as WNV coordinator for this
upcoming summer season.
• Hired project employees to survey county readiness, develop web sites for
rapid reporting, and assist with mosquito trapping and identification.
• Created and filled a management level position in the agency for a State
Public Health Veterinarian with responsibility and knowledge of WNV
issues.
6. Develop policies and plans that support individual and community WNV related
health needs—
• Developed a statewide response plan and distributed it to local agencies
(Brown Book).
• Articulated individual protection measures in WNV plans and
communication efforts.
• Provided education to local government and community groups on
creation of mosquito control districts and the functions of such districts.
• Informed critical policy bodies in the state of the issue and the plan:
Washington State Legislature,Washington State Board of Health,
leadership of local health and local government, and other state agency
• executive managers.
7. Comply with laws,regulations and policies that protect WNV related health and
ensure safety—
• Thoroughly reviewed the existing laws and regulations that apply to
mosquito control,and control of vector borne diseases.
• Coordinated with DOE and WSDA on procedures and limitations
associated with application of pesticides within the state of Washington,
and secured a blanket National Pollution Discharge Elimination System
(NPDES)permit that will be available statewide for any entity wishing to
apply larvicide's under our general provisions and control.
• Reviewed the notifiable conditions WAC 246-101 that requires cases of
viral encephalitis and rare diseases of public health importance to be
reported by health care providers to their local health authorities.
• Familiarized ourselves with the laws regarding Integrated Pest
Management(IPM)requirements in 17.15 RCW related to broadcast
spraying of pesticides.
• Established a dialogue and will continue to work with WDFW for ways to
condition applications to reduce impacts of any pesticide use to non-target
species, or the introduction of non-native fish species to control
mosquitoes (RCW 70.22).
•
• 8. Assure competent DOH and local workforce—
• Provided enhanced training to agency workforce on mosquito
surveillance, environmental surveillance, and health affects of pesticide
use.
• Provided training to agency laboratory staff and epidemiologists.
• Provided training to local health personnel and others on mosquito
trapping and identification, dead bird surveillance techniques, and
mosquito control methods.
9. Evaluate the effectiveness, accessibility, and quality of WNV related health
services—
• DOH is prepared to evaluate and modify the effectiveness of our
surveillance and response plan as the summer progresses.
• Formed and maintain an internal steering group that will monitor the
emergence of the disease in Washington and modify our response as
necessary.
• Evaluate our response more formally after this year's mosquito season has
passed, and will share that evaluation with interested parties.
10. Conduct research for new insights and innovative solutions to WNV related
1111 heath problems and issues—
• Consider innovative solutions and approaches to WNV surveillance and
response,both in forms of education and control.
• Continue to monitor the research and experience of states that have a
longer and more involved history with WNV, as well as results of CDC
studies currently underway.
WAW/MyDocuments/WNV/WNVandl Oessentialservices.doc
•
Jefferson County Health& Human Services Website
•
• What is West Nile Virus?
Since 1937 when the virus was first discovered in the West Nile district of
Uganda, West Nile virus has been the cause of a number of severe
outbreaks. In recent years, the virus has emerged in Europe and North
America posing a threat to both public and animal health. Rapidly
spreading across the United States, the virus has been detected in 44
states. From the first detection in 1999 through March 18, 2003, there
have been 4,161 human cases of West Nile virus-related illness in the
United States reported
to the Centers for West Nile Virus in the United States,2002
�\ \
Disease Control and
Prevention, including
277 fatalities.
1psaAtk
In Washington state, West Nile
• virus has been detected in four
Voillsotwits%sortimatoutd imoutxlto 2-000*d ct,ps 0.-.a*02
counties. A raven from Pend , ,sossfs)vistiasd,s or Assosobos 2002
Oreille County, a crow from Snohomish County, and recently two horses from
Island and Whatcom counties tested positive for the virus. There have been no
reports of human cases acquired in the state. The horse cases however further
establish the presence of the virus in Washington and the potential for human
infection from mosquitoes. Statewide surveillance continues for the virus in birds,
animals and humans.
How is it Spread?
West Nile virus is spread by the bite of an infected mosquito, and can infect
many types of birds, horses, and people. The virus is not believed to be spread
from person to person or from animal to person. Mosquitoes pick up the virus by
feeding on an infected bird.
•
•
•
What are the Symptoms?
Most people who become infected with West Nile virus have either no symptoms
or only mild symptoms like a fever, headache, and body aches. On rare
occasions, infection can result in a severe and sometimes fatal illness known as
West Nile encephalitis—inflammation of the brain. The risk of severe infection is
higher among people who are 50 and older.
What Can I do at Home?
The most important steps in protecting your family are to prevent mosquito bites
and reduce mosquito habitat around your home. Follow these tips:
Reduce Exposure to Mosquitoes
• All windows and doors should be fitted with
• appropriate screens in good repair. In addition
screen doors should be self-closing. In areas
with high mosquito populations you may want
to consider screen porches or enclosures when
sitting out.
• Stay indoors at dawn and dusk when
mosquitoes are the most active.
• Wear a long sleeve shirt, long pants, and a hat
when going into mosquito-infested areas, such
as wetlands or woods.
• Use mosquito repellant when necessary, and
carefully follow directions on the label.
•
Reduce Mosquito Breeding Areas
• The mosquito life cycle is as little as 7 days.
Mosquitoes need stagnant water for eggs and
larva development.
• Empty anything that holds standing water—old
tires, buckets, plastic covers, and toys.
• Change water in your birdbaths, fountains,
wading pools and animal troughs weekly.
• Recycle unused containers—bottles, cans, and
buckets that may collect water.
• • Make sure roof gutters drain properly, and
clean clogged gutters in the spring and fall.
• Fix leaky outdoor faucets and sprinklers to
reduce puddles.
Should I be Spraying for Mosquitoes?
In general, spraying for adult mosquitoes is ineffective or at best
only marginally successful. Additionally, spraying for adult
mosquitoes can be detrimental to non-target or desirable species.
Effective mosquito control involves integrated pest management
principles. These include habitat management, surveillance,
species identification and strategic use of approved larvicides. It is
important to note that pesticide use is regulated by the
Departments of Agriculture and Ecology. Any use of pesticides for
• controlling mosquitoes must be done in accordance with applicable
licensing and permitting requirements.
What about dead birds?
As in recent years, Jefferson County Health and Human Services
will be cooperating with the Washington Department of Health to
conduct bird surveillance. Although bird surveillance was stopped in
the fall of 2002 when mosquito activity declined, it is anticipated
that we will again be interested in testing birds this spring beginning
around the middle part of April. Corvid birds, crows, ravens,
magpies and jays are of particular interest. For more information
about West Nile Virus call the Washington Department of Health
hotline (1-866-78VIRUS) or Jefferson County Health and Human
Services (360-385-9444). For information regarding or reporting
• dead birds phone Jefferson County Environmental Health (360-
385-9444).
West Nile Virus Links
http://www.doh.wa.gov/ehp/ts/Zoo/WNV/WNV.html
http://www.ecy.wa.gov/programs/wq/pesticides/final_pesticide_per
mits/mosquito/mosquito_index.html
http://whatcom.wsu.edu/commun/wnvhomeowners.htm
http://www.cdc.gov/ncidod/dvbid/westnile/index.htm
http://pep.wsu.edu/
i
PHELF Report on Roles and Activities Related to Mosquito Control
Date: 3/25/03
The purpose of this paper is to outline the basic understanding of roles and authorities existing in
current law for the various agencies and jurisdictions related to West Nile Virus (WNV) and mosquito
control, and provide guidance on how these may be implemented to minimize the potential human
impact of WNV in Washington State. It is important to note that authority in and of itself does not
equal resources or capacity. Hence, it is important that the authority of an agency or jurisdiction may
not equate with an expectation of service. Service expectations must be supported with adequate
resources, trained staff, and system capacity.
Neither Local Health Jurisdictions nor the Washington State Department of Health are currently
funded to provide all the surveillance efforts or mosquito abatement through larviciding or adulticiding
noted below.
Local Health Jurisdictions (RCW 70.05)
Local health jurisdictions (LHJs) may, within available resources, provide for a routine mosquito-borne
disease education and surveillance program. Such a program may include larval and adult mosquito
surveillance, dead bird surveillance, human and horse case surveillance and public
information/education campaigns as associated activities as described below:
➢ Larval surveillance, which may include the location, mapping and characterization of mosquito
breeding habitats and collection of mosquito larvae from larval habitats, and submission for
identification of species.
➢ Adult surveillance, which may include collection of adult mosquitoes periodically during the months
of April — October, and submission for identification of species, and if possible, for pooling of
females to test for mosquito-borne virus.
➢ Recording of all available jurisdictional data collected from mosquito surveillance.
➢ Identification of organizations within the LHJ with capabilities of mosquito control.
➢ Educating local governing bodies on the creation of mosquito control districts.
➢ Facilitation, coordination or advising on the use of larviciding and adulticiding as appropriate, using
organizations capable of providing this service.
➢ Dead bird surveillance from April — October, with collection of fresh specimens of appropriate
species for submission for viral testing.
➢ Human and horse case surveillance throughout the year in cooperation with physicians and
veterinarians.
➢ Public information and education campaigns from April through the end of mosquito season as
appropriate for the level of mosquito and disease activity.
•
Washington State Department of Health (DOH) (RCW 43.20 and RCW 70.22)
• DOH will provide technical assistance and training on mosquito-borne disease surveillance, public
education messages and mosquito control measures. DOH will provide laboratory services to support
surveillance efforts. This will include training for local health, mosquito control districts, and other
interested parties, along with technical assistance on the following:
➢ Identification and mapping of mosquito-breeding habitat
➢ Techniques for surveillance of adult and larval mosquitoes
➢ Lab testing to identify adult and larval mosquito species
➢ Coordination of plans for mosquito control work by counties, cities and other municipal
corporations or government agencies.
➢ Dead bird surveillance and collection and preparation for shipping for lab testing
➢ Lab testing of dead birds
➢ Data recording and management
➢ Public information messages, news releases, brochures, web pages and toll free information
hotline.
• The DOH shall also provide statewide data on surveillance information collected through LHJs and
other means.
Mosquito Control Districts (MCDs) (RCW 17.28)
These districts, operating under RCW 17.28, may take all necessary or proper steps for the
extermination of mosquitoes, and abate, as nuisances, all stagnant pools of water or other breeding
places for mosquitoes, but are subject to the paramount control of the county or city in which they
exist.
MCDs are funded through tax levys to provide larviciding and adulticiding as appropriate. They also
have the power to enter without hindrance upon any land within the district for the purpose of
inspection to ascertain whether breeding places of mosquitoes exist upon such lands. In addition to
the above powers, MCDs may provide assistance to LHJs by:
➢ Collection and identification of mosquitoes
➢ Mapping of mosquito breeding habitat and location of disease vector species
➢ Participating in dead bird surveillance and collection
➢ Working with LHJs, cities and counties to facilitate or provide mosquito control, including
abatement through larviciding and adulticiding as appropriate.
• ➢ Directing private property owners within it's district to control mosquitoes on their land, and
causing such control to occur at the expense of the property owner under certain circumstances.
•
Counties and Incorporated Cities (Chapters 35 and 36 RCW)
These governmental entities, under their broad powers to provide for the public safety, can undertake
mosquito control measures on lands and bodies of water under their control, including larviciding and
adulticiding, when indicated and with proper licensing and permits. They are required to cooperate
with state mosquito control plans in accordance with RCW 70.22.060.
Department of Ecology
The DOE is required by law to protect the waters of the state from actions that might pollute or harm
them. The vehicle for allowing the application of pesticides to water ways is the National Pollution
Discharge Elimination System (NPDES) Permit. This permit is administered by DOE, and anyone
wishing to apply pesticides for mosquito control must obtain a NPDES permit prior to application.
The DOE may issue a statewide blanket NPDES permit to an appropriate agency. DOH has applied
and will receive a blanket permit. This will allow any licensed applicator to apply larvicides by
registration with the DOH, and agree to conduct applications according to certain procedures and
provide annual reports.
• Department of Agriculture
The Department of Agriculture has authority over the applicators of pesticides and controls their
actions through a license. Except for limited homeowner applications of some pesticides available
commercially at the retail level, an applicator of larvicides or adulticides must possess an applicators
license. This license mandates reporting requirements and ensures appropriate knowledge and
accountability of the license holders for personal safety and environmental protection in the
application of materials.
Agriculture also regulates the labeling and registration of pesticides used in the state.
•
•
Board of Health
New Business
Agenda Item # V., 2
Sever Acute Respiratory
• Syndrome
April 17, 2003
•
P. 0, (
III it/
SEVERE ACUTE RESPIRATORY SYNDROME
_TM
FREQUENTLY ASKED QUESTIONS:
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
CDC has developed responses to many of the most commonly asked questions about severe acute
respiratory syndrome (SARS). The responses are listed under the topics below and will be updated as new
information becomes available.
GENERAL INFORMATION
• The Illness
• Spread of SARS
• Cause of SARS
• The Outbreak
• Travel and Quarantine
• Other
PREVENTION AND CONTROL: CDC RECOMMENDATIONS
• Personal and Household
• Health-Care Setting
• Travel and Quarantine
11111he Illness
What is SARS?
SARS is a respiratory illness that has recently been reported in Asia, North America, and Europe. For
additional information, check the World Health Organization's (WHO) SARS Web site (see
www.who.int/en/) or visit other pages on CDC's SARS Web site (see http://www.cdc.gov/ncidod/sars/).
What are the symptoms and signs of SARS?
The illness usually begins with a fever (measured temperature greater than 100.4°F [>38.0°C]). The
fever is sometimes associated with chills or other symptoms, including headache, general feeling of
discomfort, and body aches. Some people also experience mild respiratory symptoms at the outset.
After 2 to 7 days, SARS patients may develop a dry, nonproductive cough that might be accompanied by
or progress to the point where insufficient oxygen is getting to the blood. In 10% to 20% of cases,
patients will require mechanical ventilation. For more information, see the MMWR dispatch (see
www.cdc.gov/mmwr/preview/mmwrhtml/mm5212a5.htm).
If I were exposed to SARS, how long would it take for me to become sick?
The incubation period for SARS is typically 2-7 days; however, isolated reports have suggested an
incubation period as long as 10 days. The illness usually begins with a fever (>100.4°F [>38.0°C]) (see
signs and symptoms, above).
What medical treatment is recommended for patients with SARS?
CDC currently recommends that patients with SARS receive the same treatment that would be used for
April 7, 2003 Page 1 of 8
Ili DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR DISEASE CONTROL AND PREVENTION
SAFER•HEALTHIER• PEOPLE'
Frequently Asked Questions — Sudden Acute Respiratory Syndrome (SARS)
(continued from previous page) •
any patient with serious community-acquired atypical pneumonia of unknown cause. Several treatment
regimens have been used for patients with SARS, but there is insufficient information at this time to
determine if they have had a beneficial effect. Reported therapeutic regimens have included antibiotics to
presumptively treat known bacterial agents of atypical pneumonia. Therapy also has included antiviral
agents such as oseltamivir or ribavirin. Steroids also have been administered orally or intravenously to
patients in combination with ribavirin and other antimicrobials. For more information on SARS, see
"Interim Information and Recommendations for Health-Care Providers" (see
www.cdc.gov/ncidod/sars/clinician alert.htm) on CDC's SARS web site (see www.cdc.gov/ncidod/sars/).
Spread of SARS
How is SARS spread?
The principal way SARS appears to be spread is through droplet transmission; namely, when someone sick
with SARS coughs or sneezes droplets into the air and someone else breathes them in. It is possible that
SARS can be transmitted more broadly through the air or from objects that have become contaminated.
What is the difference between droplet and airborne transmission of viruses?
Droplet transmission refers to the spread of viruses contained in relatively large respiratory droplets that
people project when they cough or sneeze. Because of their large size, droplets travel only a short
distance (usually 3 feet or less) before they settle. Droplet transmission can occur either directly when
droplets are inhaled by another person, or indirectly when droplets land on an object or surface (such as a
doorknob or telephone) that are then touched by another individual. Common-cold viruses (like
rhinovirus) are typically spread by droplets.
Airborne transmission means the that the virus is spread by very small respiratory aerosol particles or •
dust, which can be breathed in by people. Small aerosol particles can remain in the air and travel over a
greater distance than larger respiratory droplets. Examples of viruses spread by the airborne route are
influenza and measles viruses.
Can SARS be spread from touching contaminated objects or surfaces?
It is possible that SARS could be spread when a person touches a contaminated object or surface;
however, how often this might happen, or if it happens at all, is not known at this time. Previously
identified coronaviruses (scientists have reported that a new cororavirus may be the cause of SARS) have
been shown to survive in the environment for as long as 3 hours. To reduce the overall risk for infection
by touching contaminated objects and surfaces, CDC recommends that people wash their hands
thoroughly and often with soap and water.
How long is a person with SARS infectious to others?
Information to date suggests that people are most likely to be infectious when they have symptoms, such
as fever or cough. However, it is not known how long before or after their symptoms begin that patients
with SARS might be able to transmit the disease to others.
Who is most at risk of contracting SARS?
Cases of SARS continue to be reported primarily among people who have had direct close contact with an
infected person, such as those sharing a household with a SARS patient and health-care workers who did
not use infection control procedures while caring for a SARS patient. In the United States, there is no
indication of community transmission at this time. CDC continues to monitor this situation very closely.
Cause of SARS
April 7, 2003 Page 2 of 8 ill
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR DISEASE CONTROL AND PREVENTION
SAFER•HEALTHIER•PEOPLE'
Frequently Asked Questions — Sudden Acute Respiratory Syndrome (SARS)
continued from previous page)
What is the cause of SARS?
Scientists at CDC and other laboratories have detected a previously unrecognized coronavirus in patients
with SARS. While the new coronavirus is still the leading hypothesis for the cause of SARS, other viruses
are still under investigation as potential causes.
What are coronaviruses?
Coronaviruses are a group of viruses that have a halo or crown-like (corona) appearance when viewed
under a microscope. These viruses are a common cause of mild to moderate upper-respiratory illness in
humans and are associated with respiratory, gastrointestinal, liver and neurologic disease in animals.
Coronaviruses can survive in the environment for as long as three hours.
What evidence is there to suggest that coronaviruses may be linked with SARS?
CDC scientists were able to isolate a virus from the tissues of two patients who had SARS and then used
several laboratory methods to characterize the agent. Examination by electron microscopy revealed that
the virus had the distinctive shape and appearance of coronaviruses. Tests of serum specimens from
patients with SARS showed that the patients appeared to have recently been infected with this
coronavirus. Other tests demonstrated that coronavirus was present in a variety of clinical specimens from
patients, including nose and throat swabs. In addition, genetic analysis suggests that this new virus
belongs to the family of coronaviruses but differs from previously identified coronaviruses.
These laboratory results do not provide conclusive evidence that the new coronavirus is the cause of
SARS. Additional specimens are being tested to learn more about this coronavirus and its link with SARS.
If coronaviruses usually cause mild illness in humans, how could this new coronavirus be
esponsible for a potentially life-threatening disease such as SARS?
ere is not enough information about the new virus to determine the full range of illness that it might
cause. Coronaviruses have occasionally been linked to pneumonia in humans, especially people with
weakened immune systems. The viruses can also cause severe disease in animals, including cats, dogs,
pigs, mice, and birds.
Has new information about coronavirus changed the recommendations for medical treatment
for patients with SARS?
The possibility that coronavirus is the cause of SARS has not changed treatment recommendations. The
new coronavirus is being tested against various antiviral drugs to see if an effective treatment can be
found.
Is there a test for SARS?
No "test" is available yet for SARS; however, CDC, in collaboration with WHO and other laboratories, has
developed 2 research tests that appear to be very promising in detecting antibodies to the new
coronavirus. CDC is working to refine and share this testing capability as soon as possible with
laboratories across the United States and internationally.
What about reports suggesting that the cause of SARS may be human metapneumovirus?
Researchers from several laboratories participating in the WHO laboratory network have reported finding
evidence of human metapneumovirus in some specimens from SARS patients. CDC has detected this virus
in one SARS patient. There is not enough information to determine what role, if any, human
metapneumovirus might have in causing SARS.
April 7, 2003 Page 3 of 8
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR DISEASE CONTROL AND PREVENTION
SAFER•HEALTHIER•PEOPLE'
Frequently Asked Questions — Sudden Acute Respiratory Syndrome (SARS)
(continued from previous page) •
What is human metapneumovirus?
Human metapneumovirus is a recently recognized virus that appears to be responsible for some of the
respiratory infections that occur in adults and children during the winter months. It is related to the
viruses that cause a broad range of respiratory and childhood illnesses, including mumps, measles, and
croup.
What about reports from other laboratories suggesting that the cause of SARS may be a
paramyxovirus?
Researchers from several laboratories participating in the WHO network have reported the identification of
a paramyxovirus in clinical specimens from SARS patients. These laboratories are still investigating the
possibility that a paramyxovirus is a cause of SARS.
The Outbreak
How many cases of SARS have been reported so far?
Visit WHO's SARS page (see http://www.who.int/csr/sarscountry/en/) for daily updates on case reports in
the United States and other countries. To date, most of the cases have been reported from China.
How many people have died from SARS?
Visit WHO's SARS page (see httn://www.who.int/csr/sarscountry/en/) for a daily update of SARS cases
and deaths.
What is CDC doing to combat this health threat?
CDC is working closely with WHO and other partners as part of a global collaboration to address the SARS
outbreak. For its part in this international effort, CDC has taken the following actions:
• Activated its Emergency Operations Center to provide round-the-clock coordination and
response.
• Committed more than 160 infectious disease experts and support staff to work on the SARS
response.
• Deployed medical officers, epidemiologists, and other specialists to assist with on-site
investigations around the world.
• Provided ongoing assistance to state and local health departments in investigating possible
cases of SARS in the United States.
• Issued multiple notices providing guidance on ways to minimize the risk for SARS in health-care
facilities, in the household, when traveling, and in other settings.
• Conducted extensive laboratory testing of clinical specimens from SARS patients to identify the
cause of the disease.
• Initiated a system for distributing health alert notices to travelers who may have been exposed
to cases of SARS.
As always, CDC is committed to communicating regularly and effectively with public health professionals,
elected leaders, clinicians, and the general public.
April 7, 2003 Page 4 of 8 411
l
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR DISEASE CONTROL AND PREVENTION
SAFER•HEALTHIER.PEOPLE
Frequently Asked Questions — Sudden Acute Respiratory Syndrome (SARS)
•continued from previous page)
Travel and Quarantine
What is CDC doing to prevent and control the spread of SARS among persons traveling by
plane?
CDC's quarantine inspectors or their designees are distributing health alert cards (see
www.cdc.gov/ncidod/sars/travel alert.htm) to air passengers returning in airplanes either directly or
indirectly to the United States from China, Singapore, and Vietnam. The notices ask travelers to monitor
their health for 10 days and to see a doctor if they get a fever with a cough or have difficulty breathing.
CDC distributes approximately 15,000 health alert notices each day to air travelers returning from the
affected regions at 23 ports of entry. Inspectors also are boarding airplanes if a traveler has been reported
with symptoms matching the case definition (see www.cdc.gov/ncidod/sars/casedefinition.htm) of SARS.
The World Health Organization (WHO) has recommended procedures (see
www.who.int/csr/sars/travel/en/) for pre-departure screening of airline passengers from some countries
for respiratory illnesses or other symptoms of SARS.
What information about SARS is being provided to people traveling on ships?
SARS information contained on CDC's health alert cards is being provided by the major shipping
associations and the International Council of Cruise Lines to people traveling on cargo ships and cruise
ships at U.S. ports. Inspectors also are boarding ships if a passenger or crew member has been reported
with symptoms matching the case definition of SARS.
What does a quarantine inspector do?
Quarantine inspectors serve as important guardians of health at borders and ports of entry into the United
�
tates. They routinely respond to illness in arriving passengers and ensure that the appropriate medical
ction is taken.
What is considered routine health inspections of airplanes or ships versus what is happening
now?
Routine health inspections consist of working with airline, cargo ship, and cruise ship companies to protect
passengers and crew from certain infectious diseases. Quarantine inspectors meet arriving aircraft and
ships reporting ill passengers and/or crew (as defined in the foreign quarantine regulations [see
www.cdc.aov/ncidod/dg/pdf/42cfr71.pdf {pdf}]) and assist them in getting appropriate medical
treatment.
What is the risk to individuals who may have shared a plane or boat trip with a suspected SARS
patient?
Cases of SARS continue to be reported primarily among persons who have had direct close contact with an
infected person, such as those sharing a household with a SARS patient and health-care workers who did
not use infection control procedures while attending to a SARS patient. SARS has also occurred among air
travelers, primarily travelers to and from Hong Kong, Hanoi, Singapore, and mainland China.
CDC is requesting locating information from travelers who are on flights with people suspected of having
SARS. CDC, with the help of state and local health authorities, is attempting to follow-up with these
travelers for 14 days to make sure no one develops symptoms consistent with SARS.
• April 7, 2003 Pae 5 of 8
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR DISEASE CONTROL AND PREVENTION
SAFER HEALTHIER PEOPLE'
Frequently Asked Questions — Sudden Acute Respiratory Syndrome (SARS)
(continued from previous page)
4111
Who actually notifies quarantine officials of potential SARS cases? Is it the crew of the airplane
or ship? The passengers?
Under foreign quarantine regulations, the master of a ship or captain of an airplane coming into the United
States from a foreign port is required by law to report certain illnesses among passengers. The illness
must be reported to the nearest quarantine official. If possible, the crew of the airplane or ship will try to
relocate the ill passenger or crew member away from others. If the passenger is only passing through a
port of entry on his/her way to another destination, port health authorities may refer the passenger to a
local health authority for assessment and care.
If I'm on board an airplane or ship with someone suspected of having SARS, will I be allowed
to continue to my destination?
CDC does not currently recommend that the onward travel of healthy passengers be restricted in the
event that a passenger or crew member suspected of having SARS is removed from the ship or airplane
by port health authorities. All passengers and crew members may be advised by port health authorities to
seek medical attention if they develop SARS symptoms (see
www.cdc.gov/ncidod/sars/casedefinition.htm).
What does a quarantine official do if a passenger is identified as meeting the case definition for
suspected SARS?
Quarantine officials arrange for appropriate medical assistance to be available when the airplane lands or
the ship docks, including medical isolation. Isolation is important not only for the sick passenger's comfort
and care but also for the protection of members of the public. Isolation is recommended for travelers with
suspected cases of SARS until appropriate medical treatment can be provided or until they are no longer
infectious.
What does a quarantine official do if a passenger identified as meeting the case definition for
suspected SARS refuses to be isolated?
Many levels of government (Federal, State, and local) have basic authority to compel isolation of sick
persons to protect the public. In the event that it is necessary to compel isolation of a sick passenger,
CDC will work with appropriate State and local officials to ensure that the passenger does not infect
others.
Other
Is there any reason to think SARS is or is not related to terrorism?
Information currently available about SARS indicates that people who appear to be most at risk are either
health-care workers taking care of sick people or family members or household contacts of those who are
infected with SARS. That pattern of transmission is what would typically be expected in a contagious
respiratory or flu-like illness.
CDC RECOMMENDATIONS
Personal and Household
What should I do if I think I have SARS?
People with symptoms of SARS (fever of more than 100.4°F [>38.0°C] that is accompanied by a cough
and/or difficulty breathing) should consult a health-care provider. To help the health-care provider make a
diagnosis, tell them about any recent travel to places where SARS has been reported or whether there
was contact with someone who had these symptoms.
April 7, 2003 Page 6 of 8 40.
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR DISEASE CONTROL AND PREVENTION
SAFER•HEALTHIER•PEOPLE'
Frequently Asked Questions - Sudden Acute Respiratory Syndrome (SARS)
4 continued from previous page)
What has CDC recommended to prevent transmission of SARS in households?
CDC has developed interim infection control recommendations available at
http://www.cdc.gov/ncidod/sars/ic-closecontacts.htm for patients with suspected SARS in the household.
The basic precautions outlined in this document include the following:
• Infection control precautions should be continued for SARS patients for 10 days after respiratory
symptoms and fever are gone. SARS patients should limit interactions outside the home and should
not go to work, school, out-of-home day care, or other public areas during the 10-day period.
• During this 10-day period, all members of the household with a SARS patient should carefully
follow recommendations for hand hygiene, such as frequent hand washing or the use of alcohol-
based hand rubs.
• Each patient with SARS should cover his or her mouth and nose with a tissue before sneezing or
coughing. If possible, a person recovering from SARS should wear a surgical mask during close
contact with uninfected persons. If the patient is unable to wear a surgical mask, other people in
the home should wear one when in close contact with the patient.
• Disposable gloves should be considered for any contact with body fluids from a SARS patient.
However, immediately after activities involving contact with body fluids, gloves should be removed
and discarded, and hands should be washed. Gloves should not be washed or reused, and are not
intended to replace proper hand hygiene.
• SARS patients should avoid sharing eating utensils, towels, and bedding with other members of the
household, although these items can be used by others after routine cleaning, such as washing or
laundering with soap and hot water.
• Common household cleaners are sufficient for disinfecting toilets, sinks, and other surfaces touched
by patients with SARS, but the cleaners must be used frequently.
. • Other members of the household need not restrict their outside activities unless they develop
symptoms of SARS, such as a fever or respiratory illness.
CDC RECOMMENDATIONS
Health-care Settings
What has CDC recommended to prevent transmission of SARS in the health-care setting?
Transmission of SARS to health-care workers appears to have occurred after close contact with sick people
before recommended infection control precautions were put into use. CDC has issued interim infection
control recommendations for health-care settings (htto://www.cdc.aov/ncidod/sars/infectioncontrol.htm)
as well as for the management of exposures to SARS in health-care and other institutional settings
(http://www.cdc.aov/ncidod/sars/exposureauidance.htm).
What precautions should health-care facilities follow regarding visits by close contacts of SARS
patients?
Close contacts (e.g., family members or other members of the household) of SARS patients are at risk for
infection. Health-care facilities should implement a system to screen for fever or respiratory symptoms
among such contacts who visit the facility. Close contacts with fever or respiratory symptoms should not
be allowed to enter the health-care facility as visitors and should be educated about this policy. Health-
care facilities should educate all visitors about use of infection control precautions (see
www.cdc.aov/ncidod/sars/infectioncontrol.htm) when visiting SARS patients and should emphasize the
importance of following these precautions.
• April 7, 2003 Page 7 of 8
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR DISEASE CONTROL AND PREVENTION
SAFER*HEALTHIER•PEOPLE""
Frequently Asked Questions — Sudden Acute Respiratory Syndrome (SARS)
(continued from previous page) •
CDC RECOMMENDATIONS
Travel and Quarantine
Are there any travel restrictions related to SARS?
At this time there are no travel restrictions in place that are directly related to SARS. However, a CDC
travel advisory recommends that individuals who are planning nonessential or elective travel to mainland
China, Hong Kong, Hanoi, Vietnam, or Singapore may wish to postpone their trip until further notice. For
additional information about travel advisories, check CDC's Travelers' Health site (see
www.cdc.qov/travel), which will be updated as necessary.
If I must travel to an affected area, what sort of precautions should I take to protect against
SARS?
CDC recommends that people planning elective or nonessential travel to mainland China, Hong Kong,
Singapore, and Hanoi may wish to postpone their trips until further notice. People who cannot delay their
travel to these locations should refer to the guidelines at
http://www.cdc.gov/ncidod/sars/travel advice.htm for information about precautions to protect against
SARS.
What should I do if I have recently traveled to a country where cases of SARS have been
reported?
You should monitor your own health for 10 days following your return. If you become ill with a fever of
over 100.4°F [>38.0°C] that is accompanied by a cough or difficulty breathing or that progresses to a
cough and/or difficulty breathing, you should consult a health-care provider. To help your health-care 111provider make a diagnosis, tell him or her about any recent travel to regions where cases of SARS have
been reported and whether you were in contact with someone who had these symptoms.
CDC has recommended guidelines for medical aircraft that transport SARS patients. Should
commercial airlines also follow these guidelines?
No. This guidance (available at www.cdc.gov/ncidod/sars/airtransport-sarspatients.htm) is intended
specifically for air medical transport (AMT) service providers that use specialized aircraft to transport SARS
patients. It should not be generalized to commercial passenger aircraft. These interim recommendations
for AMT are based on standard infection control practices, AMT standards, and epidemiologic information
from ongoing investigations of SARS, including experience from transport of 2 patients during this
outbreak. Specific guidelines for airline crew and flight personnel of commercial aircrafts are available at
www.cdc.ciov/ncidod/sars/fliciht crew guidelines.htm. CDC also has developed interim guidance for
cleaning of commercial passenger aircraft after a flight with a suspected SARS passenger
www.cdc.dov/ncidod/sars/aircraftcleanup.htm.
April 7, 2003 Page 8 of 8 .
DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR DISEASE CONTROL AND PREVENTION
SAFER•HEALTHIER•PEOPLE"
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@.print.L.ble versin
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CSR Home 41Update 25 - Interim report of WHO team in China, status of the
Alert&Response main SARS outbreaks in different countries
Operations
Diseases 9 April 2003
China
Drug Resistance The WHO team of experts presented its interim report on the SARS outbreak in Guangdong Province this
Global Outbreak morning to the Chinese Ministry of Health and Vice Premier Wu Yi in Beijing.The team began its
investigations in Guangdong on 3 April.
Alert&Response
Network
The team concluded that the health system in Guangdong responded well to the outbreak.The province
International has a health system in which every hospital at every level reports any new cases of SARS.The WHO
Health report therefore concluded that virtually all probable cases of SARS presenting at a hospital in
Regulations Guangdong Province will be detected and rapidly reported.
Laboratory&
Epidemiology However,the team found an urgent need to improve surveillance in the countryside to head off new
Strengthening outbreaks in rural areas.The team was further concerned by an increase in sporadic cases,which could
not be linked to a particular transmission chain,as such cases raised questions about the adequacy of
Preparedness for contact tracing.
Deliberate
Epidemics
In addition,the report noted many remaining concerns about the ability of other provinces,where health
Public Health systems are not as strong as the one in Guangdong,to respond promptly and effectively to the challenge
Mapping of SARS.
In Beijing,for example,only a minority of hospitals make daily reports of SARS cases. Contact tracing is
• another problem in Beijing and does not appear to be carried out systematically.Failure to perform
careful contact tracing will allow the disease to spread.
The team observed that many of China's poorer provinces may not have adequate resources,facilities,
and equipment to cope with outbreaks of SARS,and underscored that Guangdong's capacity was
exceptional among China's provinces.
In Guangdong,the SARS outbreak placed an enormous strain on the health care system.The Guangdong
Infectious Disease Hospital(Guangzhou No.8 People's Hospital)had 150 of its 400 beds occupied by
SARS patients daily during the second week of February.The team noted that the response of the health
care system has been exemplary,and commended the dedication and bravery of doctors,nurses,and
others working in clinics and hospitals.
Microbiological findings
Large banks of stored specimens from suspected and probable SARS cases,from case contacts as well as
from"normal controls"exist at the institutions visited and are stored under suitable conditions; detailed
information about the numbers and types of these specimens are available and were provided to
members of the WHO team.Although the patient data on each of these is very limited,it is sufficient to
allow linkage with the very detailed epidemiological and clinical informations held elsewhere in
Guangdong Provincial Centers for Disease Control and the hospitals.
These specimen banks comprise different types of respiratory specimens from which the detection of
agents can be attempted and serum samples,often as paired acute and convalescent sera(i.e.the first
sample obtained during the acute phase of the illness and the second during recovery)which will allow
determination of seroconversions.The laboratory staff agreed that once a causative agent for SARS was
identified these banks should be tested and will provide very valuable information;they seemed,
however,less sure whether this time had come already,i.e.whether there was already sufficient
evidence and whether suitable tests had been developed elsewhere that would make such an exercise
worthwhile.They requested assistance from the WHO team to obtain relevant information on primer
sequences and other matters as well as access to suitable experimental tests such as
immunofluorescence antibody assays.
Main recommendations
The interim report made several major recommendations,including the following:
• -The SARS reporting system established in Guangdong is an excellent model that all provinces should
follow.Team members suggest that the MOH ensures that all provinces are brought up to Guangdong
standards by implementing this system nationwide as a matter of the utmost urgency.A programme for
evaluating and accrediting surveillance systems through evaluation by technical experts is also
suggested in order to ensure that consistent standards are achieved and maintained.
-The Guangdong experience should be used to develop uniform standards throughout all provinces for
preventing the spread of SARS in health care facilities.
-Careful contact tracing of SARS cases is vital to bring the outbreak under control.Detailed interviewing
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but potential exposure in other crowded settings,e.g.public transport needs to be routinely carried out
Contacts of cases should be provided with detailed preventive advice verbally and in writing.
-Much better collaboration between virological laboratories in China is required, particularly to facilitate
the exchange of results,specimens and reagents.The following institutions should form the nucleus of a
national SARS laboratory network within China:
• National Institute of Virology,China CDC,Beijing
•Virology Unit,Beijing Provincial CDC,Beijing •
•Virology Unit,Guangdong Provincial CDC,Guangzhou
•Department of Virology,Zhongshan University,Guangzhou
Laboratories from other areas with experience of SARS cases should also be included.Adequate funding
and human resources need to be urgently provided to ensure the proper functioning and sustainability of
SARS surveillance activities as they are essential to controlling spread of the disease. Chinese institutions
should form a national SARS laboratory network within China to speed up the exchange of results,
specimens and reagents.
-Guangdong clinicians have cared for the largest number of patients in the world and their experience
should be shared with the international community through publications, meetings and in drafting
guidelines for the management of SARS patients.
Priority actions
Priority actions recommended in the report to contain SARS include:
-early recognition and treatment of cases
-stringent infection control measures in hospitals and clinics
-prompt reporting of suspected cases
-meticulous investigation and contact tracing in the community-public awareness campaigns and
education.
Hong Kong:heavy burden on the health system
With today's cumulative total of 970 cases and 27 deaths,Hong Kong continues to have the largest SARS
outbreak,second to China.The strain on health services and staff is considerable,and strengthened
measures of infection control may be needed.
The isolation order placed on Block E,Amory Gardens will expire at midnight,April 9.The Hong Kong
Health Department has announced that residents,temporarily housed at camps,may return home after
their flats have been disinfected by the Food and Environmental Hygiene Department.
Singapore: role of"super-spreaders"
•
Singapore has increased measures to prevent transmission in hospitals following an outbreak in
Singapore General Hospital. Measures include mandatory temperature checks for all staff, limiting
visitors,and isolation of all possible SARS cases.The Singapore General Hospital outbreak involved over
20 people with suspect symptoms,nearly all nurses and doctors.Only seven have been diagnosed as
"probable"SARS cases.The distribution of cases over time suggests a point source.The health worker
considered to be the index case in this cluster of cases may be the fourth"super-spreader"identified in
Singapore.
A"super-spreader"is a source case who has,for as yet unknown reasons,infected a large number of
persons.Although transmission patterns of SARS remain incompletely understood,evidence suggests
that such"super-spreaders"may have contributed to the evolution of SARS outbreaks around the world.
Until recently,all cases in Singapore have had good epidemiological links to their source. Further work is
now required to establish similar links for the more recent cases.If confirmed,such linking of cases will
show that transmission is limited to those who are symptomatic,and usually very ill.This hypothesis is
supported by the observation that health workers continue to be the main group diagnosed with SARS.
To date, investigation of the SARS outbreak in Singapore have revealed few signs of community spread
beyond family members in close face-to-face contact with patients. However,these findings are based on
limited data on exposures.
Viet Nam:no asymptomatic transmission
Vietnam is now reporting a cumulative total of 62 cases.Four of these cases have been detected in the
last few days following stable reporting of 58 cases for several consecutive days.The stable number of
cases raised hope that the outbreak in the French hospital in Hanoi had been contained. However,a 59th
case was reported on 31 March.
This male patient had been in contact with his daughter,who was a patient at the French Hospital at the
time of Viet Nam's index case.This contact continued when the daughter became an outpatient.The
daughter's husband,who attended the Hanoi French Hospital with his wife,had a mild febrile illness
which was undiagnosed at the time and which resolved spontaneously. It is presumed that he had mild
SARS and passed the infection to his father-in-law(case 59).Assuming this to be true,WHO
epidemiologists maintain the view that asymptomatic transmission does not appear to occur.Nor does
this case suggest a longer incubation period than currently assumed(2-7 days,with 10 days considered
the rare maximum). Blood is being taken for testing of the husband.Case 60 is a doctor who cared for
•
case 59 while he was in a provincial hospital about 1.5 hours from Hanoi.Cases 61 and 62 are young
women who are part of the extended household who provided considerable care for case 59.
WHO continues to work with the Ministry of Health to investigate the contacts of these cases. It is
anticipated that a few more new cases will be linked to case 59.Careful monitoring of contacts continues.
Of the 62 cases,44 have been discharged,4 have died and 14 remain in hospital.One of the hospitalized
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•
Board of Health
New Business
Agenda Item # V. , 3
• Board Sponsors for
Environmental Health
Regulation development
April 17, 2003
•
Jefferson County Board of Health
Agenda Item Information / Description
Regular Business
Or Month of: April, 2003
Description—a brief description of the agenda item: please include project,road, contract, grant,etc.number if one is
available for the Commissioner Index:
During the Board of Health retreat in March the concept of Board sponsors,modeled on the State BOH, for regulatory
and policy creation was discussed. The following are some of the regulatory processes that are anticipated in the
upcoming months with some suggestions fro prioritization.
Issue—a short outline of the issue: including policy issue falls within; strategy or objective issue supports; key reference
areas (law/policy/regulations):
Historically staff with board review comment and revision has developed regulations being considered by the BOH. The
initial drafts have been created with little board input.Rather Staff has identified the key issues and attempted to offer
viable alternatives. Depending on the subject there have been varying degrees of public involvement in the process.
Establishing a Board sponsor for each regulatory process would create a close link between the board and staff early on
with a benefit that the sponsor will become very familiar with the issues and solutions. The sponsor will be in a strong
position to lead the BOH deliberations when the rule comes before the board.
Opportunity Analysis—what is the type of action Board is being asked to take: discussion/decision—if decision—what
is the range of possible solutions considered by the depai tment in preparing its recommendation
The attached memo identifies the breadth of policy/regulatory work that we anticipate over the next 18 to 24 months. We
ivasking the board to consider the concept of the board sponsor and, if the board wants to try this approach assign
nsors to the issues identified.
Specific Departmental Recommendation—why was the action recommended and what would be the impact of not
taking the action: what specific action is necessary by the BOCC approval—adoption—deny—remand back to
depat lment:
The specific staff recommendation is that the Board assign sponsors for the meth lab regulation, solid waste reg and the
alternative water supply issues.The Board then may want to evaluate the effectiveness of the process before taking on the
other issues. There are several reasons for these issues as priorities.The meth lab ordinance is relatively straightforward
and urgent.With the adoption of the new state solid waste regulations we are required to update ours. Decisions being
made through GMA are highlighting the need to adopt local standards to deal with drinking water supplies.
The other issues, while important have either other timelines or may be handled in different venues.
11111
.�. N's
141i6 ' t
1 Jefferson County Health &Human Services
tel' J 1 1 615 SHERIDAN • PORT TOWNSEND,WA 98368 • FAX 360-385-9401
TO: Jefferson County Board of Health
FROM: Larry Fay
Environmental Health Director
DATE: April 10, 2003
RE: EH Policy Issues/Agenda Calendar
Environmental Health has a number of policy matters that need to be brought forward for
Board consideration over the upcoming months. The purpose of this memo is to provide
brief background information and begin discussion of priority and agenda planning. The
issues following are presented in no particular order.
• Civil Penalties—Uniform Enforcement Procedures
• In August the Board saw a draft of the uniform procedures. At this time David
Goldsmith is moving this document forward with the goal of creating a standard
procedure for all departments under his authority. Therefore, this probably does
not warrant Board of Health attention unless the Board feels the need to establish
Health Department specific procedures.
• Alternative Water Supplies
As discussed in September, there is a need to make some key decisions regarding
use and standards for alternative water supplies. Between our existing policy for
rainwater catchments (modeled on the San Juan policies) and consideration for
hauling water and desalination there are good starting points. However, use of
alternative water supplies have not been broadly approved across the state. Key
decisions for the Board are whether to continue to approve alternative water
supplies and if so, under what conditions and with what limitations.
• Update of Solid Waste Regulations
Department of Ecology is poised to finally adopt WAC 173-350, replacing 173-
304, "Minimum Functional Standards for Solid Waste Facilities". DOE adoption
necessitates an update of our rule. Key issues include scope and breadth of our
rule (we could simply adopt by reference) and whether to create special standards
for biomedical wastes. (The state rule is silent of biomedical wastes). We have
one year from the date of the DOE regulation to update ours.
•
COMMUNITY ENVIRONMENTAL NATURAL DEVELOPMENTAL SUBSTANCE ABUSE
HEALTH HEALTH RESOURCES DISABILITIES &PREVENTION
360/385-9400 360/385-9444 360/385-9444 360/385-9400 360/385-9400
• BOH Procedural Rules
Dr. Locke and I discussed this very briefly with the Board earlier this year.
Essentially, this rule would establish a standard procedure for actions and
hearings with the Health Officer and/or Board. This is envisioned as being a
framework for administrative procedure for all Environmental Health ordinances
and as such is probably a priority.
• Methamphetamine Lab Rules
While environmental health involvement with clandestine meth labs has been
fairly limited we anticipate an increase in lab response and clean up activities over
the next couple of years. State regulations establish response requirements and
clean up standards. The state rules do not provide for penalties for violating
property postings or failure to clean up contaminated property in a timely manner.
• Various Standard Operating Policies
Several policies are due for update. By our policies these updates are all reviewed
and approved by the Board. These include:
o Wet season evaluations
o Subdivision procedures (with emphasis on boundary line adjustments)
o Environmental health review of building permit applications
o Two party wells
Key issue: Does the Board want to retain its rule in approving operational policy
or should this be left to management and the Health Officer?
•
• State Regulatory Revisions
In additions to the above there are two significant state BOH reg revisions
underway. These are complete rewrites of the Food Service Regulations and the
Onsite Sewage System Regulations. Both of the revisions are scheduled for
completion late this year or early next year. When these regulations are completed
we will need to revise our local codes. I expect that we will have 12 months after
the adoption of state regulations to complete our work. What this means is that we
will most likely be opening both our food and onsite codes in 2004.
•
� Board of Health
Media Report
1
April 17, 2003
•
• Jefferson County Health and Human Services
MARCH — APRIL 2003
NEWS ARTICLES
1. "Flulike outbreak raises school absentee rates"
•
Peninsula Daily News, March 13,2003
2. "Public health officers beg lawmakers for funds"
Peninsula Daily News, March 12,2003
3. "Health officials to spread word on West Nile virus"
Peninsula Daily News,March 19, 2003
4. "Tobacco intervention training set"
P.T. LEADER,March 19,2003
5. "Checking on Skookum,DM Disposal"
P.T. LEADER, March 19,2003
6. "Big Brothers/Big Sisters program needs helpers in Jefferson County"
P.T. LEADER, March 19,2003
111 7. "Decisions on Marrowstone water issues are coming drips"
slow dri s"
P.T. LEADER,March 19, 2003
8. "Jefferson County starts hot line for homeland security"
Peninsula Daily News,March 27,2003
9. "Marrowstone water use at issue"
Peninsula Daily News, March 28,2003
10. "Officials field SARS queries"
Peninsula Daily News,April 4, 2003
11. "Smallpox efforts cause care woes"
Peninsula Daily News, April 6, 2003
12. "Skookum wins recycling contract"
Peninsula Daily News, April 8,2003
13. "Drugs: a clear and present danger"
P.T. LEADER,April 9, 2003
14. "April awareness on disabilities"
P.T. LEADER, April 9, 2003
4111 15. "How much is PT Paper putting into air?"
Opinion Forum,P.T. LEADER, January 1, 2003
M 2 Ailment: Mysterious- virus
r aN ° 3 y3 §t g..
E
T ~
_ ago,i�' o u ^ 80°•'-'4 CONTINUED FROM Al I j ' I
— x n °_N ° However,this is the tail end `
t, 1 E -.
tlf -W -2 S g.a= 3 7,77f c-� of a flu season that generally ,, :r
PI a� 5:', .° c o-- , runs between November and ' '`''-
D_._ d
.2.411.1).'-:-,;;
2 1 °o.)w -x U 0. g March,she said.. '
x N_ca A ° ° o It is fairly unusual for 20 a
0 v•- N c o°•S 0E2-0
percent of Blue Heron's stu-
,
p v
g 2 v 0,a•. dent body to call in sick,and no �<- s .
r/%CCI a)5 a3 -o ,A•- other school reported as many „ £ _
sick children in Jefferson `fir t }` t[F
J County. t' P a,r i#
She doesn't know why Blue ' �'
a 8 o Heron was hit so hard. v� ."' `` 1• ` ., 'ill
° y_ 2 o "I think this has been going `4,4,'•, ( r '�
> 1-o 5 around our school and the corn- .'a
o w e ,� munity," she said. "And this " '
y ' a .n week it just hit Blue Heron." ;
oCk u c g NYS c °.§ h She reminded residents to 'A t3
8 w I a ° iv wash their hands frequently so ;�,;a,..
g.3 L 2 `o a -.5,� they won't pass on She virus. i#.F \1
C,2.X bp`a " Meanwhile, McKenzie said
.2 Z� ,a - od.NL the county has reported the ill- i° ;�4
c >,-o e $ ness to the state Influenza Sur- '',,....)1',.., <
0
.6-o c E)c5- •°._-3 veillance.Program.She said the
_�' `�'''
,,
�J
- ° ° d ° state could ask the county to
O ..0 2 -c a c --_. • provide a culture of the virus. -r I a;
But as it's near the end of - t._
L- the flu season, McKenzie �+
- -o •5 v a>i doubts that will happen. " •
S v74 a Co pPe ti".!,g 1
V /,
m-E d ° 8v ° High school i'1 \1,�.;
o
U t P°. C-a c KeveN Daews/Peninsvu DAILY News
Tom Kent, Port Townsend
o .--c • p co E High School assistant principal,
Anti Fields, principal of Blue Heron Middle School, and
(I)CO) °o•-:-, 1? en N c o ro'2 " said his school definitely hada Sandi Reid, school secretary, display the type of
N 2 ; v , number of students call in sick thermometer school staff use to evaluate whether a
-o 2 a ° m cn oo° N v student has a fever.
N o ° r,c_ c , o v Wednesday,but not as many as
CI) c " " ,� l''':'-°o ° .' Blue Heron. absent Monday and-34 were Dean of Students Josh Joslin
'O N C g-e, N 4 •N
• o a a ' c y c 3 He didn't have absentee
3 o a2 a a" K a aa '.N numbers immediately avail_ absent Tuesday. added.
laimum °z m 3 ' c able. Dalila-Dawd, secretary of. ' hasn't impacted us yet at
N 2 E°- c �n ° "I do know it's been affect- Brinnon School,said there have the high school."
ing teachers," he said. "Some been no reportsof the flu,even Reid reminded parents to
kids have had it." though some studentsare sick call 360-379-4500 Ext. 8110
i `. . -.a-8 3.-...4g.-. Marlene O'Keefe, secretary and absent from school. each day a child is determined
mg ` a a c>,,-.7;)
of Mountain View Elementary Chimacum OK to be sick.
o �, N 1.N School, said 23 students — or Otherwise, she said parents
rcent of
"We
▪o were absen Wednesday.ens number haven't
of students call great
n phlone call,arinforming automate
dthe
N g,o G m ▪ v.o. She said 26 students were sick," Chimacum High School their child is absent.
ioc o 0.>, ova
CT-8. I ,-. 'fl h tg d toti
limp 'C V:� y y f'• C Y V_ Op N
iG N 5.S .D'
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•
Public health officers
beg lawmakers for funds
•
THE ASSOCIATED PRESS districts to skimp on services
OLYMPIA—Public health such as tuberculosis prevention
officials across the state say and childhood immunizations,
shrinking budgets are endanger=- just to keep up with new man
-
shrinking
public safety and they're dates on fighting bioterrorism
pleading for help from legislators threats such as smallpox and
and voters. anthrax_ _ - ._
"The cost of inaction is pre- "If we do not secure dedicated
ventable death," said Alonzo funding, it's fair to say there will
Plough, director of public health be increased illness and there
for Seattle and King County. will be increased risk of people
Right now, for instance, he dying," said Dr.Ward Hinds,
said county health departments director of tTie Snohomish
are "absolutely not" prepared to County Health District.
deal with an outbreak of West The public health officers said
Nile virus. they are wilting to put their fate
Health officers visited legisla- in voters' hands.
tors Tuesday to tell them that
budget cuts are forcing health TURN TO HEALTH/A7
WEDNESDAY,MARCH 12, 2003 A7
_Health :• Fall-. vote
•
CONTINUED FROM Al "The chances probably are
They support a proposal in not good,unfortunately," West
the Legislature to offer a ref- said. "Not every good idea gets
erenclum in the fall, asking done the first time out of the
voters to approve a property chute, though."
tax increase of' 25 cents per The health tax proposal
$1,000 of assessed value. The raised the hackles of State
estimated $151 million raised Schools Superintendent Terry
would be distributed to county Bergeson.
health districts.
Statewide increases in
'Value of public health' property taxes have tradition-
allyState Senate Majority gone to schools, and
--Leader Jim West, R-Spokane, Bergeson said schools need the
sponsored Senate Bill 5920 to money-'or at least the option
" enabhe-the referendum. of those property .. tax -
"I know the value of public increases.
health," West said. "If people Most public health districts
want to raise taxes they get their money from county
should be able to." governments,which have been
But the bill failed to get cutting budgets due to the
approval from the Ways and downturn in the economy, and
Means Committee, led by fel- from state government.
low Republican Sen. Dino
Rossi of Sammamish, by Mon The federal government
day's deadline. While the pro- contributes as well, but usu-
posal could be revived as part ally gives grants for very spe- •
of the budget process, West cific projects such as smallpox
was not optimistic Tuesday. outbreak planning.
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Tobacco111
• intervention
training set
Jefferson County Tobacco
Prevention and Control Pro-
gram offers a skill enhance-
ment training for health care
providers on Brief Tobacco In-
tervention and Motivational
Interviewing, 9 a.m.-4 p.m.
Wednesday, April 16 in 'Port
Townsend.
As a result of this training,
participants will be able to de-
scribe the chain ofMcotine de-
pendence,utilize brief tobacco
intervention skills in a variety
of therapeutic settings, assist
patients and clients in develop-
ing behavioral change plans
and apply motivational inter-
viewing skills in their practice.
The trainer for this event is
Penny Brewer,a consultant with
•
the Tobacco Resource Center and
developer/trainer with the Cen-
ter for Health Promotion within
Group Health Cooperative in
Seattle.
There is no cost for partici-
pants to attend,and clock hours
will be available for some dis-
ciplines through the Washing-
ton State Tobacco Resource
Center. Early registration is
recommended, as seating is
limited.
For additional information
about the training, contact ,
Jefferson County Tobacco Preven-
tion and Control Program Coor-
dinator Kellie Ragan at 385-9446
or kragan@co.jefferson.wa.us.
,`t . (.,CAO ET-4Z_
•
Port Townsend&Jefferson County Leader
Checking on Skookum, DM Disposal
City, county records show issues raised with both companies
By Barney Burke out of the"tipping fee"charged tions,"adding,"It was clear to me they could do better on the cus-
Leader Staff Writer on garbage.According to Frank that personnel were aware of tomer service end," Timmons
Gifford, the coun y's_,p blic safety issues, had made them_a added. An investigation by the
The top two bidders for works director, Jefferson priority and had put significant city concluded that calls to DM
Jefferson County's recycling con- •County's tipping fee is the fourth effort toward that end." Disposal during normal business
tract,DM Disposal and Skookum, highest in Washington. But Jefferson County Envi- hours resulted in an answering
have track records with the City ronmental Health Director Larry machine 95 percent of the time.
of Port Townsend and Jefferson Skookum safety Fay said this week that Skookum And Timmons said he's been dis-
County,respectively. In March 1999, Brad still needs to get its draft safety pleased that DM Disposal some-
DM Disposal acquired Supe- Stedham, a DD adult employed plan approved, although the times gives out his phone number
rior Refuse about three and a half by Skookum,accidentally put a county has not set a deadline. instead of resolving complaints
years ago and thereby became cleaning powder in his:coffee As to daily operations, Fay directly.
the city's garbage collection fran- instead of creamer, and he re- said his department had to send Other concerns outlined b`
chisee. That contract was re- quired hospitalization. He has two notices in 2002 regarding the city in a December 2002 let-
newed in 2002 for five more since recovered and gone back to safety concerns.Those concerns ter include trucks that leak hy-
years, City Manager David work for Skookum. had to do with making sure that draulic fluid and garbage
Timmons said last week. Since that incident, everyone uses safety goggles and leachate, not replacing contain-
Skookum has been the Skookum's Recycling Manager similar equipment,and that such ers and lids,not implementing a
county's recycling contractor on John;Burke.said, the company procedures are documented in recycling education program,
a year-to-year basis since taking has implemented'changes to its the plan. and providing only three of the
over from Bayshore in 1993,ac- safety procedures,including the "I would say that periodically, five recycling drop boxes re-
cording to county officials. locking up of cleaning products we need to get on them to keep quired in the contract.
Both companies are hoping to and similar materials. the site clean,"Fay added. DM Disposal's vice president,
win a four-year contract with the In 2002, only one employee - Burke said that Sit:ookum –Edward Westmoreland, re-
county for recycling. If the---lost one day of work due to in- plans to be ISO 9002-certified by sponded 15 days later with a let-
county chooses to continue hav- jury, said Burke.Two other em- the end of 2003. That certifica- ter acknowledging the city's
ing a program for developmen- ployees were injured but did not tion, by the International Orga- concerns. He indicated that [he
tally disabled(DD)adults within miss work as a result, he noted. nization for Standardization,is a company had suffered a combi-
i.ts recycling operation, Skookum is inspected about once process used in many industries nation of truck problems but was
Skookum's bid is about$18,500 a year by a private inspection to document organizational per- making necessary repairs and
less per year, on average, than firm on behalf of the county, formance,he explained.Some of had hired a new maintenance
DM Disposal's.But if the county most recently in October 2002. Skookum's other operations are manager. Westmoreland con-
chooses to eliminate the DD pro- In his October 2002 report, already certified,he noted. firmed that company policy is to
gram,then DM Disposal's option according to Burke, inspector replace containers and lids, and
without a DD program would Christopher Christian wrote,"It DM Disposal service he would work with drivers to
cost about$21,750 less per year, was clear that many positive and "We had some rocky starts," accomplish that. He also prom-
according to county staff, pro-active changes had been Timmons said of the city's con- ised that calls would be returned
The cost of recycling is paid made'since the last two inspec- tract with DM Disposal."I think in 24 hours except on holidays
and weekends,the recycling pro-
gram was being finalized,and the
drop boxes would be provided.
— ="They substantially re-
sponded to the issues,"Timmons
said last week.
Timmons also said that the
city would like to do more recy-
` _D 3 cling, and that no matter which
vendor the county chooses,
there's no particular advantage
relative to the city's recycling
goals. "It seems to me like the
• two of them [together] bring to
the table what we need,"he said.
As to the challenge of solicit-
' ing bids in rural Jefferson
County, Timmons observed,
"There's not a whole lot of com-
petition in the marketplace."
Port Townsend 4 Jefferson County Leader
fib_
•BigBrothers/BigSiste�s �o raYin
__ _, ...40.,
needshelpens JCounty
By Janet Huck i grades. ! lescents through an intensive
Leader Staff Writer "It is a fantastic The Jefferson County group screening process, a criminal
has been able to get up and run- background check and a home
A fly fisherman came. Sao opportunity for , Hing in less than five months visit of the adult mentors.
did youth pastors, Port •
with the help of the Island Schools and community
Townsend's chief of police and our community to County organization, which members can refer possible
representatives from Jefferson " didn't make its first match for candidates for the"littles,"kids
County Parks and Recreation. have a proven three years. who are picked upon on the
About 40 community members and beneficial Instead of becoming a fully playground or have poor orga-
showed up for the kickoff pre- 6 accredited BB/BS chapter, nizational skills. In Island
sentation of the Big Brothers/ program. which does indeed take years, County, children and adoles-
Big Sisters of Jefferson County Jefferson County is becoming cents get to choose their men-
(BB/BS). Jean Baldwin - a remote satellite office of Is- tor from two possible matches.
"I'm jealous to see a group director land County. The Island "The parents and the kid
with this much diversity," said Jefferson County County group, which now has have to approve the volunteer,"
John Dyer,president of the Big Department of Health and 210 matches, plans to provide said Peggy Stanford,executive
Brothers/Big Sisters of Island___. Human Services - supervision and training for the director_of Big Brothers/Bi
County. Jefferson'County office. The Sisters of Island County.
Many came to learn how to two groups are finishing up The coordinator also p,
become a big brother or big sisr contract ;negotiations this vides close monitoring of the
ter.The flyfishing businessman month. ongoing relationships.
just wanted to know how to man Services, which is over- "It is a fantastic opportunity The 2003 budget for the
help. In the next couple of seeing the project. for our community to have a Jefferson County program is
months, BB/BS wants to de- Mentorship programs proven and beneficial pro- about $25,000, mostly for staff.
velop at least 10 one-to-one around the United States have gram,"said Baldwin."We have Chimacum School District has
mutually satisfying relation- delivered results. An indepen- worked on a mentoring pro- donated office space and a tele-
ship between youths age 6 to dent study of the Philadelphia- gram for l5 years. It's so phe- phone. Big Brothers/Big Sisters
14 and their mentors. based Big Brothers/Big Sisters nomenal s e finally have it." has budgeted$15,000 from a fed-
"It gives adults a chance to found students involved in the Under sland County's su- erally funded Drug Free Com-
give back, and it gives kids a program missed less school pervision, Jefferson County munity Support Program grant,
chance to form positive rela- than students on the waiting plans to hire a part-time match but the group needs to raise the
tionships, besides with their list, had lower levels of sub- coordinator by the end of April rest from community groups and
parents, that have lifelong im- stance abuse, showed less and begin recruiting"bigs,"or fundraising functions.
plications,"said Jean Baldwin,-_physicaL.aggression,had beater mentors, and ;`littles"It's_the "Aswe get bigger, we will
director of Jefferson County relationships with parents and coordinator's job to insure the need more money," said
Department of Health and Hu- peers and achieved higher safety of the children and ado- Baldwin.
c--,
• .
•
•
Port Townsend&Jefferson County Leader
•
iecisions on
Marrowstone wat•
er
Issues are comiiigin -slOw.__drips
By Barney Burke recommended the initiation of a assistance,but it isn't able to pro- system will have much effect on
Leader Staff Writer new comp plan amendment to vide quarterly monitoringof
property values overall on
memorialize the county's revised chloride levels within its present Marrowstone. It would add sub-
The next steps in dealing with seawater intrusion policy,and the resources, according to county stantial value to a property that
the seawater intrusion issue on board unanimously concurred. staff.
is too small for both a well and a
Marrowstone Island come-down The -esmprehensive plan-- ' The board of-commissioners -septic system, and for parcels
to more money and another amendment may take until De- has not yet decided how to fund where no potable water has been
amendment to the Jefferson cember 2003 to complete,accord- the monitoring effort, but found, he said. But many other
County Comprehensive Plan. ing to Alvarez."It definitely opens Titterness suggested that the properties are already developed,
At a March 17 workshop,the up the policy all over again for PUD consider using revenues have working wells, and are not
board of commissioners dis- public review," observed Dave from its own property tax levy, large enough to qualify for sub-
cussed how to implement the sea- Christensen, the county's natural which applies to all properties in division; those parcels would
water intrusion policies which resource manager.Dan Titterness Jefferson County. likely change little in value due
they have beefed up since losing sounded equally weary of the is- According to County Asses- to a public water system,
a challenge before the Western sue, saying, "What comes out at sor Jack Westerman III, Westerman conjectured.
Washington Growth Manage- the other end of the public process Marrowstone Island properties The PUD was slated to meet
ment Hearings Board in Decem- is what comes out at the other end are expected to generate about yesterday,March 18, to get fur-
ber 2002. of the public process." $12,910.42 to the-PUD4n 2003.----titer input from Marrowstone Is-
it isn't clear yet whether
the ty's new policies for Monitoringcosts land property owners about their
Property values interest in a possible public wa-
arrowstone will even pass mus- Meanwhile, Christensen re- Westerman also noted that ter system. That system would
ter with the hearings board.At 9 ported that a seawater monitor- Marrowstone Island properties use a well in the Tri-Area (Port
a.m. April 9, the board will_con_ ing.program is.expected to cost are up for revaluation this year ...Hadlock, Irondale, Chimacum)
duct a teleconference compliance the county about$13,500 a year. in the county's four-year cycle of connected by a pipe to the island.
hearing with county officials and Working with Jefferson County updating property values According to PUD officials,
Colette Kostelec,who represents Public Utility District 1 (PUD), throughout the county.Based on a public water system might take
the two appellants in the matter, the county intends to monitor data from recent sales, he pre- about two years to construct.But
the Shine Community Action salinity in 75 privately owned dicts that property values;will if more than 50 percent of prop-
Council and the Olympic Envi- wells on a quarterly basis. jump significantly on the island erty owners register a protest,the
ronmental Council. The PUD has offered to loan this year. PUD would be prevented from
Chief Civil Deputy Prosecut- the county.75 radio-operated Westerman said he doubts that moving forward. If the opposi-
ing Attorney David Alvarez said flow meters and provide other the addition of a public water tion is a smaller number,then the
Monday that getting specific di-
rection from the hearings board PUD board has the sole preroga
would be helpful in confirming tive to undertake the project or
__ __ - _ not. —
how the county should move for
ward in resolving the issue. He A new group,"Try Conserva
tion First," has formed on
Marrowstone to disseminate in-
formation about how water con-
servation could prove to be a
viable alternative to building a
public water system.More infor-
mation is available by calling
'�f C3 --® 3 Garth McHattie at 379-1848.
III [
•
Jefferson County
.starts llotl!n-eforr
homeland security
BY LUBE BoGUEs 'secondary emergency opera-
PENINSULA DAILY NEWS tions centers aren't manned,
PORT TOWNSEND — Abut can be if the situation
hot line has been set up to allow changes,he added.
Jefferson County residents No current threats
access to the latest homeland
security information. There are no current known
The Jefferson County terrorism threats to Washing-
Department of Emergency ton state or the North Olympic
Management recently estab- Peninsula, according to Tues-
lished the hot line at 360-385- day's recording.
9161. Residents wishing to know
A recorded message, more about emergency pre- o
updated daily,informs callers of paredness can visit Jefferson
the current national terrorism County-s Web site at
alert status and any special pre- www.cojefferson.wa.us or the )
cautions being taken by local American Red Cross site at
authorities. www.redcross.org -----
As
-
As of Tuesday, the message Local Emergency Manage- •
said the current Homeland ment officials can be reached by
Security Advisory System level calling 360-385-3831 Ext. 7.
is orange, the second-highest
alert on the colored scale with ..... ., ..
red as the highest.
The alert level means that ... .,
residents should have a three ' ka,t
day supply of food and water ? lba
ready and watch for suspicious accorgto county s ;
activity, din #� � �
Emergency.: Management
Director Bob Hamlin. �.
The county's primary ands a � ,
•
•
, ..
arrowstone water _ __ _
_ use__ at issue
Island saltwater; woes mayforce daily for each residence. solved in the next few years if
Residents, Flynn said, can the utility district installs a
y check water consumption with public potable water system
volume cuts, county officials sa
a flow meter that's available on the island.
BY JIM HANDERS areas of Jefferson Count for free from Jefferson County -The cost of a public water
Y ; Public Utility District No. 1.
esti-
PENINSULA DAILY NEWS Earlier this year, Jefferson system for the island is�PORT IIADLOCK — Mar- County; commissioners Elimination of watering mated at$3 million, according
rowstone Island residents may invoked'the 1,000 gallon limit to a letter to be sent to Mar-
see further reductions in the after the Hearings Board ruled! County water,resource spe- rowstone residents. The cost
amount of water they can steps had to be taken to keep cialist Dave Christensen said covers connections for 200
seawater out of wells. an alternative to help cut properties and 300 water
pump from wells. water use on the island would
educing the daily volume Subcommittee members meters.
said anymandated reduction wbto eliminate all outdoor There are 680 parcels on
from 1,000 to 750 gallons was watering.
one of the suggestions of a in water use might be hard to That didn't sit well with at the island.
Planning Commission sub- monitor and enforce unless least one committee member. Lash August, Marrowstone
committee putting together a the county forces residents to "Do you want us to get residents petitioned the utility
plan to meet a Western Wash- install flowmeters on wells. shot?" Elaine Rogers said. district to establish a public
ington Growth Management "I don't see how they (resi- "At least you.see if people water Supply system on the
Hearings Board mandate. dents) could object," said corn- are watering illegally," Chris- island.
Jefferson County is mittee member Phil Flynn of tensen responded. The committee will meet at
required by the board to pre- the possibility of further cur- Committee members 10 a.m. April 9 in the health
vent saltwater intrusion in tailments in the amount of acknowledged the Marrow- department, 615 Sheridan St.,
wells on the island and other -water that can be pumped- stone Island-problem could bo Por -Townsend.
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efferson
o °Aq° ° o-5 o-5 U Some people experience SARS information will soon
4.o 8 8 o 0 �u�'I ro 2 mild respiratory symptomsCountybe 'sl Homelandable on JSecurty
(1) +, ,1$ i~ o = 0- ° cn early on.
t0 0:r3`" ° . ° >cx' '" o A After two to seven days, Hot Line, 360-385-9161.
o "� °' a[o,``" c A H infected with SARS Hamlin's Clallam County
um m ° °
people counterpart, Joe Ciarlo, said
" o
P. ° -° �' L. 9 az 4. may develop a dry cough and p
.� oa 0 ° „ o m he hasn't received any calls,
m g z 0, g o m. •ti �, shortness of breath.
CD 2 .� e" •a.) b F; , 0 4S People exhibiting flulike but is working with the Clal-
�, > 2. "� G -°' Q c 6 ctl.n S' symptoms who have been to lam County Health Depart-
E°„ ' ti N F o o `� -) o '0 �, Asia or in contact with people ment to make people aware of
o a 6-ti: -a+ m S 0 g who have visited the continent SARS related issues.
c,-2 F. g 8 -S '�S a w .4 '..1 should seek a medical evalua- Locke said he encourages
tion, Locke said. residents to seek information
q o.9. 8 - • .i.a 8 �° 0 :~ b Those not in a high-risk to °R SARS.
°(n 1 o [ o contract the illness are likely "It's an important lesson in
to �' a� 8. �-, a °: a to simply have the flu, he how naturally occurring coin-
q eo i~ C 0 p, m '� added. municable diseases can spr
;8 ,9 a a) G c�b.0 a ClA. quickly around the world,
CCo a -a a g x Monitoring the splead said.
N > -8.a� � �^ ami�Qb
a ty xa) o o a o,d r. In an effort to monitor the For information
0 o •5 o "P o 0 8 0 o vi.$ 1 P Cip 'Q o spread of the disease, state Information can be
< - .4 > o m o as'" ° U o 0 officials are preparing an
E.,
a , ma) ° 3 c d o"0- N x "active surveillance" process obtained online from the state
on ° o m 2 °n-8 b 2 Z n y 'U a' to monitor people who tray- Department of Health Web
CI)
o iu¢�1 a Z 'a m o o S .o.o eled to Asia since February, he site at www.doh.wa.gou/says
x o a C� °w n m Ca „ ro U said. and a federal Internet site at
A handful of calls from citi- www.cdc.gou/ncidodlsars.
' I '.° a.a ' a 4 o w �d' zens have been made to Jeffer- Residents can also contact
MCI; , ti o g'-a'.,0• 4 8'� -� 'ti son County's Department of their respective county's
N o v - o Emergency Management, health department in Jef-
U „'L',P cb p 0.N ,�..d b coordinator Bob Hamlin said. ferson County call 360-385-
p +' �' ti a .n g ai a Those calls have been referred 9400, and in Clallam call 360-
CD ..
g ; C e -m a �., a,q X p to the Jefferson County 417-2274.
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Smallpox efforts cause care woes
takinghealth workers have been demands of smallpox planning.
Officials claim vaccinations
pulled out of clinics and home "This situation has led to
resources from other programs visits to work on smallpox vac- questionable preparedness,
cination. In Spokane County, poor response to community
BY REBECCA COOK everything do,"Plough said. public health nurses have requests for service and an
g weg reduced the number of clients overextended staff — not a
THE ASSOCIATED PRESS Health officials warn that as they see, even as the demand good combination," said Gibbie
SEATTLE — budgets shrink and bioterror- for services grows. Harris, community health
mandated prep Federally ism demands grow, people In Memphis, Tenn., some director for Wake County,N.C.
tions aredsmallpoxscarce should expect more outbreaks childhood immunizations and In a recent survey of 718
resourcesions away stealingom essential oof er tuberculosis,prevenshepatitis
diseases.and diabetes screenings have been local public health agencies by
publirublic health efforts asput on hold. Camden County, the National Association of
c. d tssuchand "The basic communicable N.J., health officials have can- County and City Health Offi-
childhood
prevention, health start to we work
said Patrick celed family planning clinics. In cials, 53 percent said smallpox
officials across the country say. Libbey, executive director of Raleigh, N.C., programswoaand bioterrorism from other public was
The Homeland Security the National Association of delayed some and takingh away other
push to make local health dis- County and City Health Offi-
tricts canceled client visits to meet the health services.
the first defense against cials.
bioterrorism, combined with While Seattle's tuberculosis
shrinking public health bud- outbreak may be the most dra-
gets, have contributed to Seat- matic example, many health
tie's worst tuberculosis out- districts are cutting bread-and-
break in 30 years, said Dr. butter services as they devote
Alonzo Plough, public health ' people, time and money to
director for Seattle and King President Bush's ambitious
•. smallpox vaccination program.
co
has forced trade-offs in In Snohomish County,
Skookum w■i
ns
•
recycling c
Firm which uses "We want to hold Skookum's feet
to the fire,"said Commissioner Glen
disabled labor gets Huntingford, R-Chimacum. i
Huntingford said Skookum's past
Jefferson approval performance left much to be desired.
The public works department
BY JIM MANDERS said Skookum didn't always respond
PENINSULA DAILY NEWS to problems relating to the curbside
Jefferson County commissioners pickup program.
responded to public pressure Monday 'Reach far in community'
and allowed Skookum Inc. to con-
tinue handling the county's recy- "People truly love Skookum, and
cling. they really do reach far out into the
But they expressed displeasure community," Huntingford said,
with how the company, which hires speaking of Skookum's hiring policy.
the developmentally disabled, oper- "It's clear the people want to see
ated in the past. developmentally disadvantaged peo-
The vote to have county staff ple taken care of, but Skookum has-
negotiate a contract with Skookum n't been very responsive to our
Inc. was unanimous, if hesitant. needs for recycling," Huntingford
'Skookum competed with DM Dis- said.
posal Co Inc. Skookum general manager John •
The public works department rec- Burke said he was pleased with the
ommended DM Disposal — which commissioners' decision.
doesn't stress hiring the developmen-
tally disabled—for the contract. ;TURN,TO RECYCLE/A2
Recycle: Skookum warned
CONTINUED FROM Al "A contract to use both(com-
"I'm excited for the chal- panes') strengths might be in
lenge," Burke said after hear- the best interest of the commu-
ing the commissioners' deci- mty, Tar rets mu.sion. "It's a great relief." "I h e Prey good direction
In an e-mail message to com- from the people who employ
missioners, Burke acknowl- me," Commissioner Wendi
edged that the contract chal- Wrinkle,D-Shine,countered.
lenge from DM Disposal would She said she received a large
provide the impetus to finding number of comments from the
ways to keep the developmen- Public favoring awarding the
tally disabled working while contract to Skookum.
increasing the amount of
county recycling.
Shared contract
Commissioner Dan Titter-
ness,R-Port Townsend,favored
creating a shared contract •
between the two companies to
capitalize on the strengths of
each. g v
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111)
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Wednesday,April 9,2003•B S
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Drugs: a clear and presen
Free workshop April 29 addresses county issues, solutions
Jefferson County's Sub- Townsend resident. ence at the county library's sues, including methamphet-
stance Abuse Advisory Board • Steve Freng, PsyD, MSW, Humphrey Room.• amine issues in the county, to
is calling specialists and the prevention/treatment manager Use of space for this year's make action recommendations to
community together for a free for the Northwest High Inten- conference is a gift to the corn- the board.The board,in turn, is
daylong community conversa- sity Drug Trafficking Area of munity from Redeemer Lutheran mandated to advise the Board of
tion about drugs.Speakers and Seattle. Church,and"we are so grateful County Commissioners on drug-
'panel discussions will look at Other conference presenters for the generosity of this church related issues.
drug activity and use in include Jefferson County District helping to make this event hap- "Participation on the task
Jefferson County, and chal- Court Judge Mark Huth, Ford pen," said Sherry Kimbrough, force is separate from,and inde-
lenge the community to find Kessler of Safe Harbor Recovery advisory chairwoman. pendent of,board membership,"
solutions to what the confer- Center, and Laurie Strong of "We hope this conference will Kimbrough said.
ence calls"A Clear and Present Jefferson Mental Health Ser- do at least two things," To reserve a place in the con-
Danger: Our Community Re- vices.A panel of recovering men Kimbrough said. "We hope to ference,including lunch,contact
sponds." and women is scheduled for the share new data and information 385-9413 or cmclarney@co.
The conference runs from 9 afternoon. with the community, and we jefferson.wa.us.
� to 4 p.m. Tuesday, April A student ensemble from Port hope to hear back from the corn- Jefferson County Community
at the Lutheran Church of Townsend High School will munity about its concerns and Network provides funding for the
the Redeemer in Port Hadlock, present lunchtime entertainment. pressing needs." conference.
but it is not'church-affiliated. Nancy Alvarez will present a Kimbrough said the board is The conference planning
The advisory board is arrang- video made by students whose hopeful that the conference will committee is.a work group of the
ing the forum with grant assis- lives have been impacted by al- encourage residents to participate board and includes representa-
tance from Jefferson County cohol and other drugs.The video in the drug task force, which is tives of Jefferson County Health
Community Network. Regis- is one of a series made by youths one of the board's activities.The & Human Services Department
tration is required because with the independent assistance task force is an ongoing group and the local DSHS Community
space is limited and a hosted of Alvarez. which looks at drug-related is- Services offices.
lunch will be provided. The conference is the sec-
Among presenters are: and project undertaken by the
•Dr.Chris Hale,epidemiolo- advisory board to reach the
gist and affiliate professor at the community with data and infor-
University of Washington School mation relating to alcohol and
of Public Health & Community other drugs in Jefferson
Medicine. County. Last April the board
•Dr.Jerry Schnell,former di- presented a community forum
rector of Seattle University Ad-, focusing on methamphetamine
dictions Studies and now a Port to a standing-room-only audi-
CPT- LOA DEle_
• ?-O3
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April awareness
on disabilities
On April 7, the Jefferson "Disabilities not only affect
County Board of Commissioners the individual but also family
and the Port Townsend City members, friends, employers,
Council proclaimed April as Dis- religious institutions,healthcare
ability Awareness Month. providers and businesses;every-
"Disabilities affect more than one is affected and no one is im-
4,700 people 5 years of age and mune," said Lesa Barnes of the
older who live in Jefferson Disability, Awareness, Surveil-
County —more than 19 percent lance and Health (DASH) pro-
of the county's population—in- motion project of the Olympic
cluding sensory, physical, men- Area Agency on Aging."I appre-
tal and cognitive disabilities," ciate that the city and the county
states the proclamation. acknowledge that accessibility
In their proclamations, the for persons with disabilities is a •
two bodies recognize thal the ,problem'&/en jn our little ofner=
1990 Americans with Disabilities of the world."
Act was intended to guarantee Because reducing barriers to
the civil rights of persons with participation for persons with
disabilities including equal op- disabilities is the responsibility of
portunities for employment; the entire community, the city •
equal access to government ser- and county proclamations ask
vices, programs and activities; everyone to participate in efforts
and equal access to places of to recognize the serious impact
public accommodations. that physical and attitudinal bar-
Additionally, they recog- riers create to full community
nized that many public spaces participation for persons with
in Port Townsend and Jefferson disabilities.The proclamations
County are inaccessible to per- state that community-wide par-
sons with disabilities, includ- ticipation is needed to elimi-
ing buildings that house nate these barriers to spaces and
government and social ser- services.Members of the corn-
vices,businesses that serve the munity are asked to join in
public, pathways that lack ap- efforts to increase the accessi-
propriate surfaces, and side- bility of Port Townsend and
walks that lack adequate curb Jefferson County for persons
cuts. with disabilities.
1-5'-03
• •
Port ibwnsend&Jefferson County Leader • n 1(11)1 ) ®Fu
rn
Wednesda ,Janua 1,2003
• s„,,t,"<''',,,,:ik.v„,,,v d , .
7 c a*F
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(Alice M:cC..onaughy, eiivironmen-
tal team leader for Port Townsend
110W•Mu :° • Paper, replies: Permitted emissions
from Port Townsend Paper Corp.are
S PT Paper . 9,442 tons per year.In 2001, actual
emissions totaled 3,894 tons,41 per-
pu' into `? cent of the permitted limit..PTPC:con-
,• '�' - sistently operates below 50.percent of
Editor,Leader: these limits.Regarding.COPD:While
I read with interest the Leader's ar- Jefferson County may be at twice the..::
ticle"PT air quality readings available, national objective rate, the county's
with its suggestion to visit 'actual,age-adjusted death rate(1994-
www orcaa.org to monitorlocal air qual- 98) was 203 per 100,000, less than
ity. The site shows a colorful graphic half the 2000 national rate of 44.3 per
• which indicates how wonderfully low 100,000:Regarding automobiles:Ac-
our air is in particulate matter. cording to 1996 Department of Ecol-
What the graphic makes no men- ogy data,57 percent of the state's air
tion of are•the numerous airborne poi- ' pollution comes frommotor vehicles,14
lutants which are gaseous as opposed percent from industrial sources,10 per
to particulate. Although rarely men- cent from woodstoves.We must be con-
tioned in this newspaper, there does ' scious of all community.pollution
appearto be a certain "sacred cow" sources.PTPC is.a well-controlled in-
near the entrance to town with alto- dustrial facility,operating underfederal
ticeable flatulence problem. Of' `and state environmental laws. We are
course, all is on the up and up, as it members of this community and work
has the legal right to discharge into hard to keep it a great place to live.)
the air each year 1,007 tons of par- .
ticulate, 645 tons of nitric oxide,
6,204 tons of carbon monoxide, 182.
tons of volatile organic compounds,
32 tons of total reduced sulfur and
1,300 tons of sulfur dioxide.
To better visualize this 9,370 tons
(I 8,740 pounds),try thinking in units
of Volvos. As 'a new Volvo
stationwagon weighs 3,368 pounds,
that is the equivalent of 5,564 Volvos
per year.
'According to the "1996 Jefferson
Community Health Report, the local
death rate for men with COPD(chronic
obstructive pulmonary disease)is about.
40 twice the national objective rate.Could
it be that Volvos are not as safe as we
once thought?
GEORGE ELLIOT
Pori Townsend
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