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HomeMy WebLinkAbout2003- May File Copy • Jefferson County Board of Health Agenda • Minutes May 15, 2003 • JEFFERSON COUNTY BOARD OF HEALTH May 15, 2003 2:30—4:30 PM Main Conference Room Jefferson Health and Human Services AGENDA I. Approval of Agenda II. Approval of Minutes of April 17, 2003 Meeting III. Public Comments IV. Old Business and Informational Items 1. Letter to Public Works Board—Trust Fund Application for Beckett Point Community Onsite Sewage System • V. New Business 1. Communicable Disease Update: Smallpox Vaccination, SARS, and WNV 2. Public Health Funding—Action Alert 3. May 13, 2003 Health of Jefferson County Forum—Next Steps 4. National Nurses Week—Focus on Public Health Nursing VI. Activity Update VII. Agenda Planning VII. Next Meeting: June 19, 2003 Jefferson HHS Conference Room • { t 4 JEFFERSON COUNTY BOARD OF HEALTH MINUTES Thursday, April 17, 2003 Board Members: StaffMembers: Dan Titterness,Member- County Commissioner District#1 Jean Baldwin,Health&Human Services Glen Huntingford,Member- County Commissioner District#2 Director Wendi H Wrinkle, Vice Chairman- County Commissioner Larry Fay,Environmental Health Director District#3 Julia Danskin, Nursing Services Director Geoffrey Masci, Chairman-Port Townsend City Council Thomas Locke,MD,Health Officer Jill Buhler,Member-Hospital Commissioner District#2 Sheila Westerman,Member- Citizen at Large(City) Ex-officio Roberta Frissell,Member- Citizen at Large(County) David Sullivan,PUD#1 Chairman Masci called the meeting to order at 2:30 p.m. All Board and Staff members were present. There was a quorum. APPROVAL OF AGENDA • Commissioner Huntingford moved to approve the Agenda as presented. Commissioner er Titterness seconded the motion, which carried by a unanimous vote. APPROVAL OF MINUTES Commissioner Titterness moved to approve the Retreat Summary and Minutes of February 20, 2003. Member Buhler seconded the motion, which carried by a unanimous vote. PUBLIC COMMENT Jean Camfield of the Beckett Point Fisherman's Club presented a request for a letter of support for Public Utility District#1 (PUD #1) to construct a community drain field system at Beckett Point. The letter, if provided, would be submitted to the PUD and accompany their application for loan funds for the project. Commissioner Titterness moved that the Board direct Staff to submit a letter of support for Public Utility District#1 to construct a community drain field at Beckett Point. Member Westerman seconded the motion, which carried by a unanimous vote. It was • understood that the Chairman would sign the letter. r ! i HEALTH BOARD MINUTES - April 17, 2003 Page: 2 OLD BUSINESS AND INFORMATIONAL ITEMS • Board of Health Field Trips: As a follow-up to the Board's retreat, Board members were asked to contact Larry Fay or Julia Danskin if they are interested in observing environmental health and public health activities. Jefferson County and Washington State WIC Report: The Board received copies of the 2002 Washington WIC Annual Report, which includes a fact sheet on those served in Jefferson County. Julia Danskin reported that this federally-funded Women, Infant and Children (WIC) program is subsidized 35 % by Jefferson County. In Jefferson County, the Health Department serves over 500 clients each month and provides nutrition education and food vouchers to clients. The Quileute Tribe serves about 20 clients at the Hoh, the Quinault Indian Nation serves about 50 clients in Queets. She also reviewed figures comparing Jefferson County to Grays Harbor and Clallam Counties. In response to a question about lactose intolerance issues, Ms. Danskin reported that WIC would also pay for Lactaid or lactose-reduced milk. State Board of Health Request: Dr. Tom Locke noted that the State Board of Health continues to send individual members to visit local health jurisdictions in an effort to improve the working relationship and to gather issues and priorities for the State Health Report. They have asked to address the Board at a future meeting. • Member Westerman moved to instruct Staff to invite the State Board of Health representatives to address this Board. Member Frissell seconded the motion, which carried by a unanimous vote. NEW BUSINESS West Nile Virus Response—A Comprehensive Public Health Approach: Dr. Locke noted that the Board received a handout entitled "West Nile Virus and the Ten Essential Services," which provides a framework for understanding and communicating public health services on this issue. Larry Fay noted that the County's website shows the general information developed by the State Department of Health which guides Jefferson County's information/education campaign. Staff briefed the County Commissioners two months ago and he and Lisa McKenzie recently did a PTTV program to talk about the West Nile Virus and Severe Acute Respiratory Syndrome (SARS). Tomorrow, they will hold a training on mosquito surveillance and control, the purpose of which is to identify the species in the community and determine what percentage of that population is capable of carrying West Nile. Staff should then be able to advise and assist citizens in determining whether mosquito control is warranted. Neither the State nor the County • has been funded to do mosquito abatement. • HEALTH BOARD MINUTES - April 17, 2003 Page: 3 • In response to a question about landscape ponds, Larry Fay noted that there are relatively safe larvicides that could be used. The Department of Agriculture is modifying the label restrictions on BTI (Bacillan Thuringieniois Israelensis) to allow homeowner use in confined landscape ponds. On the other hand, if a natural depression or wet area has developed into a pond it may be subject to State licensing and permitting requirements. Commissioner Titterness reported having received the new Low Impact Development Stormwater Manual from the Puget Sound Water Quality Action Team. He asked County Commissioner's Staff to ensure that copies were given to each Commissioner, the Building and Community Development Department, and Public Works and recommended other Board members receive copies. Chairman Masci asked if the Board of Health could issue a press release, including part of the Board's discussion and suggesting mosquito control techniques. Member Frissell moved to direct Staff to prepare a press release on this issue to include mosquito controls. Commissioner Huntingford seconded the motion, which carried by a unanimous vote. Julia Danskin reported that the Department would be restarting bird surveillance and that a State press release would ask citizens to notify the local Health Department if they find any dead Corvid birds (crows, ravens, magpie, and jays). Severe Acute Respiratory Syndrome (SARS): Dr. Locke provided background on the spreading of this virus, a determinant of which is a new form of corona virus. He noted that the level of concern about this virus changes from week to week. The majority of people with the worst infections had the corona virus. As of today, there have been approximately 3,400 cases and 165 fatalities or a case fatality rate of about 4%. There are 126 cases in Canada, 10% of which have died. In the U.S., there have been 208 cases —20 in Washington State—but no fatalities. He noted the U.S. has the broadest case designation, which makes you a suspect SARS case if you came from any endemic area. Within the next week, it should be known how many of the 208 cases have the corona virus. Most worrisome are the people who are not being tested. Preparing hospitals and healthcare workers is a major undertaking, with healthcare practitioners who are exposed also becoming a potential case. It is uncertain whether the current system for surveillance and containment will be effective. He said that the widely variable communicability is mysterious— "superspreaders" somehow spread it efficiently and others less so. It appears a co-factor (infection) occurs at the same time and produces this rapidly progressive, aggressive and untreatable pneumonia. This virus is occurring before there has been much build up of additional response capability in terms of bio-terrorism funding. Julia Danskin noted that SARS has increased the Department's workload, with two conference • calls a week and other various communications. Communicable Disease Coordinator Lisa McKenzie is getting bulletins and updates to providers. E-mail provides an opportunity to get information out quickly. A . HEALTH BOARD MINUTES - April 17, 2003 Page: 4 410 Smallpox: Chairman Masci circulated smallpox information he received as a provider. Julia Danskin noted that all licensed medical providers in the State received the same information at their home and were offered additional information. As part of the bio-terrorism plan, the County would look to licensed medical providers to assist in an event, such as a mass immunization clinic. Jean Baldwin mentioned that the Washington Emergency Operations Center(EOC) and Jefferson-Peninsula Regional Planning Committee (JPREP) have the ability to mobilize volunteers, so the County would not need to keep a volunteer list. Chairman Masci asked if the Board has the authority to produce a letter to providers soliciting volunteers. Dr. Locke indicated that he does not believe there would be a barrier to making a request. In the event of a declared emergency, the powers of the Board are very broad. Julia Danskin noted that the State houses the data for doing this. Board Sponsors for Environmental Health Regulation Development: Larry Fay reviewed that at the retreat there was interest in individual members serving as "sponsors" to help set the general direction for specific rulemaking initiatives. Referring to his write-up, he recommended the Board try this in the following areas: 1) Methamphetamine Lab Rules, 2) New State Solid Waste Regulations, and 3) Water Policy or Comprehensive Drinking Water Ordinance. Member Westerman said that even though the Board contributed significantly to the on-site • sewage code, we were unaware of specific legal limits on implementation and enforcement. Commissioner Titterness commented that the County Prosecutor could ask for an Attorney General (AG) opinion on accessibility. Dr. Locke said the State Board of Health is asking the AG about the access to property question. Larry Fay added that he shared this with the Rural Development Committee of the State Department of Health, which is seeking an AG opinion as well. David Sullivan noted that current legislation on catchment systems could impact Jefferson County (SB 1376). The Board agreed to focus on the following topics: 1. Methamphetamine Lab Rules — Chairman Masci and Member Frissell 2. State Solid Waste Regulations—Commissioner Huntingford and Member Westerman 3. Water Policy or Comprehensive Drinking Water Ordinance—Member Buhler and David Sullivan Although Member Buhler clarified that some of these issues could have a direct bearing on her business as a realtor, the Board was not concerned about her involvement in these matters. • HEALTH BOARD MINUTES - April 17, 2003 Page: 5 • ACTIVITY UPDATE/OTHER ANNOUNCEMENTS Chairman Masci welcomed PUD Representative David Sullivan as an Ex-officio member of the Board. Jean Baldwin distributed postcard invitations to the May 13, 2003 Workshop "Translating the Data: Moving from Numbers to People." She urged the Board to assist with the event. Chairman Masci recommended members attend the April 29 Substance Abuse Advisory Board "Clear and Present Danger" Conference. Jean Baldwin distributed the 2002 Public Health Improvement Plan produced by Washington State Association of Local Public Health Officials (WSALPHO), which is a summary report for legislators. Dr. Locke urged the Board read this report. Jean Baldwin reported that the House, Senate, and Governor's budgets are not in agreement on public health funding. The Senate and the Governor placed the public health backfill money (Motor Vehicle Excise Tax) back into their budgets, while the House put it in temporarily, having clear and intended language to remove it. She distributed legislative contact information and reminded that West Nile and SARS are funded out of local or through the Motor Vehicle Excise Tax. • The Washington Health Foundation Community Roundtable will be held on April 25 from 1-3 p.m. at the Port Townsend Community Center. It is an opportunity to give feedback on health care and health care access in the community. Member Buhler reported that the Hospital has talked with The Leader about publishing a series of articles on the health access issue. AGENDA PLANNING/ADJOURN The meeting adjourned at 4:02 p.m. The next meeting will be held on Thursday, May 15 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 Old Business Agenda Item # IV., 1 • Letter to Public Works Board Trust Fund Application Beckett Point Community Onsite Sewage System May 15, 2003 • •It ' .� Jefferson County Health th Human Services 615SHERIDAN • PORTTOWNSEND,WA 98368 • FAX , • April 17, 2003 Public Works Board 210 11`h Avenue Southwest, Suite G-2 Port Office Box 48319 Olympia, Wa 98504-8319 RE: Public Works Trust Fund Application for Becket Point Community Onsite Sewage System Dear Public Works Board Members: The Jefferson County Board of Health strongly supports this application. The installation of a community system more than 200' from the Discovery Bay will reduce the impact to the bay from the Becket Point onsite sewage systems. Discovery Bay is a rich shellfish production area and has maintained high water quality standards under increasing pressure from development and changing uses. The Board of Health is aware of the sensitivity of this area due to its physical proximity to the marine waters and excessively • coarse soil conditions. Both the Jefferson County Discovery Bay Watershed Plan and the Washington State Shoreline Survey of Discovery Bay highlight this area as high risk for degrading water quality. The members of the community have shown a high degree of commitment to this project through community meetings,preparation of feasibility reports and cooperation with the local health jurisdiction in correcting or minimizing impacts from these onsite sewage systems. Their efforts are admirable. We will continue to provide educational opportunities to the community in effectively managing their household practices for the effective long-term operation of this community onsite sewage system. We appreciate your careful consideration of the proposal and strongly urge your support of this project to remove at least 79 individual wastewater discharges that are in such close proximity to Discovery Bay. Since•- Geoff Masci C Jefferson C my Board of Health Dr. Thomas Loc e Jefferson County Health Officer All 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 • Board of Health New Business Agenda Item # V., 1 Communicable Disease • Update May 15, 2003 • (Asll-io) ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICIALS IMMEDIATE RELEASE MAY 1, 2003 CONTACT: Paula A. Steib, 202-371-9090 psteib@astho.orq THE ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICIALS (ASTHO)ASKS FOR MORE CLARITY ON NATIONAL SMALLPDX VACCINATION PROGRAM (Washington, D.C.)—May 1, 2003 —States must be prepared to address all public health threats and emergencies,including smallpox, according to ASTHO President Mary C. Selecky, Secretary of the Washington State Department of Health. Speaking today to the Institute of Medicine's(IOM)Committee reviewing the nation's smallpox vaccination program, Selecky stressed that to assure continued progress in this area of preparedness, federal, state, and local health officials must have: • A national consensus on who should be asked to consider voluntary vaccination at this time, and why. • A clear articulation of the best currently available intelligence information regarding the potential • risk of smallpox to the nation. • A clear statement of all currently known benefits and risks of smallpox vaccination. • A clear statement outlining all liability and compensation protections that now exist under federal legislation. • Sufficient resources for public health preparedness against all possible threats and emergencies, including smallpox. "Smallpox preparedness isn't just about numbers of people vaccinated, "said Selecky. "There are other very important elements. Planning,training, exercising, and revising the plan, are all key to smallpox preparedness." Selecky told the committee that the experiences of the national smallpox vaccination program to date must be critically reviewed as expansion efforts are being considered. She outlined four questions that minimally must be addressed: • Who agreed to be vaccinated and why? • Who declined and why? • What was the adverse event experience? • What are the risks and benefits of vaccination in light of the current level of threat? In an April survey conducted by ASTHO,jurisdictions were asked about the current status of their vaccination program, their ability to vaccinate their entire population within 10 days should there be a confirmed smallpox case, and influences on their ability to vaccinate those targeted for pre-event vaccination. Thirty-four jurisdictions (33 states and New York City)responded. • When asked if they could effectively vaccinate the entire population within 10 days,half answered"yes." • The survey indicated that the ability to vaccinate a jurisdiction's entire population is not perceived to be related to the number of individuals vaccinated pre-event. Several jurisdictions with fewer than 500 vaccinated individuals responded"yes,"while several with over 1,000 vaccinated either responded"no"or did not reply. States indicated that impediments to implementing the vaccine program have included liability and compensation issues,the unanticipated cardiac adverse events associated with vaccination,the perception of a reduced threat level, and other issues such as severe acute respiratory syndrome(SARS). Selecky told the Committee today, "Building preparedness for all potential hazards is very important. Smallpox vaccination is just one element of public health preparedness." According to the Centers for Disease Control and Prevention, approximately 33,500 public health and healthcare workers have been vaccinated as part of the national program. By mid-April 2003, four of the 62 jurisdictions receiving preparedness grants had each vaccinated more than 1,500 individuals. Fewer than 1,000 individuals were vaccinated in each of 52 jurisdictions and 20 jurisdictions have vaccinated fewer than 100. The Association of State and Territorial Health Officials is the national nonprofit organization representing the state and territorial public health agencies of the United States,the U.S. Territories, and the District of Columbia. ASTHO's members, the chief health officials of these jurisdictions, are dedicated to formulating and influencing sound public health policy, and to assuring excellence in state-based public health practice. ### s • Position Statement on Smallpox Vaccination Washington Public Health Officers Society March 24, 2003 • The guiding principle in planning for a possible smallpox attack is to balance the benefits of preparedness with the risks associated with the vaccine. Smallpox vaccine is effective at preventing smallpox, both before and within a few days following exposure. It also has the highest rate of serious side effects including death of any immunization currently in use. In addition to risk to vaccinees, inadvertent spread can occur to household members and close contacts. Data concerning the risk of contact vaccinia is from the late 1960's and considerable uncertainty exists as to the applicability of this research to populations in which HIV/AIDS, organ transplantation, cancer chemotherapy, and immune suppression are prevalent. Planning smallpox response addresses pre-event (preparations prior to any reported suspected or confirmed case of smallpox) and post-event(after a smallpox attack has occurred). Pre-event vaccination plans have been divided into three stages. Stage 1 consists of identifying volunteers for smallpox emergency response teams who will provide emergency assessment and care to initial suspected and confirmed smallpox cases. Stage 2 consists of vaccinating healthcare workers and emergency response personnel, such as law enforcement, fire and emergency medical personnel. Stage 3 consists of vaccinating the general public. Only Stage 1 has been recommended by ACIP and is being implemented. This minimizes the number of vaccinated personnel at risk for side effects while developing the capacity to rapidly provide care, investigate cases and provide focused(ring) vaccination and more widespread vaccination in • response to an outbreak. The state and local health officers of Washington agree that planning and coordinating a robust post-event response to a smallpox outbreak is the key to effective emergency preparedness and that vaccinating smallpox emergency response team members is an important part of that preparation. We do not, however, see a compelling medical justification for expanding vaccination beyond Stage 1 as a pre-event preparation strategy. Rather than expand to Stage 2 pre-event vaccination, we believe that efforts should focus on planning for rapid post-event deployment of vaccine in response to an outbreak. Based on our steadily accumulating knowledge about this vaccine, a focus of limited resources on planning and training for post- event mass vaccination offers a far greater benefit to the public and minimizes the significant risks associated with the very large scale vaccination envisioned in Stage 2 of the National Smallpox Vaccination Plan. As health officers for Washington State,we have supported and implemented a very cautious and limited Stage 1 vaccination program. While Stage 1 vaccination efforts should be ongoing (as new health care workers join existing smallpox emergency response teams), we believe that medical justification for Stage 2 vaccination is lacking and accordingly do not support such efforts. Time and resources to prepare for the formidable challenge of a bioterrorist attack are limited. Within these limited resources priorities must be made. It is our professional judgment that post-event smallpox vaccination preparedness and all hazards emergency response system development are much higher priorities than Stage 2 smallpox vaccination. We urge federal • officials to reexamine their priorities with respect to pre-event smallpox vaccination and remove Stages 2 and 3 from the national response plan. Report Faults Federal Officials for Problems in Smallpox Program April 30, 2003 By ROBERT PEAR WASHINGTON, April 29 - Congressional investigators said today that federal health officials were responsible for many of the problems that have crippled the nation's smallpox immunization program. President Bush and other administration officials had said they hoped that 500,000 health care workers would be vaccinated against smallpox within a month after the program began on Jan. 24. The actual number, 33,444 as of April 18, is only 7 percent of the goal. 110 The investigators, from the General Accounting Office, said the administration was considering a huge reduction in the number of people to be vaccinated, in the belief that a smaller number, perhaps as few as 50,000, might be enough to respond to a smallpox attack. The accounting office examined difficulties in carrying out the vaccination program at the request of Senator Susan Collins, Republican of Maine, who is chairwoman of the Committee on Governmental Affairs. In a report to Congress, the investigators said they found that the federal Centers for Disease Control and Prevention was reconsidering the goal of vaccinating 500,000 health care workers. • The Bush administration told the investigators that "there is no longer a deadline for the first stage, and that as • few as 50,000 vaccinated health workers nationwide would provide sufficient capacity to respond to a smallpox attack," the report said. But, the report said, the Centers for Disease Control has not set a new nationwide goal, has not said how it arrived at the lower figure and has not asked states to revise their plans for immunizing health care workers. The accounting office said the federal government should work with state and local health officials to revise their goals and to assess their capacity for responding to a smallpox outbreak. Dr. Julie L. Gerberding, director of the Centers for Disease Control, agreed. Up to 10 million civilian health care and emergency workers are supposed to be vaccinated in a second phase of the • smallpox program, which begins next month in some states. In the past month, the number of people receiving the vaccine averaged 2,000 a week. Federal officials said they hoped the number would rise because Congress recently authorized compensation for people injured by the vaccine. William A. Pierce, a spokesman for the Department of Health and Human Services, said the program was well run. But the accounting office said federal health officials shared responsibility for the problems, for these reasons: • The government underestimated the cost of administering the vaccine. It initially put the cost at $13 a person. State and local officials found that the actual cost is $75 to $265 a person. • • The administration rushed into the program and tried to expand it too rapidly. It distributed contradictory information about who should get the vaccine and who should not. Education and training materials were confusing. • The government refused to distribute needles that were potentially safer than those used to give the vaccine. Nurses and other health care workers were therefore apprehensive about the risk of needle-stick injuries that would expose them to live virus in the vaccine. "Progress has been slow," the report said. "Hundreds of hospitals have opted not to participate in the smallpox vaccination program at this time, contending that the risks outweigh the benefits." When Mr. Bush announced the vaccination campaign on Dec. • 13, he said, "There's no evidence that smallpox imminently threatens this country." Figures compiled by the federal government show that about half of all the people vaccinated to date are in eight states: California, Florida, Minnesota, Missouri, Nebraska, Ohio, Tennessee and Texas. The Institute of Medicine, an arm of the National Academy of Sciences, said last month that the government should re-evaluate the costs, risks and goals of the vaccination program, to determine if some states had already inoculated enough health care workers to cope with a bioterror attack. • Copyright 2003 The New York Times Company 8 G University of Washington School or Public l3eal#h UNIVERSITY • i ?' and-Community Medicine OF WASHINGTON SCHOOL OF MEDICINE The Department of Medical History&Ethics and The School of Public Health are pleased to present: ` 2003 Charles W. Bodemer Symposium AGENDA May 15, 2003 5:30-7:30pm 'Hogness Auditorium "Smallpox Vaccination: Responsible Public Health in Troubled Times" Welcome by Patricia W. Wahl,Ph.D. Dean&Professor of Biostatistics School of Public Health&Community Medicine Introduction of Speakers by James Gale,M.D.,M.S.,Professor of Epidemiology Preliminary Comments by: John Neff,M.D. • Jeffrey S.Duchin,M.D. Keynote Presentation by William H.Foege,M.D.,M.P.H. Fellow,Bill&Melinda Gates Foundation Former Director,Centers for Disease Control&Prevention Panel Discussion Brief introduction of ethical issues and the introduction of the panel by Dr.Wylie Burke, followed by a question and answer period involving audience members E.Russell Alexander,M.D. Patricia C.Kuszler,M.D.,J.D. Professor Emeritus of Epidemiology Associate Dean&Professor UW School of Public Health UW School of Law Wylie Burke,M.D.,Ph.D. Edgar K.Marcuse,M.D.,M.P.H. Professor&Chair Professor,UW Department of Pediatrics UW Department of Medical History&Ethics Associate Medical Director, Children's Hospital&Regional Medical Center Jeffrey S.Duchin,M.D. Chief,Communicable Disease Control John Neff,M.D. Epidemiology&Immunization Section Director,Center for Children with Special Needs Public Health—Seattle&King County Children's Hospital&Regional Medical Center Assistant Professor,UW Department of Medicine Professor,UW Department of Pediatrics Maxine Hayes,M.D.,M.P.H. Terri Simpson,R.N.,Ph.D. ficer Associate Professor Washington State Department of Health UW Department of Biobehavioral Nursing&Health Systems /1 Washington State Department of • ealth News Release For Immediate Release: May 7, 2003 (03-082) Contacts: Donn Moyer, Communications Office 360-236-4076 Tim Church, Communications Office 360-236-4077 State West Nile virus program resumes mosquito and dead bird surveillance OLYMPIA—State and local health departments have begun identifying mosquitoes and tracking dead birds in Washington state, looking for evidence of West Nile virus (WNV). The warmer weather of spring and summer brings on the mosquito-breeding season and with it, the threat of mosquito-borne disease, including WNV. The disease has been moving west since 1999 and was confirmed in two dead birds and in two horses in Washington last year. "There have been no human cases of West Nile virus illness acquired in Washington so far, but we know people are concerned about the disease," said Maryanne Guichard, director of the Department of Health's Office of Environmental Health and Safety. "Dead bird surveillance is a • key to tracking the West Nile virus, because finding the disease in dead birds has usually been shown to precede the first human case in a state." Local health departments around the state coordinate the dead bird surveillance efforts in their areas, working closely with the Washington State Department of Health. Anyone who finds a dead bird is asked to report it to the local health department. West Nile virus is primarily a bird disease, and mosquitoes become infected by feeding on infected birds. Mosquitoes then pass the virus to uninfected birds, humans, horses or other hosts. Crows, ravens and jays are especially susceptible to dying from the disease, making them good test samples for WNV. In addition to dead bird surveillance, the Department of Health WNV program is also working to identify mosquito species around the state. At least one mosquito species known to become infected with WNV has been found in every county in the state. "The risk of West Nile illness is low," Guichard added, "and there are steps we can all take to reduce that risk. The best defense against WNV is avoiding mosquito bites and making sure that • there are no places for mosquitoes to breed around the home." --More-- West Nile virus surveillance May 7, 2003 Page 2 Turning over old buckets or cans, emptying water from old tires, and frequently changing water • in birdbaths and water troughs helps to eliminate the small puddles of water in which many mosquito species breed. People can avoid being bitten by staying indoors when mosquitoes are most active around dawn and dusk; making sure that door and window screens are in good working condition; and using a mosquito repellent containing DEET. Safe use of mosquito repellents includes following the instructions on the label. Even after being bitten by an infected mosquito, most people won't show any signs of illness. Some may develop mild flu-like symptoms that resolve without treatment. In a small number of cases, particularly in people over age 55, West Nile virus can cause serious illness with fever and inflammation of the brain. More information is available on the Department of Health West Nile virus Web site (www.doh.wa.gov/WNV), or by calling the agency's toll-free info line, 1-866-78VIRUS. The Department of Health West Nile virus surveillance program is working with local health • departments and other state agencies, including the Departments of Agriculture, Ecology, and Fish and Wildlife on WNV surveillance, planning and prevention. ### Visit the Washington Department of Health Web site at http://www.doh.wa.gov for a healthy dose of information. ok Jefferson County Health and Human Services •� � �615 Sheridan Street Port Townsend,WA 98368 4' Tel 360-385-9400, Fax 360-385-9401 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 Disease Control and Prevention, including 277 fatalities. In Washington state, West Nile virus has been detected in four counties. A raven from Pend 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.qov/ehp/ts/Zoo/WNV/WNV.html http://www.ecy.wa.gov/programs/wq/pesticides/ final pesticide permits/mosquito/mosquito index.html http://whatcom.wsu.edu/commun/wnvhomeowners.htm http://www.cdc.qov/ncidod/dvbid/westnile/index.htm • http://pep.wsu.edu r • , Washington State Department of Health May 7, 2003 Volume 1: Issue 3 t te •a � ._.. . This is an electronic publication designed to keep you informed on issues of interest related to West Nile virus(WNV)in Washington,and provide current information to assist you in developing a response plan to WNV in your jurisdiction. Threat Level The initiation of WNV surveillance activities and the beginning of the active mosquito season puts us into Risk Category la(see Response Plan). As of May 1,twenty-five birds from fifteen counties have been tested for WNV. All have been negative. American Crows were in the majority along with one raven, one magpie, and one mourning dove. • Fifteen horses from eight counties have been tested for WNV as of May 1. All were negative. There have not been any submissions from suspect human cases. We are starting to receive mosquito samples for identification and will begin reporting results later this month. In this issue... Outdoor worker tips 2 Horse vaccine 3 Surveillance News How to subscribe 5 West Nile virus surveillance staff recently met with the Washington State Department of Transportation(DOT)to assist them in developing a surveillance protocol for their storm water facilities. The plan will include participation in the dead bird surveillance network as well as larval sampling. They have also applied for coverage under the DOH NPDES permit. Further information on the DOT WNV surveillance plan can be obtained from Norm Payton at(360)705-7848 or e-mail,paytonnawsdot.wa.gov. An article in the National Post, Canada, dated April 28,2003,discusses the discovery of the first WNV positive crow in Canada this year, showing that the virus survived the Canadian winter. The crow was from Newmarket,north of Toronto. The positive crow comes a month earlier than the first avian case last year. "It's a bigger risk if the virus can over winter and stay within the province,"said Dr. Harvey Artsob, chief of the health department's viral zoonotics and special pathogens division. "It is good evidence that the virus is seeded in hibernating mosquito populations all across Ontario,"Dr.Artsob said. • .. _ Outdoor Worker Protection Tips • Planning, good work-site maintenance, and simple protective measures can help reduce the risk of WNV infection for workers who are employed in outdoor jobs. The National Institute for Occupational Safety and Health(NIOSH)has developed recommendations for protecting workers that are available on the Web, along with further information on risk factors and resources, at http://www.cdc.gov/niosh/topics/westnile/. Blood Banks in Race Against Mosquitoes The March 21, 2003, issue of Science magazine contains an article on protection of the North American blood supply from WNV. The article discusses test development as well as appropriate use of a blood test for WNV infections. The reference is: Science, Volume 299 (5614): 1824. Horse WNV Case Surveillance John Grendon,D.V.M. and Kathy Connell,D.V.M., Washington State Veterinary Medical Association Newsletter,April 2003. While there is no evidence of WNV transmission from horses to humans, or that horses serve as a WNV reservoir for mosquito transmission to humans,the initial detection of WNV in some • counties in the United States has been through confirmed horse cases. Test results for 50 Washington horses were received in 2002. Two Washington horses were confirmed as WNV positives. Because horses are dead-end hosts,no quarantines were issued for these horses. All have fully recovered. A WNV positive horse was imported into Snohomish County from North Dakota in late August. The one-year-old gelding never showed any clinical signs of WNV. It was examined and treated for a respiratory infection on September 3. The attending veterinarian tested for WNV because the horse had recently arrived from North Dakota where many horses contracted WNV last year. The horse had not been vaccinated against WNV. Since this horse contracted the virus in another state, it is not being counted as a Washington case. The first native Washington case was a 14-year-old gelding in Island County. The horse became ill in mid-October, although it had received the equine WNV vaccine September 4 and October 2. He manifested fever, anorexia, reluctance to move, ataxia and hyperesthesia on the face. The horse was found WNV positive on November 13. The second case was an 18-year-old mare in Whatcom County. The mare received its second WNV vaccination on November 7. She was seen by a veterinarian for ataxia and muscle twitching later in November. This horse was confirmed WNV positive on December 3. • The Departments of Health(DOH) and Agriculture (WSDA), and the United States Depaitinent of Agriculture (USDA) are requesting that veterinarians report equine encephalitis cases of • unknown etiology for possible mosquito-borne disease testing. To report possible WNV in equines,veterinarians should contact: - The local Animal Health Area Veterinarian, - The State Veterinarian's Office, 360-902-1878, and/or - The local USDA Office, 360-753-9430. In support of local WNV diagnostic efforts,the Washington Animal Disease Diagnostic Laboratory(WADDL)has implemented assays for detection of antibodies in equine serum and CSF, and for molecular detection of viral nucleic acids using PCR and antigens using IHC. Practitioners with questions about the diagnosis of suspected equine WNV can contact WADDL at 509-335-9696. Fatal equine cases of suspect WNV will also be tested for rabies at the DOH Public Health Laboratory. Horse WNV Vaccine Information WNV Vaccine Information The most common question from veterinarians is about the equine vaccine. Fort Dodge's vaccine requires two doses, administered IM, 3 to 6 weeks apart. Immunity may not develop for 4 to 6 weeks after the second dose and it can take up to ten weeks for a vaccinated horse to become protected. An annual booster is necessary to continue the protection. Clients should be advised that vaccinated equines might develop an antibody response,which may affect • international export of vaccinated animals. Horses vaccinated against other mosquito-borne diseases (EEE, WEE, VEE) are not protected against WNV. Local health jurisdictions should refer specific questions on the vaccine to their local veterinarians or the State Veterinarian's Office at the number listed above. "From the Nile to the Columbia: A New Virus" That's the title of a recent forum held in Vancouver, Washington to discuss WNV. The event was sponsored by The Forum at the Library and attended by staff from Clark County Health Department,U.S. Fish and Wildlife Service, and Amazia Veterinary Service. Featured was a slide presentation and panel discussion that is available free by providing a VHS tape to government cable access channel CVTV-23. For more information about a free copy of the program, call 360-696-8233 or go to www.cvtv.org. Publications Forthcoming in June • Several WNV publications will be finalized and published in June. All will be available in hard copy and on the Web. They include: the 2002 West NileVirus Surveillance Report,which will provide data summaries and discussion of mosquito, dead bird,horse and human case surveillance; fact sheets on DEET and mosquito control compounds; a Spanish version of the WNV brochure and statement stuffer and, a WNV resource guide that lists key WNV contacts in federal, state and local agencies,tribes, and mosquito control districts. Community Comments "The Washington State Association of Local Public Health Officials would like to take this opportunity to thank you and your staff for the work that you have done in obtaining a statewide blanket NPDES Permit. Not only does your effort facilitate local government response to West Nile Virus,it enables local government to save money in the process. WSALPHO believes that this represents excellence in government and is an example of a collaborative relationship between state and local government,"Jean Baldwin, Chair,Washington State Association of Local Public Health Officials. Let us hear your comments on this newsletter,your needs, or things you would like to see,by sending them to Maryanne Guichard, (360)236-3391 or maryanne.guichard(a doh.wa.gov. • WNV Web Resources Washington State Department of Health www.doh.wa.gov/wnv Center for Disease Control http://www.cdc.gov/ncidod/dvbid/westnile/ Washington State University Cooperative Extension http://wnv.wsu.edu/ Cornell University, Center for Environment http://www.cfe.cornell.edu/erap/WNV • • DOH Contact List for West Nile Virus General Public Toll-Free Hotline 1-866VIRUS Publications: Brochures/Response Plan/Fact Sheets Laura Harper, (360)236-3380, or laura.harper(cD,doh.wa.gov. Surveillance: Mosquito Jo Marie Brauner, (360) 236-3064,or iomarie.brauner(a�doh.wa.gov. Surveillance: Dead bird surveillance and general WNV response Tom Gibbs, (360) 236-3060, or tom.gibbs(adoh.wa.gov. Surveillance: Horses, case reporting,laboratory assistance Dr. John Grendon, (360)236-3362, or john.grendon(a,doh.wa.gov. NPDES: Training, technical assistance John Daly, (360) 236-3305, or john.dalygdoh.wa.gov. Ben Hamilton, (360) 236-3364,or ben.hamilton(ci,doh.wa.gov. Clinical: Human case reporting, diagnosis,laboratory confirmation Dr. Jo Hofmann, (206)361-2831, (877) 539-4344, or io.hofmann(a,doh.wa.gov. • Assistance with news releases and media response Donn Moyer, (360)236-4076, or donn.moyer(a)doh.wa.gov. Tim Church, (360)236-4077, or tim.church(a�doh.wa.gov. WNV Program Management Maryanne Guichard, (360) 236-3391,or maryanne.guichard a,doh.wa.gov. WNV Coordinator Jack Lilja, (360) 236-3366, or jack.lilja(&,,doh.wa.gov. To subscribe to this newsletter Jill Christensen at(360)236-3000 or jill.christensen(a,doh.wa.gov. 1 � ,: tlth ` a•• °� • , .j f�'.' e erson ea 1 County Health 'Human Services T jir, 1Nt CASTLE HILL CENTER • 615SHERIDAN • PORT TOWNSEND,WA 98368 Health Care Provider Bulletin Severe Acute Respiratory Syndrome (SARS) April 16, 2003 Thomas Locke,MD,MPH Case Definition: The case definition for a suspected SARS case is sensitive but non-specific. Travelers returning from areas with documented community transmission of SARS (Mainland China,Hong Kong, Hanoi, Vietnam and Singapore) or close contact with a suspect SARS case are considered to be a suspect case if, within 10 days of exposure,they develop a measured temperature greater than 100.4°F and have clinical findings of a respiratory illness (e.g. cough). Epidemiology: Since its apparent onset in November of 2002, there have been over 3000 cases meeting the SARS case definition reported internationally. 193 are in the U.S. and 19 are in Washington State (third highest umber in the U.S. behind California and New York). The majority of U.S. suspect SARS cases have been limber travelers. 15 have been household contacts and 5 are health care workers who were occupationally exposed. Puzzling transmission patterns have been observed, including that of the "super-spreader", highly contagious cases that transmit infection to large numbers of close contacts. Evidence to date suggests no transmission prior to onset of fever. Internationally, case-fatality rates have been holding at about 4%. In the U.S. there have been no deaths attributed to SARS. Pathophysiology: Strong evidence implicates a new strain of coronavirus as the etiologic agent of the outbreak of acute respiratory distress syndrome being seen primarily in China and SE Asia. This RNA virus has been sequenced and is distinct from previously recognized animal or human coronaviruses. A PCR test has been developed by the CDC as well as specific antibody assays and culture techniques. Age and immune suppression appear to be risk factors for more severe clinical disease although young,healthy individuals have also died of this infection. Diagnosis: Individuals meeting the suspect case definition for SARS should be carefully evaluated for alternative diagnoses. A proven alternative diagnosis for the respiratory symptoms in a suspect SARS case (e.g. influenza or pneumococcal pneumonia) excludes SARS. Florescent antibody tests of nasopharyngeal specimens (wash, swab, or tissue) are commercially available for Influenza A and B, RSV, Adenovirus, and Parainfluenza. Viral and bacterial cultures can also be useful in establishing an alternative diagnosis. The University of Washington provides this testing on samples that arrive before 10 AM Monday-Friday. From the Olympic Peninsula,Federal Express "First Overnight"or lab courier are the best methods for transport of iced specimens. • Patients who meet the case definition for SARS and have no alternative explanation for their fevers and respiratory symptoms should be reported to the local health department and placed in isolation. Case 'vestigations, sample collection, and isolation guidelines will be provided by public health specialists. 11 diagnostic testing for coronavirus is being done by the CDC in Atlanta. The capability to do coronavirus- specific PCR testing at the Public Health Lab in Seattle may come within 2 weeks. RECOMMENDED RESPONSES: Infection Control Practices: Suspect SARS cases should be treated with strict isolation precautions (contact and respiratory) appropriate to inpatient or outpatient settings. Specific guidelines for health care practitioners and facilities are attached. Suspect cases should wear surgical masks when being transported and, when hospitalized, should be housed in negative pressure rooms. Health care workers who become exposed to SARS cases without respiratory protection are regarded as suspect cases if they develop fever and cough within 10 days (and lack proof of an alternate diagnosis). Outpatient Triage: A particular problem posed by SARS-related isolation protocols is the need to know about potential SARS exposure prior to a patient presenting to an ER or outpatient clinic. Recent travel history to China or SE Asia(or close contact with a symptomatic traveler) is the critical question to ask, ideally by front office staff while making an appointment or by ER intake staff. ER patients with a positive travel history should be masked and placed in respiratory isolation. Clinic patients who have a positive travel history and request evaluation should either 1)be managed at home (if appropriate) or 2) enter the clinic with a surgical mask and be seen in a private room with health care workers wearing gloves and N-95 masks. Management: Most people meeting the SARS case definition in the U.S. have mild, self-limited disease. Home-based isolation for 10 days after resolution of fever is strongly recommended. This includes exclusion om work, school, and all recreational activities. Samples for coronavirus infection testing will be collected d sent to the CDC. A positive coronavirus PCR or culture confirms infection. A negative test does not, owever, exclude coronavirus infection. Serological tests are less useful—acute and convalescent(>21 days) sera are needed for confirmation of recent coronavirus infection. A subset of suspect SARS cases will develop progressive respiratory distress with x-ray evidence of infiltrates and/or ARDS and require hospitalization. Ribaviran and other antiviral medications do not appear to be beneficial. Parenteral steroids appear to be beneficial for some severe SARS cases but have proven ineffective in others. Expert consultation is available from the CDC and other infectious disease experts for acute management of severe SARS cases. Short-term Outlook: High levels of uncertainty characterize the current outbreak of SARS activity. Specific testing for the presumed etiologic agent will shed additional light on the transmissibility of the novel strain of coronavirus that has been isolated. Outbreaks in China and Singapore are not under control and new cases of community transmitted infection continue to occur. A growing number of recent travelers are being placed under strict isolation for what may turn out to be non-SARS conditions. Health care workers can have the misfortune of being classified as an exposed case and be excluded from work for 3 or more days. Far worse, health care workers can become exposed to a new strain of coronavirus which is capable of producing severe, progressive respiratory failure and for which no known cure exists. Reporting: Reporting of suspect SARS cases should be made directly to Dr. Tom Locke, the Clallam and Jefferson County Health Officer at (360) 582-8353 (pager). Odditional Information: SARS case definitions, isolation guidelines, and exposure criteria are being continuously revised. The CDC SARS website http://www.cdc.gov/ncidod/sars/is the best source for up-to-date guidelines. D. 0 SEVERE ACUTE RESPIRATORY SYNDROME yAl GUIDELINES AND RECOMMENDATIONS Interim Domestic Guidance on Persons Who May Have Been Exposed to Patients with Suspected Severe Acute Respiratory Syndrome (SARS) Most documented transmission of SARS has occurred in either health-care workers or household contacts of patients with SARS; guidance for the management of health-care exposures (see www.cdc.gov/ncidod/says/exposureguidance.htm) and household exposures (see www.cdc.gov/ncidod/sars/ic-closecontacts.htm) have previously been made available. In addition, other persons may be exposed to SARS such as international travelers from areas with community transmission or persons identified as a result of a public health investigation. The following guidance on management is recommended for persons other than health-care workers or household contacts that may have been exposed to SARS. These recommendations are based on the experience in the United States to date and may be revised as more information becomes available. 1. Persons who may have been exposed to SARS should be vigilant for fever or respiratory symptoms over the 10 days following exposure; those who develop fever or respiratory symptoms should limit interactions outside the home and should not go to work, school, out-of- home child care, church, or other public areas. Symptomatic persons should use infection • control precautions to minimize the potential for transmission and should seek healthcare evaluation. In advance of the evaluation healthcare providers should be informed that the individual may have been exposed to SARS. 2. If symptoms do not progress to meet the suspect SARS case definition within 72 hours after first symptom onset, the person may be allowed to return to work, school, out-of-home child care, church or other public areas, and infection control precautions can be discontinued (see figure). 3. For persons who meet or progress to meet the case definition (see www.cdc.gov/ncidod/sars/casedefinition.htm) for suspected SARS (e.g., develop fever and respiratory symptoms), infection control precautions should be continued until 10 days after the resolution of fever, provided respiratory symptoms are absent or improving. Suspected SARS should be reported to local health authorities and healthcare providers immediately. 4. In the absence of both fever and respiratory symptoms, persons who may have been exposed to SARS patients need not limit their activities outside the home and should not be excluded from work, school, out-of-home child care, church or other public areas. 5. In a setting (e.g. work, school, out-of-home child care, church) which has a symptomatic exposed person in attendance during the 10 days following exposure, other participants (and guardians as appropriate) should be educated concerning the symptoms of SARS, and active surveillance of exposed persons (e.g., daily screening) for illness should be conducted by the local health department. II April 13, 2003 Paiii e 1 of 3 rrrrirr� .. DEPARTMENT OP HEALTH AND.HUMAN SERV1 ES CENTERS FOR DISEASE CONTR0L AND PREVENTION SAFER•HEALTHIER•PEOPLE' Interim Domestic Guidance on Persons Who May Have Been Exposed to Patients with Suspected Severe Acute Respiratory Syndrome (SARS) (continued from previous page) • Management of Persons Who May Have Been Person who may Exposed to SARS1 have been exposed Develops fever Develops fever and respiratory or respiratory Does not develop symptoms within 10 symptoms within 10 fever or respiratory days (i.e. meets casedays (i.e. does not symptoms within 10 definition) meet case definition) days • Use isolation precautions2 for 72 . hours Progresses to Does not progress meet the case to meet the definition case definition V Use isolation precautions2 Discontinue Isolation until 10 days after isolation 3 precautions not resolution of fever if precautions recommended3 cough improving 1 Exposure includes travel from areas with documented or suspected community transmission of SARS (currently mainland China; Hong Kong; Hanoi, Vietnam; and Singapore) or close contact with persons who have SARS; close contact is defined as having cared for, having lived with, or having direct contact with respiratory secretions and/or body fluids of a patient with SARS (e.g., health-care workers or household contacts). 2 Isolation precautions include limiting patient's interaction with others outside the home (e.g., should not go to school, work, out-of-home day care, church, or other public areas), and following infection-control guidelines for the home or residential setting (www.cdc.gov/ncidod/sars/ic-closecontacts.htm) if not admitted to hospital for care. April 13, 2003 Page 2 of 3 DEPARTMENT OP HEALTH AND HUMAN SERVICES CENTERS FOR t :ISE:ASE CONTROL.AND PREVENTION. SAFER•HEALTH,ER•<REOPL.Elm Interim Domestic Guidance on Persons Who May Have Been Exposed to Patients with Suspected Severe Acute Respiratory Syndrome (SARS) (continued from previous page) ("Persons need not limit interactions outside of home (e.g., should not be excluded from school, work, out-of-home day care, church, or other public areas). For more information, visit www.cdc.gov/ncidod/sars or call the CDC public response hotline at (888) 246-2675 (English), (888) 246-2857 (Espanol), or (866) 874-2646 (TTY) • • Aril 13, 2003 Pae 3 of 3 DEPARTMENT or HEALTH AND HUMAN 4Efritmes CENTERS FOR DISEASE CONTROL. AND PREVENTION SAFER•HEALTf1ER.PEcipi-" SEVERE ACUTE RESPIRATORY SYNDROME Updated Interim Domestic Infection Control Guidance in the Health-Care and Community Setting for Patients with Suspected SARS The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have received reports of patients with severe acute respiratory syndrome (SARS). The cause of these illnesses is unknown and is being investigated. Some close contacts, including health-care workers, have developed similar illnesses. In response to these developments, CDC is issuing revised interim guidance concerning infection control precautions in the health-care and community setting. To minimize the potential for transmission, these precautions are recommended, as feasible given available resources, until the causative agent is isolated or the epidemiology of illness transmission is better understood. For all contact with suspect SARS patients, careful hand hygiene is urged, including hand washing with soap and water; if hands are not visibly soiled, alcohol-based handrubs may be used as an alternative to hand washing. Access www.cdc.gov/handhvgiene for more information on hand hygiene. For the inpatient setting: If a suspect SARS patient is admitted to the hospital, infection control personnel should be notified AINmediately. Infection control measures for inpatients (www.cdc.gov/ncidod/hip/isolat/isolat.htm) should clude: • Standard precautions (e.g., hand hygiene); in addition to routine standard precautions, health- care personnel should wear eye protection for all patient contact. • Contact precautions (e.g., use of gown and gloves for contact with the patient or their environment) • Airborne precautions (e.g., an isolation room with negative pressure relative to the surrounding area and use of an N-95 filtering disposable respirator for persons entering the room) If airborne precautions cannot be fully implemented, patients should be placed in a private room, and all persons entering the room should wear N-95 respirators. Where possible, a qualitative fit test should be conducted for N-95 respirators; detailed information on fit testing can be accessed at www.osha.gov/SLTC/etools/respiratory/oshafiles/fittestingl.html. If N-95 respirators are not available for health-care personnel, then surgical masks should be worn. Regardless of the availability of facilities for airborne precautions, standard and contact precautions should be implemented for all suspected SARS patients. For the outpatient setting: If possible, suspect SARS patients, on arrival to the outpatient or ambulatory setting, e.g., clinic or Emergency Department (ED), should be evaluated in a separate assessment area to determine if they meet the case definition for suspected SARS and require isolation. A surgical mask should be placed on the patient if possible. All health-care personnel should wear N-95 respirators while taking care of patients with suspected SARS. .ecautions should be used when evaluating or transporting patients (e.g., emergency medical March 18, 2003 Pa e� 1 o�fe2 DEPARTMENT OF HEALTH AND. HUMAN SERvilaEs CENTERS FOR DISEASE CONTROL AND PREVENTION SAFER•HEALTHIER•PEOPLE" Updated Interim Domestic Infection Control Guidance in the Health Care and Community Setting for Patients with Suspected SARS (continued from previous page) •echnicians), or in any ambulatory health-care setting (e.g., ED or clinic personnel). If N-95 respirators are not available, surgical masks should be worn by personnel. For more information, see www.cdc.gov/ncidod/sars/triage interim guidance.htm. For home or residential setting: Placing a surgical mask on suspect SARS patients during contact with others at home is recommended. If the patient is unable to wear a surgical mask, it may be prudent for household members to wear surgical masks when in close contact with the patient. Household members in contact with the patient should be reminded of the need for careful hand hygiene including hand washing with soap and water; if hands are not visibly soiled, alcohol-based handrubs may be used as an alternative to hand washing. For more information, see www.cdc.gov/ncidod/sars/ic-closecontacts.htm. Case Definition for suspected Severe Acute Respiratory Syndrome (SARS) Health-care personnel should apply appropriate infection control precautions for any contact with patients with suspected SARS. The case definition for suspected SARS is subject to change, particularly concerning travel history as transmission is reported in other geographic areas; the most current definition can be accessed at www.cdc.gov/ncidod/says/casedefinition.htm. • For more information, visit www.cdc.gov/ncidod/sars or call the CDC public response hotline • at (888) 246-2675 (English), (888) 246-2857 (Espanol), or (866) 874-2646 (TTY) March 18, 2003 Pa eg DEPARTMENT OF HEALTH AND HUNAN $ERVJOES CENTERS FOR DISEASE CONTROL ANa PREVENTION. SAFER•HBALTIC!.ER•PEo'PL.E"' • Board of Health New Business Agenda Item # V., 2 • Public Health Funding - Action Alert May 15, 2003 Z 1 JEFFERSON COUNTY BOARD OF HEALTH I V-. Glen Huntingford,Jefferson County Commissioner •► ; Dan Titterness,Jefferson County Commissioner f Wendi Wrinkle,Jefferson County Commissioner Jill Buhler,Jefferson General Hospital Commissioner Roberta Frissell, Citizen at Large Geoffrey Masci, Chair Jefferson County Board of Health Sheila Westerman,Vice Chair,Jefferson County Board of Health May 15, 2003 The Honorable Address Address Dear Representative The Jefferson County Board of Health is responsible for"supervision over all matters pertaining to the preservation of the life and health of the people within its jurisdiction" (RCW 70.05.060). With each passing year this task becomes more difficult as we respond to new challenges while maintaining core public health services. Bioterrorism preparedness, West Nile Virus surveillance, and, most recently, SARS response are consuming enormous resources at the local public health level. Alarmingly,the • resources necessary to meet these public health threats have been shrinking for the past decade, dropping almost 10% in this last year alone. We are well aware of the budget crisis that the Washington State Legislature must deal with. We applaud the maintenance of core "backfill" funding of local public health services in the Governor's and Senate's budget and are deeply concerned about its exclusion from the second year of the House budget. This appropriation represents fully 30% of funding for core local public health services, the frontline defense against communicable diseases and environmental health threats, and a crucial provider of preventive services like vaccination,maternal support services, and family planning. We believe provision of basic public health services is a fundamental duty of government at all levels. Washington state's public health system has been sustained by a partnership of local, state, and federal government. We urgently ask you to continue this partnership by maintaining its minimum share of state funding. With this funding, the public health system is under enormous stress. Without this funding,we could be looking at a virtual collapse of essential public health services in many areas of the State. As a Board of Health, we take our responsibility to protect the public's health very seriously. We are asking you, as our elected representative, to do likewise. Sincerely, Geoff Masci, Chair, Jefferson County Board of Health • JEFFERSON COUNTY BOARD OF HEALTH 615 Sheridan Street, Port Townsend,Washington 98368 Board of Health New Business Agenda Item # V., 4 • National Nurses Week Focus on Public Health Nursing May 15, 2003 • • National Nurses Week Celebrated May 6th through May 12th each year, ending on Florence Nightingale's Birthday '... 4; or I e r (4,, .4.,,tt.:`,. le :. k '_ t1 • I. ] t _._'. zip 1. 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C% X (o 3 co l> -+ 0 .. --3 { CL co 2 = 14 a N� co N p c -+ o C co { ' _ o �' o y n i� '< 0 (°°3, oCOOo < 0 0 r3 2 : C - { co ms 3 (° Q s o u, 000 ° = Q 3 a -'• °- a N O �- �. � p C S -+ N Z C = 0 C N y -O+ -1' (c, x- �' fl C a O c 0 s -_+• sco co o ._. 0 GA) c3 o v, _ (A =' '-i� (c0 D A (moo "2. y' 3 „0 cn • lfl -+ 0 -1• -s 1p D c 3 s 3 al:, s —I z A .'1 -Q Qo -. -1' (0 =-- X z .< � = 6• o -1- c p N (o c IlL • �- A Collective Accounting of 19 Public Health Nurses At Jefferson County Health & Human Services - April, 2003 Areas of Nursing Related Expertise and Work Experience Adolescent Health Orthopedics Adolescent Recovery Programs Pediatric Intensive Care Ambulatory Clinics Post Partum Care Child Care Health Consultant Recovery Room Child & Family Therapy Rehabilitation Child Protective Services Immunizations Child Sexual Assault Medical Team Infant Mental Health Childbirth Education Injury Prevention Education Children with Special Health Care Needs Jail Inmate Health Communicable Disease Lactation Consultation Community Health Needs Assessment Lesbian Women's Health Care Crisis Response Maternal Child Health Emergency Medical Technician Medical Case Management Encopresis Mental Health Specialist, Elem. Schools Endocrinology Midwifery Environmental Health Nursing Administration Family Planning Nursing Education for ARNP & ADN Programs of Care Nursing Homes ead Start Nurse Consultant OB Ultrasound Health Care for Homeless Street Youth Prenatal Care Health Care in Homeless Shelter Primary Health Provider - Family Practice Health Care in Refugee Camps Primary Health Provider - Pediatrics Health Clinic Development Pregnant & Parenting Teen Programs Health Education Public Health Health Education in Schools Public Health Administration Hispanic Health Care Psychiatric Care of HIV/AIDS Case Management Children, Adolescents & Adults Home Health Care - Medical Refugee Health Home Health Care - Psychiatric Rural Health Care Homeopathy School Based Health Clinic Hospice Care School Health Consultant Hospitals: STD Prevention, Treatment & Research Emergency Room Substance Abuse High Risk Maternity Care Travelers Health Clinic Intensive Care/Critical Care Tuberculosis Surveillance & Case Management Aikabor & Delivery Utilization Review & Quality Improvement edical Emergency Transport Violence Prevention Medical/Surgical Care Well Child Clinics Newborn Intensive Care Women/Infant/Child Nutrition PUBLIC HEALTH Public Health has been defined as "the science and art of preventing disease, prolonging life andpromoting health through organized efforts of society'; It is concerned primarily with health and disease in populations. Its chief responsibilities are monitoring the health of a population, the identification of its health needs, the fostering of policies which promote health, and the evaluation of health services. Public health grew out of an essential trust between government and its people in pursuit of health for all. The core functions of public health: 1. Monitor health status to identify community heath problems. 2. Diagnose and investigate health problems and health hazards in the community. • 3. Inform, educate and empower people about heath issues. 4. Mobilize community partnerships and action to identify and solve health problems. 5. Develop policies and plans that support individual and community health efforts. 6. Enforce laws and regulations that protect health and ensure safety. 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. 8. Assure a competent public health and personal health care workforce. 9. Evaluate effectiveness, accessibility, and quality of personal and population based health services. 10. Research for new insights and innovative solutions to health problems. Core Functions of Public Health,established by the Institute of Medicine, 1988-as reported in JAMA, 1994 Elizabeth Soule, RN • Public Health Pioneer in the State of Washington Elizabeth Sterling Soule was the daughter of a Boston physician who grew up observing the disabling effects of poverty on health. After graduating from nursing school, she was trained in public 410k health and worked as a visiting nurse. In 1912, when she moved to Seattle as a new bride, Soule was the only nurse in the state with public health field training. Two years later, she organized the ': h . Washington State Public Health Nursing Association to deal more effectively with epidemic outbreaks of typhoid and tuberculosis. Although nurses were critical to public health in the early history of the Northwest, often providing the only source of health care in rural areas, limited formal training was available. Nurses were in short supply. By 1918, public health in Washington was in crisis. A worldwide flu epidemic had taken more American lives than World War I. State organizations asked the University of Washington to offer public health courses for •registered nurses. In 1918, UW initiated a summer public health nursing course, with field work taught by Elizabeth Soule. In 1920, when the State health department was founded, she was asked to be the first State Supervisor of Public Health Nursing. The following year UW asked her to bring her organizational talents to a new Department of Nursing, and under her direction it became one of the first in the country accredited in public health nursing. The UW School of Nursing was only the second school of nursing in the United States to be based in a university, and the first on the West Coast. When Elizabeth Soule retired in 1950, Time magazine called her the "Mother of Nursing" in the Pacific Northwest. The School of Nursing that she founded has been ranked #1 in the nation since 1984, when the first national survey of nursing schools was conducted. Soule was inducted into the National Nursing Hall of Fame and the American Nursing Association Hall of Fame posthumously in 1986. Adapted from the University of Washington School of Nursing, 2003 • PUBLIC HEALTH NURSING PRACTICE Your tax dollars at work! Public health nursing is the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences (American Public Health Association, Public Health Nursing Section 1996). > Focuses on entire populations > Focuses on health promotion and prevention > Reflects community priorities and needs > Establishes caring relationships with communities, organizations, families, and individuals > Is grounded in social justice, compassion, sensitivity to diversity, and respect for the worth of all people, especially • vulnerable populations > Promotes culturally competent care > Encompasses the mental, physical, emotional, social, spiritual, and environmental aspects of health > Promotes health through strategies driven by epidemiological evidence > Fosters participation within an interdisciplinary public health team dedicated to promoting the health status of diverse communities. > The authority for independent practice of public health nurses emanates from the Nurse Practice Act. • Jefferson County Health and Human Services - May, 2003 Community Health Programs Coordinated and Staffed by Public Health Nurses • 1. Best Beginnings —An intensive home visiting program serving first time mothers on Medicaid who are identified as having greater needs. Starting in early to mid pregnancy and until the baby turns two, home visits, parenting support and education based on a relationship model are provided. 2. Bio-terrorism Program— Provides community coordination, education, and planning for response to bio-terrorism. 3. Breast and Cervical Health Program (BCHP) — Free Women's Health Exams with mammogram and Pap test are available for women over 40 with limited incomes that are underinsured. 4. Breastfeeding Consultation —Assessment, education and support are provided to pregnant and breastfeeding women through office, home and hospital visits. 5. Child Birth Education Classes — Comprehensive classes are offered six times per year. The fee is covered for women on Medicaid. 6. Child Death Review Program — Coordinates the Child Death Review community team. Reviews all unexpected child deaths ages 0 through 18 in Jefferson County, according to Washington State law, with the long term goal of child injury prevention. 7. Child Care Health Consultation — Provides health education and resources to licensed child care providers by site visits and phone consultation. 8. Child Injury Prevention — Provides community education on the importance of bicycle helmets, proper car seat use for children and playground equipment safety. Infant car seats, child booster seats and helmets are provided free when available. 9. Child Protective Services Public Health Nursing Contracts — On referral from DCFS for children at risk, provides family needs assessment; child health screening and referrals, and parenting education. 10. Children with Special Health Care Needs — Provides service coordination for children ages birth to 17 with chronic health conditions and their families. 11. Communicable Disease/TB Program — Consultation, investigation and reporting of communicable diseases within Jefferson County; TB screening, diagnosis and treatment. 12. Family Planning Clinic — Provides community and client education, gynecology exams, birth control information and supplies, pregnancy testing and counseling, emergency contraception, STD screening and treatment. 13. Foot Care Program — Provided to seniors at homes, senior centers and other facilities throughout the county. • 14. Foster Care Passport Program — A comprehensive medical history and treatment plan is updated bi-annually and follows a child throughout their placement in foster care to improve their health outcomes. 15. Health Care Access Program — Provides outreach for Medicaid and the Basic Health Plan. Applications, assistance and information are available at the H.D, outreach clinics, schools, medical provider offices, food banks, and community centers. Ill16. HIV/AIDS Counseling, Testing and Case Management— Services include HIV testing and counseling for those at high risk, prevention education, and case management for HIV positive individuals. 17. Immunization Program — Coordinates community medical provider access to State supplied vaccines. Provides routine childhood and adult immunizations and vaccine education, with clinics on Tuesdays and Thursdays from 1:00-4:30. 18. International Travelers Clinic— Immunizations and travel health recommendations provided by appointment. 19. Maternity Support Services (MSS) and Maternity Case Management (MCM) — Through office and home visits, provides maternity support for income qualifying pregnant women their children up to age one. Additional case management is provided for at-risk individuals. Nurses provide monitoring of health status, education, support and referrals for needed services. All women on First Steps qualify. 20. Oral Health Program — New in 2002, provides community coordination of access to dental care. 21. Peer-In Program — School based prevention education program with high school youth. 22. Peninsula Syringe Exchange Program —Anonymous walk-in syringe exchange • clinics at the Health Department on Mondays from 10 to 12 and Thursdays from 3 to 5. Services include exchange of new syringes for used, secondary exchange, education and supplies for safer injecting, healthcare referrals, HIV counseling and testing, hepatitis screening and referral. 23. School Health Consultation Program— Provides public health nurses for school districts on a limited basis. Services include assessment and care planning for children with chronic health conditions; vision, hearing, and scoliosis screening; immunization review; medication administration training; health education and consultation. 24. STD Program — Provides confidential services including: diagnosis and treatment; prevention education; partner notification and medical referrals. 25. Sudden Infant Death (SIDS) Program — Provides community prevention education and follow-up counseling as needed for affected families. 26. Tea Party for Pregnant Women and Breast Feeding Mothers —A drop-in tea on Wednesdays from 1:30 to 3 at the Health Department for pregnant or breastfeeding mothers and their nursing infants. Support, mentoring, and education provided. 27. Vasectomy Referral Program — Coordinates a State grant for income eligible men who must be at least 21 years old, without insurance that covers vasectomy. Initial intake, consultation, and referrals are provided. • 28. Women, Infant, Children (WIC) —A nutrition education and supplemental food program for eligible low income and nutritionally at risk pregnant and breast feeding women, infants, and children under 5. Services provided at the Health Department and satellite clinics in Chimacum, Quilcene and Brinnon. Home visiting has been the cornerstone of Public Health Nursing since the • 1800's. As a public health improvement strategy, home visiting provides information, guidance, and support directly to individuals in their own environment. It reaches families where they live. Programs that include home visits by Public Health Nurses Best Beginnings It Breastfeeding Consultation Child Care Health Consultation cu—t _ Child Protective Service Contracts Children with Special Health Care Needs Program Communicable Disease/TB Program Foot Care HIV/AIDS Case Management Maternity Support Services and Maternity Case Management • Goals of Public Health Nurse home visits: • Promoting wellness and preventing the spread of communicable disease > Preventing child abuse and neglect > Decreasing social problems created by the challenges of poverty > Promoting prenatal care and healthy childbirth > Teaching parents about early childhood development > Enhancing parent-child relationships > Encouraging young children's learning and brain development > Providing support for families of children with chronic illness, disabilities, or developmental delays • Increasing appropriate use of community resources by individuals • and families Jefferson County Health&Human Services—May 2003 • Board of Health Media Report • May 15, 2003 • • Jefferson County Health and Human Services APRIL — MAY 2003 NEWS ARTICLES 1. "SARS fears overblown,health officials assert" Peninsula Daily News, April 14,2003 2. "Marrowstone well-testing,seawater plan collide" Peninsula Daily News, April 15, 2003 3. "Survey set to rate Jefferson services" Peninsula Daily News,April 16, 2003 4. "Port Townsend is no paradise for many disabled residents" P.T. LEADER, April 30, 2003 5. "Jefferson Transit earns EnviroStar award" P.T. LEADER,April 30, 2003 6. "Workshop addresses county drug use" P.T. LEADER,April 30, 2003 • 7. "Alcohol abuse still peril in county,forum told" Peninsula Daily News, May 1, 2003 8. "Got an old HOME computer or television that's gone BAD?" Ad for Recycling P.T. LEADER,April 30, 2003 9. "Seminar to review results of Jefferson health care study" Peninsula Daily News, May 4,2003 10. "Health data forum is May 13" P.T. LEADER,May 7, 2003 11. "AIDS celebration scheduled May 18" P.T. LEADER,May 7, 2003 12. "Who is taking out the electronic trash?" (2 pages) P.T. LEADER, May 7, 2003 13. "Anti-Smallpox Program to be held in county....Five cents each" 1936 14. "Jefferson County Nurse Reports on Year's Activities" 1937 111 15. "State Had Good Health in 1949" January 5, 1950 SARS fe ars ove rb i own • health officials assert BY REBECCA COOK bustling as usual this week, Dr. Larry Jecha, public THE ASSOCIATED PRESS although some merchants said health officer for Benton and they've seen a slight downturn. Franklin counties, said one II I have a cough and a fever. Is it SARS? Pauline Zeestraten, director problem is that the medical of the Seattle Chinatown-Inter- symptoms of SARS—fever over II My co-worker just got back from Hong Kong. Should we national District Business 100.5 degrees, cough and diffi Improvement Area, said she culty breathing—are common. make him wear a mask? • I sat next to some Asian hasn't heard complaints about "We're getting a lot of calls,a SARS keeping people away. lot of concern — a lot more people speaking Chinese yester day — and now I have a cold. "The dinner crowd is slow, than it should be,"Jecha said'. Should I be worried? but people are watching their money — it's more to do with No SARS test These are some of the ques- tions health workers around the that than the virus,"she said. state are fielding from people Hardest hit are travel agen- Because there's no test for concerned about SARS, the res- those that specialize in Asian S`O`S yet, nearly everyone with trips. Business is down about piratory ailment that has killed those symptoms who has also 116 people worldwide and is 80 percent in the past month at traveled to Asia in the past 10 suspected in the illnesses of 21 Asian Pacific Travel, said tick- days, or has been in very close state residents. eting manager Lisa Punio. contact with someone who tray- WashingtonThe answers, in order: "It's not so much the war,it's elect to Asia recently,is labeled a ■Probably not. more the SARS," Punio said. susThe u mb rSof actual SARS ■No. "You try to keep away from , II Definitely not. malls, you think twice about cases in lower than 2 1,2W1is probably Public health officials say going to parties. , health officials say • some people are blowing SARS Public health officers in "We're kind of laughing at way out of proportion. And Washington say there's not the hysteria," said Katie Tup- their fears are leading to some much to worry about. While it's called severe acute unfortunate racial profiling. International wor at tthe "No, you do not have to be respiratory syndrome, Depart- - epart Wing Luke Asian Museum. • concerned about anyone of ment of Health spokesman Tim Her boyfriend lives in Syd- Asian descent," said Dr. Alonzo Church said most of the 21 sus- ney, Australia, where concerns Plough,director of public health Pected cases in Washington over SARS are much sharper in Seattle and King County have actually been quite mild. because of the nearness to Asia, "Asian travel, not ethnicity, Nineteen of the Washington and he told her she should stay is the risk factor. We're answer- cases involve people who tray- home from work. ing a lot of questions like that." eled to Asia; the remaining two "I'm like, 'Oh, whatever,"' are health care workers who Tupper said. "It seems kind of 'Be reasonable' had come into close contact with ridiculous to stop doing what Dr. Diana Yu, public health someone who carried the virus. you do." officer for Thurston and Lewis A misnomer counties, recently spoke to a man with a cold who wondered Yu noted that she's seen if he'd caught SARS from Asian SARS referred to as"the deadly people at a restaurant in flu"in the media.That's a bit of British Columbia. a misnomer, she said. "I said 'No, sounds to me Influenza kills 36,000 people like you have a cold,"' Yu said. a year in the U.S., according to "People need to put this in con- the Centers for Disease Con- text and be reasonable." trol, while SARS has killed no SARS fears have dampened one in this country business in Chinatowns in San Only about 4 percent of peo- Francisco, Boston and New pie who contract SARS will die, York. Seattle's International according to the CDC's latest District, near Safeco Field, was research. • PDQ oasy0 o � ISL---x• b $ ao T� b $ c")m L1. • h o g N N h,,ti aE .O - yy Nom -,,.,,1 � � E 2 a 8 ".ti roOa ghi'., . tcN � ,r0d00oe o „ , , ..-0.. N y ) .gg SBF 33vsi3n E» �v a. o �° obi c��.2 -- ,%, co y 4O �y n °c°3 _ pH '').F.,O > cq . A o.� .�� a 40_ y 0 `' a.,. o..1"o a 4].o §. a>i .'d .1 o f 3p 8-° 3 E $-45 8 a $ •+� o 0• , 4"•d d p 0 $ N 'd(5 0 ci)I!Lr 0c): ,E ;° t cg slia $ a,-, $= 'fib o Umbo= :. d'-4.. a83.� v 0 7588 2.S U ,. y " Gam 2 3 gc 2 a, a -y O�.�y 0 > U U.6 C_ T 0 N `n� >i G „.,.0 a) :cam!! N 0 cd 0 Ey.- a 3 qo t-� 8 �= 0 d;b b � Ir% h)A bp-1?).`°-T:21.2P.0- E ,, 0 w ' - .2 ›,..8 d 72' 0) 0 0 gm. tLyb ya a3E " Et-L. $ ' a q'' E. a aoa °'3 °-- a �� I `°gyy °= co ,§ g g ; : 8••• 1;7. •- .8 0.l> .0 •y `h `'t, �. N 'C7 _IIIMMI 4,dmo� g 3-aeoaS . E" a8 y.G 3 4 > :aw 8 6 b83 Q) °s � ' y >'� Q) U .44i ; ) o5 a . e 3, Rv.5 A , 7. 8. 2. � a 'C tb8� 3 oN N :.; y ❑ cdau .g2ao 2 g.03 .8'77 0 .ti " a 8y� 3 g� w1a3 0 kr Q.) _ 33iflht!4li C Ct 't -,8Vs a `i-45 A E d TA 8 .off 'Spm. -� 032Qo y 00 M O00a% m • 3 a A L o E12 ,At. ▪ : .1kJ) p.y y (13c/� A ,n8 o >,d d $ 3 • Survey s torp �+ �y on serviceset BY Jim MnNmina how i $ -trE spi-iii- Residents can also ratePENINSUIA DAILYirg and':their opinion bf the service in the areas of gen- PORT TOWNSEND local,quality of life eral government,law Jefferson CO ity residents su can eys be - enforcement,recreational '�`i1ed to the'ituri y resi- facilities and grains,;!deft are about to eve the:chance dents pay for t ie stampL or friendliness and knowledge, to give`gover`iiment 0.. ; to give of- their minds ci , . %°''. fat e Jefferson animal services,landsdevel- A State of Jefferson 'tom? iuse, 1820 oprnent,public head,youth CoA" t tameof Jege,a expected Jefferson St,In"addition to a programs,senior:programs free online option. o to gown the mail by early p and�'ash'c�llection. May, offer dents the The document asks gives The survey also asks resi- Mance will tell residents three options for dents to prioritize where ent rating the quality ofiin they would choose to spend officials what the t of the,county not... se, sals w s t'i ., county funds if they con- they receive,' neutral or.satisfied, trolled the purse strings. • ®d `i 40-c3 Port Townsend&Jefferson County Leader / Port Townsend is no • for many disabled residents �,., ,.f,r ,� F,, ,,,.. "Assume-a-Disability Day" :.�� � ,,, 1 �4: • reveals barriers that most - =`� i°,,ea,,, t 'a • •.,...- . residents don't see , t Afs0�` -• '' ` ' By Scott Wilson for the next four and a half hours + `; .• z.... ` Leader Staff Writer would otherwise have been im- "�''!' ' it 'if s ''''' n possible. ' The City of Dreams can be a i nightmare for people in wheel- Jammed with wheelchairs �VV V I„ # chairs. Setting off from the Port , This writer, along with a Townsend Community Center at •- dozen other volunteers,found out 9:30 a.m,on a blustery day,the s I. -7 ' ' i ' • `' ` • a�' ,' the hard way on April 23 when fust thing all of us newly disabled • A ~ { ' '. x .;-;`•:,•..t"..1->'.Z. ..;.'"1=4:::. N r..; v, I we were randomly assigned dis- folks found was that the nearest --" 1: a,' $'.,,,' .,.;.4":;/:;:::" abilities during the first-ever"As- Jefferson Transit bus stop, on .F � 3 sume-a-Disability Day" put on Lawrence Street, was jammed s '. by DASH. with wheelchairs,electric carts, 1•°‘',.4. i DASH is the Disability walkers,blind people and stroke a Awareness, Surveillance and victims. The Jefferson Transit `•,%-',•'7.-,N1 i0 — -VI:. Health arm of the Olympic Area crew leaped to helpbut could ``_l ' ' P R �ro� � i-. s F Agency on Aging, only tie in two wheelchairs per i ad x"# : g r^l Nothing could have accom- bus.They immediately called for ,; I. k!•.,,,1,•-ti- Nothing plished DASH's educational mis- backup,and within several min �r 4r �'' ' sion better than having Jefferson utes everyone was on their a { : t ,z r P a x ' ''t� z County Commissioners Dan pointed rounds. z e ! t � , 1 Titterness and Wendi Wrinkle My first assigned stop was the € • ;. VV 0 assigned to wheelchairs,Jeffer- Jefferson County Courthouse, <, . + son County Administrator David where I was to apply for a prop- • is ' . F Goldsmith turned blind, Port erty tax exemption.But the all- ' - ata f i; • t`•.�}.r1 I Townsend City Councilor Freida important transit routes only Jefferson Transit Manager Dave TurIssIni had to use a walker to get Fenn and Commissioner Glen come within four blocks of it,on around Port Townsend during"Assume-a-Disability Day"on April 23. Huntingford unable to use their Lawrence. So Nancy and I de- He was accompanied by Gloria Bram in her electric scooter. right arms, Port Townsend cided to just roll our way there Photo by Barney Burke Mayor Kees Kolff made nearly' from the community center. deaf, and Jefferson Transit's The first intersection, offices in the next block, at courthouse's northeast side door i Dave TLrissini hobbling along in Lawrence and Tyler, has nice Harrison and Lawrence. was clearly marked.A ramp led a walker.Four other participants new curbside cuts that get a That was the easy part. to an automatic door, and we ' rounded out the array of disabili- wheelchair from the sidewalk to were inside at the stroke of 10 on ties. the street and back again.There Access map the clock tower bell. I was also assigned to a was no such cut at the next inter- To zigzag through uptown My assignment was to inquire wheelchair, although my section,or the next.Even minor streets to the courthouse now re- about property tax breaks for dis- ' "stroke" wasn't so bad that I cracks in the sidewalk,thought- quired going virtually cross abled (and senior) citizens of couldn't use my feet here and fully highlighted with yellow by country.There are few sidewalks moderate income.We had to get there. That turned out to be a city staff, could prompt a near at all in that part of town.Those to the assessor's office. The godsend,as the route that DASH head-over-heels spill or be prac- that exist feature jagged cracks courthouse elevator is a bit quick coordinator Lesa Barnes and my tically impossible to get over. and no ramps. Several would on the door closure,nipping me "minder,"Nancy Obert,laid out A two-block stroll that an dump the unwary wheelchair twice in this adventure.But once able-bodied walker would breeze jockey onto someone's soggy inside the assessor's office,help- through thoughtlessly in 25 sec- lawn,the modem version of tar ful Jodi Cossell expertly ex- onds suddenly loomed as a sur- Pits for the disabled. plained the process and got me vival test. With great relief we So Nancy and I simply took started with the paperwork. came to a newer sidewalk and over the middle of the residen- If your household income is curb cut because of new con- tial streets: Harrison to Clay, $30,000 or less and you own your struction of medical/counseling Clay to Benson,and Benson to home,the county'Spares you all the courthouse. the voter-approved levies—in my Not until we (very slowly) case, almost $4 per $1,000 as- approached the courthouse did I sessed valuation, she said.Any wonder how I would get inside. follow-up work could be done The cast-iron steps of the front over the phone,she added. • would be like the Khumbu Ice- It takes a bit of practice to get fall to someone in a wheelchair, in and out of office doors,but the walker or even with bad knees. handles were easily grasped from • 1 7yh�0 One of the best documents chair level.In a minute I was in OV produced by DASH,however,is the treasurer's office, where a map that shows disability- Sabrina Hathaway printed out friendly entryways. The See DISABLED,Page AS Jefferson Transit earns • EnviroS tar award Jefferson Transit is the first business community," said government agency to receive an Bower,adding:"Show your sup- EnviroStar. Its staff's commit- port for EnviroStars businesses: ment to properly manage and re- Get out of your car and get on duce hazardous waste has earned the bus!" it the program's highest certifi- , cation—five stars. EnviroStars is a regional pol- lution prevention program spon- sored by Jefferson County's Environmental Health Depart- ment, partnering with a variety of public agencies. In order to qualify at the five-star level, a business must comply with a long list of criteria that includes proper labeling, storage, han- dling, record-keeping, and dis- posal of all halardous materials. Perhaps even more impor- tant, in order for a business to qualify at the five-star level it must include a community out- • reach/education component in its business goals. Jefferson Transit has chosen to become involved with the Adopt-a- Highway program to help keep highways clean. Other five-star attributes Jefferson Transit has accom- plished include providing free family bus passes to all em- ployees,field-testing biodiesel fuel in its buses, recycling all possible materials, and using • , energy-conserving equipment wherever feasible. "Jefferson Transit has done an exceptional job at eliminating or recycling all of its business-gen- erated hazardous material,and it continues to explore creative ways to responsibly handle the rest of its waste," said Melinda Bower, county environmental health specialist. "We thank Jefferson Transit management and staff for doing their part to safeguard the envi- 4-50._6 3 ronment and congratulate them for being leaders in the local f4fi� cc406-r& WorkshoppdangerDugs. Clear and resent addressesContinued from Page A 1 diction)is nifty,but what they are About 24 percent of the worker productivity to increased Schnell, a retired chemical really saying is the body is dis- county respondents who drank child abuse and neglect and ad- dependence professor who has posable.It's a process of educa- did so for 20 or more days,corn- ditional law and justice cases, SDUflty worked in the field since 1977, tion so they can discover they pared with 8 percent statewide. said Carlson. said that when people are faced don't have to drink and have a More county residents,about 68 There are also alcohol over- with the choice of maintaining good time." percent,consumed at least one dose deaths.A Chimacum High their addiction or going into "Your brain is telling you that drink of alcohol in the 30 days School student died a few months drug use withdrawal,they are left with two you are doing great,when in real- prior to the survey than did other ago from apparent alcohol over- bad choices. ity you are living in hell,"said state residents,about 61 percent. dose.Schnell said the toxicology "For them,there is no choice Huth, who said he was a high Despite the misuse and abuse report said there was nothing in By Janet Huck at all,so they keep on using.It school dropout who drank and' of alcohol,American society still his body but alcohol. "Most Leader Staff Writer takes intervention from the out- useddrugs."It's not something I'm considers alcohol legal."Every people fall asleep before they side—a boss who says,'You will proud of,so 1 don't broadcast it." society decides some drugs are drink a lethal dose,but adoles- stop or I will fire you,'a police not real drugs," explained cents are at the most risk when The three top drugs of Jefferson officer who says'Stop or you'll Alcohol Schnell."We have decided that they get into drinking competi- County are alcohol, marijuana and go to jail,'or a spouse who says, According to the local Behav alcohol, tobacco and maybe tions.The,guy who wins the bet methamphetamine, but the No. I 'Stop or I'll leave you.'The user ioral Risk Factor Surveillance marijuana are non-drugs. We to drink the most ends up dying." drug problem is alcohol. Will need some kind of help.The System survey completed in classify alcohol as a beverage or Residents who drink also "If,you look at the number of purpose of treatment is to stop 2001,although there are fewer a recreation,but not as a drug.In drive.The number of arrests for and stay stopped." heavy drinkers in Jefferson other societies,alcohol is bad but driving under the influence has people affected negatively by alco- : Yet it is the psychological ad- County than in the state as a betel nut is OK." been greater in Jefferson than hol,the impact is greater than all the diction that might be harder to whole,local residents drink on However,the costs to society Clallam County, whereas the other drugs put together,"said Jerry handle.Said Schnell:"Their own more days in a 30-day period range from decreased academic drug arrests in Clallam have been Schnell,the former director of Seattle brains will tell them it (the ad- than the state average, performance among students and greater than in Jefferson County. University Addictions Studies and =persistent, persuasive risk factors' Marijuana ttow a Pott Townsend resident."Al- Schnell said marijuana isn't a cohol is a more dangerous drug than marijuana or methamphetamine;' Rural areas used to be sant- sufficient care in the womb as op- though math and reading scores harmless drug."There is a lot of wanes from the ills of urban life. posed to 16 per 1,000 for the state for fourth and 10th grades are misinformation promulgated about wanes The retired professor was speak- Now drug rates for adolescents as a whole, lower,the seventh-graders scored marijuana,"he said.Many people ing at the Jefferson County Substance are the same in metropolitan and Jefferson County children have higher than the Washington aver, believe marijuana isn't addictive. Abuse Advisory Board conference on rural areas. Methamphetamine been placed in foster care more ages in 2000. "It ignores that psychological ad- the three most prevalent drugs in use is even more popular in rural often than children statewide,but "They are staying in school,but diction is just as powerful as physi- Jefferson County.Titled"A Clear and areas than big cities,child abuse even more chilling is the rate at they are not learning enough," ological addiction,"said Schnell." rates can be higher,and poverty which children suffer child abuse. Carlson said. If they can't quit,it's an addic- Present Danger: Our Community can be more grinding. In Jefferson County,the 1999 rate For adolescents,the statistics tion:' Responds," the Tuesday, April 29 At the Jefferson County Sub- for referrals of accepted child are sobering too.Juvenile arrest Chronic marijuana addiction • conference brought together experts stance Abuse Advisory Board drug abuse cases was 54.60 per 1,000 rates for violent crime and for drug affects the user's motivation. including Schnell,treatment special- conference,professor Katherine versus 37.51 per 1,000 for the state. and alcohol crimes were double the "They lose ambitions and be- Steven Freng and Ford Kessler, Carlson spoke about the risk fac- "There is ahighcorrelationbe- state rates in 2000. come spectators in their own Carlson,an anthropol- tors—such as persistent poverty, tween substance abuse and child While the rate for adolescent life;'noted Schnell."They say tolack of living-wage jobs and abuse abuse,"said Carlson. pregnancies is going down in the themselves,' I'm going down the '(athetine expert Who analyzes Substance _that can lead to drug use or exist For individual Jefferson County statethe rate in Jefferson County sewersbut t isn't that bad.'They abuse statistics for Washington state, in conjunction with drugs. adults,thearrest records were also is going up,said Carlson. just don't care." "Drugs are making war on us and Jefferson County, the substance elevated.In 1999,more Jefferson Consequently,some groups in society," said Mark Huth, District abuse consultant said,has a high County adults than Clallam Jefferson County are more at Court judge. "They are a growing rate of poverty,an elevated num- County adults were arrested for risk.Young adults 18 to 34 have ber of children referred to foster alcohol-relatedcrimes,butClallam a lower education level and a problem,and they continue to grow care,and more arrests for domes- County had higher drug arrests. higher rate of poverty,and they unless the community begins to ad- tic violence than other nearby The rate for alcohol-relatedcnmes. drink and do drugs. dress it now." counties and the state, was 14.7 per 1,000 for Jefferson "Ruse are persistent and per- County adults and 5.8 for Clallam Addiction suasive risk factors in families,in adults.The rate for driving under Drug addiction can be a long,slow communities and individuals,"said the influence arrests was 11.4 per "You have endemic prob 1,000 for Jefferson adults and 4.43 slide.If people start using drugs such as alcohol,they can,over time,start lems wove"into the fabric of your for Clallam. abusing that drug, develo to s routine life.When you see so many "These statistics may be higher p g p y factors,it's not a quick fix.You'll because law enforcement here is chological and physiological addic- need a multidimensionalsolution." more aggressive," cautioned tions, explained Schnell. For those In Jefferson County families, Carlson. who develop a physiological addic- Carlson said more than a third of In Jefferson County schools, the children under 18 are living be- there are contradictory indicators. tion,they acquire a tolerance and then a dependence.If they stop using,they low the poverty line,but the num- The high school dropout rate in can enter into withdrawal that can be bers for different communities vary Jefferson County tends to be low from 46 percent in Port Hadlock —less than a third of the state rate. frightening and sometimes life- to 0 percent in Pon Ludlow. However,the scores on the Wash- threatening. There is also inadequate prena- ington Assessment of Student "Although most alcoholics never tal care.In this county,more than Learning(WASL)tests are lower get to the stage of delirium tremors, 22 per 1,000 children receive in- than the state average.Yet al- withdrawal is very painful and un- • comfortable,"Schnell said. ,- See DRUGS,Page A 3 . IP -- 36 6.3 - 7 c. a y Fo r 11 ,,,, ,-„,„,,,A,,,,,,,t,!liffCcf Ii,u�ttunn�, r h ' V o. o c. a 721 q i(3•Chl)t (r‘`7lcuhc,!r , MN a a 4 y E } 31c[ti rj t?isuscl" tl�ttii tTE�,�q O y •-% y a ` F,- a) CONTINUED FROM Al {ditatt!!)} - c= c-�: A lot of that may have to do �I�ytieraic O' u. 4.1 ti a w U a w c = with the economy. l ftrC},'11'tiCY, flil�TlT*c! C ° a c a - — F. More than 34percent of . ' ar y- c •c.,C,)c a = �!)4ETR(rlCt e n. - 2-O a ,;.Y children in the county live in rtstTttlea!lats E u y r y S•4 a� C families with incomes below rrtll C;T .tip dusin F Ta o the poverty line,Carlson said ltd! ttstfyT�dC t�Tl ' x But that poverty isn't - r • n ' `� a) >, equally distributed. s , 8 ' a c a Port Ludlow has no chil- r`- ». •, • n °bill 0 ' y ai x dren below the poverty line— (; _ more than 45 percent of indi- O _ ; w - > gent children are in Port Had- ` ,„r c<° c s c 0 m lock and Irondale. [') u" e 8 Older age groups also face �', .o c challenges that could lead to y Is c .+ ? substance abuse. ar-a y v, ,. t'0 There's a large number of `•, .L c c seniors with little educational q� > 8 yb oar background in the county, 'e> 14.111 -o c e o. ° 2 8 Carlson said, noting Jefferson {' �' o 0 0 County has a curiously high 66;;; ; ear C°v 8 r number of seniors who drink 1 \' acro o Lar °e.� `° v ton much. �` .o Y a7 o c w c 'a The county also has a high # ,, O a o o:a a number of younger residents y `� 8 that drink too much,she said, i 0 a 8 a a 8 ° adding that adults tend to be �, Qa more receptive to underage y drinking in rural counties. +� ��" r + . oc ,o� t'E a ,, o Q s:= ,. 7, `" 0 c Higher percentage to +'<w g� ','°--' �.7•o o Drug and alcohol arrests -8 .8.� 5 C'4..5. o here are almost three times } EEOo • �'o higher than the state average, ; "; Carlson said. aII 111111 2 y $ oo • Jefferson County has 32.6 Dr.Jerry Schnell,former director of Seattle ` �,:15'5 -, °'8 c arrests per 1,000 teenagers for 0 2 2r to `).'z underage drinking and drug University's addiction studies program, speaks during '� 0 3 �'v y o use. a substance abuse forum Tuesday in Chimacum. oto x y a`i w w The state average is 13.4. dees that he was formerly a methamphetamine to court 12. oe o p c o ;1 That may or may not play a drug user who dropped out of with them,he said. y o'8 cn 4'�o: factor in increased violent high school and didnrt start The basic choice drug user; N b-c 3 3 b•,.., crime in the county,she said. college until age 25. are faced with is. "you can go The state average is 2.8 "Not many people know to jail or you can die.- he said NNE ro d arrests per 1,000 juveniles, that about me, it's not some- Treatment is critical for INNMI Jefferson County's average is thing I'm proud of," he said. addicts,but there should be an ° ,u G 6 for each 1,000. "I'm less that I could have incarceration component to .1 j' a L o 2 a„ The higher numbers could been, I know that." discourage use,he said. ,.,4° a) y c m indicate active enforcement Huth talked about the Jefferson County Sub- V A ro a .a 8 et efforts,she said. issues he deals with as a judge stance Abuse Advisory Board. v j S District court Judge Mark when it comes to drug and which sponsored the program. y n.22: a11 Huth believes that's the case. alcohol users. hopes to make the session an a N T o b N ro • Huth told conference atten- Some people even take annual event. i 5 o•••6 °°�°ao u syr c U o o •ff' U� 0 • o ai., � _. c 8 ca.o7 - p S l—© 3ayOo s i 1 cV OO >, o1111 [ Qi paQ o" O vD H. gam~, EMI„et Ct V az V [G Q �w cc A 12•Wednesday,April 30,2003 Port Townsend&Jefferson County Leader Got an old HOME computer or g • television that'sg one BAD? ....., . A "W. ., Silicon Valley Prison T ~ 0010100100011110001 0 FOR RECYCLING! ALIASES: "Cathode Ray","TV Sett","PC Monitor","Sir Cutbord" • BUILD: Square CRIME: Containing Hazardous Waste CAUTION: May be dangerous to the environment if not recycled properly Saturday, June.7th, 10AM-4P1VI Jefferson RecyclingCenter'on Jacob Miller R'd. Call Melinda Bower for more info at"379-4491 Items to Bring - ;: ,,- • ' RESIDENTIAL ONLY 0 Coif. uterlmonitors';0 ' - .. p TVs 0 Computer Central'Processing Uiuts CPUs) ` oa Computer Accessories,such as the mouse,keyboards,spealsers" Oa VCs and DVDs t0 Printers za Cell/mobile.phones - Outer-Electronics items won't,be accepted at the event,.but can'be taken to the Transfer Station right next,door _ , Costs: $5 drop-off fee per vehicle for all items except for monitors and<TVs• ' $10 per computer monitor $15 per TV under 26"'$20 per TV more than 26" additional$5 for wood consoles , • cash'or checks ONLY ' ' This event is brought to you by the Jefferson County Environmental Health Department,the Department of Public Works,and the Washington State Department of Ecology. Thanks to King County! Jefferson County will NOT be responsible for any information or files left on computer. q . • Seminar to review results of Jefferson health care study PENINSULA DAILY NEWS I 90 percent of adults have PORT TOWNSEND — Dr. insurance. Christine Hale will lead a dis- ■ 70 percent of adults are cussion on a two-year Jefferson physically active at least five times per week for 30 minutes. County health care study and its impacts on the community II percent of children live during a daylong seminar May in poverty. 13 at the Elks Club. ■ 33 pert nt of adults abti Seats`-are limited and regis- reported some �� d tration is required for the eveni - ■+30y percent.ofi atiits"ragel which focuses on health, incur- 18 to 34 smoke. ance, activity, poverty, abuse "There is a lot of good news and smoking. to.report," county Director of Pre-registration is required Health and Human Services by Tuesday. Jean Baldwin said."Most adults During the luncheon, Hale are healthy, fit and have some and community leaders will talk form of health insurance. . about moving from the statisti- "But there are serious chal- cal analysis into developing pro- lenges in the areas of poverty g'ams• and substance abuse. Children Hale is the Seattle-based and their families are particu • - consultant who recently corn- larly vulnerable." pleted the analysis of the coun- The seminar runs from 9 tywide health survey. a.m. to 3 p.m. at the Elks Club, Survey findings 555 Otto St., and costs$15. The fee includes lunch and a Among the survey findings copy of the Jefferson County are: data book. ■ 80 percent of adults list To register, call Cathy Avery their health as good, very good at 360-385-9238, or e-mail her or excellent. at cavery@cojejTerson.wa.us. 5 - L{-0 PD � • /D • Health data forum is May 13 The public is invited to join May 9. To register, contact community leaders as they Cathy Avery at Jefferson learn the results of a two-year County Health and Human Ser- health assessment process con- vices at 385-9438 or ducted by Jefferson County and cavery@co.jefferson.wa.us. the City of Port Townsend. This project is sponsored by "Translating the Data: Moving Jefferson County Health and from Numbers to People"takes Human Services, the City of place from 9 a.m. to 3 p.m. Port Townsend, Jefferson Tuesday, May 13 at the Elks General Hospital and the Lodge, 555 Otto St., Port Jefferson County Board of Townsend. Commissioners. "There is a lot of good news to report," said Jean Baldwin, director of Health and Human Services for Jefferson County. "Most adults are healthy, fit, and have some form of health insurance.But there are serious . challenges in the areas of pov- erty and substance abuse, and children and their families are particularly vulnerable." The day begins with a pre- sentation of major themes by Dr. Christiane Hale. After lunch, participants will focus on what the data means at a community, agency and indi- vidual level. The goal of the day is to get recommendations for action to improve the health of Jefferson County residents and to provide linkages to ex- isting groups. Cost of the event is $15, which includes lunch and the Jefferson County data book. Preregistration is required by ( LE U6ii 3-7-0 3 • 11 • AIDS celebration scheduled May 18 Four local ministers are par- County Health and Human Ser- ticipating in the Jefferson vices Department,intends to talk AIDS Services celebration of about the people and families the courage of people living who are living with AIDS in this with AIDS and the people who community. have died. Since 1983,the pandemic has The event is scheduled for 3 claimed more than 22 million p.m. Sunday, May 18 at Port lives,with about 34 million nqw Townsend's First Presbyterian living with HIV and AIDS. Ev- Church, 1111 Franklin St. ery year the AIDS Candlelight The Revs. Robert Slater of Memorial Campaign holds First Presbyterian Church, events across the United State Wendell Ankeny of Trinity and around the globe.This year, United Methodist Church, Skip there are more than 1,500 corn- Cadorette of First Baptist Church munities in 85 countries partici- and Gail Helgeson of St. Paul's pating. This is the largest Episcopal Church volunteered to grassroots AIDS event in the . help raise awareness and de- world;more than one million in- crease the stigma related to HIV dividuals participated last year. and AIDS in this community and Jefferson AIDS Services vol- . throughout the world. Helgeson unteers invite the public to join plans to talk about the disease them in this one-hour, informal that is ravaging families and celebration. No one needs to whole countries in Africa. dress up;please come as you'are. Jean Baldwin, Community For information contact Tony Health director of Jefferson Estevez at 643-1572. 7?-7. GEA-1>E1 . • • • Who is takin. gtouthe electr ni By Molly Pearson Just four hours drive from 4\4 '�a'"i ® ' -�� Investigations/Compliance Specialist HongKon alongthe Lianjiang l :',`',"..\'''.,..1.7..L.-!--1,' q -* ` County Environmental River,more than 100,000 m ' �4\4f-rt.-CI' w 4 �� ",-;' j , l Health •Jefferson grant workers are employed in is .¢F• w 1 \ it y ' % . 4, . t , breaking apart and processing yr...--41‘71?-11/2.4-1§# , S Ay" — l a'' Do you have a broken or ob- computers imported primarily �� / , ' • I ` it, f �1' solete computer or TV stored from the United States. 'i 1�; s„ ,P 4 ' : °`� ')` 14r^`; t\ ,�.aj away and wonder how on earth The shockinglyprimitivecon- '• '� '' r 1 .7 4 �"-""� `J �• 'a� t,.`q• s.+`� to get rid of it?Electronics,es- ditions and archaic methods used i `, R ,t t,t ,>A. /- s"..",-*/ r a�, 'N'0,0%- i' ' . illi pecially computers and televi- to disassemble computers are e, ' F f ` i.,,, •», i -4 -•.�_ • "SSA sions, are cheaper and more devastating, even deadly.The "t"r tt ! `•'• . •7 • .is:: disposable than ever.They aren't workers earn,on average,51.50 ti t., r'• .. „ `,` ,v • ' ', designed to last.Warranties are a day. Entire families live and y.-,S�, k ,.t,4!1-4 ' . shorter,maintenance is more ex- work on the slagheaps of elec- . �'" x'�- P �i� r pensive,and upgrades are more Ironic waste,surviving on fish . �, •�' r��.'9 ! .%, e Ti's- r' 1, i. ,p difficult. pulled from the poisoned river, f' - / ++se ',;; s•r` „9 Two decades of computers constantly inhaling and ingesting "V + f+' ., �•���;i , , y�,e•' and five decades of televisions toxic particulates from the air Ay__..---i--.�s- ,* ,r •.' fry ti„�� -4;,.'''.,, 1 s`a' are piling up in closets,garages, around them.Their children's � , q:I ` '`tom /4 + :,,,,,,,,„,:e:,...,,101- 74-.4----,,� warehouses and landfills.These playground is a mountain of dis- Y -"--::J"' ac v *'-~, jay"" ." electronics are full of toxic carded electronics. ' ! t .'" ryry � ' chemicals and heavymetals like Operations include open ai,,-`" •� " ,-- ' '" s 4 `"'-'--a �� ., .t lead and mercury.Such materi- burning of plastics and wires, , , 9 lit, ,q" p -.To.- + als don't pose a risk to the corn- riverbank acid-works(to extract • .Y - ;`•c- •r .-••» ' (>,( ; . •, - „,e-,,,,r._ - _'” - puter or television users,but they a single drop of gold), and the The recycling of computer equipment imported from the United States has become a big Industry In can pose a severe environmental cracking and dumping of toxic Guangdong Province,China.However,the primitive practices used expose workers,and the local envi- risk when disposed of improp- lead cathode ray tubes(CRTs). ronment,to hazard,reports Basel Action Network,the agency that first exposed this situation. erly.One Washington county has Tons and tons of the processing Submitted photo already banned disposal in its waste are simply dumped along landfills, and ultimately these rivers,in open fields,and irriga- Puckett refers to the fact that hensive product stewardship, ter on Jacob Miller Road,just materials could be banned from tion canals. The pollution in the United States is the only de- calling on computer and TV outside the city limits of Port all municipal landfills. Guiyu,only five years after the veloped country in the world manufacturers to: Townsend.Because the county While some recyclers can introduction of this new"indus- that has failed to ratify the • design products that are will incur large collection and refurbish or break down the try,"has become so devastating Basel Convention, a U.N. en- more easily disassembled and transportation costs with this computer components,the re- that well water is no longer drink- vironmental treaty which has recycled. event, it must charge a nomi- cycling industry in the United able and the villagers depend adopted a global ban on the •use less toxic and more re- nal fee to participants. The tes is not able to deal with upon water trucked in from 30 export of hazardous wastes cycled materials. county is carefully researching overing all of the raw mate- miles away. from the world's most devel- • design products that last the available vendors and will ials for remanufacture.This These workers are truly using oped countries to impoverished longer,with replaceable parts. contract with one that guaran- results in the shipping of corn- 19th-century technology to clean nations. Furthermore, the • take back products for re- tees the collected materials can puters overseas to countries up our 21st-century wastes. United States has actually ex- building or recycling. ` be handled properly and do- with little or no environmental Jim Puckett, coordinator of empted toxic electronics waste •develop an environmentally mestically. protections,under the guise of Basel Action Network (BAN), from its own laws governing sound collection and recycling What can you do?Read on to recycling.According to Craig the agency that first exposed this exports, simply because the infrastructure. find out about reuse and recy- Lorch of Total Reclaim,a Se- situation in a shocking video material was claimed to be des- •build the costs of these prac- cling opportunities, and peruse attic electronics recycling firm, called "Exporting Harm: the tined for recycling. Environ- tices into the product price,to be the "Frequently Asked Ques- "The legal export and legal High-Tech Trashing of Asia," mental organizations are paid directly by electronics con- tions"sidebar about electronic dumping in local landfills make minces no words: calling on the United States to sumers- equipment. it very difficult for responsible "We found a cyber-age night- follow Europe's example and Jefferson County is also Right now, residents of recyclers to compete here in the mare in Guiyu.Call this 'recy- immediately implement the evaluating the merits and costs of Jefferson County have these United States." cling,'but it's really dumping by global ban on the export of haz- providing more convenient recy- options: Dumping of discarded coin- another name,"Puckett reported. ardour wastes from,the United cling opportunities locally, by •,Upgrade by adding random puters in rural"Asia is one of "Tbottr horror,'we discovered States to developing countries working with retail businesses to access memory (RAM) to in- the scandals of our electronics- that rather than banning it, the and to solve the electronics create drop sites. crease.your computer's speed driven cyberspace age.The ef- U.S.government is actually en- waste problem here at home. In the meantime,the Public and efficiency instead of discard- fects of our shocking couraging this ugly trade in or- Works and Environmental ing it. carelessness and indifference der to avoid fording real solutions Jefferson County Health departments are co- •If the computer is truly ob- are all too real to the impover- to the massive tide of computer Jefferson County is following sponsoring an electronics col- solete or broken,bag it several ished residents of Guiyu in waste generated in the United regional and national efforts to lection event on Saturday,June times to ensure the monitor Guangdong Province, China. States daily." establish a process of compre- 7 at the county recycling cen- See COMPUTERS,Page C 14 i Computers: Toxic p roblems Continued from Page C 1 to see if it has a take-back pro- problems with computer recy- remains contained,and dispose gram.Check the accompanying cling or would like to borrow of it along with your regular sidebar for a partial list of these the "Exporting Harm: the • garbage. manufacturers. High-Tech Trashing of Asia" •Take your computer to a re- •If the computer still works, video for personal viewing or gional business that will accept call Dave Numme, director of to share with your organiza- _Lc21 it.The web link to King County Information Services for Olym- tion,call the Jefferson County area businesses is http:// pie Community Action Pro- Environmental Health Depart- d n r.m e t r o k c.g o v/s w d/ grams,at 379-6338 to see about ment at 385-9444. default.shtml. donating it. 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' 'uu goo u000uoo' [ 3v kJ) l :. uE $ yEa C- u h Ec O d ' K t !!,0•,i > g U a '9 •= ' uaoO5u3▪ Eu y . Oym u � � o. 'id' 'v .0 ° '." o -' � E2G `d 7 O Q .0 u C 0 E 7 u c o•,yep d pRUi O O u u >' `3 .5 gpa1,10 4 y .e h .c u 0 u En o u > E to. ° 'E '>▪ haa a . A ° 2. oEo. E-6 E o '5u 13 Anti-Smallpox -- Program to• Be • • Held in County 11* CHILDREN WIL BE VACCINAT- . ED AT COST OF ONLY FIVE CENTS EACH Under supervision of the county 19 health officer and Miss Louise Flanagan, county nurse, a county smallpox vaccination is now being planned for the month of October. Miss Flanagan said today that many people of Washington do not know this state has the `largest; number of smallpox .cases per year of any state in the union. It Is one of the few diseases, she said, which can be prevented by . the simple use of vaccine. The cost of receiving vaccination treatment in this program.._ffip program.. be but five cents per.child t 'for the cost of vaccine. Miss Flanagan solicits the help of every parent who, she says, .can help rid..Wash-. tngton of this disease. 403 Vaccinated Vaccinationprogram. In.Program•Just • Now About Completedu About Complete, • • Miss Louise Flanagan, Jefferson! AVERAGE -OF PERCENT OF. County nurse, announced Monday COUNTY CHILDREN NOW that the-.-county health office's • PROTECTED county-wide anti-smallpox program I _. Is now aliout completed..Only child- Announcement was ,made."this ren of two schools, Brinnon and' week by .the Jefferson County: Nordland, had not been vaccinated' Health Department that a total of! Monday, but she hoped to complete 403 pupils of county •schools; out them Tuesday and today. - I Miss Flanagan, County Health• side oL.Port Townsend, were vac- Officer F. J. Delaney and Coun cinated in a program • now .about: �" completed. Only one school in this School Superintendent Edith De-1 , end of the county, Coyle, has 'not lanty made a trip-to the west end! d yet been visited It has s •but four last week in the interests of the; program. Miss Flanagan•reported! Of all schoolsvisited; 93'percent the indian children there are vac- of all children are now protected. elnated by the government, but: A total.of 55 pupils refused to be many of the white children were! .vaccinated._ In.addition to the 403 treated by Dr. Delaney. treated in this program, 207 were! already.vaccinated, which• means! .610 are now .protected. • •t The•health department is appre ciative of the splendid cooperation of parents and teachers of various! 'schools. Results are. ,.reported -mach better than in mOst counties: Two-schools; Leland- and Nord- .land'S. A.; are .protected 100. percent-as a:result of.this program.- Percentages,of other schools are! Chimacum,. 90; Port •Ludlow, Gardiner,'85; Quilcene hig irool,'; • 92; Quilcene. grade sehool, 96; Discovery Bay;98' .Shine, 90-Brin-; non, 82;.Nordland, 95; Nordland S.. D. A., 100;.Leland, 100: 'Coyle, not vaccinatgd,_yet. • l Jefferson eluded in the school County three tri visits were' . Nurse Reportspa to the west'end, once to assist Dr. F. J. Delaney health On officer, in examinin Year's Activities g and vaccina; � ing children Por smallpox.; another time to assist Dr. Delaney in check- 1110 MADE TOTAL OF 254 VISITS TO lag diphtheria and the other. time to check on corrections made,. :: SCHOOLS, INSPECTED 789 Miss •Flans an • - ` .' CHILDREN, g assisted is the Miss in which 41)3. children In her annual report Miss Lou 93 per cent ote school ichildrto al of Ise Flanagan, Jefferson County cinated in the county. so1931 curse, this week listed 254 visits to attended nurses' institutes,in:Port schools of the county and reported Angeles and Sectile, v:: • inspecting a total of 789 children ' '~ tor physical defects. Of the 789 inspected, a total of 445 were treated for various ail- � ; .. menta. -�-,r .c•--n:tv r=,-s _ 4 In addition to her calls at schools she made 526 home calls, and in- Count ' :ursefdata-esults rwr'" O i a on ,, n Sc_hoals 4_,. Q4--m. .4'!` '- a '�� :..ye��s n-c :,—: "._ » -,r _, . s w . � '�-._�^ ;. ' i� `rK"W.,.,,A., X6 53 By MISS LOUISE. ELAN N reetions VII :be .lade ,.Everyone c:-J,efferson;,'Couht Nurse ' knaw6 11ow Y hatti summer TIs :the The following figure are: he r� ;ideal time for:oorrec`Elve or&, and cult of inspections whichhav peen bOyr hnpo, taut it Is'for of '&11- Made in'the•schools 4 Brannon, dre •to gni'tq school in goo0 hysi- Chimacum, Quilcene grade:school;` nal condltio"n.. ¢ s Vi' t~-. l ..,f Quilcene high schoot,Leland;'ttar 'diner, Discovery Bay,"Shine, Nord ed"riiidi i-i suiferiea from dit teeth-1 land and Port Ludlow. Due to the act e a othe ailments haveeot no fact that all children were not-In. :ache and other ailments have i pta:ce, iirry4'>�efiool:';They` Are -nut specked in he'west'end`schools,`It �pnyslcaji' equipped to -do their is impossible t0 o give their.figures work.for .ha at the present•time,.'?;r i;. 5at`i N�. day�and i! there,are • , • . er Cent Per Gent Per Cent Per Cent iseased Decayed Under- befective School "Ton5ile" "°Teeth '"'Weight "Vision Brannon _ ''-- 53 <x. 58 I.".0 26 14 Chimacum Grade School 65 ., i,65 4r r;,15 '7.1',' ''4,6 Chimacum High School 442 ;,,,,,4128_,,W,-,!--28 , 12 Discovery Bay -' t . 13 14 Shine .-------:-. O -. '5Q .V. 10 .20 Nordland ... D' $8 -'5,'',:,-':'- ti --28 0 Leland ' _... I 20 � s,.� .;,...,:_:-..".j:115 :20 Gardiner _ `•65 _ 0 5 Port Ludlow ' '. 28 , 126 . 1¢ 10 1Quilcene Grade School ' 62„, ;,59 .-,-,.4z,,-.2, = ; 4 Quilcene High School ' `r ,... -45.6 7,.r.I'`j ,264 ,,., "...13.6 1.2 Average _., 47.k;1,4 '.47 =a'1.77.;.....:.16 ;;:10.2 :;x According to average figures over many=days like 'that the'children the United States, the' actual heti- who suffer lose interest. '"Repeat- dent-of physical defects vary, "from era" in-•grades are often found to place to place as-to ages of Phil- have defective vision, etc. -' dren examined, but the av'erage Second'notices are being sent to summary figures_ are: Diseased the.parents whose children's de- tonsils, 15 to 30,per cent' ecayed tecta seem urgent. By this it, is l teeth, 50 to 70 per cent;.'defective hoped that parents will be remind-; vision 5 to 15 per.cent. r+ ed to get_the necessary work done A glance at the'above figures will .this summer.' Due to limited or show how Jefferson County cora- labsence.of funds from.a community, pares with national averages, but source for this corrective purpose,; this must not be stressed too much_-the..responsibility fa_lls 'largely oni —rather, let us stress.,the maximum the pares of health for every. .child. This In clntosing it might be stressed' can only be attained when all'chil- that if: every school child has his dren have the necessary correc- or her defects corrected, his suffi-• tions made. Of course it is not ex, :tient rest and'play with adequate pected that all the corrections trill nursing iliet,_we would soon attain be taken care of at once; it is only our aim.-maximum health for ev • - hoped that the percentage of poor ery school„child_ At least if'these ' teeth, etc., will be _decreased ,by simple directions are,followed we September when a check-up of cor- wuld be nearer our goal. :r 4..o. n v a i24 9�6 15- . 4afq tflO., 7,t' SJ` Ou:'. t bl St .t`H ood;1 Health in 1949 Washington's health was good in 1949, Dr. J. A. Kahl, acting state di- rector of health, declared. New lows were reached in many of the communicable diseases on which health workers have been centering their efforts, while on the other hand degenerative conditions such j as heart disease and cancer appear headed for new peaks. Preliminary estimates indicate that Washington's death rate will be about the same as in 1948, while the birth rate will level off, al- though the rate of decline is small.' The state gained about 5 per cent411! population, totaling 2,264,000 inha-, bitants. 4 j New low records are seen for 1940 in typhoid fever, diphtheria, whoop-, ing cough,tuberculosis, syphilis and gonorrhea. No smallpox has been anywhere in Washington -ance the outbreak in 1946 when hag a million residents were immu- nizi8. "preventive work done by private physicians and public health work- era _shows up startlingly in t s year's statistics," Dr. Kahl said, 'l'he number of cases of typhoid later has been halved each year fair • fivA years, with only five reported • :its in 1949. Diphtheria ran to 46` •`:es, half of the 1948 figure, looping cough was half of what l was in 1947." . It was a severe year for Washing ton in poliomyelitis, for which the;O. is no known specific preventioni Cases last year totaled 585, comp' ed with 385 in 1948, or 519 in 1946k the last "peak" year. Dr. Kahl predicted that 1949 will show the "lowest death rate ever" for tuberculosis. Half a million Washingtonians h a d miniature chest X-rays in 1949. In the last two years,two persons out of every three above the age of 15 have had a chest X-ray. Adequate hospitali- zation for those discovered to have TB was assured by a special $750,- 000 additional grant from the Gov- ernor's emergency fund, and by 'completion of a new TB hospital at Selah, near Yakima to serve six Central Washington counties. Three childhood diseases claimed about the same number of sick youngsters as the year before: scar- let fever, 1,612; chickenpox, 9,250; and measles, 12,600. German mea- sles increased to 2,729 cases during the year, while mumps declined to 4,441. Dr. Kahl predicted that the lead- ing causes of death for 1949, in or- der would be heart disease, cancer, • cerebral hemorrhage a tis a kidaeT $