Board of County Commissioners on 2020-06-12 9:00 AM - COVID-19 Update

BOARD OF COUNTY COMMISSIONERS FINAL MINUTES 6/12/2020 9:00 AM MINUTES JOHN F. & RITA M. ARMSTRONG WING OF THE BLAKE LIBRARY 2351 SE MONTEREY ROAD, STUART, FLORIDA 34996 Taryn Kryzda, County Administrator Sarah W. Woods, County Attorney Carolyn Timmann, Clerk of the Circuit Court and Comptroller COUNTY COMMISSIONERS Harold E. Jenkins II, Chairman Stacey Hetherington, Vice Chair Doug Smith Sarah Heard Edward V. Ciampi COVID-19 Update CALL TO ORDER 4 - Chairman Harold E. Jenkins II Commissioner Doug Smith Commissioner Sarah Heard Commissioner Edward V. Ciampi Present: 1 - Vice Chair Stacey HetheringtonAbsent: 1. MOMENT OF SILENCE 2. PLEDGE OF ALLEGIANCE 3. APPROVAL OF AGENDA MOTION: A motion was made by Commissioner Smith, seconded by Commissioner Heard, to approve the agenda. The motion carried by the following vote: Page 1 of 46/12/20 FINAL MINUTES

4 - Chairman Jenkins II, Commissioner Smith, Commissioner Heard, and Commissioner Ciampi Aye: 1 - Vice Chair HetheringtonAbsent: COMMENTS 1. PUBLIC - PLEASE LIMIT COMMENTS TO THREE MINUTES. House of Hope CEO Rob Ranieri informed the Board that House of Hope and The Salvation Army were both working with the Emergency Operations Team to provide food to quarantined households. He also spoke about the upcoming end to the first wave of payroll protection and the additional unemployment programs, and the need to keep people housed, healthy, and safe. George Stokus read public comment emails into the record. 2. COMMISSIONERS The commissioners spoke about the catastrophic flooding in Hobe Sound and complimented Public Works Director Jim Gorton, Public Works staff, and local companies and organizations for their efforts to assist the residents. County Administrator Taryn Kryzda and Deputy County Administrator Don Donaldson informed the Board that an update on the Hobe Sound situation had been placed on the agenda for the June 16th BCC meeting. They also announced that they would be bringing back a future item on options and projects to address the flooding issues in the area. 3. COUNTY ADMINISTRATOR None at this time. DEPARTMENTAL ADMINISTRATION DEPT-1 CORONAVIRUS (AKA COVID-19) UPDATE The Board of County Commissioners will hold a special meeting to discuss County matters relating to the Coronavirus. Staff will provide an update on local efforts and coordination taking place. Agenda Item: 20-0781 Florida Department of Health Deputy Secretary of Health Dr. Shamarial Roberson (via ZOOM) addressed the Board and emphasized the importance of using mitigating strategies: wearing face coverings in public, continuously washing hands with soap and water, using hand sanitizer that is at least 60% alcohol, and staying home when sick. She stated that public health is everyone's responsibility and together we can make a difference. Cleveland Clinic Martin Health Medical Executive Committee President Dr. Tiffany Page 2 of 46/12/20 FINAL MINUTES

Weakley implored the County to recommend that our community follow six-feet social distancing behaviors and wear cloth face coverings in public settings where other social distancing measures would be difficult to maintain. She informed the Board that health professionals are seeing increases in domestic violence, child abuse, mental distress, and economic vulnerability among patients and among their own families and friends. She spoke about the increase in confirmed positive cases (almost double than what was reported less than 14 days prior), and announced that Martin County's percent positive rate was higher than every other surrounding county (except Miami-Dade). Cleveland Clinic Martin Health President Rob Lord spoke about the increase in hospitalization of COVID-related patients. He announced that Martin County had more residents test positive for COVID than St. Lucie and Indian River Counties combined. He spoke about new treatment techniques (plasma therapy, blood-based antibodies, anti-virals, anti-inflammatories, and anti-coagulants), shared the drive-through testing number (419-3360), and urged the need to stop the behaviors that are causing the increase. MOTION: A motion was made by Commissioner Ciampi, seconded by Commissioner Smith, that we go back to our weekly Friday meetings. The motion carried by the following vote: 4 - Chairman Jenkins II, Commissioner Smith, Commissioner Heard, and Commissioner Ciampi Aye: 1 - Vice Chair HetheringtonAbsent: Agenda Item: 20-0781 MOTION: A motion was made by Commissioner Ciampi, seconded by Commissioner Heard, that we request of staff that they come back to us on Tuesday with the appropriate language that would require food service workers and any employees that work within close contact with customers or clients have to wear masks for the foreseeable future. I would also request of staff that if it's going to be a violation of the executive order that would require law enforcement participation, that any one that violates that rule be given one warning prior to having it be some kind of misdemeanor charge. The motion carried by the following vote: 4 - Chairman Jenkins II, Commissioner Smith, Commissioner Heard, and Commissioner Ciampi Aye: 1 - Vice Chair HetheringtonAbsent: Agenda Item: 20-0781 Florida Department of Health Martin County Health Officer Carolann Vitani announced the times and locations of upcoming COVID-19 testing. She confirmed that there were 1020 confirmed positive cases, and spoke about their continued contact tracing investigations. She informed the Board that they were working with the School Board for their reopening in August. She urged everyone to continue preventive measures to Page 3 of 46/12/20 FINAL MINUTES

help reduce the spread of the virus. Emergency Management Director Michelle Jones reminded everyone that we are still operating under a local state of emergency order. She spoke about distributing PPE supplies to assisted living facilities, skilled nursing facilities, and county departments. She announced that the following offices were open: the courthouse (limited), the Hobe Sound office (limited), and the Community Information Center. She informed residents that 'Alert Martin' remained active and urged them to register online for updates. FPL Senior External Affairs Advisor Kate Cotner thanked the commissioners for their leadership. She spoke about FPL's implementation of their pandemic plan, including funding for front-line organizations. She shared that they were able to lower utility rates for the month of May and have suspended disconnections through the month of June. She urged anyone who is having challenges paying their bill to go to fpl.com\help for assistance. She also spoke about FPL's commitment to continue to provide service throughout the 2020 hurricane season. PUBLIC - PLEASE LIMIT COMMENTS TO THREE MINUTES. ADJOURN The Board of County Commissioners COVID-19 Update meeting adjourned at 10:56 a.m. _________________________ _________________________ Carolyn Timmann, Clerk of the Harold E. Jenkins, Chairman Circuit Court and Comptroller Board of County Commissioners /mkv Minutes approved: _________________________ This document may be reproduced upon request in an alternative format by contacting the County ADA Coordinator (772) 320-3131, the County Administration Office (772) 288-5400, Florida Relay 711, or by completing our accessibility feedback form at www.martin.fl.us/accessibility-feedback. Page 4 of 46/12/20 FINAL MINUTES

by the >> you ready. If we all could please stand for a moment of silence. And then standing for the pledge. I pledge allegiance to the flag of the united states of america and to the republic for which it stands one nation under God indivisible with liberty and justice for all. >> if I can get a motion to approve the agenda. >> second. >> we have a motion by commissioner smith. Seconded by commissioner heard. All in favor. Aye. Motion passes 4-0 with commissioner hetherington absent. We will start with our present ers first and then public comment after that, as usual. So, today, we will begin with Dr. Robertson, deputy secretary of health, florida health department. She will be on zoom. >> here she is. >> good morning, everyone. Especially the secretary of health at the department of health and so happy to be here with you today. Just a little bit about our evidents in florida. We have 67 health county departments in the state. Inte greated health system which makes us uniquely positioned to handle this pandemic. We have standardized protocol. If resources are needed across the state, we work across the state to make it happen. we are working really hard to you know, review data and provide resources to different communities. In addition to that, we want to emphasize mitigation strategies are very, very important. For example, it is very important for individuals to continue to wear face coverings while in public. Making sure they are continuous ly washing their hands with soap and water. Using hand sanitizer that is 60 % alcohol when soap and water isn't available. One of the most important things. Staying home when individuals are sick. We have a county health department in martin county. She is here on the line. But we want you to know we stand ready to support and we have an integrated system and we are working very closely with the centers for disease control and prevention. Public health is everyone's responsibility and together we can make a difference. Thank you. >> okay. Anybody have any questions for Dr. Robertson. >> see no questions, thank you very much for attending our meeting. >> okay. We will move to Mr. Lord. Rob lord, President, ceo of cleveland ching, martin health. He last has a team member that will be speaking with him. >> Mr. Chairman, we thank you so much for the opportunity and I do have remarks and am concerned about the trends we see. Before we get to that. I have the privilege this morning of introducing Dr. Tiffany wheatly. She is our medical staff President. Elected which all the other physicians in our community to serve in that capacity. That is an extraordinary honor she has earned through extraordinary service to our community. By chance, she was trained at the cleveland clinic. So, this transition has worked very well and we are very proud to have our as the medical staff President. She has an important message and I appreciate that you are giving her the opportunity to present that this morning. Dr. Weekly. >> thank you, rob. Thank you, come mix. I am Dr. Tiffany wheatly. I am here as the executive committee of the cleveland clinic martin health systems. This has the support the high est body of the executive committee. Dr. Dan holly. Dr. Fits gerard. Nathaniel hill and many independent local physicians. These particular remarks were crafted collaboratively between myself. Dr. Carol brennan, she is a speed tris with public health. >> local psychologist and Dr. Robin castle. Local neurologist. >> we are here to implore the county to recommend that our community follow 6 feet social distancing behavior and per the cdc website. To wear face coverings in public settings where other social distancing is difficult to main continue. Specifically. Inside. Retail establishments. Office was, restaurants should have employees wear masks. We must communicate the need foreall citizens to remain jij land and follow basic safety recommendations as we reopen. Some of us have taken extraordinary measures to pre vent infection in ourselves. Family members. Patients. Including moving out of our homes temporarily. Isolating ourselves in our home from spouses, children. Removing all croaghting and showering before we come near a family member. Seeing dick patients in parking lots. Cutting back our schedule and demanding our staff adhere to c dc standards. We also understand the need to begin the process of economic recovery. Many of us are small business owners ourselves and our practices have suffered during the shut down. We have seens of increased domestic violence and in our patients among our own family and friends. The data at this time remains concerning. As of June 11th. There are 1,020 cases of covid-19 in martin county. Almost double than what was reported two weeks ago. Median age is now 39. much younger than the median age in surrounding counties. Half of all cases are young adults. The very demographic that is going to work. Gyms and businesses and caring for children and summer camps and transmit the virus to other s prior to the days in developing the symptoms. Incubation can be in the range of 14 days. This cannot be explained by hot spots in indiantown as this region has 432 cases while stuart and palm city have 465. This cannot be explained by increased testing. Case in point. Between May 29 and June 4. 1.9 test results that were positive. The total overall positive is 8.9% since June 1st. In other counties the percentages have dropped with increased testing. Martin county's percent rate is higher than other counties except for miami-dade. Researchers have estimated the use of cloth has prevented positive infections as phase ii moves forward. The goal to continue to use face coverings is key to reduce transmission with the least amount of harm. If we want to keep our citizens safe. We have to adhere to this. >> cloth masks May prevent transmission of covid-19 and evidence risk based approach. I will quote the article verb baitd tim. When we apply the principles of evidence based medicine to public policy, there is high quality consistent evidence that many but not all cloth masks reduce drop let and aerosol transmission and May be effective in reducing contamination by any virus including sars cov2. >> given the severity of this pandemic and difficulty of control. We suggest the benefit of reduction in transmission like ly outweighs the possibility of harm. We suggest appealing to altruism and the need to protect others as part of clear messaging to the community. As you decide policies that promote economic recovery. We implore you to enact polic ies and recommendations that protect public health. It will recover more predict ably if we have healthy citizens and if they feel safe in public. At this time there is no effective vaccine. This is how we move forward in a pandemic without a frequent ative vaccine. Until that time we should be wearing cloth face coverings. Thank you for listening and for this time. Rob lord. >> I thank Dr. Wheatly taking time out of her busy schedule. She is one the small business owners in the community who is impacted by this. And yet you heard her message. Saddens me very much to report to this commission what has happened since the last time I was here. We have a very concerning trend in hospitalization of covid related patients. in the couple of weeks before we entered phase I of recovery, createds in single digits. Total patients in the hospital. It bounced around between six and 11. But, eight, nine. Then we entered phase I. Two weeks after that, we had entered. And we were in the low 20s. So, we more than doubled. This past week, a week ago today, we had 21 patients. Next day it was 24. And next day it was 30. And the next day it was 35. The next day it was 40. And yesterday it was 43. When I left the office this morning it was 47. We have had many successful dis charges during this time. It is just that the rate of admissions is much faster than we are able to get them out the hospital. We have long lengths of stay. Patients have been there 25, 30 days. My concern is that these number s are going to continue to grow. We recorded, as Dr. Wickly recorded, our thousandth case and we have the distinction in martin county of having more residents test positive than st. Lucie and indian river combined. It took us about three months to do that. We trailed st. Lucie by a wide margin as well we should because of the shear population the two communities. And that number will continue to grow if we do not significantly change our behavior and adhere to the warn ings from public health officials. Epidemiologists and disease experts and I all too often and I am frustrated. I apologize and I hear people rendering opinions on this. They have no more scientific expertise than I do. I am a lawyer. We need to stop listening to those people and listen to the sont tises. Epidemiologists and others. We need to wear masks. We need to socially distance. Ach void touching our face as much as possible. And that is a particular problem for me. I think I have learned during the process. Every hand gesture I have involves me touching my face. I am trying to break my habit. I want everyone else to do the same thing. We do these things not because there is a political statement or issue. We need not to poll lit size this. This is not what party you belong to. I promise everyone in the community this disease does not care what party you belong to or who you vote for. We do this to protect ourselves and also, ours. When I was here a few weeks ago wearing masks was a question of good manners. Didn't want to make it a legal issue. What do we owe to the fellow citizens. Willing bs to sacrifice for the public good. We do it to protect our family, friends. And coworkers. And if we don't do this. We much longer are past the recovery and then we will be back at some point having to shut things down. That is not what I want. That is certainly not what the system wants. That is not what any healthcare professional wants. Anyone who thinks it is a political cause or something, it is not it. We want to prevent illness and disease. We continue to be incredibly vigilant in our facilities. We tip to perform tests on every patient that comes in. We configured waiting rooms. Done everything to avoid contact. We are not having problems of transmissions within the hospitals. So, it is still safe. Warnings from the past apply. People show up with streak systems two or three days after they started. Only after they become severe. That should not happen. Please come immediately. We are cohorting patients on specific units and again. Practicing all the best practices. We are continuing to limit the number of visitors. Some see some in cleveland. They are making a decision to try and relax it visitation standards. But we cannot do that here as long as the trend stays in the direction it is in. So, we are an out liar within our own system. i hate that but it is the right thing to do for patients and the community. What are we doing to treat patients. I have not reported on this and what are we and are not doing. We developed great techniques. I am so proud the talented physicians and nurses who are providing exceptional care to the patients. Variety of treatments. Convalue lens scent plasma therapy. We are using that on appropriate patients. That is an experimental treatment. Using blood based antibodies from people who recovered from covid to boost the patient's ability to fight the virus and there are promising early evidence on some patients that it works. Re emdesivir is an antiviral medication and we are using that. It appears to prohibit the virus in some patients and is being used as appropriate. I probably butchered this. Tamilis zumad. Biological medication used for rheumatoid arthritis. I have a couple of families who deal with that. It does reduce the inflammatory response. One of the more sophisticated complications is the inflorida torery response where it can potentially be fatal and so, we are using that medication. Blood clots have been a problem and some of these patients. So, if you were brought in the hospital. It is very likely you will be given an anticoagulant to keep that from happening. I am sure that is saving lives. We mentioned patient proning. Place them on ventilators face down and all of that seems to be working. We are not having many deaths and there is a, my concern, although we have had three this week. Okay. And my heart goes out to all of their families. It is three too many and against what we have seen across the nation. We have done very well. But, as soon as that gets used to an excuse to let our guard down or not behave appropriate ly. It is just wrong. >> we tested over 3800 people at the drive through. The number is still there. If you want to test and have any symptoms at all. Please contact that and we will get you tested the health department is out there doing it. We have other folks in the community trying to do testing. And we support them. We are working collectively with the health department and everybody else to try and be a very productive community member. A good citizen. To those feeling like they feel they are lectured. I am sorry. We need to do that. I would say to this commission. You have done nothing but try to do everything you can by the community. This is behavior that is out there in the community. We need to try and stop it. I appreciate your help on that. But, it is a pleasure to present to you and work with you. In closing, I also want to touch on an issue that I think -- I think this is a week where it needs to be done. I am very proud to say. Dr. Holovitch, enterprise worldwide recognized racism and racial buys a as a -- bias as a public health issue. We are seeing that with covid-19 as a disease that has had a disproportionate impact on the african-american community. And as an organization, the cleveland clinic is pledging its support to be part of any solution in any community. We are committed to identify how racial disparity insist our society undermines 350e789's health. Those disparities are pretty apparent to many of us. There are disparities in healthcare and jobs particular ly those that offer healthcare benefits. Housing. And healthy food after -- availability. >> all important aspects of this. For many years we observed the impact of these things on infant mortality or chronic disease management. And as a society. We can do better and the chief land clinic is here to be a resource for the community as we decide to address those issues. And I thank you again for your time and we will be happy to answer any questions. >> Mr. Ciampi has one to start off with. >> Mr. Lord, thank you very much. For all of your leadership and you have been here many times as we have had these meetings and you and I happen to be personal friends and I have the huge advantage of being able to reach out to you and ask you questions during the the week when we are not having meetings for a full transparency, you and I had dim similar conversation to the message you just delivered now yesterday. It is weighting on me and I am not trying to make a new jerk rear action to what you just mentioned. I have time and I have the pleasure of being friendly, friends with Miss Vitani from the health department and she has been very good at keeping us all informed. I assumed all of us informed and I will get the text message s that just give those sad updates, the count if you will on fatalities in our community. None of us are experts up here. Dr. Wheatly, I appreciate your comments and some of the names you mentioned that are part of your executive group and I see some of them are here with you this morning. I know these are members of our community. So, us not being expert, I will speak to myself. Not being an expert. Not being like you said, Mr. Lowered, a professional in the medical field. we have to rely on the advice and smart counsel of our friends and advisors in the medical field. I have been using sort of a term for quite awhile. That you know, it wasn't so much the numbers that were test ing positive. For me, my indicators were, how many are in the hospital. How many people are in the icu and how many have passed away. >> and I have also been a big advocate of, we all closed everything in the beginning nationwide and it wasn't really so much of a personal or board decision to do that. It was, just that is what we are doing and we all did it and then the governor gave us -- how we would open up and then the issue for us was, as a community, smaller community, north of three very large communities, that had the state 's highest hot spots. We had to be different in our approach than the neighbors to the north. Because we were the buffer. Then, we had the opportunity and the advantage, if you will, to apply for and receive the assistance at the state level to bring in the team that went around and tested in indiantown that was our area of concern. Our greatest area of concern. And then to do the pop ups. And then I started to believe. Well, the reason we are having the additional positives, we are testing. We heard from Dr. Wheatly, there May not be a correlation directly related to that. We always consider indian river county, the sister county. close in location, close in population. Close in demographics and their numbers are dramatically less than ours. We have tested much more than they have. Based on the information I was able to research. With that being said. It is not like they are a little bit behind us or the percentages are not there. And then when we hear the statistics martin county now has a higher positive rate than st. Lucie and indian river combined. And to remind people. St. Lucie is nearly double the population that we have. And they have done a lot of testing there as well. So, it forces us now to look at the approach and decide what can we do differently. We heard the information from you and Miss Vitani over the last couple of meetings and we stayed the course. If anything, we were continuing to open up the final few things the county had control over. And the last couple of weeks. I am also, as a former small business owner and work for a small business, very concerned and you have heard me say in the past about the emotional and mental health and the economic health. But, you know, even if we dis count what is happening elsewhere in the state and dis count what is happening elsewhere in the country. The four of us today with commissioner hetherington not here. And our staff. we have to focus information on what is happening right here. Every word you say, you are not one for exaggeration. You know to try to fan the flame. So with that in mind. We need to have a different approach. Even if the country continues on the right course. If we don't here locally, we will have our own share of problems. Then, we are back to having to make decisions that are difficult for everybody. So, with that in mind. I think we have been very fair and ream in our approach to opening businesses. And I think we were all hopeful that it wouldn't have an add adverse effect on the numbers and over the last few reports you have given it has. Now, it is starting to come in a dramatic fashion. I have two recommendations, Mr. Chair, that I would like to make in the form of a motion. The first motion is that we go back to our weekly friday meetings like we are having now I think when I made the suggestion that we meet on fridays on weeks when we don't have a commission meeting and during the weeks we do have a commission meeting. That does either. Like for instance, today is friday, we are having a meeting and another tuesday. So we won't have any indication in we put certain practices in place by tuesday. We won't really know. I wish we would, but logically, we don't know positive re actions to. by tuesday. >> you need about two weeks. If we don't meet again next friday, we won't see, to hear and have the conversation collectively for another two weeks which I think, based on what is happening. Is too long of a period. Maybe we will meet friday and see what happens and we we can dial it back again. I know it creates a lot of effort and anxiety and stress on our staff to be here for these things. But the numbers, the serious ness of the information you have given us would require that. That is the first motion. That we go back to friday meetings. We were having them when we were in a much better situation than we are currently.% >> I will second for opening up for discussion. >> okay. Any discussion on that. Okay, we have a motion by commissioner ciampi. Seconded by commissioner smith. All in favor. Opposed. Motion carries 4-0. Commissioner hetherington not here. >> my next motion, I don't make easily. It is one of the more difficult motions but I think based on what we heard from Mr. Lord, there are medical reasons why this next step is necessary. And there are social reasons why this next motion is necessary. But, the word or the phrase I should say that Mr. Lord has used is just common courtesy and manners. We have all been out and about. We have all seen, you know, I can look out in the room and see the majority of the folks wearing masks and all of the people in the medical profession. Everyone that has any affiliation with the medical profession. They are wearing masks in this room. I made a motion a couple of weeks ago and it did not pass. But, I think it is at the very least reasonable people, will understand that we need to do something. And if I traded my position with some other individual in our community and sit up here, I think they should most likely reach the same conclusion. We need to rediscuss the concept of anyone in the food service bus, if you work in a supermarket or a deli or in a restaurant. If you are active employee in the food service business, you should be appreciative that your facility, your employer or your business is reopened. Having the opportunity to employ your workers or to make a livelihood for yourself and them. And at the very least under the circumstances that we have just been presented wearing a mask. I believe is appropriate. Entry level form of protecting. There are some people that say masks don't work. I have read into that. Most of those things we see on motion media that say the masks will do this or that or won't do this or that have been de bunked by legitimate professionals by any persuasion so, I would make a motion. Two fold motion now, Mr. Chair. One, that all food service work ers wear a mask while they are actively working. And two, because it is not just people that are food service workers. Any and all employees that work within close contact of a customer or client should also be wearing a mask. For for the foreseeable future. I know this is already happened if you go to the dentist or doctor. They are wearing masks and wear ing face shields and everything else to protect themselves and you. I know folks in hair salons. I have had a haircut since we opened barber shops. The woman who cuts my hair was very dutiful. She had a mask. Sanitized everything. Sanitizing her equipment. They were entrying the chairs down. Counters down. Credit card machine down. I think the conversation we had recently that a majority of well intentioned businesses are already doing these things. I would basically agree with that. But those are not the ones I am concerned about. I am concerned about the other folks who think, I don't need to do that. My motion would be all food service workers and all employees that work within any close contact with customers or klines -- clients be required to wear face covering for the foreseeable future including re tail. >> I think I have a feeling what our lawyer is going to say >>. >> we need just a little more detail. I need a lot more detail and whether we are talking mandatory or strongly encourage