The McLean County Board of Health neither endorsed nor rejected the 11-county Heart of Illinois plan to reopen businesses during the pandemic, but during a nearly three-hour meeting Thursday night members expressed reservations and pointed out unknowns.
The health panel was asked to give input on the plan before a May 28 special meeting of the McLean County Board to consider the HOI plan. Instead of a thumbs up or down, the health board asked Health Department Director Jessica McKnight to deliver to the county board a list of requirements the health department would need to implement the HOI plan, costs associated with them, a timeline for readiness to embark on reopening, and an estimate of how long additional staff would need to be employed to allow for responses to likely surges in COVID-19 infections in the community.
The timeline is imprecise, but could stretch into the latter part of June, beyond the May 29 start to reopening contemplated in the HOI plan.
“My plans shifted today,” said McKnight. “What resources do our staff need? It has changed a little bit in the last 24 hours.”
A coronavirus testing site at the Interstate Center in Bloomington will remain open beyond a scheduled Friday closure.
“We have plans 90% complete for testing and knowing that the IDPH testing site will continue, that buys us a little time,” said McKnight.
The IDPH will use a private company to run the site as National Guard soldiers move to a site in Peoria. Other testing efforts also are in the works.
“We have plans to work with the federally qualified health center (at Chestnut Health Systems) to move forward on testing the second or third week in June,” said McKnight. “We want a site and then want to make it mobile (for testing in rural areas). Those are the conversations we are having with Chestnut.”
“Our goal is for that second to third week in June knowing that we have a little bit more time to really do this right,” said McKnight.
Also, McKnight said this week she learned of a "substantial" grant to help pay for contact tracing staff.
The health department has six staff that do contact tracing, has identified six other staff that could be trained for that, and might need to hire an additional six to build capacity to trace people who have come in contact with newly-infected people during surges of infection.
To comply with the HOI plan, health departments in the various counties in the region also must monitor the presence of surges through the positivity rate—the ratio of positive tests of COVID-19 to the number administered.
“Positivity rate is something we do not yet have. We don’t want antibody tests mixed in with that data,” said McKnight.
She said data for the county is out there in various databases that would have to be collated and analyzed by somebody in the health department. Health Board chair Dr. Carla Pohl said there is an ongoing cost to that effort.
“Raw numbers mean nothing. It’s data over time,” said Pohl.
Critical Care Capacity
Another element affecting the HOI plan to keep businesses open is preserving 20% of critical care capacity in area healthcare facilities. Hospitals would no longer be able to perform elective procedures if capacity falls below that threshold.
Health board member Dr. Alan Ginzburg said that’s problematic because ICU use tends to roller coaster based on transfers from a hospital’s catchment area. Bloomington-Normal hospitals attract critical care patients from facilities in Dewitt, Logan, and Woodford counties, for example.
“Hospitals are very financially motivated to get their elective surgeries going. Now you have given hospitals financial incentives to keep ICU beds open and refuse transfers,” said Ginzburg.
Health board members said a successful reopening requires citizen and business participation in best practices.
“Most people are honorable and will comply, but some will not,” said health board member Hannah Eisner. “And we will need some enforcement mechanisms.”
Enforcement can be problematic under state law, said McLean County State’s Attorney Don Knapp, who told the board the health department must document seeking voluntary compliance with accepted public health standards and that failure to comply will result in significant community morbidity or mortality.
“If immediate action is required just go padlock the door,” said Knapp.
That triggers a process the state’s attorney’s office would be involved in to notify those under isolation, quarantine, or closure they have a right to a hearing within 48 hours to keep the person confined or the business closed.
“Standards are incredibly stringent as they should be if we are taking somebody’s liberty away. We have to prove by clear and convincing evidence there is no other way to satisfy public health and safety,” said Knapp.
Pohl noted that provision of the state health code typically is applied to individuals, most often tuberculosis patients who are not complying with their treatment regimen.
“COVID-19 will be the 'Full Lawyer Employment Act of 2020' because we’ll be litigating these issues for a long time,” said Knapp. “What my office believes is there will be a case-by-case review of everything.”
The HOI reopening plan depends on voluntary efforts by businesses and people to keep the overall community safe. But they have to know how to comply and there are many, many details.
McKnight said the website Peoria County built with that guidance is useful and will relieve McLean County of a burden to develop such policies, register community complaints, and follow up on them. She said McLean County could opt into that website at no charge.
McKnight acknowledged she has not yet developed a promotion plan to make businesses and individuals aware of the website, or generated a cost estimate for it.
Ginzburg said he still has concerns about any reopening plan—the governor’s Restore Illinois blueprint or the HOI roadmap.
“I don’t know how you open a bar and social distance and I have this nightmarish picture in my head of what happened in Wisconsin when the Supreme Court struck down the closure order and the bars opened and it turned into a big party. And that will be responsible for spreading this disease,” said Ginzburg
Even if restaurants abide by 50% capacity limits, Ginzburg said they are still inviting people to take off their masks and go against principles that keep infectious diseases from spreading.
“We haven’t seen it (COVID-19) as much down here which makes us much more fertile ground. They are estimating in New York that there may be 20% immunity and that is the highest in the world. Our immunity here is almost zero,” said Ginzburg.
Health board and county board member Susan Schafer said there are other considerations, both economic and health linked.
“You are starting to get into some mental health problems too, the longer this goes on. And we are also in that business, too. We have to not only consider the virus issues, but also the longer term,” said Schaffer.
Health board member Richard Ginnetti said all the talk of reopening, no matter the plan, is a "shot in the dark."
“It’s not the flu. It’s much more contagious than the flu and much more deadly than the flu. It will spread the more we put people together,” said Ginnetti.
“There is risk in opening up and there is risk in not opening up,” said Schafer.
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