WEBVTT

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Sorry, I'm not there in person, but there's a 5 o'clock meeting and What are the roads gonna do?

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And so I just came home for this.

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Gotcha. I admit you here in the chambers. Smaller crew, but it's gonna be a quiet day.

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3 of us will keep it lively here.

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Not, not if you get up and dance.

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Okay.

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Thanks. Well, it is 2 30 and we do have a quorum.

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Great. Alright, and then I will call our meeting to order at 2 30.

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And, I didn't see any public comment on the, on your email this morning, Glen.

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Nothing email then. Okay. Do we have anyone on? There's no one in the chambers.

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Do you have anyone on Zoom room? No one has, no, no one has requested, to speak.

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Grey has arrived. There's anyone out there that wants to be promoted to a panelists to speak.

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So opportunity for public comment.

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I think, we can keep it open for 15 min, but, there is nobody at this time.

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Okay. So we just seeing none, I think we'll move on.

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We have, everyone had the opportunity to look over our minutes and our, agenda. They actually put the agenda first.

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Will that motion to prove the agenda?

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I'm happy to move that we approved. Agenda for the Board of Health for Jefferson County for January eighteenth, 2024.

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I'll second.

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Hi.

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Okay.

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Hi.

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And we have a vote. All in favor? Alright, call the vote.

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I gotta call the vote. Don't I? I'm waiting for Heidi or Greg to say something.

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Yeah.

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Yeah. Second. You got this.

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Okay. Got it. Alright, moving on to the approval of the minutes.

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I'll move that we approve the minutes as presented. See the Kate's in the waiting room as well or the attendees.

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Second is.

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Hi.

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Okay.

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Hi.

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Alright, all in favor. We, Alright, moving on to. Old business. I guess we'll pass it off to Apple for the County Health Report.

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Good afternoon everybody. Nice to see you online and in the room and snow here is melting, which is a good thing.

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I know that it's treacherous for other folks and we've got a lot of folks without electricity and some without water even.

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That's what you said commissioner wrote and so anyway just keeping our thoughts with everyone and the safety of our staff as well.

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We'll see how long this. Lasts, the coldest of it is beyond us, I guess.

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So we'll see what happens. I think there is one announcement that probably should go at the beginning.

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And this is about that the city council has rotated its members around to different positions. And so Libby will no longer be with us, but she is being replaced by Aslin Palmer.

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Correct. So it was here earlier, but it's not here at the moment. Oh, Libby was here earlier.

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But it's good to know that that turn of the year change has happened for the city representative.

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Do we need to take any? . Change the Okay, I don't think so. Right.

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So I will.

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And let, Libby came over to Behavioral Health Advisory Committee. They kinda switch those 2 because of their schedules.

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Yep.

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Oh, I see. Great. And thank you to the Board of Health in general for staffing the Behavioral Health Advisory Committee as well with an alternate additionally.

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Great, thank you for offering to do that. I'm going to go ahead and I'm gonna actually share my screen so just give me a moment

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And then I'm going to. Enable this.

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Many buttons to push.

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I thought so many buttons. Dancey slide deck and I looked over it. Got great photos in there. Thank you.

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Thank you, thank you, thank you. So, happy new year. We haven't been together since the end of 2023.

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2024 is started off to the races. There's a lot to do and it seems like the celebration of the new year has already come and gone and we're in the thick of it already.

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And it seems like the celebration of the new year has already come and gone and we're in the thick of it already.

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So we're just busy. That's nothing new. There's a lot of work being done and accomplishments being made, tidied up quite a few things from the end of 2023, given it was December, 2,023, given it was December, some grants do end then or at least have big reports do so, the end of 2023, given it was December, some grants do in

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then or, at least have big reports do. So, we took care of that.

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Grants do in then or, at least have big reports do. So, we took care of that.

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We're also continuing a lot of new, innovations as well as continuance of our basic services.

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And so I just want to make sure that we in a regular way, sort of the updates from a highlights reels perspective.

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So this was a concept that we started a few years back and it's really gotten a lot more traction.

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I would say post COVID. We've had a lot more energy and the ability to think creatively and work together to really have everybody in the department.

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50 plus people now contribute in a way that's meaningful to them and to their programs to offer data to make it bite-sized so that we can utilize these highlights reels in ways that are sort of elevator speech style, but also can get more deep into the weeds about individual programs and successes they've had or events they've hosted.

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At least here in this conversation. So I did add these slides into your packet because I don't typically add any content to my just basic update, but I thought every quarter it might be nice for you to see these slides ahead of time and then you can digest them a little more rather than me just sort of.

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Giving you a flurry of them in this quick update and and maybe we don't have as much conversation about what they contain in that format.

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So anyway, I think I will do that going forward. I want to thank the communications team who puts these together every quarter.

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They're in charge of facilitating interest and kind of commitment as well as sort of fine-tuning and honing what staff give to these highlights.

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They also keep track of what we have reported on and what we haven't reported on. And if you haven't noticed over the last few years, we just have.

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So much going on so plenty plenty to share again these are very abridged They're meant to be consumed quickly.

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So there's a lot more depth behind them. That you might not see in these slides, but we really like the process.

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It's collaborative and inclusive of everybody at every level of our department. Alright, so I'm gonna.

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Move ahead here. So in September we partnered with Seattle Children's Hospital. And we hosted a firearm safety event in Quill scene.

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We engaged 25 individuals and families and distributed 56 safe storage boxes. I mean, devices including boxes, including trigger locks and include including cable locks during the event.

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We were actually trained, several of us staff who attended along with lots of volunteers and the folks from Seattle Children's to be able to, we did a train the trainers, so to speak, to learn for some of us to learn how to help others in the future.

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Continue to will receive supplies like these and continue to be able to distribute them and teach people to use them properly.

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With mentoring and coaching from from our staff. Ongoing. So that was that was really good. You could see in the picture that a few of us from public health were there, Veronica, our deputy director, myself, Barb Jones as part of the Childship program and she's been really instrumental in helping sort of in live in the discussion around firearm safety and bring that to one of our public health goals, which

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is to help families and individuals, you know, reduce health risks and also prevent violence and fatalities as well as we talked a lot about suicide prevention and youth etc.

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So I think this particular event touches on quite a lot of topics and we want to make a special thanks to our partners and volunteers including the.

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And to the event we had Cynthia with Universal Language Services offering Spanish interpretation at the event for, I think we're there for 6 h.

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We had other partners join us from the Kulsing Community Center. We've had Help from the US Veterans Affairs of Puget Sound Area Lake Division.

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We've had help from DEM from Jefferson County and also from the Sportsman's Association as well as Jefferson Healthcare.

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So it's a really collective. Concept and we applaud Seattle Children's for making this type of thing available throughout the state of Washington, but we worked with 2 of their staff.

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Really closely for a number of months to queue this up. We learned a lot. We made a lot of deep partnerships with Seattle Children's Hospital and I think, it was a great success.

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I had an incredible number of encounters with folks at this event in coal scene that I don't think had really.

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Maybe come to events of ours in the past, no matter the topic. So I felt like the variety of citizens who came was just It was very edifying.

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I think the reach was was was diverse and meaningful. So we will look forward to a potential second version of this METI in the spring.

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And we'll talk more about that later.

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Next is, our empowered teams coalition, which on October, the 20 eighth partnered with the local law enforcement and hosted 3 medication take back sites around our county.

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We had a total of 49 pounds of medication that were collected for safe disposal and we also distributed 21 Naloxone kits.

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So we've started pairing our safe disposal of medications with distribution of naloxone.

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And that pairing has actually been quite popular and we've got a lot of great feedback about it including from law enforcement who is already there.

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And I think that's helped us build some of our relationships further. With law enforcement in the county.

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Hey, 49 pounds, that must be a lot. Okay.

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Huh.

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Yeah, it is and you know sometimes a lot of it is vitamins. Which you might not think are unsafe, but disposing of all medications properly, especially expired ones or putting them in the right waste stream is really what's what's at hand here and being.

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Yeah.

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This extra safe with folks in terms of getting a hold of . To be exposed to medications for reasons that would be unhealthy for them

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And vitamins often come in tasty flavors and eaten by small kids can be just as dangerous as other drugs.

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That is very true.

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I was gonna volunteer that too as many over the counter medications can cause an overdose and children, that we might not know.

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So it's good to get rid of the vitamins too.

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And just a reminder that we do this event twice a year. So this was the October fall version.

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We do another one in April every year.

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Next on November thirtieth, we, I love this. We had 700 used tires dropped off for recycling in quill scene.

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So this tire collection event kind of roves around the county and we've done a few so far this last one in November was down in Quill scene and we had a great turnout.

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The tires, I think we've talked about this in the past, they're taken to a facility where they're processed.

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Into new products so things like playground mats and recycled wire want to make a special shout out to Nick Lawler and Alyssa Hendren who are on our team at Public Health for organizing and staffing.

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This event and to the Department of Public Works for providing the venue down in Quilstein and the Department of Ecology for funding that's this sort of cleanup and also to Liberty tire recycling.

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A lot of people come in together to really make an effort to keep. Keep our land, scape clean of of used tires for all the appropriate reasons and to get them to the right spot so they can be reused in different ways.

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Jefferson County's Wik Nutrition Program that's women infant and children has distributed over $4,000 of federal WIC.

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Farmers Market Nutrition Program funds, that's the FMNP, which happens throughout the summer and into the early fall.

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So these funds are for young families to buy fresh local produce and Jefferson County farmers market they match the funding resulting in $9,000 of produce putting more fresh local food.

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On the tables of folks in our county and this program is really strong. Gotten even stronger and I'm really proud of our WIC team for pulling this off every year.

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It's an orchestration that takes quite a bit effort and our team is small. And we have good numbers in our WIC enrollment and I just am really proud of the work they've done to continue to find ways to match and distribute funds and produce.

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So people have access to. First, the first vegetables.

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Do you have people other than? Karen. Who is it, Oprah Meyer?

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Working on that.

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Yeah, so Karen Overmire is the, program coordinator. And then we have a nutritionist which is required, a registered dietitian I believe, who actually works remotely and that was a consequence of several things including a retirement on our staff and also the pandemic and she is not local.

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But she is able to have virtual consults with our clients and it's been working very well and that was actually a suggestion from the Statewide Wik for us to have access to a registered dietician in a small rural health jurisdiction.

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Where we just didn't have access to that sort of recruitment as easily and it's worked wonderfully.

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So I'm really impressed. And then we also have Susan Taylor who is a WIC clerk who helps enroll and also walk people through the certification process.

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You have heard her speak. I think maybe it was late last summer. Which was wonderful to have her share in this way.

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And then we also have a breastfeeding peer counselor, Italina Cervantes who works to help.

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WIC clients with breast feeding and chest feeding and all of those. Scenarios in the more off hours so we know that families utilize WIC in a big way but WICK closes every day at 4 30 and we also know that there's a lot of

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There can be a lot of challenges in the evenings and the weekends and we want to make sure that families have access to talking with somebody, a peer counselor who has walked.

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Through those times also themselves and is highly trained to be able to mentor folks in those moments that are really challenging when they don't necessarily have a clinic appointment or otherwise.

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You know, professional support to help them. And part of that team is some work from our nurse on staff, Sarah Jane who is an IBCLC certified lactation consultant.

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So there is that as well.

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And I will try to hurry up. In November, Jackson County Public Health hosted 2 trainings led by Usawa Consulting.

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For Jefferson County staff. We had folks come from other departments as well and that helped participants learn more about inclusion in our businesses and organizations.

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The objective was to understand, assess, and increase organizational inclusion and you'll, some on the wrong one.

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Okay, we jumped ahead. Sorry. That's that's it. Appreciate it.

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That's stuck. And we are at a time. Yeah, we're racing down to the list.

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I have to, to have to move this along pretty quick. Okay. Let's see. Let me move here.

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Any high point you want to hit? Yeah, I will hit this one. Okay. It's so interesting.

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With the help of Washington State's Department of Health, Jefferson County Public Health has held mobile immunization clinics in each of our Washington State's Department of Health, Jefferson County Public Health has held mobile immunization clinics in each of our Jepsen County Public Health has held mobile immunization clinics in each of our Jefferson County school districts this last fall.

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Offering a range of childhood vaccinations, which obviously expands accessibility out into the communities and that's been done by the Cara Van.

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And we really appreciate that they've worked so closely with us to help bring what we call sort of pop-up clinics out into the communities directly to folks.

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And this last one that we had in December. Was in quill scene it was at the request of folks at the Kulsing Community Center, especially asking for adults to have access to COVID and the flu vaccine.

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So we appreciate coordinating with State Department of Health and having that resource in our community. The next one that we'll have is in Brennan at the Community Center on February sixth.

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And I know I need to stop. So you have the rest of the slides in your packet and if you have any questions for me, let me know.

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I'll try to do them faster in the future. Never enough time. Because there's so much good work happening.

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Public health. Thank you, Apple. Alright, Keith. Just mentioned that, our new city council representative.

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Is present. Alright.

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Yes. I changed computers because it was kicking me on and off and on and off. But hi, welcome everybody.

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Oh, well, welcome to you. Thanks for joining, joining us today. Ford, Iceland, East on board.

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All right, you. And then we should circle back to public health. I'll public. Should I do that after old business?

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I think we should probably do it now. Then we will pause in the middle of old business since we have a member of the public walk in and you want to step up to the mic.

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Thanks. Introduce yourself. Yeah, I'm Stephen Schumacher from Port Townsend.

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So what do you know? I mean when COVID hit public health said that they knew that the world needed to be locked down.

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But now, Frances Collins, the NIH director at the time. Regrets that quote, we weren't really thinking about what that would mean.

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We weren't considering the consequences. The public health people have a very narrow view of what the right decision is.

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You attached 0 value to whether this actually totally disrupts people's lives, ruins the economy, and has many kids kept out of school in a way that they never quite recover from.

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Collateral damage. And so public health also said that they knew everybody needed to wear masks, but the coconut views then and now shows that masking has no good evidence of viral effectiveness.

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And public health said that they knew that everyone had to stay 6 feet apart to be safe. But last week, Dr.

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Fauci admitted before Congress that I was just made up with no scientific basis. And went in the warp speed.

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I meant our mRNA jobs were rushed through testing and the controls were injected just weeks later so that long-term safety data was not possible.

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Public health nevertheless proclaimed that they knew that jobs were safe and effective, even though they could not possibly have known that at the time.

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After all, the child's never even tested for protection against transmission. And that's as COVID coordinator Deborah Burks later admitted the vaccine promises that she had made were just based on hope, not knowledge.

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And another thing that public health I didn't know and was recently revealed was that the trials were a bait and switch because the vaccine manufacturers couldn't produce to scale.

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So they actually ended up using different methodology to make all the jobs that everybody took. And what they actually, what was ever tested for in the trials.

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The second rate. Methodology neglected to clean up all the DNA that was produced. That was used to produce the RMRNA.

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And that's been verified by independent researchers around the world. And that the that there's actually the the vaccines that are being distributed or contaminated with random DNA.

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So anyway, so Florida, Surgeon General Joseph Lopado asked the FDA about this and the FDA confirmed that's true.

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That a different methodology was used and that the The vaxes are in fact contaminated with DNA.

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But the FDA then said that they really don't know how much effect that's going to have.

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And that they're not gonna bother to test to find out. And so when Joseph Lapado heard that response, He basically, Florida has now declared that there are no longer recommending anybody to take the vaxes in Florida because they can't know that it's safe.

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I mean, how could they know? Because the FDA is not testing to find out whether the DNA canamination is going to cause any problems.

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So anyway, just to wrap up, you know, there's a famous. Song by Leonard Cohen called Everybody Knows.

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You know, everybody knows that the boat is leaking. Everybody knows the captain lied. Everybody got this broken feeling like their father or their dog just died.

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Everybody knows it's now or never. Everybody knows the plague is coming. Everybody knows everybody knows.

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And you know, vaccine uptake at this point, only 3% of the people who are eligible take the latest booster are taking it.

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More than that are taking that in poor Townsend because of public health information. That they're giving people, but everybody knows everybody knows.

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Is there anyone on line is look like to address the board?

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There anyone online so waiting for public comment Seeing none. Saying then we'll move on. Is there any response from the board?

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Glen's guiding me here guys. Thank you. This is my first rodeo. Is there any response to Dr.

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Barry or anyone would like to respond to the public comment?

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I can give a brief response. I know we're short on time. There were several inaccuracies in that public comment.

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But I think there are some, 2 points to, to acknowledge that it is incredibly difficult to form a response to a virus that is new.

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And trying to make public policy while we learn more and more about a virus is challenging. And so that That does explain some of the changes in recommendations as we moved through this process.

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We were making decisions as we went as new information came in, we changed the guidance to match that new information.

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Early on there was an early understanding that this virus was likely spread by droplets, which is where that 6 foot recommendation came from.

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That's standard droplet precautions. But over time it became clear that it's aerosolized.

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And so that's when we learned that actually masks were incredibly important and the distance wasn't enough.

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The other challenge with this virus is that it changed. And so the virus of the very beginning actually is not the virus that we have now.

00:25:09.000 --> 00:25:24.000
And so our guidance has to change to mass, to match that. Thankfully, unlike what the commenter said, the vaccines that we have now are the most studied in the history of all vaccines.

00:25:24.000 --> 00:25:33.000
We have an incredible amount of data on the safety and ethicacy of these vaccines. We followed them very closely and they've been distributed incredibly widely.

00:25:33.000 --> 00:25:39.000
And then then continued to study as we go and they have consistently been demonstrated to be both safe. And effective.

00:25:39.000 --> 00:25:45.000
They do reduce your risk of contracting and transmitting COVID, but they don't do it to 0.

00:25:45.000 --> 00:25:51.000
I think there's there's an understandable desire for each of our interventions to be 100% effective but that's not how medicine works in really any part of medicine.

00:25:51.000 --> 00:26:02.000
What vaccines do is they reduce your risk. They're reducing risk of getting sick and giving the virus others and of dying.

00:26:02.000 --> 00:26:11.000
And that's why we, why we take them. Why we recommend them. Masks also reduce your risk of getting sick and of transmitting virus to others.

00:26:11.000 --> 00:26:20.000
Not a hundred percent, but quite a bit. And that's why we add them on. We have multiple very good but not entirely perfect interventions that we can layer reduce our risk.

00:26:20.000 --> 00:26:25.000
And I think it's important to acknowledge that we never had a full lockdown in the United States.

00:26:25.000 --> 00:26:28.000
The way things happened in China is very different than what happened here. There certainly were missteps in what was recommended in the beginning.

00:26:28.000 --> 00:26:52.000
And a good move. I think to loosen restrictions as soon as was feasible. I know in our region, I was a prominent advocate of opening schools as soon as humanly possible because of the effect on children when they close schools as well as the effect on working families.

00:26:52.000 --> 00:27:02.000
We don't always have the power at the local level to change state and national decisions when it comes to those things, but I think it isn't really important to learn from what went well in poorly in this pandemic.

00:27:02.000 --> 00:27:09.000
And one of the things I think I hope we learned is that closing school, well, actually very effective to reduce transmission of infectious diseases has very significant deleterious effects on children and their families.

00:27:09.000 --> 00:27:29.000
And so we need to be very cautious about that. And that one last quick thing. That was actually a big driver of why we switched to the vaccine order for restaurants, was because there was talk of closing schools again in response to the spike in viruses and we didn't want to do that.

00:27:29.000 --> 00:27:38.000
We thought it was unfair to ask children and impoverished families to make sacrifices that we wouldn't ask of businesses and people who can go out to a bar.

00:27:38.000 --> 00:27:43.000
And so that was actually a policy decision that we made. That's all I have for today.

00:27:43.000 --> 00:27:52.000
Thank you, Dr. Barry. Alright, I am gonna keep us moving along, Keith. Ready for the Jefferson Healthcare Report.

00:27:52.000 --> 00:28:04.000
Sure. First of all, just to second what Dr. Barry said. I have family members who are down with their second case of COVID and who are missing school.

00:28:04.000 --> 00:28:12.000
And, they're fully vaccinated. So it isn't a hundred percent, but certainly, certainly helps.

00:28:12.000 --> 00:28:26.000
In addition, COVID is here and it's probably going to be here in some form or another. Currently at Jefferson Healthcare, we have about 20 employees who are out sick on any particular day.

00:28:26.000 --> 00:28:37.000
And currently about half of those are because of COVID. And so it definitely is in the community and hard as it is to remember.

00:28:37.000 --> 00:28:46.000
That it's with us and that there are important ways that we can help. Prevent the spread. We do need to continue to be mindful.

00:28:46.000 --> 00:28:57.000
Meanwhile, in spite of the disruption. From COVID and staff being out. We are continuing to provide.

00:28:57.000 --> 00:29:06.000
Almost follow the services that we've usually provided. During our major, rebuild at Jefferson Healthcare.

00:29:06.000 --> 00:29:17.000
There is some delay in routine imaging. Because of some moves of some of the equipment There's some shortage of parking.

00:29:17.000 --> 00:29:24.000
So anybody who's coming. To our main parking lot needs to remember that parking is tight.

00:29:24.000 --> 00:29:37.000
You may have to park a little farther than normal. So leave yourself some extra time. And at the next board meeting, I'll give a little further update of how that.

00:29:37.000 --> 00:29:45.000
Demolition and new reconstruction project is going. We're pretty much on target and are very excited.

00:29:45.000 --> 00:29:51.000
About the future potential. Or Jefferson Healthcare. Thank you.

00:29:51.000 --> 00:29:54.000
Driving by the 65 building is down and there's a giant pile of bricks so there's definitely things happening.

00:29:54.000 --> 00:29:58.000
Yeah. That's right.

00:29:58.000 --> 00:30:05.000
Okay, Commissioner Dean, are you available to give the State Board of Health update while you're on the road.

00:30:05.000 --> 00:30:19.000
Yeah, yeah, thanks for tolerating me being in transit. Quickly. We had a state board health meeting last week and we did.

00:30:19.000 --> 00:30:20.000
Yeah.

00:30:20.000 --> 00:30:22.000
Approve and cast the new state on site. So that will be phased in over the next year or 2.

00:30:22.000 --> 00:30:29.000
And. I think you will be busy, dealing with that in coming months.

00:30:29.000 --> 00:30:30.000
Let's see, we spend a lot of time talking about indoor air quality.

00:30:30.000 --> 00:30:43.000
We anticipate they're being. A need for more rule writing around inter air quality. So stay tuned for more on that in the future.

00:30:43.000 --> 00:30:50.000
The state health report is something that the board has to create every couple of years and that process is upon us.

00:30:50.000 --> 00:30:59.000
So at the State Board of Health will be meeting around the state to hear from local communities about. Their health.

00:30:59.000 --> 00:31:01.000
Challenges, how they interpret the public health system. And other things which I'm really looking forward to digging into.

00:31:01.000 --> 00:31:10.000
Number of legislative things, we're discussed, and maybe we'll save that for next.

00:31:10.000 --> 00:31:17.000
Month. Like if something I forgetting but trying to be brief, so I'll leave it at that.

00:31:17.000 --> 00:31:23.000
You think of it, just throw up a hand. Okay, thank you. And then, Dr.

00:31:23.000 --> 00:31:26.000
Barry, infectious disease update.

00:31:26.000 --> 00:31:33.000
Or I will keep it relatively brief today too to keep us moving along. We are deep in respiratory season.

00:31:33.000 --> 00:31:50.000
So we have 3 very active viruses. Going around nationwide, we're seeing high rates of COVID flu and RSV all at the same time, which is really severely affecting many hospital systems throughout much of the southern United States as well as the northeast.

00:31:50.000 --> 00:31:57.000
Thankfully, we've not seen that level of the surge here. We've seen much lower rates of COVID.

00:31:57.000 --> 00:32:02.000
19 hospitalizations, RSV hospitalizations and flu hospitalizations compared to what we're seeing in the rest of the country.

00:32:02.000 --> 00:32:15.000
But it is certainly here, as you heard with the Jefferson Health Care Report, it's affecting the ability of folks to go to work, which is hard when you already have a strained healthcare system.

00:32:15.000 --> 00:32:23.000
When it comes to influenza, we have had a milder year this year than we have in past years and we do think a lot of that is due to the high rate of vaccination in our community against influenza.

00:32:23.000 --> 00:32:39.000
We've had a milder flu year in Jefferson County than in the rest of the state. And there's not a lot of good reasons that we could explain that except for that we have one of the highest rates of influenza vaccination in the state.

00:32:39.000 --> 00:32:48.000
So we do think that's preventing hospitalizations in our community, but influenza is still here and is still making people sick.

00:32:48.000 --> 00:32:57.000
Unfortunately, we have had our first influenza death in our community. We lost one of our residents to influenza as a person in their seventys.

00:32:57.000 --> 00:33:05.000
Unfortunately they had not gotten this year's flu vaccine and so it is really important to remind those of us particularly those of us who are high risk to get our flu vaccine.

00:33:05.000 --> 00:33:29.000
It's really important to reduce that risk of severe disease. Remember both age ends of the spectrum, so the very young and the very old are at the highest risk as well as those with underlying conditions and people who are Thankfully, we have seen our rates downturn when it comes to influenza, but it's still with us if you haven't gotten your flu shot yet, we recommend that you do.

00:33:29.000 --> 00:33:33.000
When it comes to COVID, we have, also seeing a relatively, we saw an increase in COVID.

00:33:33.000 --> 00:33:43.000
19 infections, but we haven't seen a severe surge in hospitalizations. We're seeing about one hospitalization per week for Covid-nineteen and no new deaths to report.

00:33:43.000 --> 00:33:53.000
So a holding study at 43 since the pandemic began. We had a total of 9 in 2023, which is quite well, compared to many of our neighbors.

00:33:53.000 --> 00:34:01.000
Rsv is the virus we're seeing the most of right now in our region. We're actually seeing quite quite a significant RSV surge in in the Olympic region as a whole.

00:34:01.000 --> 00:34:10.000
We had a relatively decent surge around the holidays, but it has seemed to be down trending this week.

00:34:10.000 --> 00:34:23.000
We have small numbers in Jefferson County, so we can't entirely count on that. I would definitely consider a still in RSV season, particularly with what we're seeing in neighboring Cleveland Kitsap County where the virus rates are surging quite significantly.

00:34:23.000 --> 00:34:31.000
We thankfully after quite a bit of advocacy, got some Near S. Mab, the vaccine for kids, monoclonal antibody for kids under 18 months of age.

00:34:31.000 --> 00:34:41.000
We got that in the Jefferson healthcare. So if you have a small person in your life who's under 18 months of age, I would highly recommend getting them vaccinated against RSV to protect them for the rest of this season or if you have any pregnant folks in your sphere.

00:34:41.000 --> 00:34:51.000
They can get a Bristol, which is the vaccine to protect their baby when they're born.

00:34:51.000 --> 00:34:56.000
Both of those are recommended through the remainder of the RSV season. And last but not least, please remember that masks work for all 3 of these.

00:34:56.000 --> 00:35:05.000
So when we were wearing masks very well for COVID-19, we had no RSV season.

00:35:05.000 --> 00:35:13.000
We had no flu season. We know that we can prevent transmission of all of these viruses with good masking and with staying home when we're sick.

00:35:13.000 --> 00:35:22.000
If we combine all 3 of those interventions, vaccination, masking, staying home when we're ill, we can prevent a lot of these cases and prevent a lot of hospitalization and death.

00:35:22.000 --> 00:35:31.000
One brief update to one other piece of comment that I forgot to correct. 15% of the nation has gotten the updated COVID-19 vaccine which is small but much more than 3 and one third of Jefferson County has gotten the updated COVID.

00:35:31.000 --> 00:35:47.000
19 vaccine. Any questions from the commissioners before I pass the mic?

00:35:47.000 --> 00:35:53.000
Thank you, Dr. Barry. Alright, is Laura Tucker in the room?

00:35:53.000 --> 00:35:59.000
Yes, she's across over now. She's not crossing over. She's coming into the room.

00:35:59.000 --> 00:36:07.000
Great. Laura is gonna be presenting us. Update on climate action committee.

00:36:07.000 --> 00:36:12.000
Yeah, I'm here. Thank you. I just had a little glitch as I was getting promoted to.

00:36:12.000 --> 00:36:22.000
Co-hosts. So I will be as quick as possible about this too. We were asked to give an update on what our climate action committee is doing these days.

00:36:22.000 --> 00:36:27.000
Let me start the slide show if I can get out of the.

00:36:27.000 --> 00:36:40.000
Although the good things that are at the top of the page here. So, here's an update on this group.

00:36:40.000 --> 00:36:41.000
No.

00:36:41.000 --> 00:36:43.000
Now are you seeing my presenter view? I can get rid of that if you'd like. Nope, okay, that's Zoom has fixed that glitch.

00:36:43.000 --> 00:36:48.000
So. For those of you that don't know the climate action committee and these are the overview that I'm going to give today is who we are.

00:36:48.000 --> 00:37:01.000
Some organizational goals and some recent actions and some of our projections that may be relevant to public health.

00:37:01.000 --> 00:37:08.000
So a bit of the overview. It's a joint committee of the city and the county, which is pretty impressive that we can.

00:37:08.000 --> 00:37:21.000
Manage both kinds of regulations. And things that we need to to work within. And so in 28 or 2,008 the climate action committee was formed to implement the climate action plan.

00:37:21.000 --> 00:37:30.000
So that's kind of our charge and we work with. Sort of change by example. So there's it's an unfunded group.

00:37:30.000 --> 00:37:36.000
So we try to do the best we can with whatever limitations or benefits that we have within our definite groups.

00:37:36.000 --> 00:37:45.000
And that we focus on reducing greenhouse gas emissions but also preparing for climate impact. So we are part of mitigation and adaptation.

00:37:45.000 --> 00:37:52.000
And we do a lot of community outreach. So in the climate action plan, the city and county adopted a goal of an 80% reduction in greenhouse gas emissions from the levels that we've had in 1,990 by the year.

00:37:52.000 --> 00:38:09.000
2,050 and that was just groundbreaking when it went through in 2,008. We know now it's not enough and it's not soon enough so there's some updates on that.

00:38:09.000 --> 00:38:10.000
Hmm.

00:38:10.000 --> 00:38:15.000
We have a fabulous group of folks that are on our climate action committee, 15 people altogether. So we have some standard positions that are filled by the various organizations.

00:38:15.000 --> 00:38:16.000
And then we have Sure.

00:38:16.000 --> 00:38:23.000
Excuse me, Laura. I'm just still seeing your first slide. Is that what I'm supposed to be seeing?

00:38:23.000 --> 00:38:26.000
Is anybody else seeing just my first slide?

00:38:26.000 --> 00:38:27.000
Yes.

00:38:27.000 --> 00:38:29.000
Yeah, we see the previews on the left.

00:38:29.000 --> 00:38:30.000
Oh, now that's bizarre. Okay, let's let's stop this and try again.

00:38:30.000 --> 00:38:33.000
Thank you. I think it didn't quite move into the slideshow. Yeah. Okay.

00:38:33.000 --> 00:38:37.000
Thank you for letting me know that.

00:38:37.000 --> 00:38:44.000
You know it's oh, let me just get it out make sure that's not on presenter view too That may be helping.

00:38:44.000 --> 00:38:51.000
So let's try one more time. This has been a week of technological

00:38:51.000 --> 00:38:52.000
We're on.

00:38:52.000 --> 00:38:57.000
And we are actually back on. We're back on time if that helps. So you don't have to rush too much.

00:38:57.000 --> 00:38:58.000
Yeah.

00:38:58.000 --> 00:38:59.000
I am still I'm not gonna take more time. Hold on a second here. It's Not, it's not resetting yourself.

00:38:59.000 --> 00:39:03.000
You have 50 min, Laura, you plenty. Okay.

00:39:03.000 --> 00:39:12.000
Well, I'll still. I would like to be. Respectful of everybody's time here but it is giving me a little bit of grief.

00:39:12.000 --> 00:39:18.000
In these windows here. So let's. Try this from.

00:39:18.000 --> 00:39:25.000
Thank you for everybody for being patient with our techno. Glitches. So let's roll again.

00:39:25.000 --> 00:39:33.000
I can scoot through these pretty quickly now because you've already listened to them once. Okay, so these were the goals today.

00:39:33.000 --> 00:39:34.000
There we go.

00:39:34.000 --> 00:39:41.000
We're gonna go over kind of who's CAC is and some of our goals and things that we have relevant to public health.

00:39:41.000 --> 00:39:51.000
This was a bit about the joint committee. And our purposes as an advisory group. And also to lead by example with an unfunded plan.

00:39:51.000 --> 00:40:05.000
And we do focus on mitigation as well as adaptation. But our goal in 2,008 was to reduce the carbon footprint of Jefferson County by 80%.

00:40:05.000 --> 00:40:12.000
By the year, 2050 and again I was that was groundbreaking for them it's clearly not enough and not quick enough now.

00:40:12.000 --> 00:40:19.000
Was on the slide where we were talking about our different members. So we have a really strong team. It's a really broad outreach to lots of different groups.

00:40:19.000 --> 00:40:28.000
So we have 15 members all together, which also include a number of citizens at large. I will tell you that we had 3 open positions.

00:40:28.000 --> 00:40:38.000
This year and we had. 10 app 9 applicants, excuse me, for those 3 positions, which was really, it's going to make it difficult for the folks that have to make that decision.

00:40:38.000 --> 00:40:48.000
So they were all incredibly well qualified, but we're hoping to rope them all in to help in other kinds of ways that they can't actually be on the specific committee.

00:40:48.000 --> 00:40:54.000
So this is a little bit of history. So, 2,007, that's when we adopted those goals.

00:40:54.000 --> 00:41:02.000
And then the Climate Action Committee formed the next year. The climate action plan was adopted by the city in the county in 2011.

00:41:02.000 --> 00:41:10.000
And then in 2,015 they came up with a climate preparedness plan. So that's kind of little ancient history there, but sort of where things got started.

00:41:10.000 --> 00:41:19.000
And currently we've done a number of things. We updated the greenhouse gas inventory for the county's emissions and I'm not going to get into the weeds on that.

00:41:19.000 --> 00:41:28.000
That's all on our page. Just to note that the highest carbon output that we have in Jefferson County is transportation and that would make sense in the sense that we're a rural community without a lot of public transportation options although we do have some great ones.

00:41:28.000 --> 00:41:39.000
But we're a very large geographic county, then people have to travel a long way and a lot of people are in single cars.

00:41:39.000 --> 00:41:42.000
So there was report that was produced. And they have all, I've got to hide a few things here.

00:41:42.000 --> 00:41:53.000
All of your faces are going to go away so I can see my slides. So we made some recommendations for some opportunities that we'd like to see the city in the county consider.

00:41:53.000 --> 00:42:01.000
And that was in 2021. And that we recently completed a forest and trees inventory as well.

00:42:01.000 --> 00:42:10.000
Dealing with carbon sequestration and there are some recommendations that have gone not only to the city and county, but to other groups that can look at them as well, like the Jefferson Land Trust.

00:42:10.000 --> 00:42:13.000
And the North Olympic Salmon Coalition, people like that. So these all went to these.

00:42:13.000 --> 00:42:20.000
2 main bodies governing bodies, but also out to the public.

00:42:20.000 --> 00:42:28.000
So there's some recommendations that we've had about biking, walking, and using transit to reduce our our transportation.

00:42:28.000 --> 00:42:40.000
Rate, which is the highest of any of our different outputs in the county. So we sent this to the BOCC and the City Council just a couple of months ago to talk about bringing in an E bike share program.

00:42:40.000 --> 00:42:47.000
And and develop plans for rapid deployment of cycling infrastructure and some changes have already been made along those lines, which we deeply are grateful for.

00:42:47.000 --> 00:42:54.000
We want to create incentives for motorists to choose cycling over driving. As well as transit over driving and transit by the way if you're not familiar is free still which is a real big.

00:42:54.000 --> 00:43:05.000
Improvement to and help to all the community. And then for safety for bicycles and pedestrians, we're trying to employ traffic calming devices and reducing speed limits and the city is doing a number of those single lanes.

00:43:05.000 --> 00:43:19.000
So that they can that does reduce the speed limits and it also allows traffic calming and more space for bicycles and pedestrians.

00:43:19.000 --> 00:43:28.000
We're working on an e bike charging system for the city and the county. Quite a few new e bikes have been talked about.

00:43:28.000 --> 00:43:36.000
And then we're looking at incentives for commuter reduction programs and that trying to encourage employers to have their employees.

00:43:36.000 --> 00:43:49.000
Commute whenever possible with each other. And carpool. Excuse me. And then there's been a managed parking strategy in downtown Port Townsend as an additional way of reducing our vehicles miles traveled.

00:43:49.000 --> 00:43:59.000
So that's strictly focusing on biking, walking, and using transit. And then each group that's part of the climate action committee sets goals for the year.

00:43:59.000 --> 00:44:10.000
And this is what public health put in last year. Was to reduce plastic with incentive items that were given to families in the community health division for WIC and things like that.

00:44:10.000 --> 00:44:16.000
So there was just some ideas of how you can reduce the amount of plastic that you use with your youngsters.

00:44:16.000 --> 00:44:26.000
Then there was also to prioritize and set goals for developing mitigation loans for climate impacts on human health, including food security, disease prevention, severe weather, and air quality.

00:44:26.000 --> 00:44:33.000
I might add also to that for helping folks replace their failing septic systems too. So this was kind of another part is that we researched the impacts of pathogens in our water bodies.

00:44:33.000 --> 00:45:03.000
There's lots of testing that goes on that our water quality group does. Keeps us all safe. And then we were supporting the food producing businesses to reduce single use plastic or replace it with compostable to go containers and that was a big program that started in July and just finished in November with about 32 different businesses in our community getting these for free to try to replace the ones that they're currently using.

00:45:04.000 --> 00:45:10.000
And then connecting food producing businesses with those that sue serve the food insecure. We've had 2 food summits.

00:45:10.000 --> 00:45:18.000
We'll have another one in March, bringing all sorts of folks that either have surplus food, including people like the gleaners, and those who need food.

00:45:18.000 --> 00:45:26.000
And the schools fall into both categories. So we're coming up with some creative ways to make that can keep going.

00:45:26.000 --> 00:45:35.000
We've also changed the type of recycling to reflect not only commodities with the lower carbon footprint, but things that really are being sent overseas to pretty much be burned or picked through by.

00:45:35.000 --> 00:45:46.000
Low-income folks and so that's why we don't take those numbers 3 through 7 they really have no value and they're not really truly recyclable anywhere here in the United States.

00:45:46.000 --> 00:45:53.000
And we're still providing home composting classes. About a hundred new households each year. And then we added 40 tons of food waste.

00:45:53.000 --> 00:46:01.000
Diverted from landfill in the last year, but we're approaching over 200 tons in about the 7 years we've been doing these classes.

00:46:01.000 --> 00:46:09.000
So we've made great progress, but we do need to adjust our goals if we're really going to reach that net 0 by 2050.

00:46:09.000 --> 00:46:15.000
So we just set out some new recommendations in December that we sent to the City Council in the BOCC where we'd like to see a.

00:46:15.000 --> 00:46:28.000
A reduction levels go 58% more. 2,030 and then 95% below our 2,018 levels by 2050 using our baseline data.

00:46:28.000 --> 00:46:38.000
So instead of an 80% reduction, we really are up to 95 now if we're really going to meet our climate goals and get the carbon dioxide out of our atmosphere.

00:46:38.000 --> 00:46:42.000
So we looked at sequestration goals too with our forests. And so these are the recommendations that we passed on.

00:46:42.000 --> 00:46:52.000
So by 2030 we'd like to see an increase in carbon sequestration to 2 million metric tons of carbon dioxide a year.

00:46:52.000 --> 00:46:56.000
And that is done in a number of ways. It's not just keeping old growth trees, but it's doing fire suppression.

00:46:56.000 --> 00:47:15.000
It's doing other kinds of intelligent and and environmentally friendly and smart forestry practices. And then by 2050 we want to see that to bump up to 40% increase and that will get us to our 0 0 net 0 CO 2 output.

00:47:15.000 --> 00:47:22.000
We've also have a great thing called the King Tide project, which Dave Wilkinson has headed up and Barney Burke participates with some of these fabulous photos.

00:47:22.000 --> 00:47:32.000
So there's some key locations around the county where we look at these large tides as sort of a bellwether of what it's going to look like as our sea levels continue to rise.

00:47:32.000 --> 00:47:39.000
So that's the Northwest Maritime Center. I've actually seen that. Tide line and the drift line up there at the top of that boat ramp.

00:47:39.000 --> 00:47:42.000
So that water gets up there and it's starting to encroach on our buildings downtown. And this is what it looks like on the other side.

00:47:42.000 --> 00:47:48.000
So many of our Water Street businesses are going to be on water or street literally at 1 point in time.

00:47:48.000 --> 00:47:56.000
So some sort of mitigation and adaptation will need to be happening there. So there's some interesting intersections of public health and climate change.

00:47:56.000 --> 00:48:07.000
So here's some projections that we can look at. So one is extreme heat and I don't want to duplicate this for a lot of people that already realize this.

00:48:07.000 --> 00:48:19.000
This is in your packet. So you can read the fine points. The heavier rainfall when when you've got a warmer atmosphere, it carries, it can came more moisture so when it rains it often rains harder.

00:48:19.000 --> 00:48:23.000
But then the other piece of that is we're having, we're getting more of these Mediterranean summers.

00:48:23.000 --> 00:48:29.000
And so it kind of dries out, but that warmer climate will dry your soils quicker and cause them to lose moisture even faster.

00:48:29.000 --> 00:48:33.000
So it's an odd kind of loop that's going on there. We've seen an increase with wildfires.

00:48:33.000 --> 00:48:49.000
We do have some grant money that Laura take, a gasoline Tatra was organizing this year to help people know where they can go, how they can get masks, and also some filtration systems.

00:48:49.000 --> 00:48:56.000
We're looking at sea surface temperatures, which is going to really change our commercial shellfish and private shellfish harvesting as well as just general organisms in the ocean.

00:48:56.000 --> 00:49:09.000
There's a lot of change going on in there. And then finally because of the King Tide project, we really are looking at sea level rise and what may be happening over the next several years.

00:49:09.000 --> 00:49:17.000
And this is without giant Sheets of ice going into the ocean if that happens that will change those numbers.

00:49:17.000 --> 00:49:31.000
So that's kind of the doom and gloom a little bit on that side. But I do see public health as being at the center of all of this, especially on the emotional side as people are just in distress over one thing or another caused by climate change.

00:49:31.000 --> 00:49:41.000
But we do have some opportunities to work together here. So these are some things that we have worked together to develop cooling centers warming centers and I mentioned that wildfire smoke filtration tools.

00:49:41.000 --> 00:49:44.000
And we're looking at working with the city. On sea level rise, there's a lot going on with the county with that as well.

00:49:44.000 --> 00:49:56.000
There's some issues with trying to get property purchase that's in dangerous places along the big and little quill and Dussy Wallops area.

00:49:56.000 --> 00:50:00.000
And so we're looking at flood management down there.

00:50:00.000 --> 00:50:02.000
And we're trying to put out community education along all these points with fire prevention, smoke filtering options, how to mitigate flooding.

00:50:02.000 --> 00:50:13.000
What to deal with with drought and extreme heat as well. And that we're working together to develop a climate and health adaptation plan.

00:50:13.000 --> 00:50:24.000
Which can address all these various things too. So we're trying to be proactive about some of the things that we see coming.

00:50:24.000 --> 00:50:31.000
And there's a lot we can do. So this is kind of a wonderful partnership between climate change issues and public health too.

00:50:31.000 --> 00:50:43.000
So, and just in general, not just public health, but all the organizations that are serving our public in a healthful way like Jefferson health care too.

00:50:43.000 --> 00:50:51.000
So any quick questions? I know that was a rather Bit of a drink from a fire hose there.

00:50:51.000 --> 00:50:53.000
And, yeah, Greg.

00:50:53.000 --> 00:50:58.000
Yeah, thanks, Laura. Always, always good to hear from the climate action committee and, you know.

00:50:58.000 --> 00:50:59.000
We're working hard.

00:50:59.000 --> 00:51:00.000
It's always a fight at the POCC every year. We all, we all wanna work with you guys.

00:51:00.000 --> 00:51:08.000
I had I guess one comment and 2 questions. I think it's comment and 2 questions. I think it's comment and 2 questions. I think it's comment.

00:51:08.000 --> 00:51:12.000
I just wanted to make sure that my recollection is. I think it's comment. I just wanted to make sure that my recollection is correct at that 80% goal from 1,990.

00:51:12.000 --> 00:51:19.000
We made really in one fell swoop by switching over to a public utility district and clean electricity.

00:51:19.000 --> 00:51:21.000
Does that that recollection correct?

00:51:21.000 --> 00:51:37.000
Well, sort of. We did just by flipping the switch. Of, our electrons from Puget Sound Energy, the PUD and getting Bonneville Power, which is 95 to 97% green.

00:51:37.000 --> 00:51:38.000
Maybe not.

00:51:38.000 --> 00:51:50.000
We did drop our carbon footprint quite a bit. The reason why we're not really acknowledging that as much as as many people would like as well as the changes that the paper mill has put in is that we don't want people to go, okay, well now we're good.

00:51:50.000 --> 00:52:02.000
And our transportation carbon footprint has been going up. So that all got factored in. Cindy Jane would be a better person to answer that because she's worked really closely with Ickley and their software with how all that was factored in.

00:52:02.000 --> 00:52:07.000
But you're right, we did drop our footprint considerably with just those 2 actions by the PUD and by the paper mill.

00:52:07.000 --> 00:52:10.000
Yeah, and I wasn't trying to pat ourselves on the back and say, mission accomplish or anything like that.

00:52:10.000 --> 00:52:14.000
No.

00:52:14.000 --> 00:52:18.000
Yeah, yes.

00:52:18.000 --> 00:52:19.000
They can.

00:52:19.000 --> 00:52:20.000
I would just, I do feel that systems changes, you know, big system can make real transformer.

00:52:20.000 --> 00:52:21.000
And then so my other 2 questions. Are and I think transportation is definitely what to focus on most.

00:52:21.000 --> 00:52:31.000
One I wonder if you can explain what are the gaps a little bit with bike chargers? Cause I just I guess I don't get it.

00:52:31.000 --> 00:52:37.000
I mean, you know, if your electric car is runs out of charge, you're kind of done, but if your electric bike runs out of charge.

00:52:37.000 --> 00:52:38.000
You still have a bike, right?

00:52:38.000 --> 00:52:45.000
You have a hundred pound bike that's a little tricky to pedal home or maybe not that heavy, but I heavy one nevertheless.

00:52:45.000 --> 00:52:47.000
And so having some bike charging stations for folks that don't come in with a fully charged bike would be really helpful.

00:52:47.000 --> 00:52:56.000
And then we're also looking at having those community bikes that stay in the charging stations. They've been successful in some places.

00:52:56.000 --> 00:53:02.000
And not successful in others. So. And because all we can do is just recommend what we'd like to see happen.

00:53:02.000 --> 00:53:12.000
So our job really is to do the leg work and then give information to the BOCC or the City Council or other sort of agencies that are managing these sort of things of what might be a good idea.

00:53:12.000 --> 00:53:20.000
So we're looking into a lot of that with hope that we can implement that sort of thing. But I don't know if you have an electric bike, but if it runs out of charge.

00:53:20.000 --> 00:53:24.000
You better be peddling it on the flat with and you can get a lot of good exercise that way I guess you can promote it in that way.

00:53:24.000 --> 00:53:25.000
Yeah.

00:53:25.000 --> 00:53:26.000
Right. Okay. I don't have.

00:53:26.000 --> 00:53:33.000
Oh my god, my electric bike ran out of. Juice on the in the roadie parade.

00:53:33.000 --> 00:53:37.000
And then I was right at the base of the hill that goes up Washington Street in front of the fountain cafe.

00:53:37.000 --> 00:53:38.000
Oh.

00:53:38.000 --> 00:53:39.000
And that's a heavy bike to move. I'm telling you, I did it. But it was one of the hardest.

00:53:39.000 --> 00:53:44.000
Oh. I think. You got it up now.

00:53:44.000 --> 00:53:45.000
Bye, rides that I ever did. Yep.

00:53:45.000 --> 00:53:46.000
Alright, good work out there Heidi. Okay.

00:53:46.000 --> 00:53:49.000
All right. Well, that's That's the hill that makes me want an electric bike. If you can ask one more question real quick.

00:53:49.000 --> 00:53:54.000
Alright, Greg. Okay, quickly, Greg, I have 2 other people with their hands up.

00:53:54.000 --> 00:54:05.000
Okay, and the last one is just maybe a Something for the CAC to consider and that I've been reading a lot about the sequestration carbon sequestration in aquaculture.

00:54:05.000 --> 00:54:12.000
I think aquaculture touches this. The issue from a bunch of different size as well as you know sustainable proteins grown here.

00:54:12.000 --> 00:54:13.000
Right.

00:54:13.000 --> 00:54:17.000
And I guess I would just love to put that on your on your roadmap as you go forward to start mapping that.

00:54:17.000 --> 00:54:20.000
There's a lot of studies about the carbon sequestration of Chinese.

00:54:20.000 --> 00:54:24.000
Yeah, blue carbon is they're calling it. Yeah, we have't really I think what we'd like to get next is a working group.

00:54:24.000 --> 00:54:34.000
We've had tremendous success with both the vehicle miles traveled working group with the electric car working group and the forestry working group.

00:54:34.000 --> 00:54:37.000
They've been and we've got so many experts in the community. It's really nice.

00:54:37.000 --> 00:54:44.000
But I totally agree. That's another area to look at, which we are. Surrounded by water, so it's a smart place to go.

00:54:44.000 --> 00:54:45.000
Thanks.

00:54:45.000 --> 00:54:48.000
Great. Commissioner Eisenhower, did you have a question as well?

00:54:48.000 --> 00:54:51.000
Nope, I answer my own question and I just use up my time.

00:54:51.000 --> 00:54:54.000
Thank you. Okay, Keith. You see your hand?

00:54:54.000 --> 00:55:04.000
Yeah, so first of all, I want to say thank you, Laura. The staff, Laura and Judy Server.

00:55:04.000 --> 00:55:20.000
From the city have staffed this committee for years and Although it is quote unfunded according to what Laura said, it would not have survived had it not been for the really superb.

00:55:20.000 --> 00:55:34.000
Management and shepherding done by both Laura and Judy. And, yeah, so it's, it's, I just want to acknowledge that, Their work has been outstanding since the very beginning.

00:55:34.000 --> 00:55:43.000
And that there are a lot there is a lot of volunteer activity that happens. Through Cindy Jane and the local, 2,020.

00:55:43.000 --> 00:56:02.000
Climate action wing. And so although we get a lot of the credit, a lot of the work is done outside by people who are passionate about helping in some way and much of that is directed by Cindy Jane and the local 2020 group.

00:56:02.000 --> 00:56:10.000
And I'd like to toss it back to case too. He was part of of the folks that put our climate action plan together and is now back as chair of the climate action committee.

00:56:10.000 --> 00:56:15.000
So I really appreciate the full circle in the institutional knowledge too.

00:56:15.000 --> 00:56:17.000
Thank you.

00:56:17.000 --> 00:56:23.000
Thank you. Laura. I hope to have you back and we get to hear her from you again in the future.

00:56:23.000 --> 00:56:25.000
And see that number. Going even.

00:56:25.000 --> 00:56:31.000
Go down with all these new innovative ways that we're trying to work on this. Thanks so much.

00:56:31.000 --> 00:56:38.000
Thank you. Dr. Barry. As we get to talk about fentanyl and opioid overdoses.

00:56:38.000 --> 00:56:39.000
Nice late talking.

00:56:39.000 --> 00:56:40.000
Yes, let me go ahead and share my screen. I'll work hard to keep us on track here.

00:56:40.000 --> 00:56:53.000
So As we've talked about a bit here before, the, the public health department doesn't just do infectious diseases.

00:56:53.000 --> 00:56:56.000
We work on a wide variety of health issues. And one that we've been spending a lot of energy on for quite some time.

00:56:56.000 --> 00:57:16.000
Is substance use disorder and overdoses generally. A lot is in the news about fentanyl and oioids and so certainly that will be a big part of this but I always want to acknowledge that there are always overdoses due to non opioid drugs as well.

00:57:16.000 --> 00:57:22.000
I want this to be as interactive as possible, so please do feel free to jump in, ask questions as we go.

00:57:22.000 --> 00:57:27.000
I only have a few slides and so really this should be more discussion than presentation. But I wanted to start a little bit with the numbers.

00:57:27.000 --> 00:57:41.000
So you might be hearing a lot of new stories about fentanyl and overdoses generally. And one of the big things that driving that is driving that is the rates are going in the wrong direction.

00:57:41.000 --> 00:57:49.000
So on this graph, the dark, the solid line, the dark red is Jefferson County and the dotted line is Washington state.

00:57:49.000 --> 00:57:59.000
So as you can see statewide overdoses have increased, doubled, since 2019, which is really rapid increase.

00:57:59.000 --> 00:58:04.000
And in Jefferson County, we've actually had a higher rate of overdoses than the state throughout that time.

00:58:04.000 --> 00:58:13.000
And unfortunately, we've even started to diverge even. From from the state in those numbers. These numbers only go up to 2022.

00:58:13.000 --> 00:58:23.000
In 2023 we did have what looks to be in the early indications of a downtrend in overdoses just in this last year, which is not what we've seen in the rest of the state.

00:58:23.000 --> 00:58:26.000
But it's too early to say that all of those numbers are complete at this point. And so we don't want to.

00:58:26.000 --> 00:58:51.000
We don't wanna over generalize based on small numbers. Looking around the state, this is a map of, of actually all drug overdoses in the state. So opioids, methamphetamines, things like that.

00:58:51.000 --> 00:58:52.000
And you can see that the dark red is bad. That is, you have a higher rate of overdoses compared to other parts of the state.

00:58:52.000 --> 00:59:00.000
And unfortunately, the whole Olympic Peninsula is in the high rate of overdoses. There are a lot of different reasons for that.

00:59:00.000 --> 00:59:11.000
High rates of poverty certainly contribute higher rates of occupational injury also contribute and high rates of opiate prescribing years ago.

00:59:11.000 --> 00:59:25.000
That started a series of addictions that we're still dealing with now. You can also see the breakdown in, what, what drugs are, causing most of the depth.

00:59:25.000 --> 00:59:32.000
The majority of our overdose steps at this point are opioid related and they're almost exclusively fentanyl.

00:59:32.000 --> 00:59:36.000
Actually in 2,023 of the confirmed overdoses that we've seen so far. We have seen exclusively fentanyl related overdoses.

00:59:36.000 --> 01:00:02.000
Many of those also had other drugs mixed in, methamphetamine in particular is one that is highly concerning as a mixture with fentanyl because what it does is it increases package in demand while the fentanyl decreases oxygen availability and so that combination is highly legal as both drugs have gotten stronger in recent years.

01:00:02.000 --> 01:00:11.000
If that's a, that's a different trend than what we've seen in neighboring Clown County where Methamphetamine is a very large proportion of the overdoses here.

01:00:11.000 --> 01:00:22.000
It's really mostly fentanyl that people are dying of. The next most common, is, psycho stimulants, which is almost exclusively, out here that people are dying of.

01:00:22.000 --> 01:00:28.000
When you look at these numbers, it can be hard for people to wrap their head around. These are all per 100,000 population and our current rate is 37 per 100,000.

01:00:28.000 --> 01:00:35.000
The for a relative indicator the next most common cause of accidental deaths has historically been and continues to be motor vehicle accidents.

01:00:35.000 --> 01:00:46.000
And we lose twice as many of our citizens every year to overdoses than we lose to motor vehicle accidents.

01:00:46.000 --> 01:01:00.000
It's a very serious issue in our community and it can affect all ages. Looking at the many people assume that people who die of overdoses are in their twenties or thirties.

01:01:00.000 --> 01:01:06.000
Last year, the majority of folks who died of overdoses in our community were in their forties to 60.

01:01:06.000 --> 01:01:12.000
So it's not just young people who die of overdoses though tragically, we lose young people as well.

01:01:12.000 --> 01:01:24.000
And I think the ages that we're losing here, does speak a bit to the unique nature of our opiate epidemic which primarily started with chronic pain and and for treatment of chronic pain.

01:01:24.000 --> 01:01:30.000
When we look at, why people use fentanyl, the most common reason that we hear sighted is they just want to make their withdrawals go away.

01:01:30.000 --> 01:01:47.000
The second most common reason is pain. They're using to treat pain. And we don't have as good of access to, do health care to treat their underlying causes of pain as we would like at this point.

01:01:47.000 --> 01:01:56.000
And the next most common is treating. Treating a mental health disorder. So people are using fentanyl to treat the symptoms of anxiety, depression, PTSD.

01:01:56.000 --> 01:02:08.000
And of course we have much better treatments in medicine for those diseases than fentanyl, but in many parts of our community it's easier to access fentanyl than it is to access proper mental health.

01:02:08.000 --> 01:02:21.000
And so we're gonna continue to see this challenge as long as that disparity exists. Despite many, quite a bit of good work, folks who are trying to change this, but we still have a big gap in access here.

01:02:21.000 --> 01:02:30.000
This is our, this is our ambulance calls. So fire and ambulance responses to opioid overdoses in the region.

01:02:30.000 --> 01:02:39.000
So this does include clam and kicks up. We have a small enough population that it's hard to get Jefferson specific numbers and have them be statistically significant or releaseable because they can become so small that they're identifiable.

01:02:39.000 --> 01:02:44.000
But when you look at the region as a whole, that trend is going very much in the wrong direction.

01:02:44.000 --> 01:02:59.000
We're seeing a rapid rise in EMS calls for opiate overdoses. The prior slides were all death related, but we have far more overdoses that thankfully don't lead to death.

01:02:59.000 --> 01:03:11.000
Someone's able to access thealoxone or able to access emergency services but I can tell you if you know anyone who's working as a firefighter or or a paramedic, they're getting exhausted by the sheer number of these responses that they're having to go to.

01:03:11.000 --> 01:03:23.000
Sometimes twice the same person. And so One of the things that we are working on is thinking of novel ways to interrupt this cycle.

01:03:23.000 --> 01:03:32.000
The way that actually to go back just a couple slides. So you can see in 27, 2,019, we were actually getting better.

01:03:32.000 --> 01:03:42.000
Our opiate overdoses were down trending. But then when fentanyl arrived in our region that really turned things around and we lost a lot of those gains.

01:03:42.000 --> 01:03:47.000
And so our responses have to be different too. Yes, Greg.

01:03:47.000 --> 01:03:51.000
Yeah, I'm just wondering if you think there's any correlation with the Blake decision as well.

01:03:51.000 --> 01:04:09.000
You know, I mean, I'm fully behind the harm reduction too, but I'm just I'm wondering kind of the other side of of enforcement and therapeutic courts and they're their participation in guiding people, you know, when you talk about 2 overdoses a day and and what are the recourses?

01:04:09.000 --> 01:04:25.000
I've talked to law enforcement and and EMS folks who are that's, that's their frustration that there's no, there's, you know, Well, we keep trying to, you know, make the bad nicer, but, is there a little bit, you know, maybe more?

01:04:25.000 --> 01:04:26.000
Stick. That's good.

01:04:26.000 --> 01:04:28.000
There is so, very good question and a common question. We hear of, you know, what, why is it getting worse?

01:04:28.000 --> 01:04:39.000
And, and what, what tools could we use to make it not get worse and get better?

01:04:39.000 --> 01:04:50.000
The argument that it's the Blake decision driving it doesn't entirely track. Because when we look at places that didn't get affected by the black decisions from neighboring states that didn't have the same change in policy, they're experiencing the same problem.

01:04:50.000 --> 01:05:05.000
And so it doesn't the causation correlation they tracked at the similar times, but when we look at places not affected by similar policy changes, we don't see any difference in effect.

01:05:05.000 --> 01:05:09.000
But what we do see is that a lot of other things happen around that time. So there was, there was a pandemic.

01:05:09.000 --> 01:05:17.000
That affected a lot of people's mental health. There was a rapid rise in housing costs around the same time and a rapid rise in homelessness.

01:05:17.000 --> 01:05:27.000
There's a common misconception that drug use drives homelessness, but what we actually see is the opposite causation is that homelessness drives drug use.

01:05:27.000 --> 01:05:34.000
So when people lose their housing, they're more likely to get hopeless to experience trauma and to end up using.

01:05:34.000 --> 01:05:43.000
And so those are 2 big upstream drivers. That we know of and also just the arrival of fentanyl in our community.

01:05:43.000 --> 01:05:48.000
Unlike much of the rest of the country, we really didn't have that now until, 2,019.

01:05:48.000 --> 01:05:59.000
And that we were able to get ahead of this with increased access to treatment, improve prescribing, improved naloxone distribution, a really full court dress is what pulled those numbers down.

01:05:59.000 --> 01:06:07.000
But then a bunch of folks got exposed to a drug that's incredibly strong and that you have to use numerous times throughout the day.

01:06:07.000 --> 01:06:11.000
So a lot of people don't know that. Fenton is very racket on and off.

01:06:11.000 --> 01:06:13.000
I know those in the BOH know that because we've talked about it on the VOCC, but, but some of the other folks might not.

01:06:13.000 --> 01:06:28.000
And so people have to use many more times throughout the day to make their withdrawals go away. And they each of those with the variability of the drug supply could be strong enough to kill you.

01:06:28.000 --> 01:06:34.000
And so it's just a higher risk. Truck whenever people are using it. Great.

01:06:34.000 --> 01:06:54.000
Yeah, hi there. Yeah, you know, from a from a structural standpoint as well, you know, I think collecting information from places like, like first responders and police is important because they have a specific perspective on certain occurrences, the things that they are.

01:06:54.000 --> 01:07:10.000
Touch with but the actual policy directions and assessments of what's correlated with what I think we've seen pretty consistently that the closer you are to this, the harder it is to see the larger scope and and.

01:07:10.000 --> 01:07:11.000
Hmm.

01:07:11.000 --> 01:07:21.000
Not trying to take those kinds of suggestions, but gather the other kinds of information I think is the way that we can best utilize those resources.

01:07:21.000 --> 01:07:34.000
Thank you. And so to talk about another possible alternative, we are starting a pilot program in neighboring Calm County when it comes to opiate overdoses and EMS responses.

01:07:34.000 --> 01:07:39.000
So talking to the firefighters. In Portangelos, where we have the community paramedic program.

01:07:39.000 --> 01:07:41.000
One of the things that's most demoralizing for them is they just want to do something that works.

01:07:41.000 --> 01:07:52.000
They bring back someone, they give them naloxone and they survive and that's amazing but it is painful to go back and then revive the same person repeatedly because not so much because they very much want to bring that person back.

01:07:52.000 --> 01:08:02.000
But because it feels like whatever they're doing is it working enough and they want other tools at their disposal.

01:08:02.000 --> 01:08:10.000
And that's understandably some folks move towards the criminal justice system as a possible tool, but we're trying to give them some other tools as well.

01:08:10.000 --> 01:08:22.000
So when we look at people who have recently overdosed and received the naloxone A lot of folks think that that would be a really good time for them to consider behavior change to think about moving to treatment, things like that.

01:08:22.000 --> 01:08:31.000
Unfortunately, if you've just gotten Naloxone, you're in intense withdrawal. Every part of your body feels terrible and you're going to do anything you can to make that feeling go away and most the most accessible way to make that feeling go away in our community is just more fentanyl.

01:08:31.000 --> 01:08:44.000
And so people go back, they get right back into using and they get back in a cycle and situations that make it hard to stop.

01:08:44.000 --> 01:08:52.000
In some other parts of the country and in Port Angel starting in the next month or so we are starting.

01:08:52.000 --> 01:09:08.000
On the spot buprenorphine dosing with paramedics. So after you've given someone naloxone and they've Come out they've survived but they're also in withdraw you can offer them buprenorphine which is a treatment for opiate use disorder on the spot in the field.

01:09:08.000 --> 01:09:10.000
Which will take away their withdrawals and could give them an experience of what it's like to be on treatment and see how they feel about it.

01:09:10.000 --> 01:09:36.000
And then they can offer them a direct connection to treatment if they want to continue on that medication. So we're piloting that to the homage is and hopefully soon King will be joining us and so we'll be studying this as we go, but we're hopeful that that will be another tool for our first responders to be more effective and provide a more direct route to treatment for folks who are at highest risk of

01:09:36.000 --> 01:09:46.000
overdose and have demonstrated that by the fact that they have just overdosed. Another thing that we are working on in the, come to your hand.

01:09:46.000 --> 01:09:57.000
It is a naloxone leave behind. So many folks who overdose don't want to go to the emergency department because of a lot of often historically bad experiences, with the medical system.

01:09:57.000 --> 01:10:07.000
And so if they choose not to be transported, this is true in Jefferson and Clown County, we leave behind a box of moloxal with them so that if something happens they have something available, and a palm card for how to access treatment if they're ready.

01:10:07.000 --> 01:10:13.000
Yes, Apple.

01:10:13.000 --> 01:10:22.000
Nelson, I was wondering what the buprenorphine is that a new Policy allowance for paramedics or has that been?

01:10:22.000 --> 01:10:39.000
Part of their repertoire just not administered in the field in that particular way has there been some legislation behind moving in that direction to help add to the tool belt when you're in the field addressing someone post come back from Knox on dose.

01:10:39.000 --> 01:10:47.000
In the current legal framework, there's no policy prohibition against it. There's no express recommendation to use it either.

01:10:47.000 --> 01:10:52.000
It's just not covered. So as a paramedic, you can give ketamine in the field.

01:10:52.000 --> 01:10:57.000
You can give delotted. You can give incredibly dangerous drugs because you've got your paramedic.

01:10:57.000 --> 01:11:02.000
You have all the skills to manage that in the field. Buprenorphine is much, much, much safer than any of the things that they currently have ability to do.

01:11:02.000 --> 01:11:24.000
But there is some, there is an ask from King County, much bigger jurisdiction to get explicit approval from the legislature on that from our legal analysis and clown we don't think that's necessary because it's not explicitly forbidden and the big change was the removal of the X number.

01:11:24.000 --> 01:11:40.000
So back in the day in order to provide buprenorphine you had to have a particular prescribing authority that was removed by a year ago and so now any any prescriber can prescribe buprenorphine whose license in the state of Washington and so just like they work understanding orders for everything else that they do they could do this understanding order as well.

01:11:40.000 --> 01:11:54.000
And so in in Clown County they're doing it undermine with partnership with their medical director. So it's an option.

01:11:54.000 --> 01:12:02.000
It's something we could consider. But I think we do need to get creative, but I think we do need to get creative, if we're gonna, we do need to get creative, if we're gonna, if we're gonna turn this around.

01:12:02.000 --> 01:12:08.000
And I think I still have 5 min. Is that right, Chair? Yeah.

01:12:08.000 --> 01:12:09.000
Yeah, go for it.

01:12:09.000 --> 01:12:13.000
I have a question too if you were done at full. I was done but I had one little question.

01:12:13.000 --> 01:12:17.000
Yeah.

01:12:17.000 --> 01:12:18.000
Okay.

01:12:18.000 --> 01:12:25.000
I'm wondering if my nursing pharmacology is weak. Anymore and I'm wondering if the buprenorphine if it's If it's helpful and reactive against.

01:12:25.000 --> 01:12:28.000
And now mixed with other things. So in in fact, you know, naloxone is not as effective for fentanyl.

01:12:28.000 --> 01:12:37.000
If it's laced with trunk. That that scenario so I'm wondering I don't know enough about buprenorphine to Oh, but I wondered if it's help.

01:12:37.000 --> 01:12:55.000
Okay. Yeah, no, thank you for thank you for the prompt. So, buprenorphine, also known as its trade name, Saboxone is a partial opiate agonist and part of why we like it in the treatment world is it binds to the opiate receptors.

01:12:55.000 --> 01:12:58.000
It partially binds to them so it doesn't fully it's not enough to it's incredibly difficult to overdose.

01:12:58.000 --> 01:13:02.000
On buprenorphine alone, some would say impossible, certainly for someone who has any kind of prior opiate exposure.

01:13:02.000 --> 01:13:08.000
But it also binds so strongly that subsequent opiates can't buy into your receptors.

01:13:08.000 --> 01:13:22.000
So one of the worries when someone overdoses and we give them the lock zone if they don't want to go to the hospital is that they might go back into overdose once that naloxone wears off.

01:13:22.000 --> 01:13:29.000
What the buprenorphine does is it continues to bind their receptors. So even if that fentanyl still around in their bloodstream, it can't do anything to them.

01:13:29.000 --> 01:13:36.000
They can't slip back into an overdose. And if they try to use later that day, it also won't do that much.

01:13:36.000 --> 01:13:46.000
And so it can it's known to reduce the risk of overdose even in people who are currently using fentanyl because you can't step on top of buprenorphine.

01:13:46.000 --> 01:13:55.000
You brought up a kind of separate issue, which is, TRANK, or, ZOOM, so that's a horse tranquilizer that has shown up in our fentanyl supply.

01:13:55.000 --> 01:14:00.000
We're seeing in about 5% of UAs and local treatment facilities. It hasn't overtaken the supply.

01:14:00.000 --> 01:14:08.000
It's a small percentage of what's going around right now. But it is there. It's incredibly dangerous and it doesn't respond from the lock zone.

01:14:08.000 --> 01:14:16.000
Just in the same way that Naloxone doesn't turn around, drank because it works on different receptors.

01:14:16.000 --> 01:14:19.000
Buprenorphine wouldn't turn around trank either. And so that's why if someone, if someone responds in a locks and they come out of it, that was probably just an opiate.

01:14:19.000 --> 01:14:28.000
But if they aren't responding if you're giving them multiple doses and they're not coming out of it.

01:14:28.000 --> 01:14:40.000
We always encourage folks to call 9 1 one. And to be clear, we always encourage folks to call 9 1 one anyway, but particularly for those in our community who are hesitant to call 900, and, 11 for a variety of structural reasons.

01:14:40.000 --> 01:14:52.000
If someone's not coming out of it quickly, you want to consider the possibility that they have something like, that isn't responding to your naloxone and you're gonna need more, more medical support to improve that person.

01:14:52.000 --> 01:14:53.000
Thank you.

01:14:53.000 --> 01:14:56.000
I know Amanda had a question and then I can go to case.

01:14:56.000 --> 01:15:06.000
Hi, I think you sort of answered it. I was curious what the other impacts or effects were of the suppressing agent.

01:15:06.000 --> 01:15:12.000
So, you can go ahead and go to Keith. Thank you.

01:15:12.000 --> 01:15:13.000
Okay.

01:15:13.000 --> 01:15:27.000
Yeah, well having Having broken my femur a month ago, I was extremely happy that the paramedic in the ambulance was able to give me some ivy fentanyl.

01:15:27.000 --> 01:15:28.000
Yeah.

01:15:28.000 --> 01:15:31.000
And I can attest to the allure. Not only did it take the pain away, I had a, I had a fabulous trip.

01:15:31.000 --> 01:15:39.000
I mean, it was just remarkable. So, And I'm also happy to say that I am no longer on opioids.

01:15:39.000 --> 01:15:40.000
Nice. I'm glad you're doing better.

01:15:40.000 --> 01:15:43.000
That's her hand up. And then I think we're going to need to move on. Go ahead.

01:15:43.000 --> 01:15:46.000
Commissioner Dean.

01:15:46.000 --> 01:15:56.000
Yeah, thanks. I've been reading some interesting articles lately, you know, however many years we are into now.

01:15:56.000 --> 01:16:06.000
Harm reduction and you know, there's some question is to efficacy, but then also just.

01:16:06.000 --> 01:16:13.000
You know, philosophically thinking about the difference between how we have successfully treated other public health. Hazards like smoking.

01:16:13.000 --> 01:16:22.000
So the cigarettes like HIV prevention where we've been able to change people's behavior.

01:16:22.000 --> 01:16:34.000
And prevent them from. From suffering from, you know, life threatening. Disease. And our response to Fentanyl is quite different.

01:16:34.000 --> 01:16:37.000
And you know, we didn't say people with, with HIV should just be allowed to do it.

01:16:37.000 --> 01:16:48.000
It's like the whole finds good treatments. We didn't say people should. Keep smoking and we will, true that treat lung cancer differently.

01:16:48.000 --> 01:17:00.000
So. You know, what is the, how is the home reduction community viewing this differently? Is it simply that these drugs are so powerfully addictive that we need a different response?

01:17:00.000 --> 01:17:03.000
I just love to hear your reaction to that.

01:17:03.000 --> 01:17:08.000
Yeah, I actually don't think we treat them that differently. So when I think as a family dog, I have patients who smoke.

01:17:08.000 --> 01:17:18.000
Would I like all my patients to stop smoking? Absolutely. It's one of the most positive things they could do for their health.

01:17:18.000 --> 01:17:24.000
But many of them won't. And so what I do while they smoke is I keep working on getting them to quit smoking.

01:17:24.000 --> 01:17:34.000
I keep doing what I can doing what I can. I engage in motivational interviewing, figure out where they are in their addiction to nicotine and whether or not they're willing to stop smoking.

01:17:34.000 --> 01:17:37.000
And then I work on mitigating the haphazards related to smoking. So they've developed COPD.

01:17:37.000 --> 01:17:46.000
I get them inhalers. I work on reducing the effects, on their children. So we encourage them to smoke outside.

01:17:46.000 --> 01:17:54.000
They don't give secondhand smoke to their children. So I would actually argue we do very similar things in at least in the medical world.

01:17:54.000 --> 01:18:01.000
I think the difference when it comes to fentanyl is the law world. We've never said if you don't quit smoking I'm gonna lock you up because it's so bad for you but but we will do that for this.

01:18:01.000 --> 01:18:08.000
It's so bad for you. But, but we will do that for this. But we will do that for this.

01:18:08.000 --> 01:18:15.000
And so I think a lot of what informs the difference in how we approach fentanyl is the difference in how we approach fentanyl is more the stigma associated with it.

01:18:15.000 --> 01:18:29.000
But it is different. It is a different situation than, the nicotine. Though I would, I would remind folks most of my patients who are addicted to that mill are also addicted to nicotine and the combined effects of those can be very, very damaging.

01:18:29.000 --> 01:18:35.000
But what do we do? One quick slide and then all the other things we can do. Interestingly, a lot of people think kids are using a lot more fentanyl and here that's not true.

01:18:35.000 --> 01:18:48.000
So in Jefferson County we've seen actually a reduction in in illicit use and a reduction in cigarette smoking in our youth.

01:18:48.000 --> 01:18:59.000
And we can speak some more about the many coalitions that work hard to make this happen, but this is different than what we're seeing in other parts of the state where we are seeing a rise in youth misuse of narcotics.

01:18:59.000 --> 01:19:08.000
We do have an increase in our region in unintentional overdoses of all of these things, particularly in infants who are exposed, who have fentanyl in their house. And so we have work to do on.

01:19:08.000 --> 01:19:20.000
Reducing risk to very small children and we see overdoses of cannabis products and infants as well because they're in candy.

01:19:20.000 --> 01:19:29.000
And so there is some safe storage work. That we need to do around both of those. But we are not seeing a spike in youth misuse of these in our region.

01:19:29.000 --> 01:19:36.000
And I think continuing the evidence-based measures that we're doing with youth is incredibly important there. But what do we do?

01:19:36.000 --> 01:19:45.000
And what can we do? So one of the things is increasing access to treatment. There's been a lot of work on that, but a lot still needs to be done.

01:19:45.000 --> 01:19:52.000
It's still easier to get fentanyl than it is to get sober here. And as long as that's the situation we're gonna keep having a problem.

01:19:52.000 --> 01:19:59.000
There are evidence-based models, so medication for opiate use disorder. Similarly to smoking, we would keep that analogy going.

01:19:59.000 --> 01:20:05.000
It's easier to quit smoking if you have access to medication like Chantix or nicotine replacement therapy.

01:20:05.000 --> 01:20:15.000
Same thing with opiate use disorder but because of stigma we've been telling people to just quit for the longest time when we know that there's more effective medications.

01:20:15.000 --> 01:20:24.000
One thing we're hoping to build is this no wrong door idea, which is if you got to an ER, if you got to a paramedic, if you go out to the public health department, wherever you could possibly go, we have a route to get you to supportive therapies and treatment when you're ready.

01:20:24.000 --> 01:20:33.000
And we have a lot of work we could do there to make sure that people who overdose are given immediate access to treatment when they're ready.

01:20:33.000 --> 01:20:43.000
And we don't have that here yet. Youth prevention there are effective prevention campaigns and there are ineffective prevention campaigns.

01:20:43.000 --> 01:20:56.000
So we know they're highly ineffective, actually made people more likely to use drugs. So I hear a lot of encouragement that we should warn kids that fentanyl is bad and I can tell you children know that fentanyl is bad.

01:20:56.000 --> 01:21:02.000
But what we can do is interrupt the cycles that make people start using. People start using because of trauma.

01:21:02.000 --> 01:21:06.000
People start using because intergenerational trauma. People start using because they have mental health disorders that are not getting access to proper treatment.

01:21:06.000 --> 01:21:26.000
We can do all of there are many evidence-based interventions for all of those including increased access to mental health care for youth and adults, and interventions to reduce.

01:21:26.000 --> 01:21:28.000
You just lost your sound, Dr. Barry.

01:21:28.000 --> 01:21:39.000
For that work with families to keep to keep to to prevent that that transition and to reduce risk for kids while they're still in the care of those parents.

01:21:39.000 --> 01:21:40.000
And preventing the upstream drivers of youths. People are more likely to use when they become homeless.

01:21:40.000 --> 01:21:46.000
And so we have to start addressing. The, way that people lose access to critical needs to keep themselves healthy and alive.

01:21:46.000 --> 01:21:58.000
People in our community don't have universal access to a place to sleep indoors or to reasonable and accessible food or medical care.

01:21:58.000 --> 01:22:13.000
Those are not universally accessible. And so if we really want to reduce drivers of addiction, we have to make those more easily accessible for all members of our community, regardless of their means.

01:22:13.000 --> 01:22:17.000
And harm reduction is not antithetical to any of these. It's a partner to it.

01:22:17.000 --> 01:22:25.000
I's acknowledging that many people we would love for people to never start. I'd love to interrupt those intergenerational cycles probably the most.

01:22:25.000 --> 01:22:26.000
That's my passion is making sure that we break those cycles. I would love to make sure everybody had access to treatment.

01:22:26.000 --> 01:22:39.000
If people are not ready for treatment, if they've started using, despite all of our best efforts, I want to make sure they don't die.

01:22:39.000 --> 01:22:42.000
I want to make sure they don't get syphilis. That they don't get hepatitis C.

01:22:42.000 --> 01:22:50.000
I want to keep them alive. Hopefully until they're ready to get to treatment, but even if they don't, they're a human being, they live in our community, I want them to survive.

01:22:50.000 --> 01:23:01.000
And that's what harm reduction says. But often in this discussion about law enforcement strategies, harm reduction is raised as in opposition to these other things, but it's not.

01:23:01.000 --> 01:23:04.000
It's a natural partner. People who engage in syringe service programs are 4 times as likely to get silver as those who don't.

01:23:04.000 --> 01:23:16.000
And so keeping these things alive is a big part of one of those doors, one of those no wrong doors to get people well.

01:23:16.000 --> 01:23:21.000
And we last bit is we have to make, we have had the change our harm reduction services to meet people where they are.

01:23:21.000 --> 01:23:26.000
So the bottom is a naloxone box where you can go get Naloxone even without coming to see us.

01:23:26.000 --> 01:23:30.000
To increase our reach throughout the community. This is actually Calum County's mobile outreach fan because I didn't have a picture of Jefferson counties.

01:23:30.000 --> 01:23:49.000
But we have one of these in Jefferson too to bring our services beyond Port Townsend so that we can connect folks and often in close partnership with substance use disorder treatment professionals so that when someone is ready for treatment, we can get them there as soon as possible.

01:23:49.000 --> 01:23:50.000
Thank you, Dr.

01:23:50.000 --> 01:23:55.000
And now I, I will stop answering questions so we can move on to the next press center.

01:23:55.000 --> 01:23:56.000
Thank you.

01:23:56.000 --> 01:24:00.000
Yeah, I wanna make sure we're able to get everyone in. Thank you so much for that presentation.

01:24:00.000 --> 01:24:10.000
I'm sure we will have more discussion in the months to come around. What's happening in column and how we can look at that in Jefferson County as well.

01:24:10.000 --> 01:24:13.000
Barb, are you? Ready to go.

01:24:13.000 --> 01:24:16.000
I, I am.

01:24:16.000 --> 01:24:23.000
Okay, we have, 45 min left on the agenda and we're running a little behind.

01:24:23.000 --> 01:24:27.000
So if there's, if we can try to hold. Comments or questions. Are you driving? I am driving.

01:24:27.000 --> 01:24:39.000
Okay, and Apple is about to. Get us on our line.

01:24:39.000 --> 01:24:40.000
Yeah.

01:24:40.000 --> 01:24:41.000
Yes, Apple is my AV master here. So. She's getting that up. I just will kind of frame out our objectives here.

01:24:41.000 --> 01:24:53.000
We wanted to make sure that the new members of the Board of Health had kind of an orientation to Chip and Chaw.

01:24:53.000 --> 01:25:12.000
And what that is. I also wanted to make sure that I am keeping the Board of Health attuned to our movement into more of a dynamic cha, which is new for Jefferson County and kind of a new movement in.

01:25:12.000 --> 01:25:21.000
Assessment work. And then I also wanted to do a spotlight on the vaccine work that we are doing, some of what, you know, Apple already showed you.

01:25:21.000 --> 01:25:42.000
You know, we successfully mobilized the. Department of Health caravan got into our schools to provide on-site vaccinations, but A downside is that even though we Mobilized that tool.

01:25:42.000 --> 01:25:52.000
The caravan is defunded. In June so it is not a tool at this point that we will have accessible to us moving forward.

01:25:52.000 --> 01:26:05.000
So. Did well. But need to find new ways to meet that population in the in the future and just note of anybody who can

01:26:05.000 --> 01:26:16.000
Stress the importance of being able to mobilize vaccines, get them to our doors that caravan was quite an effective tool.

01:26:16.000 --> 01:26:32.000
So chip, this is the community health assessment and the community health improvement plan. And Apple, you can go to the next slide.

01:26:32.000 --> 01:26:33.000
Yeah.

01:26:33.000 --> 01:26:36.000
We're having some technical difficulties. I didn't need arrow word. There we go. There you go.

01:26:36.000 --> 01:26:46.000
So our mission is a humble one. We literally want to collect the data to improve the quality of our community.

01:26:46.000 --> 01:26:56.000
Next slide please. So the assessment process and chip and chat is part of the assessment process is a core function of public health.

01:26:56.000 --> 01:27:05.000
It is a means to perform a gap analysis. The Cha scales up to look at a large population or community population.

01:27:05.000 --> 01:27:19.000
And the chip is the community engagement to address how our needs are met. Next slide, please.

01:27:19.000 --> 01:27:26.000
So with the chip shop process, we're fundamentally asking the question, where are we at and where do we want to go?

01:27:26.000 --> 01:27:36.000
It isn't an iterative process to measure, to evaluate. To engage and then to act.

01:27:36.000 --> 01:27:44.000
And next slide.

01:27:44.000 --> 01:27:58.000
So the chaw or the community health assessment is really the problem identification. It is our way that we use to measure gaps and through the chaw process.

01:27:58.000 --> 01:28:02.000
We're pulling quantitative data from over a dozen different data sources. To compile a local picture.

01:28:02.000 --> 01:28:10.000
Of our health status.

01:28:10.000 --> 01:28:13.000
And the next slide.

01:28:13.000 --> 01:28:23.000
So what we're looking at now and what we're working towards now is to take a snapshot of the data, which currently that.

01:28:23.000 --> 01:28:34.000
Data band would be 2019 to 2023. So largely it's a COVID retrospective and that's a really interesting dynamic to be in.

01:28:34.000 --> 01:28:46.000
Where typically we have done Bands of data. There hasn't been this historical event disrupting what is happening in our community.

01:28:46.000 --> 01:28:56.000
So the data it's pulled that we will be doing is again kind of that retrospective. So.

01:28:56.000 --> 01:29:08.000
Given that information, it's not going to be sufficient foundation to realign our chip goals. So our chip goals were largely formed in.

01:29:08.000 --> 01:29:19.000
2019 was the process where the community came together. To develop what were the priorities. And objectives for the community.

01:29:19.000 --> 01:29:31.000
There was then also work during COVID to put together a recovery and resilience plan, which included a lot of expectations on chip to also dive deeper into.

01:29:31.000 --> 01:29:45.000
Social determinants of health. And much of that work is still very relevant and foundational to our new normal and to what that new normal, might be.

01:29:45.000 --> 01:29:50.000
So next slide, please. So in given that context. We're moving into a more dynamic process.

01:29:50.000 --> 01:30:04.000
So as opposed to a start stop of every 3 years we gather data and go through a process. We're working to layer in data as we go and revisit our objectives.

01:30:04.000 --> 01:30:18.000
And so kind of rebuild the plane as we're flying it. And an example of that is the work that we're doing with the JAB group, the youth age band group with youth mental health.

01:30:18.000 --> 01:30:31.000
So in back in 2019, the YAB group set the objective to eliminate suicide for youth in Jefferson County, an aspirational and very important.

01:30:31.000 --> 01:30:40.000
Foundational goal. Currently, the Yab group is still meeting. They have met all the way through COVID.

01:30:40.000 --> 01:30:53.000
There are many professionals doing work with youth and mental health. The schools as well as the Y and other community organizations.

01:30:53.000 --> 01:31:05.000
Monthly talk about. The state of youth mental health as well as move towards. Bridging goals that are preventive in nature for youth suicide.

01:31:05.000 --> 01:31:18.000
So obviously through COVID, this goal has remained largely relevant and continues to remain highly relevant, especially as how unmoring.

01:31:18.000 --> 01:31:26.000
The time period of COVID was. So the last thing we want to do is have a have a stop.

01:31:26.000 --> 01:31:35.000
Why we revisit. What our goals should be. So instead we are continuing to meet and layer data in.

01:31:35.000 --> 01:31:43.000
We have the Healthy Use Survey. Which was just conducted in October. And so in the spring, we will have results of the healthy use survey.

01:31:43.000 --> 01:31:57.000
So we'll be able to take that one slice of data and look at how has that data and how has have those surveys results changed through this time period.

01:31:57.000 --> 01:32:05.000
And what it indicators does it have. As early as this fall. For youth mental health. We also are engaging the professionals who are working with youth.

01:32:05.000 --> 01:32:25.000
So we have that qualitative piece that we're building in. To be able to. Take that temperature of is the data and is the result results reflective in what we are seeing and feeling actively working with youths.

01:32:25.000 --> 01:32:31.000
So by using that data and having that forum that we can engage in, we can realign our objectives.

01:32:31.000 --> 01:32:43.000
We can also feed that information out into the community. And to other organizations that are working in that space and one of those is also the BAC.

01:32:43.000 --> 01:32:49.000
So the behavioral, or the BH, A/C, the behavioral, health consortium.

01:32:49.000 --> 01:32:57.000
With a one tenth of 1%. So. That group is both a data contributor since there is.

01:32:57.000 --> 01:33:07.000
Data collected from those programs. That we can also layer into our results. And we'll also feedback our data so that that is also informing.

01:33:07.000 --> 01:33:18.000
The board as to what we're seeing in the field. What we're assimilating into the picture of youth behavioral help at this point.

01:33:18.000 --> 01:33:26.000
So that is. How we are going to move more dynamically. With our data and with our chip.

01:33:26.000 --> 01:33:42.000
Goals. If we could go to our next slide. One of the other big realities for Jefferson County and we talked about this earlier is the fact that so much of our county we have small data sets.

01:33:42.000 --> 01:34:01.000
Quantifiable data is always going to be Port Townsend centric. So unless we are actively seeking out additional information and adding qualitative data into that, we're always going to be heavily drawn into a port Townsend anchored.

01:34:01.000 --> 01:34:11.000
Chip process. So the next page. Or in the next slide.

01:34:11.000 --> 01:34:12.000
Oops.

01:34:12.000 --> 01:34:19.000
Jumping jumping ahead. So quantitative. This is our data measurements. You know, it's population, it's COVID counts.

01:34:19.000 --> 01:34:24.000
It's the number of deaths. You know, it is what we consider data most, most frequently.

01:34:24.000 --> 01:34:32.000
The qualitative piece is that subjective data. So it is gathering information from surveys, interviews, and observations.

01:34:32.000 --> 01:34:50.000
This is really the community, the community story. Next page. And the qualitative data is hugely important because this is how we really dig into our unserved and.

01:34:50.000 --> 01:34:55.000
Part of the reason they, to be unserved or underserved is they are those small data sets.

01:34:55.000 --> 01:35:16.000
They are harder to get to data. They don't show up well in quantifiable data, so those qualitative methodologies are critically important to be able to dig into our social determinants of health and to address health, needs through a social justice.

01:35:16.000 --> 01:35:25.000
Okay. So vaccines. I can use here as a case example of. Some of the ways we have.

01:35:25.000 --> 01:35:41.000
A combined qualitative quantitative data and really are trying to act in a access their social determinant of help.

01:35:41.000 --> 01:35:51.000
Lens. For those of you who were part of this group last spring, I had mentioned that we were rebooting our vaccine workshop.

01:35:51.000 --> 01:36:06.000
And the vaccine workshop had been a priority. From the 2014 chaw chip process. And that group had made Big strides in bridging the gaps that we had with.

01:36:06.000 --> 01:36:16.000
Largely our childhood immunizations. COVID disrupted so much of our preventative help and vaccinations were.

01:36:16.000 --> 01:36:19.000
Disrupted as as well. We had hoped that we would be able to take an intervention approach and just take things.

01:36:19.000 --> 01:36:28.000
And get them back on track. So we reconvene the, COVID, or I should say the chip, sorry, a vaccine work group.

01:36:28.000 --> 01:36:44.000
And that included Jefferson County Public Health. Jeff is in health care and included schools. It also included the Washington chapter of the American Academy of Pediatrics.

01:36:44.000 --> 01:36:56.000
And with that group, we very quickly focused in on. Supporting the mobilization of vaccine clinics with our school partners.

01:36:56.000 --> 01:37:04.000
So that was the launching of the caravans. And as Apple had said, we.

01:37:04.000 --> 01:37:19.000
We were able to have a care van event in each of our East Jefferson school districts. So each of each event smell felt small, but it really accumulated in 2 being, a significant impact.

01:37:19.000 --> 01:37:31.000
In the vaccines that were delivered, but also in the partnerships that were built. And as I had also said, we're losing the tool of the caravan.

01:37:31.000 --> 01:37:41.000
But that makes those partnerships even more important to be able to engage and talk about what can we do, how do we Sponsor pop up vaccine efforts going forward.

01:37:41.000 --> 01:37:57.000
How can we engage with other assistants to make sure that we're continuing to. Improve our vaccine rates for children.

01:37:57.000 --> 01:38:08.000
And just to give you context of why this is so critically important is that the vaccination completion rate for childhood and mutations in Jefferson County.

01:38:08.000 --> 01:38:16.000
Is currently at 74%. To be protective against a measle outbreak, we need 95%.

01:38:16.000 --> 01:38:30.000
And Dr. Barry is coming on screen and she will tell you we do have facts. We do have measles spreading in Mason County.

01:38:30.000 --> 01:38:31.000
Mark.

01:38:31.000 --> 01:38:32.000
So that is really bringing it close to home. And the most important thing Clark County, sorry. Thank you for the correction.

01:38:32.000 --> 01:38:33.000
Park County but close. Yeah. It was in Mason County. We'd been way more trouble.

01:38:33.000 --> 01:38:37.000
But it is concerning. It is. It's very concerning. And preventable.

01:38:37.000 --> 01:38:49.000
It's still too close to be comfortable. And the last. And preventable and we don't want our students to to lose any more schooling.

01:38:49.000 --> 01:38:54.000
So to keep our our kids in the classroom. To keep them healthy. These immunizations are.

01:38:54.000 --> 01:39:00.000
Critically important.

01:39:00.000 --> 01:39:14.000
So another part of what we're doing is that we have engaged an organization called Village Reach and with Village Reach we have really moved into some deep qualitative research in Brennan and Quilstein, where we know that there are barriers to access.

01:39:14.000 --> 01:39:35.000
To health care. And this has been quite the educational experience as to really learn. From the community what it means to have vaccines half an hour away.

01:39:35.000 --> 01:39:50.000
And We just recently completed 20 interviews of residents and community organizations in Brenton and Cuisine.

01:39:50.000 --> 01:39:58.000
So this is a little bit of a teaser. Because we have not accumulated those survey results yet.

01:39:58.000 --> 01:40:10.000
We will be doing that in the months to come and we're also going to be engaging in a co designing a solution process, in those communities with those community members.

01:40:10.000 --> 01:40:16.000
So you'll be hearing more from. From me about that study. It has been an incredible opportunity to build those relationships as Apple had said.

01:40:16.000 --> 01:40:34.000
We actually got requests to bring adult vaccinate, vaccines to the community centers. So, you know, we jumped to try to support that need.

01:40:34.000 --> 01:40:44.000
One of the big outcomes I can tell you is that when we're talking about South County, Access is everything.

01:40:44.000 --> 01:40:52.000
There's not a conversation about disinformation or vaccine hesitancy that are relevant at this point.

01:40:52.000 --> 01:41:00.000
Fundamentally providing access to vaccines. Is the entire conversation right now. And under yes.

01:41:00.000 --> 01:41:07.000
Barb, I just, worry about 5 min before we need to get to the end of your presentation. Good time.

01:41:07.000 --> 01:41:08.000
Thank you.

01:41:08.000 --> 01:41:15.000
Perfect. Yeah, so. So again, just wanted to, you know, show.

01:41:15.000 --> 01:41:27.000
Vaccines again as an as a case example of taking our data acting on our data and bringing it to our communities as well as making sure we are drilling down to ridge.

01:41:27.000 --> 01:41:39.000
Social needs social determinants of help. So if we could go to the next. Slide. Just to Chunk off this chip person.

01:41:39.000 --> 01:41:47.000
So chip is community health improvement plan and really this is the catalyst of change so The data gives us the problem set.

01:41:47.000 --> 01:41:56.000
The chip gives us a solution set. And the most important thing, and I think this is the next slide.

01:41:56.000 --> 01:42:04.000
We could go to the next slide is that this is it's community engagement so chip is really community meetings.

01:42:04.000 --> 01:42:17.000
Engaging the community and finding solutions. And finding ways to create systemic change to bring improvement to the community.

01:42:17.000 --> 01:42:21.000
And if you could go to the next slide, Apple.

01:42:21.000 --> 01:42:27.000
So. Bringing diverse community sectors together in a collaborative process to improve community health like we talked about that we are doing.

01:42:27.000 --> 01:42:43.000
With vaccinations. And at the next slide, which is pretty much our last side. So just to give you, you know, context here for the dynamic chip when I talk about the dynamic chip.

01:42:43.000 --> 01:42:49.000
The chaw process as we've known it, I refer to that as a top-down process.

01:42:49.000 --> 01:42:57.000
We're gathering a collective data snapshot for the whole of the of the county.

01:42:57.000 --> 01:43:07.000
We are working on qualitative data from a bottom-up kind of model. So the grassroots works that we're doing and then also taking slices of that data.

01:43:07.000 --> 01:43:15.000
Like I talked about with the youth age band and youth mental health. To take the work we're doing on help access.

01:43:15.000 --> 01:43:28.000
You know, we're creating slices of in-depth, information. So we're kind of hoping we will meet in the middle with both our quantitative data from the top down, our qualitative data from the bottom up.

01:43:28.000 --> 01:43:47.000
That will give us a little bit more dynamic. But give us a highly informed outcome to inform the health status of the community and outcome to inform the health status of the community and also engage in community shaping of what our next cycle of goals in a objectives are for the community.

01:43:47.000 --> 01:44:02.000
And that is if you go to the next slide, Apple is just my contact information. If there are any quick questions before we hand it over to Tammy.

01:44:02.000 --> 01:44:04.000
Thank you. Thank you so much.

01:44:04.000 --> 01:44:09.000
Thank you.

01:44:09.000 --> 01:44:31.000
I just briefly share an anecdote to add to Barb's presentation and then move on because you're doing so great at getting us back on time is that we were just on a school call with we have a monthly superintendents call where we were talking about vaccinations for this one and we heard regularly from school nurses that they're getting religious exemptions from family members and the family member will actually say, look.

01:44:31.000 --> 01:44:44.000
I'm just doing this because it's easier than getting a vaccine. And so I think it's important sometimes we, we assume that people don't get vaccinated because they don't wanna be and that there is certainly a proportion of that and that will likely always be there to some extent.

01:44:44.000 --> 01:44:45.000
But there are a lot of folks who would get vaccinated but just have a ton on their plate and it's too hard.

01:44:45.000 --> 01:44:52.000
So in many parts of the county it's harder to get vaccinated than it is to file a religious exemption.

01:44:52.000 --> 01:44:59.000
And that's a default that we have to change.

01:44:59.000 --> 01:45:06.000
Is there a way to get a school nurse to be able to give vaccinations?

01:45:06.000 --> 01:45:13.000
Good idea. I know they have staffing challenges too, but I think one thing that I think we do need to talk about how to get creative to get these vaccines delivered, whether that's through partnerships with sending some of our people down there.

01:45:13.000 --> 01:45:27.000
Vaccinating in concert with the school nurses, any kind of legislative changes we might need to make sure we can vaccinate everyone regardless of their ability to pay.

01:45:27.000 --> 01:45:31.000
There's a lot of work we could do to make this easier for sure.

01:45:31.000 --> 01:45:35.000
Sorry, that just pinged when you're like, they're bringing the form to the nurse.

01:45:35.000 --> 01:45:36.000
Yeah, I just keep a vaccine.

01:45:36.000 --> 01:45:38.000
It's like, why can't the nurse do it? Okay.

01:45:38.000 --> 01:45:40.000
They also need special refrigeration.

01:45:40.000 --> 01:45:41.000
Yeah. Yeah.

01:45:41.000 --> 01:45:46.000
They do. So in that case, what we generally do, we are looking at ways, to partner more.

01:45:46.000 --> 01:45:49.000
We've brought the vaccines in of our school-based health centers already, which they work historically, but they are now.

01:45:49.000 --> 01:46:01.000
But potentially one thing that's been very helpful in clown is showing up at the school like back to school events with the Key vaccines that they're going to need.

01:46:01.000 --> 01:46:05.000
And so there's some creative ways that we can work around that. Challenged by the fact that neither of our institutions are very heavily funded.

01:46:05.000 --> 01:46:15.000
So staffing that can be challenging, but there's a lot of passion around.

01:46:15.000 --> 01:46:23.000
Thank you, Dr. Barry. Tammy, I don't want to cut off your time, so I'm gonna jump, have you jump right in with us?

01:46:23.000 --> 01:46:30.000
Okay, great. Thank you so much. Would it be possible to promote Alysio Livas and Mara Zimmerman?

01:46:30.000 --> 01:46:34.000
One is

01:46:34.000 --> 01:46:43.000
And I'm going to bring my presentation up and go to slide show so I hope It will. Okay, oh, fantastic.

01:46:43.000 --> 01:46:47.000
And you have a full 15 min so Okay.

01:46:47.000 --> 01:46:52.000
Well, thank you so much for having me today. It's just wonderful to be before the Board of Health.

01:46:52.000 --> 01:47:13.000
It's been a really super long time. And I'm very excited about this topic. As you probably, most of you are aware, I've been working in blood plane related restoration since Almost the day I was hired in 2,004 when the county had just received a grant from the recreation conservation office, sound recovery funding board to acquire property.

01:47:13.000 --> 01:47:23.000
In the lower dose wallets and the power line's reach. And so. Obviously then, salmon restoration work precedes me.

01:47:23.000 --> 01:47:41.000
In fact, It's been really important. Funding Stream, that they are CEOs or forward funding for public health, but also Public Works has, taking advantage of this funding source.

01:47:41.000 --> 01:47:54.000
Which is made available through the lead entity organizations, lead entities for salmon recovery. They're responsible for a lot of things but I don't want to speak for Mara and Alicia and I hope if are they with us now if they can speak up whenever they like.

01:47:54.000 --> 01:47:59.000
One of my major purposes in talking to you today is just to bring Alicia and Mara forward for those of you who don't know them already.

01:47:59.000 --> 01:48:22.000
They're tremendous resources because everything that we're talking about and I'm so grateful to Barb and she's working with me in the Brendan Dosi Wolves Collaborative Group, which is addressing very complex suite of flood plane.

01:48:22.000 --> 01:48:47.000
Related development and restoration issues. It's a it's a process and it takes a village to do it properly and takes patience and it also most importantly I think takes a little bit of magic dust that allows communities, newcomers in particular who just don't know how to see where they live.

01:48:47.000 --> 01:49:02.000
They just have never been shown. What, where they live and what it's about from a natural resources processes perspective.

01:49:02.000 --> 01:49:03.000
Okay.

01:49:03.000 --> 01:49:13.000
And it is like turning on the light in a new room you never knew was part of your house. This first image is the website for the Co-sammmon Partnership, which is the regional identity group and Mara are you there?

01:49:13.000 --> 01:49:20.000
Could you just say a quick word or 2 about 7 or 2 at least. About the Co-stAMMA partnership.

01:49:20.000 --> 01:49:31.000
Thank you, Tammy. I am the executive director for the C 7 partnership. That means that I work with multiple counties on the Washington's outer coast.

01:49:31.000 --> 01:49:33.000
We work in watersheds. Spanning from Callum County all the way to Pacific County.

01:49:33.000 --> 01:49:50.000
And so where today must you know your conversation has been about the health of human communities our focus and thought is very much about the health of watersheds and the fish populations but of course those 2 things are connected.

01:49:50.000 --> 01:50:03.000
And so, so I get to work with Tammy. I also get to work with, that a lot of other, really dedicated people who are spending their time and effort restoring and protecting the habitats.

01:50:03.000 --> 01:50:08.000
Fish habitats in the watersheds on the outer coast.

01:50:08.000 --> 01:50:19.000
Thanks so much, Mar. And so then this next image is from the website for the Vic Canal Coordinating Council, which But then it's umbrella is the lead identity for her canal.

01:50:19.000 --> 01:50:25.000
So I'd like to introduce Alicia, leave us and ask you also to say a bit about.

01:50:25.000 --> 01:50:26.000
And.

01:50:26.000 --> 01:50:36.000
Oh, thank you. My name is Alicia Leaves. I'm the 7, Program Implementation Manager in the identity coordinator for Hood Canal Courting Council.

01:50:36.000 --> 01:50:43.000
Hood can now courting council is the regional recovery organization for Hood Canal and Eastern Strait of Few.

01:50:43.000 --> 01:51:03.000
And we're also the lead entity for Chinook and Summer Chim. And Were the council of local governments, Jefferson County is one of our member governments is along with KIDSAP and Mason County and the Port Mambos Calm Tribe and Scocomers Tribe.

01:51:03.000 --> 01:51:04.000
Thank you.

01:51:04.000 --> 01:51:11.000
And our focus is on ecosystem recovery and we. You know, the lead entity focuses on habitats, in habitat.

01:51:11.000 --> 01:51:15.000
Projects, but that has to work. In in human well-being, humans are what are part of that ecosystem.

01:51:15.000 --> 01:51:30.000
We have to make sure there's not conflicts with economic growth and and such and when so we focus our work in that purview.

01:51:30.000 --> 01:51:48.000
And you know, to to talk about health in that and and how important the ecosystem is for people and including people in that ecosystem is, really important, the conversation that we have often and and we want to continue to have.

01:51:48.000 --> 01:51:50.000
Thanks.

01:51:50.000 --> 01:51:58.000
Thanks, Lisa. So. Where are the flood plains? And who's involved in them?

01:51:58.000 --> 01:52:18.000
This is just the briefest scratch of the surface of the world that we're talking about that most certainly involves people and the choices that they make both past current and future and And it's just a huge negotiation about our future and the climate is definitely a huge.

01:52:18.000 --> 01:52:27.000
Piece of all this, all of our salmon projects have to have a climate element. It's part of the competitive process to ensure that we're addressing climate with what we're envisioning.

01:52:27.000 --> 01:52:54.000
So here are the major restoration watersheds that I'm aware of, the county. Is only, I'm usually involved in a lot of these but some in a couple places we've really taken the lead but also know that the conservation futures program our smallest property tax contributes in a lot of these areas that are mostly, you know, led by tribes or nonprofits or the land trust or enhanced salmon

01:52:54.000 --> 01:52:59.000
and handsberg groups such as NOSE or the Hood Canal Salmon Enhancement Group.

01:52:59.000 --> 01:53:06.000
Sometimes it's the state. Like in the case of in the lead role but it's always a partnership.

01:53:06.000 --> 01:53:15.000
Because these are almost always. Involve projects that need to be looked at from a variety of perspectives.

01:53:15.000 --> 01:53:23.000
And so there's a basic process, Lisa and Mara, please. Tell me if I'm missing something, but basically I love this process.

01:53:23.000 --> 01:53:39.000
We have a lot of iterative feedback. We promote, we hypothesize about a project, we get some feedback, them if we are convinced that it has a merit, then we'll go through the application process, which takes many months.

01:53:39.000 --> 01:54:04.000
But it's very through and there's a review by the technical people who are invested in a particular watershed there's a review by the citizens which is the voting members of the lead entity itself you go and visit you make a presentation then the state salmon recovery funding board reviews the project then after all that is still did county whether they you know the commissioners would choose to approve the grant agreement so yeah there's just

01:54:04.000 --> 01:54:14.000
it's just very helpful in making sure that we're not forgetting something or missing something. So if you just take a quick look at these columns.

01:54:14.000 --> 01:54:25.000
So planes unlike, you know. Everywhere on the planet has its fascinating aspects. I'm a little partial to flood planes because there's so much going on there.

01:54:25.000 --> 01:54:43.000
You know, people try to dig in into their places or their activities and those are more fixed. And then the river has a different idea and it's always, it's a doing and that's not a place, it's not a thing, it's a always processing, it's always.

01:54:43.000 --> 01:54:47.000
Recreating itself and destroying itself. And making things messy and people want to clean it up and that has implications.

01:54:47.000 --> 01:55:09.000
Like surprisingly important implications, just our tendency to be tidy is a problem for fish. So one way that really important way in Western Washington that flow planes are messy is through the larger wood cycle which actually has genetic implications for fish.

01:55:09.000 --> 01:55:18.000
This is a, I sent this study around. It's on the Co-sanon Partnership website too.

01:55:18.000 --> 01:55:25.000
And then we then we also sort of have our routine that everyone kind of gets about how to propose projects.

01:55:25.000 --> 01:55:38.000
And I bring this up because with the climate change funding pipelines that are coming online, there's this tendency to believe, we have to create a process.

01:55:38.000 --> 01:55:39.000
Yeah.

01:55:39.000 --> 01:55:54.000
And I can just say, don't save yourself the headache. Use this. At least be aware of this, you know, it might be necessary and desirable to create a separate review process, but you know if you can touch into the local expertise do the lead entities you might find that you know you haven't thought of something.

01:55:54.000 --> 01:55:59.000
I've been doing this for a long time. I'm always discovering that and it's part it's wonderful.

01:55:59.000 --> 01:56:06.000
It's exciting because it's really more interesting to be part of a knowledgeable team as the health side knows.

01:56:06.000 --> 01:56:14.000
You don't want to have like newbies coming on line. They've never thought about it, but they have all these brilliant ideas about how it should be done.

01:56:14.000 --> 01:56:27.000
So it's the same thing. And so our basic process is, you know, to get information just like Barbara saying it's the data we got to look at the topography we've got to look at the geomorphology, how the water flows of the surface.

01:56:27.000 --> 01:56:36.000
Habitat, cultural resources, wetlands, and then circling it to the community, sort of saying, hey, this is what we're seeing.

01:56:36.000 --> 01:56:41.000
And, and then what I was talking about before. Make sure that we have a technical review, then you know we're getting into public works projects and these are serious.

01:56:41.000 --> 01:57:02.000
They're like open heart surgery. That's the analogy. The cost hundreds of thousands if not millions of dollars lots of trees get taken from upland forested areas to be put in floodblades to create that complexity and messiness that nature thrives on and so it's serious business.

01:57:02.000 --> 01:57:19.000
There are trade-offs. If you can flood one area, you might have flood risk. Reduction elsewhere if you Put wood in, you might elevate the groundwater, that could impair agriculture, but it could also reduce wildfire risks.

01:57:19.000 --> 01:57:34.000
I mean, it's just fascinating to know end. You know, trying to put together a suite of very a of projects ideally to deal with a really serious problem of climate change.

01:57:34.000 --> 01:57:44.000
And you know, I don't know if you've I don't know how far it is in the pipeline, but I know that a ring dike is being seriously contemplated for all around Hookwiam and Aberdeen.

01:57:44.000 --> 01:57:51.000
You know, so a ring dye would be putting a very serious pile of linear pile of rocks.

01:57:51.000 --> 01:57:55.000
To protect that community from the Shellis River and sea level rise. And that's got all kinds of implications.

01:57:55.000 --> 01:58:05.000
So, you know, maybe that's the best that we can do. Oftentimes, but maybe not.

01:58:05.000 --> 01:58:12.000
The best we can do all the time. In terms of cost versus benefit and longevity and stuff like that.

01:58:12.000 --> 01:58:20.000
So. Climate change impacts you. I'm sure you've heard this ad nauseam just gumbs back to the fact that.

01:58:20.000 --> 01:58:28.000
How the climate operates in a watershed translates into how a river responds and how a community is impacted.

01:58:28.000 --> 01:58:34.000
And then I just want to say, you know, in the climate. And,

01:58:34.000 --> 01:58:44.000
The climate action plan on page 17 is the statement about Oh, sorry, don't bed. About flooding.

01:58:44.000 --> 01:58:57.000
There's not much on flooding. But it gives the example that we need to adapt and I just wanted to make it a proposal that if this is plan is updated or in your thinking about this part of the plan.

01:58:57.000 --> 01:59:03.000
That we can do this in a certain way. We can definitely, we want to do what the plans suggest, but.

01:59:03.000 --> 01:59:12.000
It's about how we do it because ultimately like climate change is not a pretty thing. You know, we don't want to sugarcoat that.

01:59:12.000 --> 01:59:19.000
And really oftentimes, you know, whatever we do with people who are going to remember what they're going to care about is how we did it.

01:59:19.000 --> 01:59:26.000
And I just really love. This is a model for how to do things and to bring in more community health side.

01:59:26.000 --> 01:59:30.000
I've always hoped for that to bring the community health side into the practition the practice of flow plane restoration and vice versa.

01:59:30.000 --> 01:59:44.000
And so I'm just thrilled to have Barb attending minute meetings and Brent Butler and you know just having more of a well-rounded team involved in the lead enemy.

01:59:44.000 --> 01:59:52.000
Work for my in the case of my project anyway. And then I just wanted to mention we have groups for marine environments too.

01:59:52.000 --> 02:00:09.000
They're not so geared up for specific public works type projects but it's still these are great great groups to just connect with they're still diverse and they're happening groups like we just had our marine North Pacific Coast Marine Resources Committee meeting this Tuesday.

02:00:09.000 --> 02:00:15.000
I mean we routinely get 15 to 20 people every month. It's there there's just a it's a wonderful team.

02:00:15.000 --> 02:00:21.000
I'm sure the Jeffers of Calmary County Marine Resources Committee, a lot of the CAC members are climate action committee members are on that.

02:00:21.000 --> 02:00:31.000
So then this proposal. Is to mention the MRCs as well. And I hope that this is helpful.

02:00:31.000 --> 02:00:42.000
I know you a lot of you know a lot about Lead and Andy work already, but I just am hopeful that you'll think of them when you consider our response to climate change.

02:00:42.000 --> 02:00:43.000
Thank you, Kami. We wrap up here. So.

02:00:43.000 --> 02:00:48.000
Yeah. Yeah, I'm done. Unless there are questions.

02:00:48.000 --> 02:00:58.000
Have 1 min if there's any burning desired questions in the room. Okay. Thank you so much for, Michael.

02:00:58.000 --> 02:01:01.000
How's a hand up? Michael Dawson. You have 1 min.

02:01:01.000 --> 02:01:11.000
Hey, thank you. And I just wanna really thank Tammy for presenting today. I know that sometimes the board doesn't hear as much about the natural resources work that goes on in the county.

02:01:11.000 --> 02:01:33.000
And I just really want to encourage. Members. If you have questions about, you know, any of these kinds of areas that Tammy has mentioned, she, you know, she alluded to her wealth of experience over the 20 years or so that she's worked in the county and also she just partners with the most knowledgeable people.

02:01:33.000 --> 02:01:38.000
You know, some of whom she brought in here today and. Many others in addition and I just.

02:01:38.000 --> 02:01:45.000
Think. anybody should. Feel free to reach out to Tammy on questions.

02:01:45.000 --> 02:01:54.000
You know, having to do with. Rivers and climate change and sea level rise and all those sorts of things for the expertise that we have in here.

02:01:54.000 --> 02:01:56.000
Thank you.

02:01:56.000 --> 02:01:57.000
Thanks, Mike.

02:01:57.000 --> 02:02:18.000
Right. Thank you, Michael. Tammy. Thank you for taking care of our waterways and our salmon and in the old ways those are the most important parts of our ecosystem and they tell us so much about how we have to respond and it taking care of our fish and taking care of our water and taking care of our trees and taking care of all the living things is taking care of us.

02:02:18.000 --> 02:02:25.000
So it is a huge piece of public health. So thank you for taking the time today. I'm sorry that it was rushed.

02:02:25.000 --> 02:02:37.000
And thank you all for bearing with me as my first. Chair chair chair moment. And with that, if there's nothing else, it's 4 30 and I'm gonna adjourn this meeting.

02:02:37.000 --> 02:02:38.000
Good job, Amanda. Thank you.

02:02:38.000 --> 02:02:39.000
We'll see you all next month on time. Okay.

02:02:39.000 --> 02:02:40.000
Thank you.

02:02:40.000 --> 02:02:43.000
I, nice to see you.

02:02:43.000 --> 02:02:46.000
On my phone. That's 4 32. My phone. This is 4 32. My, my computers is 4 30.

02:02:46.000 --> 02:02:59.000
That in action. Oh my gosh, I, I felt like I was. Thank you, Glenn.

02:02:59.000 --> 02:03:01.000
And I'm sorry we give you such a cramped, things moving. And I'm sorry we give you such a cramped agenda, but we've been doing that a lot.

02:03:01.000 --> 02:03:20.000
Well, it's a it's a it's a cramped agenda, but we've been doing it a lot.

02:03:20.000 --> 02:03:24.000
Well, it's a cramped agenda, but we've been doing it a lot. Well, it's a, it's a, it's We jumped in.

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And, and, and Glenn is. And Glenn is invaluable as usual.

02:03:30.000 --> 02:03:37.000
Yes, he is a great co-captain. Keys, these are big, big shoes to fill.

02:03:37.000 --> 02:03:38.000
Alright, take care everyone.

02:03:38.000 --> 02:03:44.000
I shouldn't say big feet, big shoes to fill. Do well. Rest rest

02:03:44.000 --> 02:03:49.000
Thanks, I will.

02:03:49.000 --> 02:03:59.000
Thank you. Good you. I think I'm the only one who loved today. I think I have to.

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When the highlights reels come. When we do our agenda planning meeting. Glenn, I'm talking to you so you can help me remember.

02:04:09.000 --> 02:04:13.000
Yeah, I have I have that problem.

02:04:13.000 --> 02:04:18.000
When we have highlights, reels to do every quarter. I think I need to take You know, we toggle between 5, 10, and 15 min.

02:04:18.000 --> 02:04:26.000
And then I didn't, didn't even occur to me when we were setting up this that you need.

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I do not write the narrative. Communications team does and I want to do good service to them and I want to do good service to them and I want to do good service to them and read what they're doing.

02:04:35.000 --> 02:04:39.000
And I want to do good service to them and read what I want to do good service to them and read what they put a lot of effort in all their work.

02:04:39.000 --> 02:04:43.000
Put a lot of effort in all their work. Put a lot of effort in all their work. And I also have my sites and I wanted more people to talk and have questions.

02:04:43.000 --> 02:04:46.000
And, anyway, maybe I was talking. It's a lot minus. 10 speed or so.

02:04:46.000 --> 02:04:52.000
No, it's dead