We're recording now. Okay, pursuant to Governor Baker's March 12, 2020 order suspending certain provisions of the open meeting law, general law chapter 30 a section 18. This meeting of the Board of Health is being conducted via remote participation. I will have a roll call to check and make sure everyone on the committee and the staff's video and audio is working. So, Steve here. Tim. Yeah. Maureen. Here. John. Here. Emma. Emma. Are you here? And Nancy here. So the meeting is called to order. And the first thing on our meeting is to review the draft minutes from 2011. I mean, February 11, 2021. I read them. I didn't see anything. Does anyone have any comments? Changes. Okay. So we have a motion to accept the minutes as presented. A move we accept the minutes as presented from February 11, 2021. Second. I'll second it. Okay. All in favor, Steve. I. Tim. Hi. Maureen. Hi. John. Hi. Nancy. Hi. Hi. Hi. This is tapestry harm reduction program. And Liz. Why not is here. Hi, Liz. Hi, everybody. So at our last meeting, Liz presented material and asked us if we would like to. I'm sorry. To people in. Amherst. Sorry about that. And last week I talked to Liz and I went and got the. Law. And Liz and I put together the request, which I sent out to all of you for the van to be coming to. Amherst. I'm sorry. I don't have time to read it. Finishing now. People have questions, comments, concerns. I have two pieces. When I sent this out, I CC'd Emma and Jen Brown. And I don't know if you saw Jen Brown's reply today. I don't know if you saw it. I saw it in the garage. And there was something to do with it. And on that same line last year, right before the pandemic, I was walking in town and there was snow. And I saw a needle on the ground between the toy box. And the new apartment complex. I didn't have gloves. I didn't have a sharp box. So I, and it was four 15. So I, the board of health was. I had to go over to the fire department. So I went over to the fire department and I said. What I was and she said, well, we don't have people with sharp boxes to pick these things up. So it just got left on the sidewalk. And it was close to the toy box. So that's dangerous. So that's one point in the second point. Both Belcher town and Montague have approved this. And I think that's one of the things that they did. And all they did was vote on it during their meetings. And then they send a letter to the state and supposedly, and I have a copy of the letter, but Liz can provide us the letter. And that's all those other two did in their February meetings. And they're both moving forward with tapestry. So I thought I'd share that information that I got. This in the past week with you. And I think that there are a lot of things that are going to be published. But that was what I was thinking and I think it was a lot of the public hearing about it. It would delay it. And with the law, there's no need for public hearing. And. There, this is the first really push for the Vans and the western part of the state. It's all been in the Eastern part of the state. And I looked in the Eastern part of state. No one's had. Meetings, all they've done is the boards of health have voted on it. I, I, I looked at a couple and as far as I can tell, I didn't go into every van, there's that map and I went into all those different, I went into several towns. And from what I gather and I don't know Liz, if you have any more information, but towns just the Board of Health just approve this. Montague and Belcher Town did it at their February meetings. Correct. Yep. I don't, I don't have information about that how it was approved where mobile outreach exists in Eastern Mass. I, yeah, I do want to say that I had the opportunity to reach out to the police chief and the fire chief. The fire chief and I have been playing phone tags are both really busy and engaged with our each of our departments. So we haven't been able to directly communicate. But I know that I spoke with Chief Livingstone, and he is and he supports Amherst Board of Health with this program for harm reduction. He says that they, they don't see a lot associated with this. I've tried to educate that, you know, sometimes we don't see the true outcomes and, you know, the stuff that we see is just the tip of the iceberg that this is a really beneficial program. It's the captive audience to get one step closer to possible treatment or engagement and trust so and like I think you've said Nancy it's one of those 2030 goals for public health correct. Yes, it is. I personally support it but I just think you know sometimes people have a question they want to raise and it's better if do it beforehand but I can see if nobody else is doing it it's fine. Let me just raise one thing that somebody would say that somebody might say and you could tell me what the answer is. So, and I think it's the obvious that someone say well it definitely will help the people who are current users but by normalizing it, it will possibly put somebody who's a little bit on the fence or they have a, you know, it's a sudden opportunity and it might make them go the wrong way if they know that they're not going to get HIV or Hep C and so it might encourage somebody to do it and I looked up the data on it. And we could certainly say you know there is quote, no evidence of that. But what does that mean you know you're talking about absence of evidence really not evidence of absence and you know the studies doesn't seem like they necessarily had statistical power to really detect a small number of people doing that. So what do you say to somebody that says it's fine you're helping all those people but my relative and my loved one might be tempted to use because of this. Yeah, well, so, in addition to I think the evidence will say because some of the other evidence you know shows drastic decrease of HIV and hepatitis C. But I do engage with certain access programs are more likely to enter treatment it doesn't have effect on crime or, or, or it's actually helps with public safety officials with with needle sticks and possible transmission. I think it's also important to know that you can purchase syringes at any pharmacy and so downtown Amherst, wherever and then also to make it clear so so tapestry is funded by the state and to be able to use state dollars to provide the service we need local board of health approval but outside of that it's any anybody it is actually legal for anybody to distribute syringes now. So on a volunteer basis or anything like that so. So that, and then in addition, we are in the midst of a really terrible fentanyl infiltration of heroin that the overdose rates are going up. Unfortunately, COVID has impacted the amount of people that have started using drugs again or started injecting injustice suicide rates and everything related to this hard year that that we've experienced. There's a lot of so with that the lack of evidence I guess, versus the incredible amount of evidence of how helpful this is for people who need it and their families and the community and the benefits it has. That's, that's made some. I might be able to speak a little bit to the site. I did a lot of public health work in Springfield and in the North and and at treatment programs and sites for users. And the big argument for over 20 years in Springfield was just what you're bringing up Steve that if you have needle exchange here, you're going to have more people using well guess what they found out. In the needle exchange, they had less less deaths, more Narcan and more people going into treatment, and they saw it as a positive outcome. I don't know if you can address that because I stepped back from my work in the north end of Springfield after I retired from Elms College. When I was with tapestry before needle exchange was approved in Springfield or Holyoke which are the two hardest hit cities by far and Western Mass and it felt terrible to only be able to leave bleach kits, which is provided by the DPH and not be able to leave syringes and in addition to that the amount of HIV from injection drug use has just been very high amount of overdoses and decreasing so so so it did exist before it was approved some and then I mean in Holyoke especially it's been really I think wonderful to see the positive impact that it's had in the community because I grew up in Western Mass and you know just familiar with Holyoke in different ways. And as far as the community support in 2012 and Holyoke was approved it was very controversial. We did a sear after it was approved we did a lot of education to the community we started neighborhood cleanups and did a lot of community involvement I mean topster is known I think for being involved with the community. And that that grew the support, my experience has always been where people who are hesitant like the education experience is always gone and the way of understanding how important the services I guess. When they were just doing bleach kits in Holyoke and Springfield because that's where I did public health with students, you saw needles all over the place on the ground. And the literature shows that and that dangerous what if a kid picks it up, and you don't know if the person who's Anna has had hep C or HIV and a kid gets a needle stick. They said I saw this by toy box that's why I was so worried last year. There's been decrease syringe litter in both of those cities, after the syringe for exchange program went through people in Amherst have been able to exchange syringes. Since you opened 25 years ago doing it North Hampton. It's a little more convenient for some people without transportation and other issues. One other very important thing also to mention is that we do syringe disposal so the pharmacies don't offer syringe disposal and I'm not I'm not sure what Amherst's current method of disposals like but that. That would be another service that we would integrate into this and we, and we would do disposal for people died of people with diabetes or you know other things that they just need like a free and easy way to dispose. Yeah, currently we do have a needle disposal program it's it's how housed out of the transfer station since the start of the pandemic, but we do offer that but I think this is a great addition to. A $100 permit to get into the transfer station. I think they accept it without the permit if you have how many people know that all I know is I need $100 permit to drive my car in there. Yeah, I know that during some homebound visits I've transported some sharps for people in closed containers because of that fact that's a good point Nancy. And also, I'm responding in the 1990s. We knew three kids who died of overdoses in town. My daughter's classmate December senior year, another friend of hers brother, and another friend of hers whose mother is a realtor in town, her brother so three boys. Mid to late teens in Amherst overdose and if there was harm reduction and if they could have been led to some kind of program, maybe they, and it just scares me if you look at any of the literature now it's the fentanyl that's going way up in numbers. And that's what's causing death set if we can just save. And if you see that we had three deaths here in Amherst and in 19, and what were the number of 30 EMS incidences, which says there's a problem. So, other comments or questions for Liz, Tim, or John, Maureen. I do, I was just curious about the needle exchange I mean how do you have to exchange them to get new ones or if you just need new ones can you get new ones. Well, so we do it on based on what the person needs in that moment. There, there's a lot of reasons why the like one for one exchange isn't isn't the best way to go. One in Western mass I mean, in addition to I think that things outlined, it might have been outlined in the in the document that Nancy and I worked on but transportation is a really big barrier, especially in rural parts of Massachusetts including and we work with all sorts of people, some a lot of people, and I'm thinking of people from the greater Amherst area will come to us, but only bring syringes in after a few months. There's still a fear of transporting syringes and because I mean you technically can get arrested or it could be a problem cause for further search and so there's all a myriad of reasons why it's important to be flexible. But our data. That was a barrier to getting. Yeah, safer syringes. But that is also I think a community concern I mean I've definitely been asked that question before our tapestry data does consistently show that we are bringing actually bringing in more needles than we're giving out. And we, you know we we do things. We're starting and so we're actually starting like one thing I'm interested in doing more and Amherst is going to people's homes or wherever they are and providing it there you know we started to implement cell phones and text messaging and kind of like, like, even lower barrier ways of meeting people. So that so that in itself I think will also help to increase the amount of needles coming in. I saw in Northampton there's a like a stainless steel disposal box near the near where that homeless encampment was and I wondered is that was that through tapestry was that part of that was that was from the health directors. They installed those during COVID. Yeah. Yeah, but we we dispose of the syringes after that but and yeah, but they did that on their own. That's great. John. I don't have any questions it seems clear to me and a positive thing to do. Yeah. I think it's needed for our community. I think especially the trends and need a place for having a safe and confident connection for people who are at high risk. I think this is a great way to do that in. Steve. I appreciate those. I'm just thinking about if somebody asked me, I think I know more what to say. I appreciate it. Yeah. Yeah, it's good discussion. Any more discussion or can I have a motion. Emily want to say anything about it. Yeah, I just, I'm so pleased that we're, we were able to bring this to the table and to the board of health. I, I think this is really an exceptional moment for the Amherst community that that Liz came forward and that we've had this opportunity to discuss with her and that the board will take their vote shortly I think. I just, I think it's, it's a demonstration of how far we've come societal wise with understanding drug addiction and the stigma around that and I'm just really, I want to thank everybody for being in this virtual room together. Can I have a motion. No, go ahead. Okay, I was just going to move that the board proved the request from tapestry to provide the needle exchange or the sort of this, let's say syringe access program. Mobile harm reduction is. Okay, okay. Yeah. We're giving up. We're notifying the state that we are supportive of the program. Isn't that what we're doing. Correct. How do we pose that in a motion. I mean, that's the tech, the technical action. So the letter, right? Yes. Liz, do you send us the draft of the letter that we then send. I have a template. Yeah, that I can send you in the directions with who to send it to. Okay. So we're proving the program vote specifically we're proving sending a letter to the State Health Department of Public Health, to establish that program in Amherst. That we approve of hosting to the tapestry program in Amherst. The mobile harm reduction mobile harm reduction program. It encompasses it's more than a syringe. Yeah. Narcan it's education it's connecting people to treatment when they're ready for treatment. And then they're also doing other health. So if they see someone with a wound or someone might be having cardiac problems from using they'll help make referrals so it's, it's, it's, it's a bigger program than just syringes but that's. And so that's important to tell people, Steve that the syringe piece is a small piece of this but it's really harm reduction for people who use and it decreases chances of needle sticks of employee of our town employees and people walking on the street in the garage and next to the toy box. And those are all I'm sure there are plenty more places people have seen needles. Okay, so what did I move. The, the, the, it says it only the, the needle exchange port part of it that needs the approval from the town to the state, how about though. I mean, so to do all those other things you wouldn't need their approval but. We need the implementation of the harm reduction program, including needle exchange. Okay. Have that Steve. We're going to move you to the board approved hosting the tapestry mobile harm reduction program, including needle exchange in Amherst. We have a second. I second it. Okay, now. All in favor Steve. I. Tim. Hi. John. Hi. Maureen. Hi. Nancy. Thank you. Thank you. Yeah, unanimous. Thank you, Liz. Yeah, this is really wonderful. Reading this and sharing your concerns and support. I really appreciate it. Yeah, thank you so much. Is it. Is it Emma's task to inform the state? Is that what. I'll email Nancy and Emma, maybe the template of the letter and the directions for who to send it to letter. And then you need to send a copy of the minutes with the letter. I'll get the letter ready. And then when we approve our minutes at our April meeting. The letter and the minutes go to the state. This is what both Belcher town and. Yeah. I think that was the process. Makes sense. And then the state gets a hold of you guys, right? The tapestry. Yeah. Yeah. You have to make a yearly report. Yeah, I can come more than that as well. Thank you. Thank you. Thank you. So long. Right. Thank you. Thank you. Thank you. Steve McCarthy and the tobacco regulations, the update, and this is on how. The. Businesses are doing with our quiz for all employees that handle the sales of. Tobacco products. Hello, everybody. My name is Steve McCarthy and the licensing coordinator for the town of Amherst. I work at Inspection Services in Town Hall and the bulk of my job is dealing with things like liquor licenses, restaurant licensing, helping businesses open up in Amherst, but I do dabble a bit in health as well and tobacco is a part of that. So this year with the pandemic, we've been trying to migrate most of our license applications online, everything from residential rental permits to liquor licenses to food licenses and tobacco and we've been using the OpenGov software suite, which has been really great. It's been much simpler for applicants and people to use and it's got, you know, good access for the public to look at records and things like that. We're pretty delighted with it. And so we did construct the tobacco license application for the businesses around the new year. We were kind of always playing catch up with this with COVID coming along and trying to frantically get everything online, but we were able to get most of our annual licenses made in time for the renewal at the end of the year. And speaking with Emma a few weeks ago, she brought to my attention that part of the tobacco quiz and the regulations also includes that each employee must also pass a quiz. So I have developed an application in OpenGov for each employee to be able to take a quiz online and certify that they understand the regulations and so on and so forth. So I thought I'd be happy to show you all that and see what you think and if you have any suggestions, but I thought the best place to start would be to refresh you with what the quiz was on paper. So this is what we would give out to applicants here. We would typically only get one back because they would, you know, I think they were supposed to have their employees just keep these on site. But I did my best to recreate that as best I could in the software. Let me pull that up. So we call the tobacco handlers quiz and this is the form they would have to fill out. They have to fill in their name, email address that could be useful. There's ever any change regulations or something where we have to notify them. What business they're employed by the business address, they have to certify they are over the age of 21, which is of course one of our regulations. There is a link to the Board of Health Tobacco Regulations and the Massachusetts Department of Health Tobacco Retailer guidance information. Now, in the most recent regulation document that the Board of Health put out, there was a link included in there to this and it does seem to be out of date and broken. So I searched the website and this was the closest thing I can find. Now, I don't know if this seems like what you'd be looking for for that. Yeah, that link. OK, great. And then they would have to go down. And I think we might have to tweak this language a little bit. I just copied that verbatim from the old quiz and they have to check each of these boxes that they understand the different aspects of the regulations. And at the very end, they do have to do a digital signature. And once they've completed that, it will go to me to review to make sure they have checked everything that they are over 21. And once they have been approved, they would get this certificate they can print out and in lieu of the quiz itself being kept on-premises as the regulation state, that wouldn't really be extremely easy with our software. I thought that a certificate like this printing out would probably suffice if you if you also agree with that. Yes, and that quiz looks different than the quiz we provided you. I can go back and show you I did attempt to copy it verbatim from the the questions included on my 2015 edition of the application. Sorry about that. They were actually questions, I thought. Yeah, yeah. Options like with all sorts of tribunals and multiple choice. So that could be. And this this responsibility came to me just about 18 months ago when I switched positions. And this has kind of been moving back and forth. So it's possible there is a piece of documentation that didn't make it to me. This was included in our in our paper tobacco application that we've been using for renewal as long as I've been involved. This is the application here. And it says the permit holder of the establishment applying for the Board of Health Tobacco Sales Permit must initial each of the statements below and sign the statement at the bottom. These are all the questions I used. And it says attention, tobacco retailers, please make as many copies of page two of the permit application as you need so that all the appropriate persons may sign an initial copies of page two corporate officers and each local store manager must sign an initial copies of page two. So that that was my best understanding is that that was probably the quiz. That's what we've been using for the retailers themselves. It's possible that something got misplaced before this was all handed down to me and I would be happy to modify the quiz. Yeah, with our with the the regulations we signed had a much different quiz with it. So do you have a copy of our June regulations and the quiz? Did that get sent to you? I do have a copy of the of the regulations. I don't believe I have a copy of the quiz. OK, so I can follow up with that over. So, Emma, do you want to send the quiz? Yeah, I'll follow up with that for sure. Now, how are we keeping track? Whether everyone who sells tobacco has taken the quiz? Now, that's a very tough question. Am I reading nothing in the regulation states that they have to update a list of all their employees who are they say they have to keep it on file in their store? Yeah, that's true. We don't have any any method in inspection services to go in and verify those things. I guess we've been taking it on the honor system. Because my thought is, OK, we have this regulation. We passed it. Now, if we don't enforce it and check up on it, it's now. Emma may be able to speak more to this than I am, but I do know that there is an intertown compact that is tasked with enforcing the tobacco regulations. And yeah, the PVTC does that. With the inspections, Nancy. So we need to figure out how we're going to get this linked. The the quiz we have in our regulations that we voted on with. What we say in our regulations, otherwise, we're going to be a laughing stock and nobody's going to follow up on it. Well, if if we get the right quiz to see they could produce, you could probably get that online and also have a certificate that could be kept in in the establishment for each employee. Because those employees are going to, you know, are likely to be changing in the course of the year. But I guess if the the inspectors go in and they say, who are your employees? Where are their certificates on this thing? That would that work? Yeah, that would be easy for me to if I had a different, you know, a new copy of the proper quiz, it wouldn't be difficult at all for me to set that up to have that those questions be used. And that was my intention with the certificate was, you know, the regulations that states they should have a copy of the quiz, their completed quiz.  But the intention would be that each employee would be required to print out that certificate once they pass the exam, which would be graded by me or one of my colleagues. And they would have to keep that on file at their store. What do you think, Nancy? Would you have a list of each store and who's taken the quiz? We would have a record of everybody who's taken it. There is that file of there is that question of what which store they work at. So there would, you know, we would be able to generate, you know, an Excel sheet of everybody who's taken it, which would have information about which store they work at. That's great. That's because then maybe the people who are doing the inspections through the consortium can get those lists once or twice a year. That would be something I could provide. Other thoughts, Tim, Steve, John. I think the questions you have, like understand, is some sort of a second part of it, I think I would say if you have the quizzes as a first part, they have to clear. And I also would suggest, you know, if there is any way to randomize them. Unfortunately, there's not. This software is a bit of a clutch to get it to do quizzes. This is this software is really designed for, you know, building permit applications and things like that. So, you know, even even the grading will take a little bit of manual labor to kind of go through it. But, you know, I think I think it will work. And instead of printing out your building permit at the end, it just prints out that certificate that you passed it. Is there an argument for just using a little fashion paper and just giving each each tobacco licensee a bunch of some copies of the quiz and let them do it all? Yeah, I mean, you know, from the inspection services side, I mean, we've been really pushing very hard to get everything we administer online just not not only because of COVID, but especially with that. But just because of everything is a huge amount of paper that goes to our office. And, you know, things get lost and mixed up and the the transition to digital has been great. So in terms of things that we handle, I think that we would really be trying to move away from paper, but in terms of being able to provide the quiz to the licensees and, you know, leaving the responsibility in their hands that they have to administer this test to their employees and hold it. And, you know, hold that past quiz on site. I mean, that is the existing regulation, the existing practice. And I would certainly have no objection with that. We wouldn't just have as much oversight, I guess, with those databases we could produce. I like the online. Yeah, yeah, it does sound like potentially it has all the information in an easier, easier somebody can access it. Fortunately, do the do the people taking the quiz have to log on to open Gov? They will have to make an account. Yep. Oh, make an account. Yeah. So they have to. Secure 100 percent score or is that a threshold when they will be passing? I'm sorry. I'm just saying, you know, in terms of the points they get, like if they miss one quiz, will they still pass or? Well, I guess that's a that's a question for you. My understanding of the quiz was it was just that series of check marks. So whatever you guys are looking for out of the quiz, you know, what threshold you're looking to pass question, I was going to ask you is what, you know, is there is an expiration on these? You know, how long should they be valid for? Is it a one time thing if you're an employee? Is it something you're going to have to do nearly? OK, it's so that they and the whole thing is a tool so that the employer knows that the employee knows the regulations so they're not going to get. Find or have their businesses not be able to sell for three days. It's really it's really to help in education. It's not to be to be punitive. It's to decrease the chances of an employee selling to an underage and it being found and then they lose their ability to sell and they get a fine and they get, you know, it's really it's an educational tool. Timothy, you remember that they can take it an unlimited number. They can, right? Yeah, you can. Yeah, it's, you know, it doesn't sound like the software is geared to this kind of activity, but some things are, you know, you can take it until you get it all right. You know, that that's the kind of thing that would be ideal. It's like it's like the the public, you know, the freedom, not freedom of information, but that thing, that state thing that we're supposed to take. But that you can do it as many times as you can. Oh, the conflict of interest. Open meeting, open meeting, and conflict of interest, too. Yes. But that's but your system, Steve, doesn't really do that. It's not that's not what it's designed to do. No, and actually, now that you mentioned that, I'm not even really sure how we would facilitate somebody taking it again, other than them just filling out an entire new application because it's the software is great when it comes to, you know, you can have it go to, you know, Fire Chief and the plumbing inspector and have them all wait to sign off before you issue a building permit or something. But it's not quite so so good at having people take a test over again. I mean, a lot of ways that the paper quiz probably would be simpler. But, you know, but this is an option that, you know, Emma Emma brought this to me as we went online. And if this is something you're all interested in, it's something we can do our best to implement. We can try it and then evaluate it in six months and see what needs to be changed, what's working, what isn't working. How do we do this? So it's easy and it provides education and it helps people enforce the regulations. That's the whole purpose of it. Because often when we've gotten hearings, because people are losing the ability to sell and the tobacco for three days or seven days and they've gotten fines and the fines have gone up. It's well, I had a new employee who didn't know who this or that. And this is a mechanism to help them not have a new employee who doesn't know. And if that's the excuse, then they're not following the regulations. Another possibility would be to use some other, you know, existing there's plenty of existing software that can easily do quizzes. And that's a whole nother ballgame, I guess. That's not something I have. It wouldn't be any experience and since my college days, maybe on the other side of it, but yeah. I wonder if we could make a Google form or something. Yes, something like that. Like a Microsoft form, that's just where my brain goes. But I don't know. So, Emma, do you want to email the quiz to Steve? And Steve, you look at it and let us know what your thoughts are. And then we can try it and then move forward and evaluate it in three months, six months. Certainly. Yeah. And Tim, do you have a thought or job? All you professors, do you know any software that does this? I mean, there's all kinds of learning, management, course management software, but that's not the path you're going to go on here. No. It doesn't make sense to me. I think it should be integrated with your already existing permitting software. We should not have some sort of people go off into Google forms or anything like that and come back to this software. You know, so one thing I thought it might help for new employees is to have a fact sheet.  Instead of just directing them to the regulations or something. I mean, just a highlighting once. Yeah. Right. Right. Was that something we should do going off of our regulations? I believe so. We want to do education. The royal we should. Yes. Which generally means Nancy. But so anyway, that's good. I'm all for it. Do you want me to take a stab at that in the next. Month and I'll email it out and see what people think of fact sheet for taking the Amherst tobacco handlers quiz. Fact sheet for the regulation. I'm sure you could pull stuff from that document that, you know, for the tobacco sales guidelines, you know, just for retailers, I don't know. I mean, this will be helpful if there is going to be only one attempt. Mm hmm. OK, I'll look at the I'll open up my document and look at the quiz and I'll come up with a fact sheet for safely for for for making sure the regulations are upheld. I'll come up with some title and then and then we'll look at it and then we'll get it to you, Steve, and see how you can get it in there and also look at the quiz and see how you can put the quiz in, seeing that that's what we voted on last June. Yeah, I'm sorry for the miscommunication there, but it should be an older version from something else, you know, that that all comes from the state. And I was I was trying to figure out with Julie once the the you got separated from the board of health, the health department because the inspectors and all used to be in the health department. Then you all got moved over, although the licensing was separate. And I was when I was looking at what the state did and what. Yeah, and I was trying to sort of piece that out with Julie. But and we just stuck to the regulations, because that's what. We are, but the whole licensing has, if you go online, they have this whole packet of things versus the regulations. So so that's where we can. Any other suggestions? We come up with a fact sheet to help with the quiz. Steve comes up with putting the quiz in the. Form you can keep. You can still keep that state thing there. That's fine that you already have there, because that's that comes from the state. The I understand. Checkmark boxes. Yeah, OK. Stay and our quiz is different. I see they read that and then check they understood it. And then they took the quiz and then we'll revisit this. The fact sheet at the end, Steve, you can let us know if you could put the quiz in and then we can figure out where to go from there. That sounds good. And yeah, my idea was that once this is all complete, I would send out an email to all of our licensees, reminding them that all their employees have to take this quiz and that it's now online. So I will hold off until our next meeting. Once I've had time to update that and we have a fact sheet worked up to do that. And we should be able to get it all out in one push. We can say they had a covid grace period. OK, any other thoughts, questions? Thank you, Steve. All right, well, thank you all.  I print on the bottom of all the licenses. Have a great afternoon. Enjoy the good. Thank you so much for your help. And I like the online bit. Thank you. Glad thanks. OK, so we have all that next. We have standing item, the health inspector update for food, dining, seasonal events and then well septic and inspections. Emma and I talked about this. We skip the prohibiting smoking in the work. Oh, I'm sorry. Goodness, I wasn't too unhappy about that. But I'm sorry. I'm sorry. OK, prohibiting the smoking and vaping in workplaces. I I think I said that to everyone last week. I don't know if people got to take a look at it, but it's essentially the same as it was the last meeting, except the first paragraph was edited down to make it more concise and cleaned up and the right names and dates of the names at the bottom and some headings and spacing. And it seemed to be, you know, I just had a formatting in our original. Can we get rid of all these lines? I don't know where they came from. They weren't in our prior line. So under town of Amherst, there's a line regulation. There's a line. Did you get all these lines on yours? Can you see my no, no, no, no, I'm getting all these lines. What is this strange formatting thing? Oh, no, yeah, we didn't have lines. No, no. Every time I print it, I get these lines and I don't know why. OK, that was my only no lines. That was my only comment. And then I just had a question for Emma after and when we passed these lines, these regulations, I noticed outside the bangs, there's just a small sign. I wonder if we could do better signage around our town buildings and the parks about the smoking, because there is this as you walk into bangs, there's this little sign right as you walk on the fence that you might not even see. So my question would also be about better signage in town. Absolutely. I think that's something that we can work on. And I think that we would have funding for. Yeah, for town on playgrounds, parks, recreation and then municipal buildings, just those signs. But I thought you did a great job, Maury. Looks great. Well, with help from other all you guys. You and Steve, you did a nice job. Now, I didn't notice this before, but I'm just looking at my copy and it seems to have a little bit of formatting that I didn't really see before that at the bottom of each page. It says approved XX, you know, at the effective date and a kind of a reddish brown line. I don't have that online at all. I just have all these other lines. Yeah, that was that was taken from the the previous version. You know, when we started, it had that. And I thought that's not a bad thing to have. No, it's not. I didn't I didn't notice it even when I right before I sent this out. I don't know. So but it's just that if people see just one page, then they for some reason, then they are you know, you know, you're right because at the top of the page, it has a heading, which is it's good. But I just wondered if everybody else was seeing those because I don't think I saw them before I looked at it right this minute. It looks like you got the section breaks or page breaks for a different first page because the first page doesn't have the footer. The other pages do. So it's that's just a word format, page break thing or something. Anyway, different first page or something for the footer. But that's flexible by somebody. But I think the footage is a good idea. OK, I know what you know what you're looking at. So I guess what's the process now? OK, so the process is do we want to vote on this and do we want to pick an effective day? Well, we don't. We shouldn't vote before the public hearing or else in the public hearing. My head is just we need a public hearing so that we can we can decide that we're all perfectly satisfied with it, with the exception of that one form or anything, which I'll take care of. And then we want to go ahead with public hearings. Yeah, I think we should go with the meeting the public hearing. Yeah, we do it at our next Board of Health meeting in April. What about I just have to notice in the paper and stuff. OK, I'm going to need to get that done. What effective date makes sense? I think we talked about July 1st. June 1st. Yeah, isn't that the July 1st calendar year for the town to fiscal year fiscal year fiscal year. That's what I meant by. Again, it sort of depends on when the hearing comes and what happens with the hearing and whatever. But technically, it does. Most likely it won't change things. Yeah, because there isn't much of a change in right now. It's just updating everything and making sure it has the. Oh, on electronics, right? It just at the yeah, that's the vaping. Yeah, it doesn't change and some areas outside. In this, we don't exempt the town common. So the common is included now. The last one, we exempted the town common because of Ganja Festival, which is gone. And then it would include Sweetster and Kendrick Parks, too. So I'm going to do you want to take care of getting this for the first item of our next. Yep. April 8th, so we'll have a hearing. Then we'll vote on it with from what we think now is a July 1st effective date. Now we can go on to new business. Sounds good. And as I was saying, Emma and I had a discussion, especially given with all the COVID regulations from the governor and every day with open up eating places and other seasonal events. Although I do not think there's going to be the taste of Amherst or the town fair this year to make sure that the health inspector we get reports on what's going on with the health inspectors and our restaurants and food selling. Pieces. Yeah, I did reach out to Susan Malone. She said that she didn't have anything specific to update on today, but with that, we do know that outdoor dining will be starting again very shortly as spring is coming upon us. So that's coming. The farmers market did make a proposal. I believe they were presenting to town council if they haven't already done so very soon. Their plan does include limiting the amount of people that would be on the common in addition to like social distancing, having hand sanitizers available and then a traffic flow pattern. And also I know Ed's here to speak about the next agenda item. But I wonder if he has something to add maybe as well. I just put you on it. As a panel, look at that beautiful background. You're muted, Ed. I think it's the same place as Maureen's picture. Different. Yeah, yeah. And both of them still have that tree and it's now. Yes, I have something from that view, too. So yeah, we have a I think a fairly routine well proposal. This is a lot that appears not to have been built on before. Integrity construction. I'm not sure if Anna Novi Cook is in the waiting room. She had the link. I said that she certainly could attend. I'm not sure if she would be here. She's from integrity builders. Yep, she's here. And I just promoted her to a panelist as well. OK. And. There's Anna. Hello. Hi. I did notice one small mistake in the the letter of support that I wrote. The picture number three is actually looking to the east from the well location. And then we spun around 180 degrees. And number four actually is the view to the west. But it's not a level lot, but there's the location is at the rise at the top. And it is accessible by the drilling equipment. Sorry, I really don't anticipate any issues with the site. Tim and John. I'm grateful the two of you are on. Yeah, I was just curious if you could tell me where if I were to pull up Google Maps where I would see this. If you pull up 96 Flat Hills Road, this is the lot just to the south of it. Thank you. I do that. Oh, 94, 94 and 66. 94 Flat Hills. Correct. Just curious where it is. Yeah. Kind of towards the southern. Yep. I see that. OK. Yeah. Near where it goes up on the west side. Well, is it on the east side of the well? Is it on the east side of the west side of the Flat Hills Road? This is the lot. The west side. Just just above the steepest section of Flat Hills, just as it starts to kind of taper out. Yeah. OK. Yeah. Too high for the public water. I've always had my class design the extension there, but anyway, it ends a couple of houses south according to the town map. Yeah. Yeah. What's what is it? I didn't even look at the map or the real elevations on the map there. I don't know. I do have a topo map. If I'm allowed to screen share, I could pull that up. I mean, I saw some elevate. I was just thinking of some elevations somewhere. Yeah. Those are, those aren't real elevations. Those are relative to some. Temporary benchmark. Usually the top of the foundation wall, I think. Well, there's no existing foundation wall. Right. So it's going to be some. Yeah, some sorry. Yeah. It's going to be some real thing. There it is. I got it. Benchmark pin in pole one 1496. That's a strange number. That's, I mean, that is at 400 feet elevation, which is why it doesn't get water, not 115 relative to sea level. Anyway, Boston. That's a weird, weird elevation. I wonder what it shows. It's a funky one. I was just curious what the real elevation. Sorry. Yeah. Am I allowed to screen share? I could show you the topo map that Randy Iser did. I'm looking at a topo map of the site. It's just that the numbers on the lines don't make sense with real elevations. I see. I see. I mean. Real meaning. Yeah. Yeah. It doesn't matter anyway. Just curious. So the well, so it's sloping down. From the road. Yeah, the lot generally slopes north to south, like in, in line with flat hills, but as you go from flat hills to the west, it kind of undulates up and down a little bit. Yeah. I mean, it's actually sloping down to the north on this plan.  Never mind. I got my north's messed up. At least I can't even find north on this, but since you said it's on the west side, then that north has to be down to the right of this plan. Okay. Yeah. There's a north arrow up there in red. Got it. Yeah. It's on his checklist for the septic plan, so it better be there. We try to leave something easy off for you guys to catch. Okay. What's the size of the lot. The, the parts shown here is about an acre, but they're buying four acres in total. The lot on paper, there's, they're building one. There's a flag lot behind it with its frontage on the south side. And they're buying both together. So it's four total. Yeah. I don't have any technical questions. May they hit good water. Not too deep. Always the question. When you drill, you never know. It's always an allowance for us in our contracts that well cost. But anyway, this is on a. It's got a lot of, a lot of topography above it. Yeah. That's good. I would just add, I just saw one thing in the letter. It says you visited the site on three, five, 20, 23. Oh dear. So I. Wow, Ed. Well, I'm good. No. Time traveler. A lot of use of this. What else happened then? There has been a lot happening. Totally unpredictable. This is. Interesting days to be a health inspector. And a health director. Yeah, that's for sure. Yeah. And a health board. Do not envy your jobs. Okay. So this, it was the 2021. It was just last Friday. Okay. Okay. And if there's anything else you think we should look at. I don't think so. There'll be some other well business coming to future meetings, but we'll send that along. You know, and for next month, perhaps. I know the town is discontinuing. The town is adding some. Customers to public water. From, is it leverage or shoot spree? Leverage. Yeah. Leverage. Okay. Five or six wells. I think are being discontinued up there. Yep. I don't think that impacts the board. No. Yeah. Nothing else on wells. That's the one show contamination and leverage. Of those wells. That's why the extension extensions happening. Just as one other general thing, there was a, I haven't received it yet, but I was told by a well drilling. Representative that. There may be a major project to me, major geothermal project coming to us. And we'll get into the specifics, but in the past we've permitted those. 50 dollars per. Proposal. This one is going to eclipse perhaps anything that. We've ever brought. It could be. Some hundreds, perhaps of wells is what I was told. So. I think that will be $50 per borehole. Which. The. Person asking didn't flinch at at all, but was saying he thought that that. Was in line with other projects that they've done. So I just wanted to say that they're. I'm going to try to get you information about this project as soon as I get any. For evidence about it. It is. Well, actually we don't need to bother in with this. I have a question about that, but that's a different subject. But I'm just curious if it's. The traditional in the sense that the, the holes are just conduits to move water through for, for heat transfer. They're not actual. Any kind of extraction of groundwater. I think that's right. The former, like, like what we've done for other. Yeah. It's just, just simply a conduit to. Make use of the heat sink or gain from the, from the ground. Right. Yeah. Okay. I think so. So it's kind of weird that I brought this up before. I don't understand why we. We permit them as wells. They're not wells at all. They're holes in the, they're long. They're narrow, skinny, deep excavations. Is what they are. But they, if things happen during the course of construction. Yeah. The ground water, right? Yeah. Yeah. Yeah. It's just, it's just odd to call it a well. Oh, okay. Well, he was calling the boreholes. So. It is a borehole. That is accurate. Yeah. That is accurate. Okay. So more, more to come later. Yeah. Yeah. It's a different subject then. Then a well for extraction of portable or agricultural water. Yeah. Interesting. Okay. I don't, I don't have any questions about the well. First one. What, what's next? Nancy. I guess we, we. We need to move. Do we need to have a motion to approve the, the well. Permit, right? For 90 flat hills. Can I ask a couple of questions? I know that. Oh, I'm sorry. I'm just curious, you know, what is the. Level of use of that well in terms of pumping. How many, I mean, it's probably used for one family is right. It is. Yeah. It's a single family home. Two occupants. Okay. I mean, they also, I mean, I think Ed mentioned that there's not. Going to be any water body, you know, close by or, but it looks like in the downstream, there is a Brooke. I don't know what name of it, you know, essentially draining to that. Right. So I'm just curious, you know, there is potential. Impact on the flows there and it may not, you know, but it all depends on the pumping rate. So my understanding is we're far enough away from that, but it on the map on the far west side, you can see some wetlands delineated, which are outside of the 100 foot radius off the well. And those were just recently flagged last week. I guess I'm not aware of a stream over there and just, just those wetlands to the west there. Yeah, there are a couple of branches coming in, you know, looking at what I'm looking at Oliver. It's a GIS map, you know, of the location. So it's a little bit more information there, you know, so there is a confluence of two Brooks very close by on the west side. I think that that flows into the heather stone or something. Okay. So I'm just curious, you know, if how far is it and how far is it going to be going to be any influence on the flows there. But it may not be in at all depends on the pumping rate. And the depth. I would imagine it's going to intercept an aquifer way below those surface features at that location. Maybe, maybe not. I don't know if we, if we can find out the depth of the wells for the houses on either side, if that would be any, any indication of what we're going to end up doing. I can look on the state weld rollers. I don't know. I don't know. I don't know. I don't know. Well logs for the state. It does say something intermittent stream on one of those maps that is included in the packet. Something. There's a green line. Under. Yeah. Oh yeah. That's labeled. Yes. I remind us sideways here. That's looking like that too. Yeah. Yeah.  Which just eyeballing it looks like maybe 25 feet off the well, that 100 foot setback is maybe 25 off the well. Which map are you guys looking at? There's, there were two. There's one that shows like some orange lines of like. Protection from. I don't know. I only see one map. I'm just looking for the file. The one that's 03.05 PDF. It's like flat hills road plan revised with well and wetland changes. Wow. I don't see that. Okay. I have a couple of well depths here. Number. 134 is 385. That one didn't extract when I did my extraction. Now I got it. Thank you. Go ahead, Ed. What'd you say? 83 flat hills is 280 feet. 133 is 260. Tim, are you saying you, you want to see some more data or something that we don't usually see or what are you asking? I'm curious. Well, I'm, I'm not asking for more than a, but I'm just thinking about this aspect of the closeness to intermittent stream. I told, that's why I said in it's all depends on the pumping rate. How, how, how much we are going to extract and so, but it may not be a critical issue. You say, okay, can I ask one more question? I'm sure there is a culvert is right below the Henry street. A culvert below Henry street. No, yeah, I think just close to the west of that property. I don't know. Yeah, there is a couple of this intermittent streams are draining or crossing the street is right in the street. I mean, it would make sense. It's generally sloping that way. So yeah, I'm sure there's plenty of them. Yeah. So it should be in the proximity. That's why I was curious, you know, how much is the influence on that? But for what it's worth the house design, it's just in the beginning stages of design, but it's going to be built to passive house standards, low impact, low energy use. So I understand the well capacity and the pump might provide more. Then the homeowners are intending to use, but as the ultimate goal is a pretty low impact house. Sounds good to me. Okay. Okay. So what's our steps. Folks. Nancy. So we need a motion to accept the well. The permit, the application for. Drilling permit, I think is what it actually is. Right. Right. The septic is something I approve traditionally. You welcome the way in. No, it's fine with me. I'm still figuring out what we do and what we don't do. Yeah. There's a second step to this process that after the well drillers data is in and testing has been done on the water. So I think that that information will be brought back to the board. For a water supply certificate. Okay. Thank you. So we needed, do we need a motion and a vote? Yeah. Are you making the motion, John? I guess I approve. I, I did it before. I think I moved. We approved the, the permit for well drilling for the. I'm not on flat Hills road, whatever the number is. I'll second it. On favor. Steve. Yeah. I. Tim. I. John. I. Maureen. Nancy. I. Okay. Okay. Thank you so much. Happy drilling. Thanks. Great. Designing. Okay. Thank you. Thank you. Thank you. Thank you. What's next. Next. Report. Yeah. This case is testing vaccine distribution. I was actually. Party. Thank you. Yeah. Thank you. Yeah. So in terms of COVID. Testing. The UMass site continues at this time to do. It's free of charge. It's free of charge. It's free of charge. It's free of charge. It's free of charge. It's free of charge. It's free of charge. County, you know, available testing to the public. Several days a week. You can go in there. Moments. It's, it's free of charge. It's provided by the state. They are seeing lower. Rates of. Testing engagement throughout the state. So that's just, it's still a resource that's here and available to us. In terms of local testing. We have some mobile testing for some. Children of a childcare program that had some identified transportation, language, cultural barriers to be able to go to a different site that really needed access. To COVID testing after an exposure. And that was done this weekend. So. I was really proud of, of our department. We were able to coordinate that with Dr. K. Ackerson and Cooley Dickinson with Dr. Levin and Kathy Reed with the lab. To be able to bring that service to those families in need. In terms of. Count case counts. This past week we've had 66 cases and Amherst. When I pulled the report. Five of those of the total were not in college related. 58 of them were UMass. Two of them were Amherst college and one was Hampshire college. Of all of those. 69 of the cases were between the ages and 17 and 23. And seven of them were 27 and older. 59. Between. Yeah. Sorry. Sorry. 59. Yeah. And then in terms of that. We've done just over 5,000. We've also in at our Amherst sites. We've also done 60 homebound. That includes six towns in our surrounding area as well. UMass stated today, they've just done a little bit over 12,000. Which is exciting in terms of vaccine availability. It does is still extremely. Constricted with supply. We have a lot of sites that have a lot of capacity. We have a lot of sites that are partnered with North Hampton as a regional site. They're the primary site where the satellite with them under that agreement. We are, we get 23% of the allocation. We are both sites that have a lot of capacity. We have a big volunteer force and staff that are ready to go. But we just need the supply. We have a lot of resources. So that's a good point to that with the clinics that were recently transferred back to the bank center. Our first clinic there. We had a lot of opportunities for growth. With how it was set up outside. We didn't have the tent wasn't set up quite yet. I think with having the bigger space at the high school, there, there was obviously more space to be accommodating with the community. We had to do some after action review. We did the spacing inside in the queue area. That tent is outside now for to keep people sheltered from the elements. We also helped identify, you know, risks for, for the curbs and everything like that outside with fall risks and transfer challenges, which I know were brought forward and we definitely take seriously. We've also. We've also included what documentation we're sending out with our patients with the COVID cards. We now print out labels with those lot numbers for the vaccine that go right on the cards when they come in. And then this past week and a week and a half, we've now been, we've initiated. Giving a placeholder card for your second dose appointment. And then we book it for those individuals with our. We've also included a number of other, you know, robust interns and other people that are assisting us with clerical assistance as well. So individuals don't have to go through that. In my own words, nightmarish process of trying to sign on with through prep mod and all the registration. So we assist with that. Other updates in terms of vaccine. We've also included a number of, you know, a number of other things that we've done. We've also partnered with them and be their, not sponsored, but to help be their partner for vaccine distribution to senior and affordable housing. In those communities. Also, I've been in discussions with John Liebman from the John, the anti-health center. Certainly with their clinic set up downstairs. It's very narrow. It's kind of a railroad set up. But we are working with them to see how we can assist them with vaccinating their, their clients, their patients, as well as assisting with doing some targeted outreach to their identified population, Saladorian, Cape Barrier and other groups as well. And then in addition to those, I talked briefly about our homebound program, which we're really excited about. I have a, another meeting tomorrow with chief Nelson, but so far it's been really successful collaborative effort with the eastern eight Hampshire County. Communities among council on aging's. Boards of health or health departments with public health nurses. And fire the fire department having a shared. Um, Excels spreadsheet that's secure for us. Um, and then scheduling their appointments, going and doing like a visiting nurse route, um, to them. And Amherst and some other communities like Beltran, Howden and Granby, we actually went out with the ambulance, which was really exciting. Um, but thinking about the, the future of the plan moving forward and making expanding on the model. since the state is going to be, there is this state branch of the program for homebound that will be coming out in the next couple of months. But really thinking about our communities in Hampshire County and Western Massachusetts, the unique care that we can give them from us as a local board of health and health department taking care of our own. And then also we can have some assurance in terms of communicating with our public, those community stakeholders that we're partnering with and then also having the good customer service and delivery that we can give rather than going straight with the state private program. And then teachers are coming up, which I know is really exciting. We had a meeting today with Northampton about that how are we gonna help support our teachers? Cause certainly we wanna do that, but with vaccine allocation being so constricted, it's a real challenge, but trying to overcome those barriers to still be able to make sure that we're hitting those teachers and faculty because it does have that trickle down impact to our families and our kids. So we're problem solving that and hoping that that plan will be solidified by the end of this week. So we can do some teacher vaccines. And I think that's it for vaccination stuff. In terms of, we continue to- We have some questions on vaccination. Okay, the homebound, another board of health, not ours, but sent me that survey and asked me how we were going to answer it. So I hadn't gotten it. Had you gotten that survey that was for the boards of health? So I answered that because it's for local board of health. It's not for the health director. Okay. Is that how it goes? I think, so I also received it and I interpreted it that as I'm the agent for acting on the local board of health that I performed it on the board's behalf. But the board should be informed about actions like that because I was taken by surprise when some other boards of health people called me. See, I get all these calls because my name's up there as chair. So we should be informed even though you're the agent, we shouldn't be blindsided. So the form actually came out last week, Nancy. We've been doing this homebound program for about three weeks even before the state announced their plan for a homebound program. We were the first homebound program in the state. We really pioneered kind of and we're trend setters that way. So I should not have been blindsided about the form because I got the call from a neighboring town because they had some homebound people and they wanted to know how we were filling it out because they knew we were making visits and what was happening. And I said, well, what form? So she then sent me the form. And so I feel like if a form that goes out to the board of health that we should get it so that if we get these phone calls, we're not blindsided. Just a communication. Yeah, I think the challenge too is just how quickly everything's going out and being done by the state. And getting to be approved before we even had this meeting. It wasn't, no, it's just getting that information. So when I get a phone call, I don't have to stumble. And she said, what do you mean? You're the chair of the board of health.  It was a chair from another board of health who called me because she had some homebound people and wanted to know how we were answering that question. That survey. Do you guys, does the board of health for Amherst not have their own email? No, no. Oh, because the board of health in other towns where there's still a health department do have their own email. No, we don't. So I guess that's something that I'm learning. Yeah, so it was just that I would got blindsided and I said, oh, but I know we've been doing it. And I said, no, I'll talk about it because it's not Doodle Friday and I'll make sure it comes up at the board meeting. And she was reassured because she didn't know what we were doing. And she just wanted to know because she's in our catchment area for the homebound. Well, maybe a lot of these smaller towns don't have a health director. And so it goes to a different route. Oh yeah, absolutely. Yeah. But because we have a health director, you got this, Emma, and the board, the board didn't see it. Yeah, so when you see that because it said local board of health just forward it to us so we know that it's just communication so we know that it's happening. And take action as you should have. Just so did you submit this, Emma? Yeah, yeah, I submitted it. Good, good, good, just tell us. Good, good, but just so that we're not, and because my name's up there, that's why these home calls come to me. And so I just said, oh, I will just check in on that. We've been very busy with the clinics. I know we've been doing home visits. So I just covered it all. And that's when I then sent it out because this other board called me. So you clicked option one. My local board of health chooses to take it. Yeah, and actually that's part of what my meeting is with Chief Nelson tomorrow. I've drafted a continued plan pilot draft of the plan that I want Chief Nelson to sign off on moving forward. I know Meredith O'Leary is really excited about this program potentially being of value for all of Hampshire County. Yeah, it's fantastic. Can you send us a copy of that please? Yeah, absolutely. Great, that's fantastic. So Emma, this is extremely time consuming. And so I just wondered what you've envisioned for staffing it and whether volunteers are a part of that or whether it's all from a professional staff. That's a great question. So it is pretty time consuming. It's basically developing visiting nurse routes based on the communities that you're serving. We have an Excel spreadsheet with the previous schedule for what communities have been had vaccines and on what dates and what would be their second doses and of what vaccine. We were able to do 12 grammy homebound within four hours with the ambulance doing a leapfrog model of care, meaning that us the Amherst team we would vaccinate and then in grammy, the gramby fire and EMS crews would stay with the patient for that observation period that's really decreased. Yep, that decreased our observation time. And then in other times where each patient takes about half an hour to 45 minutes, you get there, they're all preregistered, you go, you do your initial assessment for the just in time questions and assessment before you give them the vaccine. And then really during the observation period is when you can do your documentation in the computer system. We have go bags for these nurses which will probably be hired per day of nurses for this that would be provided under CARES funds. That's great. CARES funds is what is state funds? Yeah, it's the state and federal funds. State and federal funds. For COVID response, CARES Act. CARES Act, oh, okay. How are people in need, individuals in homes identified? Who has a list of that? Where does that originate from? Yeah, so there's a lot of different lists. Like our library in Amherst has a list that they do deliveries for. Councils on Agings have a list. But there are also, even with those two great lists, there are so many people that aren't elderly and are homebound. So one thing that we've done, Brianna Sundred, the communications director and I, we together developed a Google, not a Google, but a Microsoft form that people can fill out. That's very, that follows that algorithm, Nancy, that you might have seen on the PowerPoint for the local boards of health with the same types of questions. Are you able to leave your home with a separate person or do you require an ambulance or a two person assist to go out? Those same questions for the form. How do you try to reach those people to give them that? Yeah, so that's part of the, yeah, so that's part of the final PowerPoint, the present agreement with Chief Nelson tomorrow is so we can get this out officially to our communities. So before tomorrow afternoon, if it's approved, we've been receiving calls and from councils on aging, obtaining that information or local boards of health, like with the Quabban Health District, Amy Langone, their public health nurse has worked really in a conjunction tandem with Jessica Langlis, their senior services director. Networking, I mean, there is no one formal way to do this. Absolutely. Well, that's one thing that we're trying to streamline with this form. Individuals, if they are tech savvy, can fill out the form on our website or councils on aging and health departments can. Also, we're going to be hopefully opening our health department line and the COVID concerns line as well, where our COVID ambassadors and phone takers can go through this form, this process to see if people can enroll in the program and if they would fall into it and be acceptable. So just the homebound program to date, have you advertised it at all? Is it on our website? Or have you just done it word of mouth? So it's been pretty much word of mouth with the eight communities. Beyond that, I think WWLP did a quick two-minute thing and put up the senior center numbers for the eight towns. But that was several weeks ago. It was a website that you have done this. I mean, that was an advertisement, but it was a public, you know. Yeah, I think Brianna might have put up the form tonight on the website. So you might find that as a new addition. Do the area agencies on aging, such as Highland Valley or West Mass, do you have any input from them? Yeah, so there's some communication challenges in terms of Western Mass. I know South Hadley has been really trying to diligently work with them in terms of information sharing that there seems to be, they can't share information in terms of their clients. They are willing to give flyers to their clients, talking about this program. So that's one thing that Sharon Hart has been trying to work on with them. She's the South Hadley director. So there are some challenges. How has Highland Valley been for you? Have they been, because I've heard they've had a change in... Yeah, I've reached out to them twice and haven't really had a good response back. What I'm hoping for is that once I communicate with Chief Nelson tomorrow, and if we get the go ahead with expanding this program because we've had a successful few weeks on this smaller model, that with the growing it out, with the support of North Hampton, growing it out into the Western part of Hampshire County, that because of it being a larger in the area that Highland Valley will be more invested. Okay, thank you. Yeah. I had another question as you're developing processes and procedures. Have you developed a process for a fair and equitable for your extra remaining doses at the end of clinics? Yes, so Jen Brown sent to me. Oh, now I'm not going to be able to find it, but it's the ASAP. Yeah, I've looked at that. It's, yeah, and morbidity and AC, I think. Yeah, they did it and it was published in the weekly morbidity and mortality report. I think it was published through them. Yep. Yeah. So I know that this last night, I was calling waitlist individuals sorted by age up until eight o'clock last night. I called 50 people and was able to enroll three people for our clinic today and that were initially waitlisted. Following our clinic today, we had three doses. I also went down the waitlist again, sorted by age and was able to get three people by that. Emma, can you delegate some of this? For being the health director, there's so much leadership. Can you delegate some of this? Yeah, absolutely. And certainly looking forward to that, Jen Brown has taken a few days off yesterday, today and Friday. So normally she would be taking that on. We're really looking forward to these two additional interns being onboarded to be able to assist with that as well. Okay, because I like to support you and if we need to ask Paul for more help so that you can do the leadership rather than all of the down in the ground mud because as we start opening, we're gonna need so much leadership in all the possible issues, problems to keep everything going. Yeah, I think that's definitely something that has been heard. We're hoping to get more administrative support as well coming up for additional admin. So that way I can kind of pull back a little bit as a wider lens. We're also still trying to onboard that contact tracing support position. That's a carous position to really have that tight focus on the COVID exposures, tracing that's going on in Amherst to really follow that. And then also we do have an offer out and it was accepted for the vaccine site coordinator position and that's Michelle Moore and she's expected to start March 22nd. So that'll take a bit off the plate too. What's her background? Yeah, Michelle Moore, she was a Perkins scholar at Mount Holyoke. She's initially from this area. She was briefly out West staying with children during the pandemic. She did state some history with working with UMass during alumni events, great volunteer engagement and also has roots in this area. So I'm really excited about her coming back out and joining our team. Is that a full time position for you? It is 25 to 35 hours a week position for the vaccine coordinator. It'll be great. And she's got great energy, which is fantastic, yeah. Great. So I think that's it for me. I know, oh, one thing that today was a informational session on public health excellent grant program. This is a grant program up to $300,000 for possible shared or regional services that are new plans or expanded agreements from previous years. And I was interested in that because certainly any opportunities that we have to expand services in Amherst and support other smaller health departments, like you said, John, is good. But I know that I'm new to my position and I certainly wanna hear the room's ideas here on possible ways that things that you could see being beneficial to our local community or partners or anything like that. And from whom, Emma? I'm sorry, what did you say? Who's the grantor? DPH. State, state DPH. Yep, state. So the request for proposals is due by the end of this month. Official MLUs with those communities is not expected until July. So right now it's just kind of like the what could we possibly do? So regional work is much, much needed. But the pros and the cons of Massachusetts is that we have 351 health departments and some towns don't wanna give some of that up. This may have changed over COVID. So one thing I really hope I can see you be able to do is build our health department. We need a good public health infrastructure and the Amherst Health Department has been whittled away over the past two decades, especially the past decade. So along with going regional, I think we really need to look at how we can build up our department that we can spread some regional pieces. And that's why I asked if you have more help so that you can take a leadership role in building up our department because it has been desecrated. I mean, they used to have a, all the inspectors used to be there. We used to have a full-time administrative assistant. It's just years ago for 20, 30 years you even had a home care department and the school nurses used to be under you. And then everything's gotten pushed away when it used to take up the whole top floor of Bangs Plus to you got these two little rooms together. So not only the space, but that's how big it had been and then it's just been shrinking over the past several decades. So that I'd like you to be able to grow that and maybe some things with the senior center, with me, Sandy, with Craig's doors for some of us. And I liked how you were reaching out to some of the minority populations that we need to, I don't know if I'm blabbing on too much but I'd like to see some growth in all of that area. And then also going a little regional but I think you need to get our department looking like we can do a regional rather than a full-time director and a part-time nurse. And now you're getting some other but those positions can disappear with the CARES money too. Well, yeah, I mean, we're in the process right now of budget hearings. We just had our initial one a few weeks last week. I am proposing a permanent administrator and an additional part-time nurse for the next year. We're also looking to hopefully acquire through CARES funds as well. I proposed a mobile health fan for the health department where we could do vaccinations, testing. It could be used potentially for Craig's doors, for medical care and also for events and education. The options are endless but primarily we want our focus right now to be on the COVID response for it to be eligible for those CARES funds. But I agree Nancy, I think part of showing that our department is gonna be big is trying to show our ability for growth by not necessarily regionalization but if there's any kind of shared services that we can blend in there, show our worth and our efforts together to be able to keep that sustainability going. So as any of these positions come up, see if you can get someone with an MPH who has a solid public health background who can look in the larger picture of public health. Comments from other people? Well, Emma, I'm gonna suggest something that could be on our Board of Health or our Health Department webpage. You bring up health issues and stuff. I guess I would suggest and I can maybe provide some contact is to promote the current program that I'm trying to, I'm helping the state implement on free testing of lead in drinking water for family, all childcare providers. So I got two students working their way down a list of 8,000 childcare providers in the state that we're calling because we've had this program and we've gotten 110 applicants out of 8,000 possible because everybody's just trying to work and take care of kids. I mean, it's so low priority but we could have something about lead for childcare providers. I don't know where I'm looking at the website for childcare providers or childcare stuff on the town website. There isn't much to see. Yeah, we can update that. Jen Brown usually does our website but I can definitely move that forward. Well, I'm just thinking of something to promote and I can give you the link and... That'd be great. Yeah, we've sent out magnets and poke and postcards. That's one thing that we could do. It's not about a grant. I'm just sort of brainstorming about things to do. Certainly staff-wise, like Nancy said, seems to make sense. Are there services or educational initiatives that you can see going regional that would be part of that? I guess I'm so stuck in the COVID and the vaccine and the testing and whatever and I think about infectious disease but there's so much more to public health that I'm not seeing. I guess that I don't, I can't visualize. So I'm just curious about initiatives that you think might work for a regional approach. Yeah, I kind of, my knee jerk where I instantly go to is like food safety with if other communities are following the FDA food safety program standards because there's also additional grant funds that are available through that program by the FDA. But I think that's just because of my own local health experience as well, that that was a deficit in my previous time. I know PVTC, when I think about shared agreements, I know Pine Valley Tobacco Commission, they're, you know, they do some education and the shared inspections and regulation updates for us. And then I think some other communities have shared nurses agreements. I'm not sure if that would be very beneficial for Amherst right now, but that's why I'm new in my role. So I'm really trying to lean on all of your expertise in terms of what's worked before or could be done. My experience has been that the towns and the colleges work together a lot in certain situations. And that's the sense, my sense of the, when I've done anything that had a regional impact and it was often around outbreaks, you know, whether it was a meningitis case or cases or whatever other kind of outbreak. But that's sort of a little bit of a narrow view, I guess. Also, you know, looking at what we can do for aging in place so that people aren't, people are moving to Hadley, people are older, people are moving at the, if they don't move to Amherst, Applewood, they seem to go to the new housing in Hadley or that being the Summerhill Project, which is very lovely in Belchartown. So we're getting, and I don't know if we're meeting all the needs of people who are aging. That's where I started in 1985 when I moved. I was a council on aging. And I stayed with that until I got on the board of health. So I've gone from the council on aging to the board of health and that, but not to lose that population. And once the 2020 census data comes out, to look at our pockets. I know when I looked at the Department of Education statistics, 48% two years ago of families in our grammar schools were on free or reduced lunches. So there's a poor population here that somehow are we missing? You lose that when we get to the junior high in high school because we have Leverett Pellum and Schuetsbury come in. So there are more kids in the denominator that aren't for the numerator of free lunches. So it goes down when you get into the middle and high school, but the grammar schools, it's been close to 50% on free and reduced lunch. So there's a significant population of poor kids in town. In terms of the older residents, I've been involved in a volunteer organization that is relatively new. It sort of was supposed to launch last March 29th. And we can tell you that didn't happen. And it called Amherst Neighbors. And the idea is to help people age in place by providing the social contacts and events and neighborly services like helping with grocery shopping or changing a light bulb or perhaps taking the screens in and out and simple things that don't require any kind of licensing or anything else. And it's just gonna start getting off the ground now. This year they've had a lot of online programs and talks and discussions, but I think it's gonna probably take off in this year. And a lot of it is about fighting isolation and loneliness. And I think that is a big factor in that age group when people are housebound or limited and their ability to travel or get around. So I think in a lot of other, it's a nationwide, part of a nationwide network called Village to Village. And a lot of the services provided our rides, like rides to the doctor, but rides to your friend's house for visit rides to the, it doesn't have to be like for it's, they're trying to work with the Council on Aging, not to overlap and not to butt head. So it's a little more open than the ride programs they're offered in other settings. So that's something that's happening. And at Suitsbury and Leopard have one, I think, and Northampton has a very much more active group already. It's sort of like a local, no income eligibility, volunteer Highland Valley elder services, because you have to be income eligible pretty much for most of Highland Valley. But it, yeah, this is, and it's just, it's all volunteers. Some of these Village to Village programs charge a fee. And actually they provide more services. They might have plumbers on their list or something, but this is basically no fee. And all volunteer at this point. And, you know, I think one of the things that's on the director, the board of directors minds is that reaching populations that are more diverse. I think that's an active thought and how to do that is still unknown, but you're trying to work on some of that as they get going. So I've just been volunteered for them a little bit over the last couple of years and hopefully that will come to be. But, you know, that's the whole population that we think about a lot. Nancy, I've got a seven o'clock commitment. Okay, other comments? Then if there are no further comments, can we have a move to the meeting? I move adjourns. Second. Okay, all in favor, Steve? Aye. John? Aye. Maureen? Aye. Tim? Aye. Nancy? Aye. Thank you all. And I'll work on that tobacco fact sheet. Okay. Have a good week. Thank you, Emma. Yeah. Thank you. Yeah. Thank you all. Made a supply of doses hold. I got a second dose appointment next Friday in Northampton is... Oh, that's fantastic. What are the odds of it holding? Pretty good for second dose. Well, that's what I was making those calls yesterday and so many of the people had already gotten other appointments. I think they were expecting me to be disappointed and I was like, that's so great. You already got vaccinated. So thank you everybody for your support. Thank you. Yeah, take care. Take care. Have a good month. Bye-bye. Bye-bye. Bye-bye.