the Board of Health meeting is open. Pursuant to Governor Baker's March 12, 2020 order suspending certain provisions of the open meeting law, General Law Chapter 30a, Section 18, this meeting of the Board of Health is being conducted via remote participation. I'm going to conduct a roll call to make sure everyone, the committee members, video and audio is working properly. And I want to remind people that the meeting is being recorded to the web and may be shown on Amherst media and broadcast on the town of Amherst YouTube channel. Okay, the meeting is called to order. And I'm going to ask who's present, Maureen. Present. Please. Steve. Here. Okay. Timothy. Here. John. Here. Okay. We're all here and Nancy is here. And Emma too. Emma's here too. But Emma's not here yet. Yes, she is. Oh, hi. Welcome.  What a day for the book. Let me not need any more help on days. I certainly will. These days that may not hold until tomorrow. Okay. So we're going to review. Pardon me. Sorry. It's Angela. Yes. Emma, with your permission, can I make you host and make Nancy co-host? Yeah. And then you can bounce. All right, my friend. And we're in step six of phase one still, correct? We're in step three of phase one. Perfect. Yes. I've been following that via your email. Yeah. I'll send you the image of right where we're at. Okay. I'm on the phones tomorrow. Thanks so much. Oh, thank you. I have a good meeting. Thanks. Oh, okay. So first we're going to review the minute, minutes of the meeting of December 12. And when people are ready, I'd like any discussion and then a motion to accept. I have a question. Correction or for the part, new business number one, the physician need for COVID vaccinations. Right. It doesn't quite capture what I meant to say, although I might have said that. Okay. Oh, no. No, go for that. I think the part about the medical reserve court doesn't apply. It's just that's what I mentioned when I discovered the fact that physicians and nurses are granted immunity in administering immunization and other protective programs. So it doesn't have to do with the actual medical reserve court in any way. Oh, just delete that sentence. Yeah. I guess, yeah, we could just delete that. Or what would you suggest? No, that seems fine. And then I am able to do it. So that was the news there. Just was how I discovered that. I see. That had to do with that. Got it. Yeah. Great. Okay. I'll do that. Yep. Any other comments, corrections, clarifications? I don't know if this is necessary or not. NEMMA should weigh in, but the line about the Moderna product, which unlike the Pfizer vaccine does not require a minus 80 degrees C refrigeration. So that's true, but it doesn't give anything what it does require, which might be useful to have relative. It's not like you cook it in the stove or something. Sure. It might be good to mention that. NEMMA must know. Yeah. So standard freezer temperature is around 26 degrees is ideal. And then it can be stored in the refrigerator for 30 days. So 26 F is Fahrenheit below, just below freezing. Is that what you mean? Or minus 26 C? No. She means the former. I'll change it to Celsius. So minus two Celsius. Yes. I'm like that. Yeah. Okay. Anyway, I just might be valuable to mention what the Moderna. Yeah. It says 26 degrees Celsius. Oh no. Minus 26. No. No way. No way. No way. I thought it didn't have to be those requirements. It was colder than yeah. It was a minus 80, but it wasn't casual. Okay. It was being something that maybe you might use for other vaccines like varicella or something like that. Okay. Okay. Minus 26 Celsius. Got it. And then and then just regular refrigerator for up to what? For up to 30 days. Okay. I'll put that in. Good. Much more user friendly sounds like. Yeah. Yes. That's why they gave it to us and most of the people in the community, because it's easier to store. Yeah. Yeah. Let's just get the minutes done. Lots of questions about this stuff for down the road. But anyway, let's get the minutes. Any more correct comments, additions? Can I have a motion to accept the minutes as correct? I'll make a motion to accept minutes as corrected. Second. Second. Okay. All in favor. Okay. John's second. All in favor. Tim? I. Are you? I. John. I. John. I. I. Steve. I. Are you hearing me? I hear something breaking up a little. Okay. Yeah. Maureen. I could always go to my iPad. And Nancy. I. Okay. So next on the agenda is prohibiting smoking in workplace and public places. Maureen, thank you for your work on it. Yeah. I apologize for getting it out like yesterday. My son, I had a big computer meltdown kind of rolling meltdown going on for the last two weeks, and I would be able to do it. And then I couldn't see it. And anyway, I thought I, since it was on the agenda, I would get this together and send it out. And I said two versions. One is with, you know, without all the cross outs and options and, and comments. And the other one just shows what those options were. So I didn't get, there was some question that we would get some wording on, on things from DJ, which I don't think we have yet. And I think that had to do with the ride sharing car, ride sharing cars and maybe municipal, not municipal, but membership clubs, which I thought we decided not to regulate at this time as we don't perceive a problem. But I don't know if anyone had actual time to kind of check on that. So any, I don't know if people had a chance to read through and if they had questions as they did so. Steve helped me update the references. And other way, I mean, it actually seems kind of straightforward, but we might want to go through that, that lists, you know, a part, whatever that part is with all the different places that smoking is not allowed. Okay. I just had a comment about even changing the title of it. Well, I actually wondered about that to the title and the first paragraph, but I didn't do it. Right. So I thought regulating prohibiting smoking and vaping in workplaces and public places. And the last sentence where it says scientific evidence indicates that there's no risk-free level of exposure to secondhand smoke or e-cigarette aerosol with a parenthesis vape. Only the scientific evidence is sort of iffy, although I went and I checked a few, but it's not hard and fast, but the evidence is beginning to come out. So I don't know how it would want to word that. Right. Even the reference that we found that had a review of the literature about outdoor exposure to secondhand vape products, it was kind of iffy, but they felt like the studies weren't all that high quality. And I think because of COVID, the research on this is all put on the back burner. So let me just, I noticed that the model didn't change the title or the first paragraph. I don't think it did not. But that doesn't mean we shouldn't. I think it would be important to get the word vape. Okay. And then also it's called, vape is really e-cigarette aerosol. And we could add that definition, e-cigarette aerosol parentheses vape. As a definition in the first paragraph itself. In the definitions. And also I don't know what people think about having a definition of vaping, which is the action of exhaling and inhaling vapor aerosol containing nicotine. And flavoring by a device designated for that purpose. I can send all this to you. Since that is part of what we're talking about. Right. Then in the 2016 e-cigarette use among from the Surgeon General, which was Murphy, it stated that electronic cigarette aerosol is not harmless. It can contain harmful constituents, including nicotine, flavoring with, and then it and volatile organic compounds, heavy metals and cancer-causing chemicals is another thing that I found. And I can send you that reference. It's from 2016. Okay. Although that doesn't talk about second exposures particularly. Or maybe it does. No, but wait a minute. I read some place I read, but there again, the science is not solid yet because the research hasn't been out. But one place I read talked about that they contain these these compounds. Do we really believe that scientific evidence indicates that there is no risk-free level of anything? I mean, that is not literally true. Right. True. I would leave that sentence out. That's not the purpose. And I would say that's true for smoking as well as vaping. They could say emit scientific evidence on Steve and just say there is no risk-free level of exposure to secondhand smoke. No, no. We do everything. Anything we say is based on scientific evidence. And so we shouldn't say something that's not true. There's no, you know, we don't have to go into this, but this is not a good thing to say. And it's not the purpose that's in this statement of purpose. Later on, it gives the references. I would leave that sentence out. The whole sentence. Yeah. Yeah. Okay. It just says what we're going to do rather than why. Oh, I guess, wait a minute. Maybe that is the only place that the references are referenced. Okay. Well, in that case, we better leave it in or something like it because, yeah, we need to have a place in the document that mentions the references. And I guess that is the place. All right. Well, is there a better way to say it? That's not no risk-free level. Indicates there is risk to exposure to secondhand smoke. Documented risks. I mean, there it is. Secondhand smoke is definitely documented risks. Oh, yes. Oh, yes, but not there is no risk-free level. So what they mean is that, you know, nobody's found, you know, at the levels that can be detected, there's a risk. So, yeah, scientific evidence indicates a risk of exposure. Just a point of reference. I googled looking for a term for secondhand smoke and aerosols, you know, vaping aerosols. And I came up with an article. It's April 2019, Preventing Chronic Disease. And so the acronyms, the second hand smoke is the acronym is SHHS and secondhand aerosol from e-cigarettes is an acronym is S-H-A, secondhand aerosols, just as an acronym. But in about the third paragraph, there is no risk-free level of S-H-S exposure, citing number two. Anyway. Yeah, I know. I know. People like to write, but this is from Yeah, I think we didn't make that up. I mean, that was in there before. It was, yeah. 2010 or whenever there was reason to write that down. Although it does seem hard to prove. It's not. That's definitely not literally true. So just say scientific evidence indicates a risk exposure. Okay. Oh, it's from the CDC. We don't, we don't believe them any. Right. I came across that one today, John, too. Should we call them? Their citation is a surgeon general report from 2006. Yeah. And I think we updated that. And if you look through the 2016 surgeon general's report on e-cigarettes, a lot of that comes up on that. So it's a 2016 document. Yeah. Figure out where. So do we want to separately talk about secondhand smoke and secondhand aerosols or combine them? Or what are we thinking here? We want to combine them, I think. Which is possible. Yeah. No, it gets a little awkward in that first paragraph to combine them. I'm confused because I thought there's, like, my 1-9 revision doesn't seem to have the right. Oh, it does. It still has, it has the correct, or at least the reference I thought it did. It was still 2006, but it was viewed in 2020. Okay. But if we can update that, that's good too. How often in the document do we need to refer to both things? Not often. There are a lot of places, I thought. Because basically it just, it doesn't refer to it except to say that the use of e-cigarettes or other electronic and nicotine delivery systems or whatever it is, are banned wherever smoking is banned. So it doesn't really say that. In the section for smoking prohibited and smoke-free environment, that that implies e-cigarette. It states it number three. Vaping aerosol is part, is what we mean by smoke. Is that right? Yeah. Or should it be like in section four I put down, it should be the responsibility of the employer to provide a smoke slash vape-free environment? Yeah. Again, I think I followed the model which just put in the sentence number three, the use of e-cigarettes. And I think I added and other electronic nicotine delivery systems is prohibited wherever smoking is prohibited. I think in the definitions, they include vaping also in smoking. So if you look at the definition of smoking, we had this in the second part of that paragraph, you can see including the use of electronic cigarettes. So I think we are already defining it as included in smoking. All we need to do is use some words in the opening thing that makes clear we're combined. These two things are together, right? Mm-hmm. I think Nancy suggested it seemed to be simple, you know, just putting in smoking and vaping because that's the way people think about it. And then in the first sentence of that first paragraph to say second hand smoke and the e-cigarette aerosols or something. In a 2017 article on it's from preventing chronic disease public health research practice and policy, it says scientific evidence indicates the aerosol admitted by EVP, meaning the electronic vapor product may expose non-users including children and infants to aerosolized nicotine and other potentially harmful substances, including heavy metals, ultra fine particles, and volatile organic compounds. Thus, aerosol, thus this aerosol is not as safe as clean air. Well, that sounds good because I don't think we really addressed the vaping in the references. Okay, so then I can systematic review of the health risk of passive exposure to electronic cigarette vapor. I can type this up more. I mean, you know, these are pretty recent, these other two, both the vaping one and then also the outdoor areas, which is probably the harder one to demonstrate. So I can type this and send it to you Maureen. Okay, sure. Very good. That's a misspelling. Just had a quick question. If the scientific evidence shows that there is impact on children, but this by-law is essentially on the health of employees. Should we still consider that? Public places. The reason this says children is it was about harm to children. So that's why they put children, but it says it can expose non-users and it said including children, so non-users. Yeah, and that study cited also was like people being in the same room where someone else was using an e-cigarettes basically. And the article was focused on harm to children by secondhand aerosol. So, but the original part says expose non-users, including children. Right. And the public places includes children in my mind too. And this is from the Surgeon General's report and it says smoke-free indoor air policies should be updated to prohibit the use of both conventional cigarettes and e-cigarettes, thereby preserving the standard for clean indoor air. And that came from that 2016 report just to support us. I don't know if you want to put it in. Yeah, I think we should have some more support documents. I don't think it hurts to do that. Okay, well I'll send all of this to you. I'll type it up at some point tomorrow and send it to you. If you just want to take a picture of it and send it to me, that's okay. Like the citing. Okay, here's something that in 2016, California, Delaware, Hawaii, Maine, North Dakota, New Jersey, Oregon, and Utah have enacted comprehensive smoke-free laws that prohibit conventional smoking and electronic vapor product use in all indoor areas of worksites, restaurants, and bars. So I don't know if I could go check. We could check there. For what? This one. They have enacted comprehensive smoke-free laws, including this. This is all just supporting why we should include it. Moving down to where we go through the different places in section four, and that would be number four in section four. So yeah, in A, I guess DJ said to leave that in, although it seems like... I think what he said was to repeat the ban on smoking bars so we don't have to have it, don't have to, you know, redundantly ban smoking and smoking bars. Okay, so we did do that number five. So we can take out A in nursing homes. That's not a change. Vehicles controlled by the employer. That's not a change. D went from 50 percent of rooms to all in bed and breakfast hotel and motel rooms. I remember we sort of hypothesized we kind of predicted that none of them now do even the bed and breakfast. We don't really know that and so we can do it. Yeah, the employed closed workplace, that is not changed. And we added, we just changed from retail tobacco stores to in adult only retail tobacco stores because that is our new term for those stores. Good, yeah. And the outdoor areas, refood and beverages are served to the public. That is what was in the previous regulation. And the 20 feet, I think we decided to leave at 20 feet. I think DJ said between 20 and 30 or something. 15 and 25, right. So we were, we were right in the middle of that on that. Excuse me. We'll have to get better signage for the municipal buildings. Because when we were, when I was out volunteering at the COVID clinic at Bangs, there's just one little sign on one place and it's very small. So I don't know if people could see it. So we might want to encourage the town to get better signage for municipal buildings. Well, yeah, I don't know if we have those, but often there's also a place to drop your cigarette like a standing ash tray or something. You know, those are trash and with ash tray on top, but that's one way. Marina, are you editing a document? Like as we, I just did one thing. Is that terrible? No, I, because I want to know, I want to, do you want to hear about any typos workplace is one word, for example, not to where is that workplace? It is telling me that, but I think maybe that may have come that way. Yeah, but it isn't according to Merriam Webster. Yeah, right. And yeah, it's doubly underlined in mine. So it does tell me that's a problem. I just, yeah, anyway, I don't know if you want to hear about such things while we're looking glancing or why not? Okay. Um, all right. So on in I, this is changed because some things are added. And so on town Oden playgrounds, I think that was there before. Parks, I don't think were recreation areas. Can't remember athletic fields were only when there was a registered event. So I just deleted that and swimming areas were mentioned in that, in the previous one. I didn't specifically say the common and I don't know how that is represented here. Is it a town park or recreation area? Yeah, I don't know. Because then we would have a little three, you know, the North Common, whatever, was it Kendrick Park, not Kendrick, the Kendrick, yeah Kendrick. And then what's the one with the fountain? Sweetster. Sweetster. Including downtown parks? Well, it says parks now. Parks, yeah, that, you know, other parks, the Groff Park and Mill River and, and lots of little parks. I mean, yeah, like Sweet Alice, Brooke and all, you know, all these little, you know, like those, what are trails like the Robert Frost Trail, for example, is that a part of that, that's a recreation area? I don't know what that is either. It's a trail and I think the trails and also the bike path would be separate. Different, that's something different. Yeah, bike path is controlled by DCR. Yeah, that's right, right. But other trails are, I don't know, actually, who manages or controls those. I'm guessing some are town and some are maybe managed by like Kestrel Trust or, although maybe in coordination with the town. I know like Mount Pollux is, is kind of both. So that might, is a trail of, yeah, I don't know. Do we want to conclude trails, town-owned trails? We have to figure out what those are. Well, there's a lot of, you know, there are a lot of trails. Like, you know, there's that one down by Mill River that goes from, from Groff Park back to, you know, I have never seen anybody smoking ever, not even once on any of those, but I would believe it. I don't know how people feel about that or just leave well enough alone here that, you know, places where people are. Excuse me? I'd say leave well enough alone and if, yeah, it doesn't seem to be an issue. Maureen is, I would imagine trails wouldn't want people smoking on them in case of fires.  That's DCR too. Yeah, a lot of it. Mostly. But Groff Park and Mill River.  I think it's good where it is. Yeah. Yeah. Is item J from the sort of recommended thing or? It was, actually it existed in our old guidelines, our old regulations. I mean, I think the wording's not very good. Yeah. I mean, I think this is what it meant. I might write, if I were to write it, I would write in lowercase p public transportation vehicles. Well, that's covered by the state and I don't think we have to do that. That was a sense I had from DJ. The areas like those bus stops or maybe places where people. Oh, so in public transportation. So maybe waiting is also qualified by waiting areas. Okay, the wording is is creating waiting first waiting areas. Yes, yes, for public transportation and how I don't know how to say that really but in waiting areas for public and private transportation services. Um, taxi is not public, right? No. That's what that's what we mean, right? In waiting areas for transportation services, correct? Yeah. Is there a taxi waiting area at Amherst? Yeah, it might be. Well, I think, I don't know that it's official but I think there are a couple places parking places that are designated for taxis. Normal taxi stands. Yeah, why not just say in, I would advocate for in waiting areas for public and private transportation services period. It covers it, all kinds of things. Bicycles, buses, taxis, horses, whatever. If it's a designated waiting area then. What number? Excuse me? What number, I can't find it in here. What number is that? J, 4J. 4J. 4J, I have on town owned athletic fields for J. Well, that must be the old version. Yeah, you got to look under marine strikeout version, January 9th. January 9th, the 19-20. Oh, I don't have. I sent both 19 and 17. And I tried to send that one clean but it didn't go up clean. It didn't 1-7. I don't know, I printed several things but I have two of the same. I don't have that one then. Okay. I think up top, like draft and the date, so. I do. It's like, now. I have MM revisions 19-21. But it didn't print on the file. So I don't have it. Okay. I printed a bunch of stuff but I don't have it. Well. Anyway, do you like that wording I proposed? Just to. So one aspect of that is private transportation. Private transportation includes everything, right? Even passenger vehicles too, right? I think saying taxis is probably better because, well, you know, if I'm picking Tim up, I don't need to have, you know, it's. How about this? How about this? I got a slight, I would say in designated, in design, if it's a designated waiting area, I don't care who's coming to, to, we're talking about areas where humans wait to meet these services, correct? That's what we care about. And they're designated. What? Designated. I think it's a loose definition, right? I mean, if you look at. Well, it's less loose than, I mean, taxi waiting area or bus, I don't know. Yeah. I mean, Uber and Lyft. Well, that was. Are all over, right? Right. But there are places like an airport. There are some places in towns and designated signs for those waiting areas. You don't want people smoking there. But I don't think we have those. I know we're writing a regulation for the ages, Nancy. This is going to. Okay. Got it. I think in something like, I was just trying to use a simple words that capture all kinds of modes of transportation. To me, the key area is key that is some kind of designated waiting area where people are supposed to wait for transportation and smoking shouldn't be allowed. So in designated waiting areas for in designated transportation, waiting areas or private services is what John said about designated public waiting areas, meaning, meaning it takes away your front lawn. If you're waiting for Uber to pick you up. Yeah, that's not, you don't have a sign on your front lawn saying. No, you don't. So I mean, I think the word designated only appears when it's public, but that's, you know. Yeah, I was trying to look to see if the model had anything to say specifically about that, but it, it doesn't really. I'm probably sensitive to the, or thinking about the words here because I work in civil and environmental engineering. I have a transportation group and the transportation modes are constantly training. It could be a scooter waiting area. It could be. Yeah. I mean, there's lots of kinds of waiting areas of these days. So pretty soon a lot of vertical takeoff and landing. All kinds of things. Drones. Why don't I go with that and send it around again and see how we do some try to get that wording from mostly based on what you just said, John. Yeah. Um, and then I, okay, I just which is in vehicles of ride sharing services while they are engaged in providing rides to the public. All right. You got that one. Okay. Back to Jay. Do we want to have during registered events or just in town owned athletic fields? Period. Because I took out the registered events. I just said athletic. I did find the one with other eye, but it had it on. Okay. I don't know. I just have so many versions of this that I printed out in the last day. Okay. I'm sorry. The late action on my part didn't help. Did you out of that print world yet, Nancy? I'm such a paper and pencil person. Does that make sense to you? They're just leaving out that qualification? Yes. Okay. I think so. Did you think we got through that major section? Everyone? Yes. Yeah. Okay. And number five is smoking bars are prohibited in the town of Amherst. So that just out there. And enforcement did not change except for section five, which just adjusted the 4.3, 4.4, 4.5 from whatever it was before. It was a different, it was two, three and four, I think before. And I think that that otherwise was not a change from the original regulations. In item six, the word regulations is Smith's spell. Oh, I think I fixed it already. Good. You got it. Yeah. I don't know how that happened. Easily. Yeah. And I think I caught something in eight. It was inspection. The final phrase, their local inspection department, and it said of the equivalent. I made it or the equivalent. I think that was right to say that. I happened to like the last comment, a list, but I'd put a comment after department, but that's people have different opinions about this. Yeah, that's it. I've heard that phrase. So there's a little bit of editing around including vaping or aerosols more in the beginning of this, just to get that in there and get some of the definitions maybe into the definitions. And I guess the one thing I don't know is like how that ridesharing is that sound. I mean, it sounds okay to me, but I don't know if it encompasses the right that well. Anyway. And in that ridesharing, the last word public, check that out. Yeah. Yeah. What is weird, John? No, I was mostly talking to myself, but just the format, I don't understand like 4.1, why there's three lines. Where the, what we used to call a carriage return occurs, but there's weirdness in some of these things. Yeah, I know. And some of them I couldn't make go away. So maybe I will work harder on that.  Yeah, returns that I shouldn't be there in this section. There's tons of them. Sometimes I think they move from like one page to another. Mm-hmm. Do you like to see one space between them? What those in? No, it's not about spaces. It's about text that doesn't wrap. It goes to the next line because there's a return. You have, you know, the paragraph symbol is there and it's just at the end of a, those exist on items one, two, and three in the version I opened. I don't think you can see that actually. Okay. Well, do you have that turned on so you can see them? You do? Yeah. I don't know. I'm not sure. Okay. In word, it's under view and there's home. There's a little button you push and it shows the, I show a lot of paragraph symbols. Right. The unnecessary one. So it causes line breaks at wrong places. I don't know why they're in there. I don't know. Maybe they were, I don't know. I have no idea. And I don't know how to deal with those, but maybe I can.  The ones that shouldn't be there. The only place I'm seeing them is in that section. Oh, yeah. I see that now. I never did that before. Thank you. Items one, two, and three have weird, weird things. I'll write that one down too. Paragraphs. So we'll keep on going. Yes. And Nancy, if you can, if you just want to, you know, take a picture of the type, you know, that has the highlighting on it. Finding it online, just send me that. I'll do it by Sunday. I'm doing remote teaching tomorrow and I have two overnight little guests tomorrow night to Saturday. I'll try to get it to me. I don't think that's, that should be a problem. And then also if on the top, if you put draft and the date. Okay. So that I've been including it in the way at the end. So I'll try it right up top there. Okay. My own name. I leave it, left it there, but I'll leave it on top. So we'll kind of keep track better. Okay. You want to get. Thank you for all your work. Well, you're welcome. This one hasn't seemed to be quite as complex as the tobacco sales one. That just required a lot more change. So this one is more limited in spoke. So that's good. Okay. That off the table. While we're on smoking and tobacco, I just have a question and maybe education for Emma. There, Emma. Can you hear me, Emma? Uh-oh. Have I faded? Nope. He was muted. He was shaking her. Okay. In our, in our tobacco regulations that got sent out sometime this fall and took effect January 1st, we have, we have a piece that the tobacco sales permit holder has to keep on file copies of the tobacco handlers quiz that anyone who's selling tobacco in the place has to take. How can we follow up on that? Or do you have any ideas? Or are you overwhelmed with COVID? Do you want to pass it out to, I don't even know how these all the stuff got out. They got mailed. Yeah. So Steven, I forget his last name. He's our licensing coordinator. So he's the one that got all the stuff out. Thank goodness for that. So that would have been a heavy lift. I know in other local health, health boards, it's, it's challenging this time of year getting everything out for the new year. So I can follow up with him and see how that's going. That's no problem. I like questions like that. Yeah. That was just, you know, just follow up because we'll have to check and make sure it's being done. Otherwise, why do we have it? Right. Okay. What's that? It's got to post it in everything Nancy. Perfect. Makes it official. And so now we're moving on to the director's report. Maybe I should just put this in Emma asked me a question about wood burning stoves or smoke. Remember that Emma? Yep. Yep. So she reached out and gave me the information and I forwarded it on. We had a resident call and certainly I'm new to Amherst, right? And I know I don't certainly don't know everything about the great policies that you have and everything. And I admit that. So I heard some concerns from a resident about wood, her neighbor's burning wood and that being very smoky and staying around her area. So I reached out to Nancy and Nancy's expertise. And I was able to find that you in fact already had language surrounding that. So we forwarded that on to our one of our health inspectors. Other than that, I haven't heard back yet, but that was the. Okay. Cause I just, cause that's another quiz and I just looked it all up again. So I wanted to make sure you got that information that you needed. Yep. Thank you so much. All right. So now the director's report. Drum roll. Amazing work. Oh my heavens. It has been a flurry. I know that Stephen and Nancy have been able to come by. I know Maureen, you're going to come by tomorrow evening. It's going to be great. Four o'clock. Yeah. You can show up any time between four and four 30. Okay. Yeah. Okay. Let's see. Let's look at the numbers. Today we saw 159. And I know on Monday we saw 202. And then I believe Tuesday night it was 100. So just really remarkable stuff. One of the, I haven't been there. I have to stop you, Emma. It is so well organized, so well thought out with the safety of the staff and people coming in. It was just stellar. I just have to stop you and just share that with the board. I was so impressed with all the little things you thought through for the first go because you keep reading about how this has been a disaster throughout the country and how well you've initiated this piece here. And you'll just build on it as we go into other phases. I was just so impressed. I agree. Yeah. Thank you so much for that. It's certainly a great opportunity for me to really, this is my skill set. I really like setting up clinical events and buildings of opportunity. That's what I do in my federal job. So it's been pretty great having that be able to come at the time that we need it. If I can just inject the question, can you remind us of who was the audience, the allowed people to take these vaccinations and did they sign up online? I just don't remember what was written in the paper once quickly. Yes, John. And that's a great question because it's changing every day. Yeah. And different people are saying different things, right? Like the federal recommendations and standards are different than the rollout here in Massachusetts, which is making it very challenging. Yeah, yeah. That's why I'm asking, what is this one specifically? I understand there's a whole universe, but I know. So right now we're in phase one, step three, I'm going to try and pull up the website, which is first responders. I'm going to do something fancy. I'm going to share screen in a minute.  All right. Way to go. COVID vaccine. How many screens you have in front of you? Two. Yeah, that's the challenge. You got one in one. It's easy to screw up. I've found, I've learned. I have three in front of me. I'm always sharing the wrong one. All right. So we're here. So this is your normal, when can I get a COVID vaccine, which is great. Lots of people have seen it. This is a kind of a small one. You can have to squint your eyes to be able to read it, which is not very helpful. But boom, look at what this great thing that they just put out yesterday, which is a nice visual, which can show us all where we are in phase one distribution. So right now we can see this arrow here, which we are in week two of January. And the yellow arrows on the left show the areas that are currently being served during the distribution as approved by the Massachusetts Department of Public Health rollout. So right now, COVID facing health care workers, most of those in the hospital, including primary care physicians, long term care facilities, first responders, which are really the primary focus that we are looking at, and our congregate settings, meaning shelters and corrections. We did start to engage Craig's doors, volunteers and staff today, which was wonderful to see and get them in here. And then I think with availability, I always had the great opportunity to speak with Kevin Noonan today, that the guests of the shelter tomorrow evening, I do believe we're going to have some slots and we're going to really encourage them to get the vaccine and try to do some education for those guests with them. Yeah. So, so this is a really good visual, John. I think of where we are right now. Yeah. No, I'm pretty familiar with these. And I know lots of instances that go outside of those groups from various extensions of tentacles. And it's just, it's interesting. And I was just curious of the, and for lots of great logical reasons. They take it like my mother, 92 year, 91 year old mother-in-law got who's in an independent apartment, but in a huge complex of all kinds of flavors got her vaccine first shot today in Worcester. Yeah. So, and I know like the lab techs at the Isles lab in UMass, I think, got got vaccinated who are doing COVID-19 tests. I think they got vaccinated at UMass today this week. So it's good. There's some good tentacles going up. Yeah. Just like you mentioned, the Craig's doors, folks, that's perfect. Yeah. So good. Yep. We were designed for reminding the bank. UMass is on the site, the stuff that happened this week, the state site, the UMass campus center. Bangs was also one that responders from certain towns were supposed to sign up, or is it just show up? No, no, we're covering eight towns. Eight towns. Amherst, Belcher town, Granby, Hadley, Hatfield, Hellam, South Hadley and Ware. And do they sign up, or was it? Yep. So they sign up. It's through the mass immunization site, which is the software is called PREP Mod that the state has rolled out for us to use. And they sign up online and you schedule an appointment and then you come. And where are our results? The results, the specimens being examined for the specimens collected at Amherst. Thanks, Mark. Well, so we're not collecting specimens, we're giving vaccinations now. Excuse me. I'm sorry. No, it's okay. I know it's, I know we've had to change our lingo. Both, both are happening on campus here. So yeah. And does the state agency, who delivers vaccines to a town, the town or let's say university health services or something? Who does the? Yeah, it comes via UPS in the mail. I probably shouldn't say because it's probably supposed to be some super secret magic package. I don't know. But it comes via UPS. And it also comes with the equipment from the Strategic National Stockpile for 100 doses, like meaning our syringes, alcohol preps, face shields. No band-aids though. Just an interesting fact. And we are in our practice, we are wearing gloves. I know that has been a concern in other sites. It's not necessarily indicated per the CDC with giving vaccinations. But we felt very strongly about being able to wear them. We are using a reduced waist model, meaning that our staff are sanitizing their gloves in between patients. But that way, they're at least wearing something, which I know is important to patients and then also some clinical staff. So we wanted to make sure those people felt validated. So this week, our program was just this week? This week for first responders. Yep. And then we did reach out to the state because they reached out to local boards of health that were doing vaccine programs for first responders about possibility of continuing throughout three phases of distribution. I spoke with Paul Backelman about that, and he does support that. So we put that through in terms of an interest in something to continue. We have not heard back yet because we just submitted that on Wednesday, but hopefully more to come. I know that there's lots of work to be done. I think this is really a team effort with that. Like you said, John, you talk about those tentacles. I think we're going to be able to, there's going to be multiple pathways where people are going to be able to access this vaccine. I know that there are going to be smaller sites like ours would be. And then the state is planning on several what they call mass vaccination sites like at Gillette or the Topsfield Fairgrounds. And I think I believe I heard maybe the Big E, but more to come with that. What percentage of our first responders from Amherst do you think have been vaccinated? Oh, that's a good question. I would have to go back and review the data, but I saw a whole lot of them come through and extremely good feedback, just so thankful about us putting this on for them and showing our commitment to our community. I think just is remarkable that we were able to do that. And we also got that continued thanks, not just from our own here in Amherst, but for the other towns that we were able to support. And those first responders could also just opt to go to UMass, that part was confusing to me. So it's like two sites. So ours is really dedicated to the Hampshire first responders. The UMass site is a catch-all, if you will. There are many counties and municipalities that weren't able to stand up sites and that weren't able to be vaccinated on the local level. So UMass is a site that's available to all those individuals that don't necessarily fall under a smaller umbrella. I see. Yep. I have this hope that the UMass site is geared up so that those of my faculty and staff and TAs who are doing face-to-face instruction starting in two weeks will have a chance to get vaccinated sooner than later. But we'll see. Yeah. There's lots of categories, right? Lots of needs. How do you prioritize? That's really helpful. Well, and the fact, John, that I'm not the one doing the prioritizing, right? Yeah, I know. And that makes it so hard. And especially when today we did have, I think people are so anxious about getting this vaccine, right? And people want to make sure that they get it as soon as they can. And we did have quite a number of seniors sign up for vaccines today because, unfortunately, they had heard from an uneducated source that they could get the vaccine. And we didn't have to turn them away because they're not under what DPH has given us as a very clear guide of the population that we're supposed to vaccinate at this time. And then just before this meeting, I was actually calling seniors that had signed up for our vaccine clinic tomorrow evening to try and let them know now. So is the sign-up sheet not as clear as it should be? I mean, the header should be like, you are eligible if. The header on the town webpage is very specific like that. Unfortunately, when you go into the sign-up, which is that state software that we don't have any control because it's the state. But it's not as specific as it should be. It seems if. Yeah. It was not built to do this kind of specific thing. So we're trying to make do as we can. And I know it was a great opportunity. We had the COVID ambassadors come over and help us with some of our outside time to be able to help engage some people as they came and greet our guests and be able to spend that extra moment that I know I'm stayed pretty busy in the clinic trying to make sure everything's running well. But they are really they were able to give that kind of extra moment to people to make them feel acknowledged and appreciated even if we weren't giving them the answer that they really wanted. Yeah. But I know that Jennifer Brown and I are just really excited about this next step. We've been working alongside the fire department, Jeff Olmstead and Chief Nelson, and the paramedics are helping being vaccinators and the school nurses. I just and and then our great volunteers that have come. It's just really remarkable to see everybody coming together for this kind of next step. And I just want to thank each of you, you know, and your support as well to be able to make it possible. I wouldn't be here if it wasn't for you all. You wouldn't be at this meeting. That's for sure. We didn't actually have any say in hiring you. So, yeah. Well, we're glad you're here. I have a question for you. I saw in the newspaper that the Hanley Board of Health, which is doing something amazing, they're having a Zoom COVID education piece. Yeah, that was yesterday evening with the select. And do you think that's worthwhile doing here in Amherst? I think it would be great. Because I've always been saying we need to educate people and I hadn't thought of that. And I said, well, wait a minute, this sounds great. Yeah, I think that would be really fun. Tell us about it and how do we start setting it up? No, yeah. So it was actually it was through the select board and one of our board of health members, Dr. Mosler, and they were able to say that we were going to be out there. I know one of our special, we had two special guests, Dr. Joanne Levin and Dr. Estevan Garcia from Cooley, and they were terrific. And then the superintendent of schools, Annie McKenzie, spoke about the school safety and everything. And then I spoke a little bit on metrics and data and trends and did a little PowerPoint for that to kind of show the Hadley data over time. So it was well received for Hadley. It was a big meeting. We had 60 people. And we had some really great questions, you know, and at least even if we weren't able to answer everyone's questions, we were at least able to give them resources like the where to go to find regular new information. So yeah, I think it would be great. I know that I had mentioned me and Paul had briefly discussed it a couple days ago because he had seen the same thing. And he thought it would be a great idea to have. Should the board of health sponsor it? I think I personally think that would be terrific. And the town council because Monday Town Council is crazy. Yeah, and long. Yes, that's what I meant by crazy. So long. Not like it's crazy, but the hour. Oh, that's a long meeting. You know, I've been to meetings, but that town council, that's a meeting. Yeah. Yeah. Emma, can I ask a question? Yeah, of course. You know, I was working with Amherst neighbors, which for those who don't know is a volunteer organization that aims to provide social interaction and services to Amherst seniors. And one of the questions that came up was we're trying to think about what services we can actually provide as as time goes on here. Was whether what what's the thinking about getting the vaccine to seniors who are living on their own, but might not be able to drive or get to the site of the vaccine? Yeah, so I love that question because Jen Brown and I have already thought about it. I read over and lift is giving rides, but I didn't know we're actually really interested in doing mobile clinics and doing push distribution, meaning that if someone lived in an apartment complex, like is it Ann Well, Whelan, that's with the Housing Authority, that like we would go and do a clinic there or more than one clinic there or some of these other housing facilities. But that's what we've kind of been envisioning. And I know Jeff Olmsted from the fire department was also thinking that unprompted today. So that was really neat to see. But not thought about people who live out in about in their own homes or whatever. We could do that too, when the time comes. How home visits. Right. Maureen, you and Leslie could do that.  But just thinking about those vulnerable groups who might not be as mobile to get in line and drive their car to a big E or whatever. Yeah. And certainly even the younger population that still might have those barriers to transportation, multi-generational families in apartment complexes. We're trying to think about that now. So that way we can meet them in a meaningful way. Yeah. There are a lot of sites that would benefit from outreach in mobile administration, sounds like. So you guys are ahead of me, huh? No, no, it's just, it's the things that I wake up in the middle of the night going, oh, I didn't think about that yet. I got to write that down. But Emma, you even forward thinking because you ordered those travel packs that you can take the best out to mobile clinics. So she's on the ball and has it already. Yep. We have the equipment to do it. We have two mobile packs that'll maintain their temps. They're on wheels. They're very protected. I was able to purchase those when I bought our free fridge and our freezer that can also maintain those temps off without power for five days with the remainder rate remainder of our carers money from the fall. And I, and we did actually just recently get, I believe, another $20,000 which was great to see. So and I think the Piner Valley Planning Commission, they had sent out a questionnaire this week, a survey because they were being allotted. I believe it was $230,000 but it's to support all of their communities that are under their umbrella. But for continued asking for continued funds, if we could use them, of course we can use them by golly. I can always find a use for stuff. For, and those funds would be able to be used for COVID testing, media materials, but I envision being able to set up more of a mobile testing clinic, probably going to different apartment facilities where there's a large density of population and people might not be able to easily go to a site like Mill River, because I really want to meet people where they're at, not necessarily have people have to come to me. I think it would mean a lot for people to see us out there. I know in the short time for our vaccine clinic here, people have really said wow, the town of Amherst is here and they're helping us. What's your sense? We can go on and keep talking about this.  We just have questions, but if it's okay to keep asking questions. Yeah, go for it. I probably won't have the answer. Now, what's your sense of the supply rate, which is from the state to versus the rate we can administer vaccines? Is the supply going to constrain us? I hope not. I know that they send out a survey every week that I submitted yesterday asking us how many we're going through and what could our clinic support and go through a week? Yep. That's DPH. That was reassuring because they're asking for the amount that we can go through. We could easily administer, not a math person. This is shameful. My brother would be so embarrassed. My brother has his PhD in math and astrophysics. We can do about 600 vaccines a week. He's the smart one. I can talk to people. That's thank you, Nancy. We've let DPH know the amount that we can go through in that survey. Right now, that's how they are trying to get a hold on how much vaccine to push out. They're also looking at, with the MIIS in real time, the amount that we're processing to get a hold on that too because they don't want people to kind of hoard stuff if they can't deliver it. I was interested because I didn't look at this week's but last week's report on vaccines that was pretty uneven in the counties like Berkshire had. I can't remember 6% of what, and like Franklin had like 2% and we were at 3%. I was just curious if you had thoughts about that. I have no idea about that. I would have to look at that better, but I've been so busy. I was just curious. I wondered, is that because the hospital numbers versus regular population? Yeah. I bet you're probably hospitals and long-term care facilities. We're the only ones referenced in that. My guess is maybe per capita they have more of those people in Berkshire. Also, if we think about our density, compared to out east, those people east of Worcester, there are so many of them. I opened the weekly report from today. It must come out just in the last half hour. I just opened it up and it's a little disappointing on delivery to the state of vaccines was zero last week, essentially. New stuff. I know Bay State was stating they were depleting their supply on Monday and we're hoping for a shipment. Is today Wednesday? No, today's Thursday. So they were supposed to get a shipment yesterday. So this is through the 12th.  Yeah. That'd be nice to get them, but hey, 33,000 people have their second dose already. So that's good. Speaking of that, so Emma, you don't have any control over, you know, you can't be absolutely sure that you're going to have them for the second dose or can you be sure? Well, that's something that DPH initially said we are securing. And I think with the changing climate of possible distribution, they're not sure now. Yeah. So more to come. Because you do have a whole clinic set up for the second doses of these first responders in four or five weeks. We sure do. Right. UMass, I saw they advertised the same thing one month later, essentially four weeks. Yeah. The UMass site for the state. I'm sorry. It just happens to be a physical location. Actually, it's not. I know. And then it's like, is it the UMass site in Amherst or is it the Amherst site at the bank center? Who's staffing the, do you know who's staff doing the one at the campus center? Is it Ann Becker and staff or? Yeah. Yeah. It's Ann Becker and her crew. I'm not sure if there's some nurses, nursing students that might be here a little early doing some clinical stuff. Maybe the, what I'm thinking is maybe those like accelerated students that don't do the traditional, they usually go through intersession and summer and everything. So we're interesting than watching people swab their nose in the campus center or so. That's true. That's true. Does that, do you guys have any other questions? Look at Nancy. I have one question. I last time, at our last meeting, you had said that the Amherst numbers had suddenly flipped from being mostly UMass related to suddenly community related. And I wanted you to, that has persisted and how contact tracing and all of that is going in the midst of all of what else you're doing. Yeah. So we've really made the decision. We are doing some contact tracing, but not a ton. There are some school nurses that continue to want to be involved in that, but not all and we're respecting that. And many of the cases we are sending over to the CTC at this point, the contact tracing collaborative through the partners in health. John Welch is their head person and put on a great presentation last week where their capture rate, meaning the amount of people they're making end contact with for contract tracing, since they've increased staff and really onboarded people has once again increased to about 80%, which is pretty standard for what we were being able to complete on the local level. And by being able to for us to engage the CTC, we're able to shift our focus on vaccines. In terms of the data, I do know that the college age population does slowly start to increase again. I slowly, I mean, right after New Year's, seems like a whole bunch of them got together. So we've been watching that but we still do continue to have those multi-generational families involved and children. I believe right now we have a two year old. So yeah. I was meaning to ask this question, which I've forgotten, but came back to my mind and brought up on this. So given the contact tracing that's going, why is our case rate in Massachusetts, unfortunately in the top 10 of the country per capita? I understand it's mostly in the dense eastern mass, but what are people saying for reasons of transmission? What are we still doing so horribly wrong? What social behaviors are still happening? Even with these mitigation strategies that people are starved for their families and their friends and their loved ones. Just can't keep being isolated. They've reached this point in the pandemic where people really felt like they had to get together over the holidays or New Year's. They continue to have gatherings or birthday parties and every, not everyone, that's mischaracterization. But I do hear from quite a number of individuals that I have the right to make my own decisions about risk and sports and going out and doing this activity. And I think inherently that is something that people, especially in the United States, take on with a lot of pride, being able to have that independent kind of thing. And that makes it very challenging in a pandemic to be able to control. So people don't like to be told what to do, John. No, no, no. And here's the other belt. If you take cumulative cases per capita and look at the data like in the New York Times. So we had North Dakota, horrible, they're up to about 12% of the population from testing has had COVID. I'll bet you it's much higher. So maybe they got they're pushing herd immunity. Is that why their cases are dropping down? I can't imagine their behavior changed. I do not think their behavior changed. So is it herd immunity due to contract? You know, yeah, I don't know. North Dakota can't find me putting in a mask order, whereas South Dakota, I don't think did. I'm not sure orders and behavior in North Dakota are going to carry much weight. It's my that's you're there this summer. But anyway, it's it's fascinating. There's so much data that's going to be analyzed in 7 million papers written on this stuff. It's it's unbelievable. Yeah, I like Steve's certificate shared with us a plot of the Amherst cases over time. I loved that seven per day for the last 100 days. It's like dead linear. Quite linear, yeah. But you don't have the data to do the UMass? Well, there's a big gap in UMass. I have it. I just thought it was clear to just give the Amherst, because first of all, their number of tests per week has gone way down. And so it doesn't really show anything at this point. Now, when school starts up again, if you really do have large numbers of UMass students, that's going to be quite interesting. I'll still keep track of it, of course. But yeah, I didn't see that green line. So Steve, that data was excluding any it's it's what the town is on our website every day. Correct. But that includes off campus students, right? Yeah, whatever the town knows, whatever, you know, what I don't know, you can say where that exact number comes from and who's counts as a resident, but it's just what is posted on the town website every day. Which Emma, that's students in off campus housing, right? Correct. Oh yeah, if they live in Amherst, they should be there. That's essentially all of them because on campus is in the noise. On campus cases are only 20 or 30, you know, 50. It's not important. So it's fascinating to me, it's that linear. Given people talk about holidays and the bump after this and the bump after that. Not in Amherst, it's seven a day, no matter what we're doing. Interesting. It's fascinating. John, what's happening with students coming back to UMass? Have you heard? No, I think we're all waiting. The Chancellor's got away in. I'll predict tomorrow at 5 p.m. Just to guess, there's sort of a two week window that was used in the summer when the there was a big change two weeks out. It's tough to demobilize or mobilize a bunch of housing related things that close. So I've heard no indication that they're not going to do what was advertised. There's no indication of that. We're all preparing from a teaching and instructor point of view. Face to face classes, labs, a lot of boxes and masks and face shields and stuff arriving in our college. I did doing testing, you know, on the week I go every week and get my test. And in line, it was clearly this was Monday. People like coming back to work in dining facility. I mean, they were like, yeah, I got assigned here or what it's, I think things are gearing. I mean, you're not going to have 5000 people show up in dorms two weeks plus two days from now without being getting ready. So and I think students were encouraged to come as much as a week beforehand to quarantine. There's a lot of testings and stuff going on. So I don't know. Emma, what do you know from town gown? Is there any trigger point decision making you've heard about? I have not. I have not heard that they are committed to changing any decision. I heard not as many students registering to come back as they had hoped. That's what I had. Yeah, they were hoping for 6000. And I think they only got a little bit over five. Yeah, the initial predictions were as high as eight. And, and that dropped back to about five in addition to the, yeah, 5400 was the last number I heard. But, but even, I think they can renege even very, you know, soon in terms of coming on campus. I mostly see it with some of our face to face classes. I'm dealing with students who for various reasons choose not to come and they're supposed to be in a face to face lab part of a class and how are we going to deal with that? That's the thing George. I can't even imagine. So then I got to figure out are they graduating in May or they graduating when, which semester could they take it?  That's weird. And we get our grad, various students who'd like to go to graduate school caught in various countries. I'm sure, I'm sure that's in your department too, Tim, where you've had something where you need to go. There must be some students who can't get here. You've got plenty. So I don't know. I think everybody's expecting some announcement. But nothing yet. I think Smith and Mount Holyoke are coming or arriving. I heard that Mount Holyoke was on track. I didn't hear anything new. I still talk to people there a little bit. Again, I don't know if they'll be pulling the plug. At Amherst, they delayed the return of many of the students for a couple of weeks, but they are going ahead and they have tested as soon as you arrive. And some students who were cleared beforehand were tested positive already after they arrived. But they're doing a pretty good job of isolating.  Well, we actually communicate very regularly with Dr. Emily Jones and Matt Hart, their emergency manager. They do an incredible job with their team with contact tracing and then getting their students into isolation or quarantine and making sure that they're supported and able to do that fully and safely. So really, I think they would be a great model for other institutions for that. Are they inviting all students back? No, not all, but many more. But more than the fall? Way more, way more than the fall. So I think it's going to be in the fall they had maybe 600, I think it was, or something like that. And it's going to be 1200 students. At Amherst, no. For this spring or for the last fall? This spring, yes. Hampshire is expecting about 500 to 550. Mount Holyoke was expecting about a little bit over a thousand. That's about 50 to 60%, I would guess. Yeah. And Smith was expecting 1,300. I'm looking at my notes from a five college meeting. Yeah, yeah. Yeah, we'll see. What's the level of concern? I thought you had brought it up, but what are towns, people, what level of concern our people have about this, you know, the students returning? Yeah, I don't know. I haven't heard a lot of direct, we haven't gotten a lot of direct reports here at the health department for that. I think people are so focused on the vaccine for us. But I know that, you know, I have family in the area who's a little worried. What kind of calls are you getting on the COVID line? Do you get a sense of what's coming into that? Yeah, I do. I am included in that file. Let me open. But I know that they're primarily answered by Angela Mills or Jenton-Moylston in the main office, but here it's a lot about some groups. Some are, man, I've been exposed. What do I do? Or some are, it tends to go in waves, because a couple weeks ago it was all about the testing, right? And where was my testing site and are we setting up again? And then every once in a while, we do get questions about rental assistance and resources that we can refer, give to people, for help, for social services. But a lot of times too, it's about compliance concerns. So it kind of varies. Great. Anything else? I don't see any topics. Anybody else? Questions? Second Thursday in February, February 11th? That's right. It'll be here before we know it. Emma, do you want to think about a public education sponsored through the Board of Health, the Health Department and the Board of Health? I think that would be great. I think we should do it soon. What do you think? How do we go about doing this? Yeah, sooner or better, because people are going to have lots of questions about the vaccine when they can get it, where they can get it. I'm sure that's going to be a big question. Was that one of the questions that came out a lot yesterday for you? Yeah. In Hadley? Yeah, it sure was. I think we should try to do it next week. My husband might not agree with that, but I think it would be great. I think one week's enough, I think two weeks would be better. Well, I think two weeks a holiday. Oh, that's right. You're right. I think two weeks would be better, but I know that there is all of this desire for information from people and anxiety. So if we did it like the beginning of the following week, so it's less than two weeks, you know, like 10 days, like the 25th or 26th? Yeah, let me. What I will do is I will reach out to Paul and Brianna and Angela, and we can see maybe which day would be better depending on maybe other meetings and stuff. And then I know Brianna can work on getting the counselors meeting on Monday. That's a great point, Nancy. Now, what role do you see us as a board having? I think, I know in Hadley, like Dr. Mosler was kind of like our moderator who got to introduce the speakers, which was kind of nice to see. Certainly, I know Hadley and Amherst have a, we have a different setup for our boards of health and health departments, but I think if, if you wanted to take on that role to kind of like introduce me and then I can try and engage Dr. Levin, and Estamon. Yeah, okay. I think that would be great. What do you think? I think it'll be excellent. Hey, whenever I read that, I said, hey, why didn't we think of that? And I said, we got to tap Amna. I didn't think of it either. I have to defer to Dr. Mosler. I think for us, we've got to educate people. We've got to educate people. And I never got beyond my mantra. So, well, now we are example over there. So I'll read out tomorrow. So should I talk and Monday's a holiday? Should I talk to you on Tuesday? Sure. That sounds great. Okay, great. So I'll call you and you can tell me or we can figure out what best to communicate with you. Sounds good. I just want to, Nancy, if I can mention two things. Sure. I would say anybody else has something to say. Yeah, in public health, that just there are these are the long, my long-term engagement on projects we're doing for the state of Massachusetts, but there's reasons for each of them to maybe be a little more. So you may have heard the news yesterday that a couple of that former governors of Michigan and other of us were indicted in a civil court. Anyway, you know, all the other cases got thrown out on Flint and lead in drinking water in Flint. So that's got a little got some press yesterday and the pediatrician who, you know, looked found the high blood blood level. She was interviewed on NPR this morning. Mona, the author of this book here, What the Eyes Don't See, about her, you know, finding the proof, which is the blood blood levels of children having raised doubled and stuff. So that issue might come up and in that, in a little higher, the lead project that we're doing for the state, you know, we're really, really, really struggling to get childcare providers to be interested to sign up. They're just trying to float instead. So COVID dominates everything from the public health perspective. But if you run across or meet a child care provider, don't hesitate to talk about the free lead testing program where we're doing, the state is doing to help them, for them to, you know, have samples collected and measured for lead and to safeguard kids' health. So that's one thing. And then the other one project we're doing for the state is there's a new regulation on this compounds PFAS and drinking water that came into effect. Various size public water supplies, depending on your size, have to sample, have to start sampling, starting this month, depending on the big ones and working its way down. There's also a program that is targeting, trying to find sources by targeting 81 communities that have 60% or more of the residents supplied by private wells. And private well owners are being invited to perhaps have their well water tested for PFAS. And the first two, our first two pilot communities in the program were Belcher Town and Granby that got postcard sent last week that looked like, you can't see it, but anyway, there's a picture of a well head in a picture of a well head and there's your well contained PFAS and that went out. And we'll see where that goes. I have a feeling there won't be a lot of volunteering for that either, but we'll see what happens. So anyway, PFAS, lead, public health, drinking water, you might hear more about it. So just want to let you know. I've been seeing it and thinking of you. Is there is going to be testing for PFAS or do they already do check for PFAS? They haven't tested yet, but will be. They're required to. And I'm forgetting, I forget the size schedule to be honest. The littlest ones are long ways out and the bigger ones are sooner. And I can't remember about Amherst right now. It's source based. So what percentage, you know what percentage of our homes are on private wells versus water? Do you know how many, what percentage of our homes are on private wells versus public water here in Amherst? Well, population wise, probably 5% are on private wells, 95% public. If I had to guess, I don't know. We're way up there. I know this. Something, some number like that, way up there. The private well thing is that doesn't apply to Amherst. Whereas Belcher Town is, you know, there's almost 15,000 people in Belcher Town and like 12,000 of them are on wells. I mean, yeah, it's one of the big, big ones. Granby's pretty high, two, 90%, you know, 80% on wells. Of the 81, it quickly drops down into hundreds of people. You know, we get a lot of towns in the Commonwealth with total populations of 600 people. But, you know, when you get up to the bigger, I was surprised, Belcher Town is one of the bigger total absolute populations served by private wells. And they have carbon in it. Yeah, that's a different. I know, I know. It goes someplace else. And there's a, if you Google around, there's a great public facing dashboard. Story map is a word that's used in the GIS world now to tell stories and GIS and maps and things. There's, there's one in the DP site. State of New Hampshire has a really amazing site too. But we have a, we, meaning Massachusetts has quite a very stringent regulation as does Vermont and New Hampshire, but this is one of those areas of health that states have taken action because the federal government hasn't.  So it's, it's a, yeah, interesting story. Well, it's a story of humans in the globe. Anyway, just want to mention that, that those things are going on and you might hear about it. Nothing really amnesty, you know, about this, but. Yeah, I know I was following in the Michigan piece. Yeah, yeah, Flint is other comments from anybody. Okay. Well, if not, our meeting can be someone can make a motion to close our meeting till our February one. And Emma and I will keep you posted about the public education on COVID. Okay, I'll move comments. I'll move we adjourned. I second it. Okay, all in favor, Maureen. I I Steve, I John, I Tim, I Nancy, I okay. Well, thank you all have a good month. Be safe and Emma keep up the amazing work you and Jen are doing absolutely stellar. Thank you. Good night, everybody. Bye.


This man formed a cult and exploited countless women, but some say that the cult leader had other, much stranger reasons for creating this bizarre belief system. Keith Rainier was the leader of a cult known as Nexium, which had 700 members at its peak. Nexium was founded back in 1998, but it wouldn't be until 2017 when rumors began to circulate about the devastating abuse that took place within the cult. While it's pretty obvious that Keith's true intentions were of a sexual nature, Keith had other demons he was hiding as well.  In the end, Keith was sent to prison for life for his crimes against women, as well as various other offenses. But this may not be a big deal for him because most prisoners love playing volleyball. Follow for more true crime stories.


Yeah, one foot is tough especially under six foot gang your boy made progress this year right actually last year with COVID right before I had My best one foot jump of all time translates into Welcome to dunk tip Tuesday every frickin Tuesday. We're back one foot jump technique Super pumped you guys asked. Thank you guys for voting on my poll. Thank you guys for commenting really helps me out I'm excited to share these things. I wish I knew in my dunk journey get you flying and I guess what super exciting news I have a free live training class to jump higher this Saturday sign up now completely free for any athlete excited to see you there Right before I had my best one foot jump of all time So that was really exciting because I had chronic knee pain for almost two years If not over two years healed that up and was able to jump higher So there's hope you got to just stick with it. You never give up You have to learn about the body you have to heal the body you have to get in tune with the body So, you know what's causing it and how to strengthen those things I truly believe you can get to any limit you want to get to the only limit you have is the one you limit on yourself I truly believe that it's about finding the solution and not giving up so that way you can overcome them and Build healthy habits healthy body healthy tendons if you can build on top of those on the foundation That's why I'm so big on the foundation You are limitless So if you're a one-foot jumper two-foot jumper, you can make vertical progress Anyway to no limit as long as you stick with it. Let's go. What's up guys? So one foot technique really tricky one thing I had to learn for myself first of all I had to get over the knee pain So if you have knee pain check out my knee pain video, but it's a lot of force in that one leg That's why it's been really hard for me to increase because as a short dunk I produce so much force It's hard to make progress Without loading it too much because with two-foot jumping what I can do is I can jump so much Which is that one of the best things you can do for your vertical once you're strong enough And once you once you're in that phase of jumping higher you have to push yourself to jump higher But pushing yourself to jump higher off one foot is tricky because if I do it too much to get that stimulus I overload and I get hurt So it's a it's been a long game meaning like I have to think really long term get it super strong Do very little jumps and slowly but surely once it's strong enough it can handle those jumps I could add more force to it, but I have to make sure it's crazy strong enough and again for me It's not my focus my focus is the two-foot jumping So that's why my one foot doesn't really make that much progress because I'm more focused on the two-foot jumping But two-foot jumping is still putting load on that one foot even though it's my less dominant leg off right left It's hard to it's hard to do two things at once so but into the technique we go You know almost forgot the comment of the week the winner of the free jump program Let's hit the random comment generator right now. Here we go. Here we go. Oh my god. Oh my god Simon Lee writes my favorite two words. Let's go free program for you or sure or figure it out Let's go leave a comment for you to win this week's comment raffle. Let's go So with the one-foot technique one thing I've noticed for myself is when I got rusty off it I was really trying to load up like I was off two feet because off two feet I run and get like super low, but it's not the same type of feel for me There's different types of jumpers. I'm more of a speed jumper off one So a quick mindset was that I would just go for the rim and stop thinking about trying to jump my Hires and just run fast and jump naturally.  It's legit 10, but I don't feel that bounce here It's not like sometimes you just don't feel that it's cold. Whatever excuses eliminate them. Anyway with the one-foot technique Why that speed jump helps me is for these keys is because when I do keep my body upright when I go speed I'm not trying to load. I'm doing it naturally and natural is good If you have the right rhythm and your body kind of knows but luckily I do But this is what I'm doing right when I mean natural is when I come at the rim I'm taking a big step, but I'm not trying to like emphasize this one This one my back leg is just as much force as the left leg So I'm pushing and I'm taking off quick quick knee drive keeping my chest up and I'm not slowing down So a lot of times when I was trying to really load that force I was running and then I was like trying to load up so much that I was slowing myself down So by speeding up and do and trying to just think lighter It feels like I'm not lowering as much, but I'm just lowering at a more efficient way So another really big key that I learned with my one foot is that when you run you run like this and off Two foot. It's really easy to get that arm swing rhythm But for one foot I had to learn it. It's really awkward But you want both arms to come back to use that arm swing because there's no ball on your hand You can do that if you have the ball in your hand You could bring it to your opposite hip and drive it through Point is you want that arm swing you want to get that arm swing with your one foot So when you're just going for the rim Just try to think of when you do your penultimate Bring both arms back as you step through right so it's gonna feel it might feel awkward at first But once you get that rhythm down It's that one arm stays back So you're running and then instead of this arm coming forward It goes back again, and you drive up just drive up with that knee up So one quick drill that I do for that is Is I just stand close to the rim and you just take off and you only do the arm swing So you're not trying to go like this and then switch you just come here Boom and jump for it again Hard to get high because you have very little speed But you want to focus on each piece and then all the pieces build together So try that out and then when it comes to one foot jumping Do both legs as well.  Let's see. I'm trying to get that 40 club with the one foot. So stay tuned. Here we go rhythm Beautiful just beautiful what I really focused on early to is when I went for the takeoff I always want to like take off full speed, but you rhythm you have enough speed by the time you get there So be slow. I don't want to say slow be Controlled be methodical the speed will come If you're like me, I need to slow down my speed. I'm always trying to add a lot of speed other people We need to add speed so figure out what you are That's why it's really hard to give advice because some people are attacking too slow Some people are attacking too fast. There is an optimal speed for everybody and everybody's different So not only are you on different sides of the spectrum trying to meet at the optimal speed But everybody's optimal speed is different too. So learn your body type if you're like me This is why I give my advice what works for me and I try to give you the the mindset of how to find what works for you Yo, your boys coming out with a live coaching community. Please join is a free class coming soon I'm so excited. It's been a long time coming you guys I hope to see you there working with me so we can do these things work on your technique work on your craft If you're interested in getting your vertical up working with me directly, I'll see you there Thank you guys for watching. Thank you for loving dunk tip Tuesday We're doing it every freaking Tuesday, and it's feeling great. Let me know what you want to see next week I hope to see you there. Let's live live better jump higher. Let's go. What's the deal? Hello? Don't forget free class this Saturday sign up totally free for any athlete that wants to get their vertical up Let's go


Thank you so much. So John Peter already talked about my background because I have been started to work in the aid service organization 30 years ago and in Germany to fight for harm reduction and I changed from the NGO to the governmental side in 1998 or so, in 1989, no, 98, yes. There was then also there was a harm reduction part of national drug policy in Germany, including implementation of drug and substance groups, things like that already mentioned. But at that time I was also in the last 16 years member of the official delegation to the Commission on Narcotic Drugs in Vienna, which had been already presented by Jamie. And you can imagine also like rooms like this and people sitting there and discussing on resolutions, 24 hours more or less. And sometimes discussing whether there should be a semicolon or a comma. But sometimes they're also discussing on the content, I will come back to that later. So it was already mentioned by Jamie in the last 10 years is a very big change in this wording and the policy of the UN and the CND. And now it's seen also when you look to the pathogenetic Jesus of dependency disorders, it's not only a point of dependency or what is going on in the body in the brain, but it's also part of all these social exclusion situation, why people using substances. Of course they're using also for recreational reasons, but many people using it to forget their really depressive situation. On the other hand, when you look come into access to treatment in only in Western Europe there's quite good access to treatment. In other parts of the world only very few people get access to treatment. And as I'm now speaking on behalf of the University of Frankfurt, which is part of the European project in Central Asia, Central Asia Drug Action Program. In this region there's very little access to treatment options. Already mentioned in Kazakhstan they have some OST sites, but very low coverage, a little bit better coverage in Kyrgyzstan and increasing coverage in Tajikistan, but in Uzbekistan and Turkmenistan no access to OST. There's some access to other harm reduction measures like CND exchange schemes, but they are not state driven and sometimes the users don't use these kinds of treatment or harm reduction measures. But anyway it's very important that there had been change of the idea of what is dependency and it's no longer seen as a criminal behavior, but as a chronic relapse in this order. Of course it's a medical definition and we can discuss this, but anyway that changed the attitude towards people using substances. And also there's a moving from sanction oriented approaches to health oriented approaches all over the world, but in some parts of the world vary slowly. And already mentioned this political declaration from 2009, it said it should be promoted and effective comprehensive integrated drug remand reduction programs based on scientific evidence, whatever that means, and including measures for example so-called social related support services. And that is interesting because this term related support services means harm reduction. Because at that time especially German delegation together with NGOs and also other European delegation had a hard big fight to use the term harm reduction in this resolution, but it was rejected by a coalition of United States, Federation of Russia, Iran, Saudi Arabia, wonderful coalition you know, and China for example and other states. So because all this in this the text must be supported by 100% of the delegates. This is why it's very, very difficult to get this kind of support. Anyway, it is mentioned that supply reduction alone does not work and you must know most of the delegations, delegates are law enforcement people now and now more and more up from the public health side, but that means it was really a hard fight to get this into this resolution. Supply reduction alone does not work. Anyway, there was then the special session of the United Nations General Assembly in 2016 in New York and also there had been asked to ensure non-discriminatory access to broad range of interventions including psychosocial, behavioral and medication assisted treatment. This is also very important because this medication assistant treatment had been rejected normally especially by Russia and other delegation, but here in this outcome document it is mentioned for the first time. So it is really an improvement I guess. And also it was then a resolution supported to promote and implement these international WHO and UNODC guidelines and standards, international standards of the treatment of drug use disorders and to provide these guidance to assist and train health professionals all over the world and this is one part of the EU project in Central Asia which we try to do. Of course there are other international standards by UNODC but also some standards concerning harm reduction measures mainly because of the HIV crisis and of course when you look to these guidance of course the whole range of services, harm reduction services are supported by UN and UNODC documents. And of course this is necessary because what means treatment in many, many countries this kind of treatment is still defined as treatment although everybody knows this is causing harms not treatment. And in so far we have supported these international standards and on the other hand we had a vivid debate with Jamie and the other international NGOs on this because when you look into the text you will find some wordings and critical which of course could be and should be read critically and you must know that these standards are based mainly on their scientific research from the United States and there in the last years of course they are using this term that drug dependency is a brain disease or part of brain disease not alone but anyway in that causes of course strong debates on this and we had not a fight but a friendly discussion with our friends and colleagues from the NGOs. Anyway we think that it is important and I know of course we know that there are a lot of when you could look to the history of concepts what is the drug dependency you will find a lot of very difficult different ideas on that but for more moral and moral attitude to more and more the idea that it's a chronicle disease. Anyway of course it's also mentioned it's a chronicle relapsing brain disease and we can discuss this. Anyway I think this document this are standards are very useful because they are really based on asking for human rights protection of the patient rights and you see here all this thing which is very important to have anonymity of confidentiality no compulsory treatment which is in most of these countries also in Central Asia still existing informed consent contact with family relatives voluntary HIV testing prohibition of physical and psychological curation and transparent procedures from complaints. This is very important also availability accessibility of the treatment that means also there must be a legal framework there must be flexibility of the opening hours and the treatment must be affordable. This is very important because only in Kazakhstan it's paid by the state budget in other countries in this region Kyrgyzstan Tajikistan for example the patients have to pay for certain kind of treatment detox is mainly paid or by insurance but it's only very very hard to say every even for medication you have to pay by your own only OST is paid by international donors that cause also some problems because some people for example with diabetes don't get a syringe I have to buy a syringe whereas drug users get the syringes for free and that causes sometimes also in the society problems you can imagine. Anyway it is also important to that these standards are based on the dignity of the patients and on the protection of human rights of the patients and also concerning imprisonment or imprisonment prison settings treatment should be an alternative to penal sanctions and if this is not possible it in the treatment system and it should be also these standards should be used. So I will not go into all the details. You can on the website of UNODC you can see this loaded down but anyway these principles I think it's a very important and now I came to our project because the German part of this project is to support the Central Asian countries in their treatment and harm reduction programs and actions and we using more or less best European practices and international standards and we already organized several trainings and we normally use German experts who are speaking Russian or coming from this region and because many of the German working in this field had been born and lived in Central Asia and especially in Kazakhstan now working and living in Germany but they know the culture, they know the language and this is very important for us to and helpful. Anyway we conducted many of these trainings you see here Professor Sturba for example he just trainings together with a colleague from Vienna from Austria on a prison system and we organized also study visit to Berlin and showed them how treatment system including harm reduction services like drug consumption rooms are working in Germany. They are impressed but of course to say unfortunately we are not able to implement such things in our countries. Anyway I think it can help to change the attitude of these people and most of these people are narcologists so-called narcologists and working in this field for many many years and they want to change these attitudes. They want to change the Russian idea in the concept of narcology as a work to change the attitudes of people to change because it had been seen in Russian times or in Soviet times as an anti-social behavior that must be cured or and this has changed totally now most of these treatment is based on scientific evidence and also on psychosocial support services but of course the structure is not comparable with western European countries and yeah we organized in the last months two trainings in Kyrgyzstan and Kazakhstan on these international standards and we hope very much that it can help to introduce to implement these standards because when you look to the CND resolution all these countries have to implement. They are not forced but they should do it and we hope very much that it could happen and I have to also to mention that concerning the delegations the official delegations Jamie already mentioned this in Germany. Now we have also I think last CND in Vienna first time and a representative of a German drug user organization was part of the official delegation and that is very important and I tried to fight very hard for this many many years but now we could succeed and this is a very important part and I think also the German delegation is hearing to the voices of the NGOs and try to take them at least into account not always supporting but anyway it's a good relationship I think and this is very important. Well now I'm retired from my official job in the ministry so I can talk on behalf of the university I'm a little bit more free to say what I'm thinking I did it also when I worked with the ministry but anyway it's a very pleasure to be again here at harm reduction conferences because I had done this for many many years but then in the ministry my bosses didn't like so much that to send me to harm reduction conferences so thank you very much for your attention. Thank you very much.