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John Douglas, director of Tri-County Health Department, felt that he had to act to change the health department’s policy that allowed counties to opt out of public health orders. He argued the opt-out policy has created confusion among local government officials.
“It’s severely limited the ability of Tri-County to carry out our statutorily required public health duties,” Douglas said during the Monday meeting.
Those duties of local public health agencies — such as Tri-County Health — include the responsibility “to investigate and control the causes of epidemic or communicable diseases,” according to Colorado state law, as Douglas cited during the meeting.
In the health director’s view, it’s “become glaringly apparent” that Tri-County’s opt-out policy wasn’t effective amid the delta coronavirus variant’s surge — and, Douglas said, amid the “vacuum” left by Gov. Jared Polis’ stance that health orders such as broad mask mandates are local matters at this point in the pandemic.
The Colorado Chapter of the American Academy of Pediatrics wrote an Aug. 10 letter to the governor, the state public-health department and Colorado’s local public health officials, urging them to require “universal masking” in all Colorado schools and childcare settings.
“The time has come for statewide action,” the letter read.
School mask policy has been a volatile and, at times, confusing part of life in Adams, Arapahoe and Douglas counties in the past few weeks, with the onus having been placed on counties and school districts to make controversial decisions of whether to require mask wearing.
Douglas, the health director, likened it to passing the “hot potato” around, during his comments at an Arapahoe County commissioners’ meeting earlier on Monday.
John Douglas, director of Tri-County Health, responded to concerns among some parents that masks are making kids anxious or leading to other negative mental health outcomes.
“Really there is no science (supporting) the concern about masks impacting mental health,” Douglas said at the Tri-County board of health’s meeting on Monday.
Mental health concerns among young people are likely due to family life and routines being disrupted amid the pandemic, along with isolation and uncertainty, according to Douglas.
“Kids are stressed. Being back in school and having them connect with other kids and having whatever we can do to help that happen, whether it’s vaccines or masks,” is part of the solution, Douglas said.
The text of Tri-County Health's initial mid-August mask order also addressed the topic of mental health. It reads: “Children’s Hospital Colorado clarified that mask wearing has not been linked to mental health problems in children or any other group and did not contribute to their declared ‘state of emergency’ for pediatric mental health.”
Elizabeth Whitehead, a spokesperson for Children's Hospital Colorado, confirmed the accuracy of that statement.
Amid the more-contagious delta variant, even when people are vaccinated, if they are in a tight setting, they could be asymptomatic and still spread the virus, Douglas said.
Douglas said masks have been shown to be “50-70% effective.” The federal Centers for Disease Control and Prevention’s website says: “Multi-layer cloth masks can both block up to 50-70% of … fine droplets and particles and limit the forward spread of those that are not captured.”
Masks are primarily intended to reduce the emission of droplets toward others, an effect known as “source control,” as opposed to “wearer protection,” the CDC’s website says.
But studies also demonstrate that cloth mask materials can also reduce wearers’ exposure to infectious droplets through filtration, including filtration of fine droplets and particles less than 10 microns.
“The relationship between source control and wearer protection is likely complementary and possibly synergistic, so that individual benefit increases with increasing community mask use,” the website adds.
See the long list of studies the CDC cites about mask effectiveness and related topics on the bottom of that page.
Mask wearing in itself shouldn’t be the only strategy people use to prevent COVID-19, Douglas said, noting people should also take advantage of vaccines, social distancing, testing and good ventilation, and should stay home when sick.
Undoing decisions by Douglas and Adams counties to opt out of a requirement for masks in schools, the Tri-County Health Department on Monday repealed the ability of counties to opt out of its public health orders and issued an order requiring masks for all people age 2 and older in schools and childcare settings.
The decisions at an afternoon meeting were made over the objections of Douglas County’s appointees to Tri-County’s board of health, the policy-making body for the health department that serves Douglas, Adams and Arapahoe counties.
The health agency should “not have the least-affected folks, which are the children, carry the burden on behalf of adults,” said Kevin Bracken, who hours earlier was appointed as an interim health board member from Douglas County.
Generally, COVID-19 thus far has not made children as sick as adults, but “we want to keep kids from transmitting COVID to their parents,” especially among high-risk family members, John Douglas, executive director of Tri-County Health, said previously.
Douglas at the Monday meeting urged wearing masks partly to avoid disruptions to in-person classes due to outbreaks and isolation of individual COVID-19 cases.
School settings in Arapahoe, Douglas and Adams counties saw 15 confirmed coronavirus outbreaks starting in August, according to Tri-County Health data as of Aug. 26. Across the counties, officials had also seen 23 suspected outbreaks as of that date.
Of the total — confirmed and suspected — most are at K-12 settings, and one is from a childcare setting, according to Tri-County Health. Days later, the number of confirmed and suspected outbreaks since the beginning of August in the three counties had risen to 44, the health agency said in an Aug. 30 news release.
Many of the outbreaks have occurred at high schools and middle schools, according to Douglas, the health director, though elementary schools also contributed heavily.
Tri-County’s board of health approved its initial school mask order on Aug. 17, and it took effect Aug. 23, requiring masks for all children aged 2 through 11 years old — and all the individuals working or interacting with those children — in all indoor school and child care settings in the three counties. Children younger than 12 are not currently eligible to be vaccinated against COVID-19.
Some school districts in Adams and Arapahoe had implemented mask requirements before that initial order was approved.
Because of when mask policies took effect, Douglas said they might begin to affect virus trends soon. Due to how long coronavirus infections can take to manifest, and with more days needed after that to record cases, it can take a couple weeks for outbreaks to take shape after virus spread starts, Douglas said.
The text of Tri-County Health’s new school mask mandate defines "school setting" as any indoor facility used for pre-K through 12th-grade instruction of academic or extracurricular activities. It includes public, private and charter schools.
Bracken, the interim board member from Douglas County, argued that COVID-19 hospitalization data doesn’t support requiring children to be masked.
“You are, and we are, collectively masking the wrong demographic,” Bracken said. He added: “You’re punishing the children.”
Bracken referenced the hospitalization threshold that Tri-County Health had set in the spring that would have triggered the return of “COVID-19 dial” capacity restrictions on businesses, saying that hospitalizations haven’t reached that mark. Tri-County Health allowed its dial policy to expire in mid-August.
Douglas argued that evaluating coronavirus policy regarding schools is a separate matter.
Tri-County Health officials felt that the earlier hospitalization threshold — 2 per 100,000 residents, measured a certain way over a 14-day period — was an appropriate measure by which to guide restrictions that would have economic repercussions on businesses.
“This is a different matter now,” said Douglas, citing concerns about spread of COVID-19 in schools and the interruptions to in-person classes that it could cause.
“The current patchwork of school policies across the state will result in more COVID-19 cases, more transmission of the virus, more quarantines, and repeated school closures,” the letter read.
It also cited concern about newer versions of the coronavirus, such as the delta variant, that are more easily spread among children, adolescents and adults.
And while children age 12 and older are eligible for vaccination, many middle- and high-school students remain not fully vaccinated, Douglas said.
It is “hardly unique” that Tri-County Health would consider a mask mandate for all students, Douglas said, pointing to decisions in other metro Denver counties.
The Denver Department of Public Health and Environment issued an order that all individuals aged 2 and older must wear a mask in all childcare facilities and preschool through grade 12 schools regardless of vaccination status. The order is dated Aug. 17.
Likewise, Jefferson County Public Health issued an order requiring masks inside all schools and child care settings, preK-12, for all individuals aged 2 and older regardless of vaccination status, according to an Aug. 16 announcement. Jefferson County later amended its order to include everyone ages 3 and older, according to an Aug. 28 announcement.
The issue of whether to require masks in schools amid the delta surge has evoked contentious responses from community members in all three counties, with residents speaking in public meetings by the dozens in recent weeks about whether local government bodies should support mask requirements to combat COVID-19.
A crowd protested the initial Tri-County Health order on school masking outside the Adams County Government Center on Aug. 24 before the county commissioners — the county’s elected leaders — voted 3-2 to opt out of that earlier mask order.
At least several dozen people protested outside the Arapahoe County administration building on Monday ahead of a preliminary discussion by that county’s leaders on whether it should opt out of that earlier Tri-County order, a choice now removed by Tri-County’s action later that day.
The three Douglas County commissioners unanimously approved a decision to opt out of the initial mask order on Aug. 19.
The Tri-County board of health in its afternoon meeting Monday rescinded that mask order and approved a similar order that expands the mandate for indoor school and childcare settings. The agency now will require all individuals 2 and older to wear masks in those places. The order takes effect on Sept. 1.
The board of health also approved a decision to rescind its policy that allows county commissioners to opt out of countywide public health orders. That policy was adopted by the board in November 2020 amid a rift between Douglas County and Tri-County Health about the agency’s pandemic policies.
Tri-County’s board of health is composed of nine seats — three each representing Adams, Arapahoe and Douglas counties.
The board of health vote on the new school mask mandate was 5-3, with Bracken, Douglas County’s Linda Fielding and Arapahoe County’s Thomas Fawell voting no. The vote on repealing the opt-out policy was the same. Kim Muramoto, another Douglas County representative on the board, was absent.
Douglas County commissioners released a statement Monday shortly after the health board’s decision.
The “decision to rescind the opt-out provision from their policy during their meeting this afternoon unilaterally reversed our negotiated Nov. 10, 2020, agreement. This decision removed from the Board of County Commissioners the promised local control regarding the issuance of countywide public health orders,” the statement said.
The commissioners noted that they will continue directing county staff to work with “expert professionals” and the Douglas County Public Health Advisory Committee to identify a public health agency framework “that will honor the needs of Douglas County citizens.”
The county has long been contemplating separating from Tri-County Health to form its own local public health agency.
Douglas, the health chief, noted that one of the messages of Adams County commissioners’ statements about opting out was that they support masking and mask mandates but that they don’t support the idea that commissioners should decide whether an order should continue — they would rather have public health officials deciding on matters of health expertise, Douglas said.
The health agency’s Monday meeting came shortly after Douglas County officials aired complaints about the process by which the Tri-County board of health had approved the initial mask order.
The county was seeking to overturn that order, claiming that the board of health violated open meetings law by deliberating during executive session, or a closed-door meeting, in a way that went outside the scope of the narrow discussions executive sessions are intended to include. Such sessions are known to discuss legal questions, for example.
Repealing the earlier mask order and reissuing another one effectively allowed the board of health to sidestep Douglas County’s complaints about the process, at least for purposes of keeping a mask mandate in place.
As the health board was considering removing Tri-County’s opt-out policy in the Monday meeting, board member Linda Fielding abruptly changed the topic, saying: “I want to bring a criminal matter to the board’s attention.”
Fielding then referenced Colorado statute 18-8-306, a state law that prohibits coercion of public officials. The law bars “attempts to influence any public servant by means of deceit or by threat of violence or economic reprisal against any person or property, with the intent thereby to alter or affect the public servant’s decision, vote, opinion, or action concerning any matter which is to be considered or performed by him or the agency or body of which he is a member.”
“I have information directly about one case, and there may be other (cases) that I suspect, and this is concerning board members that have been basically compromised because they have had complaints filed against them,” Fielding said.
It wasn’t clear from the meeting who was allegedly the target of coercion or how complaints filed against board members would relate to the state coercion law. Fielding didn’t specify which board members she was referring to or list details of alleged complaints. A spokesperson for Tri-County Health wasn’t immediately available to comment on Tuesday.
Fielding called the Monday meeting “compromised” and said it should be canceled “until we can resolve the matters of these board members.”
Then Kaia Gallagher, board president, asked whether the board members were available for an executive session to take place that night, but not all the members said they were.
In response, Fielding made a motion to terminate the meeting and void what the board had discussed thus far. She argued the meeting was improperly called as an emergency meeting and that there was no reason to hold the meeting on short notice. Bracken seconded that proposal.
Douglas, the health chief, said the gathering was a “special meeting,” not an emergency meeting. The difference between the two wasn’t clear from the discussion.
Douglas said he talked with Gallagher about organizing the meeting because he felt that the nature of rising case rates, two counties opting out of the mask order and a third considering it “needed immediate attention.” The Arapahoe County commissioners had been scheduled to decide whether to opt out of the initial school mask order at a public meeting Tuesday morning, but Tri-County's Monday action removed that choice.
All the Tri-County board of health members aside from Fielding and Bracken voted against ending and voiding their Monday meeting.
Randy Dement, Tri-County Health’s legal counsel, said Fielding’s concerns should be discussed in executive session because she raised legal issues.
Gallagher said the board would talk with Tri-County Health’s attorney to set up an executive session. It wasn’t immediately clear when the session would occur.
School districts, schools and child care facilities weren’t required to follow the earlier mask order if their county leaders had opted out, but they could still choose to do so, according to Tri-County, and several did.
Douglas County School District Superintendent Corey Wise had said the district must follow the health order, regardless of whether county commissioners opted out. In a letter to the community, he cited district policy that states Douglas County Schools will follow the guidance of local and state public health agencies in responding to common communicable disease.
At the time of the Adams County commissioners’ decision to opt out of the earlier order, several districts in Adams County already required masks for young students.
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