TOWN OF PLYMOUTH BOARD OF HEALTH MEETING June 17, 2020 @ 3:00 PM MINUTES
The following Board of Health meeting was held on Wednesday June 17, 2020 at 3:00 PM via PACTV
PresentU U AgendaU Birgitta E. Kuehn. LP, MBA, CCP Emeritus, Chairman Barry Potvin, PhD, Professor Emeritus, Vice Chair
Nancy O’Connor Gantz, MS, RN, ANP-BC • Public Participation in a Virtual Meeting Jerry Levine, BS, MS, MBA • Minutes Dr. Kenneth Terkelsen, MD • Septic Variance: 10 Wagon Wheel Dr • Chairman Announcements Karen Keane, Public Health Director • Director’s Report Margaret Coe, Administrative Assistant • Other Business
• Disclosure: These minutes are not verbatim – they are the secretary’s interpretation of what took place at the meeting. – Open Meeting Law, G.L. c. 30A § 22. • These minutes are a record as accepted by the Board of Health. • All materials presented during this meeting are available in the Public Health Department. • Administrative Business – May include topics not reasonably anticipated by the Chair 48 hours in advance of the meeting
Pursuant to Governor Baker’s March 12, 2020 Order Suspending Certain Provisions of the Open meeting Law, G.L. c. 30A, §18, and the Governor’s March 15, 2020 Order imposing strict limitation on the number of people that may gather in one place, this meeting of the Plymouth Board of Health will be conducted via remote participation to the greatest extent possible.. No in-person attendance of members of the public will be permitted, but every effort will be made to ensure that the public can adequately access the proceedings in real time, via technological means. In the even that we are unable to do so, despite best efforts, we will post to the Town of Plymouth website an audio or video recording, transcript, or other comprehensive record of proceedings as soon as possible after the meeting.
3:00 PM Welcome from Chair
3:01 PM – Septic Variance: 10 Wagon Wheel Steve Kotowski of Webby Engineering presented the variance request. On a motion by Nancy O’Connor Gantz and seconded by Dr. Potvin, the Board voted unanimously to approve the variance as requested. Voted: 5/0
3:09 PM – Director’s Report (see attached)
3:40 PM – Chairman Overview Ms. Kuehn explained that as of 7/1/2020, businesses must comply with 25% occupancy per office. The Town will be 1
filing a request for exemption for the Treasurer/Collector Office, Fire Station Headquarters, Department of Public Works and Crematory. The Board of Health finds it may be necessary to exceed the required occupancy due to the necessary need. Ms. Kuehn explained to the board that Article 18 – Fall 2018 Town Meeting, had not gone through with the state for unexplained reasons. State Representative Matthew Muratore would be looking into it. Ms. Kuehn asked the board for suggestions as to how restaurants could be more consistent with hand washing, social distancing and wearing masks. There were several suggestions made, ranging from websites, social media, local newspapers and signage.
4:24 PM - Adjournment On a motion by Jerry Levine and seconded by Dr. Potvin, the Board voted unanimously to adjourn. Voted: 4/0
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Public Health Director’s June 17, 2020 Bi-Monthly Report Prepared for the Board of Health Members
Karen Keane, Public Health Director Town of Plymouth - Department of Public Health Coronavirus
COVID-19 COMMAND CENTER Was daily – now will be published Monday, Wednesday and Friday • COVID – 19 Response Command Center o Daily Situation Report o Testing Update • Public Health Data • Confirmed and Probable Case Breakdown • Mobile Testing Numbers for Long Term Care, Assisted Living Residences • Holyoke Soldiers’ Home Update • Chelsea Soldiers’ Home Update
• Get Tested for COVID – 19: June 17th and 18th
Have You Attended a Large Gathering? o Eligibility . Open to Everyone . You don’t need to have symptoms . No cost to you o Test Results . Will be provided to each participant confidentially . Participants are encouraged to share these results with their doctors o Closest sites to Plymouth . Brockton, Harwich Port, North Quincy, Randolph . CVS Locations – Bridgewater, Carver, East Falmouth, Holbrook, Westport
GUIDANCE FOR TOWN MEETINGS TO ADDRESS COVID-19
School Nurses • Carilyn Rains and 7 volunteers • Nurses send me an email each day they are available • Cases will be assigned to each nurse • 20 Cases as of 6/16/2020 • Contact each case • Complete Surveillance Assessment Check-In • Nurses have list of resources for referrals • Nurses have my email and cell phone number
Page | 2 Nursing Homes Nursing Home Hotline: (617)660-5399
Numbers continue to be reported from Long Term Facilities
Center for Active Living
Member of the Re-Opening Task Force: Create sector specific COVID-19 safety recommendations for Plymouth Center for Active Living and provide instructions to help protect against the spread of COVID-19.
TOBACCO
Municipal Tobacco Control Conference • Flavored Products • Concept Flavor • Enhancers • Nicotine Strength • General tobacco retailers CANNOT sell vape products that have a nicotine strength of over 35 mg/ml. • Adult-Only Retail Tobacco Stores and Smoking Bars are exempt from this policy o Required Retail Signage o State Fines o Marijuana and CBD Flavored Vape Products
Flavored Products are Prohibited for Sale Starting 6/1/2020 • No Menthol, No Mint or Wintergreen, No Flavored Pods, No Flavored Vape, No Flavored Enhancers, No Flavored Premium Cigars, No Flavored Small Cigars and Cigarillos. • Violations, Order to Cease and Desist, Enforcement st o 1 Offense - $1000 nd o 2 Offense - $2000 and suspension for 1-7 business days or longer rd o 3 or Subsequent Offense – 36 months from first violation - $5000 and suspension for 7-30 days or longer. o Copies of Correction Orders
TICKS AND MOSQUITOES Educational materials ordered through the Massachusetts Clearing House Page | 3
This concludes the Director’s report for June 17, 2020.
Karen Keane, Public Health Director Town of Plymouth 26 Court Street Plymouth, MA 02360
Page | 4 Mo Monday, June 15, 2020 COVID-19 RESPONSE COMMAND CENTER CO COVIDDAILY SITUATION-19 Command REPORT Center Ma Massachusetts Emergency Management Agency
Situation Update
Note: Beginning today, the Command Center Situation Report will be CCenterpublishedSituation on a Monday, ReportWednesday, Friday 23 Schedule.
State Actions in Today’s Report:
Governor Baker Provides Daily Update Situation in Numbers Pop-Up Testing Sites for Participants of Large Gatherings Public Health Data: Dashboard Indicators Massachusetts current as of 6/15 Update on Mobile Testing Numbers Update on Holyoke and Chelsea Soldiers’ Homes 105,690 Total Cases (click here for more information)
7,647 Deaths (See dashboard below for key daily public health indicators)
712,875 patients tested for the virus to date by MA State Public Health Laboratory, hospitals and commercial laboratories.
United States Last Updated 6/15 Case numbers are updated regularly at noon. Saturday/Sunday reports are preliminary and have not been confirmed with state/territorial health departments.
Helpful Links: Total Cases Reported to CDC: Reopening Massachusetts Jobs Available to Assist Long Term Care Facilities 2,085,769 Total Cases Get Involved: Community Contact Tracing Collaborative 115,644 Deaths Mass.Gov/covid19 Massachusetts Emergency Management Agency 55 Jurisdictions Reporting Cases (50 Unemployment & COVID-19 states, D.C., Puerto Rico, Guam, Dept. Of Transitional Assistance Online Portal Northern Marianas, and US V.I.) FrontlineMA.org Emergency Childcare Site Social Distancing Basics: MBTA.com/covid19 Stay Home COVID-19 Cost Eligibility and Tracking Guidance Call/Facetime/online chat Complete List of Emergency Orders & Guidance with friends and loved ones. If you go out for essential needs: Background on the Command Center Avoid crowds The COVID Command Center, under the leadership of Secretary Marylou Stay 6 feet away from others Sudders and reporting to Governor Charlie Baker and Lt. Governor Karyn Don’t shake hands or hug Polito, is the Commonwealth’s single point of strategic decision making and Wear a face covering or mask coordination for the Administration’s comprehensive COVID-19 response. if physical distancing is not possible.
COVID-19 RESPONSE COMMAND CENTER DAILY SITUATION REPORT State Actions Today, Governor Charlie Baker and Lt. Governor Karyn Polito joined Secretary of Health and Human Services Marylou Sudders to provide an update on Coronavirus and announce a new testing initiative. (See video here).
Baker-Polito Administration Announces Pop-Up Testing Sites for Participants of Large Gatherings The Baker-Polito Administration announced the availability of pop-up COVID-19 testing sites throughout the Commonwealth for individuals who have recently participated in large gatherings. These free testing sites will be available at over 50 sites throughout the Commonwealth on Wednesday, June 17th and Thursday, June 18th. The Administration is urging anyone who has attended a large gathering in the past two weeks to get tested for COVID-19 at one of these sites. Test results will be provided to each participant confidentially, and participants are encouraged to share these results with their doctors.
A full list of all testing sites is available at www.mass.gov/gettested.
Social distancing, wearing face coverings, the frequent use of disinfectant and handwashing have been important to the Commonwealth’s efforts to decrease the number and rate of newly confirmed positive cases. COVID-19 can spread easily and quickly in large groups of people who are in close contact. Some people do not have symptoms but may have the virus and could spread the virus to others, including family members.
The Administration has worked with partners across the Commonwealth to provide these sites including Baystate Health, Berkshire Medical Center, Beth Israel Lahey Health, Brockton Community Health Center, Brookside Community Health Center, Cambridge Health Alliance, Community Health Connections, CVS, Fairview Hospital, Lawrence General Hospital, Lynn Community Health Center, Massachusetts General Hospital Chelsea, Outer Cape Health Services, Manet Community Health Center, and UMass Medical Center.
To date, Massachusetts has tested more than 700,000 people for COVID-19. On average, 10,000 individuals are tested each day, comprising 4.4% of the state’s population each month. The state currently has capacity at 45 labs to perform up to 30,000 COVID-19 tests per day, and its nursing home testing strategies have been replicated by states across the country.
The Administration continues to prioritize expanding access to testing, with a key focus of that strategy being ensuring access to testing in skilled nursing facilities, rest homes, and assisted living residences and other 24/7 staffed congregate care settings. On May 30, 2020, the Administration filed its required federal plan to expand COVID-19 testing under the Paycheck Protection Program and Health Care Enhancement Act of 2020. Massachusetts has received $374 million in federal funding from the Act.
This funding will help the Commonwealth implement a comprehensive testing strategy that includes:
Increasing lab testing capacity to 45,000 by the end of July; COVID-19 RESPONSE COMMAND CENTER DAILY SITUATION REPORT
Goal of reducing and maintaining a positive test rate to less than 5 percent; Ensuring on-demand access to testing for all symptomatic individuals and their close contacts; Increasing access to testing for vulnerable and high-risk populations; Building a testing infrastructure to support a potential second surge; Modernizing public technology infrastructure to provide real-time data on cases and testing; and Operating a best-in-class contact tracing program.
Testing Update:
Yesterday (June 14th) over 9,000 new tests were reported in Massachusetts with approximately 500 confirmed positive. Around 700,000 individuals have been tested to date. o The average positive test rate declined to 3% which, represents an 90% reduction in positive cases since 4/15.
Hospitalizations & Capacity Update:
As of June 14th, 1,000 people have been hospitalized, a decline of 70% since mid-April.
COVID-19 Public Health Data Key data reflected in the June 15th Daily Dashboard is provided below: Secretary Sudders announced today that the Command Center will begin providing a new data point in the Daily Dashboard regarding the total number of molecular (viral) tests administered. This will provide additional insight on testing to go along with the established reporting on the daily and total number of individuals tested during the pandemic.
COVID-19 RESPONSE COMMAND CENTER DAILY SITUATION REPORT
COVID-19 RESPONSE COMMAND CENTER DAILY SITUATION REPORT Weekly Public Health Data Report The Weekly COVID-19 Public Health Report, which is released on Wednesdays, includes town-by-town case and testing information, along with detailed case and death data related to long term care facilities. The report also includes information on nursing facility audits and more. You can find all the data reports by visiting the COVID- 19 Response Reporting page. (Find the Data Files Here).
Data on Recoveries Also in the Weekly Report are data on the number of number of individuals deemed to have recovered from COVID-19. Residents who had a confirmed case of COVID-19, and are no longer in isolation, are considered for purposes of this report to be recovered. As part of this definition, DPH is counting people as released from isolation after 21 days of illness or 21 days past the date of their test in all settings including nursing homes and state facilities. You can find data on those who have recovered from COVID-19 on page 22 of the report.
Important Updates
Update on Mobile Testing Numbers for Long Term Care, Assisted Living Residences and EOHHS Sites Note: The hours of operation for the Nursing Home/Long Term Care Family Resource Line have changed. The Family Resource Line is now available Monday-Friday, from 9 am to 5 pm.
Onsite Testing Mobile Testing at EOHHS Group Homes & Care Date Number Unique Sites (as of 6/15 by Fallon Ambulance Service) of Tests Facilities Completed Visited DDS, DMH, DCF and DPH Facilities Clients 12,460 6/15 653 8 Staff 18,209 Total (as of 6/15) 57,058 493 Total Tests 30,699
Number of Locations 2,020 COVID-19 Cases in Long-Term Care (LTC) Facilities (as of 6/15)
Residents/Healthcare Workers of LTC Facilities 22,795 LTC Facilities Reporting at Least One Case of COVID-19 366 Deaths Reported in LTC Facilities 4,817
COVID-19 RESPONSE COMMAND CENTER DAILY SITUATION REPORT Holyoke Soldiers’ Home Update
The Soldiers’ Home in Holyoke is preparing for the first outdoor visits tomorrow, Tuesday, June 16. In preparation for resuming limited visitation, the Soldiers’ Home in Holyoke retested all Veteran residents and staff. The Veteran resident results returned were largely negative - with only 8 remaining positive - a marked improvement and a promising sign of recovery. o The Soldiers’ Home is following visitation guidance, and is developing outdoor visitation protocols that prioritize the health and safety of our Veterans and staff with continued focus on infection control. This plan will be contingent on the continued stability of infection controls and public health metrics, which we continue to monitor daily and coordinate with state and local health officials. Outdoor visitation will be in addition to continued video visits for regular family communication through video chat, and the Family Hotline is available for ad hoc updates with support from social work and clinical staff. o Families can call the Family Hotline at 413-552-4764 Monday - Friday 8:00 a.m. - 4:00 p.m. Families can also request updates via email at [email protected]. o Please note the Soldiers’ Home can only share medical information about a resident with the authorized health care proxy on file. If a family member requests an update and is not the health care proxy, the name of the health care proxy will be shared and it will be suggested that the health care proxy should call and request the update. The Home continues its work to resume recreational activities for Veterans, and veterans continue to go outside today with nursing and recreation staff. Soldiers’ Home leadership is moving into the Transition & Rebuilding Phase that is focused on rebuilding the organic staff leadership and team and positioning the facility to move forward safely. Holyoke’s Clinical Command continues to respond to the COVID-19 outbreak, monitoring staffing levels, while bringing on additional management staff for nursing, facilities, and administration staff. The Holyoke Soldiers’ Home has been intently focused on following infection control procedures and maintaining best practices for the safety of veteran residents and staff, and to support the recovery of veterans as the health status of many stabilizes. All veteran residents’ health is being monitored and retesting is being conducted for veterans both on- and off-site as clinically appropriate. Governor Charlie Baker has advised flags be lowered to half-staff until the end of the public health emergency at the Soldiers' Home in Holyoke, Soldiers' Home in Chelsea, as well as the Massachusetts Veterans Memorial Cemetery in Agawam and Winchendon due to the fact Military Honors are unavailable during this public health crisis.
Veteran residents have been retested, and the results as of June 15 are as follows: o Retesting results of all residents: . 8 veteran residents are positive (across the Home and those at Holyoke Medical Center), and 2 results were inconclusive and are being treated as positive . 127 veteran residents have tested negative o Resident locations: . 122 residents are onsite . 29 residents are offsite . 27 residents are at a dedicated skilled nursing unit at Holyoke Medical Center . 2 residents are receiving acute care offsite o 95 veteran resident deaths (76 positive, 17 negative, 1 unknown, 1 recovered) COVID-19 RESPONSE COMMAND CENTER DAILY SITUATION REPORT
. Today’s update includes the death of 1 veteran resident who had recovered from COVID-19, and whose medical orders were do not resuscitate and do not hospitalize (DNR/DNH). Employees at the Home have been retested. There are only 2 positives remaining, and 4 inconclusive results, who will be retested.
Chelsea Soldiers’ Home Update
Today, the Soldiers’ Home in Chelsea is resuming outdoor visitation. The Soldiers’ Home is following visitation guidance, and has developed outdoor visitation protocols that prioritize the health and safety of our Veterans and staff with continued focus on infection control. While visitation begins today, ongoing plans are contingent on the continued stability of infection controls and public health metrics, which we continue to monitor daily and coordinate with state and local health officials. o Outdoor visitation will occur in addition to continued video visits between veteran residents and their loved ones. Families can also request updates on their loved ones by contacting the Home at [email protected] and through phone and video conversations. Medical information can only be shared with an authorized health care proxy. As infection control remains a focus of the Chelsea Soldiers’ Home, the Chelsea Clinical Command continues to monitor and enforce staff use of personal protective equipment (PPE), as well as source new PPE, and over the past week has received shipments of gowns, masks, and hand sanitizer. We are also continuing to coordinate closely with the VA Health Care System. Governor Charlie Baker has advised flags be lowered to half-staff until the end of the public health emergency at the Soldiers' Home in Chelsea, Soldiers' Home in Holyoke, as well as the Massachusetts Veterans Memorial Cemetery in Agawam and Winchendon due to the fact Military Honors are unavailable during this public health crisis.
The results of retesting as of June 15 are as follows: o Residents . 6 veteran residents who have tested positive . 208 veteran residents who have tested negative . 41 veteran resident deaths (31 tested positive, 10 tested negative) o Employees: . 36 employees tested positive
Resources
COVID-19 Isolation and Recovery Sites The Commonwealth’s COVID-19 Command Center and MEMA have stood up regional isolation and recovery sites located in hotels across the state. Providers or individuals from Boston can access isolation sites by calling (617) 534-5050. Individuals who do not live in Boston can access Isolation & Recovery Sites in Everett, Taunton, and Northampton by calling (617) 367-5150 between the hours of 7 a.m. and 7 p.m.
More information, to include clinical and financial eligibility, can be found here.
Disaster Recovery Information On March 27, the President declared a Major Disaster Declaration for the Commonwealth of Massachusetts related to the COVID-19 pandemic response. Through this declaration, federal aid will be made available to cities COVID-19 RESPONSE COMMAND CENTER DAILY SITUATION REPORT and towns, state agencies, and certain non-profits in all Massachusetts counties to help pay for emergency protective measures (response costs) related to the COVID-19 pandemic. MEMA’s Recovery Unit has developed a webpage with information and guidance on, but not limited to, disaster declaration, eligibility criteria, and the application process.
COVID-19 Public Resources Map MEMA, together with MA VOAD and other partners, has developed a COVID-19 Public Resources Map showing the location of resources available to the public, such as food banks, houses of worship, and Project Bread site locations. Please note that this map is not inclusive of all resources and is only as accurate as the information that has been provided to MEMA.
Massachusetts COVID-19 Response Dashboard MEMA has developed and maintains a public-facing COVID-19 ArcGIS Online dashboard, available here. This dashboard is continuously updated and captures information about current COVID 19 case counts, cases by age, cases by county, hospital status, hospital bed status, death tolls, and deaths by age. Users should refresh the dashboard on a daily basis as enhancements are continuously being added.
Stay Informed
Get information from trusted sources. Visit https://www.mass.gov/covid19 for the latest news, case counts, and lab testing results. Call 2-1-1 with questions. Text the keyword COVIDMA to 888-777 to receive notifications to your phone. To receive these notifications in Spanish, text COVIDMAESP to 888- 777 Take care of your emotional health: Call 2-1-1 and choose the “CALL2TALK” option. Samaritans is continuing operations 24/7, as always. During this unprecedented time, it can feel overwhelming to receive constant messages about COVID-19. Call or text their 24/7 helpline any time at 877-870-4673. The Disaster Distress Helpline, 1-800-985-5990, is a 24/7, 365-day-a-year, national hotline dedicated to providing immediate crisis counseling for people who are experiencing emotional distress related to any natural or human-caused disaster, including disease outbreaks like COVID-19. This toll-free, multilingual, and confidential crisis support service is available to all residents in the United States and its territories.
Please share our Communications Resources
NEW: The DPH video “How to Safely Cover Your Face Outside of Home” is now available in Spanish, Portuguese, Simplified Chinese, Traditional Chinese, Haitian Creole and Vietnamese. Please share! (Find The Videos Here)
Infographics Stop the Spread of Germs Social distancing: for youth for general audience Coping with stress or fear What to do if you are sick 10 tips for at-home quarantine or self-monitoring
COVID-19 RESPONSE COMMAND CENTER DAILY SITUATION REPORT Short videos: How to Safely Cover Your Face Outside of Home 10 Tips for at home quarantine or self-monitoring Stop the Spread of Germs like Seasonal Flu and COVID-19 (:30) Help Prevent COVID-19 with Social Distancing (:30) How Young People Can Help Prevent COVID-19 with Social Distancing (:30) Coping with Stress and Fear from COVID-19 (:30) Stay Home - Save Lives (:06)
Spanish Radio Spots (available on request): Prevent the Spread of Germs Social Distancing Stay Home. Stay Safe. Save Lives.
How to Help Out Donate to the Massachusetts COVID-19 Relief Fund. Volunteer opportunities for health professionals: Please click here. Get involved with the new Community Tracing Collaborative: Please click here. Donate or sell personal protective equipment: Please click here. Health care facilities can learn more about requesting personal protective equipment here. Apply for Jobs at COVID-19 Temporary Care Sites (Details Here).
The Need for Blood Donations Continues, and Recovered Covid-19 Donors Can Help Save Lives In coordination with the U.S. Food and Drug Administration (FDA), the Red Cross is seeking people who are fully recovered from the new coronavirus to sign up to donate plasma to help current COVID-19 patients. People who have fully recovered from COVID-19 have antibodies in their plasma that can attack the virus. This convalescent plasma is being evaluated as treatment for patients with serious or immediately life-threatening COVID-19 infections, or those judged by a healthcare provider to be at high risk of progression to severe or life-threatening condition. Interested individuals can visit RedCrossBlood.org/plasma4covid to learn more, and if eligible, sign up to help.
We are also encouraging people who have not had COVID-19 to schedule and keep appointments to donate blood or platelets to ensure a stable blood supply during this pandemic. Donating blood products is essential to community health and the need for blood products is constant. As part of our nation’s critical infrastructure, healthy individuals can still donate in areas that have issued shelter in place declarations. The Red Cross follows the highest standards of safety and infection control, and volunteer donors are the only source of blood for those in need. To make an appointment to donate, please visit www.RedCrossBlood.org Requests for Red Cross Emergency Response American Red Cross
The American Red Cross (ARC) of Massachusetts is committed to fulfilling our Mission of providing emergency relief to our neighbors following a home fire or other disaster. We have implemented temporary changes to our COVID-19 RESPONSE COMMAND CENTER DAILY SITUATION REPORT response protocols. ARC we will be responding to your requests for service with a virtual response and ask your assistance in sharing this information with your Incident Commanders and Dispatch Center personnel.
Notification: Continue to request a response by contacting our long-standing emergency line 800-564-1234.
When calling: Please have contact information for the head of household for each displaced family unit. A point of contact from the Fire Department or Emergency Management on-scene that we can coordinate with if needed. Quick assessment as to extent of damage.
What we will do: Contact each head of household by phone or video chat. Open a virtual case for each affected family. Arrange for lodging if needed. Deliver a Client Assistance Card (financial assistance) to hotel, family member’s home, etc. Provide Recovery guidance and assistance in the days following the incident.
If a virtual response is not possible, we will send a minimal number of Red Cross volunteers to the scene to orchestrate the virtual intake process. We value our partnership with your department and encourage you to contact us with any questions.
GUIDANCE FOR TOWN MEETINGS TO ADDRESS COVID-19 As of June
Purpose These sector specific COVID-19 safety recommendations for Town Meetings are issued to provide municipalities with instructions to help protect against the spread of COVID-19 as in- person meetings resume.
These standards are advisory only and are not exclusive or exhaustive. The public health data for disease prevention upon which these guidelines are based can and does change frequently.
General Standards
These standards apply to all town meetings.
Town officials should communicate to residents that if they are feeling sick, are exhibiting any of the following symptoms (fever, cough, shortness of breath, chills, muscle pain, headache, sore throat, or new loss of taste or smell), or have potentially been exposed to someone with confirmed or suspected COVID-19, then they should not attend town meeting in person. A potential exposure means having household contact or having close contact (within 6 feet) with an individual with confirmed or suspected COVID-19 for prolonged periods of time (over 15 minutes) while the person is symptomatic or 48 hours before symptoms developed.
Persons who are particularly vulnerable to COVID-19 according to the Centers for Disease Control (e.g., due to age or underlying conditions) are encouraged to stay home.
Town officials are encouraged, to the extent feasible, to hold meetings virtually or outdoors and to ensure that attendees are spaced at least 6 feet apart. If outdoor meetings are not feasible, towns are advised to abide by the following policies in conducting town meeting.
I. Attendance
• Hosting town meeting by remote participation and reduction of quorum as allowed by Chapter 92 of the Acts of 2020, is strongly encouraged • Attendees of town meeting should sign in as they would normally do. Town staff should ensure that they have the correct contact information for attendees.
II. Social Distancing
Seating • Seating should be arranged to permit attendees to sit at least 6 feet apart. Members of the same immediate household may be allowed to sit together and less than 6 feet apart • If there is fixed seating, rows should be blocked off and kept empty to allow for sufficient distancing between rows
1 • Town officials are encouraged to place tape or other visual distancing markings on seating to delineate 6 ft separations and to post signage indicating the maximum number of persons permitted per row • Promote ventilation for enclosed spaces where possible. For example, open windows and doors to allow airflow • Lines at microphones for questions or comments should be taped to keep people six feet apart. Microphones should be disinfected after each speaker
Entering and Exiting • Town meetings are advised to take steps to encourage orderly entering and exiting of meetings in a manner that encourages social distancing. For example: o Signage or floor markings should be posted to have one-way aisles or otherwise direct attendees to follow certain pathways for entering and exiting the meetings o If a line forms outside of the meeting, those waiting should be directed to maintain social distancing. Tape or other markings on the ground outside of the meeting should be placed to encourage attendees to maintain social distancing of at least 6 feet o Staff should direct people in high traffic areas to help maintain social distancing o Town officials or other staff should direct successive, row-by-row exiting
III. Face Coverings
• All residents over the age of 5 and staff must wear face coverings or masks in accordance with COVID-19 Order No. 31 and the Department of Public Health’s Guidance while inside and while entering and exiting locations of town meeting or otherwise participating in in-person meetings, except where a person is unable to wear a face covering or mask because of a medical or disabling condition • A person who declines to wear a face covering or mask because of a medical or disabling condition shall not be required to produce documentation verifying the condition • Individuals addressing town meeting may remove his or her face covering while doing so, provided that he or she is able to maintain a distance of at least 6 feet from other persons present. • Installation of protective, plexi-glass or other transparent barriers are recommended for podiums and other points of address • Towns are strongly advised not to arrange for or permit communal gathering pre or post meeting (e.g., coffee or other food services)
IV. Cleaning and Disinfecting and Hygiene Protocols • Locations of meetings shall be cleaned and disinfected before and after each meeting, including disinfection of heavy transit areas and high-touch surfaces (e.g., doorknobs, bathrooms, microphones, shared instruments) • Markings should be placed outside of bathrooms to adhere to the 6 ft distance between each attendee • If town meeting officials learn that an individual with COVID-19 attended a meeting or otherwise entered the building, the town should conduct a deep cleaning and disinfecting of any areas visited by the infected individual consistent with the Centers for Disease Control guidance: https://www.cdc.gov/coronavirus/2019- ncov/community/disinfecting-building- facility.html
2 • Town meeting officials should ensure that officials and residents have access to handwashing facilities, including soap and running water, and allow workers sufficient break time to wash hands, as necessary. They are also encouraged to make alcohol-based hand sanitizers with at least 60% alcohol available, if possible • Town Warrants and other paper that is distributed at a meeting should be done so in a manner to ensure social distancing and not be shared between attendees Towns that use electronic voting machines should disinfect the machine between each use
V. Notification of Positive Case
• Town meeting officials should work with the board of health in the event that anyone is exposed to COVID-19 at the meeting. Meeting attendees may need to be identified and contacted by the board of health or Contact tracing Collaborative.
3 MUNICIPAL TOBACCO CONTROL CONFERENCE
RETAILER EDUCATION & INSPECTIONS (Workshop #2)
MASSACHUSETTS TOBACCO CESSATION AND PREVENTION PROGRAM JUNE 11, 2020 PRESENTERS
• Sarah McColgan, Massachusetts Health Officers Association • Joyce Redford, North Shore/Cape Ann Tobacco Policy Program • DJ Wilson, Massachusetts Municipal Association WORKSHOP TOPICS
• What is a ”flavored” product? … a “concept” flavor? … an “enhancer”? • Required manufacturer nicotine strength letters • Required manufacturer flavored product letters • Required retailer signage • New higher fines • Retailer education best practices • Inspection protocols and forms • Assertive inspections • Marijuana and CBD flavored vape products WHAT IS A “FLAVORED” PRODUCT?
• State policy uses the same set of definitions, notably for “Characterizing Flavors” that are used in the local policy. • Unflavored vape products are not flavored. • Tobacco flavor in both conventional tobacco and vape products is not flavored. • Yes, in vape products the “tobacco” flavor is manufactured and not natural. • Many manufacturers have removed descriptive words from the product. Inspector may need to ascertain if it is flavored while in the store by buying the product, opening it and smelling it. If the inspector believes it to be flavored and penalizes the store, buy a second one for BOH. WHAT IS A “CONCEPT” FLAVOR?
• One step beyond taking the descriptive word off of the product is to give the product a name that has no bearing on the flavor. Examples are: • Unicorn Vomit • Jazz • Royale • Problem: kids know what they are while parents and inspectors do not. • Has not commonly happened with conventional tobacco though Marlboro has several different colored packs with a variety of non-flavor names BLACK & MILD ROYALE WHAT IS AN “ENHANCER”?
• State law very proactive in including this in the state’s flavor policy. • Definition: Tobacco Product Flavor Enhancer: Any product designed, manufactured, produced, marketed or sold to produce a characterizing flavor when added to any tobacco product. • Examples are: • Selling vials of flavor next to unflavored e-juices; • Mason’s Flavor Strip from New Zealand (pictured) MORE ENHANCERS REQUIRED MANUFACTURER LETTERS REGARDING NICOTINE STRENGTH
• General tobacco retailers CANNOT sell vape products that have a nicotine strength of over 35 mg/ml. • Adult-Only Retail Tobacco Stores and Smoking Bars are exempt from this policy. • Juul currently does not make an e-juice that is weak enough to be sold in a general tobacco retailer BUT they can sell their hardware. • Retailers must have letters, on the manufacturer’s letterhead, attesting to the products that are 35 mg/ml or weaker and should have them available for inspection. • Nicotine strength attested in any other format than “mg/ml” is unacceptable. SAMPLES OF A MANUFACTURER’S LETTER REQUIRED MANUFACTURER LETTERS REGARDING CONVENTIONAL FLAVORED PRODUCT
• Conventional tobacco products include, but are not limited to, cigarettes, cigars, chew tobacco, pipe tobacco, loose tobacco. • General tobacco retailers CANNOT sell conventional tobacco products that are “flavored” as they have a “characterizing flavor”. • Only Smoking Bars are exempt from this policy. • Retailers must have letters, on the manufacturer’s letterhead, listing the products they make that are not FLAVORED and these letters should be available for inspection. • Language for this requirement will be at www.mass.gov/newtobaccolaw REQUIRED RETAIL SIGNAGE
• The New State Law requires the following signage to be posted at ALL permitted tobacco vendors: • M.G.L. c. 270, §§6 and 6A; • Referral information for smoking cessation resources; • Statement that the sale of tobacco products, including e-cigarettes, to someone younger than 21 is prohibited; • Health warnings associated with using e-cigarettes; • Non-age restricted and adult-only retail tobacco stores must also post a notice to consumers that the sale of flavored electronic nicotine systems is prohibited REQUIRED RETAIL SIGNAGE UNIQUE TO SMOKING BARS & ADULT-ONLY RETAIL TOBACCO STORES
• Sign stating that you must be 21+ to enter; • Sign warning that smoking/vaping may be present on the premises. This does not apply to municipalities that have prohibited: • (1) smoking/vaping in adult-only retail tobacco stores; • (2) smoking bars; and/or • (3) smoking in smoking bars • Additional signs will be needed after the June 1 regulations take effect. SIGN: STATE LAW SIGN: UNDERAGED SALES SIGN: E-CIGARETTE HEALTH WARNING (small and large available) SIGN: FLAVOR POLICY SIGN: ADULT ONLY SIGN: SMOKING OR VAPING IN SMOKING BARS SIGNS ARE AVAILABLE…
• At: WWW.MACLEARINGHOUSE.ORG • In: • Spanish • Portuguese • Simplified Chinese • Vietnamese • Haitian Creole HIGHER STATE FINES
• MANDATED state fines are: • $1,000 for 1st violation; $2000 for 2nd violation; $5000 for a 3rd+ violation • Tolling period is 36 months • A range of permit suspension times for all but 1st violation • Notify your retailers, through merchant education either in–person or via correspondence, about these fines before issuing them • Cannot use non-criminal disposition as they are over $300 – letter template exists! • Also inform clerk magistrates and city/town clerk – template letter exists! HIGHER STATE FINES (CONTINUED)
• Local Fines for Uniquely Local Policies • Higher State Fines for these policies covered by state law: • Sales to minors • Signage violations (oddly, gets an additional $10 fine!) • Failure to Check ID • Selling without a Local Tobacco Sales Permit • Sale of Prohibited Flavored ”Tobacco Products” • Nicotine Content violation • Free Distribution, Coupon Redemption, Out-of-Package sales • Liquid Nicotine Containers without Child-Proofing INSPECTION PROTOCOLS
• Maintain an email list of all Tobacco Sales Permittees for quick communication • Hand local regulations to all retailers each time they are updated • Humidors – locked or unlocked • Lottery in AORTS • Report to police: marijuana sales, crack pipes, “bath salts”, synthetic marijuana RETAILER EDUCATION BEST PRACTICES
• Go behind counter • Loosies - multiple open packs • Look in backroom for prohibited products • Discourage ticketing on site during compliance checks due to the presence of youth • Backroom ”distribution” issue will be settled in June • What to do when an inspection is refused SAFETY CONSIDERATIONS
• Be aware! Trust your gut! If you feel uncomfortable or threatened, leave! • Let someone else know where you will be. • Deterrents to unsafe situations: in-store cameras, other staff/customers present • Cell phone: • Leave your cell phone line open (and, if need be, let the owner/clerk know it is on) • Program in a local emergency number rather than 911 • Parking: Be aware of lighting, distance from the establishment, keep keys ready • Entrances: Check where exits and entrances are – maintain awareness. SAFETY CONSIDERATIONS
• Store History: Does the store and/or store owner have a history of being difficult? What is their current status on violations? • De-Escalating a Situation: • Remain as calm as you can; • Don’t tell them to calm down; • What can you do to make sure that they feel heard? • Do you understand what their concern is? • If that fails, ask “What do you need right now? • Worry about safety - not being right. SMOKING BAR COMPLIANCE CHECKS
• Two types of checks: compliance checks for minors & compliance checks for products • If you question if a place is a Smoking Bar, ask for their MA DOR-issued Permit • MA DOR website has application for Smoking Bar Permit • MA DOR will ask applicant to call city/town for initial approval • At least 51% of revenue must come from tobacco, vape or accessories • Smoking Bars cannot sell product “to go” • Banning Smoking Bars vs. Banning Smoking in Smoking Bars WHY ASSERTIVE INSPECTIONS
• To become familiar with inventory • Identify where they keep what they sell • Identify where back stock is kept • Insure product compliance • Identify any illicit or questionable products WHY LOOK EVERYWHERE? FOUND IN A FLAVOR RESTRICTED MUNICIPALITY DURING THE GOVERNOR’S EMERGENCY BAN OF VAPE RETAILER WAS UNDER SUSPENSION - MUNICIPALITY PROHIBITS FLAVORED PRODUCT & BANS BLUNT WRAPS CONVENIENCE STORE IN FLAVOR RESTRICTED MUNICIPALITY 2-24-2020… WHAT’S WRONG HERE? MARIJUANA AND CBD FLAVORED VAPE PRODUCTS
• DEFINITIONS FROM MGL. CH. 270 §28: • “Electronic nicotine delivery system”, an electronic device, whether for 1-time use or reusable, that can be used to deliver nicotine or another substance • Marijuana or marijuana products as defined in section 1 of chapter 94G shall not be subject to this section. • FOR CBD: If it is a flavored vape product, it is within the regulation. If it is unflavored OR is an edible, a drink, a tincture, a cream, etc., it is not within the regulation. • FOR MARIJUANA: Not within the regulation – report any sightings to your police chief • Framingham and Norwood have separate permit for “Smoke Accessory Sales” QUESTIONS
Note: Thanks to Hilary Hackbart of the MA Dept. of Labor Standards for the “Safety Considerations” information! $1000, $2000, $5000 – So what do we do now?
CHERYL SBARRA, J.D., DIRECTOR OF LAW AND POLICY, MASS. ASSOC. OF HEALTH BOARDS JAMES J. WILUSZ, R.S., EXECUTIVE DIRECTOR, TRI-TOWN HEALTH DEPARTMENT LEE, LENOX AND STOCKBRIDGE BOARDS OF HEALTH JUNE 11, 2020 Disclaimer
This information is provided for legal educational purposes only. It is not intended to constitute legal advice. Please consult your municipal attorney for legal advice. Best Practices from the Field (Jim)
Permitting Process ◦ Online fields ◦ Contact person ◦ File tracking ◦ Sample language
Fining and Stacking ◦ Pros and cons ◦ philosophy Crimes Against Public Health G.L. ch. 270, §§ 6, 6A, 7, 22, 27, 28
•Tobacco-related “crimes” • Sale to person under 21 • Sale of flavored tobacco products • Signage • Smoking in public places • DPH may “promulgate such procedures, rules or regulation as it deems necessary to implement [tobacco-related sections.]” •Other “crimes” against public health • Flammable eyeglass frames • Poison for rodents; placement • Wood alcohol in food or drink • Candy containing alcohol • Burning of refuse within marine or shoreline boundaries, etc. Public Welfare Offenses
•Addresses conduct that has not necessarily caused harm but is “potentially harmful or injurious.” Staples v. United States, 511 U.S. 600 (1994). • Early statutes “almost uniformly involved statutes that provided for only light penalties such as fines or short jail sentences.” Staples v. United States, supra at 616,617. • High fines, but no jail sentence. 105 CMR 665.000
•MINIMUM STANDARDS FOR RETAIL SALE OF TOBACCO AND ELECTRONIC NICOTINE DELIVERY SYSTEMS • Permitting Requirements • Required Signage • Advertising • Identification Requirements • Prohibition on Coupons and Other Discounts • Out-of-package Sales • Liquid Nicotine Containers • Requirements for Retail Establishments • Violations • Order to Cease and Desist • Enforcement Violations of DPH regulations (not specific local regulations (capping, ban smoking bars, etc.)
•Correction Order issued, and •1st offense: $1000 •2nd offense within 36-month period: $2000 and suspension for 1 – 7 business days or longer •3rd or subsequent offense within 36 months from the first violation: $5000 and suspension for 7 – 30 days or longer
Scenarios under new fining structure
1. First Offense: $1000 fine. It gets paid. Done.
2. First Offense: $1000 fine. Retailer wants hearing and requests it within 7 days after being served. • Specific service requirements. • After hearing, the Board may sustain, modify or withdraw the order and send decision in writing to petitioner.
3. First Offense: Retailer still doesn’t pay. Common Sense Strategies Still Apply
• Written request for payment (one last time) • If no payment: • Wait until Retailer’s permit is up for renewal. • Serve Order to Cease and Desist for failing to comply with Correction Order • Required by DPH regulations • Service requirements in regulation, include service by health agent and actual notice. • Same process used for Correction Order. • Why 2 orders? • In the regulations.
Still no payment. Now what?
1. Application for Criminal Complaint always an option. 1. Familiar 2. Note that retailer no longer has the right to request a hearing, only the BOH now. 3. Won’t necessarily result in fine going to municipality. 4. Can move to treat a violation as a civil infraction (G.L. ch. 277, §70C). 2. Civil Contempt Proceedings (MA Civil Procedure Rule 65.3). 1. For violating an administrative order (to Cease and Desist). 2. Can be filed in District or Superior Court. 3. Unchartered territory in tobacco control world. 4. Need to meet with Clerk Magistrate. What to do with the fees (Thank You Sarah McColgan!)
•General Fund, unless:
•Revolving Account (G.L. ch. 44, §53E1/2) • Resources to conduct specific activities by a specific program, for a specific purpose and in a specific department. • Need approval of Selectmen, Town Council or Mayor. • Meet with Finance Committee and/or Comptroller. • Describe need for and source of funds. • Need vote of Town Meeting or City/Town Council to authorize the fund. • Fund must be for a specific amount authorized by Town Meeting or Town/City Council or any related increase that is authorized. • Cannot spend more funds than are authorized. • Annual authorization of expenditures and receipts by city/town council or town meeting.
MUNICIPAL TOBACCO CONTROL CONFERENCE
WORKSHOP #1 OVERVIEW OF TOBACCO REGULATION 105 CMR 665
Patricia Henley Director, Massachusetts Tobacco Cessation and Prevention Program
June 11, 2020 Ten Months in Tobacco Control
September 2019 EVALI Vaping Emergency Vaping product ban November 2019 Act Modernizing Tobacco Control signed Flavored vaping products restricted to adult only smoking bars December 2019 Vaping Ban lifted March 2020 Governor Baker declared an emergency in the Commonwealth to respond to the spread of COVID-19 June 2020 All flavored tobacco and vape products restricted to adult only smoking bars
2 105 CMR 665.000, Minimum Standards for Retail Sale of Tobacco Products and Electronic Nicotine Delivery Systems
• On November 27, 2019, Governor Baker signed into law An Act Modernizing Tobacco Control (“Act”), which provides DPH with additional regulatory authority to regulate minors’ access to tobacco products and all ages’ access to electronic nicotine delivery systems (ENDS). Some sections of the act took effect immediately and some went into effect on June 1, 2020.
• The department promulgated regulations on an emergency basis to set forth standards for the retail sale of electronic nicotine delivery systems (ENDS) regulations in order to implement those sections of the law that became effective immediately. Final amendments to 105 CMR 665 were approved by the Public Health Council on May 20, 2020.
3 Summary of Regulation
105 CMR 665.000, Minimum Standards for Retail Sale of Tobacco and Electronic Nicotine Delivery Systems:
• Was promulgated on an emergency basis on December 11, 2019 and sets forth standards for the retail sale of electronic nicotine delivery systems (ENDS) pursuant to sections of An Act Modernizing Tobacco Control that went into effect immediately upon being signed into law on November 27,2019;
• Restricts the sale and distribution of all flavored ENDS to smoking bars;
• Restricts the sale and distribution of all unflavored ENDS with a nicotine concentration greater than 35 milligrams per milliliter to retail tobacco stores and smoking bars;
• Requires retail establishments, including smoking bars and retail tobacco stores, to conspicuously post signage, in the form developed and made available by the Department;
4 Summary of Regulation (continued)
• Prohibits retail establishments from advertising tobacco products that they cannot sell, use fraudulent or misleading statements in advertising, or display advertisements with celebrities, cartoons or similar endorsements;
• Establishes identification requirements for each person selling or providing tobacco products to verify age of purchaser and/or for entry into age-restricted establishment;
• Prohibits coupons and other discounts in all establishments, and prohibits free samples except in retail tobacco stores and smoking bars, prohibits out-of-package sales and cartridge refills and requires liquids or gels containing nicotine be packaged in child-resistant packaging;
• Establishes a fining structure beginning at $1,000 for a first offense and up to $5,000 for a third offense and allows for a suspension of sales of tobacco products for any second or subsequent offense; and
• Provides additional authority regarding ENDS that are proven by a regulatory agency to be the cause of an imminent threat to public health
5 Summary of 105 CMR 665 final amendment:
• Revisions were made to address the sections of the Act that went into effect on June 1, 2020.
• Restricts the sale of all flavored tobacco products to smoking bars
• Requires retailers to obtain nicotine disclosure documentation from manufacturers prior to selling the product.
• Requires all tobacco retailers except smoking bars obtain documentation indicating each tobacco product for sale in the establishment is unflavored.
6 Where and What Products Can Be Sold in Massachusetts per 105 CMR 665
Non-age restricted retail Adult-Only Tobacco Smoking Bars establishments (e.g., Retail Store (21+) (21+) convenience stores/gas stations, liquor stores)
Product UNFLAVORED cigarettes, cigars, e-cigarettes and other tobacco products FLAVORED cigarettes, cigars, e-cigarettes and other tobacco * products UNFLAVORED e-cigarettes with nicotine content 35 mg/mL or less UNFLAVORED e-cigarettes with nicotine content over 35 mg/ML
Tobacco product flavor enhancers *
* For on-site consumption only
7 Required signage by type retail establishment per 105 CMR 665
Convenience Stores/Gas Stations Adult-Only Tobacco Retail Store (21+) Smoking Bars With a Retail Tobacco License (21+)
Sign Minimum Legal Sales Age*
State Law (MGL ch 270, sections 6 and 6A) Pictures of signs
Referral Information for Smoking Cessation Resources*
Health Warning for E-cigarettes
Sale of Flavored Tobacco is Prohibited
Must be 21+ to Enter
Exterior notice of smoking/vaping inside *
8 Tools for Enforcement
• MTCP Complaint Line 1-800-992-1895 • Retailer Letters • Signage • www.mass.gov/maclearinghouse - order free of charge • www.mass.gov/newtobaccolaw - download other languages • Retailer and Signage Charts • Retailer Inspection form
9 Counter Tools Point of Sale Toolkit (POST) www.countertools.org
10 Cessation Support
• Massachusetts Smokers’ Helpline at 1-800-QUIT-NOW (1-800-784-8669) • provides counseling and 8 weeks of NRT • Currently has an incentive program for users of menthol tobacco
• This is Quitting powered by truth® is a free and confidential texting program for young people who vape. Young people can text “VapeFreeMass” to 88709.
• My Life, My Quit™ has youth coach specialists trained to help young people by phone or text. Young people can call or text "Start My Quit" to 855-891-9989 for free and confidential help or visit mylifemyquit.com to sign up online.
11 Vaping Education Support for Adults and Youth
GetOutRaged.org Mass.gov/vaping
12 Questions contact:
Patti Henley, Director, Massachusetts Tobacco Cessation and Prevention Program [email protected] P: 857-243-0871
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