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Dallas County Medical Society

Community Emergency Response Committee

Meeting of Aug. 5, 2012

Minutes

The DCMS Community Emergency Response Committee met by conference call on Sunday, Aug. 5, at 7

p.m. John Carlo, MD, chair, called the urgent call to order to discuss the alarming rise of West Nile Virus

cases in Dallas County.

Members on the call were Drs. Terry Allen, John Carlo, Mark Casanova, Wendy Chung (abstained from

voting), Cristie Columbus, Robert Fine, Ray Fowler, Gordon Green, Sarah Helfand (by proxy), StephenLanders, James Luby, Mark Mlcak, Carol North, and Don Read. Also participating on the call were Rick

Snyder II, MD, DCMS president; Michael Darrouzet, DCMS EVP/CEO; and Connie Webster, DCMS

senior vice president of operations.

After Dr. Carlo gave a brief overview of the role of the committee, Dr. Luby provided a status report on

West Nile Virus. He said that the Health Department staff has done an excellent job of accumulating and

analyzing the epidemiological data. The following information was discussed:

Dallas County is in the midst of a severe seasonal outbreak of West Nile Virus. Since the first

human case was reported on June 20, the numbers of infected people have consistently risen. Asof Aug. 5, Dallas County Health and Human Services has confirmed a record number of 123 West

Nile Virus infections in Dallas County residents and confirmed 6 deaths from the virus. As of

Aug. 5, Dallas County has the highest number of confirmed cases in the nation and likely will bethe site of one of the largest urban WNV epidemics in the recorded history of the virus.

Patients with severe WNV disease who are under physicians care are very ill and often in

intensive care units. Those who do not die from their illnesses will have a prolonged and difficultconvalescence and rehabilitative course.

DSHS is seeing earlier and larger than normal disease activity compared to previous years. More

cases of West Nile Virus illness have been reported this year than in any year since WNVappeared to the state in 2002. Nationally, 241 cases have been reported to the Centers of Disease

Control and Prevention; Texas cases account for more than 60 percent of this total and half of the

deaths (as of late last week).

WNV activity typically peaks in August. Human infections are expected to increase in upcomingweeks.

Dr. Chung, chief epidemiologist with DCHHS, gave an epidemiology update that provided the current

timeline and summary, epidemiology case definition, national and state context, epi curves, andgeographic distribution of cases. She also provided an environmental summary.

The following information was discussed regarding chemical treatment of areas where West Nile Virus

has been prevalent.

The last time Dallas County did an aerial spray of insecticide was summer 1966 to address the St.

Louis encephalitis epidemic. The proliferation of WNV necessitates aerial spray of insecticide in

areas of the county that continue to have cases despite the use of conventional mosquito control

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efforts.

Ground treatment has limited access (e.g., cannot access alleys).

Aerial spraying has the advantage of blanketing areas with pesticides.

Aerial spraying has been scientifically proven effective in reducing human illness from WNV.

Spraying would be done at night.

Dallas Medical Reserve Corps could be used to educate the public. Members could go door-to-

door to provide a preventive response (e.g., wear long sleeves and pants, wear repellent and stayinside).

The risks associated with WNV vs. aerial spraying would need to be communicated to the public.

Although pesticide treatment is considered safe, there is still the fear of the unknown, whichtypically brings on hysteria.

The public health risks from WNV this season clearly exceed the risks from exposure to mosquitoinsecticides.

Action Items:

ACTION Item 1: Upon a proper motion and second, the committee unanimously voted to inform the

DCHHS and the DCMS board of directors that based on the scientific evidence presented, it appears thatthe benefits of aerial spraying of insecticide outweigh the risk of exposure to mosquito insecticides.

ACTION Item 2: Upon a proper motion and second, the committee unanimously voted to recommend

to DCHHS and the DCMS board of directors that aerial spraying of insecticides be done immediately,with no delays.

The conference call was adjourned at 8:10 p.m.