SOUTHWEST UTAH PUBLIC HEALTH FOUNDATION | FALL 2020 SHINE A LIGHT
COVID BASICS
STRIDES IN SCIENCE
PG. 6
PG. 14
PG. 22
" Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less." -Marie Curie
FROM THE HEALTH OFFICER
Welcome to the 23rd issue of HEALTH Magazine, published by the Southwest Utah Public Health Foundation and dedicated to the residents of Washington, Iron, Kane, Beaver, and Garfield counties. We usually put out three issues per year, but, as most of you will agree, this year has been anything but usual. This is the first installment of 2020, which we hope will provide useful information regarding COVID-19 and other health-related topics. I salute my health department staff who have been hard at work, readapting programs during the pandemic, cross-training, and working long hours tracking down cases and helping those infected to avoid infecting others. A major goal of public health efforts since this pandemic emerged has been to slow the spread of the virus enough to protect our most vulnerable community members and ease the burden on our healthcare resources. Even with the best individual and community precautions, no one is completely risk-free of getting infected with COVID-19, and our hearts go out to those who have lost loved ones, battled illness, or have had their lives disrupted. I have been heartened to see the extraordinary efforts made by many in our communities who have taken care of the sick, assisted those impacted by shutdowns and economic fallout, and gone out of your way to help those most vulnerable to this disease stay safe. During my career, I have been part of the response for two pandemics and many outbreaks of disease. There has likely never been such a mobilization of resources on such a large scale to understand and deal with a contagious disease. While we may look to science and government leaders to provide solutions in fighting this pandemic, this has been an opportunity for all of us to shine forth with our best selves, and many have done so. I invite you to take steps to protect yourself and others from this disease. Seek reliable sources of information and choose goodwill and compassion over fear and criticism.
This has been an opportunity for all of us to shine forth with our best selves.
Sincerely,
David W. Blodgett, MD, MPH Southwest Utah Public Health Department (SWUPHD) Director & Health Officer
INSIDE PREVENT 6. SHINING A LIGHT
By David Heaton
8. E-BIKING
By Kye Nordfelt
10. NUTRITION
By Mary Orloski
12. YOUR IMMUNE SYSTEM
By Shana Chavez
PROMOTE 14. COVID BASICS
Q&A
ON THE COVER The artistic vision for this issue is inspired by the beloved children's author Beatrix Potter. She was a writer, illustrator, natural scientist, and conservationist. Her watercolor studies of fungi were well known in the field of mycology, although she became famous for her anthropomorphic (animals behaving as humans) illustrations in her series of children’s books.
18. YOGA
Deanna England
20. I TESTED POSITIVE
Local residents
PROTECT 22. STRIDES IN SCIENCE
The information and guidelines regarding COVID-19 contained in this issue of HEALTH Magazine are current at the time of publication but are subject to change as new developments occur.
By John D. Loike & Salomon Amar
24. HEALTHY RESTAURANTS
By Bailee Williams
26. COVID-19 GUIDELINES 28. 2019 ANNUAL REPORT 31. COLORING PAGE
HEALTH MAGAZINE DIRECTOR/HEALTH OFFICER:
David W. Blodgett MD, MPH The entire contents of this publication are Copyright ©2020 HEALTH (the magazine of the Southwest Utah Public Health Foundation) with all rights reserved and shall not be reproduced or transmitted in any manner, either in whole or in part, without prior written permission of the publisher. Health magazine hereby disclaims all liability and is not responsible for any damage suffered as the result of claims or representations made in this publication. Printed by Hudson Printing Company / Salt Lake City, Utah / hudsonprinting.com
PUBLISHING DIRECTOR: Jeff Shumway
EDITOR:
David Heaton
DESIGN & ARTWORK:
Kindal Ridd
SHINING A
When the world seems dark, seek the light BY DAVID HEATON
Editor, SWUPHD Public Information Officer
he Southwest Utah Public Health Department (SWUPHD) began posting daily COVID-19 updates on their official Facebook page in March, soon after results began rolling out to local health districts from positive tests. The SWUPHD was among the first to include a count of those recovered. The first comment on the April 5th Facebook update was by a young woman named Allison who simply wrote “11 recovered!!” She soon became a regular in the comments section, sometimes near the top (“103 recovered!!”), sometimes further down (“515 recovered!!”). While some commenters expressed encouragement and appreciation, others criticized her cheerfulness, especially after the SWUPHD adopted the state’s criteria for recovery, which is 21 days after a positive test (and not deceased). It was pointed out to her that “recovered” doesn’t necessarily mean they don’t have lingering health problems. “I know,” was her reply. On July 23rd, Allison commented “1827 recovered!!” which again led to some discussion about the uncertain future of the health of those individuals. Allison then revealed, “I currently have it and time will only tell with any long term
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issues and side effects, but I will continue to that others — like us — are decent, imperfect celebrate the recoveries.” human beings each doing their best.” It’s interesting how someone’s spirit and at- “There’s a darkness that has enveloped us all,” titude can have an influence, even on social wrote local columnist Ed Kociela in an opinmedia where interacting through a screen ion piece for The Independent on July 14, seems to make it easier to attack and berate 2020. “Those who are the peacemakers, the others. Allison’s calm, the kind who daily comment on IT TAKES MORE INNER STRENGTH, MORE PA- try to reason with a health departTIENCE, MORE COMMITMENT, INTEGRITY, AND others, try to talk ment’s Facebook in from the INTELLECT TO OPERATE FROM KINDNESS them page has provided ledge, try to point THAN ANGER. a small ray of light out the ego inflaamong the grim tion that causes us numbers that have documented a pandemic to level blame at everybody else, are the real surge with its hospitalizations and loss of life. heroes. The lesson here, by the way, is to never mistake kindness for weakness. It takes more That light hasn't gone unnoticed, as evidenced inner strength, more patience, more commitby comments like this one: “Thank you ment, integrity, and intellect to operate from for your positivity!! I pray for you to have a kindness than anger…(m)ost importantly, speedy recovery! I have enjoyed your positive seek the lightness. Do not be afraid to break outlook- one which I choose to have as well.” from anger and despair. We spend too much time regretting yesterday and worrying about In a recent American Enterprise Institute blog tomorrow rather than taking care of today. post, Benjamin Ho warns us about “pandemic We’re going to make it. I am confident.” shaming, the tendency to judge people who make different choices than we would during Hard times can bring out the best and worst the COVID-19 crisis. Pandemic shaming is in people. They reveal our character but give understandable in a scary situation where us a chance to be a little better if we’re willing. one’s actions can bring harm to others. But There’s still time before this pandemic fades the coming months will be easier if we instead away to be the kind of person who made a difadopt a presumption of decency, which holds ference.
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New Research Suggests E-Bikes Can Provide Significant Health Benefits BY KYE NORDFELT
SWUPHD Health Promotion Director
he COVID-19 pandemic has created the biggest surge in bicycle sales in decades, as cooped-up people wary of gyms and public transportation have taken up peddling. But what if you want to work the heart without burning your lungs, or are you daunted by hills and distance? An electric, or e-bike might be what you’re looking for. E-bikes have a small electric motor that engages when you pedal to give you a boost, which is especially helpful on inclines. A recent study found that a rider’s “average heart rate on an e-bike was 94 percent of the average heart rate on a traditional bike.”
E-bikes are a fun form of exercise that are becoming increasingly affordable. My parents retired and moved to St George a couple years ago. Both were educators in public schools and physically active all their lives. My dad coached sports and mom has always enjoyed the outdoors. Retirement found them being less physically active and they both experienced health challenges including chronic pain and joint replacement. Running was out, going to a gym or riding a pedal bike was not appealing, and walking became mundane. Exercise
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to them seemed like an undesirable chore. Their age and health conditions made them more susceptible to complications from illnesses like COVID-19. I came across a Harvard study showing that “overweight or obese people who engage in leisure-time physical activity can extend their lives by as much as four years.”
I started talking to my parents about trying an e-bike. It took awhile for dad to warm up to the idea, but eventually we began to shop around. I will never forget the first time my dad rode an e-bike. First thing I noticed was the large smile on his face as the pull of the pedal-assist motor quickly got him up to 20 mph. It was like he was a kid again, but the cost kept him from purchasing the bike at that time.
We kept researching and eventually found a number of online e-bike options that were around $1,000 (new e-bikes can average about $2,800). Dad bought one for mom for her birthday. A short time later “These very specialized, powerful im- he found one in the classifieds - basically mune cells are like the Army Rangers of brand new - for $800. Now my parents the military,” says exercise immunolo- are exercising more regularly. gy researcher David Nieman, DrPH., a professor of biology at Appalachian State Not only do my parents ride their bikes for University and director of the Human fun around the neighborhood, they also Performance Lab at the North Carolina reduce car trips by occasionally riding to Research Campus. “They come out and the grocery store, to work, to church, and circulate during exercise at a higher rate to visit friends. Exercise changed from than normal. Any pathogens are more being an undesirable chore to an enjoyeasily detected and destroyed during this able activity with physical and mental health benefits. E-biking gets them out of process.” the house to experience the wind in their My parents are not obese, but if they were hair and sunshine on their faces. physically active for at least half an hour E-bike batteries can last up to 40 miles or per day, our family could enjoy having longer, so now my parents don’t have to them around longer and they might be worry about getting exhausted and not less likely to get seriously ill from diseases being able to ride home. Their e-bikes oflike COVID-19 and influenza. fer different levels of pedal-assist so they Dr. Cougar Hall, PhD, a lead author in the can adjust how much work they want to e-bike study referenced in the first para- do. graph, said “We are suffering from what If you’re looking for a fun way to exercise we call lifestyle diseases. Cardiovascular and want to ride a bicycle that can make disease, cancer, stroke, diabetes. These are you feel years younger, consider an e-bike. all diseases that are directly related to our Your financial investment could extend lifestyle. So to get people moving more your life expectancy and save you money — and to find a healthy outlet for the on healthcare and car-related expenses. stress that we feel in our work and in our families — is essential. And so I just see Ultimately, whether it’s an e-bike, trae-bikes as one additional tool, one addi- ditional bicycle, walking, running, or tional opportunity to help people who are weightlifting, we invite our readers to find otherwise fairly sedentary or not enjoying an exercise that you do frequently to stay active and healthy. physical activity.” Regularly engaging in 30 minutes of physical activity that gets the heart rate up also deploys certain types of white blood cells that can prevent communicable diseases.
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HEALTHY ON THE INSIDE BY MARY ORLOSKI
SWUPHD Registered Dietician/WIC Director
s we venture forward into an uncertain world in the face of a pandemic, there are universal recommendations that can reduce the spread and risk of infection. In addition to washing our hands, social distancing, wearing a mask, and avoiding large groups, there are ways to keep yourself healthy on the inside, especially when it comes to nutrition. Despite what those infomercials tell you, there are no miracle foods or pills. Everything you need for a well-balanced, healthy diet can be found at your nearest grocery store. We need protein in order to build and repair our bodies. It can be found in lean meat, poultry, fish, eggs, beans, nuts, and legumes. Protein shakes and powders don’t provide the additional vitamins and minerals that come with real foods. Lean meats and plantbased proteins such as beans, lentils, nuts, and seeds offer zinc; a mineral that helps maintain your immune cells and aids in wound healing. Fish and eggs contain choline, which assists in the maintenance of brain cells which may improve memory and cognition as well as reducing the risk of ischemic stroke. Eat plenty of vegetables and fruits every day, in meals and for snacks. Aside from being virtually fat-free and full of fiber, vegetables and fruits are one of the best natural sources of antioxidants, vitamins, and minerals.
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Vitamin C is known for its immune says “contains live and active cultures” system boosting qualities, from short- and is low in sugar. Yogurt contains ening the duration of the common probiotics - beneficial bacteria that cold to stimulating the formation of help maintain good digestive health. antibodies to fight off disease. Our Having a healthy gut is critical to a bodies cannot make or store vitamin healthy immune system. If dairy products are something C so it is important to you avoid or can't eat, eat vitamin C-rich vegePAYING look for the many dairy tables and fruits such as ATTENTION TO alternatives available oranges, lemons, limes, THESE such as soy or almond grapefruits, strawber“milk-like” products. NUTRITIONAL ries, broccoli, cabbage, They should be fortified spinach, and red bell PRINCIPLES to give you the health peppers. WILL KEEP YOU benefits of dairy. HEALTHY LONG Vitamin A helps your Finally, stay hydrated AFTER THE body regulate its own with plenty of water. Our immune system, proPANDEMIC IS bodies are 60 to 70% watects against infection, ter, which aids in every OVER. and promotes good eye bodily function: eating, and skin health. Sweet digestion, muscle movepotatoes, carrots, broccoli, red bell ment, even our heartbeat and breathpeppers, and spinach are good sourc- ing! When your body is fighting off an es of vitamin A. illness or infection, your need for water actually increases to aid in flushing Dairy products are fortified with vi- bacteria and other toxins. tamin A and D, and naturally contain calcium which our bodies need for Paying attention to these nutritional strong bones and teeth (calcium also principles to help protect your imhelps with blood pressure regulation). munity now will also create a healthFor an added benefit, choose low-fat ier future, long after the pandemic is or fat-free yogurt. Make sure the label over.
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YOUR
SYSTEM How to protect yourself against disease BY SHANA CHAVEZ SWUPHD Clinical Assistant
he immune system is our body’s defense network. It protects us from germs and other harmful substances that could make us sick. Without our immune system we’d have no way of fighting off illness. Its main functions are to prevent or limit infection by detecting and removing pathogens (such as bacteria, viruses, and parasites), recognizing and neutralizing harmful environmental toxins, and fighting changes caused by other non-infectious agents in the body, like cancer cells.
that react immediately upon recognizing a foreign substance by surrounding and engulfing it.
The adaptive, or acquired, system works with the innate system to produce antibodies that protect our bodies from specific invaders. After developing over a period of days, antibodies can then recognize and more easily fight these specific pathogens if we are exposed to them again. Vaccinations work in this way by training our immune system to produce the antibodies Immune cells are numerous and reside in that protect against specific diseases. specific organs and tissues throughout the body - such as skin and bone marrow - or Our immune system does such a great job circulate through the bloodstream and of protecting us against disease that we allymphatic system. The immune system most don’t notice it’s there – until it fails us. itself is made up of two subsystems: the When our immune system is weak or caninnate immune system and the adaptive not respond as needed then problems can arise, like an infection. The more underimmune system. lying health issues we have, the harder it is The innate, or natural, system is the one we for our bodies to fight illness. As we age, were born with. It is our rapid response our immune response declines as the numsystem and provides a general or non-spe- ber and quality of immune cells decreases. cific protection. It is mostly comprised of While we don’t have absolute control over killer cells and phagocytes (eating cells) the genetics and environment that affect
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our health, there are lifestyle factors that can STRESS – Chronic stress can cause systemic instrengthen or weaken your immune system: flammation and increase the risk of chronic diseases like atherosclerosis (build-up of plaque in arNUTRITION – Consuming the right nutrients in tery walls which can restrict blood flow). Chronic the right amount is required for the health and stress has also been shown to activate latent vifunction of all cells. Each stage of the immune ruses, such as the one that causes shingles. While response depends on the presence of critical mi- it’s impossible to totally eliminate stress, it can be cro-nutrients such as vitamin C, vitamin D, sele- minimized by giving yourself adequate nutrition, nium, iron, zinc, and protein. Diets that consist exercise, and sleep (as mentioned above), along primarily of processed foods lack these necessary with spending time in nature, nurturing relationnutrients and can negatively affect a healthy im- ships with friends and family, and self-care. You mune system. The USDA’s MyPlate guidelines provide a simple, effective way to eat a balanced can even seek counseling when needed. A profesdiet and prevent nutrient deficiencies. See page 10 sional therapist can help identify sources of stress for more information on the importance of nutri- and recommend coping strategies. tion and immunity. SMOKING – Smokers are generally less healthy than EXERCISE – Regular exercise improves cardiovas- non-smokers, suffering more health problems and cular health, lowers blood pressure, helps control requiring more doctor visits and hospitalizations. body weight, and protects against many diseases. Smoking can lower the level of protective antioxiIt promotes circulation, which allows immune dants in the blood. If you don’t smoke, don’t start. cells to work more efficiently, and may have an an- If you are a smoker, talk with your doctor about ti-inflammatory effect. It is also known to reduce options for quitting. You can also call 1-800-QUITstress and anxiety. The general recommendation NOW or visit WayToQuit.org for free resources. is about 30 minutes a day for five days a week, ALCOHOL – Since the body can’t store alcohol, mewhich can easily be done with regular brisk walks. tabolizing it becomes a priority which interrupts SLEEP – Adequate sleep is imperative for a proper- other normal processes. Excess alcohol not only ly functioning immune system. Without sufficient weakens the immune system, but can also cause sleep, the body produces fewer cytokines – a type liver disease, cardiomyopathy (weak heart), panof protein that targets infection and inflammation. creatitis (inflammation of the pancreas), and inIt is also during deep sleep that the body works to crease the risk of some cancers. According to the repair muscles, organs, and other cells. For most Mayo Clinic, no amount of alcohol is risk-free. adults, 7-8 hours of sleep per night is optimal. Research shows that people who don’t get enough There’s no magic shield to protect us from every sleep (less than 6 hours) are more likely to get sick harmful thing that comes our way, but optimizing after being exposed to a virus and take longer to these factors in your favor, practicing good perrecover from illness. Long-term sleep deprivation sonal hygiene, and keeping up to date on vaccines can also increase the risk of obesity, diabetes, and can help keep your body primed to fight infection and disease. cardiovascular disease.
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BASICS Although there is still much we don’t know about COVID-19, here are some of the basics we’ve learned so far, based on information from the Utah Department of Health (UDOH) and the Centers for Disease Control (CDC)
WHAT IS COVID-19?
COVID-19 (CoronaVirus Disease 2019) is a new strain of coronavirus that causes a respiratory illness ranging from mild flu-like symptoms to severe pneumonia. The symptoms of COVID-19 include fever, cough, shortness of breath, headache, muscle aches, sore throat, and a decrease in smell or taste. Symptoms of COVID-19 may appear 2-14 days after exposure. Most people with COVID-19 will have mild to moderate symptoms. Those most likely to suffer severe illness are people older than age 60 and those with medical conditions like heart and lung disease or diabetes. Children and adolescents appear to be less likely to experience severe illness. Some people
who get infected will have no symptoms at all.
HOW IS COVID-19 SPREAD?
The virus is thought to spread mainly from person to person, mostly through respiratory droplets produced when an infected person coughs, sneezes, or talks. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Spread is most likely when people are in close contact with one another (within about 6 feet).
HOW LONG DOES COVID-19 SURVIVE ON SURFACES?
Studies show the virus that causes COVID-19 may last on surfaces for up to 72 hours depending on the surface. That's why it is so important to not
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touch your face, clean and disinfect surfaces and objects that are touched often, and wash your hands with soap and water or use an alcohol-based hand sanitizer. However, surface contact is not thought to be the main way the virus spreads.
DO YOU HAVE IMMUNITY ONCE YOU GET COVID-19?
There is much we don't know about COVID-19, including how much immunity a person will have after being infected with the virus.
CAN I GET COVID-19 FROM FOOD, WHAT IF I GET EXPOSED TO COVID-19? WATER, PETS, OR IMPORTED GOODS? Being exposed means having close conThere is no evidence that COVID-19 can be spread to humans through food, drinking water, pools, hot tubs, or imported goods/ packages. Although a small number of pets have been reported as infected with the virus (likely from people), the risk of infection from pets to people is considered low.
WHAT ABOUT PREGNANCY AND NEWBORNS? Pregnant women might be at increased risk for severe illness from COVID-19, so they should make sure to get adequate prenatal care and discuss any concerns with a healthcare provider. Newborns can be infected with COVID-19 after being in close contact with an infected person, but severe illness at that age has been rare. Breast milk provides protection against many illnesses and is the best source of nutrition for most infants. It is not likely that breastfeeding passes the virus from an infected mother to her child.
ARE THERE ANY MEDICINES TO PREVENT OR TREAT COVID-19? Scientists are working to develop a vaccine and are conducting studies to determine if medications already on the market could be effective in treating COVID-19. Most people get better on their own and treat symptoms by drinking lots of fluids, getting plenty of rest, and using over-the-counter medications.
tact (within 6 feet) with someone who has COVID-19 for 15 minutes or longer. You’ll be asked to quarantine for 14 days if that happens, although exceptions are made for essential workers, services, and activities, using extra precautions. Public health departments do contact tracing when someone tests positive for COVID-19. They will contact every person they feel may have been exposed to the virus. If they don't contact you, it means you were most likely not exposed.
HOW CAN I GET TESTED?
You can get tested for COVID-19 if you have any of these symptoms: fever, cough, shortness of breath, headache, muscle aches, sore throat, or a decrease in smell or taste. Contact your doctor or the phone number listed below for the nearest testing location: ST. GEORGE: Intermountain 400 E. Campus (call 844-442-5224) ST. GEORGE: Test Utah Site (complete screening at testutah.com) CEDAR CITY: Instacare (call 844-442-5224) KANAB: Kane County Hospital (call 435-6445811, Dr.’s order required) BEAVER: Beaver Valley Hospital (call 435438-7100) MILFORD: Milford Valley Memorial Hospital (call 435-387-2411) PANGUITCH: Garfield Memorial Hospital (call 844-442-5224) ESCALANTE: Kazan Memorial Clinic (call 435-826-4374)
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You may also be approved for testing if you were exposed but don’t have symptoms, although you may be asked to wait several days after exposure to do so, which reduces the chances of a false negative. The COVID-19 PCR test uses a thin swab that is inserted into the nasal cavity to get the sample, which is then sent to the state lab for processing. You will be notified of results within 2-5 days and should quarantine in the meantime. Insurance usually covers the testing and there is no charge if you are uninsured. A newer method called “antigen” testing, which can give results in minutes, should be more available in the near future.
tine protects others in case you might be infectious until enough time has passed to know either way). If you are sick or test positive for COVID-19, you should: • Stay home unless you need medical care. • Try to stay in a different room and use a different bathroom than other people in your house. If this is not possible, stay at least 6 feet away from other people and wear a mask. • Clean surfaces that are touched often. • Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze. • Wash your hands with soap and WHAT IS ANTIBODY TESTING? water right after you cough, sneeze, or blow your nose. If you do not Antibody (or serum) testing is a blood have soap or water, you can use an test that may be able to indicate if you alcohol-based hand sanitizer. were exposed to COVID-19 in the past. A positive result does not guarantee immunity and they are not al- WHAT IS SOCIAL DISTANCING? ways accurate. Antibody testing is Social distancing is vital during a panmainly used for research purposes. demic because it slows the spread of COVID-19. Avoiding crowds protects WHAT IF I GET SICK OR TEST you and your family. Try to stay at POSITIVE? least 6 feet away from people outside If you tested positive and had symp- your household. toms you should stay isolated from other people until you have been fe- WHAT ABOUT WEARING A ver-free and your symptoms are gone MASK? for at least 3 days and it has been at It is recommended that you wear a least 10 days since you first got sick. face covering (that has at least two If you tested positive but never had layers) in public settings where people symptoms, you can stop self-isolation are present, especially when there is 10 days after you tested positive. Ev- the possibility of being within 6 feet of eryone who lives in your house should others, mainly to help protect others in quarantine for 14 days after they were case you are infected. Recently, a team last around you (self-isolation protects of researchers from Brigham Young others if you are positive/sick but not University reviewed over 115 indeill enough to be hospitalized; quaran- pendent studies on the science behind
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face coverings related to COVID-19. Here is the executive summary of their findings: 1. In the first few months of the pandemic, there was scientific uncertainty about the usefulness of public masking. Conflicting guidance was given by several official sources. 2. There is now convincing evidence from multiple controlled experiments and field observations that wearing masks reduces the transmission of COVID-19 for healthcare workers and the public. Most of this evidence is COVID-19 specific and has emerged in the past few months. 3. Masks prevent infected people from spreading the virus to others by trapping the respiratory droplets (tiny moisture particles) that are produced when we cough, speak, and breathe. Cloth masks can stop 90% or more of the dispersal of droplets carrying the virus. There is some evidence that cloth masks also protect the wearer from infection, though this is less certain. 4. Masks are highly safe, with only minor and uncommon side effects. In addition to many medical studies, public masking has been proven safe among children, adults, and the elderly in cultures where this practice has long been common. However, some sensitive individuals should not wear masks, such as those with severely compromised respiratory systems and individuals who cannot remove or adjust their own masks
(children under 2 and people with severe disabilities). 5. Researchers from hospitals, universities, the private sector, and government agencies have concluded that masks could be one of the most powerful and cost-effective tools to stop COVID-19 and accelerate the economic recovery. There is universal agreement, however, that masking alone will not be enough to stop the pandemic. Masking is most effective when combined with physical distancing, frequent hand-washing, rapid testing, and coordinated contact tracing. (Used with permission. Link to original study: pws.byu.edu/covid19-and-masks)
WHERE DO I FIND RELIABLE INFORMATION ABOUT COVID-19?
Many rumors related to COVID-19 circulating on social media are false or contain misinformation. Reputable health organizations are a good source of information, including the following:
SOUTHWEST UTAH PUBLIC HEALTH DEPARTMENT: daily updates
on local cases and trends can be found at swuhealth.org and on Facebook at swuhealth.
UTAH DEPARTMENT OF HEALTH:
statewide data with current updates and guidelines (coronavirus.utah. gov).
CENTERS FOR DISEASE CONTROL & PREVENTION (CDC): National data and
updated information on all aspects of the pandemic (cdc.gov/coronavirus)
WORLD HEALTH ORGANIZATION (WHO): Global status of the pandemic (covid19.who.int)
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Fight stress and find serenity BY ANNA ENGLAND, GUEST COLUMNIST o those who haven’t tried yoga, it may be hard to understand why anyone would want to give it a shot. If you have avoided yoga under the notion that it’s just light stretching, a religious practice, or “not real exercise,” then you’re missing out! WHAT IS YOGA? As far back as 6000 years ago, yoga was used as a spiritual practice. More recently however, yoga has evolved into a form of exercise laden with well-known health benefits. Coming from the Sanskrit word for “union,” yoga is an attempt to balance the mind and the body with one’s own breathing by using a series of controlled poses. These poses are used to increase strength and flexibility while breathing techniques are used to keep control over the body and quiet the mind. Although it may seem a little complicated, a good instructor ensures that each person knows
the next pose before they transition into it and that they are doing it correctly. Yoga follows the philosophy that exceeding personal limits may lead to injury. Perhaps one of the most interesting aspects of yoga is its adaptability. For example, if a pose becomes uncomfortable, it is perfectly acceptable to alter it or omit it completely. It is one thing to have a pose be challenging, but it is quite another for it to be painful. For this reason, yoga is quite suitable for individuals of all shapes, sizes, ages, and genders. However, as with any form of exercise, it is important to check with your doctor if you have any medical conditions, or if you are pregnant, as some yoga postures may pose a risk. WHAT ARE THE BENEFITS OF YOGA? Yoga has a wide array of health benefits and is often recommended as a form of therapy for multiple medical conditions.
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According to the university of Maryland Medical Center, practicing yoga may help with the following conditions: • Anxiety and stress • Arthritis • Asthma • Cancer (reduces stress and strengthens immunity) • Carpal tunnel syndrome • Chronic back pain • Diabetes • Heart disease (when combined with a healthy diet) • High blood pressure • Hormonal imbalance • Irritable bowel syndrome • Migraine headaches • Pregnancy The Mayo Clinic points out that yoga can help maintain a healthy weight and can even be used for weight loss when paired with additional aerobic exercise. They go on to say that yoga can improve “balance, flexibility, range of motion, and strength,” and brings about a relaxed state. Other sources say that additional benefits include increased cardiovascular fitness, circulation, and improved digestion. HOW DO I GET STARTED? Getting started with yoga is as simple as putting on some comfortable clothes and purchasing a yoga mat. Yoga is performed without shoes and socks so there is no need for fancy footwear! Most com-
munity recreation centers are very low cost and may even include a mat you can use, but be sure to bring sanitizing wipes to guarantee that you’re using germ-free equipment. Here are some tips I’ve learned over the years that have made my yoga classes more enjoyable: • Wear stretchy pants with a high-rise fit. You wont care what you look like the second you realize that they don’t ride down and you have full range of motion. • Wear a fairly form-fitting shirt and don’t wear necklaces. The first time you need to bend down to touch your toes or hang upside-down you’ll understand why. • Wear a hair restraint; a simple hair elastic or headband will work wonders to keep your hair out of your face. WHAT ARE OTHER WAYS I CAN PRACTICE YOGA? For those who prefer to forgo the group setting, there are other options to fit your needs thanks to DVDs or online videos, instructional books, and card decks. Yoga is an amazing form of exercise suitable for anyone. Once you see how beneficial an adaptable yoga can be, you’ll wonder why you haven't tried it sooner. Next time a yoga class is offered, don’t pass it up… you just might be pleasantly surprised at what you discover.
WANT TO GIVE YOGA A TRY FROM HOME? Check out Yoga With Adriene on YouTube; she offers hundreds of free yoga classes and has over 8 million subscribers!
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I TESTED
Three local residents share what it’s like to have COVID-19 On Thursday, June 11th I started to get a sore throat. On Friday by midday I had a fever, chills, body aches, and the sore throat was getting extremely bad. I went to a testing center and was tested. As Saturday and Sunday rolled on, the symptoms got worse. Sunday night my fever broke and I started to feel better. On Wednesday, June 17 the test results came back positive. The health department called to recommend isolation, which I had already been doing, and asked if I had been around anyone who had tested positive. I figured it had to be from a store or a restaurant. I had not been wearing a mask very often but I was good about washing my hands and trying to not touch my face. They also needed to make sure anyone I had been in close contact with was notified to quarantine for 14 days. On June 23, after finding I had no symptoms for the past 3 days, the health department released me from quarantine. Within two days I started to have body aches and a fever appeared that night. On Friday, June 26th I didn’t have any symptoms but I took a rapid test requested by my physical therapist and found I was still positive. On Saturday, June 27th my sore throat started to reappear. The next day I had body aches and a fever. On Monday night I had a massive fever which broke early in the morning. On Tuesday my sore throat was worse and the body aches, fever, chills, headaches were back. By Friday my symptoms slowly improved. After July 6th I have not had any symptoms other than the lingering cough which I was told may last for several weeks.
-Del
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My husband and I started having horrible headaches around June 26th. On June 29th he started feeling extremely tired and felt like he’d been hit by a bus. Then he started throwing up. We were camping so we thought it was just heat exhaustion. We got home late that night and he felt tired but not as sick. He went to work the next day feeling pretty good. I woke up feeling like there was something wrapped around my chest but felt great. My 11 year old woke up with a dry cough. I still didn’t have Covid-19 in my mind. My friend posted on Facebook that she had just tested positive and her symptoms were the same as my husbands! I instantly thought “oh no”. Seconds later my husband walked in the door and said he was sent home and had to get tested for COVID-19. We decided to get the three of us tested and drove to the testing sight at the old hospital. We waited in line for about 20 minutes before each had the nasal swab test. Ouch, that thing burns! By that evening I was sick with fever, chills, body aches, major fatigue, headache, and I felt like I had just run a long distance when all I was doing was laying there! My husband had a headache, fatigue, and diarrhea. Three of our five kids started showing a combination of symptoms. The next day we got positive results for my husband and I. My 11 year old was negative but the health department told us to treat her as if she were positive. As far as the isolation went, my kids hadn’t really been out in public so it wasn’t really different for them. My husband was able to get some projects done for me, so I thought that part of quarantine was wonderful! He didn’t like it as much; it was hard for him to not be out helping customers. I couldn’t do anything or go anywhere because I was so sick, and it was hard asking for help to pick up groceries. It was also a constant battle of up and down emotions for me, and all the different opinions about COVID-19 going around didn’t help. My husband recovered after 7 days. My 4 kids who were sick had symptoms that lasted for 5-10 days. I was very sick for 16 days and had a tightness in my chest- at times my oxygen would dip in the low 80’s and cause a panic attack that made breathing even harder. I also had extreme fatigue and exhaustion, which was very frustrating for a mom of 5 kids! On day 16 I called the health department and told them that my only symptom was fatigue and they said I could end isolation. Unfortunately, the fatigue and exhaustion lasted about 30 days. I feel like I am finally starting to feel back to normal.
-Morgan
I was asked by my employer to get tested on June 8th for COVID-19 because a coworker’s family had tested positive. I was surprised when the result was positive! I had been feeling fine but noticed some congestion and body aches for about three days as I started my isolation period, although I thought it might be allergies and sore muscles from working out. I had been in close contact with my wife when I could have been contagious but she never got sick and had two negative tests. I secluded myself in a separate room at home for ten days. The first two days weren’t bad but after that I could see why humans weren’t meant to be alone. It was hard but I wanted to do my part to keep others safe. I was mostly asymptomatic and am feeling good now, although I do notice a little tightness or pressure in my chest on occasion.
-Cameron
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STRIDES IN MEDICAL
The world health community takes on a new pandemic BY JOHN D. LOIKE & SALOMON AMAR Guest Columnists from 'The Scientist' magazine
hile scientific misinformation from social media and from high-profile published papers has spread like wildfire in these past four months, there has also been an astoundingly rapid dissemination of validated scientific research published since the first case of COVID-19 was reported. Under normal conditions, scientific research is meant to be a slow, peer-reviewed, and calculated process of developing and testing a hypothesis, reporting the answers, and, finally, waiting for the scientific community to corroborate or disprove the findings. We are experiencing unprecedented times, and the scientific community has stepped up to address this pandemic.
measure the level of antibody titers that should protect individuals from infections; 4) testing treatments and cures; and 5) conducting clinical trials of vaccines.
In an incredibly short time, scientists at research universities and biotech companies have achieved remarkable successes regarding the first three milestones and have made impressive achievements in the latter two milestones that will hopefully lead to cures and vaccines. Despite the parallel dissemination of scientific misinformation, this progress is still a testament to the machinery of science and the passion of scientists. Comparing the timelines of COVID-19 accomplishments to those of There are many critical research milestones previous RNA virus pandemics highlights just that have been either achieved or in active how rapidly research has moved. development and reported in thousands of papers published about the coronavirus pan- For example, acquired immune deficiency syndemic. These include: 1) deciphering the ge- drome (AIDS) was a term first used by the US netic code of the virus and how it infects cells; Center for Disease Control on September 24, 2) developing accurate assays to detect the vi- 1982, almost 18 months after the first cited rerus in people; 3) developing accurate assays to port (June 5, 1981) of five AIDS patients. And
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it wasn’t until 1984—almost four years after the first the potential efficacy of treatments in randomized case—when Pasteur Institute and National Institutes or open-label clinical trials. The FDA issued its first of Health scientists independently reported the dis- emergency use authorization (EUA) of a real time covery of a retrovirus (HIV) that caused AIDS. Two RT-PCR diagnostic test in early February. There are years after that, the US Food and Drug Administra- now scores of RT-PCR assays with high accuracy and tion (FDA) licensed the first commercial blood test few false-positives with other human coronaviruses to detect HIV. A year later, in March 1987, the FDA or common respiratory pathogens.The FDA issued approved the first anti-retroviral drug for AIDS, zi- the an EUA to Abbott for an assay to detect antiboddovudine (AZT), in a record 20 months. Finally, the ies against this virus in March, and now lists more first clinical trial for a vaccine began in August 1987, than a dozen serology tests given EUA. and VaxGen launched Vaccine development the large-scale trial in for COVID-19 has been THE RAPID PROGRESS TO ACHIEVE SCIEN1998. These clinical trials similarly rapid and rofailed, leading this nowTIFIC MILESTONES IS BEING SEEN IN REAL bust, with dozens of merged company (DiaTIME WITH COVID-19. companies and collabdexus Inc.) to bankruptorators developing and cy in 2016. To date, there trialing both conventionare only a few ongoing al and innovative technologies. Traditional methods clinical vaccine studies, but no FDA-approved HIV include designing a vaccine with an inactive or atvaccines. tenuated virus that will not infect the recipient but the immune system to prevent viral infectivity. By comparison, scientific milestones were signifi- trains New technologies include one that introduces a mescantly accelerated in response to the SARS epidemic senger RNA into an individual so that it can direct of 2003. On November 16, 2002, the first case of atyp- cells to make critical COVID-19 viral proteins that ical pneumonia, probably caused by the SARS-CoV are viewed by the immune system as “foreign” and virus, was reported in southern China. Less than five enable the body to build effective immunity. This months later, the US Centers for Disease Control and approach, used by Moderna in partnership with Prevention published the genetic sequence of SARS- the National Institute of Allergy and Infectious DisCoV. By May and December 2003, two articles in eases (NIAID), has not been used in any approved the New England Journal of Medicine described the vaccines to date. On May 22, 2020, NIAID Director application of real-time reverse transcriptase PCR Anthony Fauci said it’s still possible that a coronavi(RT-PCR) to accurately detect SARS-CoV in human rus vaccine using classical or innovative technologies blood or tissue. Real-time RT-PCR is a very fast and will be available in the US by December. There are precise method to amplify viral RNA that quantifies now more than 100 potential vaccines in clinical triviral particles in human biological samples (that is, als running at an unprecedented pace. blood or a nasal swab), and it is extensively used in the COVID-19 pandemic. Still, the response to the The rapid pace of publishing scientific preprints SARS outbreak did not deliver the milestones we’ve and peer-reviewed articles during this pandemic is seen in just a few short months with COVID-19. bound to result in some mistakes from inaccurate or poor analyses, but this casualty is worth it in Currently, there is no medication that is known to data light of the astonishing progress that has been made effectively treat SARS. Treatment is only supportive. and will continue to be made in the face of this global In part because the SARS pandemic subsided within threat. History has shown that the scientific commua few years, there are no listed clinical trials for SARS nity takes full advantage of peer review, collaboraand no FDA-approved vaccine for this virus. tions, confirmatory studies from other scientists, and The rapid progress to achieve scientific milestones self-assessment to correct scientific mistakes. The is being seen in real time with COVID-19. On Dec rapid pace of scientific research in its ongoing search 31, 2019, China reported a cluster of cases of pneu- for truth is not perfect, but the accelerated response monia in people at Wuhan, Hubei Province that lat- has great merit and potential to be used for current er became known as SARS-CoV-2. Less than two and future pandemics. weeks later, on January 12, the first genomic char- Original article: J. D. Loike and S. Amar, “Opinion: Don’t Disacterization of the virus was reported. Across the parage the Pace of COVID-19 Research,” The Scientist, the-sciglobe scientists quickly launched trials to examine entist.com, June 22, 2020. Used with permission.
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R E S T A U R A N T S Dining out can be healthy and delicious
BY BAILEE WILLIAMS SWUPHD Health Educator
ameron Payne, owner of Twisted Noodle Café in St. George, Utah, is showing his community that dining out can include delicious healthy options. After working for the Biggest Loser reality show for eight years, Cameron realized that St. George was a hub for active lifestyles but there weren’t a lot of options for healthy eating. He wanted to create a place where people could enjoy good food that would be delicious, nutritious, and wouldn’t leave them with that full, weighed down feeling. Five years later, Twisted Noodle Café is a prime example of
that vision, and now many others are showing that dining out does not mean unhealthy eating. That is why the Southwest Utah Public Health Department created the Healthy Habits Restaurant Recognition Program. This program rates restaurants in the St. George area on the health value of their menu options, including calories, fat content, preparation, whole grain options, and allergy-friendly alternatives. In 2019, seven winners were awarded the gold, silver, or bronze level out of 22 applicants, with Twisted Noodle
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Café earning the gold level. These restaurants display the qualities mentioned above. Give them a try and look for our Healthy Habits seal of approval in their window. Restaurants interested in applying for the 2020 Healthy Habits award can contact Alecia Ledward at aledward@swuhealth.org.
SUBSTITUTE YOUR GRAINS The carbohydrates in grains can add up! Some restaurants even offer lettuce wraps as a substitute for bread. Some menus display this option, but if they don’t it never hurts to ask. You can also optimize your grains by choosing whole grain rice, bread, or pasta.
HEALTHY TIPS FOR EATING OUT
EVALUATE YOUR SIDE OPTIONS What side options are you choosing when you dine out? Do you lean toward the French fries, chips, and bread, or a side salad or bowl of fruit? Maybe next time, when asked what side you want, stop and think “What would be the best choice? How would this affect my calorie count? Is this helping me get a balanced amount of food groups in my diet?” Choosing a side salad or fruit instead of the bag of chips might be less appealing at first but in the end you will be happy you made that healthy choice.
KEEP TRACK OF YOUR CALORIES Calories can add up, especially when dining out. It might seem like no big deal ordering a cheeseburger, fries, and a coke, but there goes over 1,000 calories - half of the recommended daily total. When you are calorie conscious and look at the nutritional value of what you eat, you become more aware of what is going into your body. Maybe you get a meal that is less calories or eat half and save the rest for later. HOW IS THE FOOD PREPARED? Is the food you are going to order fried (often called “crispy”) or can you get it grilled, steamed, or baked? This can make a big difference in the nutritional value of what you are ordering.
DRESSINGS AND CONDIMENTS: get them on the side. Ever ask for your dressing on the side? It's second nature just to expect dressing and condiments to be served on your food, but that doesn’t allow you to decide how much you really need. You might enjoy the meal with less sauce.
2019
TWISTED NOODLE, VIVA CHICKEN, TWENTYFIVE MAIN, PORT OF SUBS, CHICK-FIL-A, MAD PITA EXPRESS, GEORGE'S CORNER RESTAURANT
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FOR COVID-19 IN SOUTHERN UTAH "The data is going to inform us. We aren't going to be governed by fear or politics." -Governor Gary Herbert Utah’s forward progress against COVID-19 won’t be instant like flipping a switch. It’ll be more like gradually moving a dial. A color-coded health guidance system has been developed to guide health behaviors for individuals and businesses. Each level of the dial is guided by a measurement system which can be different by each county. Higher-risk individuals operate under stricter instructions because they are more likely to suffer severe illness from COVID-19.
AS OF JULY 2020, SOUTHWEST UTAH’S STATUS IS: Washington & Iron counties: YELLOW Kane, Beaver, & Garfield counties: GREEN visit swuhealth.org/covid to see the guidelines for each color
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PHYSICAL DISTANCE
6 FEET APART
PROTECT OTHERS
WEAR A MASK
WASH HANDS OFTEN
20 SECONDS
IF YOU'RE SICK
STAY HOME
These precautions help keep our hospitals from being overwhelmed and protect our vulnerable neighbors and family members (people over 60 and those with underlying health conditions)
ALL BUSINESSES ARE OPEN!
Use this guide to provide a safe environment for customers (look for the COVID-19 Business Guide link at swuhealth.org/covid)
SCHOOL IS BACK IN SESSION!
Here are the plans to keep kids and teachers safe (look for the COVID-19 School Guide link at swuhealth.org/covid)
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2 019 A N N U A L R E P O R T B OA R D O F H E A LT H Commissioner Gil Almquist » w ash ing ton count y
D r. S t e ve n Va n N o r m a n
» w ash ing ton
count y
Commissioner Pa u l Cozzens » i r on cou nty
D r. C l a y t o n Pe t t y » iron count y
Commissioner Lamont Smith » kane count y
Ro s a l i n d Metcalf
» k a ne
cou nty
Commissioner Mike Dalton » b e ave r count y
S c ot t Symond
» b e ave r
count y
Commissioner Jerry Ta y l o r » g ar fi eld cou nty
The Southwest Utah Public Health Department (SWUPHD) serves the nearly 244,000 residents of Washington, Iron, Kane, Beaver, and Garfield counties. Our mission is to protect the community's health through the promotion of wellness and the prevention of disease.
SERVING OUR COMMUNITY NURSING SERVICES • Immunizations administered: 12,772 • International travel consults: 3,208 • Health Screenings: 668 • TB (Tuberculosis) screening: 2,064 • WIC (Women, Infants, & Children) clients: 3,105 • Community immunization clinics: 76 • Maternal child health services: 1,994 • Epidemiology investigation contacts: 4,391 • Birth & Death certificates issued: 7,279
ENVIRONMENTAL HEALTH • Total food service inspections and consultations: 4,768 • Food Handler Cards issued: 8,671 • Water samples analyzed (for swimming pools and drinking water facilities): 6,294 • Public pools & spas in district: 750 • Restaurants/food establishments in district: 1,014 • Total septic system inspections and consultations: 6,689
EMERGENCY PREPAREDNESS • MRC (Medical Reserve Corps) registered volunteers: 457 • Trainings held: 79 (2,750 participants) • Full-scale Strategic National Stockpile/Medical Counter Measure Exercise with 42 partner organizations, with administration of 3,042 vaccines • Events held (exercises/drills, trainings, etc.): 276 (7,804 participants) • Access & Functional Needs Coalition members: 260
HEALTH PROMOTION • Certified car seat installation checks: 214 • Residents completing online courses: 7,650 • Retailer tobacco compliance checks: 372 (91% compliance) • Funded active transportation committees in St. George, Washington City, and Cedar City • Helped advocate for the installation of 2 bike lanes in St. George • Helped secure $450,000 to build a bike/walk lane on a dangerous school route
REVENUE County Contributions: 27% Other: 1% Contracts/Grants: 42%
Nick Re y n o l d s
» g ar f ield
Fees: 30%
count y
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2019 FRIENDS OF PUBLIC HEALTH Every year, the SWUPHD selects three members of the community who have demonstrated exceptional support and service to the field of public health.
Pictured from left to right: Peter Kuhlmann, David Blodgett, MD, MPH (SWUPHD Health Officer), Mayor Jon Pike Not pictured: Kenneth Elmer.
Former Washington County Emergency Manager
PETER KUHLMANN
JON PIKE
Mayor of St. George City
KENNETH ELMER
Pete Kuhlmann retired in 2019 after nine years serving as Washington County’s Emergency Manager. With a background as a sheriff’s deputy and fire chief, Pete was known as a disaster response guru who provided leadership and direction during flooding and wildland fires. He was a great team player with partner agencies and his presence in the Emergency Operations Center was appreciated during drill exercises or actual events. Pete encouraged both community and individual preparedness and responsibility.
For the past 12 years, Mayor Pike has championed the development of city facilities that help residents get physically active. If you enjoy walking or biking on the trail system or using the parks and recreation facilities St. George has to offer, you are seeing the influence of Mayor Pike’s vision for our community.
Ken Elmer retired after serving 27 years as a member of the Southwest Utah Board of Health, representing Beaver County. His time as a board member was marked by dedicated attendance, wisdom, and strategic thought. Ken will be missed, his institutional knowledge will be irreplaceable, as will his gentle yet effective matter in sharing what he was passionate about; the health of the community he served. Thank you, Ken, for your service as a member of our board of health.
Mayor Pike prioritizes active transportation and has also been a champion of youth drug and suicide prevention. He has worked with our youth coalition to change some key city policies related to tobacco-free parks and bus stops.
Former Board of Health Member
BEST OF STATE HEALTH Magazine won its third Best of State medal in the Visual Arts - Publication category, awarded at the June 2019 gala.
Pictured from left to right: David Heaton (Editor/SWUPHD PIO), Kindal Ridd (Designer/SWUPHD Media Specialist), Jeff Shumway (Publisher/SWUPHD Business Manager) SWUHEALTH.ORG | PAGE 29
S O U T H W E ST U TA H P U B L I C H E A L T H D E PA R T M E N T SWUHEALTH.ORG WHAT IS THE ROLE OF THE HEALTH DEPARTMENT IN MY COMMUNITY? OUR MISSION IS TO PROTECT THE COMMUNITY'S HEALTH THROUGH THE PROMOTION OF WELLNESS AND THE PREVENTION OF DISEASE.
WHERE IS MY COUNTY'S HEALTH DEPARTMENT LOCATED? BEAVER: 75 W 1175 N. Beaver, Utah 84713, 435-438-2482 Garfield: 601 E Center, Panguitch, Utah 84759, 435-676-8800 Iron: 260 E DL Sargent DR. Cedar City, Utah 84721, 435-586-2437 Kane: 445 North Main, Kanab, Utah 84741, 435-644-2537 Washington: 620 S 400 E. St. George, Utah 84770, 435-673-3528
I HAVE QUESTIONS OR COMMENTS REGARDING 'HEALTH' MAGAZINE: EMAIL INFO@SWUHEALTH.ORG
AT LEAST THERE'S A VACCINE FOR THE FLU!
SAVE THE DATE! 2020 FLU SHOOTOUT SEPT 22 (8AM-12PM) WASHINGTON COUNTY FAIRGROUNDS (WALK IN) SEPT 29 (8AM-12PM) ST. GEORGE-RED CLIFFS MALL (DRIVE-THRU) OCT 3 (9AM-12PM) CEDAR CITY (LOCATION TBD) OCT 10 (9AM-12PM) KANAB MIDDLE SCHOOL (DRIVE-THRU/WALK-IN) OCT 15 (12-4PM) PANGUITCH (LOCATION TBD) BEAVER (DATE AND LOCATION TBD) CHECK SWUHEALTH.ORG/FLU FOR UPDATES
Eye Spy Coloring Page VISIT SWUHEALTH.ORG/FREE-COLORING-PAGE TO PRINT
CAN YOU FIND THE ITEMS THAT WENT MISSING DURING THE COVID-19 PANDEMIC?
five toilet paper rolls hand sanitizer mask bike milk jug brain school bell
The entire contents of this publication are Copyright ©2018 HEALTH (the magazine of the Southwest Utah Public Health Foundation) with all rights reserved and shall not be reproduced or transmitted in any manner, either in whole or in part, without prior written permission of the publisher. Health magazine hereby disclaims all liability and is not responsible for any damage suffered as the result of claims or representations made in this publication. Printed by Hudson Printing Company / Salt Lake City, Utah / hudsonprinting.com
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