Harnett County Board of Health Minutes of Regular Meeting September 16, 2021  The Harnett County Board of Health met in regular session on Thursday, September 16, 2021 in the Health Department Board Room, Harnett County Governmental Complex, 307 W. Cornelius Harnett Blvd., Lillington, North Carolina. A virtual Board of Health meeting using audio conference call was held for the September 16, 2021 meeting. Due to COVID-19 the Board of Health meeting was not open to members of the public to attend in person however, citizens were provided options to listen to the meeting. Only Public Health staff necessary to conduct the meeting or to speak on scheduled agenda items were in attendance. As the Board demonstrated compliance Members present by conference call: Ms. Amy Allen, RN, Vite-Chairwoman, Dr. Amanda Langdon, DVM, Ms. Barbara McKoy, Ms. Stacie Hogan, RPH, Ms. Linda Sturdivant, Dr. Kim Fowler, PhD, Dr. Catherine Evans, DDS and Ms. Emily Barefoot. Members present: Dr. Laura Smith, Chairwoman and Mr. John Rouse, Jr., Health Others present: Mary Jane Sauls, Oliver Tolksdorf, Debra Harris-Hawkins, Melissa  with State law and prudent public health practices.  Director.  McLamb, Gail Hobbs and Natasha Johnson.  Chairwoman Smith called meeting to order at 7:00 p.m.  Announcements = Mr. Rouse reported for the meeting tonight Melissa McLamb, Physician Extender III is filling in for Ainsley Johnson, Public Health Nursing Director Consent Agenda - Minutes - Motion made by Ms. Amy Allen, RN for the July 15, 2021 minutes to be approved as presented and seconded by Ms. Emily Barefoot. Consider additions and deletions to the published agenda - None made. Public Comment - Period of up to 30 minutes for informal comments allowing 3 minutes for each presentation - Chairwoman Smith opened the floor for informal comments by the public, allowing 3 minutes for each presentation up to 30 minutes. Citizens were allowed to call in and provide their public comments verbally during this period. No one called in and no public comments were received. Chairwoman Smith  II.  Motion Carried.  closed the informal comments.    Page 2 Board of Health September 16, 2021  Harnett County Health Department Board Room  Nomination Committee = Chairwoman Smith appointed Ms. Emily Barefoot as Committee Chair, and Ms. Amy. Allen as Committee Member to serve on the Nominating Committee. The committee will report at the next regular meeting in November 2021 Debt Setoff - Gail Hobbs reported we have received an additional $197.99 since the last Board of Health meeting in July. The total amount of Debt Setoff money received  and at the January 2022 meeting, the officers will be nominated.  year to date is $4,819.47.  Accreditation Activities Report - John Rouse, Jr.  Review of Operating Procedures Mr. Rouse reviewed and presented the Operating Procedures with the Board through handouts provided in the member's packets. There were no recommended changes. Mr. Rouse reviewed the Rule Making/Procedures and Authority section, the Board of Health has not had a need for any ordinances or local ruling since the last Operating Procedure review on September 24, 2020. Mr. Rouse related that we will have the Chair Communicable Disease Report - Melissa McLamb provided incidence data of confirmed disease cases using the North Carolina Electronic Disease Surveillance System (NCEDSS). Handouts of chart slides were provided in member's packets with data ranges from July 1, 2020 through December 31, 2020 and from January 1, 2021 through June 30, 2021. Currently the Health Department has six nurses who divide and work Communicable Disease cases. The first slide reviewed gastrointestinal, vector-borne and tuberculosis (TB) cases. Salmonella had 30 cases in the last year. In the prior year, July 2019- June 2020 there were 38 confirmed cases with a decrease of this reportable disease. Health education staff promote food safety by educating the public through news articles and website postings regarding food preparation. Environmental Health continues to inspect and ensure proper food handling in Harnett County establishments. Tuberculosis cases have increased this year from last year. In 2020, Harnett County did not have any cases with currently having one case in 2021. This current case is receiving Direct Observational therapy (DOT), and requires a: nurse to physically observe the client take TB medications for a specified amount of time. Referring to the second slide for Hepatitis information. Harnett County had one case of Hepatitis A in year previous and reported one case; this rate has remained the same.  sign the Operating Procedures yearly on a signature log.    Page 3 Board of Health September 16, 2021  Harnett County Health Department Board Room  The Health Department reported two Acute Hepatitis B this year and this has decreased from the year prior with three cases. This year we report four Chronic Hepatitis B cases and we previously had zero Acute Hepatitis C that is down from last year where we had one case. We had 106 Chronic Hepatitis C cases have been reported which is an increase from 83 cases. Plans are in place to resume Hepatitis A vaccination outreach in county detention center and county treatment centers. Hepatitis B and Hepatitis C testing are available for Medicaid eligible or uninsured patients who meet high-risk criteria. Pregnant Women who are high risk are offered testing twice during their pregnancy. Referring to slide three to review Sexually Transmitted Infection (STI) and Human mmunodeticiency Viruses (HIV) data for this past year there was an overall increase in all STD cases. This year Chlamydia was reported at 782 cases, and last year Chlamydia rates for Harnett County were 730. Gonorrhea for this quarter has increased with an annual number of 295 cases, and in comparison with last year's number of 290 cases were reported. Syphilis has the most increase of all STIs listed. In the first half of the year, eight cases were reported and the second half 22 cases were reported, totaling 30 cases for this period. The Health Department continues to see an increase in Syphilis cases. Last year 18 cases were reported for the entire year of July 1, 2019 through June 30, 2020. Due to the increase, the Harnett County Health Department had a strategic meeting with North Carolina Department of Health and Human Services (NC DHHS) Medical Consultant Dr. Mobley and the NC Communicable Disease Branch. The Health Department has set action items that lead to an increase in case investigations, seamless communication pathways between DIS and LHD and efforts to identify community-based organizations that can assist with screening/preventon efforts. The Health Department continues to work with the state on action items to prevent and treat syphilis in the community. In 2020, Harnett County had seven HIV cases, and currently we have reported three cases in the first two quarters of 2021. Influenza update; Flu cases the past year remain low and the geographic spread of flu was sporadic. Harnett County had no flu deaths in the 2020-2021 season. Compared to the 2019- 2020 season Harnett County had two deaths. Statewide the 2020-2021 flu season resulted in seven deaths. The Health Department offers flu vaccine in our clinics Monday thru Friday, and we visit several off site locations in the community to administer flu vaccines. In addition, our Epidemiology (EPI) Team at the Health Department has investigated several other communicable disease    Page 4 Board of Health September 16, 2021  Harnett County Health Department Board Room  threats in the county this year. Our EPI Team consists of the Health Director and a representative of each of the following divisions: Nursing, Health Education, Environmental Health, Laboratory, Management Support, Administration, and Preparedness. In the past year, our EPI team have been activated to continue COVID-19 investigations, investigate a Norovirus outbreak at' Triton High School in May 2021 and conducted daily monitoring of three Monkeypox high-risk contacts in July 2021. The EPI team continually monitors potential communicable disease threats and educates community partners on the risks. Recent Centers for Disease Control and Prevention (CDC) guidance have been shared with primary care providers to be vigilant in detecting measles and polio in travelers from high-risk countries and regarding the increase of Respiratory Syncytial Virus (RSV) cases in North Carolina. Workforce Development - Melissa McLamb reported workforce development in Public Health aims to improve health outcomes by enhancing the training, skills, and performance of Public Health workers. A strong Public Health workforce is vital to protecting the public's health. Effective Public Health action requires an adequately staffed, highly skilled, diverse, and interdisciplinary workforce. The Harnett County Health Department is committed to providing employees with training opportunities, sO they are better equipped to deliver the 10 Essential Services of Public Health. The goal of the plan is to ensure a competent workforce that receives the training and guidance they need to be successful in the implementation of the Public Health programs we provide and serve our patients and clients to the best of their abilities, while also rising to meet any future workforce needs. The Health Department currently has 67 full time employees, 20 contract employees and 9 Community Care of North Carolina (CCNC) COVID-19 employees. In 2021, the Health Department welcomed five new full time employees. The Health Department encourages advanced degrees and certifications that enhance the training, skills and pertormance of our Public Health staff. Currently Environmental Health have four full time employees with advanced degrees, Health Education staff have three full time employees with advanced degrees, Aging/Care Management have three full time employees with advanced degrees and one Social Worker currently enrolled in an advanced degree program, and Women, Infants and Children (WIC) have four full time employees with advanced degrees. The clinical staff currently have 13 total Nurses with four Registered Nurses (RN) with a Bachelor's degree, one RN with a Master's degree, and two licensed Nurse Practitioners. One RN is certified in Public Health and Healthcare Privacy  and Security.    Page 5 Board of Health September 16, 2021  Harnett County Health Department Board Room  Four Nurses are Rostered Enhanced Role Child Health Nurses and two are Enhanced Role STD Nurses. The clinic also have one Certified Physician Assistant and an additional Physician Assistant starting September 20, 2021. The department has six Nurses that have completed the North Carolina Communicable Disease (CD). Branch training and are CD Nurses. Three full time employees are fluent in Spanish and one contract employee. Health Department employees are required to complete several mandatory trainings and obtain program specific continuing education throughout the year. Annual trainings for Health Department employees include Health Insurance Portability and Accountability Act (HIPAA), Customer Service, Title X (mandatory for certain employees), Occupational Safety and Health Administration (OSHA)/Satety, Respiratory Fit Testing/Hazard Exposures, Violence in the Workplace, Annual Policy Reviews, Diversity/Cultural Competency, and Emergency Preparedness. Clinical staff are also required to attend Cardiopulmonary Resuscitation (CPR) bi-annually, and two clinical staff are Advanced Cardiac Life Support (ACLS) certified. All staff are required to obtain program specific continuing education trainings and maintain licensures. Education opportunities are available to staff this year in the form of webinars and online trainings. WIC's Breastfeeding Peer Manager, Peer Counselors, Registered Dietitians and Registered Diabetic Technician have completed continuing education throughout the year. In Child Health, two Nurses recently attended car seat training for special needs children. The Laboratory Technicians have completed Stateside Program for Infection Control and Epidemiology (SPICE) trainings this year. All Staff are trained on Emergency Shelter operations and complete National Incident Management System Training (NIMS). Departmental supervisors are required to complete Intermittent Incident Command System (ICS) 300 and Advanced ICS Command System 400 trainings. The Management Team continues to strategize and implement plans to increase employee satisfaction and staff retention. To promote teamwork and a positive work environment we conduct team building exercises and activities surrounding Public Health month. We seek employee input with ideas to improve areas of service, and strive to meet the requirements set forth in State Agreement Addendums and update our programs based on recommended best practices. In looking at the succession planning process, it is estimated that approximately one full time employee will be eligible for retirement in the next year. Ten employees will be eligible for retirement in the next five years; this is 15% of our current workforce. Efforts I    Page 6 Board of Health September 16, 2021  Harnett County Health Department Board Room  continue to ensure our workforce members have advancements in skillsets, training, and knowledge base to continue in serve to their citizens of Harnett  County.  Health Director's Report and Program Reports - John Rouse, Jr.  Medicaid Transformation Update - Mr. Rouse discussed the Health Department is in the third month of Medicaid Transformation. Revenues are coming in with some issues and denials with the Prepaid Health Plans (PHPs). The North Carolina Association ofLocal Health Directors (NCALHD) has formed a committee to address billing concerns and timely matters with payments and COVID-19 Updates - Mr. Rouse announced the most recent total of COVID-19 cases in Harnett County, with 16,390 confirmed cases and 213 deaths. Since August 1, 2021 to today, Harnett County has had 30 COVID-19 deaths, with an age span of 40-86 years old. Of the 30 deaths, 72% were unvaccinated and 17% were in the age group of 40-60 year olds. Mr. Rouse provides a COVID-19 report to the Board of Health on Tuesdays and Fridays of each week. The data shows an increase in cases since in the past four weeks. The Health Department also has started a graph in June 2021 with the positive case among age groups. The age groups consist of 1-4 years old, 5-18 years old and 19 years and greater. Data shows birth-18 years old consist of 25% of cases for the end of August 2021, and current data shows birth-18 years old consist of 30% of the cases for the two weeks in September 2021. The school age group of ages 5-18 years old account for 24% of the current cases the past two weeks. COVID-19 testing is available at the Health Department and Optum Serve offers testing in Lillington and Dunn areas. Mr. Rouse discussed the monoclonal antibodies (mAbs) treatment of COVID-19 clinic managed by the North Carolina Department of Health and Human Services and FEMA will start next week and will be located in the back parking lot of the IT/Planning Department Buildings on Alexander Drive. The site address is 420 McKinney Parkway, Lillington. The Health Department continues to provide COVID-19 vaccinations every day of the week in the clinics and at the weekly mass vaccination site in the Governmental Commons. At this time, the Health Department will continue to offer the booster COVID-19 vaccine to immunocompromised individuals, more information will be available the closer time gets for all groups to receive the  denials.  booster.    Page 7 Board of Health September 16, 2021  Harnett County Health Department Board Room  The Health Department is administering all three brands of COVID-19 vaccines; Moderna, Pfizer and Johnson & Johnson's Janssen. The Health Department is acting as a hub for storing vaccines for other agencies this is because of the refrigeration unit that was purchased by Campbell University and given to the Health Department. The Health Department has transferred approximately 18,913 doses to community partners to increase vaccinations in the county. WIC Food Expenditures Report - Mr. Rouse reviewed the presentation for the Women, Infants and Children (WIC) program and the economic impact in Harnett County. The WIC program infused approximately $2,426,928 million in funds into the Harnett County retail food economy fiscal year 2020-June 2021. The benefits of this economic boost extend beyond WIC families to the local economy. In addition, through the Department of Social Services (DSS) Food and Nutrition Services/Food Stamps, issued approximately $46,354,037 million to the local income July 2020 - June 2021. Approximately, close to $49 million dollars through these two programs, for 2020-2021, WIC and the DSS Food and Nutrition Services/ Food Stamps greatly impact the local economy. Financial Report 2020/2021 Year Ending - Mr. Rouse reviewed the closeout revenues and expenditures summary reports for FY ending June 30, 2021. The revenue report shows funds by programs; Aging and Health programs are able to carryforward an estimated $1,670,765 million into the new fiscal year due to COVID-19 funds. The Health Department has received $2,387,276 million in COVID-19 funds for FY 2020-2021. Environmental Health has done well with receiving revenues for FY 2020-2021 and will carryforward $266,591. The Health Department will be returning $1,632,846 million in unused funds back  to the county for FY 2020-2021.  Clinical Report - Melissa McLamb  COVID-19 Vaccination Update = Melissa McLamb reported the total COVID-19 vaccinations given to date are 24,749 doses and this includes first and second doses. Vaccine demand has increased slightly over the last two months. In the month ofJuly 2021, we administered 449 COVID-19 vaccines. August 2021 we administered 564 doses and for September 2021, we have given 289 doses. The Health Department does allow walk-ins at our vaccine clinics, and in the month  of August 2021, five off-site vaccination events were held.    Page 8 Board of Health September 16, 2021  Harnett County Health Department Board Room  The Health Department administered COVID-19 vaccines at Spout Springs Fire Station # 2 on two occasions, and at Liberty Tire Recycling in Cameron. The event was collaborated with RCL Contract Company to provide COVID-19 vaccinations at the Dunn Housing Authority location Harnett Terrance and 84 Lumber in Dunn. COVID-19 vaccinations were also provided to incarcerated individuals at the Harnett County Detention Center. In September 2021 the Health Department and RCL staff vaccinated students and staff at five Harnett County Schools; Triton High School, Dunn Middle School, Coats Erwin Middle School, Western Harnett High School and Western Harnett Middle School. The events vaccinated 60 people, and second dose vaccine clinics are planned for later this month. In addition, second dose vaccination clinics are scheduled at the Dunn House Authority Harnett Terrance, Liberty Tire Recycling, and 84 Lumber. We continue to work with community members and community partners to provide off-site vaccination clinics in our county. Child Health - The clinic is continuing to provide well child physicals, sick visits and immunizations with an increase in patient numbers for August 2021. Child Health well visits increased from 84 visits in July 2021 to 140 visits in August 2021, immunizations visits increased from 166 in July 2021 to 267 in August 2021, with sick visits also increasing from 107 in July 2021 to 171 Employee Clinic - County employees continue to utilize the clinic for acute care visits and immunizations. Employee clinic numbers increased from 143 Adult Health - STD services and Prenatal clinic visits have overall increased since July 2021. STD services have increased to 105 visits, with the reportable disease count decreased to 66. Prenatal visits have increased to 170 visits. Lab-I Laboratory clients have increased from 584 in July 2021 to 797 in August 2021, and 1,157 laboratory tests were performed in August 2021. RSV cases have increased in Child Health. In July 2021, the lab tested two patients for RSV compared to 2020 zero were tested. In August 2021, 24 children were tested for RSV and 10 were positive. In August 2020, no patients were tested for RSV. In July 2021, NC DHHS released a CDC and Health Alert Network (HAN) notifying providers of the increase of RSV in our state and recommendations for  visits in August 2021.  visits in July 2021, to 177 visits in August 2021.  increased awareness and testing.    Page 9 Board of Health September 16, 2021  Harnett County Health Department Board Room  Influenza - The Health Department has started administering flu vaccines in Adult Health and Child Health clinics the week of September 7, 2021. Flu vaccines are available for all ages, including high dose flu for ages 65 and older. The Health Department has started outreach flu clinics to senior nutrition sites, assisted living facilities, county offices, and scheduled events for staff vaccination at Harnett County Schools. On October 4, 2021, the Health Department will host a drive thru flu event in the Harnett County Health Aging/Case Management = Mary Jane Sauls reported Medicare open enrollment would be held October 15, 2021 through December 7, 2021, during this time beneficiaries could reevaluate their coverage. The Division on Aging will start making appointments to review prescription drug plans on October 1, 2021. In house protocols such as temperature checks prior to entry, masks and social distancing will be in place for in person appointments. After hour and Saturday, clinics will be available, and there will be an option to have plans reviewed by phone. On September 9, 2021, the Division on Aging hosted a Red Cross Blood Drive. There was also a reception honoring First Responders and Red Cross Staff in remembrance of the 20th Anniversary of 9-11. Mr. Rouse and assistant County Manager Coley Price offered remarks and thanked them for  Department front parking lot from 2pm-6 pm.  their service.  Environmental Health - Oliver Tolksdorf reported Food & Lodging and Onsite Wastewater have started to notice supply chain issues. For the Food & Lodging division restaurants are limiting menus and hours, with some establishments having transitional permits and running into problems getting new equipment, this is especially a problem with establishments whom are changing ownership. Onsite Wastewater have had issues with installers being limited on the number of tanks they receive weekly and not enough work force to make the tanks. Onsite Wastewater has also noticed drain field materials and pump components  being out of stock.  Marketing/Communy Outreach - Debra Harris-Hawkins presented the Health Department has several community health and educational events  scheduled in the coming months.    Page 10 Board of] Health September 16, 2021  Harnett County Health Department Board Room  The "Fall into Fitness" Virtual Move More Challenge is a free program that will encourage people to be more physically active. The challenge includes weekly newsletters with tips to help you move more, program log to track activity and points, and earning points for being physically active. The program begins on September 27, 2021 through October 24, 2021. Information for registration is available on the Health Department's website. The Health Education Division will host a "Girl Talk" virtual Zoom event for girls ages 9-11 with a mom/guardian for a session that will provide information on what you need to know about puberty. The event will take place on Thursday, September 30, 2021 from 6:00pm-7:00pm via Zoom. Registration is free and the deadline for registration is Friday, September 24, 2021, participants can contact the Health Department for registration. The Health Department is collaborating with Another Barber Shop for a COVID-19 vaccination clinic "Shots @ the Shop" on Friday, October 1, 2021 in Dunn. The clinic will offer free Pfizer COVID-19 vaccine for everyone ages 12 and older. The Health Department will hold a "Car Seat Safety Checks" on Friday, October 1, 2021 from 8:00am-11:00am and 1:00pm-4:00pm. The event allows parents and caregivers to have their car seats and seat belts checked to make sure they are installed and being used correctly from a Certified Child Passenger Safety Technicians from the Child Health Division. Participants can contact the Health Department to schedule an  appointment.  Closed Session - There was no need for closed session.  New Business - Chairwoman Smith opened the floor for New Business. Being none  Chairwoman Smith closed New Business. Chairwoman Smith adjourned the meeting.  Respectfully submitted, a Vny John Rouse, Jr. Health Director  AmAun Dr. Laura Sgith, Chairwoman