Harnett County Board of Health Minutes of Regular Meeting May 19, 2022  The Harnett County Board of Health met in regular session on Thursday, May 19, 2022 in the Health Department Board Room, Harnett County Governmental Complex, Members present: Dr. Laura Smith, Chairwoman, Ms. Amy Allen, RN, Ms. Gayle Adams, Dr. Amanda Langdon, DVM, Ms. Linda Sturdivant, Dr. Kim Fowler, PhD, and Members present by conference call: Ms. Stacie Hogan, RPH, and Ms. Barbara Others present: Oliver Tolksdorf, Ainsley Johnson, Debra Harris-Hawkins, Mary Jane  307 W. Cornelius Harnett Blvd., Lillington, North Carolina.  Mr. John Rouse, Jr., Health Director.  McKoy.  Sauls, Natasha Johnson and Gail Hobbs.  Chairwoman Smith called meeting to order at 7:00 p.m.  Announcements = Mr. Rouse reported no announcements for tonight's meeting. Consent Agenda - Minutes - Motion made by Ms. Amy Allen, RN, for the March 3, 2022 minutes to be approved as presented and seconded by Ms. Linda 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. Seeing no one, Chairwoman Smith closed the informal comments. Health Disparities Report - Debra Harris-Hawkins presented a power point presentation for the 2021 Health Disparities report. The report provides information and assess use of public health programs and health care services by underserved, at- risk and vulnerable populations. Many factors contribute to health disparities. Examples of] Health Disparities includes, mortality, life expectancy, burden of disease, uninsured/underinsured and lack of access to care. If a health outcome is seen to a greater or lesser extent between populations, there is disparity. Reducing health disparities is a major goal of public health. The data we are presenting looks at the utilization of a few of the Health Department programs and services. We are providing programmatic data for the clinical services, from the EMR system, Women Infants and  Sturdivant. Motion Carried.    Page 2 Board of Health May 19, 2022  Harnett County Health Department Board Room  Children (WIC), from state reports and the mammography screening from program Clinical services data, approximately 6,943 persons were seen in 2021 which is a slight decrease from 2020 of about 750 less clients. Of those seen approximately, 30% of the clients were uninsured according to reports, those who are uninsured are more likely than those with insurance to postpone health care. Approximately 70% were insured and of those that presented insured the primary source was either Medicaid and or private insurance. By gender, the number of women seen approximately 4,624, which was almost twice as the number of males 2,317 seen in our clinical programs. By race, twice as many Whites approximately 4,858 were seen through the clinics compared to African Americans 1,833. According to the most recent census, the racial and Hispanic origin, for Harnett County residents: predominately White (60%) and African American (21%), Hispanic or Latino (13%) representing racial Women, Infants, and Children (WIC) is a special supplemental nutrition program. To qualify for WIC the household income must meet income guidelines. The priority population includes low-income pregnant, breastfeeding, and non-breastteeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk. Over 45,403 participants were seen in, which averages approximately 3,300 participants each month for 2021. Ofthe participants, average number of children is 2,038 Mammography screening program uninsured women and those with no usual care have the lowest rates of reported mammogram use. The partnership with Rex Mobile Mammography provides access to screening and funding assistance for women who are uninsured. Approximately 179 women were screened, with approximately 45% identified an uninsured. Ofthe women screened by race/ethnicity data, approximately 34% identified as White followed by 33% African American and 26% Hispanic/Latina women. Disparities due to language, families with limited English proficiency (LEP) face barriers to health care service. We utilize the use of Health Department medical interpreters to assist with this program. Currently this program remains the only program that provides funding assistance for uninsured women to obtain ai mammogram. The mammography screening program is a another example of1 how the Health Department is working to implement programs and services for the priority populations to assure needs are being met. These are a few examples of programs we continue with our ongoing community outreach with faith communities, public housing and other site to address disparities and access to services. Hawkins stated, the main goal of these types of programs are to identify and carry out public health activities specific to selected communities  data the timeline is January-December 2021.  or ethnic minority groups.  per month.  and to address differences in health outcomes.    Page 3 Board of Health May 19, 2022  Harnett County Health Department Board Room  State of the County Health Report (SOTCH) - Debra Harris-Hawkins presented the "State of the County's Health" report it is a requirement for Health department with Re-Accreditation and as a part of the Consolidated Agreement with the Division of Public Health. The Health Department provides the report during each of the interim years between the Community Health Assessment (CHA), the traditional paper based SOTCH reports are now optional. The state has provided a web based reporting format. After the review ofinformation from our current SOTCH report, it will be uploaded and posted on the Health Department's web site. Copies oft the report were provided. The three priority areas from 2019 included Diabetes/Nutrition, Heart Priority: Diabetes/Mutrition in collaboration with First Health of the Carolinians. Outcome: Due to COVID-19, the 2021 class size for the program was reduced. Five people participated in the program of those 100% of participants lost weight and increased their physical activity by the conclusion on the program. Priority: Heart Disease: "Go Red Sunday." The Harnett County Health Department provides faith communities heart health information. Outcome: We experienced a reduction in the number of churches that participate in this initiative. Many churches were not having in person services and did not participate in the program. We had five churches participated in Cancer ranks as the second leading causes of death in the county, peer counties, and North Carolina. The Harnett County Health Department in partnership with Rex Mobile Mammography provided access to 14 mobile mammography screenings with the capacity to screen 252 women. Outcome: Approximately, 215 women were scheduled and 179 were screened. Overall, approximately 83% of the women kept their screening appointment. Approximately 45% of the women screened were uninsured. COVID-19 Vaccination Impact: Many vaccines, including the COVID-19 vaccine, can cause lymph nodes to temporarily increase in size. Enlarged lymph nodes can cause a false-positive mammogram result. Our staff continuously worked scheduling and rescheduling women following guidelines for waiting approximately four to six weeks after they receive a COVID-19 vaccine or booster to have ai mammogram. Emerging Issues: Vaccine Hesitancy, many factors influence vaccine decision-making, strong confidence in COVID-19 vaccines within communities leads to more adults, adolescents, and children being vaccinated, which leads to fewer COVID-19 illnesses, hospitalizations, and deaths. Social Isolation practicing social distancing is an effective means of curtailing the COVID-19 pandemic, as it has the potential to increase loneliness and social isolation, especially for those older adults and Communicable Disease, NC and Harnett County are experiencing an increase in syphilis cases. Identify new initiatives: "Pink Ribbon Parade", instead of annual breakfast, we provided a community drive a drive thru and pick up event consisted of exhibits and resources on breast health information, COVID-  Disease and Cancer.  2021.    Page 4 Board of Health May 19, 2022  Harnett County Health Department Board Room  19 information, incentives and breakfast. The event was in partnership with the Harnett County Health Department, Breast Cancer Support Group of  Harnett County and Mary Kay Cosmetics.  Community Health Assessment (CHA) - John Rouse discussed the CHA. Every three years, Harnett County Department of Public Health is required to conduct a Community Health Assessment (CHA). With the help of Campbell University and Harnett Health we are working together to conduct a Community Health Assessment for Harnett County. This survey is being conducted to learn from residents more about the health and quality of life in Harnett County. The results of the survey will be used tol help identify and address the major health and community issues in our county. This survey is voluntary, and takes a few minutes to complete. Surveys are provided in English and Spanish, and a link is posted on our web site. Clinical Patient Fees, Eligibility and Bad Debt Write Off Policy Revision - Gail Hobbs reviewed the policy update that was updated using a template provided by NCDHHS and per the last Administrative audit from NCDHHS and consultant recommended transitioning to this format. This will allow ease in locating items pertaining to the audit and will be uniform across the state. Also included in the revision was required Family Planning updates to be in compliance with Title XI rule changes. Included in the update was the addition to address medical record request fees as follows: Pages 1-13 $10.00, Pages in excess of 13 pages are $20.00 (i.e. 14 pages copied will be $20) and is no charge for medical records sent directly to a Motion to approve the Clinical Patient Fees, Eligibility and Bad Debt Write Off Policy Revision from Dr. Amanda Langdon, DVM and seconded by Ms. Gayle Mr. Rouse explained the fee schedule was included in the FY 2022-2023 Budget Proposal at the March 3, 2022 meeting, the fee schedule included increases for the  medical provider.  Adams. Motion Carried.  following procedure codes due to Medicaid rate changes.  CPT CODE J1050 S0281 90651 90716  DESCRIPTION Depo Provera (150mg @ $.20) Medical Home Management Fee Human Papillomavirus Gardasil 9 Varivax Chicken Pox Vaccine  RECOMMENDED PRICE $30.00 (.20mg) (old rate $15.00 .10mg) $225.00 (old rate $150.00) $275.00 (old rate $240.00) $180.00 (old rate $145.00)    Page 5 Board of Health May 19, 2022  Harnett County Health Department Board Room  Debt Setoff - Gail Hobbs reported we have collected a total amount of Debt Setoff Operating Procedures Update - Mr. Rouse related conference call-in meetings will not be allowed once the Federal Public Health Emergency ends and the scheduled date  money received for 2022 is $2,526.90.  at this time is July 15, 2022.  Health Director's Report and Program Reports - Mr. John Rouse, Jr.  COVID-19 Report - Ainsley Johnson discussed since the March 3, 2022 meeting the Health Department has seen downward trends in COVID-19 cases but recently over the past few weeks we have seen an increase and also an increase in the whole state. In the past two weeks, we have seen a 10% increase in cases each week. This week we have reported 210 cases, VS 191 from last week. The total historical COVID-19 cases in the county as of today is 34,501 cases with 346 associated deaths reported. Currently for 2022, our total is 13,903 cases, and this almost surpasses the number for the entire year of 2021, which was 14,671 cases. In March 2022, we reported 1,119 cases, April 2022 we reported 742 cases and sO far for May 2022 we had 574 cases. Some of the case numbers may be skewed due to the clean-up process. The Health Department is currently working through NCCOVID and faxes to ensure all cases are accounted for. Other counties are also inputting older information related to Harnett County residents and this results in increase daily case counts. The last COVID-19 reported confirmed death was on April 24, 2022. Currently the county has 2 active outbreaks in long-term care facilities. These outbreaks were initiated in the beginning of May 2022. During the week ending on May 7th, 2022, North Carolina Department of Health and Human Services (NCDHHS) reports the percentage of emergency department visits for COVID-19 like illness had also increased from the previous week. On May 4, 2022 NCDHHS integrated with NCDAVE (NC Database Application for Vital Events) to give North Carolina a more comprehensive picture of the true number of COVID-19 deaths. This system allows for COVID-19 deaths to be reported when the cause of death is listed as COVID-19 on their death certificates. Until now, deaths on NC's COVID-19 dashboard have been reported through physicians, hospitals, and case investigation by local health departments. This process only dated back to cases since January 1st, 2022. Since this integration, Harnett County has added 10 deaths to our COVID-19 death count. COVID-19 vaccinations continue to be available every weekday as walk-ins or appointments in the clinics. We began administering 2nd booster doses to eligible populations on April 4, 2022. To individuals age 50 years and older, 12    Page 6 Board of Health May 19, 2022  Harnett County Health Department Board Room  years and older who are mmunocompromised or those received 2 doses ofJ&J vaccine. We have administered 547 2nd booster doses. Since first booster doses began on September 26, 2021, 3,467 doses have been given here at the Health Department. The total COVID-19 vaccinations given to date are 29,980 doses (this includes first, second, third and booster doses). We continue to transfer vaccine to vaccinating providers in our county and have transferred approximately 54,071 doses to community partners to increase vaccinations in our county. ACIP (Advisory Committee for Immunization Practices) is meeting to determine recommendations for a booster dose for children ages 5-11. Financial Reports - Mr. Rouse reviewed the expenditure summary and revenues summary from July 2021 -1 March 2022. Federal and state funds are coming in as expected. Communicable Disease allocation funds were received in April 2022 and approved to receive by the Board of Commissioner at the end of April 2022. The amount is $206,000 and will be carried forward to FY 2022- 2023, the Health Department will receive another amount of $206,000 later in the year. Aging funds and revenues are coming in as expected also. Family Planning and Prenatal clinic revenues have decreased slightly for the third quarter and this is due to fluctuations in payer sources among patients. COVID-19 funds of $2,600,000 for Health and $225,000 for Aging are carryforward money for FY 2022-2023. The budget proposal for FY 2022-2023 has been presented to the county, and is awaiting approval. Mr. Rouse reported the Employee Clinic saved the county $225,528.00 through the third quarter  and remains to be an active clinic among county employees.  Clinical Reports - Ainsley Johnson  Child Health - Child Health (CH) has been steady based on numbers seen on the activity summary. CH has had 126 sick visits and 89 well visits for April 2022. CH continues to provide car safety seat assessment and education one day per week by appointment. Through this program the CH staff have installed and inspected 19 seats in the last 2 months. The new Public Health Nurse II, Samantha Clark started on May 16, 2022, and all clinical positions Employee Clinic - County Employee clinic continues to operate effectively and efficiently and the number of employees served in April 2022 increased to 126.  are now: fully staffed.    Page 7 Board of Health May 19, 2022  Harnett County Health Department Board Room  Adult Health - Family planning, Sexually Transmitted Disease and Prenatal clinics are continuing to do well and numbers are on track with previous April counts. Reportable disease cases on the activities summary are at 25 for the month of April 2022. The communicable disease staff have been up to date on the latest information of Avian Influenza outbreaks, and the Health Department has been notified of two contacts in Harnett County that were potential exposures, and the state Communicable Disease branch was notified. Tuberculosis - The Health Department currently does not have any active tuberculosis (TB) cases in the county. The TB nurses are aware of the national back order of the first line TB drug Rifampin, and we have a limited supply and the Centers for Disease Control and Prevention (CDC) hopes the shortage will be resolved mid to end June 2022. The CDC is currently working to replenish the emergency stockpile. A state memo was released regarding the prioritizing the use of Rifampin for current cases, close contacts, and those cases where the drug INH (Isoniazid) is contraindicated. In the Adult Health (AH) and CH clinics we have installed negative pressures rooms. These rooms will allow clients who have a potential airborne disease to be seen in house while more adequately protecting our staff. The negative pressure rooms will be used for tuberculosis, COVID-19, and other infectious disease care. In addition, we are installing handicap accessible doors to the front of the Health Department and the Commons area to allow for increased access of care for all persons with Lab - Testing in the lab continues steady over the last several months. Flu 2022 compared to 2021, increased over the last two months. The positivity rate for flu in our lab is at 16% compared to a 0% positivity rate we had during the Flu Update - The statewide respiratory surveillance report released on May 19, 2022 showed increased influenza like illness. The report shows the geographic spread of flu is LOCAL this week. Influenza A continues to account for the majority of cases. per The Morbidity and Mortality Week Report (MMRW), this late season activity has also resulted in noteworthy, high, late season weekly hospitalization rates on week 17 (which was the last week in April 2022) of the season. In fact, the weekly rate of1 hospitalizations for this season was the tp/ddcswmwimdshtm, The Health Department  disabilities and limited mobility.  same period of time last year.  highest weekly rate seen since the 2010-2011 season    Page 8 Board of Health May 19, 2022  Harnett County Health Department Board Room  continues to administer flu vaccines in AH and CH clinics during the month of QIQuality Improvement Update - The Health Department's management team initiated a quality improvement measure in March of 2022 after reviewing our Community and Consumer Surveys. The team decided to work the initiative ofi increasing patient portal use for our clientele. The results of the consumer survey showed only 24% of clients assess patient portal to view their profile, laboratory results, visit encounters, and message their provider. In March 2022, client handouts were made with simple step-by-step instructions for patient portal use. These handouts were given at check-in in all clinical areas. Posters were also made for each waiting are for clients to begin accessing their account while waiting for their visit. These initiatives were extremely successful. From March 2022 to May 2022, 603 clients accessed the patient portal, and this number has doubled from the previous two months, with only 298 clients accessing the portal. We have received positive feedback Environmental Health = Oliver Tolksdorf: reported the Wampus Cat Music Festival was scheduled for May 13th-15th has been postponed until August 5th-7th. The live music festival is sponsored by Indie On Air and Gross Farms and will host three stages with different types of music. Environmental Health is working in conjunction with Fire Marsha/Emergeney Management, Sheriff's Aging & Case Management - Mary Jane Sauls announced senior sites have increased in attendance since COVID-19, averaging 50 people per site and averaging 160 home meals delivered daily. The first Senior Games in the past three years was held recently and was very successful. Interviews for the position of family caregiver Human Services Coordinator have been completed and will be filled soon. Family caregiver support group will hold the first in person meeting since COVID-19 on May 26, 2022, in the training room at the Harnett County Resource Center. Grandparents Raising Grandchildren support group will meet in person on May 24, 2022 in the training room at the Harnett County Resource Center. "New to Medicare" class will be held on May 25, 2022 at the Harnett County Library. Currently Harnett County has 24 active senior sites across the county with 215 active senior volunteers. The Department of Aging continues to recruit volunteers for the Meals on Wheels Marketing/Communty Outreach - Debra Harris-Hawkins presented The Health Education recently concluded the" Step into Fitness" walking Challenge. This was a month long challenge that encouraged participants to  May.  from clients and staff on this initiative.  Department and State Highway Patrol.  delivery program.    Page 9 Board of Health May 19, 2022  Harnett County Health Department Board Room  move more by offering simple suggestions to increase physical activity through walking. The Walking program had approximately 117 residents sign up with 75 persons completing the program. As part of the Health Department's Strategic plan one of the goal is to reduce the number persons who are at risk for chronic diseases. Prevent type 2 diabetes, sessions are being conducted from 5:30-6:30pm each week. This program is in collaboration with First Health of the Carolinians, with the goal to help people prevent or delay type 2 diabetes and improve their overall health through lifestyle change.  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  John Rouse, Jr. Health Director  Dr.  &g