Harnett County Board of Health Minutes of Regular Meeting May 20, 2021  The Harnett County Board of Health met in regular session on Thursday, May 20, 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 May 20, 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 with State law and Members present by conference call: Dr. Amanda Langdon, DVM, Ms. Gayle Adams, 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, Ainsley  prudent public health practices.  Director.  Johnson, Gail Hobbs and Natasha Johnson.  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 Dr. Catherine Evans, DDS for the March 4, 2021 minutes to be approved as presented and seconded by Ms. Gayle 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. Health Disparities Report = Debra Harris-Hawkins provided power point handouts regarding the annual Health Disparities report for 2020. The overall report provides information and data regarding the Health Department's programs and services utilized by the following priority populations, uninsured, children, and women, underserved, at-risk and vulnerable populations. The timeline for the report included  Adams. Motion Carried.  Seeing no one, Chairwoman Smith closed the informal comments.  January-December: 2020.    Page 2 Board of Health May 20, 2021  Harnett County Health Department Board Room  Health disparities are differences in health outcomes and their causes among groups of people. There are many health disparities; a few examples of prominent health disparities include cardiovascular disease, cancer rates, and HIV/AIDs. It is important to address health disparities because often that many are preventable. Improving the disparity in health outcomes will enable increased population and individual health outcomes. Reducing health disparities is a major goal of public health. The largest racial/ethnic groups in Harnett County, according to the data in the 2019 Community Health Assessment (CHA) are predominately White (67.5%) and African American or Black (21.2%), and approximately 3.29 % representing racial or ethnic minority groups. Programmatic data was reviewed, for the Health Department's clinical programs, the Women Infants and Children (WIC) program and the Mobile Mammography screening program. The report also include a snapshot of the Community Outreach initiatives for 2020. This timeline and data reflects when the Health Department was beginning to address COVID-19 pandemic, the first COVID-19 case was reported in Harnett County on March 13, 2020. There were fewer persons seen in the Health Department clinics. Clinical programs approximately 7,704 clinical visits were recorded in 2020. Approximately 32% of those person identified as uninsured. By gender, the number of women seen is almost twice as the number of males with 4,785 verses 2,258 respectively. By race, 4,849 persons identified as White compared to 1,960 identified as. African American or Black followed by Other at 141 and Mulit-racial at 94. Approximately 32% of the persons seen were uninsured. For those insured, private insurance was indicated for 2,413 persons seen, followed by self-pay with 2,234 and then Medicaid for approximately 2,048 persons. Approximately 16% percent of the county residents are below the poverty line. Women, Infants, and Children (WIC) is a special supplemental nutrition program. WIC was established as a permanent program to safeguard the health of low-income women, infants, and children up to age five who are at nutritional risk. The priority population includes low-income pregnant, breastfeeding, and non-breastteeding postpartum women, and to infants and children up to age five who are at nutritional risk. To qualify for WIC your household income must be at or below 185% of the federal poverty income level. The Health Department's WIC program remained open to serve eligible family members. There were modifications in how services were provided in response to COVID-19. Everyone whom is an active participant of WIC could receive their benefits thru automatic transfer because of COVID-19. Waivers allow nutritionally at-risk: mothers, babies and children to use their benefits in a safe manner and enables the WIC program to operate based on local conditions throughout the pandemic. Over 40,000 participants were allocated benefits in 2020.    Page 3 Board of Health May 20, 2021  Harnett County Health Department Board Room  The Health Department's collaboration with Rex Mobile Mammography provides access for women to obtain a screening mammogram. Due to the COVID-19 pandemic, the mobile mammography program, cancelled two screening in 2020. The number of screening dates was reduced from 14 to 12. Due to the reduction in screening dates, the number of mammography appointments available decreased from 322to 216. In 2020, the Health Department provided access to 12 mobile mammography-screcnng dates. Approximately 166 women were screened, and 43% were identified as uninsured, which is one of the priority population for this program. When we look at the number screened by Race/Ethnicity the women identified as 45% African American or Black, 30% as White, and 20% as Hispanic and 5% as Other. The Health Department's outreach efforts with our faith-based initiatives included collaborations with many churches during 2020-COVID-19 pandemic. Many churches canceled worship services due to COVID-19; the Health Department collaborated with approximately eight churches and implemented the "Pink Sunday" program, reaching approximately 355 women in the community. The Health Department collaborated with Coats Church of God of Prophecy located in Coats to provide access to free rapid antigen testing for COVID-19 on December 9, 2020. This drive thru testing event was held at the church, and a large crowd was onsite with approximately 150 residents tested for COVID-19. The Health Department educated individuals and the community about health and available public health services. Again, this report provides a brief overview of a few of the programs and services we hope it provides insight as to how we are working to improve health outcomes and address health disparities.  Establish Fees - Gail Hobbs presented the recommendation to establish a: new fee. This new: fee is a result of vendor (Sanofi) vaccine change from Menactra to Menquadfi.  Price for Menquadfi will be kept at the current price for Menactra.  CPTCODE 90619  DESCRIPTION Menquadfi (Meningitis)  RECOMMENDED PRICE $152/dose  Motion to approve the new fee from Dr. Catherine Evans, DDS and seconded by  Ms. Gayle Adams. Motion Carried.  Debt Setoff - Gail Hobbs reported we have received an additional $3,712.30 since the last Board of Health meeting in March. The total amount of Debt Setoff money received  year to date is $11,952.83.    Page 4 Board of Health May 20, 2021  Harnett County Health Department Board Room  COVID-19 Report = Mr. Rouse announced the recent total of COVID-19 cases in Harnett County, with 11,681 confirmed cases, 173 deaths, and age range is 1 week- 101 years and average age is 39 years. Over 112,000 COVID-19 test have been performed in Harnett County since January 2020 and 1,400-1,600 tests are currently done weekly. A COVID-19 testing site is located at the Brightwater building in Lillington, and more providers are performing testing at their facilities. In North Carolina, there has been 13,000 deaths due to COVID-19 and 590,000 deaths in the United States. The COVID-19 deaths in the United States have decreased the life expectancy. Mr. Rouse reported fiscal year (FY) 2018-2019 Harnett County deaths were 753, FY 2019-2019 deaths were 818 and for FY July 2020-April 2021 deaths Currently in the United States an average of 37.5% have received the COVID-19 vaccine, and in North Carolina 37% have been vaccinated. In Harnett County, 21% of the population have received the first dose of the COVID-19 vaccine and 19.5% of the population are fully vaccinated. The age group of 65 years and older in Harnett County that have been vaccinated is 64% and the age group of 18 and older is 29% vaccinated. Several pharmacies in Harnett County have collaborated with the Health Department to help distribute vaccines at locations across the county. The Health Department has started administering the Pfizer vaccine to ages 12 years and older. COVID-19 funds received for the Health Department is $2,197,427 and the department will carryforward any unspent funds to fiscal year (FY) 2021-2022. Aging has received $276,216 in COVID-19 funds and will carryforward $102,000 to federal  have already reached 942, the increase is due to COVID -19.  FY, and will spend funds by September 30, 2021.  Health Director's Report and Program Reports - Mr. John Rouse  Updates - Mr. Rouse announced the Accreditation Board sent a letter on the Health Department's reaccreditation timeline. Last year and this year, the health department received an extension. The Health Department's reaccreditation visit will take place during the fall of 2023.  Medicaid Transiormation - Mr. Rouse reviewed Medicaid open enrollment was extended from May 15, 2021 to May 21, 2021. Vendors for Medicaid open enrollment were available on May 18th at Harnett County Department of Social Services for Medicaid recipients. Starting June 1st, those recipients who did not sign up during the enrollment period will be auto enrolled. The Medicaid Financial Reports - Mr. Rouse reviewed the Expenditure Summary from July 2020 - March 2021 and Revenue Summary from July 2020 - March 2021. Revenues within our programs and Medicaid revenues in the Health Department are on target for March 2021. Medicaid cost settlement funds are expected to come in by June 2021. Environmental Health revenue remains  Transformation start date is still set for July 1, 2021.    Page 5 Board of Health May 20, 2021  Harnett County Health Department Board Room  steady and the department remains busy with onsite wastewater permits. Employee Clinic numbers have decreased due to COVID-19 and no cases of influenza this year. The budget proposal for FY 2021-2022 has been presented  tot the county, and is awaiting approval.  Clinical Reports = Ainsley Johnson  Clinical - Clinical service availability has increased since our last meeting. Due to the decrease of demand for COVID-19 vaccinations, the clinic appointments have been increased. COVID-19 clinics primarily operate on Tuesday and Thursdays allowing clinical staff to be in their previously assigned clinical areas more. All staff completed annual trainings in diversity, cultural competency, OSHA/Safety, respiratory fit testing, respiratory hazards, violence in the workplace, Health Insurance Portability and Accountability Act (HIPAA), and Title Xin April 2021. The Health Department welcomes two new staff members since our last meeting. Hollyn Campbell is a Registered Nurse that joined our Child Health team on April 5, 2021 and Veronica Aguirre is a Processing Assistant IV who joined our Adult Health team in May 3, 2021. COVID-19 - Vaccination clinics now operate on a primarily Tuesday and Thursday schedule. One day is reserved for 1st doses and one for 2nd doses. Total COVID-19 vaccinations given to date are 22,733 doses (this includes first and second doses). Currently we are primarily administering Pfizer and Johnson & Johnson's Janssen COVID-19 vaccine. Vaccine demand has decreased. In March 2021 we administered 6,979 COVID-19 vaccines and in April 2021, 4,875 COVID-19 vaccines. For the month of May 2021, we are at 773 COVID-19 vaccines given. The Health Department offers appointments but also allows walk-ins at the vaccine clinics. Through our partnership with Community Care of North Carolina (CCNC), we have increased community outreach with the use of text messaging and phone calls to previous contacts in the county. Over 38,000 text messages have been sent out to offer COVID-19 vaccinations. Over the last month, COVID-19 cases averaged 32 new cases per day. Harnett County's last COVID-19 reported death was on May 8, 2021. The county currently has one active facility outbreak. We continue to perform case investigations on priority cases and have contracted case investigators through Child Health- Child Health is continuing to provide well child physicals and immunizations. The Health Department is working to increase awareness of our  CCNC.    Page 6 Board of Health May 20, 2021  Harnett County Health Department Board Room  Child Health clinic and the need for back to school physicals and immunizations prior to the start of the school year. They are also preparing for Medicaid Transformation by attending North Carolina Department of Health and Human Services (NC DHHS) trainings and monthly CCNC teleconferences. Child Health numbers have been consistent at 99 visits for the month of April 2021, and the well clinic was 76 visits. The Health department saw 134 clients Employee Clinic - County Employees are continuing to utilize the clinic for acute care visits and immunizations. Employee clinic numbers increased from 107 visits to 115 visits in April 2021, however the overall numbers for this year Adult Health - Family Planning, Sexually Transmitted Disease (STD) clinics, and Prenatal clinic numbers have increased since our last meeting. Family Planning saw 115 visits compared to 107 in March 2021, and STD clinic also increased to 81 visits. Reportable STDs went down from 42. to 24 cases and Harnett County had one case of syphilis for April 2021. The Health Department continues to have no active TB cases for the month of April 2021. Prenatal numbers have also increased from our last report from 123 in March 2021 to 139 total visits in April 2021. Prenatal clinic collaborated with Health Education to distribute "Oh Baby- Moms to be" resource bags during the month of April Lab - The lab continues to process in house rapid COVID-19 antigen and sends out COVID-19 specimens to our state lab and LabCorp. For the month of April 2021, we have an increased the number of clients seen for 676, and 996 tests were processed, with 86 tested for human immunodeliciency virus (HIV). Flu Update- The North Carolina Communicable Disease Branch issued their May 2021 Influenza-like Illness report. The geographic spread continues to be sporadic. For the week ending in May 8, 2021-- the state lab processed 57 influenza specimens and none were positive for flu. At the Health Department, our last positive influenza case was December 9, 2020. The Health Department continues to offer 2020-2021 season influenza vaccine in the clinical areas. Communicable Disease (CD) Outbreak - The Health Department's Epidemiology (EPI) team investigated an outbreak of gastrointestinal llnesses in staff members at Triton High School this month. The outbreak of symptoms began on Friday, May 7, 2021 and our EPI team initiated an outbreak  for immunization services in April 2021.  have decreased.  2021. Over 80 bags were distributed to expectant mothers.    Page 7 Board of Health May 20, 2021  Harnett County Health Department Board Room  investigation on Monday May 10, 2021. Symptoms in staff members' range from vomiting, fever, diarrhea, nausea, and abdominal pain. There were 78 interviews conducted with staff during this investigation, and 62 persons were symptomatic. The staff affected did eat a school-catered luncheon on May 7, 2021. An Environmental Health inspection was performed at the catering site and stool specimens were sent off to the state lab for testing of seven individuals. Results concluded 5 out of7 individual's specimens detected Norovirus. Norovirus was determined to be the causative agent for the outbreak. Education was given regarding cleaning and when staff were able to return to work. All findings have been reported the NC Communicable Disease Environmental Health - Oliver Tolksdorf discussed the frequency of pool permit inspections has decreased this year, with 38 pools permitted in Harnett County. As of May 20, 2021, 16 pools have been inspected, with 22 not inspected. That is a very low number coming into the week ahead of Memorial Day weekend. Onsite Wastewater remains steady with workload due to the Aging & Case Management Mary Jane Sauls reported the Care Management staff is completing training for Medicaid transformation. Mandatory trainings are held weekly for staff and supervisors. Under the new system, each of the health plans will have a liaison to review the data measures and assist with strategies to ensure they are met. Care Managers will continue to use the Virtual Health documenting system and data will be provided by CCNC. July 1, 2021 is the target date to open the nutrition sites in the county. Site managers are in the process of making sure that safety protocols are in place. COVID funding allowed the Health Department to purchase items such as disinfectant wipes, masks, gloves and hand sanitizer for the sites. The Division on Aging sponsored a "Stay Healthy and Safe drive-thru" on May 19, 2021. Family Caregiver and Grandparents Raising Grandchildren and registered participants received masks, hand sanitizers, disinfectant wipes, gloves and  Branch.  increase of subdivisions in the county.  educational literature.  Marketing/Communty Outreach - Debra Harris-Hawkins announced COVID- 19 allowed for the exploration of alternative methods to provide health education programming for the community. The Board was provided an update on the Health Department "Step into Fitness Walking Challenge" this was a virtual walking program, provided by the Health Education Division. A month    Page 8 Board of Health May 20, 2021  Harnett County Health Department Board Room  long challenge that encouraged participants to increase physical activity through walking. Over 100 residents participated in the program with ages ranging from 4 years old to 92 years of age. We know that through regular exercise and physical activity promotes improves respiratory, cardiovascular health, and overall health. The positive feedback from the community, for this type of program we are planning to  implement again in the future.  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,  John Rouse, Jr. Health Director  hal  RE  Dr. Laura Smith,  - Chanoman