Harnett County Board of Health Minutes of Regular Meeting January 19, 2023  The Harnett County Board of Health met in regular session on Thursday, January 19, 2023 in the Health Department Board Room, Harnett County Governmental Complex, Members present: Dr. Laura Smith, Chairwoman, Ms. Emily Barefoot, Ms. Barbara McKoy, Dr. Amanda Langdon, DVM, Dr. Kim Fowler, PhD, Dr. Brandon Washington, DDS, Dr. Catherine Evans, DDS, Ms. Staci Hogan, RPH, Ms. Gayle Adams and Mr. Other present: Dr. David Tillman, PhD, Brent Trout, County Manager, Mary Jane Sauls, Oliver Tolksdorf, Debra Harris-Hawkins, Ainsley Johnson, Gail Hobbs, and  307 W. Cornelius Harnett Blvd., Lillington, North Carolina.  John Rouse, Jr., Health Director.  Natasha Johnson.  Chairwoman Smith called meeting to order at 7:00 p.m.  Announcements = Mr. Rouse introduced Mr. Brent Trout, County Manager and David Tillman, PhD, from Campbell University will be attending tonight's meeting. Consent Agenda = Minutes - Motion made by Dr. Catherine Evans, DDS, for the November 17, 2022 agenda and minutes to be approved and seconded by Ms. 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. Community Health Assessment = David Tillman, PhD presented a PowerPoint presentation Community Health Assessment. The 2022 Community Health Assessment (CHA) document summarizes assessment efforts and provides the foundation for community health improvement planning over the next three years. The Health Department is required to conduct a Community Health Assessment (CHA). Through this assessment process, the Health Department works with other crucial partners and stakeholders including Healthy Harnett (a community coalition), Harnett Health, Cape Fear Valley Health Systems, and Campbell University Department of Public Health. In reviewing the health status of the community as well as collecting information about perceptions of health and quality of1 life in the count from our residents The PowerPoint presentation was presented along with handouts for the Board of Health to review data and citizen input in order to identify help develop goals and objectives. The input from residents was captured through  Emily Barefoot. Motion Carried.  Seeing no one, Chairwoman Smith closed the informal comments.    Page 2 Board of Health January 19, 2023  Harnett County Health Department Board Room  the health assessment process through surveys. Tillman discussed data and provided handouts for the CHA results that include 568 individuals were surveyed. Board of Health members provided input regarding identifying priority areas. By the Board of Health participating in the survey, and ranking, this will help to assist with identifying priority areas for the Community Action Plans. From the CHA findings, the next step is to develop a plan of action for addressing the health issues deemed as priorities. Dr. Smith and the Board acknowledged support of the Health Departments on-going efforts to educate the public, elected officials and various boards about community Consumer/Patient Satisfaction & Community Survey Report - Mary Jane Sauls presented a PowerPoint presentation to the Board. The data from the 2022 Consumer Satisfaction survey and the Community Satisfaction was reviewed. Members of the Board of Health were given the results in writing. The group reviewed the results to evaluate any programing needs that may be addressed to improve services within the Health Department. Regarding the Consumer Satisfaction Survey, 305 surveys were collected. Data indicated that 99% of those surveyed reported being treated with respect during their visit and 99% would recommend the Harnett County Health department to their friends. Regarding hours of operation, 93% reported that the hours of operation 8am-5pm were good for them and 3% stated that there should be extended hours after 5pm at least one day per week and 4% stated the Health Department should close later than 5:00pm. The group was informed that the management team along with clinical supervisors would be exploring options regarding after hours clinics. The board acknowledged agreement with this plan. It was also discussed that the new mobile unit may allow services to be provided during non-traditional hours. The Board of Health then reviewed the Community Satisfaction Survey results; with 155 surveys completed, 13% of the respondents were men, and 87% were women. The survey was shared widely and the public was directed to complete the survey on-line. The survey link was posted on the county Facebook page and website, Health Department Facebook page and website and a notification was sent out via Next Door. Based on the Community results 92% of the respondents reported that the hours of operation 8am-5pm were good for them and 8% reported these were not convenient. The board had no questions or concerns regarding the Recommendation to Establish Fee = Gail Hobbs presented the following fee for an  health issues.  survey data.  increase on established fees:  CPT CODE 90677  DESCRIPTION Prevnar20 (pneumonia vaccine)  RECOMMENDED PRICE $302.00  Motion to approve the increased fee from Ms. Emily Barefoot and seconded by  Dr. Amanda Langdon, DVM. Motion Carried.    Page 3 Board of Health January 19, 2023  Harnett County Health Department Board Room  Influenza/COVID-19 Updates - Mr. Rouse and Ainsley Johnson reported Harnett County is currently at a HIGH COVID-19 Community Transmission level per Centers for Disease Control and Prevention (CDC). Metrics across the state increased over the holidays. Harnett County's overall total reported case count as ofJanuary 13, 2023 was 42,551 with 367 associated deaths reported. An updated report will be released January 20, 2023. This number does not include unreported at home COVID-19 testing. We reported 545 positive COVID-19 test results sO far for January 2023. In addition, we currently have seven active outbreaks in facilities in Harnett County. At home testing distribution program continues to be successful. We have received additional shipments of at home tests, and we have an adequate supply for the public. Kits are available every weekday from 8am-1lam and lpm-4pm. In the past four weeks, we have distributed 1,530 test kits. Mr. Rouse reviewed a handout in the packets on the summary of COVID-19 cases from June 2021 to current. The pie graph shows the breakdown in ages with 74% being adults 19 years and older and 26% age birth to 18 years old. The chart also showed a table comparing Harnett County and North Carolina case rates per year. The new omicron subvariant XBB.1.5 has become predominant in the Northeast and is emerging in North Carolina. North Carolina Department of Health and Human Services (NCDHHS) reports that COVID-19 bivalent boosters continue to offer strong protection against severe illness with all circulating omicron subvariants. COVID-19 antiviral oral treatments are also expected to retain their effectiveness against this variant and all other currently circulating variants. The Health Department continues to encourage COVID-19 vaccination for all ages. Bivalent COVID-19 boosters are available every day of the week by appointment or by walk-ins. Bivalent COVID-19 booster uptake has been steady over the last two months. NCDHHS reports 20% of North Carolina's population has received an updated booster. Bivalent boosters are now available for everyone 6 months and older. We continue to carry primary and booster vaccines for all authorized brands: Moderna, Mr. Rouse and Ainsley reported current surveillance in Harnett County and the state has shown a decrease in respiratory viruses including influenza, RSV (Respiratory Syncytial Virus), and Rhinovirus since December 2022. Flu A continues to be the prominent strain. The highest week for positive flu tests in the state was the week of December 10, 2022. Emergency Department visits for influenza-like illnesses have decreased across the state. Long-term care facilities and local schools are required to report clusters of respiratory illnesses to the Health Department. We currently have no reported flu clusters. So far this season, North Carolina has reported 149 influenza associated adult deaths and three pediatric deaths. Nationwide CDC estimates 16,000 deaths from flu. On December 14, 2022, the CDC issued a Health Alert regarding the prioritization of antiviral treatment of flu while there is a limited supply of Tamiflu. This alert was sent out to all providers in our county. The Health Department continues to encourage everyone to receive their annual flu vaccine. Flu vaccines are  Pfizer, Novavax, and Janseen.    Page 4 Board of Health January 19, 2023  Harnett County Health Department Board Room  available by appointment or as walk in/drive up visits. Due to the high demand this season, there is a limited supply; the Health Department currently has some in stock.  Health Director's Report and Program Reports - John Rouse, Jr.  Accreditation - Mr. Rouse stated Dr. Laura Smith, Chairwoman signed a letter for Accreditation that the Board has not had any adjudications for 2021-2022; The Board of Health has done an evaluation and feels no new or amended rules or ordinances are needed since 2022, and will continue to monitor. Legal Counsel - Mr. Rouse informed the Board that the county has attorneys and the Board ofHealth has access to legal counsel. Harnett County Staff Attorneys, Christopher Appel and Thomas Royer are accessible to the Board and Health Department for any legal issues, and is readily available to our Financial Report - Mr. Rouse provided a handout of the second quarter's finance report for July 2022 through December 2022. Finance will begin to review the six-month budget with supervisors soon, and start working on the 2023-2024 budget. The revenues for federal and state contract money is coming in as expected. Revenue fees in Family Planning and Prenatal clinic are currently decreased, however the numbers of patients seen in the clinics are stable, and this is due to the change of payer source with more patients on the sliding fee scale. Mr. Rouse discussed the expenditures report by reviewing the number of Morgue cases has increased this fiscal year. In December 2022, we had 36 cases and in FY 21-22 we had 164 cases with a cost of $8,200. For the next six months of 22-23, we have had 156 cases with a cost of $7,800. Mr. Rouse reported the Employee Clinic saved the county $75,852.00 in the first quarter and $98,465.00 in the second quarter for a total of $174,317.00. Mr. Rouse discussed the Women, Infants & Children (WIC) program has increased their caseload to over 3,500 per: month since the COVID-19 pandemic. Some appointments are being conducted face to face in the Lillington office and some are still virtual appointments. WIC will be looking at continuing their satellite Mr. Rouse provided an update to the Board on the status regarding the purchasing of the mobile health unit and provided a picture of the unit. Since receiving approval from the Board of Commissioners in October to proceed with the purchase, the next step included the county's legal and finance departments to post a Request for Proposal (RFP). The RFPs were reviewed and M3-Mission Mobile Medical from Greensboro was chosen.  department on an as needed basis.  locations in the county in the next six months.    Page 5 Board of Health January 19, 2023  Harnett County Health Department Board Room  Mr. Rouse provided an update to the Board on the COVID-19 carryforward funds allocated through North Carolina Department of Health and Human Services (NCDHHS) that were used to install handicap accessible doors at the front entrance oft the Health Department and the Commons front and back doors. The project has been completed and the doors are working in both areas.  Clinical Reports - Ainsley Johnson  Employee Clinic - Employee Clinic visits, as indicated on the activities summary, have been steady at 165 visits last month. We have seen less COVID- Child Health - Sick visits to our Child Health clinic decreased in December 2022 compared to November 2022 visits due to the decrease in respiratory viruses. Well physicals decreased slightly in December 2022. Child Health is reaching out to all children in need of physicals prior to the start of the school year, and this is also a measure that we are working for in Medicaid transformation. Each Medicaid health plan has a goal to increase pediatric well visits. Meeting these measures will result in incentive for our Health  19 and flu in this population in the last month.  Department.  Adult Health - Adult Health clinic visits increased last month. The Health Department initiated a partnership with a new. laboratory Natera, they provide Horizon carrier screening and Panorama DNA to assess a baby's health during pregnancy. They are evidenced based practice tests performed in the prenatal clients. This genetic prenatal testing is a great benefit to the clients. Syphilis and Sexually Transmitted Disease (STD) cases remain elevated at 49 for December 2022. We offer same day appointments for STD care five days per week and are continuing to work with our: regional Disease Intervention Specialists (DIS) to contact all cases and contacts for treatment. On December 19, 2022, NCDHHS issued a public health alert regarding the increase in female and congenital syphilis infections. Between 2012 and 2021, there was a 538% increase in women. This public health alert was sent to all healthcare providers in the county and informed healthcare providers of ways to help decrease the number of cases. Our health education has several events planned to offer human immunodehiciency virus HIV)/syphilis testing at Monkeypox Update - The Health Department continues to have no active cases of Monkeypox to report and we have vaccine available.  various locations across our county.    Page 6 Board of Health January 19, 2023  Harnett County Health Department Board Room  Laboratory - The lab continues to serve all clinical areas, and with a decrease in respiratory illnesses, testing numbers have decreased slightly. The lab staff continues to assist in outreach events and the Commons Governmental Complex COVID-19 testing that occurs every Friday from 9am to 1lam. Environmental Health - Oliver Tolksdorf reported the process of permitting food trucks through Food & Lodging. The food truck business will submit an application and a plan review to Environmental Health, Environmental Health will need to establish the business has a commissary to store and dump items. Once the commissary has been approved, a full plan approval goes in effect and the unit is built, finally an initial inspection is done to verify the unit has been built according to the plans. Regular inspections are performed by Food & Lodging on a schedule, this schedule is a 2-4year inspection based on menu. Food truck owners are required to call the county they are setting up in for Aging & Case Management - Mary Jane Sauls reported The Harnett County Division on Aging sponsored a blood drive on January 12, 2023. Appointments for the blood drive were full with 38 units of blood collected. To make the blood drive successful volunteers were recruited through the Harnett County Volunteer Program, they assisted with making appointment reminders, helping staff set up the room, provide baked goods to serve in the canteen and work at the registration table. The next blood drive will be held on Thursday, March 9, The Medicare Program continues to be busy with new to Medicare individuals needing help with supplemental insurance options and drug plan assistance. During the Medicare Open Enrollment Period of October 15th- December 7th, 2022, the Harnett County Division on Aging served 527 Medicare Beneficiaries with a combined savings of $272,621.00. A New to Medicare 101 Class will be held on Tuesday, January 31, 2023 at the Harnett County There are 52 clients on the In-Home-Aide Program at this time. A Mid Carolina In-Home-Aide Program monitoring was completed on January 18, 2023, with no issues found. The consultant praised the staff for their chart organization and We continue to recruit for the Nutrition Project Coordinator position, the job posting closes on January 23, 2023, and it will be the third time it has been advertised. The Elderly Nutrition program provided 4,354 meals that were served in November to include home delivered meals, congregate meals,  inter-county inspections.  2023 from 1:00pm - 5:30pm.  Resource Center/Library from 3:00pm - 4:30pm.  documentation.  emergency shelf meals and frozen meals.    Page 7 Board of Health January 19, 2023  Harnett County Health Department Board Room  The Division on Aging currently serves 104 beneficiaries on Community Alternatives Program for Disabled Adults (CAP/DA) services in Harnett County. The Care Management for high-risk pregnancy program is currently serving 161 pregnant women and collaborates with 32 Obstetrics and Gynecology providers. Care Management for at risk children is serving 140 children, ages birth to five years old to collaborate with 24 primary care providers. Since July 2022, Care Managers have engaged 31 Plan Of Safe Care Referrals for substance affected Marketing/Communty Outreach - Debra Harris-Hawkins presented the Health Education Division have a couple of community health and education events scheduled over the next few months. Community Health Outreach programs play a critical role in improving and extending the reach of the Health Department. Included in the packets are flyers for two upcoming outreach programs. The Prevent Type 2 Diabetes program, key components of the program include participants work together to learn about healthier eating and increasing their physical activity in order to reduce their risk for developing diabetes. The session will be February 23, 2023 from 5:30-6:30pm. Flyers were provided regarding the upcoming Girls are Great conference. The Health Department in partnership with Cooperative Extension will provide the Girls are Great conference Saturday, April 15, 2023, the event is for parents and children and works to provide information on the physical and emotional changes that take place with girls during puberty. Additional information about these community events are available on the Health Department's web site.  infants.  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.    Page 8 Board of Health January 19, 2023  Harnett County Health Department Board Room  Respectfully submitted, Cvw John Rouse, Jr. Health Director  8g2.