2020 State of the County's Health Report 

for Guilford County

North Carolina requires local health departments to conduct a Community Health Assessment (CHA) every three to four years and submit a State of the County's Health (SOTCH) report during years between assessments. Guilford County's last assessment was completed in 2019. This report provides an overview of progress on Guilford County Division of Public Health’s Community Health Improvement Plans (CHIP), changes in mortality and morbidity, emerging issues and updates on community initiatives. 

Implementing our CHIP process during the COVID-19 pandemic presented a unique set of challenges. The pandemic led to increased workload on department staff and partners, limitations on in-person planning sessions and necessary changes to program implementation to ensure safety.

Despite these challenges, the Guilford County Division of Public Health (GCDPH) has successfully:

• Adopted the Results-Based Accountability^TM (RBA) framework in our CHIP development.
• Transitioned our paper-based CHIPs to the web-based Clear Impact Scorecard, with results, indicators, programs and performance measures.
• Linked our CHIPs to the Healthy North Carolina 2030 Scorecard.
• Certified one staff person through the Clear Impact Academy RBA training.

Maternal and Child Health

During the COVID-19 pandemic, GCDPH staff has been instrumental in community COVID-19 testing and subsequent vaccination rollout. In March 2020, COVID-19 mitigation efforts required shifts in staffing as well as adjustments in protocols and in hours for some services to reduce potential exposure clients and staff.

Care Management for High Risk Pregnancy (CMHRP), Care Management for At Risk Children (CMARC) and Family Connects Guilford (FCG)

The CMHRP program provides free case management to pregnant women enrolled in NC Medicaid and a limited number of low-income insured women. FCG follows the Family Connects International evidence-based model for implementation, offering nurse home/telehealth visits and follow up contacts to all Guilford county residents following the birth of a baby, providing support, education, and early identification and referral of health and safety concerns. CMARC is a free case management for children up to five years of age who are born with chronic conditions, at risk for developmental delays or have been impacted by social determinants of health and toxic stress or trauma.

The CMHRP, CMARC, and FCG programs postponed in-person visits for the protection of clients and staff during the COVID-19 pandemic. CMHRP and CMARC transitioned to primarily phone check-ins, virtual visits and scheduled drop offs for essential items, serving 477 new clients and 594 new clients respectively between July and December 2020.  Family Connects Guilford transitioned to virtual visits and phone contacts during this same time period, serving 2,526 clients. All three programs are currently reviewing protocols to resume in-person programming to ensure this takes place safely. The data tool for the GFC and CMHRP is currently under development.

Reproductive Health Services 

During this time, GCDPH continued to provide quality reproductive health services through its Maternity Clinic, Family Planning/Just Teens clinics and CenteringPregnancy programs. 

While managing COVID challenges, for the 2020 calendar year:

• GCDPH’s Maternity Clinic provided comprehensive prenatal care for 571 women with low to medium risk pregnancies. Of those clients who delivered in 2020, 95.3% had babies that were more than 2,500 grams at birth. 4.7% of the babies were low birth weight or under 2,500 grams at birth.
• CenteringPregnancy is a model of delivering prenatal care that includes health assessment, education and support. Women with similar due dates meet for their prenatal visits with two co-facilitators about ten times during their pregnancies in the same Centering room. Centering groups paused in-person sessions from April to June 2020 and in June 2020 piloted a virtual format.  
• Family Planning and the Just Teens Clinics provide comprehensive family planning services for women and men (teen and adult) based on current recommendations from the Women and Children’s Division of the NC Department of Public Health. During 2020, Family Planning and the Just Teens clinics together served 3,296 clients through 5,832 visits. 

Behavioral Health and Opioid Misuse

New Behavioral Health Crisis Center Complete! 

Construction on the innovative Behavioral Health Crisis Center located on 3rd Street in Greensboro is complete and will open to clients in the summer of 2021. This facility includes a mental health urgent care center and two 16-bed facility-based crisis centers, one for adults and one for children and adolescents, and will provide comprehensive behavioral health services 24-hours a day, seven days a week. Using an integrated services model, staff will treat adults, children and adolescents in crisis and address their physical, mental and substance misuse issues. This holistic approach will include medical care, treatment for substance misuse and other specialized mental health treatment. This facility also has space for outpatient services for adults, adolescents and children. Guilford County covered the design and construction costs of the adult crisis center and Cone Health will serve as the service provider. Similarly, the county covered the design and construction costs of the child/adolescent crisis center and Alexander Youth Network was chosen through a request for proposal process to provide treatment to children and adolescents.

Click below to see a virtual tour.

Guilford County Formerly Incarcerated Transition (FIT) program

The Guilford County FIT program connects justice-involved persons (JIP) with chronic medical conditions, mental illness and/or substance use disorder to patient-centered primary care, assisting with additional insurance, medication assistance and medically related services. This program improves the health of JIP who have been recently released and their chances of successful community reentry. Administered by Triad Adult and Pediatric Medicine (TAPM), specially trained community health workers build trust and act as a peer navigator for reentry with a special focus on opioid use disorder.

Despite the COVID-19 pandemic, during the nine-month period from June 1, 2020 through February 28, 2021, the FIT program successfully served 92 JIP through 584 contacts and provided 107 social determinant of health referrals. These include referrals for food, housing, transportation, employment, education, legal services, job training and other needs, which are vitally important to a JIP's successful reentry into the community. TAPM and the NC FIT program also partnered to develop a video for Second Chance Month in April 2021 to provide more program information (See link below). TAPM staff also received training by the American Red Cross and GCSTOP for naloxone kit distribution. GCDPH receives NC Department of Health and Human Service grant funds and subcontracts to TAPM to provide these services in Guilford County.

Collaborative Opioid Efforts

Guilford County Solution to the Opioid Problem (GCSTOP), a joint initiative housed within the University of North Carolina at Greensboro’s Department of Social Work, and Guilford County EMS's Post-Overdose Response Team (PORT) work together to reduce repeat overdoses and empower clients to enter treatment for persistent substance use and utilize evidence-based harm reduction practices.

During 2020-2021 COVID-19 Pandemic both GCSTOP and PORT staff were required to make service adjustments due to COVID-19 mitigation efforts. Outreach has been more challenging as not as many people have been out and there has been limited entry into the High Point and Greensboro jails due to COVID-19 concerns. Community needs have also expanded as COVID-19 mitigation has affected jobs, schools and other social institutions that are normally operational. Social determinants of health such as housing, food, jobs, and medical and mental health care have all been adversely impacted.

While managing these challenges, during the nine-month period from June 1, 2020 through February 28, 2021, the GCSTOP’s Syringe Services Program, EMS and partners:

• Served 166 EMS-referred individuals identified by PORT.
• Served 618 individuals through 930 contacts.
• Tracked 300 community overdose reversals that originated with GCSTOP.
• Distributed 2,900 naloxone kits.
• Added a new mobile services site in High Point to accommodate for the COVID-19 pandemic and to abide by safety measures of social distancing.
• Provided referrals for harm reduction services.
• Facilitated linkages to primary care and other allied health services.
• Addressed clients’ social determinants of health needs.
• Dispensed 132,000 and received 53,700 syringes.

Leading Causes of Death

In 2019, the two leading causes of death in Guilford County were cancer and heart disease, comprising about 39% of all deaths. Lung cancer was the leading type of cancer death, followed by colorectal and breast cancers. Unintentional injuries, comprised primarily of unintentional poisonings, falls and other external causes of death (excluding motor vehicle crashes), ranked as the third leading cause of death, followed closely by dementia and stroke. Please note that these 2019 data do not capture the significant impact COVID-19 has had in the last year (See more below in Impact of COVID-19 Section). 

There are important differences by race, ethnicity, gender and age. For more information on these differences for 2019, click here (Attachment 1) or go to the 2020 Leading Causes of Death Data Brief https://www.guilfordcountync.gov/home/showdocument?id=11951 .

Select Sexually Transmitted Infections in Guilford County

Of the 70+ reportable diseases in the state, sexually transmitted infections (STIs) are among those having the largest impact on public health. The leading STI in Guilford County is chlamydia, with 5,413 cases in 2019; gonorrhea cases numbered 2,327.  Syphilis cases numbered over 123 cases in 2019, while new HIV infections and AIDS cases were 123 and 29 respectively that same year. Significant racial disparities exist with respect to STIs. African American residents account for a disproportionate percentage of the cases as compared to Whites.  

Impact of COVID-19 on Morbidity and Mortality in Guilford County

COVID-19 has had a profound impact on the health on our Guilford County families and community in the last year. Based upon 2020 provisional mortality data from 2020, in March 2021, the Centers for Disease Control and Prevention announced that COVID-19 was the third leading cause of death in the United States for 2020, after heart disease and cancer. Nationally, COVID-19 was reported as the underlying cause of death or a contributing cause of death for an estimated 377,883 (11.3%) of deaths.¹ The following charts highlight the impact of COVID-19 on morbidity in Guilford County from March 15, 2020 through April 30, 2021.

Morbidity

During this time period, Guilford County had cumulative number of 47,410 confirmed cases of COVID-19.

This chart illustrates COVID-19 hospitalizations from March 2020 through early May 2021, with select peaks in hospitalizations identified. The highest number of hospitalizations took place the week of January 11, 2021 following the holiday season.

From March 2020 through April 2021, more than a third of cases identified as White, slightly less than a third identified as Black, 4.2% as Asian and 8.3% as Other. Race was not known on 19.4% of the cases.

8.3% of cases identified as Hispanic, but ethnicity was not known for 42.2% of cases.

Of the 47,126 cases reported during this time period, 45.1% identified as male, 54.1% as female, and for 1% sex was not known.

A significant portion of COVID-19 cases were 25 to 48 years of age (38.7%), followed by ages 18 to 24 (17.3%), those ages 60 to 85 (16.3%) and 50 to 59 (14.3%). The remainder were ages 0 to 17 (11.5%) and those 86 and over (1.8%).

Mortality

Guilford County COVID-19 mortality data is preliminary as the processing requirements of death certificate records results in a delay in public availability of the data. Please interpret these data with caution as they will need to be vetted when the final detailed 2020 mortality data is released from the state.

It is estimated that from March 15, 2020 through April 30, 2021, Guilford County had 708 deaths due to COVID-19. Of these, it is estimated that 58% where White, 33% were Black, 3.4% were Asian, 0.3% were Native American, 4.2% where Other and 1% were Unknown. Approximately 5% were identified as Hispanic and 52% of deaths were male and 28% were female. These preliminary data show that those ages 60 and over were impacted the most. 55% of the deaths were ages 60 to 85 and 35% were ages 86 and over, while 6% where ages 50-59 and 4% were ages 25 to 49. 

For real time Guilford County COVID-19 data go to the Guilford County COVID-19 Dashboard at: Guilford County COVID-19 Data Dashboard . Additional data is also available on the State COVID Dashboard at: https://covid19.ncdhhs.gov/dashboard.

¹Ahmad, FB, et al. “Morbidity and Mortality Weekly Report (MMWR), Provisional Mortality Data — United States, 2020.” Morbidity and Mortality Weekly Report, U.S. Department of Health and Human Services, 9 April, 2021.

COVID-19 Pandemic

COVID-19, an emerging issue faced by every community and family in 2020, has had a profound impact on our community. On March 15, 2020, Guilford County reported its first case of COVID-19 and on March 31^st, its first death. To reduce the negative impact on the community’s health and to address existing inequities intensified by COVID-19, new and enhanced partnerships supported our COVID-19 community response. These partnerships have focused on surveillance, COVID-19 testing and vaccination, communications, ordinance compliance and issues around equity. These collaborations have also focused on preexisting disparities in social determinants of health that have been exacerbated, such as housing, food insecurity and mental health concerns (See below).

Guilford County Launches the Guilford CARES – Emergency Rental and Utilities Assistance Program 

Guilford County continues to prioritize existing community needs that were made worse by the COVID-19 pandemic while managing the local response. In January 2021, the U.S. Department of the Treasury launched a $25 billion Emergency Rental Assistance Program (ERAP) to assist households that are unable to pay rent and utilities due to the COVID-19 pandemic. Guilford County was awarded $7.25 million in treasury dollars and the Board of Commissioners allocated an additional $747,000 for the County ERAP, which launched in February 2021. The County’s allotment supports residents throughout the County, the City of High Point and smaller communities within the County. For more information, go to https://www.guilfordcountync.gov/services/grants/emergency-rental-and-utilities-assistance-grant-program. The County ERAP is part of the “Guilford Cares” initiatives that began in 2020 to provide relief to those negatively impacted by COVID-19. These efforts support small businesses, reduce food insecurities, provide child care assistance and provide grants to reduce the financial impacts to tourism and arts and culture programs.

The City of Greensboro received a separate $9 million allocation from the U.S. Treasury Department and launched their ERAP in March 2021 for City of Greensboro residents (Go to: www.greensboro-nc.gov/COVIDHousingAssistance). For information on how to apply for COVID-19 rental and mortgage assistance programs, go to Housing Consultants Group (HCG), a nonprofit organization that helps families obtain, maintain, and sustain their homes by providing tailored education and services.

COVID-19 Related Initiatives 

The Importance of Local Surveillance and Testing

Accurate and timely local data, testing and contact tracing have been essential to our pandemic response. The Guilford County Division of Public Health (GCDPH) began tracking COVID-19’s impact in March 2020. To regularly inform the media, community leaders, partners and community members, Guilford County created a COVID-19 Dashboard to track key metrics, including number of cases, hospitalizations, deaths and tests, positivity rates and demographic data for cases and deaths by age, race and ethnicity. For continually updated data, go to: https://www.guilfordcountync.gov/our-county/human-services/health-department/coronavirus-covid-19-info/covid-19-data.Testing and contact tracing has also helped to diagnose, slow the spread of the virus and better understand the prevalence, spread and contagion.

Public Health staff supported Guilford County community testing efforts from May 2020 to December 2020 at various community sites including North Carolina A&T State University, High Point University Community Center and five local recreation centers (Warnersville, Peeler, Griffin, Morehead and Craft). Drive through testing was offered at the University of North Carolina at Greensboro and GCDPH sites in Greensboro and High Point. Prior to beginning our vaccinations efforts, GCDPH secured StarMed Healthcare and eTrueNorth Health Care to support our Greensboro and High Point testing sites, respectively, with additional assistance from National Guard members.

COVID-19 Communications

In June 2020, GCDPH launched the www.healthyguilford.com website to address the need for factual COVID-19 information to inform our community’s response. This website is the local “go to” site for accurate up-to-date COVID-19 information from reputable sources, links to COVID-19 testing and vaccinations and tracking of local COVID-19 metrics. In February 2021, a companion healthyguilford.biz site was added to help businesses and community members to navigate pandemic challenges. GCDPH has also partnered with Guilford County Emergency Management, local hospitals, universities and others to ensure correct consistent information is being communicated in the media and on social media platforms.

COVID-19 Vaccinations 

In late December 2020, GCDPH began COVID-19 vaccinations in partnership with Emergency Management and partners. This included the administration of Pfizer, Moderna and Jansen & Jansen vaccines at the Greensboro Coliseum, Mt. Zion Baptist Church, High Point University Community Center and a site at Bur-Mill Park for first responders and employees considered to be at high risk. GCDPH followed the NC Department of Health and Human Services phased approach to prioritized groups and partnered with faith communities and community-based organizations to ensure equity in vaccine distribution.

The FEMA-supported COVID-19 Community Vaccination Center at the Four Seasons Town Centre in Greensboro enhanced local vaccination efforts. This site offered drive through and walk-in service to residents of Guilford and surrounding counties seven days a week from March 10 to May 27, 2021. For more information, go to https://governor.nc.gov/news/federally-supported-community-vaccination-center-open-north-carolina

As of May 30, 2021, GCDPH has vaccinated 118,435 individuals, including 63,612 partially vaccinated individuals and 54,823 fully vaccinated individuals. (Note: These totals do not include those vaccinated through the Greensboro FEMA site, Cone Health or other providers). Go to https://covid19.ncdhhs.gov/dashboard/vaccinations for more information about North Carolina vaccination efforts.

Other Initiatives

New Primary Care Clinic at Division of Public Health Wendover Building Complete

GCDPH began construction for a primary care clinic on the 3^rd floor of the existing 1100 East Wendover Avenue site in June 2020, and in January 2021, received the Certificate of Occupancy. This clinic will provide traditional primary care services for adults, including preventive services, diagnosis and treatment of acute sicknesses like urinary tract infections and management of chronic conditions like diabetes. This clinic includes four exam rooms, a waiting area and two negative pressure rooms that can be used to test, counsel and treat patients with suspected communicable diseases. Since many staff have been assisting with county COVID-19 testing and vaccination clinics since March 2020, this clinic will become operational in June 2021. 

Medicaid Transformation to Restart in North Carolina and Guilford County

In July 2020, state legislation authorized the restart of Medicaid Managed Care transformation, with a July 1, 2021, launch date for Standard Plans. Medicaid recipients will receive comprehensive care through primary care providers, integrating physical, behavioral and pharmacy health. The four health plans to choose from are AmeriHealth Caritas of NC, Blue Cross and Blue Shield of NC, United Health Care of NC and WellCare of NC. Enrollment Brokers through Maximus will provide choice counseling, outreach, enrollment and mailing all notices. Open enrollment began March 15th and ends on May 21st. Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans for individuals with significant behavioral health needs and intellectual/developmental disabilities, has a planned launch on July 1, 2022. For more information, go to www.ncdhhs.gov/assistance/medicaid-transformation.

Every Baby Guilford Initiative

In 1991, GCDPH formed the Guilford County Coalition on Infant Mortality to increase public awareness about infant mortality and to develop strategies to provide for more healthy birth outcomes. From October 2020 through May 2021, the Coalition organized a strategic planning process with partner Root Cause, to envision bold goals, develop collective action strategies and redesign the Coalition to address the persisting and stark disparities in birth outcomes and infant mortality in Guilford County.

In June 2021, the Guilford County Coalition on Infant Morality became the newly branded Every Baby Guilford.  Strategies have been developed to build an inclusive collective action movement to disrupt longstanding racial disparities in birth outcomes. Using a racial equity lens, Every Baby Guilford (EBG) will pursue the following strategies:

• Advancing health equity by addressing systemic racism and implicit bias within the continuum of care for maternal and infant health.
•  Creating collaborative solutions with radically inclusive community engagement.
•  Strengthening the continuum of care of reproductive life planning for equitable access to quality care.
•  Promoting infant wellness and positive child development.

Interventions to support these strategies include:

• Solidifying EBG infrastructure to manage the logistical aspects of the collective action process and guide community partners to act and measure progress that result in agreed upon outcomes.
• Co-designing a community "care checklist" that is developed, shared, and promotes self-advocacy to build trust between patients and providers.
• Creating education and awareness campaigns with messaging across the continuum of maternity care and well childcare.
• Leading community storytelling projects to amplify the experiences of community members, create collaborative solutions and drive health improvements.
• Creating community circles/groups to support families, strengthen connections, share information and advocacy.
• Promoting healthcare access and referrals for care using existing partnerships and local navigation services.
• Implementing collective advocacy to address barriers to healthcare.

For more information or to get involved go to: www.everybabyguilford.org