Throughout the pandemic, our focus shifted from community health improvement plans to the immediate needs of the community. This situation lead to difficulty in implementing our CHIP due to the restrictive nature of engagement and redirected work of staff. Since March 2020, our staff had to switch gears to provide education and outreach on not only our priority areas, but also on Sars-CoV-2 and COVID-19. COVID-19 dramatically impacted Rowan County's SOTCH and CHIP process and the ability to work with partners and implement planned programs

We were able to complete the following items:

1. Adopted Results-Based Accountability (RBA) through an introduction to staff after the RBA workshop in June 2020. 
2. RBA was also introduced to our Board of Health by our Quality Improvement Specialist. Our goal is continue to educate our board on the importance and the value of RBA. 
3. Began utilizing Clear Impact ScoreCard for CHIPs including adding relevant data that is easily accessible to the community. This included providing the importance of the data, the results, indicators, programs, and performance measures. We are currently continuing to work on integrating ScoreCard on our website. 
   1. As we look to the future, our goals include using ScoreCard to document the changes in health status of our populations based on the goals and objectives selected and based on the identified goals of Healthy NC 2030. 
4. We were able to link our ScoreCard to the Healthy North Carolina 2030 Scorecard to generate awareness of population health and accountability back to the comunity

Morbidity and Mortality changes of the Rowan County population for 2020 are focused on the impact of COVID-19 on our community. In the years to come, we understand that there may be long-lasting impacts to the physical, emotional, and mental health of Rowan.

COVID-19 data from March 2020 - April 6, 2021:

1. Total # of cases: 15,895 
2. Total # of deaths: 299
3. Total # of "active cases" (new cases in the last 14 days): 610

Important to the discussion of cases and deaths due to COVID-19 are the disparities that persist in who was impacted by the virus.

Demographics:

1. Race: 
   1. American Indian/Alaskan Native: 0.6%
   2. Asian: 0.6%
   3. Black or African American: 13.3%
   4. Native Hawaiian or Pacific Islander: 0.0%
   5. White: 60.5%
   6. Other: 9.1%
   7. Unknown: 15.9%
2. Gender:
   1. Female: 52.6%
   2. Male: 47.0%
   3. Unknown: 0.4%
3. Age:
   1. 0 to 17 yrs: 11.4%
   2. 18 to 24 yrs: 11.4%
   3. 25 to 49 yrs: 36.9%
   4. 50 to 64 yrs: 22.6%
   5. 65 to 74 yrs: 9.3 %
   6. 75 yrs+: 8.3%

Vaccines were developed to protect against COVID-19. Rowan County Public Health directed considerable resources to the promotion of vaccines, to the coordination of mass vaccination clinics, and to ongoing education of vaccinations against disease. Three vaccinations were developed and approved for emergency use, including: Pfizer-BioNTech (two-dose mRNA vaccine series given 3-weeks apart), Moderna (two-dose mRNA vaccine series given 4-weeks apart), and Janssen/Johnson-and-Johnson (one-dose vector vaccine). As of April 2021, the following vaccinations had been completed:

Vaccinations:

1. US Population: 23.9% 
2. North Carolina: 26.1% 
3. Rowan County partially vaccinated (one of two dose series): 30,063 - 21.2% of total population; 27.3% of population 18+
4. Rowan County fully vaccinated (both of two dose series or completed one dose series): 21,175 - 14.9% of total population, 19.3% of pouplation 18+

COVID-19

Rowan County's first reported case of COVID-19 was on March 18, 2020 and the first death associated with COVID-19 was on March 27, 2020 for an individual with underlying conditions. This was the fourth death due to COVID-19 in the state of North Carolina. As of April 6, 2021, Rowan County had 299 deaths associated with COVID19. The health department and community agencies continue to work together to promote COVID-19 vaccinations. The goal for the community is to provide vaccinations for every citizen who would like to receive one and reach at least 50% of our population vaccinated against COVID-19 by the end of 2021. 

Economic Distress

One emerging issue from 2020 into 2021 was the impact of COVID-19 on economic development. Rowan County was downgraded to the bottom tier in the North Carolina Department of Commerce’s 2021 county distress rankings.  The primary culprit for Rowan County’s regression is the unemployment rate, which went from 4.02% and No. 57 in the 2020 rankings to 7% and No. 25 in the 2021 rankings. Economic development and employment are signifciant non-medical drivers of health in our community. When individuals lose their jobs, they also lose security, health insurance, and have a significant negative impact to their mental health. Rowan has a very large service, hospitality, leisure, entertainment, recreation sector that disproportionately has been hit much harder than counties where individuals had more opportunity to stay-at-home for business operations. 

We continue to anticipate other areas of social determinants of health to have an impact in our community. 

Mental Health

COVID-19 negatively impacted the mental health of the citizens of Rowan County. COVID-19 not only caused the loss of loved ones and a loss of jobs, it also caused the loss of community support and interaction, loss of in-person schoolingn, and the social isolation of seniors. Opportunities for individuals to find connection have diminished over the last year due to COVID-19. The Health Department responded with significant education and outreach campaigns; however, traditional means of communication shifted dramatically due to COVID-19. 

Substance Use

Rowan County saw a signficant rise in the misuse and use of substances. In 2020 alone, North Carolina reported that 8 individuals died daily due to drug overdose. Here in Rowan, the number of overdoses that PORT has responded to has more than doubled since COVID-19 (141 calls pre-COVID vs 333 calls post-COVID). In addition to the number of overdoses increasing, Rowan County has also seen the number of overdose fatalities increase by almost thirteen-fold since COVID’s inception. Whereas there were 3 too many overdose fatalities from October 2019 to March 2020, that number tragically increased to 40 overdose deaths in 2021 alone. 

Rowan County Public Health shifted as we directed the charge in pandemic prevention and response while still continuing to provide essential public health services for our community.

• Distributed 46,000 masks in partnership with Rowan County Emergency Management through two Mask Up! Rowan events and testing sites
• Created a COVID19 billboard campaign to encouraging masking and vaccination which generated an estimated 14 million impressions
• Staff responded to more than 3,821 phone calls to the COVID-19 information line which operated 24 hours 7 days a week
• Held 88 free COVID-19 testing events for community members
• Maintained the COVID19 Facebook and Website with up-to-date data keeping citizens informed
• In December of 2020, the health department began providing vaccinations against COVID-19 for citizens. We utilized a mass vaccination model to move through as many individuals as quickly as possible to get vaccinated. 

Substance Use

1. Health education and promotion materials were used to address tobacco-use and vaping during the pandemic. Staff worked with marketing agencies and used technology to reach people with advertisements. 
2. The Post Overdose Response Team (PORT) transitioned to putting more efforts towards community outreach. Mobile Narcan distributions stations continued in an effort to prevent and to reduce the risk of an opioid related overdose death. 
3. Community Outreach Walks began as another way to offer support to those in need: and because of their success, they are now done on a monthly basis. This service has not only helped with the distribution of Narcan kits and making referrals for treatment, it has helped us make more contacts with our ever-increasing homeless community and those who are unable to receive support from our local homeless shelter.
4. PORT has collaborated with our county’s IT Department and GIS Manager to strengthen its data collection efforts. By being able to do this, PORT is able to gather demographic information for each individual served, identify veteran status if applicable, determine access to medical insurance, as well as determine active drug use areas or “Hotspots” within Rowan County.

Mental Health

1. The health department partnered with the local Rowan County United Way branch on an annual suicide prevention walk that was held virtually and in person. The purpose of this walk was to connect survivors and families to support them during a time of greiving. 
2. RCHD held a Community Resiliency Model (CRM) training virutally to buildl capcity within the community to promote resilience and address trauma. This model offers six wellness skills that focus on the importance of communication and what is happening in the present moment instead of what happened in one’s past. By offering this new educational piece,  individuals have a new set of skills that could allow them to become more resilient with the overall personal goal of creating a more healthy and productive life.

Obesity

Obesity and chronic disease continue to be a focus of the health department and our community partners. Local pediatric agencies highlighted that the loss of in-person school prompted poor health behaviors like excessive screen time, lack of physical activity, poor sleep hygiene, and poor nutrition. The following actions were taken from March 2020 - March 2021 to continue to address obesity across the lifespan:

1. Go NAPSACC - an early childcare center intervention to promote drinking water, offering healthier items, and encouraging activity. Staff worked with four childcenters to achieve "REACH" program recognition. 
2. "Adventure at the Y!" - Staff held “Adventure at the Y!” sessions for K – 8th graders at the three YMCA locations to reach around 100 – 120 students. This program promotes physical activity and teaches nutrition education tpo students and their families. 
3. Daily Mile - this is a program where students are permitted 15 minutes of instructional time to run, walk, or jog am ile very day. Schools used this program to promote physical activity when students were back in school during portions of the Fall of 2020 and early Spring of 2021. 
4. Exercise is Medicine and Lifestyle Medicine: The Medical Director at our local free clinic, theCommunity Care Clinic of Rowan, continued to prescribe exercise for patients even as she utilized telehealth services to meet client needs. The goal for this agencies it to expand to offer Lifestyle Medicine prescriptions to address the impacts of COVID-19 including prescriptions for healthy eating, stress management, tobacco cessation, healthy relationship, and sleep prescriptions. 

Community Coalition

Healthy Rowan, a local community coalition funded by The Duke Endowment's Healthy People, Healthy Carolinas, continued to meet monthly and compiled information on local resources for the community. This coalition brought together over 40 community agencies and the meeting allowed for space for organizations to share information related to COVID-19 and work together to address local needs.