2021 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 (Click here for 2019 CHA). 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 challenges, including 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.
• Implemented Maternal and Child Health and Behavioral Health and Opioid Misuse CHIPs and COVID-19 related initiatives. 

Maternal and Child Health

As the COVID-19 pandemic has continued, GCDPH staff continues to support the community COVID-19 vaccination rollout and adjust service delivery for some services to reduce potential exposure clients and staff.

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

The FCG program 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. The CMHRP program provides free case management to pregnant women enrolled in NC Medicaid and a limited number of low-income insured women. CMARC is 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. While all three programs have adjusted home visit protocols for the protection of clients and staff during the COVID-19 pandemic, program staff continue to have a significant impact on the lives of expectant mothers and their children. 

• FCG: In 2020, FCG staff transitioned to virtual visits and phone contacts and for the 2021 calendar year, engaging with 2,427 clients through virtual/phone integrated visits and supportive calls to clients. On July 1, 2021, FCG began offering brief (< 15 minutes) in home vital signs and weight check assessments for families at high risk (concerns with infant weight, feeding and maternal blood pressure). On December 1, 2021, these brief in home assessments were expanded to all families completing a virtual/ phone visit. Of those families completing a virtual/phone visit, 25% also accepted and completed a brief in home assessment. In 2021, FCG also secured a grant from the American Heart Association (AHA) for their COVID-19 Postpartum Hypertension Self-Management Project to purchase home blood pressure monitoring equipment. Women in need of blood pressure monitoring during their postpartum recovery received this equipment. Several monitors were also shared with the CMHRP Program to distribute to women who had a need to monitor during their pregnancy (see below). FCG continues to be in the process of developing a new internal database and this Fall began meetings and development with Coastal Cloud.  As of January 10, 2022, the project is 30% complete. The projected launch date of the new database is July 12, 2022.  In Fall 2021, The Foundation for a Healthy High Point awarded FCG $194,150 to support nursing staff dedicated specifically to the 27260 and 27262 zip codes, where low birth weight and infant deaths are more concentrated.

• CMHRP: During 2021, CMHRP case managers successfully enrolled 1, 229 high risk pregnant women. Due to the pandemic, case managers did not complete home visits with patients but instead completed drop-off visits to deliver essential items. Obstetric providers understood the value of the case managers assigned to their practice and allowed in-person visits at the office with COVID precautions in place. Through this collaboration, case managers completed 1,960 face- to- face visits. Over 5,400 patient-centeredinteractions were completed, including phone calls, videoconferences, texts, and emails. Patients that had a need received blood pressure monitors provided through the FCG AHA grant and food was provided to families from the Food Pantry at the Health Departments in Greensboro and High Point in partnership with Backpack Beginnings.

   

  

• CMARC: From January through December 2021, CMARC staff enrolled 1,233 new clients and completed 610 socially distanced home visits. At these visits, case managers delivered essential supplies such as infant formula, diapers, safe sleep equipment, children’s clothes, and food to entire families. The photo below illustrates a delivery to four families in High Point made on 12/22/2021 (Photo credit: Andrea Hay). In 2021, CMARC also received 285 Plan of Safe Care-Opioid /Substance Exposed Infant referrals that were assigned for outreach. 

Reproductive Health Services 

In 2021, 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 2021 calendar year:

• GCDPH’s Maternity Clinic provided comprehensive prenatal care for 486 women with low to medium risk pregnancies. Of those clients who delivered in 2021, 96.7% had babies that were more than 2,500 grams at birth. 3.2% 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. In 2021, Centering groups continued in a virtual format. For clients who delivered in 2021 for which data is available, 7.1% of the babies were low birth weight and 8% of the births were preterm. 

• 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 2021, Family Planning and the Just Teens clinics together served 2,985 clients through 5,184 visits.  

Behavioral Health and Opioid Misuse

New Behavioral Health Crisis Center Complete!  

What began as a vision of more integrated behavioral health services in 2017, has become closer to reality. On June 1, 2021, Guilford County Government, in partnership with Cone Health, opened the new Behavioral Health Urgent Care (BHUC) located at 931 Third Street in Greensboro. The BHUC offers acute behavioral health services and emergency medical care provided by Cone Health staff 24 hours a day 7 days a week for both adults and adolescents. This facility also includes two 16-bed facility-based crisis centers, one for adults at the BHUC site and a separate one for children and adolescents adjacent to the BHUC at 925 Third Street.

Using an integrated services model, staff treat adults, children and adolescents in crisis and address their physical, mental and substance misuse issues. This holistic approach includes medical care, treatment for substance use and other specialized mental health treatment. This facility also has pharmacy, outpatient and peer counseling services for adults, adolescents, and children. Guilford County covered the design and construction costs of the adult crisis center and Cone Health is the service provider. Similarly, the county covered the design and construction costs of the child/adolescent crisis center and Alexander Youth Network provides treatment to children and adolescents. In September 2021, Debra Mack, MSN, RN-BC was named as BHUC Director to oversee the county’s behavioral health partnership with Cone Health. She brings her leadership skills and experience from Monarch Crisis in Greensboro and more recently Cone Health Behavioral Health Hospital, where she served as Director. 

From June 1, 2021 through Nov. 30, 2021, there were a total of 6,622 patient visits at the BHUC. On the first floor of the site, Cone Health offers crisis walk-in services 24 hours a day 7 days a week, 23 hour observation, and facility-based crisis services. From June 1, 2021 through Nov. 30, 2021, 2,602 patients received services on the first floor. Of those patients served, 729 arrived via EMS or Law Enforcement that were diverted from the Emergency Department. On the second floor, Cone Health offers the following Behavioral Health Outpatient Services: therapy, medication management, partial hospitalization program (5 hours per day 5 days per week) as an alternative to inpatient hospitalization, substance use intensive outpatient program (3 hours per day 3 days per week), and medication management and reverse integration of primary care services. From June 1, 2021 through November 30, 2021, 4,020 patients received outpatient services.

Click below to see a virtual tour of the BHUC.

 Supporting and Empowering Formerly Justice-involved Persons

The Guilford County Formerly Incarcerated Transition (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 ongoing COVID-19 pandemic, during the nine-month period from March 1, 2021 through December 31,2021, the FIT program staff successfully served 134 JIP through 627 contacts and provided 140 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. While staff cannot currently go into the jails due to COVID restrictions, they have developed relationships with WellPath, the correctional care entity responsible for clinical care in the jails and the Guilford County Re-Entry Council, both of which refer JIP to the FIT program upon release.

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). After receiving training by the American Red Cross and GCSTOP for naloxone kit distribution, TAPM staff began distribution in 2021. From March 1, 2021 through December 31, 2021, FIT staff distributed 25 kits to clients with guidance from clinical staff based upon substance use disorder screening. TAPM also began office based opioid treatment (OBOT) on January 24, 2022. OBOT is a type of medication assisted treatment (MAT) often used in combination with counseling and behavioral therapies. MAT is a clinically effective approach to help clients maintain their recovery and reduce opioid overdose. TAPM also relocated their High Point office location to 606 North Elm Street.

FIT staff connected 30 JIP to community health insurance programs during the enrollment period to support their care. Staff also actively participated in trainings in Mental Health First Aid and Addiction Specialist Certification program facilitated by North Carolina State University. GCDPH receives NC Department of Health and Human Service grant funds and subcontracts to TAPM to provide these important services in Guilford County. For more information about NC FIT, click here.

Collaborative Opioid Efforts 

Guilford County Solution to the Opioid Problem (GCSTOP), an 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 2021, GCSTOP and PORT staff have continued to make service adjustments due to COVID-19 mitigation efforts. Outreach has been more challenging as people may have reservations about being out, staff are required to wear masks and maintain social distance from clients, which can make it more difficult to develop trust, and there continues to be limited entry into the High Point and Greensboro jails. 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 continue to be adversely impacted.  

Despite these challenges, the GCSTOP’s Syringe Services Program, EMS, and partners:

• Served 250 EMS-referred individuals identified by PORT (March 1, 2021 - December 31,2021)
• Served 260 individuals through 649 contacts.
• Tracked 523 community overdose reversals that originated with GCSTOP.
• Distributed 1,201 naloxone kits.
• Provided referrals for harm reduction services.
• Dispensed 133,452 and received 53,384 syringes. (March 1, 2021 -August 31,2021)

Also, June 30, 2021 through August 31, 2021, through Kaitlyn’s House, 37 referrals to address clients’ social determinants of health needs and 15 linkages to primary care and other allied health services were made, including a few patients who are have been prescribed medication assisted treatment (MAT), which has helped to define patient follow up processes.  GCDPH is also pursuing a standing order for Narcan kit dissemination and necessary staff training to authorize designated health care team members who are trained to disseminate to clients. Partners also moved forward to implement the Save a Life Guilford campaign, held Overdose Remembrance Day events and GCSTOP created a new home at Kaitlyn’s house.

Save a Life Guilford Campaign

For individuals who use drugs, stigmatizing language around substance use disorder can be a significant barrier to seeking out and obtaining treatment. To increase public awareness around this issue and harm reduction strategies like Naloxone, local partners created the Save a Life Guilford public awareness campaign with support from Vitalink, a marketing firm. Partners included GCDPH, GCSTOP, TAPM, the NC FIT program, and the University of North Carolina at Greensboro. This campaign, which took place in the summer of 2021, included the development of the savealifeguilford.com website, a public service announcement (PSA), media outreach kits, poster billboards, and social media outreach.  Click below to see the PSA https://youtu.be/fIOEE-xq7jg.

For more information about how to help stop the stigma, download the NCDHHS Stop the Stigma Resource Guide by clicking here.   

Overdose Day of Remembrance

On August 30th and 31, 2021, community partners hosted a special two evening Overdose Awareness Day event at College Park Baptist Church in Greensboro. On August 30th, the NC Survivor’s Union, Truth Pharm, Faith in Harm Reduction, and United Church of Christ hosted An Evening of Remembrance and Celebration to honor the lives lost to overdose, that included a call of names, creation of memorials and a release of paper lanterns. The Mobilizing to End Overdose event followed the next day, with an evening of guest speakers focusing on innovations in the field of harm reduction, live music and a visual representation of lives lost to overdose. Participating partners included Prescription Addiction Intervention Now (PAIN), We are the Drug Policy Alliance, GCSTOP, NC Survivor’s Union, Urban Survivors Union, Medication Assisted Treatment Support and Awareness (MATSA), and Atlanta Harm Reduction Coalition.

GCSTOP’s New Home at Kaitlyn’s House 

On September 19, 2021, GCSTOP dedicated Kaitlyn’s House in High Point as its headquarters. This house was so named in honor of Kaitlyn Drake, a 24-year-old Greensboro resident who lost her life to an overdose to heroin laced with fentanyl in July 2020. Kaitlyn’s House serves as both a place of hope and a transitional and sober living home. The facility offers showers, laundry services, kitchen and baby supplies, and other harm reduction services. Consumers who have a need also have access to both clothes and food pantries. GCSTOP is also utilizing fentanyl test strips with clients and orienting them on how to use them as an additional harm reduction strategy. Below are few impact stories.

Leading Causes of Death and the Impact of COVID-19 on Morbidity and Mortality in Guilford County 

At the time of this report, 2020 Guilford County mortality statistics had not been released so the full impact of the COVID-19 pandemic on leading causes of death locally is not known, but provisional national mortality data and life expectancy changes provide important insights. According to the National Center for Health Statistics National Vital Statistics System, there was a 15.9% increase in the age-adjusted death rate nationally from 2019 and 2020. COVID-19 became the third leading cause of death nationally in 2020, after heart disease and cancer. COVID-19 was reported as underlying cause of death or a contributing cause of death for an estimated 377,883 deaths or 11.3% of the total number of deaths. Populations most impacted nationally include males, older adults, Hispanic persons, and non-Hispanic American Indian or Alaska Native persons (1).

From 2019 to 2020, United States life expectancy at birth declined by a year and a half from 2019 to 2020, from 78.8 years to 77.3 years. COVID-19 contributed to 74% of this decline in life expectancy, followed by unintentional injuries (11.2%), homicide (3.1%), diabetes (2.5%), and chronic liver disease and cirrhosis (2.3%).  The Hispanic population experienced the largest decline of 3 years from 81.8 to 78.8 years with 90% due to COVID-19. African Americans followed closely behind with life expectancy dropping 2.9 years, from 74.7 to 71.8 years, with 59.3% due to COVID-19. Non-Hispanic Whites’ life expectancy dropped from 78.8 to 77.6 years, with COVID-19 contributing to 67.9% of the decline (2).Because these data are provisional, over time additional information will provide more clarity of the pandemic’s impact; however, it helps us understand the likely impact here in Guilford County.  

In 2019, the two leading causes of death in Guilford County were cancer (932 deaths) and heart disease (890 deaths), comprising about 39% of all deaths. Lung cancer was the leading type of cancer death, followed by colorectal and breast cancers. Unintentional injuries (284 deaths), comprised primarily of unintentional poisonings (131 deaths), falls (102 deaths), and other external causes of death (excluding motor vehicle crashes), ranked as the third leading cause of death, followed closely by dementia and stroke (for more detail go to the 2021 Leading Causes of Death Data  Brief). 

These 2019 data do not capture the significant impact COVID-19 has had in 2020 and 2021. The following charts highlight the impact of COVID-19 on mortality and morbidity in Guilford County from March 15, 2020 through January 31, 2022.  For the most updated and detailed Guilford County COVID-19 data by race, ethnicity, age, and gender 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.

Since the onset of the pandemic, GCDPH has verified each COVID death and from March 15, 2020 through January 31, 2022 the pandemic, Guilford County has lost 994 individuals (See chart below). There were 312 confirmed COVID-19 deaths in Guilford County in 2020 and 631 deaths in 2021. It is likely that COVID-19 will be the 3rd leading cause of death in 2020 and 2021 as well.  Please Note: Guilford County COVID-19 mortality data for 2020 and 2021 is preliminary as the processing requirements of death certificate records results in a delay in public availability of the data. Please interpret with caution as these data need to be vetted when the final detailed 2020 and 2021 mortality data is released from the state.

From March 15, 2020 through January 31, 2022, Guilford County had cumulative number of 94,829 confirmed cases of COVID-19 (see chart below).

The chart below with select points identified illustrates Guilford County COVID-19 hospitalizations from March 15, 2020 through February 1, 2022. In 2020, hospitalizations reached their highest in late December at 226 (12/25/20) and this wave peaked at 275 hospitalizations on 1/11/21. In late summer 2021, we had another peak in hospitalizations with 171 on 8/26/21. The highest number of Guilford County hospitalizations during this time period occurred on 1/26/22 with 313 hospitalizations.

1- Ahmad FB, Cisewski JA, Miniño A, Anderson RN. Provisional Mortality Data—United States, 2020. MMWR Morb Mortal Wkly Rep. Published March 31, 2021.  https://www.cdc.gov/mmwr/volumes/70/wr/mm7014e1.htm?s_cid=mm7014e1_w

2 - Arias E, Tejada-Vera B, Ahmad F, Kochanek KD. Provisional life expectancy estimates for 2020. Vital Statistics Rapid Release; no 15. Hyattsville, MD: National Center for Health Statistics. July 2021. DOI: https://dx.doi.org/10.15620/cdc:107201

Select Sexually Transmitted Infections in Guilford County, 2018-2020 

Sexually transmitted infections continue to have a significant impact on the community’s health. While reported cases for chlamydia, gonorrhea, early syphilis and HIV decreased from 2019 to 2020, this is likely due to the reduced availability of testing due to the COVID-19 (see table below). According the 2020 NC HIV Surveillance Report, Guilford County ranked fourth in the state for newly diagnosed HIV among adults and adolescents with a three-year rate of 23.6 per 100,000 population (2018-2020), just behind Washington, Mecklenburg and Scotland counties. Guilford County also stands out with newly diagnosed cases of early syphilis, ranking fifth with a three-year rate of 31.7 per 100,000 population (2018-2020), following behind Durham, Mecklenburg, Cumberland, and Vance counties. Significant racial disparities exist with respect to STIs. African American residents account for a disproportionate percentage of the cases as compared to Whites.

COVID-19 Pandemic 

COVID-19 has continued to be the pressing concern that has continued to impact every community and family in 2021. It has also had a profound effect on the health of our Guilford County community.  From March 15, 2020 through January 31, 2022, Guilford County has reported 94,829 cases and lost 994 valued community members to COVID-19. To reduce the negative impact on the community’s health and to address existing inequities intensified by COVID-19, new and enhanced partnerships have c ontinued to support our COVID-19 community response. These innovative 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. These COVID-19 related initiatives are detailed in the section below (New/Paused/Discontinued Initiatives Since Last CHA).

Increasing Awareness of Equity

 The disproportionate impact of COVID-19 among historically marginalized populations (HMP) as well as the continued structural and social determinants of health that shape the distribution of power and resources that have influenced the impact of COVID-19 and other health inequities have led to an increased understanding of and focus on health equity.  According to the Centers for Disease Control and Prevention (CDC), “health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.” 

In Fall 2021, to support our equity work, GCDPH received grant funding from North Carolina through the CDC’s Advancing Equity effort. As a part of this effort, GCDPH will address COVID-19-related health disparities and advance health equity by:

• Developing an organizational equity plan to address staff training and internal equity practices.
• Implementing a communications campaign addressing COVID-19 prevention and vaccination for populations at higher risk, underserved, and disproportionately affected, including HMPs or other priority populations. 
• Establishing or joining an Equity Advisory Council that can provide guidance to support equity in internal and external operations.
• Hiring a Health Equity Coordinator in 2022 to assist these efforts and in the design and coordination of organizational changes to enhance activities related to the elimination of health disparities and inequities.   

The American Rescue Plan Act– Coronavirus State and Local Fiscal Recovery Funds 
In July 2021, the Guilford County Board of Commissioners accepted $104 million allocated by the U.S. Department of Treasury under the American Rescue Plan Act. Guilford County is committed to investing these Coronavirus State and Local Fiscal Recovery Funds in local projects that:
•    Center community voice in decision-making,
•    Honor County values of equity/inclusion, accountability, service excellence, and transparency/communication,
•    Build on a foundation of existing County and regional efforts,
•    Maximize funding by combining funds with other efforts, and 
•    Focus on sustainability with one-time uses or by establishing a path to sustainability. 
To inform allocation decisions, Guilford County is leading a four-phase public engagement process from September 2021 - March 2022, that includes Listening, Visioning, Prioritizing and Recommending. For more information about this process, click here.

Opioid Settlement Will Provide Much Needed Help to Guilford County, Greensboro, and High Point

While the effect of opioid use disorder on the health of Guilford County residents is not new, in July 2021, Attorney General Josh Stein announced a $26 billion multistate agreement that will bring vital resources to communities like ours that have been impacted by this epidemic. This agreement is a settlement of opioid litigation over the role of three drug distributors, McKesson, Cardinal Health and AmerisourceBergen, and one manufacturer, Janssen Pharmaceuticals, Inc., and its parent company Johnson & Johnson, in this epidemic. These resources will support opioid mitigation and require these businesses to improve safety and oversight over opioid prescription distribution.

In January 2022, the Attorney General, the North Carolina Association of County Commissioners, and the North Carolina League of Municipalities announced that all 100 North Carolina counties and 45 local municipalities, including Greensboro and High Point, have signed onto this agreement. North Carolina is expected to receive close to $750 million for treatment, recovery support, harm reduction, and other strategies to address the opioid epidemic. For more information about this effort and the Memorandum of Agreement between the State of North Carolina and local governments, go to www.morepowerfulnc.org.

Medicaid Transformation in North Carolina and Guilford County

In July 1, 2021, with the restart of Medicaid Transformation, Medicaid beneficiaries began receiving Medicaid services through NC Medicaid Managed Care. Through Medicaid Managed Care, Medicaid recipients choose a health plan and receive care through that plan’s provider network. Recipients receive comprehensive care through primary care providers, integrating physical, behavioral and pharmacy health. The five health plans to choose from in Guilford County included WellCare, UnitedHealthcare Community Plan, Healthy Blue, AmeriHealth Caritas, and Carolina Complete Health. Open enrollment began March 15, 2021 and ended on May 21, 2021 and beneficiaries had until Sept. 30, 2021, to change plans for any reason. For more information, go to https://medicaid.ncdhhs.gov/transformation. In North Carolina, specifically tailored plans for individuals with significant behavioral health needs and intellectual/developmental disabilities have a new planned launch date for December 1, 2022. For more information about these plans,  click here. 

COVID-19 Related Initiatives 

The Importance of Local Surveillance

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 and maintains a COVID-19 Data 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.

COVID-19 Testing 

Testing and contact tracing has helped to assess and mitigate the impact of COVID-19 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, five local recreation centers, and drive through testing at the University of North Carolina at Greensboro and GCDPH sites in Greensboro and High Point. Prior to launching our vaccination efforts in December 2020, 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. These testing resources remained in place through 2021 to assist with increased demand from the Delta and Omicron surges. Since June 2020, GCDPH has promoted and maintained www.healthyguilford.com, which keeps an up-to-date list of community testing resources in Guilford County. 

In January 2022, to accommodate the most recent demand for testing GCDPH partnered with Cone Health and the City of Greensboro expand testing with the help of MAKO Medical and later eTrueNorth at Piedmont Hall in Greensboro. Throughout the pandemic, GCDPH nursing staff, school health nurses and state-contracted support staff have also provided valuable contact tracing to reduce the spread of COVID-19 in our community and our schools.

Waste Water Testing  

Measuring the SARS-CoV-2 virus that causes COVID-19 in wastewater is an affordable, accurate, rapid, and effective method to track COVID-19 trends in underserved and vulnerable communities. Wastewater surveillance can detect virus shed by symptomatic individuals as well as asymptomatic persons. In wastewater, the particles are no longer infectious but can still be measured.  In August 2021, GCDPH partnered with North Carolina A & T State University to develop an epidemiological surveillance system for tracking the transmission of the SARS-COV-2 virus in the built environment. Regularly collecting and analyzing wastewater samples at 12 locations throughout Guilford County is helping to identify and mitigate the transmission and population spread of existing or new variants of COVID-19 in the community. Guilford County Water Resources have helped to select viable sites for wastewater sampling out in the field and samples are analyzed at an NC A&T Environmental Health lab. This strategic partnership allows both partners to further strive to become participatory epidemiologists and environmental health science driven advocates of vulnerable populations. In these photos, Charles Naney, GCDPH Epidemiologist and Dr. Dongyang Deng, Associate Professor at NCA&T are setting up the apparatus they use to safely extract the wastewater for analysis in the lab.

Executive Orders and County Mandates 

To mitigate the threat of COVID-19 transmission in North Carolina, Governor Cooper issued several Executive Orders to ensure comprehensive COVID-19 control measures, effective between March of 2020 and July of 2021. The State measures included limiting mass gatherings, temporarily closing public schools, and urging compliance with CDC and NCDHHS recommendations on social distancing, handwashing, frequent cleaning of high touch areas, and wearing masks in populated indoor spaces. Along with State initiatives beginning in March of 2020, GCDPH formed a compliance team to support the State Executive Orders in the local health department service area. 

The State executive order was lifted on May 19, 2021 as case numbers declined. With the emergence of the Delta variant, the Guilford County Board of Commissioners, acting as the Board of Health (BOH), put in place the first county wide mask mandate effective August 27, 2021. This rule required that all Guilford County residents, regardless of vaccination status, to wear a mask within all indoor public spaces. This rule was rescinded on November 15, 2021 after a review of the data confirmed that County positivity rate was at or below 5% for three consecutive weeks. However, due to a significant surge in 14-day positivity rates from 7.4% to 26.8% in December 2021 and its impact on hospital capacity, medical supplies, and the County’s ability to effectively address current and future needs, the Board reissued a BOH Indoor Mask Rule on January 13, 2022. Click here to review the most recent Board of Health Mask Rule (https://www.guilfordcountync.gov/our-county/human-services/health-department/coronavirus-covid-19-info/covid-19-enforcement-board-of-health-rule).

Enforcement of the local mask mandate effort was conducted by GCDPH staff focusing on two areas of outreach among local businesses to promote mask mandate effectiveness: education and compliance. To help businesses and organizations to navigate the pandemic challenges and adhere to required measures, a companion website, https://healthyguilford.biz/ was added to the www.healthyguilford.com that was established in June 2020. 

While the mask rules were in place, GCDPH compliance team members provided information on compliance and educated local businesses, schools, and faith communities on safety measures to reduce the continued spread of COVID-19 and its impact on our community’s emergency and hospital systems. The team goal is education and compliance of the mask rule, through fair and consistent enforcement.

Due to the mandate compliance and education effort, there were significant declines in complaints received about local businesses and a pronounced decrease in daily incident rate of COVID-19 transmission in Guilford County were observed, between September 2021 and November 15, 2021.

From late August 2021 through December 20,2021, complaint and education visits were made to inform local businesses in Guilford County about mask effectiveness to control the transmission of COVID-19. Outreach activity is shown in the map below.

An additional opportunity to observe the effectiveness of the local mask mandate with only an educational intervention component occurred after the local mask mandate was rescinded in Guilford County on November 15, 2021. At the same time an increase in the daily incident rate of new COVID-19 cases was identified that preceded emergence of the Omicron variant a month later in December of 2021. Enforcement began again on January 13, 2022 when the BOH mask mandate was reinstated.

In June 2020, GCDPH launched the  www.healthyguilford.com website and continues to maintain this resource to address the need for factual COVID-19 information in our community. 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. The healthyguilford.biz site was added as an additional resource in 2021. GCDPH has also continued to partner with Guilford County Emergency Management, local hospitals, universities, and otheion officers.rs to ensure consistent messaging in the media and through social media through regular meetings of the public information officers.

Understanding Community Perceptions and Attitudes toward the COVID-19 Vaccine

In 2021, to inform GCDPH’s COVID-19 health messaging and support better vaccine coverage, especially among vulnerable populations and those with existing health disparities, GCDPH engaged the UNC Greensboro Center for Housing and Community Studies and Department of Health Education to conduct a study on community perceptions and attitudes towards the COVID-19 vaccine. The study explored COVID-19 vaccination rates, vaccination disparities, drivers of vaccine hesitancy and made recommendations for increasing vaccine confidence.  This study and the scientific literature informed our communication, vaccination, and outreach efforts to include the following strategies:

• Employing communication and messaging strategies that involve members and trusted leaders from the communities we are trying to reach.
• Establishing and building upon existing collaborative partnerships, in our communication, vaccination and outreach efforts.
• Implementing interventions at the individual, interpersonal, community and structural levels.

To read the full report, go to: https://chcs.uncg.edu/eval-policy-gis-unit/covid-19-vaccine-messaging/. 

COVID-19 Communication Campaign 

To support our communication efforts in 2021, GCDPH secured the assistance of VitaLink, a marketing firm in Raleigh. To increase vaccination rates and prevent COVID-19 hospitalizations and deaths, GCDPH launched a multi-channel community outreach campaign from April through September 2021 using research-based communication strategies. This campaign included both messages for the general population and more tailored messages for African American and LatinX audiences, college students, and those in more rural parts of Guilford County. A variety of methods were used, including print and digital ads, digital and poster billboards, flutter flags, signs, bus wraps, posters, kiosks, convenience store posters, gas pump toppers/nozzles, pizza box flyers, ice box wraps, and movie theater ads. GCDPH also utilized social media, community outreach and the use of influencers to further extend the campaign’s reach.

As the samples illustrate, GCDPH and Vitalink developed television, radio, and print messages to reach out to specific audiences, involving members of the intended audiences in developing and delivering the message to promote equity, make more relatable and address common concerns. For example, recognizing that most families are eager to gather together again safely, the vaccination messages below highlight that desire, for both the general population, as well as in the African American and LatinX communities. 

To reach out to young adults and college students in Guilford County, we collaborated with representatives from those college communities to both promote COVID-19 safety messages and emphasize the importance of taking these safety measures not only to protect yourself, but to protect those in your family and community who may be a greater risk.

To reduce systemic barriers, GCDPH developed and maintained an appointment system that allowed appointments to be made online or by calling our appointment line. For those community members who may have challenges with online technology, a call back system was put in place. Those who had not received their second doses received call back reminders as well. Recognizing that having some may have a desire to schedule appointments to go together as a group, communication messages were also tailored to encourage that as well. 

In recognition of this important work, GCDPH and VitaLink received the 2021 Gold Aster Award for Crisis Communication around COVID-19. The Aster Awards is the nation’s most elite competition recognizing the most talented healthcare marketing professionals for outstanding excellence in communications.   

Vaxfluencer Campaign

GCDPH also partnered with an outside company, XoMad to implement the Guilford County ‘Vaxfluencer’ campaign. This campaign engaged 41 trusted social media influencers based in Guilford County who promoted COVID-19 vaccines to their respective audiences. Collectively, they posted more than 191 pieces of content from June 2, 2021 – August 7, 2021 (See sample photo below). This Vaxfluencer campaign led to:

• An interview segment with the Health Director on The Daily Show with Trevor Noah.
• 959,000 views and impressions across Instagram, Twitter, and Facebook.
• 15,100 social engagements.

During this campaign, Guilford County saw an increase in vaccination rates during periods when state-wide vaccinations declined.

COVID-19 Vaccinations

Since late December 2020, GCDPH has engaged in a monumental effort to vaccinate community members to reduce COVID-19 illness, hospitalizations, and deaths. GCDPH partnered with Emergency Management and numerous other partners to administer Pfizer, Moderna, and Jansen & Jansen (J & J) vaccines at larger mass vaccination sites and community-based and mobile clinics. Throughout this process, GCDPH has followed the NC Department of Health and Human Services phased guidance on prioritized and eligible groups and partnered with faith communities and community-based organizations to ensure equity in vaccine distribution and address systemic barriers.  As of January 31, 2022, 64% (342,504) of the total population of Guilford County has received at least one dose and 60% (321,159) have received two doses or one dose of J & J (See table). Of the population five years of age and older who are eligible to receive a COVID-19 vaccine, 68% have received at least one dose and 63% have been vaccinated with two doses or one dose of J & J. The total population for Guilford County is 537,174 residents and those five years of age and older is 506,018 residents (2019). For demographic details, please visit the NC DHHS Vaccine Dashboard at https://covid19.ncdhhs.gov/dashboard/vaccinations.

From December 29, 2020 to January 31, 2022, GCDPH administered a total of 139,819 doses to those 12 years and older and 1,703 doses to those ages 5 to 11. Please note these totals do not include those vaccinated through the Greensboro FEMA site, Cone Health, local pharmacies, grocery stores or other local providers). Go to https://covid19.ncdhhs.gov/dashboard/vaccinations for more information about North Carolina vaccination efforts.

Our effort began with a site at Bur-Mill Park for first responders and employees considered to be at high risk in December 2020 through January 2021. In January 2021, GCDPH worked with Guilford County Emergency Management to establish three larger fixed vaccination sites at the Greensboro Coliseum (January - July 2021) and Mt. Zion Baptist Church (January -May 2021) in Greensboro and High Point University’s Community Center (January - April 2021). Having a continued presence for several months at a time provided more visibility and consistency and enabled GCDPH to serve more community members as state prioritized groups became eligible to receive their vaccine.  From March 10 to May 27, 2021, to expand local access, FEMA offered mass vaccinations through its COVID-19 Community Vaccination Center at the Four Seasons Town Centre in Greensboro. This site offered drive through and walk-in service to residents of Guilford and surrounding counties. For more information, go to https://governor.nc.gov/news/federally-supported-community-vaccination-center-open-north-carolina. From October through December 2021, GCDPH returned to the Greensboro Coliseum, High Point University Community Center and added sites at select local high schools on weekends and evenings to accommodate the demand for boosters and the additional age group of five and over who became eligible in November 2021. 

Going to Communities 

Recognizing the need to be flexible, reduce access barriers, and meet community members where they are, in May and June 2021 GCDPH piloted a few vaccine clinics at community locations. In July 2021, GCDPH shifted to a community and mobile model in delivering COVID-19 vaccines to increase vaccine access and promote vaccine confidence. This also expanded the capacity of our clinics to serve a larger number of people.  From July to December 31, 2021, GCDPH held more than 100 community and mobile COVID-19 vaccine events out in the community by collaborating with over 70 community partners. Partners included faith communities (19), businesses (11), schools (12), congregate living sites (14) such as apartments, retirement centers and public housing communities, and other community sites (14), such as local non-profits, parks, and community centers. GCDPH also purchased a mobile unit which increased our capacity to host pop-up vaccine events. With many partners, we went to the same location two to three times to support delivery of 2nd dose and booster shots. The map below illustrates the variety of locations where GCDPH was able to have a presence. 

VaxConnects

GCDPH, the Foundation for a Healthy High Point and Hayden Harman Foundation funded the YWCA of High Point to assist with a vaccination outreach effort in High Point through VaxConnects. VaxConnects is a community collaborative that engages individuals to serve as vaccine connectors in vulnerable communities with lower vaccination rates. These vaccine connectors conduct door to door outreach to talk with individuals and families. Connectors listen to community members’ concerns, answer questions, and help them make appointments while they are with them if that is something they would like. This effort has helped to address vaccine confidence in some communities. When possible, GDCPH staff and/or VaxConnect partners conducted outreach in neighborhoods adjoining community vaccination sites prior events to inform community members, make appointments, or leave door hangers (see photo). Because of its success, this effort has been expanded to Greensboro.

Other Initiatives

New Primary Care Clinic at Division of Public Health Wendover Building Now Serving Patients

After completing construction in 2020, the new primary care clinic on the 3^rd floor of the existing 1100 East Wendover Avenue site began seeing patients in June 2021. This clinic provides 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. Primary care services have also been added at our 501 E. Green Drive location in High Point. Since adding this service, GCDPH provided primary care for 215 patients from June 2021 to December 2021.

Looking for Safe Ways to Become or Remain active? Try Piedmont Discovery!  

Piedmont Discovery is a park and trail locater mobile app that enables users to search for parks, trails, and recreational opportunities in the Piedmont. Residents and visitors can explore nearby parks, trails, playgrounds, dog parks and a wide range of recreation areas and facilities owned by parks in Guilford County. The mobile app also shares information about trail terrain and difficulty, park amenities, and links for more information. Guilford County, the City of High Point and the City of Greensboro launched Piedmont Discovery in 2019 and continue its design and management. In 2021, recreational opportunities in Gibsonsville, Jamestown, Oak Ridge, Pleasant Garden, Stokesdale, and Summerfield were added. Users can download the app in the mobile app store for Android and Apple users.

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 Institute 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) is pursuing 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.

Since that time, Every Baby Guilford has formed a Collective Action Team for each focus area to move activities and progress forward. Efforts in 2021 include:

• Infrastructure - In September 2021, EBG added two new staff members, Monét Kees as Health Equity Manager and Danielle Deshazor as Perinatal Health Coordinator to support this important work.
• A Learning Journey of Health Equity - EBG is collaborating with the Racial Equity Institute (REI) to offer their Groundwater Training in 2021 and 2022 and REI Phase 1 in 2022. These trainings use stories and data to illustrate the structural nature of racism with the goal of helping practitioners understand the systemic nature of racial inequities that impact maternal and infant health to move towards transformative change. In 2021 and 2022, EBG is also partnering with March of Dimes to present their Implicit Bias Training for health care providers who care for birthing people before, during, and after pregnancy.
• Crucial Community Conversations - To support families, strengthen connections, and share information about relevant topics that impact maternal and infant health outcomes, EBG partnered with March of Dimes Ready for Life to host three virtual community conversations. On June 26, 2021, the focus was preconception health, prenatal nutrition, and infant mortality in Black, Indigenous, and People of Color communities. On September 20, 2021, the session addressed the role of breastfeeding in maternal and infant health, including lactation and doula support programs that can enhance breastfeeding experiences. On November 8, 2021, the conversation centered around maternal mental health to provide information about the signs and symptoms of postpartum depression and anxiety and where to get support.
• Education and Awareness Campaigns - In recognition of Infant Mortality Awareness Month (IMAM) in September 2021, EBG launched an education and awareness campaign and encouraged local partners to adapt and share EBG-specific social graphics and messages using the #EveryBabyGuilford or #EBG and #IMAM hashtags. EBG also promoted events aimed to end the gaping racial disparity in breastfeeding rates while also encouraging diversity in the lactation field as a part of Black Breastfeeding Week, August 25th-31st. In early 2022, EBG is launcing a Preconception Ambassador Program, the Baby Steps for a Healthy Family and Future community walking/running effort, and Amplifying Every Voice, a community storytelling project to share pregnant and birthing people's experiences in Guilford County (see samples below).  
• Diaper and Baby Clothing Drive - In November 2021, EBG partnered with Shred415 Greensboro to hold a diaper and baby clothing drive collect items to support public health programs for vulnerable families. 

• Fetal Infant Mortality Review (FIMR) - In 2021 EBG launched the FIMR implementation to identify root causes of infant mortality in Guilford County. It is anticipated to begin in early 2022 after going through a long process for obtaining access to medical records of births from local hospitals. A Community Review Team will work with the FIMR Coordinator to review medical records of infant deaths, identifying system level changes that can be elevated to a Community Action Team of local policy leaders who will receive recommendations quarterly.
• The Adopt-A-Mom (AAM) program, which continues as a EBG program, provides access to health care for vulnerable populations, as well as health education, counseling, and information on needed resources. In 2021, the AAM program helped 218 women get the prenatal care they needed. 
• Community Doula Program - EBG is working with the YWCAs of Greensboro and High Point and Cone Health to create a county wide community-based Doula program. Each entity is already implementing programs and EBG is convening each organization in a design phase for creating a county wide model with aligned activities and outcomes.
• CenteringPregnancy - EBG is working to enhance existing CenteringPregnancy in Guilford County by receiving through funding from The Duke Endowment. GCDPH is receiving pass through funding to enhance existing CenteringPregnancy programming. Cone Health’s MedCenter for Women will begin program planning and design for implementing CenteringPregnancy in mid 2022. Centering Health Institute will provide training and technical assistance. 

To learn more or to get involved go to: www.everybabyguilford.org.