HNC 2030 Scorecard: Guilford County

Executive Summary

Vision Statement 

The 2019 Community Health Assessment (CHA) vision is to conduct a “deeper dive” to develop greater understanding of the health focus areas of Maternal and Child Health, Healthy Living and Active Living, Behavioral Health, and Social Determinants of Health. CHA goals are to identify key actionable issues, potential points of leverage and services or program gaps to inform efforts to eliminate health disparities and improve population health. Click on the image to view the full report. 

Leadership

The 2019 CHA leadership is bi-sectoral. The Guilford County Department of Health and Human Services Public Health Division and local hospitals (Cone Health, Wake Forest Baptist Health-High Point Medical Center and Fellowship Hall) are accountable to the NC Local Health Department Accreditation Board and the Internal Revenue Service, respectively, for successful completion of the CHA every three years.

Partnerships   

The CHA Team included the following partner types:

Theoretical Framework/Model   Social-Ecological Model

Collaborative Process Summary

Primary data on the four focus areas were collected through a series of online Key Informant Surveys and workshops attended by persons known as subject matter experts or otherwise knowledgeable regarding the focus areas. The survey included questions about key challenges to making improvements in the priority focus areas, as well as disparities and population subgroups impacted, gaps and needs in existing services and programs, existing programs and policies that are perceived to be effective and ideas for needed programs and policies. At a series of half-day workshops, participants engaged in facilitated discussion to consider both quantitative data and data from the Key Informant Surveys to identify key issues and recommendations for improvements.

Key Findings

Maternal and Child Health (MCH)

Poor birth outcomes are a significant problem, with rates of low birthweight, preterm birth, and infant mortality substantially higher than national benchmarks, NC, and peer counties, with African American women experiencing consistently poorer birth outcomes than Whites. Much of the racial disparity in infant mortality can be explained by the disproportionate number of very low birthweight births among African American women. The biggest challenges to improving pregnancy outcomes identified by MCH Key Informants were reductions in inequalities in the social determinants of health, issues of toxic stress and improvements in preconceptional health.

Healthy Eating/Active Living (HEAL)

The county has 26 “food desert” census tracts with limited access to healthy food outlets and limited resources to purchase healthy foods, as well as high rates of obesity and persons not engaging in leisure time physical activity. The crucial issues are access to healthy food, the cost of healthy food and lack of access to healthy food outlets. The most important challenge to increasing physical activity noted by Key Informants was safety issues of crime and traffic, followed by cost of exercise facilities and lack of sidewalks. Improvement approaches include targeting areas with fewer resources, support for a living wage, equity-oriented policies and transformation of policies that previously led to inequality of access to resources.

Social Determinants of Health

Life expectancy in Guilford County varies by up to 20 years depending on the census tract in which one lives. Low life expectancy, low educational attainment, high poverty areas of the county are also areas with higher concentrations of African Americans and other racial/ethnic minorities, creating areas of concentrated disadvantage that have negative impacts on population health. African Americans living in areas of concentrated disadvantages are living with the legacy of segregation, housing redlining and governmental policies that have perpetuated segregation and social inequality for decade. Improvement will require targeted development coordinated across systems.

Behavioral Health (Mental Health and Opioid Misuse and Overdose)

County suicide rates show an increasing trend, while mortality rates from unintentional drug poisoning are higher than in peer counties. Emergency Department visits due to opioids showed a small improvement in 2018. The most crucial behavioral health issues identified were access to mental health services and the important role of the social determinants of health.  Critical challenges to improving the problem of opioid misuse are access to dependency treatment services, cost and knowledge of available treatment services and limited availability of medication-assisted treatment.

Priorities

Guilford County Priority Health Issues

• Maternal and Child Health
• Healthy Eating and Active Living
• Behavioral Health (Mental Health and Opioid Misuse and Overdose)
• Social Determinants of Health

Why Is This Important?

Preparing children for a great start in life begins long before birth. Mothers and children benefit from healthy nutrition, daily physical activity, social support and trusted health care providers. They also need supportive neighborhoods and communities with a variety of resources and policies that support women and children. Deficits in these areas may lead to poor birth outcomes.

If we are successful in fully achieving this result, we envision a Guilford County where:

• Every mom has access to prenatal care and postnatal care.

• Every child’s physiological, safety, belonging, love, social and esteem needs are met.

• Supportive services for moms and partners are accessible.

• Families are economically safe, have peer support, are free from substance abuse and have equal access to needed services.

Action Plan

What We Will Do:

The Division of Community Health Services of the Guilford County Department of Health and Human Services will provide free case management to pregnant women enrolled in NC Medicaid and a limited number of low-income insured women through the Care Management for High Risk Pregnancy (CMHRP) program. The goal is to reduce the infant mortality rate in Guilford County and promote positive birth outcomes by assisting mothers with high risk needs during pregnancy. Care management is provided by registered nurses or social workers.

Who Is Involved:

GCDHHS, Public Health Division

Cone Health Family Medicine Center 

Cone Health and Wake Forest High Point Medical Center Emergency Departments and Labor and Delivery Departments

Cone Health Neonatal Intensive Care Unit

Guilford Child Development -Nurse Family Partnership

Get Ready Guilford Initiative

Practice offices include:

Center for Women’s Health Care - Elam, Greensboro, Stoney Creek, High Point and Renaissance, Greensboro OB/GNY, Green Valley OB/GYN, Physicians for Women of Greensboro, Central Carolina OB/GYN, a Division of Unified Women's Health Care of NC, Moses Cone Family Practice, Dr. Henry Dorn, Wake Forest Health Network OB/GYN -Elm, Pinewest OB/GYN, and Eagle OB/GYN

When this Takes Place:

Service begin upon identification from the referral source to 6 weeks post-delivery. 

 How We Will Do it:

Services include care coordination, support of patient and/or OB provider identified needs, collaboration with the OB provider, service referrals to medical care, food and housing resources, transportation (for appointments), and other programs, like childbirth or breastfeeding education classes, Women, Infants and Children (WIC) nutrition program and family planning. Eligibility criteria include: History of a preterm birth < 37 weeks gestation; chronic illness such as diabetes, hypertension, HIV; homelessness, family violence, or substance use including smoking, alcohol and drug use during pregnancy and a provider request of services. Specially trained nurses and social workers assess and provide follow up to patients via phone contacts, office visits, home visits and telehealth weekly to montly based on need. 

Action Plan

What We Will Do:

Community Health Services of the Guilford County Division of Health and Human Services will implement Family Connects Guilford as part of Get Ready Guilford Initiative’s effort to expand existing and proven programs that serve families prenatally through age 3. Family Connects Guilford 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. 

Who Is Involved:

GCDHHS, Public Health Division

Ready for school, Ready for Life

The Duke Endowment

Guilford County Partnership for Children

Smart Start

Foundation for Healthy High Point

Wake Forest Baptist Health - High Point Medical Center Hospital and Cone Health

Obstetric and Pediatric practices

When this Takes Place:

These services are ongoing.

How We Will Do it:

Nurses with advanced knowledge and experience in public heath, perinatal nursing and lactation support will conduct post-delivery visits with follow-up as needed. Visits include a thorough physical assessment of mom and baby, psychosocial assessment of family and environment, referral and follow up of identified needs and educational counseling. Interpreter assistance is provided to Spanish-speaking families and for other languages on a more limited basis.

Action Plan

What We Will Do:

Community Health Services of the Guilford County Division of Health and Human Services will implement Care Management for At Risk Children (CMARC), 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.

Who Is Involved:

GCDHHS, Public Health Division

Ready for School, Ready for Life

Pediatricians: Triad Adult and Pediatric Medicine, ABC Pediatrics, Triad Pediatrics, Dr. David Rubin, Carolina Pediatrics of the Triad, Immanuel Family Practice, Moses Cone Family Practice, Cornerstone Pediatrics, Eagle Physicians at Lake Jeannette Pediatrics, Pleasant Garden Family Practice, Cone Health Center for Children, Greensboro Pediatricians, Kidzcare Pediatrics, Northern Pediatrics, Northern Family Medicine, Novant Health Forsyth Pediatrics, New Garden Medial Associates, High Point Pediatrics, Pediatrics – Quaker Lane, Northwest Pediatrics, Brown Summit Family Practice, Pediatrics Premier, Piedmont Pediatrics

Parents as Teachers

Bringing out the Best UNCG

Cheshire Center and other Speech and Language and developmental serivces agencies

Guilford County Dental Services 

Pediatric dentists

Various community service providers

When this Takes Place:

These services are ongoing.

How We Will Do it:

Specially trained nurses and social workers coordinate visits with parent or guardian and develop a comprehensive care plan with goals to address any identified concerns or risk factors. Services include assistance with communicating with doctors, making appointments, exploring child care options or making referrals to other agencies and programs and providing information regarding age-appropriate growth and development and providing periodic developmental screenings, if needed, until the child turns five years of age.

Action Plan

What We Will Do

Guilford County’s Division of Public Health will work with community partners to provide quality reproductive health services through:

• Maternity Clinic provides comprehensive prenatal care for low to medium risk pregnancies, including a six -week postpartum exam.
• Centering Pregnancy is a model of delivering prenatal care that includes health assessment, education and support.
• Family Planning/Just Teens provides comprehensive family planning services for women and men (adult and teen) based on current recommendations from the Women and Children’s Division of the NC Department of Public Health.

Who Is Involved:

GCDHHS, Public Health Division

Moses Cone Health System Outpatient High Risk Clinic

Guilford Coalition on Infant Mortality’s Adopt-A-Mom Program

GCDHHS Care Management for High Risk Pregnancy, Guilford Family Connects and Care Management for At Risk Children Programs

Piedmont Health Services and Sickle Cell Agency’s Triad Baby Love Plus program

Centering Healthcare Institute

Healthy Tomorrow Alliance

YWCA Greensboro

Foundation for the Healthy High Point

When this Takes Place:

These services are ongoing.

How We Will Do it:

Maternity Clinic: Women who meet eligibility criteria for the Medicaid for Pregnant Women program, receive care free and other women are charged on a sliding scale according to income.

Centering Pregnancy: Women with similar due dates meet for their prenatal visits with 2 co-facilitators about 10 times during their pregnancies in the same Centering room.

Family Planning/Just Teens: Services include a full range of birth control options plus education and counseling. New patient and annual return visits include a complete examination, pap test and other laboratory as indicated.

Why Is This Important?

 Mental health is defined as “a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to contribute to his or her community” (World Health Organization, 2019).  Such definitions underscore the importance of mental health and its relationship to a fundamental sense of well-being, meaning and resiliency. The term “Behavioral Health” is often used to describe the connection between our behaviors and this sense of well-being.  

According to Centers for Disease Control and Prevention (CDC, 2018), half of people in the United States will be diagnosed with a mental disorder at some point in their life. Despite that, it is estimated that only about half will get the treatment they need (National Institutes of Mental Health, 2018). The prevalence of substance use disorders is also a concern at the national, state and local levels. Opioid use disorders have become especially problematic, leading to an increase in emergency department visits and overdose deaths. Despite effective treatments being available, people often don’t get the treatment they need. Mental and substance use disorders are also linked to other health concerns.  

If we are successful in fully achieving this result for Behavioral Health and Opioid Misuse, we envision a Guilford County where all Guilford County children, adults and families: 

• Live free of stigma associated with mental health diagnoses or substance use issues.

• Develop and maintain strong social support.

• Have access to high quality behavioral health interventions, including the integration of mental health care in primary and emergency care.

• Can readily access effective prevention, treatment and recovery programs for mental health and substance dependence. 

Action Plan

​​​​​What We Will Do:

The Guilford County Behavioral Health Crisis Collaborative, made up of Guilford County, Cone Health and Sandhills Center, are creating an innovative Behavioral Health Crisis Center using an integrated services model that will treat adults, children and adolescents in crisis and address their physical, mental and substance abuse issues. This will include a mental health urgent care center and two 16-bed facility-based crisis centers (one for adults and one for children and adolescents). These centers will provide comprehensive behavioral health services 24-hours a day, seven days a week. This holistic approach will include medical care, substance abuse treatment and other targeted and specialized treatment for mental health issues. This facility will also have space for outpatient services for adults, adolescents and children.

Who Is Involved:

Guilford County

Sandhills Center

Cone Health

Alexander Youth Network

When this Takes Place:

Construction of the future adult mental health urgent care center is underway and expected to be completed by the end of 2020. The facility plans to open to patients in spring 2021.

How We Will Do it:

The Behavioral Health Crisis Center will include a mental health urgent care center and two 16-bed facility-based crisis centers, one for adults and one for children and adolescents.  The centers will address both the behavioral and physical needs of those in crisis and reduce the load on local hospital emergency departments. 

Guilford County will hire a Behavioral Health Director to manage the Guilford County Behavioral Health Center, collaborate with other mental health organizations, service providers, law enforcement agencies, and interact and update the Board of Commissioners and other entities in the county and region on current pressing and future needs. The Director will provide direct supervision and oversight of Behavioral Health Center operations to ensure the delivery of services and compliance with program policies/regulations consistent with the center’s strategic plan and business plan. The Director of the center will be responsible for the development, implementation, administration and management of the program, development and implementation of organizational procedures and guidelines, approving all marketing materials and other program education, and oversee grant writing and client advocacy.

For provision of services, upon entry to the Behavioral Health Crisis Center, an assessment would take place, followed by triage, stabilization and the development of a safety plan. Following assessment and triage, a treatment plan would be developed, including linkage to care and community resources.  The adult facility will include three to five day admission, including acute detoxification as well as integrated physical and psychological care. Outpatient services will include group and individual therapy, as well as pharmacy and laboratory services.

Guilford County will cover 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. Adult service provision is projected to start in early 2021, followed by the child service provision in March. Organizational steps to follow include securing accreditation, hiring staff, developing policies and procedures. The partnership will seek additional financial assistance from the State of North Carolina and other grantees and donors.

Action Plan

What We Will Do:

Using a three-tiered approach, partners will:

• Establish and expand the Guilford County Formerly Incarcerated Transition (FIT) program,
• Facilitate a “Linkage” to medical and behavioral health care as well assist with other social and community needs and  
• Support the Post-Overdose Response Team’s ongoing work to reduce overdose deaths and increase access to harm reduction strategies and treatment options.

Who Is Involved:

Triad Adult and Pediatric Medicine (TAPM)

UNC Family Medicine

Guilford County Department of Health and Human Services, Division of Public Health (GCDHHS)

Guilford County Solution to the Opioid Problem (GCSTOP) 

Guilford County Emergency Medical Services (EMS)

When this Takes Place:

These efforts are ongoing.

How We Will Do it:

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. Administered by Triad Adult and Pediatric Medicine, the program utilizes a specially trained community health worker to build trust and act as a peer navigator for reentry with a special focus on opioid use disorder (OUD). During the intake and new patient process, the community health worker determines many of the essential needs of the participants and will “link” the participants with additional insurance, medication assistance and medically related services. This program improves the well-being and health of people who have been recently released and improve their chances of successful reentry into the community. UNC Family Medicine, which partners with the North Carolina Department of Public Safety, the North Carolina Community Health Center Association and others, provides consultation to the Guilford County FIT program and trains providers. Guilford County Department of Health and Human Services, Division of Public Health receives NC Department of Health and Human Service grant funds and subcontracts to TAPM to provide these services in Guilford County. 

Guilford County Solution to the Opioid Problem (GCSTOP) and Guilford County EMS's Post-Overdose Response Team work together to prevent repeat overdoses and to counsel persistent users to enter treatment or adopt evidence-based harm reduction practices. GCSTOP provides a staff person to the Post-Overdose Response Team. GCSTOP also provides syringe exchange, harm-reduction training and education to the community about overdose response. This effort began with special appropriation funding from the state to Guilford County’s EMS to address the increasing number of opioid overdoses and opioid related deaths. The GCSTOP program is housed in within the Department of Social Work at the University of North Carolina at Greensboro. In addition to providing counseling on treament options, team members can assist in linking individuals with a medical home and treatment. Guilford County Department of Health and Human Services, Division of Public Health receives NCDHHS grant funds and subcontracts to GCSTOP and Guilford County EMS to provide these services in Guilford County. 

Progress on CHIPs

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.

Morbidity and Mortality Changes Since Last CHA

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.

Emerging Issues Since Last CHA

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.

New/Paused/Continuing/Discontinued Initiatives Since Last CHA

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

Progress on CHIPs

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.

Morbidity and Mortality Changes Since Last CHA

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.

Emerging Issues Since Last CHA

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. 

New/Paused/Continuing/Discontinued Initiatives Since Last CHA

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.

Progress on CHIPs

This 2022 State of the County’s Health Report shares progress on Guilford County Division of Public Health’s Community Health Improvement Plans (CHIP) to address two priorities identified in the 2019 Guilford County Community Health Assessment (CHA): 

• Maternal and Child Health and 
• Behavioral Health and Opioid Misuse.  

We also highlight changes in mortality and morbidity since Guilford County Division of Public Health's (GCDPH) last CHA, emerging issues are impacting our community, and other select community initiatives that are underway to address our community’s health.  

Maternal and Child Health

Family Connects Guilford, Care Management for High-Risk Pregnancy, and Care Management for At Risk Children

Family Connects Guilford (FCG), Care Management for High-Risk Pregnancy (CMHRP), and Care Management for At Risk Children (CMARC) continue to provide invaluable community-based services to support pregnant women and their families in Guilford County. Following the Family Connects International evidence-based model for implementation, the FCG program offers 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 services to high-risk pregnant women enrolled in NC Medicaid and a limited number of low-income or uninsured pregnant 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. Staff from all three programs continue to have a significant impact on the lives of expectant mothers and their children as we all continue to adapt to the challenges of the COVID pandemic. For more information about these programs, click here.

Family Connects Guilford (FCG):  On April 1, 2022, FCG staff transitioned back to in-person in- home visits. For the 2022 calendar year, FCG staff engaged 4,664 families with new infants and completed 2,606 home visits or supportive calls with these families (56% of those engaged). For those families who declined the in-home in-person visit, supportive calls continued to be offered per Family Connects model guidelines. FCG nursing staff continued to serve all families in Guilford County including the 27260 and 27262 zip codes, where low birth weight and infant deaths are more concentrated. Of the home visits or supportive calls provided, 867 families had an identified risk, and 3,152 referrals were made to assist these families. Identified risks may include needed supports for health care, caring for an infant, a safe home, and supports for parents.

To support program development, FCG worked with Coastal Cloud in developing a new internal database on the Salesforce platform in 2022 and successfully implemented the new Family Connects Management Information System (FCMIS) on September 13, 2022. We also continue to recruit and interview applicants for our open positions. During 2022, several nurses completed the NC Lactation Education Training Program.  Two nurses graduated in December from UNC Wilmington with their Master’s in Nursing Education (MSN-NE).  One nurse received Lactation Consultant Certification (IBCLC) in January 2022, and one nurse is currently participating in the NC A & T Human Lactation Pathway 2 Program.

CMHRP: During 2022, CMHRP case managers successfully engaged 1,220 high risk pregnant women. Case managers completed 3,428 face-to-face visits at the OB office or in the home. Over 6,127 patient-centered interactions were completed, including phone calls, videoconferences, texts, and emails. Care Managers are back to meeting with patients face-to-face in the various OB offices within the county and surrounding area, as well as via TeleHealth videoconferencing, to engage and deliver quality care management services to pregnant clients. The strain on the economy found many new mothers lacking resources to purchase personal hygiene items. With the help of a local church, United City Greensboro Church, and a local women’s organization, Women the World Over, case managers were able to assist women in need. The photo to the right shows Melissa Randleman (left), and another one of our care managers, Myrica McCain (right) accepting Unity City Greensboro Church’s donation. Backpack Beginnings continues to support families in Guilford County by supplying food and diapers for the Food Pantries located at the Greensboro and High Point Health Department locations. CMHRP Care Managers continue to deliver these much-needed items to families, along with linking them to sustainable community resources, as added support to families with high-risk pregnancy concerns.  

CMARC: From January through December 2022, CMARC staff enrolled 1,291 new clients and completed 704 socially distanced home visits. At these visits, case managers completed comprehensive needs assessment and developed tailored care plans with goals for families. Case managers also delivered essential supplies such as infant formula, diapers, safe sleep equipment, children’s clothes, and food to entire families. In 2022, CMARC also received 248 Plan of Safe Care-Opioid /Substance Exposed Infant referrals that were assigned for outreach. 

Reproductive Health Services 

In 2022, GCDPH continued to provide quality reproductive health services through its Maternity Clinic, Family Planning/Just Teens clinics and CenteringPregnancy programs. For the 2022 calendar year:

• GCDPH’s Maternity Clinic provided comprehensive prenatal care for 543 women with low to medium risk pregnancies. Of the 342 clients who delivered in 2022, 95% had babies that were more than 2,500 grams at birth and 5% of the babies were low birth weight or under 2,500 grams at birth. For more information about the Maternity Care clinic, click here.
• Family Planning and the JustTEENS 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 2022, Family Planning and the JustTEENS clinics together served 3,178 clients through 5,388 visits. To learn more, go to the following links: Family Planning Services or the JustTEENS clinic.
• CenteringPregnancy is a best-practice group prenatal care program that follows the recommended schedule of 10 prenatal visits, each lasting 90 minutes to two hours long. This gives women ten times more time with their provider. Women engage in their care by recording their own health data followed by private time with their provider for pregnancy care. After that private time, women engage together during interactive activities and facilitated discussion, developing a sense of community and support. The providers cover information on nutrition, common discomforts, stress, management, labor and delivery, breastfeeding, and infant care. Women of different ages, races, and socio-economic backgrounds share the common experience of pregnancy, birth, and family care in these groups. For clients who delivered in 2022 for which data is available, 0% were low birth weight and 0% of the births were pre-term. Ninety-four percent were breastfeeding at discharge. In 2022, Centering groups continued in a virtual format until November, when two in-person groups started up again. Also, Every Baby Guilford received $23,280 from the Duke Endowment to renovate DPH existing CenteringPregnancy program space (see photo), support training for new staff, and purchase educational materials and snacks for programming. For more information, contact Catherine Richardson at 336-641-4718 or go to PH CenteringPregnancy Program.  

Behavioral Health and Opioid Misuse

Guilford County Behavioral Health Crisis Center 2022 Highlights

The Guilford County Behavioral Health Crisis Center (BHCC) in Greensboro offers behavioral health urgent care, facility-based crisis services, and behavioral health outpatient services provided by Cone Health staff 24 hours a day 7 days a week for both adults and adolescents (ages 4-17) who reside in Guilford County. This facility includes two 16-bed facility-based crisis centers, one for adults at the BHCC site and an adjacently one for children and adolescents with treatment provided by the Alexander Youth Network. 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 funded the design and construction costs of the centers. All services are available to the insured and uninsured.    

The Behavioral Health Crisis Center continues to expand its operations since it began offering Behavioral Health Outpatient and Urgent Care June 1, 2021.  Below is a summary of accomplishments:

• Since opening in 2021, the BHCC has provided 13,478 outpatient clinic visits and 9,686 urgent care visits (91% have been Guilford County residents). Of these urgent care visits, 79% of patients were stabilized and discharged without hospitalization. During this time, Cone Health Emergency Departments in Guilford County have seen a 20% reduction in psychiatric visits.
• In August 2022, the Facility-Based Crisis therapeutic environment opened, offering lower acuity crisis and detoxification for alcohol use disorder and opioid use disorder. These 16 short-term crisis care beds provide an immediate, safe place for observation and care for adults with significant mental and emotional health care needs, enabling the center to serve those who need more than a therapist visit but less than a hospital stay. From August 1, 2022 through December 31, 2002, 280 patients were served with average duration of 3 days.
• In July 2022, BH Outpatient Services added a long-acting injection clinic for patients with schizophrenia, enrolling and following 90 patients through December 31,2022.
• Medical Construction and Design Magazine features how these Centers have adapted to enhance behavioral health care in their July/August 2022 edition.
• In October 2022, Alexander Youth Network celebrated one year of services for the Child and Adolescent Facility-Based Crisis Center. To view a virtual Tour video of this facility, click here.
• In October 2022, the BHCC hosted a gathering for community providers to support networking.
• Within the next 12 months, the BHCC plans to provide medication assisted treatment (MAT) services and a chemical dependency outpatient program for adolescents.

 Supporting and Empowering Formerly Justice-involved Persons in 2022

The Guilford County Formerly Incarcerated Transition (FIT) program continues to connect 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. 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. GCDPH contracts with TAPM to provide these important services in Guilford County.

To support justice-involved persons upon release, FIT staff have referral relationships with WellPath, the correctional care entity responsible for clinical care in the jails and the Guilford County Re-Entry Council. On January 24, 2022, TAPM also began office based opioid treatment (OBOT). 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. NC-FIT/TAPM also provides treatment referrals to the GCSTOP program (for patients without insurance) through a limited grant funded program, Eleanor’s Health (for patients with insurance) and other community partners including Alcohol and Drug Services, Caring Services, Inc., Family Services of the Piedmont, Daymark, and Continuum of Care Services.

During the six-month period from March 1, 2022 through August 31,2022, the FIT program staff:

• Served 147 JIP through 704 contacts.
• Provided 117 social determinant of health referrals, including referrals for food, housing, transportation, employment, education, legal services, job training and other needs, that are vital to a JIP's successful reentry.
• Continued naloxone kit distribution and began fentanyl test strip distribution in 2022 to support harm reduction and distributed 22 naloxone kits and 16 test strips to clients.
• Connected 62 JIP to community health insurance programs during the enrollment period to support their care.
• Greatly increased their community presence through 50 community partner contacts and utilizing TAPM’s mobile unit for events, including blood pressure screenings, food pantries, job fairs, and COVID test kit giveaways.
• Participated in opioid-based and Mental Health First Aid trainings.

For more information about NC FIT, click here.

Collaborative Opioid Efforts in 2022

Guilford County Solution to the Opioid Problem (GCSTOP), a partnership between the University of North Carolina at Greensboro (UNCG) Department of Social Work and Guilford County EMS, continues to work together to reduce overdoses and opioid related deaths and empower clients to enter treatment for persistent substance use and utilize evidence-based harm reduction practices. The Post-Overdose Response Team (PORT) provides case management, counseling, service linkage and harm reduction for those who have experienced an overdose. GCSTOP also provides syringe exchange services, support for those involved with the justice system, and free Hepatitis C testing and linkage to medical care.

From January 1,2022 to December 31, 2022, GCSTOP:

• Had 1,981 contacts with participants.
• Tracked 656 community overdose reversals that originated with GCSTOP.
• Distributed 7,843 naloxone kits.
• Dispensed 332,727 syringes.
• Provided referral and linkages to care. For example, from October 1, 2022 to December 31, 2022, 80% of the 56 individuals who requested referral for substance use treatment attended their appointment and successfully engaged in services.

Collaborative Opioid efforts in 2022 include:

• GCSTOP’s location in High Point is now co-located with Caring Services at 2638 Willard Dairy Road. This location now has an office-based opioid treatment clinic with physician staffing on Friday as well as pharmacy and phlebotomy services. This empowers GCSTOP to connect with individuals through outreach and then refer them to this clinic to get a Medication Assisted Treatment (MAT) prescription within a few days.
• GCSTOP will receive $379,330 in funding from the Carolina Collaboratory Opioid Abatement and Recovery Research Program to increase awareness and decrease later overdoses among the opioid-naïve population through psychoeducation, peer counseling, and safer use supplies such as fentanyl strips and naloxone training. Opioid naïve describes an individual who has not used opioids consistently and may have larger reactions because their bodies are not used to them. Melissa Floyd-Pickard, Ph.D., is the academic partner at UNC Greensboro. This is one of five new research projects through the Carolina Collaboratory focused on community and local government engagement to assist opioid abatement and recovery efforts.  For more information, click here. 
• Kaitlyn’s House, a transitional and sober living home house in High Point is now transitioning under Caring Services in High Point. Caring Services offers a holistic continuum of care to individuals who are ready to make a commitment to their recovery. Kaitlyn’s House is named in honor of Kaitlyn Drake, a Greensboro resident who lost her life to an overdose to heroin laced with fentanyl. Click here for more information about Caring Services. 
• GCSTOP has: 
  • Significantly increased its weekly outreach presence at many Guilford County locations, such as Walgreens, Compare Foods, and others, providing education and naloxone distribution as needed. Click here to see a GCSTOP Weekly Schedule.
  • Provided harm reduction education and naloxone training to the Guilford Community Care Network, North Carolina A&T State University, High Point University, and Family Services of the Piedmont. GCSTOP also partnered with Sandhills Center to train 48 first responders from Greensboro and High Point Police, the Guilford Sheriff’s Office, EMS and Metro 911 on substance use and harm reduction.
  • Continued grant collaborations with the Cone Health Foundation, the Gilead Foundation to support Hepatitis C testing and linkage to medical care, and the Health Resources & Service Administration for Opioid Workforce Expansion.
• Partners GCDPH, GCSTOP, TAPM, the NC FIT program, and UNC Greensboro continue to support the Save a Life Guilford Campaign/savealifeguilford.com website (see photo). This effort seeks to reduce the stigma around substance use disorder that can be a significant barrier to treatment and promote harm reduction strategies such as the uses of Naloxone and where it can be obtained for free in the community.
• These partners also participated in Guilford County’s special opioid settlement meeting on October 31, 2022.
• Partners are also increasing availability of lifesaving medication Naloxone.
  • Free naloxone kits and training on its use are now available at the GCDPH pharmacies and TAPM locations in Greensboro and High Point. For more information, go to: https://savealifeguilford.com/#get-naloxone.  
  • A Naloxone vending machine has also been installed at the Greensboro Detention Center. Research shows that justice-involved individuals are at much greater risk of dying of an opioid overdose shortly after release. This National Center for State Courts provided this vending machine to Guilford and six other North Carolina counties at no cost and GCSTOP works to stock with nasal Narcan (GCSTOP's Kianna Cuascut, Justice Involved Coordinator and Emily Motsinger, JMSW intern pictured stocking the vending machine below).

Morbidity and Mortality Changes Since Last CHA

2020 Guilford County Leading Causes of Death

As in years past, the two leading causes of death in Guilford County in 2020 were cancer (891 deaths) and heart disease (867 deaths), comprising about 34% of all deaths. Following a national pattern, COVID-19 became the third leading cause of death in Guilford County in 2020, causing 346 deaths. Dementia followed closely behind with 341 deaths. Unintentional injuries (295 deaths), comprised primarily of unintentional poisonings (158 deaths), falls (96 deaths), and other external causes of death (excluding motor vehicle crashes), ranked as the fifth leading cause of death, followed by stroke (266). Lung cancer was the leading type of cancer death, followed by colorectal and breast cancers. 

Males had more deaths due to cancer, heart disease, unintentional injuries, chronic liver disease, Parkinson’s Disease, suicide, and homicide. Females had more deaths due to dementia, Alzheimer’s Disease, and strokes. African Americans had higher age-adjusted death rates than Whites for heart disease, cancers, stroke, diabetes, and homicide, while Whites had higher age-adjusted death rates due to chronic lower respiratory disease, chronic liver disease, and cirrhosis, and unintentional injuries.  The following chart highlights trends in leading causes of death in Guilford County between 2018 and 2020.

 *2020 is the most recent year for which these data are available. The processing requirements for birth and death certificate records result in a delay in public availability of the data.

For more detail on other leading causes of death and injuries, go to the 2022 Leading Causes of Death Data Brief and the 2022 Injuries Data Brief.  

Guilford County COVID-19 Confirmed Cases and Deaths

According to the Guilford County COVID-19 Dashboard, Guilford County has reported 155,266 total cases from March 14, 2020 through February 15, 2023 and has had 1,142 COVID-19 deaths during that time.  For continuously updated county data go to the Guilford County COVID-19 Data Dashboard. 

Please note: COVID-19 cases are reported by clinicians and laboratories by the date a person was tested. Total cases do not include all people with COVID-19 as some people do not get tested and many people use at-home tests of which results (positive or negative) are not reported to the State. COVID-19 mortality data for 2021 and 2022 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 2021 and 2022 mortality data is released from the state.

Guilford County COVID-19 Hospitalizations

The chart below illustrates Guilford County COVID-19 hospitalizations from March 15, 2020 through December 31,2022. In 2020, hospitalizations reached their highest in late December at 229 (12/31/20) 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. Hospitalization then gradually declined until early November 2021 when they began to rise again. The highest number of Guilford County hospitalizations during this surge occurred on 1/26/22 with 313 hospitalizations. There were two smaller peaks in 2022, one on 8/19/22 with 83 hospitalizations and a second on 12/22/22 with 86 hospitalizations. 

Select Sexually Transmitted Infections Cases and Rates per 100,000, Guilford County, 2018-2021

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 STI testing due to COVID-19, stay at home mandates, and quarantine procedures in place during the COVID-19 pandemic (see table below). In 2021, rates of newly diagnosed chlamydia, gonorrhea, syphilis, and HIV have all increased.  According to the 2021 NC HIV Surveillance Report, Guilford County ranked fifth in the state for newly diagnosed HIV among adults and adolescents with a three-year rate of 25.4 per 100,000 population (2019-2021), just behind Martin, Scotland, Mecklenburg, and Cumberland counties. Guilford County also ranked fourth for newly diagnosed cases of early syphilis, with a three-year rate of 40.4 per 100,000 population (2019-2021), behind Durham, Mecklenburg, 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.

Opioid Overdose Deaths

In 2020, the overall leading cause of injury deaths was unintentional poisoning. Unintentional poisoning deaths—which increased from 131 deaths in 2019 to 158 in 2020 - were due primarily to adverse reactions to prescription and nonprescription use of opioid drugs.  The following chart which shows the breakdown of overdose deaths by drug type from 2014 to 2020 highlights the role of opioids and synthetic opioids.

Violence Related Deaths

As the chart below illustrates, violence-related deaths increased from 2019 to 2020 in Guilford County. In 2020, there were 73 homicide deaths in Guilford County, up from 62 the previous year. Males (82%) and African Americans (76%) were disproportionately impacted. That same year, suicide deaths also increased from 58 in 2019 to 65 in 2020. 85% of suicide deaths were among males and Whites (85%). Firearms were used in 86.7% of the homicides and 63% of the suicides.

Emerging Issues Since Last CHA

The Impact of COVID-19

Like 2020 and 2021, COVID-19 continued to be a pressing concern impacting the health of our Guilford County community in 2022. According to the Guilford County COVID-19 Dashboard, Guilford County has reported 155,266 total cases from March 14, 2020 through February 15, 2023 and has lost an estimated 1,142 valued community members to COVID-19. To continue to reduce the negative impact on the community’s health and to address existing inequities intensified by COVID-19, Public Health continues to utilize partnerships to support our COVID-19 community response. These innovative partnerships focused on surveillance, COVID-19 testing and vaccination, communications, and issues around equity. For more information on these COVID-19 efforts are detailed in the section below (New/Paused/Continuing/Discontinued Initiatives Since Last CHA).

Increasing Awareness of Equity 

In Fall 2021, GCDPH received grant funding from North Carolina Department of Health and Human Services (DHSS) through the CDC’s Advancing Equity effort to support our equity work. Health equity recognizes the history of systemic oppression and necessitates the creation and strengthening of policies, practices, and organizational structures that produce fair outcomes and eliminate disparities based on social factors.

At GCDPH, we serve individuals and families from vastly diverse backgrounds with unique histories, cultures, identities, and lived experiences. While we strive to improve our community’s health and address health disparities, there is evidence that links significant differences in health outcomes to race and other marginalized identities, neighborhood of residency, educational attainment, income, language, and other social factors. Because of these disparities, it is critical that we continually assess our department’s ability to address the health inequities that many individuals we serve may face. It is equally important to operationalize our commitment to equity in all dimensions of our institution by developing and implementing strategies to advance health equity across all areas of work within Public Health.

Major accomplishments made by GCDPH in the 2022 calendar year include: 

• The formation of the Health Equity Core Team in early 2022. The Core Team meets monthly, and their purpose is to design, coordinate, and organize racial and health equity plans and activities across GCDPH.
• The Health Equity Staff Assessment. The Health Equity Core Team distributed the Staff Assessment in Spring 2022. These survey responses are informing the operational strategies within the organizational equity action plan, which includes policy review, employee trainings, department focus groups, and much more!
• The addition of a new Health Equity Coordinator position. Jacob French, MPH (he/they) assumed this role at GCDPH in July 2022, and they are serving as one of the leaders in ensuring equitable structures for both employees and community members.
• The adoption of the Equity Corner column in GCDPH’s The PULSE newsletter. The goal of this column is to make employees aware of the equity-work happening internally so they can feel empowered to advance equity in their inter-departmental work or inter-personal work relationships.

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. These funds are intended to lessen the impact of the COVID pandemic. They can be used to assist households, small businesses, and nonprofits; offset County revenue losses, improve infrastructure and support impacted industries, such as tourism and hospitality.  

From September 2021 to March 2022, Guilford County led a four-phase public engagement process to inform local allocation decisions. This process included resident surveys, community conversations, a Broadband survey, economic analysis, and a digital inclusion analysis. Guilford County issued a Growth and Recovery Request for Ideas process (RFI) in early 2022. This process invited collaborative project proposals to assist the community with short and long-term growth, our response to COVID-19 and its negative economic impacts. Guilford County used Federal guidance, the Board’s core values, and community survey priorities to guide this effort. For more information about this RFI process, click here. 

As of December 31, 2022, Guilford County has budgeted $104.3 million of the APRA Funds.  is a breakdown of funded projects in the following strategic priority areas:

For more information about the funded projects and their progress, click here.

Local Impact of the North Carolina Opioid Settlement 

In July 2021, to lessen the harm caused by the opioid epidemic and bring vital resources to local communities, Attorney General Josh Stein negotiated a $26 billion settlement for the State of North Carolina. This settlement resolves opioid litigation with three drug distributors, McKesson, Cardinal Health, and AmerisourceBergen, and one manufacturer, Janssen Pharmaceuticals, Inc., and its parent company Johnson & Johnson. 

As a result of the settlement, our local county and municipalities will receive the following settlements over an 18-year period:

• Guilford County - $21,735,653
• City of High Point – $1,329,849
• City of Greensboro – $3,397,546

Local governments may choose one of two options to use these funds. With Option A, they may fund one or more strategies from a shorter list of high-impact strategies. With Option B, they engage in a collaborative strategic planning process to choose from the list of Option A and Option B strategies or a longer list of strategies from the national settlements. The Guilford County Board of Commissioners voted for Option B.  This Option B approach recognizes the complex nature of opioid use disorders and how they often interact with other substance use and mental health challenges. It will also allow the county to build partnerships with community stakeholders to create solutions. A link to the strategies under Option B is here.

On October 31, 2022, Guilford County hosted a special meeting to share updates on the opioid settlement funding to be received by Guilford County from the state of North Carolina. In January 2023, the Division of Public Health named Amanda Clark as Drug and Injury Prevention Manager, who will facilitate the development and implementation of the County’s opioid recovery strategies to reduce community prevalence in opioid-related injury and death. For more information or to get involved in the next steps of the Guilford County response, go to Guilford County’s Opioid Settlement webpage. For more information the state settlement, click here.

If you or someone you know is struggling with opioid addiction, seek help by visiting the link for the Guilford County Behavioral Health Centers or calling (336) 890-2700. Guilford County also offers free naloxone kits (overdose reversal kits) and instructions/training on its use. For more information about why Naloxone is important and where you can pick up a free kit, go to: https://savealifeguilford.com/#get-

Public Health's Education, Testing, and Vaccination Efforts to Address Mpox  

Mpox (formerly known Monkey Pox) is a rare disease caused by infection with the mpox virus. Anyone can contract mpox through direct contact with infectious rashes, scabs, or body fluids. It can also be spread by respiratory secretions during prolonged, face-to-face contact, or during intimate physical contact, such as kissing, cuddling, or sex.

In May 2022, due to a global outbreak in many countries without a history of mpox, the Centers of Disease Control and Prevention (CDC) and partners began efforts to reduce the spread of mpox in the United States. North Carolina’s first case was identified in June 2022. 

To prevent and mitigate the impact of mpox locally, GCDPH has partnered with local health and medical providers to ensure they are informed on the symptoms, risk factors, and could make referrals for testing if they do not have the ability to test at their locations. Based upon data through January 31, 2023, Guilford County has 21 confirmed and 49 probable cases. Probable cases must be confirmed by the CDC. GCDPH also offered community education and collaborated with local non-profit organizations and universities to provide tailored outreach and vaccination clinics to specifically reach populations at higher risk. Through December 7, 2022, GCDPH has administered 514 doses of JYNNEOS vaccination to eligible individuals. Example graphics highlight special events and samples from a social media campaign with COMMANDO Advertising to assist us in engaging with the LGBTQ⁺ audience on the most relevant social, web, and dating platforms.  For more information about mpox, go to click here.

Guilford County's Resolution on Gun Violence

On June 2, 2022, Guilford County Commissioners issued a resolution declaring gun violence a public health crisis. This resolution demonstrates Guilford County will partner with local municipalities, community partners and community members to support evidence based public health efforts to address the underlying social, economic and systemic factors that promote gun violence.  Click here to read the resolution. 

In November 2022, GCDPH added a Social Determinants of Health Coordinator position. Alexis Powell, MPH (she/her) accepted this role and will provide leadership and support efforts to enhance activities related to the elimination of health disparities and inequities to address systemic issues. For more information about the impact of violent deaths in North Carolina and in Guilford County, go to the NC-Violent Death Reporting System (NC-VDRS) Data Dashboard.

New/Paused/Continuing/Discontinued Initiatives Since Last CHA

COVID-19 Related Initiatives Continue 

In 2022, Guilford County Division of Public Health (GCDPH) continued to:

• Provide local COVID-19 surveillance,
• Ensure accurate, timely information is communicated to the public,
• Support access to testing and vaccinations, and
• Actively reach out to underserved communities to increase COVID-19 vaccinations.

Local COVID-19 Surveillance

As of February 15, 2023, GCDPH continues to track COVID-19 metrics through its COVID-19 Data Dashboard to regularly inform the media, community leaders, partners and community members. This dashboard tracks key metrics, including number of cases, hospitalizations, deaths and tests, positivity rates and demographic data for cases and deaths by age, race, and ethnicity.

GCDPH also continued its COVID-19 Wastewater Testing partnership with North Carolina A & T State University that began in August 2021. Wastewater testing is an affordable, accurate, rapid, and effective method to track COVID-19 trends in underserved and vulnerable communities. GCDPH highlighted this innovative collaboration at two national conferences, the 2022 National Association of County and City Health Officials (NACCHO) 360 Annual Conference in July 2022 in Atlanta and the American Public Health Association in November 2022 in Boston. Charley Naney, Public Health Epidemiologist, received a scholarship to attend the American Geophysical Union (AGU) Science Conference in Chicago in December 2022 as a guest of the Thriving Earth Exchange. GCDPH has been partnering with Thriving Earth to develop a community consortium for exploring the Wastewater Water Surveillance process with residents and decision makers in Guilford County during the COVID-19 Pandemic. GCDPH looks forward to continuing their empowering work with AGU Thriving Earth and NCAT in 2023.

Emergency Declarations

On March 13, 2020, the Guilford County Board of Commissioners, acting as the Board of Health (BOH), issued a countywide emergency COVID-19 declaration to mitigate the threat of COVID-19 transmission in Guilford County. Guilford County terminated its local emergency COVID-19 declaration on August 15, 2022. As of February 15, 2023, the federal government declared its intention to end the COVID-19 national and public health emergencies on May 11, 2023.

County Mask Mandates

The Guilford County Board of Commissioners put in place the first county wide mask mandate on August 27, 2021, due to the emergence of the Delta COVID-19 variant. This rule required that all Guilford County residents wear a mask within all indoor public spaces regardless of vaccination status. This rule was rescinded on November 15, 2021, after a data review confirmed that County positivity rate was at or below 5% for three consecutive weeks. Because of a significant surge in 14-day positivity rates from 7.4% to 26.8% impacted hospital capacity and medical supplies as well as the County’s ability to effectively respond to needs in December 2021, the Board reissued a BOH Indoor Mask Rule on January 13, 2022. This rule stayed in effect until February 18, 2022, when it was repealed. To offer support, GCDPH held two drive thru N95 mask distribution events in January 2022, one at the Roy B. Culler Senior Center in High Point and one at the Greensboro Coliseum in Greensboro.

Communication 

GCDPH continues to maintain the www.healthyguilford.com website launched in March 2020 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, vaccinations, and local COVID-19 metrics tracking.

To address disparities and connect to the least vaccinated groups in the county, GCDPH Health Education staff collaborated with VitaLink to develop and launch the “My Why” Campaign. This campaign included tailored messages to reach African American and Latino community members to ensure they had accurate information to protect their health and the health of their families.  Below are some examples of these messages:

COVID-19 Testing

Access to testing continues to be an important tool to reduce the spread of COVID-19. In 2022, GCDPH:

• Continued to support availability of local testing at Piedmont Hall, Four Seasons, and GCDPH in High Point by partnering with vendors.
• Promoted the free at-home COVID-19 rapid test give away launched by the Biden Administration in January 2022 to empower individuals to secure tests through COVIDtest.gov.
• Launched the state supported Community Access Points (CAP) program in August 2022 to increase access to free home COVID-19 tests. This program expands access to free at-home tests by making them available at 12 community-based locations in the county like local libraries, community-based organizations, and others. From August 2022 through December 31, 2022, GCDPH and partners have distributed 38,907 tests. For more information on free testing locations and testing kit information, click here.

   

Outreach and Vaccinations

Since the initial release of COVID-19 vaccines in late December 2020, GCDPH has engaged in partnerships and outreach to vaccinate community members to reduce COVID-19 illness, hospitalizations, and deaths. This effort began with larger mass vaccination sites and subsequently shifted to community-based and mobile clinics. GCDPH has followed the NC Department of Health and Human Services guidance and partnered with numerous organizations, faith communities and community-based groups to ensure equity in vaccine distribution and address systemic barriers.

Recognizing the need to be flexible, reduce access barriers, and meet community members where they are, in spring and summer of 2021, GCDPH shifted to a community and mobile model in delivering COVID-19 vaccines and boosters. From July to December 31, 2021, GCDPH held more than 100 community and mobile COVID-19 vaccine clinics by collaborating with over 70 community partners. In 2022, GCDPH offered vaccinations at both Greensboro and High Point GCDPH clinic locations daily. We also held 50 community and mobile vaccine clinics with 32 community partners. Partners included faith communities, businesses, schools, congregate living sites, and other community sites. Three mobile units increased our capacity to host pop-up vaccine events. Because COVID-19 worsened issues like food insecurity, GCDPH built collaborations with groups like Definition Church and One Step Further’s Community Food Market to host vaccine clinics during market hours.

GCDPH partnered with the YWCA High Point’s VaxConnects program that engages individuals to serve as vaccine connectors in vulnerable communities with lower vaccination rates in High Point and Greensboro. 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 if needed. In May 2022, VaxConnects received an Achievement Award from the National Association of Counties (NACo), which honors innovative, effective county government programs that strengthen services for residents.

As of February 1, 2023, out of all people in Guilford County, 66% have been vaccinated with at least one dose, and 63% have completed an initial series (see charts below). Out of those who have finished their initial vaccines in Guilford County, 60% have been vaccinated with at least one booster, and 20% with an updated Omicron booster.

Public Health is Going More Mobile

With three new mobile units to support our community work, GCDPH continues to pilot new ways to use these resources. In addition to using the mobile units to support COVID-19 vaccination clinics with community partners, these units are now being piloted to support the following Public Health services:

• The Community Access Points (CAP) program to increase access to free home COVID-19 tests at our two health department clinic locations.
• Integrated Targeted Testing Services (ITTS), offering education and testing for sexually transmitted infections and HIV (see photo to the right with health educators, DeVontee' Tanner, Kristy Brown, Jordan WIlson, and Kaleigh Rhodes).
• Mpox community education and vaccinations to high-risk individuals.
• Seasonal flu shots.
• Required immunizations at select schools through our School Health and Clinical Services programs.

GCPDH will continue to explore other uses such as diabetes screening and referrals to primary care in the future.

Primary Care Services at Public Health in 2022 

In June 2021, the Guilford County Division of Public Health began offering 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. These services also support patients in making healthy choices to maintain good health and increase access to regular health screenings for prevention and early detection. These services are available at both 1100 East Wendover in Greensboro and 501 E. Green Street in High Point. In the 2022 calendar year, GCDPH provided primary care to 593 patients, up from 215 patients from June to December 2021.

In April 2022, Guilford County Public Health received the 2021 North Carolina Public Health Association (NCPHA) Dr. Sarah Taylor Morrow Health Department of the Year. This award, which is given to health departments who have demonstrated outstanding and exemplary health initiatives like those highlighted in this State of the County’s Health Report. It is named in honor of Guilford County’s very first female Public Health Director, Dr. Sarah T. Morrow. 

2022 Every Baby Guilford Accomplishments

In 2020, Every Baby Guilford went through a redesign and strategic planning process to envision bold goals and collective action strategies to disrupt longstanding racial disparities in birth outcomes and infant mortality in Guilford County. Using a racial equity lens, EBG continues to build an inclusive collective action movement that began in 2021 by:

• Advancing health equity,
• Creating collaborative solutions with radically inclusive community engagement,
• Strengthening the continuum of care of reproductive life planning for equitable access to quality care, and
• Promoting infant wellness and positive child development.

Every Baby Guilford 2022 highlights include:

• Hosting Crucial Conversations: The State of Infant Mortality in Guilford County, a Virtual Leadership Breakfast on February 24, 2022. Representative Alma Adams shared a national message of Black maternal health as keynote speaker with the 2021 Momnibus Act. The 2021 Momnibus Act directs multi-agency efforts to improve maternal health, particularly among racial and ethnic minority groups.
• Hosting Racial Equity trainings to disrupt longstanding health outcomes and racial disparities in Guilford County. From November 2021 – December 2022:
  • 431 community leaders, health care systems, allied health professionals, social support partners, and community members attended Racial Equity Institute (REI)) Groundwater trainings.
  • 86 participated in REI’s 2-day workshop, Phase 1.
  • 118 took part in the Dismantling Bias in Maternal and Infant Healthcare™ Awareness to Action workshop in partnership with March of Dimes.
• Amplifying Every Voice, a community storytelling project to learn about and share pregnant and birthing people's experiences in Guilford County is wrapping up year one and will be unveiling these stories in 2023.

• Continuing to connect 231 uninsured birthing people to prenatal care through the Adopt-A-Mom (AAM) program. This program provides access to health care, health education, counseling, and information on needed resources for vulnerable populations.

• Launching EBG Preconception Health Ambassador program by recruiting community members to serve as social influencers to perinatal health. In summer 2022, Ambassadors created and shared relatable prenatal health messaging and social media content with over 290 Guilford County residents to increase understanding of reproductive health and local resources. Topics included connecting with a doctor, the importance of taking vitamins (folic acid), and eating well. EBG recruited new 15 Ambassadors for fall 2022. 
• Implementing EBG’s Fetal and Infant Mortality Review (FIMR) program, which was inducted into the National Center for Fatality Review and Prevention Institute. FIMR is a community-owned, action-oriented process to improve service systems and resources for birthing people, infants, and families.
• Promoting Baby Steps for a Healthy Future and Family. With this walking campaign, families collectively walked 34 million steps (15,000 miles) and accessed health messaging for families of child-bearing age through Baby Steps with EBG podcasts hosted by Danielle Deshazor, Perinatal Health Coordinator. Click here to listen to the podcast.
• Hosting Pregnancy and Infant Loss Remembrance Day 2022 and the wrap up of the Baby Steps Campaign on October 15, 2022, at Center City Park in Greensboro.
• Collaborating to expand CenteringPregnancy, a group-based model of prenatal care with Duke Endowment funding. Through this expansion, GCDPH renovated their CenteringPregnancy space in 2022 and resumed in-person sessions in the fall of 2022. Cone Health’s MedCenter for Women trained staff and prepared space to launch its first CenteringPregnancy cohort in January 2023. 
• Partnering with Children's Home Society of North Carolina to expand the Triple P – Positive Parenting Program and Cone Health's MedCenter for Women to implement a Mothers and Babies curriculum to reduce maternal stress and postpartum depression.  
• Promoting breastfeeding friendly businesses through the Making It Work Toolkit to ensure employees have access and opportunity to continue lactation upon their return to work. 
• Implementing the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) project, which supports evidence-based efforts to address three Aims: Improve Birth Outcomes; Reduce Infant Morality; and Improve the Health Status of Children Ages 0-5. This grant effort is coordinated by new EBG Grant Coordinator, Tairra Booth and is funded by NC Department of Health and Human Services, Division of Public Health.
• Promoting Perinatal Health Education: In December 2022, Jada Rogers and Rebecca Eliassaint joined EBG as Community Health Workers to help connect community members to information and education, services, and resources in high impact communities in our county.

Coming up in 2023!  New Reducing Infant Mortality in Communities (RIMC) Grant!

Beginning June 1, 2023, the Guilford County Division of Public Health will receive $225,000 annually during the next 3 years. This grant will support a community-based Doula program, Reproductive Life Planning, and a Diabetes Management program in our DPH clinical services. After a year-long process of designing a program engaging maternal health stakeholders invested in this work, GCDPH will hire a Doula Coordinator and contract with 5 Community Doulas to be matched with patients served from home visiting programs serving birthing people prenatally.  This grant award comes from the NC Department of Health and Human Services, Division of Public Health.

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