Health

Delta compels local health departments to pivot – again.

Eighteen months into the COVID-19 pandemic, the Delta variant is forcing public health workers to accelerate their work, for what they hope will be the last time.

By Rose Hoban

The heat and humidity were oppressive last Saturday afternoon in Northwest, population 785, in rural Brunswick County.

Nonetheless, Alexis Grainger-Clemmons was certain that her fellow congregants from Spring Grove Missionary Baptist Church would turn out for a family fun day, the first since the beginning of the coronavirus pandemic in early 2020.

Grainger-Clemmons had arranged pony rides and bouncy castles. The Kayla’s Ice Cream truck had been lured out from Wilmington and was parked next to a shaved ice kiosk. Members of her congregation were doling out barbecue with all the fixings, and DJ Shack was spinning tunes of praise from under a tent raised to block the harsh noon sun.

“Because of COVID, everybody had kind of separated, didn’t want to mingle together,” Grainger-Clemmons said. “I organized this fellowship fun day for the family, to kind of break the ice to get the kids mingling back, hopefully see that we can have fun in the church and just bring your kids back out here.”

The day wasn’t just for the kids though. Grainger-Clemmons had also called the county health department to bring out their mobile vaccination van.

On the other side of the field, close to the road, Jose Noguera, a worker from county emergency services, and a half dozen others had pulled the van close to another tent, where they were ready to give COVID vaccinations. Three large fans blew mist, trying to cut the heat as the workers sweated behind their masks, ready to give a jab to anyone who showed — church congregant or not.

When asked if the heat and the weekend hours and the long months of COVID response had him tired, Noguera was quick to respond.

“It’s my pleasure, actually,” he said. “When I go home, I feel good that I have gone the extra mile to help out the community.”

Noguera is one of thousands of local health department workers who’ve been working on COVID response, day after day for the past 18 months, through peaks and lulls in cases, continuously altering their responses to a virus that’s proven to be a wily and capricious foe.

For the Brunswick County Health Department, that’s meant ramping back up to almost daily pop-up clinics. Across the state, public health leaders and workers are trying old and new ways to reach the unvaccinated, as the numbers of cases and hospitalizations surge.

shows people milling around near a van with a canopy and an adjacent tent. Large fans are set up to cool things down.
Members of the Brunswick County Health Department and the county emergency services had set up a mobile vaccination clinic on the afternoon of Saturday, July 31, alongside Spring Grove Missionary Baptist Church. Photo credit: Rose Hoban

Even if Noguera said he’s not tired, many in public health say they’re exhausted from the past year and a half of sprinting in this marathon of a pandemic just to keep up.

Facing the next wave

“One of the things that we had already realized after we got past the worst of times in late winter, early spring, is that our people were absolutely tapped out,” said Steve Smith, head of the Henderson County Health Department.

Before the most recent surge, Smith was able to gather some of his front-line leadership for a debriefing, and some of them opened up.

“I think a term that came up is they just don’t have much ‘gas in the tank’ anymore,” Smith said. “Although it hasn’t been like a crisis level every single day for the community, there’s always been something on point that we were running on in terms of response.”

Now they’re facing another wave in the pandemic as the Delta variant latches onto the unvaccinated, making the hosts of the virus sicker quicker with an illness that health care workers know vaccines could have prevented or at least tamed.

“I just don’t have, you know, that same energy and same level of resource even though I might have the same bodies,” Smith said.

With the Delta variant turning most of the state’s counties from a yellow alert level to an angry red in less than a month, Smith said his people know they need to just keep powering through.

That has meant tapping into deeper wells of energy. The good news is that Smith has seen more people show up to the health department in Hendersonville recently asking for vaccinations.

There’s some other good news too.

“By and large vaccination coverage rates for seniors in some of those most at risk in long-term care facilities is pretty good,” Smith said. “So those kinds of highest risk cases that often lead to death are pretty well protected,” he said. But, “once you get down into that middle age category, and younger folks, our coverage rates are really low.”

Smith said he’s been watching what’s happened in other countries such as India and Great Britain, where Delta caused rapid infection peaks and had equally rapid declines. Maybe, just maybe, the worst of Delta will be done by the time Henderson County schools open August 23.

Maybe.

Younger people more affected

In the late winter and spring, health departments across the state set up mass vaccination clinics, where people lined up for hours in their cars for their shots.

Now the Brunswick County model is the rule, where public health workers are fanning out into the community, beating the bushes to find willing vaccine recipients.

“We’ve long since done radio interviews and TV interviews,” said Cumberland County Health Director Jennifer Green. “We’re also thinking about, like, text campaigns and how can we get the word out to young people via texting? Or how can we get the word out to young people via social media.”

The Cumberland department has answered many questions about how a vaccination might affect fertility, one of the many examples of misinformation about the COVID vaccine that’s circulating almost as aggressively as the virus.

“We hear about both males and females, ‘it’s going to do something to my sperm,’” Green said of the many young people with questions.

It’s those young people who are the target audience now for a reason —because they’re being hit harder with COVID.

According to Department of Health and Human Services data, of the cases reported during the week of July 18, 60.6 percent of them were in people ranging in age from 18 through 49. During the week of Jan. 3, 51.6 percent of cases were in that age group.

Where the younger cohort is really disproportionately showing up now, though, is in hospitals. On the last day of the week starting July 18, 32 percent of those hospitalized were ages 20 to 49, at the end of the week of Jan. 3, those same ages were only 12 percent of the hospitalized.

Almost all of the new cases and the new hospitalizations are people who haven’t been vaccinated yet. Some young people are interested in getting a vaccine, health care workers say, but have put it off for a variety of reasons.

“These are what we call the ‘young interesteds,’” said Durham Health Director Rod Jenkins. “These are the ones who feel as if you know, ‘I’m okay… I don’t have too much to worry about.’

“Perhaps part of what’s keeping these young people from getting a vaccination is that up until now, the conventional wisdom has been that COVID is more serious for older people. But Delta has changed the equation.

“They are certainly the ones that are driving infections right now.”

Convincing the ‘interesteds’

One health director contacted by North Carolina Health News compared the current vaccine campaign to hand-to-hand combat. Certainly, it’s more face-to-face, with health care workers going door to door in many counties, including Wake and Durham.

Jenkins said he sent a team out to a street festival last weekend where they were able to give 85 shots in three hours. His department is using community health workers, non-professionals who are trusted community members. They’re trained to deliver health messages in English, Spanish and other languages. There’s a deep tradition of community health workers in Latin countries.

“We were able to hire some very, very unique individuals, bilingual individuals, people who truly care about the community, and they are still helping us with this effort today,” Jenkins said.

Local public health officials may get some help from an initiative announced Tuesday that the state Department of Health and Human Services is giving away $100 gift cards (while supplies last) to anyone over 18 who shows up for a vaccination.

When it’s said and done, the biggest thing that may persuade the “interesteds” to get a shot are the many conversations they’re having with family and friends.

“What we’re learning from the data is that really, it makes the difference, especially for people that are on the fence, to hear from their friends, their neighbors, their family members,” Green said. “It matters if I say it, but it really matters if, you know, your friend or neighbor is recommending.”

Shows two young women wearing masks holding up paperwork and stickers saying,
Lorena,27, and Araceli Garcia, 31, came out to get vaccinated at the pop up vaccination clinic next to Spring Grove Missionary Baptist Church in Brunswick County. They said they were the only ones in their extended family who hadn’t yet gotten shots.

“We were a little neglected at first to get it. But now we’re seeing that the COVID is rising up again, we just want to make sure that we’re not being selfish and protecting the ones around us and ourselves as well,” Lorena said. “Since we’re younger, it’s like we’re okay, but maybe the older ones have a little bit tougher time and we want to make sure we’re doing it for them.” Photo credit: Rose Hoban

The good news from Green is that more people are requesting vaccination teams to come out to events.

“Especially for back-to-school events… movie nights in the park, that kind of thing,” Green said. “We’re working with the state’s Healthier Together campaign for them to help us get out some messaging because they have experience in working in communities and knocking on doors and canvassing and putting out flyers and getting using different types of approaches.”

So her people are hitting the gas, just when they want to take a break.

“The exhaustion is a real thing and we feel it, I feel it personally,” Green said. “We know our community is tired. We know, the world is tired of COVID and wants it to go away.

“It feels very, like, 2020. And the path forward out of that, to avoid that 2020 feeling is to get people vaccinated.”

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