DOH-Palm Beach County 2020 Annual Health Profile

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1 ANNUAL HEALTH PROFILE 2020 It is impossible to think of the year 2020 without recalling the events of the world’s most devastating pandemic in recorded history. COVID-19 has changed our lives in ways that we still do not fully comprehend. This catastrophic event will shape the future of all spheres of our well being from the physical, mental, and spiritual. It has also brought to the forefront some of the most basic health disparities and most important social determinates of health that Public Health holds deeply at its core. It is with this in mind, that we recognize this year as a milestone in our effort in Palm Beach County to uphold our mission is to protect, promote & improve the health of all people in our county through integrated state, county, and community efforts. There is no greater role the Department of Health in Palm Beach County (DOH-Palm Beach) can play than to be “the agent of change” for the community. We have seen the Community Health Assessment (CHA) and Community Health Improvement Plan (CHIP) embraced throughout the county by countless community partners both small and large. This tool has been used as a compass steering our community away from silos and into united goals. The community has embraced implementing the lens of equity to eliminate disparities and break down barriers. As an agent of change, DOH-Palm Beach is bringing the issues of equity, racial disparities, and social justice to improve the health of our community. We have demonstrated that to create change we must help the community develop their own tools and skill sets to be more self-sufficient, improve their economic stability and get involved in policy changes as we progress to a new normal as the COVID Pandemic evolves. Our future looks brighter and stronger than ever. As an Accredited Health Department by the Public Health Accreditation Board, we stand as a trusted source of information for our community leaders. The public relies on our skilled and competent work force to battle emerging communicable diseases, provide lifesaving preventive services, maintain and protect our environment, and improve and promote a healthier lifestyle to ensure that all people have full and equitable access to opportunities that enable them to lead healthier lives. Alina Alonso, MD Director Florida Department of Health Palm Beach County

2 PALM BEACH COUNTY FLORIDA DEPARTMENT OF HEALTH Assistant Director Chief of Operations Jacqueline Lobban-Marsan Laboratory Jupiter Health Center Nutrition Services Director Environmental Public Health Rafael Reyes Palm Beach County Board of County Commissioners Security Inform. Chief Legal Counsel Cathy Linton, Esq. Risk Management Tuberculosis rev. 4/2021 School Health Community Immunization Services Director of Nursing Dana Heinlein Epidemiology HIV / AIDS Director Epidemiology Dr. Karen Thomas Sexually Transmitted Diseases Public Health Dentistry William S. Staten DOH-PALM BEACH COUNTY Functional Organizational Chart Health Care District of Palm Beach County Director of Community Health Merlene Ramnon Director Maternal Child Health Joanne Newman Nurse Family Partnership Healthy Beginnings Nurses Women’s Health Initiative Director Public Health Residency Dr. Denise Josey Human Resources Lead HR Liaison Ericka Lacker AAIII Joann Grabowski DIRECTOR Dr. Alina M. Alonso Chief of Preparedness & Performance Improvement Lisa Vreeland Quality Improvement W.I.C. Usleur Cook Emergency Preparedness Community Health Planning Director Vital Statistics Amarilis Salazar Air & Waste Information Technology Environmental Control Food Facilities & Institutions Child Care Licensing Dr. Alonso’s Direct Reports Water Permitting & Enforcement Public Information Officer Alexander Shaw General Services Chief Financial Officer Andy Edwards Network Volunteer & Family Planning Lantana / Lake Worth Health Center Health Information & Informatics Delray Beach Health Center C.L. Brumback Belle Glade Health Center Call Center Northeast Health Center West Palm Beach Health Center

3 ANNUAL HEALTH PROFILE 2020 Mission: To protect, promote & improve the health of all people in Florida through integrated state, county, & community efforts. TABLE OF CONTENTS Director’s Message .1 County Health Ranking, Florida. 4 Administration .5 Vital Statistics .5 Finance & Accounting.5 Vision: General Services. 6 Communicable Diseases . 6 To be the Healthiest State in the Nation Core Values: (I CARE) Innovation: We search for creative solutions and manage resources wisely. Collaboration: We use teamwork to achieve common goals & solve problems. Accountability: We perform with integrity & respect. Responsiveness: We achieve our mission by serving our customers & engaging our partners. Excellence: We promote quality outcomes through learning & continuous performance improvement. Epidemiology & Disease Control . 6 TB Control Program . 8 Sexually Transmitted Disease .10 HIV/AIDS. 11 Public Health Dentistry . 13 Community & School Health .14 Healthiest Weight Florida .14 Tobacco Prevention & Control Program. 15 School Health. 15 Environmental Public Health .16 Health Access.19 Health Centers Highlights.19 Community Immunization Services.21 Comprehensive Nutrition Program.22 Maternal Child Health.23 FDOH Palm Beach Laboratory .23 WIC .24 Performance, Improvement and Preparedness.25 Preventive Medicine / Public Health Residency Program . 27 Volunteer Health Care Provider Program . 27 Volunteer Health Services Program. 27

4 FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH RANKINGS 2020 County Health Outcomes Health Factors Alachua.26 . 5 Baker .49 . 41 Bay .44 . 37 Bradford.64 . 49 Brevard.32 . 18 Broward . 11 . 12 Calhoun .55 . 57 Charlotte.28 . 11 Citrus .57 . 39 Clay .27 . 19 Collier .2 . 6 Columbia .61 . 50 DeSoto.38 . 55 Dixie.63 . 62 Duval .45 . 34 Escambia.47 . 29 Franklin.34 . 48 Gadsden.65 . 66 Gilchrist.42 . 43 Glades .41 . 54 Gulf.31 . 36 Hamilton .58 . 63 Hardee.25 . 64 Hendry.43 . 65 Hernando.37 . 33 Highlands.46 . 44 Hillsborough.19 . 24 Holmes .48 . 51 Indian River .14 . 16 Jackson .50 . 60 Jefferson.56 . 45 Lafayette.39 . 42 Lee.16 . 15 Leon.9 . 23 Levy.59 . 58 Liberty.30 . 46 Madison.62 . 56 Manatee.15 . 17 Marion.53 . 38 Martin.4 . 4 Miami-Dade .6 . 32 Monroe .8 . 8 Nassau .33 . 9 Okaloosa .12 . 14 Okeechobee .52 . 61 Orange.7 . 21 Osceola .18 . 31 Palm Beach .10 . 7 Pinellas.23 . 10 Polk.35 . 40 Putnam .66 . 67 Santa Rosa.13 . 13 Sarasota .5 . 3 Seminole.3 . 2 St. Johns.1 . 1 St. Lucie.29 . 30 Sumter.22 . 25 Suwannee.54 . 52 Taylor.60 . 53 Union .67 . 47 Volusia.40 . 27 Wakulla.21 . 28 Walton .20 . 35 Washington.51 . 59 PALM BEACH COUNTY What are Health Outcomes? Everyone wants to experience long and healthy lives, yet places have different resources and opportunities. To understand the health outcomes in a community, we measure both length and quality of life by county within Florida. Health Outcome Ranks 1 to 17 18 to 34 35 to 50 51 to 67 How Do Counties Rank for Health Outcomes? The green map shows the distribution of Florida’s health outcome ranks across counties. The map is divided into four quartiles with less color intensity indicating better health outcomes in the respective summary rankings. What are Health Factors? Many factors shape our opportunities to be healthy and influence how well and how long we live. Health factors represent the things we can change to improve health for all, like opportunities for quality education, good paying jobs, access to quality clinical care, healthy foods, green spaces, and secure and affordable housing. We measure four health factor areas. Health Factor Ranks 1 to 17 18 to 34 35 to 50 51 to 67 How Do Counties Rank for Health Factors? The blue map shows the distribution of Florida’s health factor ranks across counties. The map is divided into four quartiles with less color intensity indicating better health factors in the respective summary rankings. You can also learn about how we calculate health factor ranks, at www.countyhealthrankings.org. What Do Differences Between Ranks Mean? Counties are ordered by the health outcome rank, with a top-ranked county (rank 1) having the best health outcome score. Ranks are easy to communicate, but they mask differences in health within counties and from one ranked county to the next. The chart next to the map shows the spread of health outcome scores (ranks) for each county (green circles) in Florida. This graphic shows the size of the gap between ranked counties. The different background colors correspond to the four quartiles used in the map. Figure

5 ANNUAL HEALTH PROFILE 2020 Administration 25,000,000 Vital Statistics On Mar. 23, 2020, we closed both Offices of Vital Statistics to the public and suspended in-person service until further notice to slow the spread of COVID-19. 20,000,000 15,000,000 At the same time, this agency continued to provide essential services of Birth & Death Certificates to our community, serving by online at www.vitalchek.com, by fax (561) 837-5081 and by mail: PO. Box 29, WPB, FL 33402. The Vital Statistics opened to the public on September 2020 in the COVID-19 II phase. As the pandemic continues to affect nearly every aspect of our lives Vital Statistics continues helping the community. Even with safety measures, we find ourselves periodically understaffed due to COVID-19. Vital Statistics until now we continued to serve our community and give 100% to our 0,000,000 5,000,000 0 State Funds Federal Funds Local Contribution Vital Statistics Clinic Environmental 2019 2020 clients. Palm Beach County Births . 14,112 Palm Beach County Deaths.17, 223 Finance & Accounting 2019 State Funds. 15,546,584 Federal Funds . 10,268,587 Local Contribution . 19,934,737 Vital Statistics . 1,817,326 Clinic . 5,034,129 Environmental . 2,855,718 Total . 55,457,081 2020 22,274,443 13,279,031 19,640,266 1,869,856 3,756,771 3,027,453 63,847,820 Increase in 2020 State & Federal funding is COVID funding Decrease in 2020 clinical funding due to COVID closures FEES 8,654,080.00 13.55% LOCAL SOURCES 19,640,266.00 30.76% STATE FUNDS 22,274,443.00 34.89% FEDERAL FUNDS 13,279,031.00 20.80%

6 FLORIDA DEPARTMENT OF HEALTH PALM BEACH COUNTY General Services The SNS and RDS exercises were an excellent training experience. The FDOH team exercised the push receipt of materials, staging, inventory control, picking, and the distribution to both open and closed POD’s for dispensing operations. This provided the FDOH team the opportunity to experience a simulation of a complete mass dispensing plan and operation. The success of these ongoing trainings became very apparent during Hurricane Dorian when the supplying and setup of the special needs shelters was completed efficiently and in record time. The training of FDOH staff is always varied and continuously ongoing in preparation for any event and scope that may arise. Fixed Asset Missing by % of Total Dollar Value “Goal 2.0%” Reconciliation process not completed due to COVID-19 0.06% 0.04% 20 20 20 19 0.00% 0.00% 20 18 20 17 20 16 0.00% Lakeside Hospital Western Shelter Tent - Belle Glade COMMUNICABLE DISEASE Epidemiology About COVID-19 Epidemiology in Palm Beach County. When a new infectious disease is discovered, epidemiologists work with other scientists to find who has it, why they have it, and what can be done to mitigate the spread of disease. From the beginning of the COVID-19 pandemic, scientists at CDC and around the world have been working to identify the source of the outbreak. In December of 2019, COVID-19 otherwise known as SARS-COV2 was first identified in Wuhan China. Epidemiologists went to the area in China where the disease first appeared and conducted surveys in the community and health facilities. They collected nose and throat specimens for lab analyses. These studies showed who was infected, when they became sick, which was intended to identify a possible source. Florida Department of Health in collaboration with the CDC (Center for Disease Control) has been monitoring and tracking cases, deaths, hospitalizations, as well as the percentages of those who became ill and survived. Palm Beach County Epidemiology keeps track of the number of COVID-19 cases and collects information on the disease from surveillance systems that report different kinds of data, such as new cases, hospitalizations, deaths, demographic information (like age, race/ethnicity, or sex), symptoms, and treatments.

7 ANNUAL HEALTH PROFILE 2020 This surveillance data, including information polymerase chain reaction ( PCR) test results, and other kinds of studies such as antibody levels have been used, to find out more about the disease, such as how long someone with COVID-19 is contagious, risk factors for severe illness, and which medical treatments are most effective. COVID 19 has had major global impact, socially, mentally, economically in ways that could not have been predicted. Guidance has constantly changed as we have learned over time, more about the disease and how best to protect the community. Measures that have worked to slow the spread of disease: social distancing, wearing of masks, avoiding crowded areas, and good hand and cough etiquette has been the most effective way, which bought scientist time to develop effective COVID-19 vaccines. COVID-19 vaccines are now available for those Palm Beach County Case Count who are 12 years of age and older, with the hope March 2020 - May 2021 that by the Fall of 2021 vaccines will become Total# of Cases by Month in PBC (March 1st, 2020 - May 17th, 2021 available for the younger population. During 25000 23723 2020, there were 3 major spikes in the number of 19324 COVID cases July, November, and December. It 20000 18069 is believed to be attributed to persons gathering 13246 11800 in close contact, dismissing the social distance 15000 12911 11392 guidance, and not wearing of masks during the 10000 8445 8280 holiday periods in these months. With vaccines 4401 4186 now widely available, we are already seeing a 5000 3556 2454 3100 555 decline in the number of positive cases, but still 0 need to educate those who are still hesitant about receiving the vaccine. Education is the key. Source: Merlin Analysis Tool (Parameters: PBC, COVID-19, 2/1/20-5/18/21) 2020 Palm Beach County Communicable Disease Report DISEASE / CONDITION (as of 06/14/2021)------------- 2020* Disease / ---Total Anaplasmosis, HGA (A. phagocytophilum)------------------- 2 Arsenic poisoning ----------------------------------------------- 2 Babesiosis - -- 1 Botulism, ------ 1 Campylobacteriosis -------------------------------------------255 Carbon monoxide poisoning -----------------------------------17 Chikungunya fever ---------------------------------------------- 0 Ciguatera fish poisoning---------------------------------------- 6 Creutzfeldt-Jakob disease (CJD) ------------------------------- 2 Cryptosporidiosis ------------------------------------------------ 8 ---------------- 8 Dengue fever -- 3 Ehrlichiosis, HME (E. chaffeensis) ----------------------------- 1 Giardiasis, acute ------------------------------------------------ 31 H. influenzae invasive disease--------------------------------- 10 Hepatitis ------ 15 Hepatitis B, -- 34 Hepatitis B, chronic --------------------------------------------333 Hepatitis B, --- 0 Hepatitis B, pregnant women--------------------------------- 40 Hepatitis C, --120 Hepatitis C, chronic --------------------------------------------925 Hepatitis C, --- 0 Hepatitis D ----- 1 Herpes B virus, possible exposure ----------------------------- 0 Influenza-associated pediatric mortality --------------------- 1 Lead poisoning 01 Legionellosis -- 72 2019 Total 2 1 4 0 270 38 1 7 6 27 44 31 2 88 34 79 27 393 1 49 29 1103 3 2 3 0 132 48 DISEASE / CONDITION (as of 06/14/2021)------------- 2020* ------------------ 3 Lyme --------- 18 ----------------- 1 Meningitis, bacterial or mycotic ------------------------------- 7 Meningococcal disease ----------------------------------------- 1 Mercury poisoning ---------------------------------------------- 0 Mumps --------- 4 Pertussis ------- 11 Pesticide-related illness and injury, acute--------------------- 2 Rabies, animal - 0 Rabies, possible exposure -------------------------------------197 Rocky Mountain spotted fever and spotted fever rickettsiosis -- 0 S. pneumoniae invasive disease ------------------------------ 33 Salmonella Paratyphi infection -------------------------------- 1 Salmonella Typhi infection ------------------------------------- 3 Salmonellosis -------------------------------------------------- 404 Scombroid poisoning ------------------------------------------- 1 Shiga toxin-producing E. coli (STEC) infection-------------- 40 Shigellosis ----- 34 Varicella ---- 32 Vibriosis (other Vibrio species) --------------------------------- 2 Vibriosis (V. alginolyticus) ------------------------------------- 11 Vibriosis (V. fluvialis) -------------------------------------------- 1 Vibriosis (V. mimicus) ------------------------------------------- 1 Vibriosis (V. parahaemolyticus) -------------------------------- 3 Vibriosis (V. vulnificus) ------------------------------------------ 0 West Nile virus disease------------------------------------------ 5 Zika virus, non-congenital -------------------------------------- 0 2019 3 19 0 24 3 2 6 20 2 4 307 1 58 5 10 609 11 63 174 67 7 8 2 0 4 2 0 2 -------------2804 3837

8 FLORIDA DEPARTMENT OF HEALTH PALM BEACH COUNTY Tuberculosis (TB) Control Program Tuberculosis remains one of the world’s most prevalent diseases. Florida’s yearly TB occurrence has steadily declined to the current incidence rate of approximately 2.2 cases per 100,000 persons. The TB Control Program in Palm Beach County engages in the overarching effort to achieve the national goal of TB elimination with less than 1 case for every 1 TB INCIDENT RATE million persons. Palm Beach County & State of Florida 2013 - 2020 5 4 4 3.8 3.6 3.1 3.3 3 3 3 3.1 2 3.1 2.8 2.7 2.4 2.6 2.2 1.9 1 0 2013 2014 2015 2016 PBC 2017 2018 2019 2020 FLORIDA REPORTED VERIFIED CASES OF TB Palm Beach County, 2013-2020 60 54 50 53 49 43 44 40 42 35 33 The TB Control Program maintains a surveillance system and is responsible for the control and prevention of TB disease throughout the county. Despite prevention and intervention efforts, the percentage of cases seen in our area continues to be higher among minority groups and those born outside of the United States. The Florida Department of Health is committed to ensuring every individual with active disease is treated to cure and ensuring anyone exposed receives proper care by offering clinical services for screenings and evaluations, identifying contacts to cases and providing Directly Observed Therapy (DOT) for individuals receiving treatment. Palm Beach County has the fifth highest occurrence of TB disease in the state and the TB Control Program at FDOH-Palm Beach continues to exceed state goals in performance objectives. 30 For additional information or to submit a report, please call (561) 803-7342 or fax the confidential line (561) 8400171. 20 10 0 2013 2014 2015 2016 2017 2018 2019 2020 Sexual Transmitted Disease (STD) Program: COVD19 disrupted many facets of everyday life, not just locally but globally. However, instead of allowing COVID19 to be an obstacle for the STD program, our members utilized it as an opportunity to make necessary improvements for whatever life throws at us. Below are the sustained adaptations implemented within the STD program in response to the pandemic. Surveillance: The surveillance program had several improvements implemented within the past year in response to the COVID19 pandemic. Firstly, the surveillance record book was updated from a paper format to a SharePoint Excel document, allowing the surveillance staff to access the document from any location, as well as, simultaneously work together on the document safely and remotely. Furthermore, this new electronic format has significantly improved the distribution of field records in a timely manner. Secondly, E-Fax was initiated within the STD department, replacing traditional paper faxes. An E-fax organization system was set up and has allowed for improved record keeping as well as better case communication between the surveillance staff and providers. Finally, cases were assigned based on priority, rather than area, due to the suspension of field visits on non-priority cases. As a result, priority cases were more equally distributed among DIS officers. Picture A: Phlebotomy demonstration using COVID PPE.

9 ANNUAL HEALTH PROFILE 2020 Daily DIS Field Work The Field: In lieu of in person post-test counseling sessions and interviews, meetings with patients were conducted via phone calls or Microsoft Team video calls; however, HIV cases were strictly Microsoft Teams video calls. Field visits and in person interviews for high priority cases were classified as essential and continued with strict protocols set in place, following social distancing guidelines and using PPE. Some examples of precautions being exercised due to Covid-19 include: remaining in the car while talking on the phone with client vs. conversation inside car/ home meeting in a large room to maintain 6ft. distance temperature and symptom screening questionnaire prior to interaction with clients The Clinics: In response to the COVID19 pandemic, clinics were operating only essential services such as STD treatment. At the start of the pandemic, clinics began limiting the number of persons allowed inside as well as requiring a referral letter or a positive lab result to receive STD testing and treatment. Strong communication between clinics and the STD team amidst changing protocols greatly reduced obstacles for clients in receiving treatment. For instance, interdepartmental communication significantly improved with the newly developed ability to update, add progress notes, and register clients in HMS (FDOH Medical Record System). Furthermore, this newly implemented electronic system allowed for a better continuation of care throughout the Florida Department of Health programs. Outreach: COVID19 may have slowed down but did not halt the STD/Viral Hepatitis Outreach program. During this time, the program explored new avenues for reaching susceptible populations. Outreach locations switched from a high focus on treatment and addiction centers to areas recommended by DIS clients, areas with a history of high-risk behavior, and by zip code/demographic trends found in the 2019 STD surve

Tobacco Free Florida Palm Beach County. Tobacco use is the leading cause of death in Florida, resulting in over 32,300 deaths annually in the state. On the other hand, the youth cigarette smoking rate in Palm Beach County reported 1.6% in 2020 according to the 2020 Florida Youth Tobacco Survey (FYTS).

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