2021 Reflection
Grand Forks Public Health Director Debbie Swanson
Greetings!
The year 2021 required a great deal of agility to maneuver the many changes in our COVID-19 response work, which had consumed us in 2020. Our Grand Forks Public Health team demonstrated outstanding flexibility and persistence by following the science and frequently adjusting our response efforts to protect the health of all Grand Forks County residents. The year started with an “all hands on deck” approach, delivering more than 37,000 COVID-19 vaccines in collaboration with community partners at the Alerus Center. This was followed by a spring and summer vaccination outreach endeavor that took our vaccination team all over Grand Forks County. Supported by contact investigators, a communication team and data experts, the COVID-19 testing team kept up with a steady demand as variants waxed and waned. One silver lining of the COVID-19 pandemic is the relationships built in 2020 were strengthened, which will serve us well into the future. We recognized staff members for their outstanding contributions to public health (see additional article in this report for more on our awards) and our super volunteers, Dr. Brad and Ms. Gayle Aafedt who helped us vaccinate thousands of residents against COVID-19. We can’t thank them enough for showing up and demonstrating what volunteerism looks like during a pandemic. And speaking of thanks, we grew our public health workforce by almost 30% in 2021 thanks to additional funding provided by federal, state, and local sources. We could not have accomplished all that we did without our new team members, who were guided by experienced staff every step of the way.
The personnel at Grand Forks Public Health were able to resume many of our routine public health programs and services in 2021. From restaurant, pool, and septic inspections; to health and wellness screenings; prevention activities; social detox services; mosquito control; and everything in between - we have been a health department in constant motion!
As we move through 2022, we will be monitoring health data to ensure we are addressing the needs of residents and future policies align with preventing disease, promoting health, and protecting the health of Grand Forks County residents. Once again, Grand Forks Public Health will partner with Altru Health System and the UND Masters of Public Health Program to develop a Community Health Assessment to guide our future work, with a focus on health equity and community resiliency.
Enjoy reading our annual report and, as always, feel free to contact me if you have an idea to share. Your engagement is our goal!
Debbie Swanson, Director
2021 Grand Forks Board of Health
Jeannie Mock, Grand Forks City Council
Cynthia Pic, Grand Forks County Commission
Dr. Sally Pyle, Citizen Representation
Dr. Grant Korsmo, Citizen Representation
Dr. Joel Walz, Public Health Officer
COVID-19 RESPONSE
Grand Forks Public Health (GFPH) continued to work tirelessly to keep the community safe and provide guidance, resources, testing and vaccines for all. GFPH collaborated with elected officials and community partners to implement prevention measures, response, and recovery steps to protect the community. During the COVID-19 pandemic, GFPH had largely been organized into an Incident Command Structure (ICS). This structure is used to effectively respond during an emergency or event. In January 2020, GFPH had approximately 45 full and part-time team members, not including the mosquito control seasonal workforce. At the peak of our COVID-19 response our team expanded to 63 members.
PUBLIC HEALTH EMERGENCY ORDERS
Under North Dakota Century Code Section 23-35-12(2)(g) and 23-07-21(1), local public health officers have the authority to take any action necessary for protection of public health and safety. On January 18, 2021, Grand Forks Health Officer, Dr. Joel Walz, issued a continuation of the mask mandate for Grand Forks County when the statewide mandate expired. The purpose of a universal masking order is to protect vulnerable populations, preserve hospital capacity, suppress illness, and prevent deaths. According to the Centers for Disease Control and Prevention, data supported the use of mask mandates to aid in the reduction of the spread of COVID-19.
VACCINATION
Many of us received the COVID-19 vaccine with the hope of bringing a close to the pandemic. On December 23, 2020, GFPH administered the first doses of vaccine to the GFPH team who would then begin to vaccinate the community against COVID-19.
In early January 2021, GFPH completed vaccination of the first priority group defined in Phase 1A per the North Dakota COVID-19 Vaccine Prioritization Plan. As the demand for vaccines quickly outpaced the national inventory and vaccine storage and handling complexities increased, community partners combined efforts to meet the community’s need for a seamless vaccination delivery model. A community vaccination site at the Alerus Event Center was facilitated to deliver COVID-19 vaccine to the general public, guided by eligibility tiers. Over 37,000 vaccines were administered from January to May, during 37 unique COVID-19 community vaccine clinics. These clinics were supported by the Alerus Center, Altru, City of Grand Forks, North Dakota Department of Health, North Dakota National Guard, the University of North Dakota College of Nursing, the University of North Dakota Master of Public Health Program, and numerous community volunteers.
While one central location for COVID-19 vaccine was ideal for most, inaccessibility for the homebound to access vaccine was identified. As a result, a partnership with WelCore Health was established, and homebound community members were able to receive the vaccine in their home.
Eventually, the supply met the demand for COVID-19 vaccine. By the spring of 2021, pharmacies and healthcare providers were able to offer the vaccine, increasing accessibility at multiple locations throughout Grand Forks County. In June 2021, the threshold of vaccine-interested community members was seemingly met. Therefore, GFPH strategically implemented a delivery model that could accommodate a more passive population, meeting individuals where they were in workplaces, retail, and community settings. A mobile pop-up vaccination plan was established, offering COVID-19 vaccine throughout Grand Forks City and County. This model placed a pop-up vaccine clinic within a ½ mile of 95% of those residents within the City of Grand Forks and within 10 miles of each home in Grand Forks County. The success of the COVID-19 vaccination events relied heavily upon the efforts of our internal logistics and communication team. Multiple communication strategies were used to promote events that were hosted at private businesses and public locations. Over 1,600 vaccines were administered through the mobile clinics, thanks to many community partners, including the City of Grand Forks Streets Department, Global Friends Coalition, Wall’s Health Mart, WelCore Health, Widman's Candy Shop, and public and private site hosts.
To increase accessibility and visibility, GFPH established two semi-permanent COVID-19 vaccine clinics. With UND and Grand Forks County schools transitioning to in-person learning, in addition to the emergence of the Delta variant, the COVID-19 vaccine had a critical role in reducing the spread and severity of disease. To encourage unvaccinated individuals to become protected, incentives were provided to 112 individuals who received their first dose of COVID-19 vaccine at a special clinic held on September 22, 2021 at the Alerus Event Center. Incentives were provided by the City of Grand Forks.
In November 2021, COVID-19 vaccines were authorized for children ages 5 to 11. The 65 doses of pediatric vaccine allocated to GFPH were administered within the first hour of this special clinic. Demand for pediatric vaccinations was strong initially, but did taper off.
TESTING
GFPH began 2021 with scheduled COVID-19 testing and screening dates for the community at the UND Fritz Pollard Jr. Athletic Center, Grand Cities Mall, and the Columbia Mall. In May 2021, GFPH identified a need for a routine public COVID-19 testing site. In collaboration with the University of North Dakota and support from the North Dakota Department of Health, GFPH established a static testing site at UND’s Fritz Pollard Jr. Athletic Center with free testing available.
In September 2021, in response to the surge of COVID-19 cases due to the Delta variant, Altru and GFPH partnered to offer drive though testing in addition to the UND site. This partnership allowed for expanded testing hours and the utilization of Altru’s laboratory for quicker result times for PCR tests. At the end of 2021, 41,020 PCR tests and 33,074 antigen tests had been administered through the UND sites.
Two COVID-19 testing events were established at the Ralph Englestad Arena (REA) for fans planning to attend the U.S. Hockey Hall of Fame Game in Nashville, TN at the end of October. Vaccination or negative test results were a requirement for attendance at the game. Robust promotion of the testing events and vaccination availability by GFPH led to 333 tests administered at the REA special test events and an overall increase in vaccinations in the weeks prior to the game.
CONTACT TRACING
Disease investigation is a critical intervention to prevent and slow the spread of disease. Caseworkers contact people who have tested positive for COVID-19 to provide guidance on isolation, support needs, monitor symptoms, and assist in identifying close contacts.
In 2021, 5,991 cases were reported in Grand Forks County. Of those cases, GFPH caseworkers investigated 2,065. The team continually adapted to new guidance related to COVID-19, including changes in vaccination recommendations, modifications to isolation, quarantine, and testing protocols, and the use of masks.
In partnership with our community stakeholders Altru, Northland Rescue Mission, City Area Transit, Centre Inc., and Spectra Health, we identified individuals infected with or exposed to COVID-19 who did not have a place to isolate or quarantine and provided housing and support services to these individuals throughout 2021.
GFPH also provided COVID-19 mitigation guidance and support to businesses, organizations, high-risk living facilities, the correctional center, a homeless shelter, public schools, daycares, and community members. This included assistance in workplace infection prevention, contact tracing, responding to questions related to quarantine and isolation, testing, and vaccination.
PARTNERSHIPS & COMMUNITY ENGAGEMENT / COMMUNICATIONS
GFPH continued to partner with leaders in schools, businesses, organizations, and community members to answer questions, listen to feedback, share resources, and communicate needs.
The communications team created and distributed print and electronic materials, conducted a reminder recall for individuals due for COVID-19 vaccine, created videos, news releases, maintained website content, responded to media requests, managed our social media presence, and ensured translated materials were available. In addition to these outreach efforts, the communications team promoted the pop-up vaccination sites within designated neighborhoods throughout Grand Forks County.
GFPH partnered with the New American and Foreign-Born Immigrant (NFI) populations through the New American Integration Center, Global Friends, and the United African Community to provide education on vaccine hesitancy and COVID-19 response. GFPH provided a presentation on COVID-19 and vaccinations at the Islamic Center and designated a weekly COVID-19 vaccine clinic day with support from community leaders from the Liberian, Somali, and Arabic NFI groups and created three COVID-19 videos in Tagalog, Somali, and Arabic languages. A vaccination clinic was held on World Refugee Day in June in collaboration with Global Friends Coalition.
DATA
The data team analyzes data to provide information and answer questions about cases, trends, and other points of interest. During 2021, the team presented dozens of reports to the Grand Forks City Council, Grand Forks County Commission, Grand Forks Board of Health and community stakeholders to drive decision making. The team published a daily Grand Forks Health Officer’s Dashboard report and answered numerous media requests. The team collaborated with external stakeholders, contributed to social media posts, and provided valuable learning opportunities to students from UND.
By the Numbers
44,500: COVID-19 vaccines given
37,145: doses given at the 37 Alerus Center clinics
7,423: doses given at pop-up vaccine sites
5,992: positive cases of COVID-19 in Grand Forks County
74,000: COVID-19 tests administered
$1,500,000: additional funding received in 2021 for staff and supplies for response efforts
53: Media responses
Grand Forks Public Health Media
Alerus Center Vaccination Guide : Step by Step
Christine Gets Her Vaccine
Matt Bonzer (Bonzer's Sandwich Pub) Interview
Paint the Patch Pink Breast Cancer promotion
Health Tracks
The North Dakota Health Tracks program serves children from birth to age 21 on Medicaid insurance through screening, early intervention, and preventative services provided by a public health nurse. Health Tracks was the first program to resume in-person visits in the office on February 23, 2021. During 2021, over 100 children were screened through the Health Tracks program, an average of three referrals are made each week for vision, dental and physically and behavioral services.
SCHOOL NURSE PROGRAM
Two county school nurse positions were added to the GFPH team in 2021 to meet the increased workload with COVID-19 response activities and the need for dedicated school nurses in Grand Forks County schools. The nurses serve public school districts in Emerado, Larimore, Manvel, and Midway. Services include disease surveillance, addressing student and staff health concerns, offering immunization support, and education. The additional funding for this program has been valued by school administrators.
WOMEN'S way program
Women's Way (WW) provides patient navigation for breast and cervical cancer preventative screenings for eligible North Dakota Women along with a way to pay for most breast and cervical cancer screenings. With the pandemic still impacting preventive care, WW focused on encouraging women to prioritize their health and complete preventative screenings. WW received an additional grant from the North Dakota Colorectal Cancer Initiative to provide colorectal screenings to WW clients.
WW coordinated a pumpkin decorating content for breast cancer awareness titled “Paint the Patch Pink”. Pumpkins were displayed virtually and onsite at All Seasons Garden Center. A prize basket donated by community partners, Smiling Moose Deli, Avant Hair & Skin Studio, and All Seasons Garden Center was awarded to the community’s favorite pumpkin decorator.
Women’s Way by the Numbers
362: women enrolled in the program, of those 111 were new clients
595: breast and cervical cancer screenings completed through the WW program, of those screenings, 357 were breast cancer screenings and 238 were cervical cancer screenings
1: woman was diagnosed with breast cancer
5: women were diagnosed with cervical dysplasia, which resulted in needed treatment
3: mobile mammography events hosted to reach medically underserved women in the community with 29 screenings completed
Adult Home Visits
Health maintenance nurse visits are provided to individuals in Grand Forks County with the goal of delivering services that assist individuals in remaining safely in their own homes. Services include medication management, health monitoring, and community referral. The visits continued throughout the pandemic with safety precautions in place to keep this vulnerable population safe. More than 300 home visits were provided in 2021.
TUBERCULOSIS PROGRAM
The tuberculosis (TB) program is responsible for monitoring treatment of latent TB infection, sputum collection for people with active and suspect TB disease, directly observed therapy (DOT) and video directly observed therapy (VDOT), and contact investigations. The TB program monitored 27 persons with latent TB infections and three individuals with active TB disease.
The TB Program’s collaboration with Spectra Health was recognized by National Association of City and County Health Officials (NACCHO). The collaboration between GFPH and Spectra Health was selected as one of three partnerships in the nation as a case study which was published in a widely disseminated report by NACCHO in July 2021.
RYAN WHITE PROGRAM
Ryan White services are available to low-income HIV positive North Dakota residents. The program addresses the unmet health needs of persons living with HIV disease, optimizing their health outcomes through support services to enhance health care access and retention in care.
On average, the nurse case manager at GFPH had 90 encounters per month with clients. The most common vital health resources that were supported through the program were eye care, glasses, dental exams and treatment, HIV medical care, medications, and insurance premium support.
SYRINGE SERVICES PROGRAM
The Syringe Services Program is an evidence-based harm reduction strategy which provides services to individuals who may inject substances or would otherwise be at risk for disease transmission due to substance use or reuse of injecting equipment. In 2021, the program returned to pre-pandemic service model which allowed for additional time to be spent with clients and improve the quality of services and referrals. The team expanded access to HIV and Hepatitis C testing to the clients utilizing the program.
Syringe Service Program by the Numbers:
47: New clients
306: Visits
81: Unique clients
81%: Syringe return ratio
713: Sharps containers
888: Naloxone doses
174: Client reported overdose reversals
31: HIV tests
33: Hepatitis C tests
Correctional Health
Grand Forks County Correctional Center (GFCCC)
GFPH nurses completed 697 health assessments within 14 days of an individual being booked at Grand Forks County Correctional Center. All inmates must be tested for tuberculosis within 24 hours if being held with Immigration Customs and Enforcement or 14 days for all others – 542 TB tests were conducted.
During 2021, the nursing team at the Correctional Center expanded to include an additional nurse to increase the capacity to allow for a dedicated nurse to complete health assessments and COVID-19 response including testing and vaccination.
GFCCC by the Numbers:
3,495: medical concerns addressed by the nursing team
334: inmates assessed by the Altru Family Medicine Residency Team on Doctor Day
COVID-19 in GFCCC and Juvenile Detention:
1,372: COVID-19 tests administered
47: positive cases in GFCCC and 0 in Juvenile Detention
346: inmates and 99 staff received COVID-19 vaccines at the GFCCC
ONSITE SEWAGE TREATMENT PROGRAM
The GFPH Onsite Sewage Treatment (OSTS) program serves five counties: Grand Forks, Walsh, Pembina, Nelson, and Griggs and is responsible for overseeing the site selection, system design, permitting, and inspection of On-site Sewage Treatment System (OSTS) systems. The program requires permits for all new OSTS and repairs to existing systems. In 2021, there was a total of 28 site evaluations, 14 permits issued, and 14 new installations. Three environmental health concerns regarding OSTS's were investigated.
LICENSED ESTABLISHMENTS
The Environmental Health Team inspects food, lodging, aquatics, and body art facilities. Licensed establishment field work consists of routine inspections, re-inspections, plan review applications for new establishments and remodels, complaint follow up, foodborne and waterborne illness investigations, and ensuring food safety compliance. In 2021, the team collected data and assisted with inspection information for a statewide risk factor study that was coordinated by NDDoH Food and Lodging Division. During 2021, 635 routine inspections and 65 other pre-operational, follow-up, or repeat inspections of licensed food establishments occurred.
Twenty-eight new establishments or remodels needed plan reviews, this being the largest number of plan reviews completed in a single year. Plan reviews include licensing consultation, review of menus and processes, reviewing adequacy of facility design and flow, verifying proper equipment and finishes, onsite construction visits and pre-operational inspections. The environmental health professionals also review standards, policies, and training needs with the new owner or manager.
Public aquatics inspections serve five counties which include Grand Forks, Walsh, Pembina, Nelson, and Griggs. The team is responsible for ensuring safety and the health of the public pools and hot tubs. In 2021, 43 year-round and 14 seasonal aquatic facilities were all inspected twice during the year.
Additionally, the Environmental Health Team reviewed 327 nuisances and environmental concerns in the City of Grand Forks, 96.4% of which were responded to within two business days. Of those, 94.9% of nuisances were resolved within 30 days, with enforcement actions utilized to resolve the remainder. An Environmental Health Intern was hired to meet the growing needs of the division.
Preventative Health
Public health received a $10,000 Preventative Health and Health Services grant from the NDDoH to increase access to fresh produce through the implementation of two gardening projects.
Grand Forks Community Garden
2021 was the second year that all 20 garden plots were filled. GFPH offered a stipend to individuals that qualify for TANF or WIC benefits. A garden manager offered mentoring to all gardeners throughout the summer.
Farm-to-Childcare
GFPH recruited eight childcare providers in Grand Forks County to grow a vegetable garden. Providers were given supplies needed to grow a 3’ x 3’ raised garden bed. They received coaching throughout the summer which included onsite nutrition and gardening lessons and ongoing communication through a private Facebook group.
“This was a fun project! The kids learned a lot and retained the information. We look forward to growing a garden again next summer.” - Angie, Larimore Resident, and Farm-to-Childcare participant
Lindsay from The Joyful Tots Daycare, a previous grant recipient, successfully planted three times more produce this year to provide fresh, nutritious meals to the children she cares for.
UND Center for Rural Health Community Grant
GFPH received a $2,500 grant to improve access to fresh produce for local families. GFPH partnered with local childcare providers to identify 80 families that would participate in a container gardening project. These families were given a small container to grow a pepper plant and lettuce. Families were invited to join a private Facebook page to communicate questions and share successes.
“Thank you for putting together programs like this! I hadn’t ever heard of it before now; very cool idea!” - Project participant
TOBACCO PREVENTION
The GFPH Tobacco Prevention Team works to prevent the use of tobacco by promoting and implementing evidence-based strategies, policies, and practices.
The team also provides leadership to the Grand Forks Tobacco Free Coalition. This coalition meets monthly and engages community members, as well as provides stakeholder education and advocacy efforts.
The Tobacco Prevention Team collaborated with the Grand Forks City Attorney’s office to draft proposed amendments to Grand Forks City Code, increasing the minimum legal sales age of all tobacco products (including e-cigarettes) from age 18 to age 21. On October 4th, 2021, the Grand Forks City Council adopted the proposed amendments. Education was provided to each of the 62 local tobacco retailers and future compliance checks utilizing purchasers up to age 20 will be conducted in coordination with the Grand Forks Police Department.
In April 2021, the Tobacco Prevention Team coordinated with the Grand Forks Police Department to conduct 33 tobacco compliance checks. 31 Grand Forks tobacco retailers were compliant.
Through continued education with all local tobacco retailers, the team ensured 100% compliance with tobacco licensing requirements in 2021.
MATERNAL AND CHILD HEALTH
The Grand Forks Maternal and Child Health Program hosted three virtual Breastfeeding Skills Training for 45 UND Nutrition and Nursing students.
GFPH partnered with UND’s “Don’t Quit the Quit” program to train postpartum doulas in their role of supporting breastfeeding mothers in recovery from opioid use disorder.
World Breastfeeding Week was observed August 1-7. GFPH partnered with Grand Forks WIC to find seven local moms to recognize during World Breastfeeding Week. Each day, one mom was recognized through a Facebook post.
AWARDS
Theresa Knox – North Dakota Public Health Association, Outstanding Service Award
Grand Forks Public Health – Northlands Rescue Mission, Hope is the Heartbeat of the Soul Award
Dr. Walz – ND Chapter of Family Physicians, Physician of the Year Award
Theresa Knox – ND Center for Nursing, Legendary Nurse Award for Leadership
Credits:
Created with images by digitalskillet1 - "Close up view of an African American woman wearing a face mask" • BASILICOSTUDIO STOCK - "Close up of female health Professional in PPE introducing a nasal swab to a senior female patient at her house. Rapid Antigen Test kit to analyze nasal culture sampling while coronavirus Pandemic." • fotogestoeber - "cubes with person symbols and lines symbolizing contact tracing on blue background" • LIGHTFIELD STUDIOS - "Selective focus of data analyst pointing with finger at computer monitor near papers and glass of water on table" • Rido - "Proud african school boy" • coombesy - "old couple people" • JustLife - "Old man taking pills. Senior drinking medicine. " • WavebreakmediaMicro - " Psychologist having session with her patient" • daschorsch - "handshake hands children" • ant - "A business sign that says ‘Open’ on cafe or restaurant hang on door at entrance. Vintage color tone style." • vladk213 - "A drop of pure water dripping from the tap. Selective focus." • encierro - "woman with green gloves planted in a bed of small marigold, gardening in a springtime " • grki - "Watering flowers in the garden" • Kostiantyn - "Beautiful woman holding and showing empty card" • Alena Ozerova - "Loving mom carying of her newborn baby at home"