By Natalie Anderson
natalie.anderson@salisburypost.com

SALISBURY — Local health officials worry that increased food insecurity, not receiving physicals and immunizations as well as not attending important doctor’s appointments due to the pandemic could have long-term effects on children’s health in the county.

In the 2019 State of the County Health Report, Rowan County ranked 73rd out of 100 in the state. Local health officials note that food insecurity, children living in poverty and obesity among children and high-schoolers are areas of concern. As of 2019, 25% of children live in poverty, though the state’s average is 20%. And the state’s average of people with limited access to food is 7%, though 17% of Rowan Countians are considered food insecure.

In addition to the county’s health report, a statewide nonprofit organization called NC Child provides a snapshot of children’s well-being in every county. The county data benchmarks used in the 2020 findings tracked children’s health prior to the pandemic. NC Child used five key indicators to measure children’s health, including a strong start, family economic security, nurturing homes and communities, health and wellness and high-quality education. The data was pulled from the state health department, the state Office of Budget Management, the U.S. Census Bureau and the North Carolina Department of Public Safety.

Rowan County’s data card from NC Child shows the rate of children without health care rose from 4.1% in 2017-18 to 7.4% in 2018-19. During the pandemic, local health officials report they’ve seen more Medicaid patients. The number of referrals for local WIC patients, which includes low-income children and pregnant or post-partum mothers, also rose in 2020, according to Rowan County WIC Director Shanelle Wilkey.

Wilkey said in fiscal year 2019-20, the department served 2,388 children and mothers. But as of July, the start of the 2020-21 fiscal year, the department served 2,874 children and mothers. She added that this is a trend being experienced across the state as well.

Wilkey said she anticipates the reason for the increase in referrals is due to more families being out of work due to the pandemic.

Additionally, the state waived some restrictions for WIC recipients, including broadening the options for items like bread and milk at the grocery store and providing WIC benefits for anyone who’s part of the program whether they’re active or not. The state also extended the yearly deadline for WIC re-certifications by three months.

Health officials worry about sustaining that participation once those federal waivers run out. Wilkey added that WIC recipients will have to come for an in-person visit to be recertified. The WIC clinic cannot open its office to visitors until 30 days after the national public health emergency is declared over, and even then, Wilkey anticipates parents may be reluctant to attend in-person visits.

It’s also difficult to keep track of children’s and mothers’ weight, height and iron levels if they’re not regularly going to the doctor.

The lack of in-person visits has also impacted the level of care from case managers in the county’s Care Management Department, who provide care management for at-risk children and high-risk pregnant women. Examples of at-risk children includes those in foster care who experience “toxic stress,” as well as children with low birth weights, medical disabilities and children impacted by substance abuse. Case managers’ main goal is to connect these children and high-risk pregnant mothers to resources available for them throughout the community.

Home visits are “the meat” of what’s done in that department, said Tomesia Courtney, who supervises social workers in the department. Until the department can implement virtual visits, all check-ins are being conducted over the phone. Since children were out of school for a while, and some still are, “not as many eyes” are on the children like before, she added.

Additionally, the department has had trouble linking clients to services they need such as therapy or regular doctor’s appointments. Staff members say they’re realizing parents have not been taking children to their necessary doctor’s appointments.

Parents’ anxiety at the beginning of the pandemic was also high due to social isolation, Courtney said.

Part of what the department does is ensure children receive their immunizations and physicals, which are required to attend local schools. Courtney said care managers have had to work diligently to follow up with the parents of about 3,000 local children to encourage taking their children to doctor’s appointments. Additionally, there are still parents who aren’t open to having their children take a flu vaccine, which is even more important with the current pandemic.

It’s possible for someone to be infected by both COVID-19 and the flu, according to state health officials.

Courtney said throughout the pandemic, Medicaid enrollments have increased, which has also increased case managers’ case loads.

The county’s Family Health Services Department, supervised by Nursing Director Meredith Littell, operates as a primary care clinic, focusing on providing immunizations to children or seeing sick children.

Angela Worley, one of the Family Health Services nursing supervisors, said there is concern children will be put out of school for not receiving their immunizations even despite the school district extending the deadline to Oct. 31.

The department is another that has had to adjust to not seeing patients in-person. A lot of the nurses’ attention has been leading COVID-19 investigations, which keep track of positive and hospitalized patients as well as COVID-19 deaths.

The county health report shows the current third-grade reading proficiency rate is 51%, while the state’s average is 56.8%. The goal is to increase the statewide level to 80% by 2030.

Programs like Salisbury’s nonprofit ApSeed, founded by Global Contact Services CEO Greg Alcorn, help with that. ApSeed distributes tablets to children that include educational resources, with a goal of improving children’s overall reading proficiency and kindergarten preparedness. Wilkey said more than 3,000 tablets have been given to children in the county from the WIC department since the program’s inception in 2016.

NC Child also advocates for lawmakers to consider those without health care, especially as hundreds of thousands of North Carolinians have lost jobs due to the pandemic. Additionally, they state problems that have arisen out of the pandemic can result in long-term impacts to children’s healthy development.

Wilkey said lawmakers should concentrate on expanding Medicaid as it will trickle down to more help for children and mothers who need WIC benefits.

“WIC plays a major role in reducing infant mortality,” she said. “We do save public health dollars.”

Additionally, Wilkey said the WIC program helps support communities by keeping funds within the local community. And in addition to WIC recipients buying food at local grocery stores, the state has a voucher program for WIC recipients to use at local farmers markets in an effort to promote healthy fruits and vegetables.

“We bring in a lot of food dollars into our local economy from people who use WIC,” she said.

However, Wilkey said several of the people who were supposed to receive those farmers market vouchers did not receive them in the mail.

Littell said lawmakers should consider children’s access to health care and health inequities, which have been exacerbated amidst the pandemic. Most of the patients the Family Health Services department sees are Mediciad patients, though they do accept private forms of insurance.

Contact reporter Natalie Anderson at 704-797-4246.