OC Health Department Wins Award for Smoking Ban

Orange County’s smoking ban has received national recognition, as the National Association of Counties (NACo) has awarded the Health Department and Board of Health with a 2014 Achievement Award.

“We are thrilled with this award. It is wonderful that Orange County is being recognized as a national leader in the quest for healthier communities,” Orange County Manager Bonnie Hammersley said in a press release Monday.

NACo awards counties from across the United States for increasing the well-being of its residents while modernizing county government. Orange’s smoke-free public policy beat a host of other county policy applications to win its first Achievement Award.

The smoking ban, put in place on July 1, 2013, prohibits smoking in all outdoor locations owned by Orange County and its towns, including sidewalks, bus stops and parks, in addition to indoor areas that are open to the general public.

The goals of the ban are to educate residents about the dangers of cigarette smoking and eliminate secondhand smoke, one of the leading causes of preventable disease in the state.

To learn more about Orange County’s smoking ban, click here or visit the Health Department website.


Chikungunya Is Coming Part II

[Dear Readers:  It takes me the better part of each week to research, write, and edit my columns. Some weeks, like this one, events occur mid-week which have a bearing on the topic, but I don’t have time to fully rewrite the column to incorporate them. As I was putting the finishing touches on this one, the first ever case of local transmission of chikungunya in the United States occurred in Florida. Please keep that in mind as you read. - Jeff.]

Last week, in Part I of this series, I explained the background of chikungunya virus and why I believe an epidemic of this disease, which is transferred from person to person by mosquito bites, is likely to occur in the continental United States in the coming months. I received some feedback from several readers who thought I was being a bit alarmist. Let me respond to those comments before proceeding.

Mosquito-borne diseases are by no means unknown in the United States. In the early 1900s, malaria, a disease transmitted by mosquitoes, was common in every U.S. state other than Alaska. The Centers for Disease Control (CDC) was created specifically to combat malaria and organized the National Malarial Eradication Program from 1947 to 1952, which primarily involved spraying massive amounts of DDT. This effort was successful, and malaria was eliminated from the U.S. Unfortunately, this public health achievement came at the expense of significant environmental damage, as famously summarized in Rachel Carson’s classic book from 1962, Silent Spring.

In 1999, the first case of West Nile Virus, another disease transmitted by mosquitoes, was detected in New York City, the first recorded local transmission in the U.S. In just 15 years, this disease has spread throughout the country, with an estimated annual infection rate in excess of 100,000. So as you can see, we here in the U.S. have no special magic powers to protect us from diseases that we may have thought only affect other people in far away places.

Despite the fact that it has been clear for a long time that chikungunya would eventually reach the U.S., we have not been preparing in a meaningful way. In particular, we have not created a vaccine, nor have we been trying very hard to do so. A vaccine for chikungunya would come from either government labs or the pharmaceutical industry. Government health research has been hampered for the last several decades due to funding cuts, and developing new vaccines is not viewed as sufficiently profitable by the shareholder-value-driven pharmaceutical industry. As a result, we are about to be caught with our pants down.

While it seems clear to me that the southeastern United States is about to experience an epidemic of chikungunya (the first two locally-transmitted cases occurred this week in Florida), what is unclear is its likely extent. The current epidemic in the Dominican Republic may provide some insight.  Since chikungunya struck the Dominican Republic in early April, there have been almost 200,000 cases, an incidence rate of 20 per thousand for this nation of 10 million people. If the Southeast, with a population of approximately 80 million, had the same incidence rate as the Dominican Republic, we would expect 1.5 million cases in the first 100 days of an epidemic. However, due to widespread availability of insect repellent here and our stay-inside-the-air-conditioned-space lifestyles, our incidence rate is likely to be lower. For the sake of argument, let’s assume our incidence rate will be 1/3 that of the Dominican Republic. This would translate to half a million cases in the first hundred days, and we would then project approximately 10 million cases in the first year. With chikungunya’s fatality rate of 0.4%, an epidemic of this scale would kill 40,000, with fatalities being disproportionately among the very old and very young.

To put those 40,000 deaths in perspective, this is about the same number of annual deaths we see in the U.S. from each of the following causes: influenza, car accidents, suicides, and shootings. While we have become somewhat desensitized to deaths stemming from these familiar hazards, I anticipate that public reaction to an epidemic from a new and unfamiliar disease with a strange name will be something approaching widespread panic. Let me try to explain why.

First of all, nothing about the current level of function in either our state or federal government suggests that they could effectively coordinate either communications or logistics in a public health crisis. Now add to this the fact that a large portion of the public seems to have developed rather extreme anti-science views, for example the anti-vaccine and intelligent design communities. I think we can anticipate a fair number of non-productive conspiracy theories to arise from these factions and distract from addressing the problem. Furthermore, I think we can also safety assume the epidemic will be politicized almost immediately. Given that chikungunya has reached Florida already, we could only be hours away from claims that this epidemic is President Obama’s fault and that the public is being put at risk by “liberals” who valued salamanders over humans by banning DDT. I expect calls for the return of DDT as well. (1)

So what can or should we do here locally to prepare for chikungunya? Epidemics are all about math. In this case the key variables are the number of currently infected people, the number of mosquitoes that can transmit the virus, and the number of mosquito bites. As time passes, a fourth variable, the number of people who are immune from having had chikungunya already, will become a factor. We can collectively help to slow the spread of chikungunya by reducing the overall rate of mosquito bites in the county through common sense measures of which you are already aware: using bug repellent, wearing clothing the covers the body, minimizing pools of standing water near your home, and not going out at dusk and other times of day that mosquitoes are most active.

In addition, the Orange County Health Department should start making preparations. Cases of chikungunya will occur in geographic clusters. People who get the disease need anti-inflammatory and pain-reducing medications as well as fluids to fend off dehydration. Unfortunately, the United States is currently experiencing a shortage of sterile saline which is used to treat dehydration. In addition, if we had a cluster of cases in Orange County we could easily run out of hospital beds. We need to have a plan in place – and we may already have one – for a temporary clinic for hospital overflow, and we should work to build an inventory of saline solution. We also need a communications plan so that, at least here locally, people will have accurate information.

On the national level, an emergency allocation of money should be given to the National Institutes of Health to fast-track vaccine research and development. The economic return from avoiding waves of chikungunya epidemics will more than justify the expense. Plus, it’s just the right thing to do.

I will be continuing to monitor this situation as it develops. Follow my Twitter feed @commonscience for updates.

Have a comment or question? Use the interface below or send me an email to commonscience@chapelboro.com. Think that this column includes important points that others should consider? Send out a link on Facebook or Twitter.


(1)   In addition to its attendant environmental impact, DDT is not as well suited to fighting chikungunya as to malaria. Malaria is caused by a parasite rather than a virus. Having malaria does not make you immune to future infections, giving you the wonderful opportunity to have it over and over again. Therefore, the only effective way to get rid of malaria was to kill all of the mosquitoes and, therefore, the parasites. The CDC was able to do this in 5 years.

Chikungunya spreads much faster than malaria and you can only get it once. Long before we could even come close to killing off the mosquito population, the human population would have developed a fairly high level of herd immunity from the spread of the disease. So by the time we finished killing the mosquitoes it would not be necessary to do so any longer, and we would be despoiling the environment for no reason. Sadly, I expect the nuances of this to be too subtle for some.


“Washing With Soap And Water Is Best”

If you’re given a choice between buying traditional soap or hand sanitizer, Orange County Health Department Community Health Services Supervisor Judy Butler says there’s only one way to go.

“Washing with soap and water is best, especially if your hands are visibly dirty,” Butler says. “Let’s say you’ve been out changing the oil in your car or working in the garden, hand sanitizers are not as effective when you clean your hands when they are visibly soiled.”

Hand sanitizers reduce the number of microbes on your hand, whereas washing with soap and water actually carries them away.

And, Butler says it’s especially important when dealing with viruses.

“Hand sanitizers are not effective against Norovirus,” Butler says. “So that would be if you were dealing with the situation where you were preparing food or potentially dealing with someone who’s been ill with gastrointestinal symptoms.”

Butler says the Orange County Health Department is very proud of the work the nurses do in the county’s school systems. She says they go to kindergarten classes to teach best practices and check on the children to make sure they’re following them.

Breaking it down further between traditional soap or the foaming variety, Butler says she wasn’t able to find any research that favors one over the other.

“The information that I found was pretty consistent that it’s the way you wash your hands more so than the actual soap product that you use that is so important,” Butler says.

She says that doesn’t mean that some soaps aren’t better than others, but that a lot of the data points to best practices.

And remember, to get a good clean, the rule of thumb is to scrub for 20 seconds after you’ve lathered. Humming happy birthday twice is a good measuring tool.


OC SportsPlex Offers Healthier Food Options

The Orange County SportsPlex is cutting some of the fat out of its snack bar and replacing it with more nutritional food options.

The recreational facility took the first step by replacing the snack bar’s deep fryer with a convection oven. It was purchased with a matching grant through the Orange County Health Department’s Innovation Grant Program.

While starting out mainly as a recreational facility, the SportsPlex has evolved into a more fitness and health-oriented center, and has updated its cooking techniques to meet that new standard.

After a registered dietitian reviewed the food options at the snack bar in June of 2013, the SportsPlex began a series of recommended changes to improve the nutrition of both cooked food and packaged food.

Board of Health Strategic Planning Manager for the Orange County Health Department Meredith Stewart told WCHL that increasing the availability and affordability of healthy food choices is essential to the Orange County community.

“In order to have changes in things like obesity rate and physical activity, we need both individual behavior change as well as policy change to make our community healthier,” Stewart said. “This is one of those changes. And we’re really excited that these changes offer the opportunity for healthier choices for all groups of people when they’re at the SportsPlex.”

The SportsPlex is already replacing sugary breakfast bars, reducing the amount of candy sold as well as continuing to offer healthy snacks such as yogurt and fruits.

Membership and Marketing Director at the Orange County Sportsplex Mary Catherine McKee says customers seem to like the new change, and the baked options are even attracting a few new faces to the facility.

The snack bar now offers baked alternatives of its usual lunch favorites, including chicken tenders, french fries and whole grain pizzas. With no more fried foods on the menu, the SportsPlex is adapting to the new changes in its kitchen.

“We’re still playing with the cooking times,” McKee said. “I think that’s been the biggest difference because the fryer can do things very quickly where as we only have a convection oven and microwave combo right now so we’re still playing with how to create those items at a faster rate.”

Also known as the Triangle SportsPlex, the facility is equipped with three indoor pools, an ice rink and a fitness center and also hosts parties and a summer camp.


Ways To Reduce OC Child Poverty: A “Comprehensive Holistic Approach”

ORANGE COUNTY – More than 4,600 children in Orange County were living in poverty in 2001, according to census data. That was almost 18 percent of the total number of children living in the County at the time. A decade later, more than 2,300 additional children were living in poverty.

Dr. Colleen Bridger, Director of the Orange County Health Department, said poverty remains one of the biggest, yet least acknowledged issues in our area.

She discussed possible ways to reduce child poverty at a County Board of Health meeting Wednesday night. Bridger explained that Orange County’s child poverty rate is on trend with the majority of other counties.

“Like in a lot of aggregate statistics, we look better than the State average. The challenge is that we still have families who are living in abject poverty in Orange County, and sometimes aggregate statistics can mask that,” Bridger said.

She added, “When you go back to the stereotype for Orange County, you hear that for example we have the lowest unemployment rate. So people, I think, make the next logical step to say ‘Well, if we have the lowest unemployment rate, then our poverty numbers must not be matching other areas in the State.’ That is just not the case.”

The Health Department’s analysis indicated that there are six prevalent pockets of poverty throughout our area, encompassing 21 of the 29 schools in Orange County.

Many poverty indicators, such as the number of children enrolled in Medicaid and the number of students on free or reduced lunch, have increased in the last five years, both countywide and also in both Chapel Hill-Carrboro City Schools and Orange County schools.

As of 2011, more than 7,000 children in the county, or 25 percent, were enrolled in Medicaid. More than 30 percent of students enrolled in both school districts received free or reduced lunch.

Long-term Impacts of Child Poverty

Children living in poverty, Bridger explained, are much more likely to experience “adverse childhood events.” Examples include abuse, neglect or a general category of household dysfunction.

“The reason that this is important is because when children are exposed to an adverse childhood event, it structurally affects their brain,” Bridger said.

Research shows that the more adverse events a child experiences will increase the likelihood for chronic diseases, mental health problems, and behaviors that lead to teen pregnancy or the contraction of sexually transmitted diseases.

“Those adverse childhood events are extremely linked to adult public health outcomes that we really want to see changed,” she said.

Possible Solutions

While poverty cannot be eliminated immediately, Bridger said that there are ways to address the problem now and prevent future difficulties in our local children’s lives.

“A county government cannot fix poverty. What we can do, however, is mitigate the effects of poverty on children. The only way to do that is through an extremely comprehensive holistic approach.”

The Harlem Children’s Zone Project was launched in New York City and promotes positive environments for area children. Bridger said she hopes to launch a program like that here in Orange County.

“One of the biggest successes that it [the Harlem Children’s Zone Project] showed relatively quickly is that it literally eliminated the racial disparity in math and reading for children in elementary school,” Bridger said.

Durham has a similar program already up and running, called the East Durham Children’s Initiative

As part of her larger goal to implement a program like the Harlem’s Children’s Zone project in Orange County, Bridger will recommend several initiatives at next month’s Board of Health meeting.

A component of her proposal is to create a new program manager position to focus on a community dealing with childhood poverty in our area.


Highest Weekly Flu Death Total Reported In NC, Death Toll Rises To 44

ORANGE COUNTY – Eleven people have died from flu-related complications last week in North Carolina, the highest weekly total so far this flu season, according to figures released Thursday from the State Department of Health and Human Services.

Forty-four people in the State have died from influenza since flu season began in October of last year.

Pam McCall, Director of Personal Health Services for the Orange County Health Department, said peak flu season is upon us.

“This does correlate with what it was like last year. This past week in 2013 also registered the highest number of flu deaths [so far for the 2012-2013 flu season].”

The number of cases typically increases in January and February, though she added that in 2013, there were flu deaths reported as late as May.

McCall added that the number of deaths is not unusual at this stage of the flu season.

“Last year at this time, there were 41 total deaths reported, and right now, we are at 44 so it is a little higher. This flu season, the difference is the age ranges [who are being affected]. Last year, the older adults made up a majority of the flu deaths. This year, it is in that 25-64 age range.”

Typical seasonal flus tend to impact very young children with underdeveloped immune systems or the elderly who have weakened immune systems.

But for the 2013-2014 flu season, 19 of the total number of deaths have occurred among adults aged 25 to 49, followed by people aged 50 to 64, with 14 deaths.

Some good news is that the number of new flu cases reported by UNC Hospitals has dropped significantly.

For the week of January 19 through January 25, they were 41 lab-confirmed influenza cases compared to 82 the preceding week.

“That too seems to indicate that we have reached the peak of the season so far since we have had a dramatic drop at UNC Hospitals, at least in the number of cases. It does look like the numbers are going down overall in the State,” she said.

It is not too late for people to get their annual flu shot, but McCall said it does take two weeks after inoculation for the antibodies to develop in your body and become effective. The Center for Disease Control recommends that people six months and older get vaccinated for the flu.

McCall said if you do come down with the flu, the antiviral medication TAMIFLU® can reduce the severity and duration of symptoms.

The flu vaccine is offered at the Orange County Health Department. To find other locations where the vaccine is administered, click here.


Norovirus Outbreaks Flare Up Across NC, But Not Orange County

ORANGE COUNTY – Officials from the Orange County Health Department say that a Norovirus outbreak has not moved into our area, though outbreaks have flared up across the state.

Pam McCall, Personal Health Services Director for the Orange County Health Department, explains that Norovirus is a highly contagious gastrointestinal illness which is most common during the winter months. Outbreaks have been reported in Alamance, Henderson, Burke, and Beaufort Counties, according to the Associated Press.

“It is not a fun illness to have, but it is pretty self-limiting and usually goes away in one to three days,” McCall says.

The symptoms include nausea, vomiting, diarrhea, and possibly stomach cramping. Some people may also have fever, chills, headache, muscle aches and a general sense of tiredness. The illness begins suddenly, and the infected person may feel very sick. There are no specific medications to treat Norovirus.

“It can be dangerous for people who have their immune system compromised because they can become dehydrated. That is the main danger with people who have some kind of underlying medical condition. The elderly and young children are probably the most at-risk for that,” McCall says.

Norovirus is present in the stools and vomit of sick people during illness and for a few days after they recover.

People can get sick through direct contact with a person who has the virus, by touching contaminated surfaces, or by eating food or drinking liquids that have been contaminated with the virus.

McCall says the most effective way to prevent the spread of the Norovius is through hand washing.

“Some of these waterless hand sanitizers are not effective against the Norovirus, so you really need to use soap and warm water and vigorously wash your hands after you go to the bathroom and before you prepare food,” McCall says. “If you do have a diarrheal illness like this, do not prepare food for other people up until 48 hours after the symptoms resolve.”

Epidemiologist Nicole Lee, of the N.C. Department of Health and Human Services Department, says that there are several illnesses that must be reported to the health department in accordance with state laws. Lee says that individual cases of the Norovirus are not required to be reported, but outbreaks of the virus are.

“It really is more of a state-wide issue where we would want people to know to stay home if you are ill. We get reports of people who are symptomatic, and what we are seeing is that there are outbreaks from November to April. We are starting to get reports in various counties,” Lee says.

Many commonly used disinfectants are not effective against Norovirus. McCall recommends cleaning with a diluted bleach solution to disinfect surfaces after an episode of the illness.

Public health experts recommend the following measures to protect yourself and your family from Norovirus:

  • Clean up vomit and diarrhea immediately.
  • Do not prepare food for others to eat while you are sick and for at least 48 hours afterward.
  • Even after symptoms are gone, wash your hands frequently, especially after going to the bathroom.
  • Remember that you can spread the virus for days, and sometimes weeks, after the illness ends.

Flu Causes 3 Deaths In North Carolina

ORANGE COUNTY – Three North Carolinians have died from the flu, according to State health officials, marking the first deaths of the annual flu season.

The North Carolina Department of Health and Human Services said Tuesday that the patients were from Eastern North Carolina, the Triad region, and the Charlotte area. They were middle-aged adults who were at increased risk for influenza complications due to underlying medical conditions.

Pam McCall, Director of Personal Health Services for the Orange County Health Department, said that flu season runs from September until around March. The number of cases typically peaks in January or February.

McCall said it is not too late for people to get their annual flu shot.

“It does take two weeks for the shot to become effective and for the antibodies to develop in your body,” McCall said. “The flu season is continuing, and we are getting reports of more positive flu tests, so people should go ahead and get the shot now. It is really the only way to prevent the flu.”

The Center for Disease Control recommends that people six months and older get vaccinated for the flu.

“People who are elderly, children under age two, pregnant women, and people with chronic medical conditions are more susceptible to the complications of the flu,” McCall said. “So if they got the flu, it may lead to something more serious.”

The vaccine protects against various strains of flu virus circulating this year, including H1N1. It is available in nasal spray and shot form.

“I really would encourage everyone to get an annual flu vaccine, and in addition to that, to use the other precautions such as hand washing, staying home when you are sick, and covering your cough.”

McCall said the flu vaccine is offered at the Orange County Health Department. To find other locations where the vaccine is administered, click here.


Durham Child Dies Of Possible Meningitis; Health Official On The Deadly Illness

CHAPEL HILL – A 5-year-old child died Wednesday in Durham due to a probable case of bacterial meningitis, according to health officials. The disease is rare and can be deadly if not caught early.

A spokesman for the Durham County Department of Public Health told multiple news outlets that the case was under investigation. Nine classmates of the infected child, who attend Mount Zion Christian Academy, were being treated with preventive antibiotics.

Susan Rankin, the communicable disease coordinator for Orange County Health Department, explained that meningitis is a disease caused by the inflammation of the protective membranes covering the brain and spinal cord, known as the meninges.

“The most common is viral meningitis, which is caused by a virus. [Another type is] bacterial which can be cause by several different types of bacteria,” Rankin said.

Meningitis may develop in response to a number of causes, usually bacteria or viruses, but can also be caused by physical injury, cancer, or certain drugs, according to the Center for Disease Control.

Rankin said that bacterial meningitis is not an airborne illness and is not spread through casual contact.

“It is transmitted in secretions such as saliva or nasal secretions, like when people have a runny nose—you’ll be infected through contact like that.”

The average onset of bacterial meningitis is three to seven days, though it depends on what kind of bacteria caused it. Symptoms include fever, headache, a stiff neck and trouble thinking.

“A parent should take their child to the doctor if they are demonstrating any of those symptoms and let the doctor know that they were in contact to meningitis,” Rankin said.

Rankin said that the last case of bacterial meningitis reported in OrangeCounty occurred sometime in mid 2000’s.

“In the United States, about 4,100 people a year become sick with some sort of bacterial meningitis, and that is across the whole United States. There are about 500 deaths per year.”

Several childhood vaccines prevent variations of bacterial meningitis.

The severity of the illness and the treatment for meningitis differ depending on the cause. That’s why it is important to target the specific cause of meningitis.


Spotting Heart Problems in High School Athletes

Photo Courtesy: Getty Images

CHAPEL HILL – As the summer draws to a close, high school student athletes are gearing up for competition once again. However, the recent tragic deaths of student athletes related to undetected cardiac conditions, including a high school football player in North Carolina last month, have prompted schools to focus on preventing these tragic events.

Scarlett Steinert, Coordinator of Healthful Living & Athletics for the Chapel Hill Carrboro City Schools, says the CHCCS have policies and procedures in place to help spot warning signs of cardiac problems before the student athlete can take to the field or court.

“At the high school level, we are really making sure we’re looking at those physicals. We are talking to kids about any problems that they may be having. Things that our athletic directors and coaches are really good at honing in on are things that add to different kinds of health issues like stress,” Steinert says, adding, “The most important thing I think that we have done here in Chapel Hill/Carrboro City Schools is that we have full time trainers in our high schools, and our trainers talk to our students and educate them about current issues.”

The system also follows guidelines set forth by the North Carolina High School Athletic Association. Steinart says a student has to undergo and pass one physical every year, with a physical form that is mandated statewide.

“Really what to look for is if there are any changes in the athlete. If you’ve never had headaches and you have a headache, it is important to seek medical attention, and also let mom or dad know that this is happening, or letting a trainer or letting your doctor know,” Steinart says.

Steinart also suggests that student athletes have a family physician who are familiar with their medical history.

Evan Raines, a sixteen-year-old junior defensive end from Fayetteville, collapsed on the football practice field on August 3 and later died. The Fayetteville Observer reported that Raines’ father said hospital officials told him his son died of cardiac arrest, though questions still surround his death.

Ronald Rouse, a teenager from South Carolina, died of cardiac arrhythmia suddenly during his homecoming football game last October. He was a week short of his 18th birthday.

Dr. Julie Monoco, Medical Director for the Orange County Health Department, says that incidents like this make it critical for children to have a sports physical, which is more thorough than just a well child check. She says all children who are physically active, not just high school student athletes, are encouraged to have a thorough physical annually.

During the physical, she says doctors will ask a series of questions to determine if the child has a pre-existing condition. Symptoms such as significant shortness of breath, dizziness and/or chest pain are immediate red flags of a heart condition and will often require further testing.

“We do specific screening questions for the patient to risk-stratify the patient’s cardiac-related issues,” Monoco says. “The main thing that we want to rule out is something called Idiopathic Hypertrophic Cardiomyopathy.”

Monoco explains that condition causes a thickening of the heart muscle wall.

“That affects about one in 500 adults. Most of the time it isn’t an issue and is usually more prevalent in males versus females. It tends to become more of a problem in athletes who play high intensity sports such as basketball and football,” Monaco says.