State health director talks about children and COVID-19 hours after Pfizer news
Dr. Elizabeth Tilson, the state health director, talks about children and COVID-19 hours after Pfizer recommended a smaller dose of its vaccine for children 5-11.
wonderful. I hope people follow along all of our trends on our dashboard. We have tried to have as much robust and granular level data as possible on our dashboard. This is our numbers from friday. We do update the dashboard um by noon monday through friday and we have been following for the whole course of the pandemic are four key metrics because one metric alone is not perfect. So looking at all for those together, give us a pretty good idea of what's going on in the state and at the county. So we have our key metric of the number of lab confirmed cases. That's the top left. You will see that we, because of this delta, the spread of the delta variant. We have been in an upsurge starting to stabilize a little bit which is good. But that's what you see in those recent trends on the far right. We also couple that lab data with our percent positive just to see whether or not the number of cases is just because we're testing or if there's more viral spread And when you see also an elevated percent positive that gives you an idea it's more viral spread. Um in our percent positive and has been elevated as well with our goal of less than 5%. And then we also see the people that are needing hospital level care of the emergency department or hospital level care on the bottom left. You will see the number of people hospitalized with Covid. Um, and that has thankfully started to stabilize a bit. I'm on the right hand side. You'll see the number of people that are coming to the emergency departments for Kobe like illness. That very steep red line is um, this year. The other lines are past years and so you see that we are definitely elevated from past years but starting to also come down a little bit. So although all of our four trends are up, we are seeing um hints of stabilization across those four key metrics, which is really really we are cautiously optimistic that that trend will continue what we will see because there's a lot of different things and play what might happen in the next month or two. Next slide please. Next. Uh that just as a reminder although our and our trends are stabilizing, we still have very high rates of viral spread. All 100 of our counties are characterized as high rates of transmission by the CDC criteria. And then you can see amongst the high level our own data of where we're even highest. The darker the blue, the higher the viral spread to give you a sense of where we are across the state. Next slide please. And again, this is most likely due to the fact that the delta variant is almost exclusively the variant that is circulating in north Carolina as well as the country. Far more transmissible um than prior variants. So it's spreading quickly. Um, is including amongst our Children as well. The prior variants. An estimate that for every person infected they may affected to other people with delta ratio is more like for every person infected, 6-8 people can be infected from that one person so far more transmissible than prior variants. Next slide please. Great. So just breaking it out by age a little bit more to get more into our child centric data. Um So as I said, our cases are declining across all of our age groups, which is good, but the yellow line is the Children 0 to 17 and you'll see in the past two weeks, this was the first time in the entire pandemic That our Children are 0-7 had the highest case rates of any um of any age group. So we are seeing and you see that high rate of acceleration. Um and again the Children having the highest rates of cases um in the past two weeks, thankfully they are coming down a bit, but that is a new trend for us next line please. And then if we break it down, this is just within Children 0 to 17, we broke out those age groups and you will see that high school and middle school um have the highest, the highest rates of uh spread uh 5 to 9 year olds, that third highest. And then our preschoolers have a lower rate which is consistent with what we've been seeing as well that we are seeing overall higher rates of cases and clusters in our older people, elder Children next slide, please. The other thing, we look at it again, looking at the percent positivity, is it just that we are testing more Children that we're finding more cases or is there more viral spread? Um And so the yellow line in this, this looks at the the percent of tests that are positive that yellow line is our Children against. You can see our Children are having not just the highest rates of cases, but also the highest percent positive. So this isn't just because we're testing more Children. It is also that there's more viral spread amongst our Children. And again, this is the um uh highest amongst all the other age groups. Next five please. And then this looks at specifically um the age groups of people coming to the emergency department for covid like illness. I showed you statewide that that was up in this graph. The Children are that Duke Blue 0 to 18. Um so we are seeing the um the highest percentage of people coming to the emergency department are in those Children, those Children as well. So they're not just getting cases, they have the highest percent positive and again, coming to the emergency department for these covid like illness. Yeah, that's like also looking at rates of hospitalization. Now, thankfully rates of hospitalizations are low amongst Children in general. They do have relatively mild to moderate illness. Now there are some disparities in their Children with comorbidities. Children of racial and ethnic minority groups tend to have higher cases but overall we do have relatively low number of cases. But when we compile all the Southeastern states together and get a big bigger end, you will see the sharp increase we've had in rates of hospitalizations among our Children for this region. That's why. Please. Uh huh. Now again the rates of as I learned to the rates of complications of uranus are relatively low. But we do have um has documented this multi system inflammatory syndrome in Children. This see again low overall low rates. Um And you'll see this is our most updated numbers with our miss cases. We had that big surge over in january february. We had so many cases. Um and you can see we are not good news, we are not having a big surge again of our miss cases in Children but we will continue to follow this and this is a bit of a lagging indicator. Often that misc happens after that acute illness sometimes a month or six weeks. So we're gonna still keep an eye on this to see whether or not we might have another surge of that sick quella of our miss cases and Children Next slide. Now again we as I allude to that we're having more cases than kids, some kids come into the E. D. Although although proportionally low we are having increase in hospitalizations but the other thing to remember and what we're learning more and more. Um is that Children can also spread to other people in the beginning. It was a little bit of a question. Can Children spread it to other people other Children and other adults? What we're learning more and more? And especially with this delta variant is that yes Children can spread to other people and can spread to other adults. And so we look at this as some of our cluster data in K12. We have had the highest number of cluster pay 12 clusters at any time. In the pandemic. On the left hand side you will see a breakdown of our clusters are K. 12. Is that gray bar? Um And you can see that the most recent week. Um Much more. Many more K. 12 clusters than any other time in the pandemic. Just to help you with the code. The yellow is our college and universities. The dark blue as childcare. And then camp was red. Which we saw that we're seeing over the summer where kids were in camp. So they definitely can spread to each other there. Schoolmates and teachers. Um as well. There are numerous, numerous studies that Children are quite efficient spreaders to their households as well. So if Children were having infection and coming back to their households, they're very good at spreading it to those members of the household who may have a higher risk of severe disease and death from Covid it's just as uh what we're learning more and more about Children can transmit to others. Next slide please. So many of the things we put into place to try to reduce the spread um in settings that are predominantly um uh populated with Children. I'm sure many, hopefully many of you are aware of our strong school toolkit, not just for childcare but also our K. 12 schools where we have really mapped out the multi layered protection that can be put in place to really decrease the amount of viral spread. What we learned last year is that if you have these multi layered um protections including universal face coverings, you can keep transmission low in school settings, in pre K settings even if you have high viral transmission in your community but it is dependent upon having multi layer of protection including universal face coverings. Next slide please, I'm gonna go in just a couple of examples of some of the of these elements. One and a really nice thing is this year we have a tool that we didn't have last year which was vaccination so that you'll see that as the first Tool and that tool kit is everybody 12 and up ensuring that they get vaccinated as a really important way to decrease viral spread. And I wanted to show the data that we have. We are looking at our effectiveness data not just at the state but also nationally we have this in our surveillance data so you can continue to check on the effectiveness of vaccines as we move forward, but that vaccines lower your risk of getting a covid infection by four times. So fully vaccinated people are four times less likely to get covid than people who are not vaccinated and fully vaccinated people are 13 times less likely to die from covid than unvaccinated people. So vaccines are working to prevent infection but also to prevent that severe illness and hospitalization and death, which has been the main goal of vaccines. And again, we continue to look at this week by week to make sure as our variant shift, make sure we have a good idea of our vaccine effectiveness. Next slide please. And so we also are tracking our vaccination satisfied by age across our population. Amongst our adults, we have almost 70%, of our adults, 18 up have had at least one dose of vaccine and 66% of our people 12 and up have had at least one dose on the right hand side. You will see a breakdown of vaccination by age, much higher rates of our older people, which is good because they certainly are the highest risk of death and severe disease. Remember we're making progress in our adolescents, about 43% of our adolescents have had had at least one dose. And again he had one does most people, vast majority of people go on to have that second dose and that fully vaccinated. So we still have work to do um in our adolescents um, and bumping up that vaccination rates. And in our young adults as well. I will before we move to the next slide, I will also comment on some of the upcoming uh potential authorizations around vaccination. Um, so data has been submitted by Pfizer to the FDA and we may we may have authorization for vaccines uh for people five and up potentially by the end of october we will have to see but we've been hearing more and more data being submitted and wanting to make quick action. So we we may well have vaccine authorized for five and up by this fall and we may have a vaccine authorized for six months and up potentially by the end of this year we will still see and this needs to follow the pace of science with Children because the difference with Children is you have to figure out what's the right dose for Children. They're not just many adults. You really have to think about what is the right right dose. And that was what was involved in a lot of those clinical trials. But I am hopeful that again, we will have authorization for five and up by this by this fall and six months and up perhaps by the end of the year. We will keep you posted as we learn more. Okay. And then the next slide when we think about the other really, really important preventive measure, a vaccine being first but masking being second um is that the vast majority of our school districts that covers the vast majority of our public schools do have universal mask policy, which is great. The vast majority of our of our students um um and families are for the protection of that. We continue to work with some of our counties um that have opted not to that um and working through that with them. But the take home is the vast majority of our of our counties have adopted universal mass policies which in a time of viral spread when you have the highest viral spread. That is when it's critical to have as many layers as protection as possible as our viral spread comes down and it will come down. That is when we can start taking away some of those layers. But right now with this area of high viral spread, having as many of these preventive strategies in place is really critically important. Okay. And with that I am done. Um, I think I can probably take a couple of questions if that is of the wish of the chair. If not then um, happy to share these. I guess these these slides are shared. We're gonna take every two minutes left that we have with you dr tilson and open it up to see if anyone has questions and kelly, you're going to have to help me see if we do I yeah if you have a question definitely unmute yourself because we want all questions to be verbal and not in the chat box. Thank you. Hey Karen and Betsy this morning. Just just a quick comment on the slide with the pediatric hospitalizations. I sense that is probably not covid hospitalizations but but I think what a lot of us know especially the pediatricians on here is that we have seen a massive surge in rhinovirus and RsV And that is accounting for really what is um really clogging up our hospitals on pediatric wards over the last 4-6 weeks. It's made life very very difficult for a lot of us. And Medicaid has even responded to this. They've approved early approval and use of synergies which is fantastic. Um for use which typically we don't start using that until october some seasons even into november. But it was approved a couple of weeks ago. So lots of things going on right now which are hammering the pediatric population. Yeah marty you're right and we were very actively proactive about that. But this was this is specifically covid hospitalizations in that slide. Not overall but specifically covid office hospitalizations but you're right. It is now the covert hospitalizations on top of R. S. V. And the other ones is making it even harder. Mm Other questions. Let's see we are right at 10:00 and I want to honor your time. Thank you so much for coming. And being with us today is an absolute pleasure and thank you for presenting all this information and good luck at your next meeting. OK thank you all so much. Really appreciate being with you. Okay. Bye bye. Thank you. So when we were having a discussion about bringing this meeting on we knew one of the things that folks were going to want to see was what was the impact of Covid on Children. Um and so our next presenter, Shannon Gary from the mph is gonna talk with us about update on injuries to Children and what kind of trends we're seeing in the pandemic because we know that when Covid hit our Children's movements, where they were going how they were spending their time adjusted rather dramatically in a short period of time which has impacted um what is happening as far as injuries. So with that I'm gonna turn this over to you ma'am and I'll let you give us an update. Alright, great. Thank you. And while the sides are coming up I'll do a quick introduction. Miss Karen mentioned my name is Shannon Geary. I'm an epidemiologist and the injury and violence prevention branch of the Division of Public Health. We prevent represented some of these slides to you all last year when you met. So we have a full year of data now have updated those. So you can go on to the next slide. Um as Karen mentioned, what will be sharing are the numbers of overall injuries. Both deaths and emergency department visits during 2019 and 2020 to understand the impact during the pandemic. We'll look at overall injuries but also specific types of injuries. Before we jump into it. I do want to mention that the 2020 data are still provisional and subject to change. We're looking at the death certificate data from the State Center for Health Statistics and our emergency department visit data from NC detect, which is our state syndrome. X. Surveillance system and Shannon just one second. Um Not that I am in any way to be providing technical information, but if you want to see this, um the presentation a little bit larger, you can double click on the square that has it and it will pop it up larger and that is probably the only technical advice you'll get from me ever. So there you go pass it on to you. Thank you. Um and you can go ahead to the next slide. There's gonna be some transitions in here just as we go between the injury topics. So for 2020, looking at a provisional data, there were 319 child injury deaths, which was a 15% increase from what we saw in 2019. Um I will say in previous years the trend among Children for childhood injury was going down. So this represented the first increase in the most recent five year period. The slide that you're looking at is showing the number of deaths per month for 2019 and 2020 2019. Zingre 2020 is highlighted in purple. And you can see there's some fluctuation around the trend that we saw in 2019. With some higher numbers across multiple months, particularly towards the end of the year in 2020. Next line. So the next slide is going to be a breakout of the type of injuries. So, these are injuries by mechanism and intent. And I'll say in our death certificate data, um the majority of childhood injury deaths are unintentional, but it varies between like half to 60% between 2019 and 2020. Uh so you can see the leading mechanism and intent of injury in 2019 and gray was unintentional motor vehicle traffic injuries. You just a moment if I could just remind everyone to please mute your phone while you are not speaking, someone is providing quite a bit of feedback. What? All right, thank you. Um so between 2019 and 2021 of the things that we saw a change was a decrease in our unintentional motor vehicle traffic injuries. So you can see there are 20 fewer deaths in 2020. Um looking at some of the other big things that changed. Uh the biggest thing that stands out is firearm deaths among Children, which almost doubled in 2020 compared to 2019. Um some of the other categories that you can see on here is leading causes of death among Children. Suffocation stayed relatively the same. We saw that drowning is actually decreased during the pandemic. And then unintentional poisonings went from 8 to 15 deaths in 2020. Uh the vast majority of those are medication drug overdoses among Children and are mostly among our older Children. 15-17. Go ahead to the next slide please wow. Uh huh. So before I jump into our emergency department data I wanted to give some background and we presented this last year as well. Um there was during the period of the pandemic in 2020 and overall 18% decrease in 80 visits for any cause and for all ages. Um so there was a reduction in the utilization of the EU during 2020 and that was also seen nationally. So what this figure is showing you is the number of overall 80 visits per week in 2019. The lightest gray, the darker grey is 2020. And you can see we start we started at that range of about 100,080 visits per week. And then right around the time of the stay at home order there was a huge drop in utilization of the E. D. And that sense of increasing but we're still lower than what we saw in 2019. The dark blue line is our provisional data for 2021. And you can see the trying to start and get back towards our normal utilization rates. Uh But we're still early parts of this year a lower utilization of the E. D. And there is that blip around bay which is a no data quality issue due to a transition in our data vendor for the N. C. Detect any data next line. And I will say that um decrease was true for Children overall and it was more exaggerated about a 30% decrease in overall et visits. But the slide you're looking at is specifically to injury et visits among Children ages 0-17 where we saw 31% decrease in the number of child injury et visits. Um So again the same the same lines with the light gray being 2019 that darker grey. 2020 with the dip around the stay at home order without went to effect in early March in april. Um And then the dark blue line is our 2021 et visit numbers by week. So I will say for the slides and presenting on 80 visits will be presenting the proportion of child injury any visits rather than the count because of this decrease in the number. And you can go to the next slide. I'll give you another example of this. Can I interject again if anybody is connected through their cell phone or landline and they're not connected to the computer audio, could you please mute your cell phone or landline at this time? We're perceiving some feedback. Thank you so much. Oh. Uh huh. Uh huh. Uh huh And it appears to be somebody in their car because we can hear your turn signal. So if that's you check your phone and hit that mute button, thanks guys and you're still turning Okay? Thank you. Uh so what you're seeing on your slide now is the number of child injury et visits by the type of injury. And you can see there's a little bit of a difference in the types of injuries that we see in the et setting over 92% of our visits uh that are related to childhood injury or unintentional, which is a little bit different than what we see in the death certificate data. Uh the leading cause of injury for Children in the 80 setting is unintentional falls, followed by unintentional motor vehicle traffic injuries. What you can see on the figure here with the 201,980 visits in grey and our 2020 provisional data in dark blue is that the number of injury et visits decreased across all of the injury categories. Which is very much in line with the trends we just looked at around utilization. Um if we were to do a proportion of visits, these would be pretty consistent between 2019 and 2020 with some smaller fluctuations and we'll look at that in some slides a little further into the presentation next life and you can go ahead and jump to the next one. We'll start with motor vehicle traffic injuries, starting with child deaths. Uh the number of deaths between 2019 and 2020 for motor vehicle traffic injuries among Children decreased by 32%. Um, from 2019 to 2020 most of the deaths were among our older Children ages 15 to 17. And that's true for both years. But you can see there was a decrease across all ages, particularly the 10 to 14 year olds. They saw the biggest dip in the number of deaths during 2020. Another interesting change that we saw is that In 2019 the distribution by sex was pretty similar. Where In 2020 we see this huge decrease, a large decrease, I should say. And the number of deaths among females where the number among male Children stayed relatively the same next time. So what you're seeing on your side now is the distribution of those motor vehicle traffic deaths by race, ethnicity. So the number of deaths is on the left broken out with the 2019 data again and gray and the 2020 data highlighted in purple. Uh the numbers of deaths decreased among non hispanic, white and non hispanic black Children. However, there was a slight increase in the number of deaths among hispanic and american indian Children during the pandemic. And I will say on the right were showing rates per 100,000 of motor vehicle traffic deaths. However, we're only showing that for hispanic and non hispanic black and non hispanic white due to small numbers issues. Um I will say that change between 1-4 death is pretty substantial among American Indian Children. And we saw a stark increase in rates among American Indians of all ages during the pandemic for traffic-related deaths. So just keep that in mind, even though we're not able to display the rates for you on the side for this population due to small numbers. But you can see that rates decreased for both non hispanic black and non hispanic white Children with a slight increase in the rates for hispanic Children during the pandemic. Next line, looking at the proportion of child injury, et visits that were related to traffic injuries, you can see that Between 2019 and that latest grey in 2020 and the darker grey that for the most part across the year, they were pretty consistent. Motor vehicle traffic injuries represented anywhere from between 6 to 12% of child injury et visits between those two years. And there was a dip off around April where we had that um stay at home order go into effect. What we're seeing is actually an increase in the proportion during 2021. We're starting around march of this year, that proportions jumped up to closer to around 15% of our child injury. Edie visits next night And we'll transition to those firearm injuries. Now, you can go on thank you. So, child firearm injuries increased by about 88% in 2020. Um the slide that the figure on your slide is showing the breakout by intent with again, the 2019 data, and grey and our 2020 data in purple, where most of the deaths that we saw were high. homicides or assaults followed by self inflicted injuries or suicides. With the biggest increase, you can see almost a doubling of the self inflicted um firearm deaths. And I will say that in 2019 there were 56 deaths, 105 and 2020 but in previous years, um there was a slightly lower number um of 53 and 46, but in 2018 that jumped up to 62. So just wanted to give you that clarification the trend that in 2018 we were higher than where we were in 2019. As we're looking at this trend, and I'm sorry, I don't have a visualization of that for you next line. So looking at this breakout by age group and sex, most of the deaths that we saw were among again, are older Children. That we saw an increase among those 10 to 14. And um, well, really across all age groups, I should say, but most pronounced among our 15 to 17 year olds and then the number of firearm deaths increased for both males and females. But males represented the largest burden of firearm deaths in the state for both 2019 and 2020 next time. So this is that same breakout by race, ethnicity that we looked out for traffic injuries. But now for firearms, where we see an increase among almost all of our racial and ethnic groups, the number of firearm deaths tripled among the non hispanic white population among Children. And there was also an increase among non hispanic black Children. However, when we look at the rates on the right per 100,000, um, you can see that the rates increased more substantially for the non hispanic black Children. And there's actually this maintained disparity where non hispanic black Children are currently still experiencing the largest burden of firearm deaths in the state next life. Uh looking at the proportion of child firearm injury, et visit e. G visits out of all of our child injury, et visits, um you can see that there's been a bit of an increase around 89%. But I want to preface this, that these represent a very small proportion of overall childhood injury et visit. So if you look at the y access, we're talking less than 1% of all et visits for firearms. Um, and you can see that's been slightly higher through 2020 and has continued to be higher in 2021, but still around less than a percent to half of a percent next slide And a big reason for that is the fatality rate of a firearm injury. Uh they are much more common to result in a death. And you can see that closer to 80% of the injury et visits for firearm or unintentional injuries. Look at which Children are most impacted by these firearm et visits. Again mostly are older Children ages 15-17 and over 80% of those Children are male. And those proportions are about the same for 2019 as well. So that's why we're only looking at the 2020 data on the right backside. I did want to highlight and see faster which is a new activity that were participating in the north Carolina, firearm injury surveillance through emergency rooms. Uh We were among 10 states funded through C. D. C. To do enhanced firearm injury surveillance using our emcee detect emergency department data. With the goal of trying to disseminate aggregate level data for our partners that are working to prevent or respond to firearm injuries across the state. And the detectives are most timely data source. We get those data updated multiple times a day. And so it's developing a syndrome definition that goes beyond our could based definition to identify more injuries and let us know if there's a problem or where those problems are occurring. Um And so the uh faster group is working on our first dissemination product And we have representation from the task force involved in our partners group that's helping shape what that's going to look like and happy to share that with you all once it becomes available next life. So now moving on to suicide and self inflicted injuries, Um, in 2019 there were 36 suicide deaths and that jumped to 55 deaths in 2020, which is about a 53% increase. But before I dive into that a little bit more, I will say 2019 was a lower number of suicide deaths among Children than we had seen in previous years between 2016 and 2018. That was between 44 and 52 deaths a year. So that comparison of 2019 is a little bit lower. So just keep that in mind as we're looking at these slides. Um, most of the difference that we see between 2019 and 2020 are again those firearm suicides among Children. Next slide by demographic group, we're looking at those Children ages 10 and older. Um, most of those deaths are in the 15 to 17 year old age group that we saw a slight increase in both, um, and particularly more for our older Children. And most of those suicide deaths are among our male Children, that we saw an increase among both males and females during 2020. Next slide, this is a breakdown by race, ethnicity. I'm only showing the counts here because so many of our racial ethnic groups have small members for a single year. So I'm not able to show you the rates the way we did for some of our other categories here. But the number of suicide deaths increase the most among our non hispanic white Children. From 20 Deaths in 2019 to 37 deaths in 2020. Next line this is looking at the proportion of our child injury et visits that were related to self inflicted injury. I do want to mention that in the E. D. Data we can't parse out self inflicted injury um from suicide attempts and self harm. So this is an all encompassing self inflicted injury category which still gets at the burden among Children that were interested in. Um So between 2019 and 2020 there was about a 44% increase in the proportion of those visits. You can see most of that happened at the very beginning of the year and later in the year and then has been even higher in 2021. With closer to 4% of the child injury et visits being self inflicted. Next life. I will say before we jump onto the med drug. Just a thought I forgot to mention in the E. D. Setting for those self inflicted injuries about 60% of those are females. So it's a little bit different than what we see in the death certificate data where more of those deaths are among males. Just to keep that in mind. Uh So for medication and drug overdose you can go on to the next slide. I'm only going to be sharing the trends for eating visits. Um I will say as I mentioned at the top of the talk that most of the deaths were related to medication, drug deaths and those did increase during the pandemic. But looking at our et visits specifically at Children 15 and 17. Since they really represent the burden here. The proportion of those 80 visits for child injury that were medication, drug overdoses increased about 43% between 2019 and 2020. Again a smaller proportion of the overall child injury, 80 visits between one And 2% during that 2019 and 2020 timeframe. And we've seen again an increase in 2021 in the early part of the year. Next slide And we'll wrap up looking at child maltreatment. I know this has been a very big concern with the pandemic. So the proportion of child abuse and neglect, 80 visits and this is a code-based definition with suspected or confirmed abuse or neglect Between 2019 and 2020. We saw an increase in the proportion of 24 where it's mostly stayed around 1 to 1.5% of ET visits and again we're seeing a slightly higher proportion so far in 2021. Um This is a very conservative definition And we are working with partners at U. N. C. At the injury prevention research center. There to help try to establish a broader definition using our syndrome IQ surveillance data to try to build this out and get a better idea of the burden of child maltreatment especially during the pandemic. And we're also working on broader definitions to better understand utilization of the E. D. For mental health and behavioral health services rather than just looking at those self inflicted injuries and in this case the abuse and neglect. So hopefully we'll have some more detailed information for you all soon on those next life. And with that I'm happy to take any questions that you may have. How about this? Hello. Go ahead. Hey this Jim Berg. And tonight can you go back to page 27 And and I got a question about other on that page. Hello? Yes we'll be there in a second. All right thank you. Peter Bergen. That's 27 is in the next page. Uh Is it? No the one before that. The overall number of visits by injury category was the one you're interested in. Yeah that page right. There was 26. I'm sorry I I saw the other one I thought was one before that. All right. The other those are big numbers. I mean we go through all of these categories down to 3000 And then we have other 26 and 21. There's got to be a beggar. I mean there's gotta be some other categories that for that number to be so big. What's in other there is a lot of other I will say every category is smaller than that 3000 number that we're looking at there just all lumped together. And part of that is that these are broken out by mechanism and intent. And so some of the other is going to be those intentional injuries that we don't have a large number of in the 80 visit data. Um There things like overexertion. I'm pulling up the broader list now. Fire burns um For example there were less than 1800 fire and burn related visits but I will add that um Part of this is the completeness of the C10cm coding for mechanism and intensive injury. So the codes that we use for injury surveillance often aren't codes that are billable and so we are using a secondary data source. The primary source of those of those codes is for billing and there is About 75% of our et visits that are related to injury. Get a code that helps us understand mechanism and intent. Um so some of those other are unspecified or unknown mechanism and intent to injury. Um so we can get you a broader break out of that list but that's all of those kind of clumped together where it's just a bunch of other ones that are smaller than that amount or ones that aren't specified on what the type of injury was. Well something like in fact fire is what I was thinking about fire or burn and and I mean that's 1800 is a pretty significant number to to me that if you don't mind, I'd love to see those other those other categories if we could. I'm concerned about that. That just seems like a lot of stuck out at me and on the all the on the deaths, the especially the self inflicted. Um and those categories um I'm and I don't know if you can go back to that or not and I should have probably gone there first but I've written these in order uh on the self inflicted with those categories. Can you get back to that slide? I did not write that number down. I was watching something else on one of the slides and thinking about it. Can you go back to the self inflicted? I think it's 30, It was at 34 38. Is this the slide sir? Go to the one before that that one the number of deaths among but this is one of the ones I was thinking about but this is not this is just total firearms. I was the one I was thinking about was a self inflicted. I thought that are you are going to send or maybe you already have or are you going to send us all these slides? Yes. Senator Bergen these are already I believe posted on our child fatality task force website. More slides And we should be to the one I think that he's interested in. That's it. Yes. All right. Child suicide. This increased 53 if our um and suffocation now the farm was uh and I'm sure that I know that they investigated all of these. Um were these because we've had some interesting discussions about about firearm safety and securing firearms and stuff. Uh Do you have any more data on these? As far as drill downs on how they acquired the firearms or any of that? Unfortunately I don't, I think the medical examiner would probably be able to describe those a little bit better Or we often use the data from our north Carolina violent death reporting system. But because those cases are abstracted, it takes a little bit more time to finalize those data. So unfortunately I can't dive in a little bit more on those ones As far as cause of death, not cause, but reason for death. Does anybody document that? Because I think that would be interesting to see is is why did these uh you know, why did these 51 kids choose to do this? And Well the 31 20 and I didn't count the poison and the one other. But but um you know, do they investigate that? Was it was it mental health because of of uh isolation from peers? Was do they do any investigative that we can know more about that on why these Children chose to commit suicide That is often available from the medical examiner data. I will say what N. C. Video S. Does is abstract the medical examiner reports along with data from law enforcement to help describe the circumstances surrounding to the suicide and other violent death. To help us understand exactly that the why as well as the how. Um But again those data can take up to two years to abstract and finalize. But the medical examiners may be able to provide some additional insight in the meantime. But is there without me having to contact each medical examiner? Is there any is there any place that that information is gathered? Because the wise the more important to me than the house. Yeah this is Alan Shannon I worked together I guess I'll just have to say one of the really tragic and unfortunate thing about suicide deaths is the why question often cannot be answered because the person who's best in a position to answer that isn't around. And the family members are often caught unaware. So you're you're voicing a large concern and frustration that we all share in working in suicide is doing the best we can to piece together the story and the investigations are also occurring during a very very tragic moment in family's life. So I'm not trying to minimize that. I'm just saying your questions are the ones we ask and unfortunately we often aren't able to get better answers than what's available. And Senator Bergen, this is Kala Hatcher. I would also add to that that um part of the purpose of child death reviews And you're going to hear later today from members of local teams who perform these reviews. I mean part of what they're trying to do is really understand what happened and um and and see if there were you know opportunities um for public systems to have played a role in prevention, you know for future debts as well. And part of the data that you're wishing for would be collected if we were to participate in that national data system um that um I know you know something about because it's in uh it's in the child fatality prevention system strengthening legislation. So if we were to participate in a system like that we would be able to pull out what information we do have. As Alan said, we're not always going to have that information even from reviews. But to the extent that we have it we would be able to look at aggregate data on on things like that. I hope that's helpful. Thank you other questions Shannon, I want to thank you so much for your presentation. It was very very helpful. Um and with that we're gonna move on to a quick legislative update and review of the 2021 chop fatality prevention system and any of you had questions. You saw Shana's information up there you can contact her directly. So I'm gonna roll through where we are at this point. I would just note that um we're still in session so and we don't have a budget yet so a lot of things are in flux. Um Normally when we do this report sessions done but we're not done with sessions so we're a little more influx about um what exactly is going to happen. The other thing I want to just bring out is this has been a really difficult legislative session I believe for legislators and I hate to speak for them And those who are on the call disagree with me. You can let me know but they've had so many items being pulled at them because of the pandemic and and sort of the the impact of the pandemic. Um Whether it's I can't hire a child a person to be able to work at my child care center we need increased rates or I need someone to help with my direct support workers for I. D. D. I can't hire anyone or it's um the schools need more money to be able to manage those youth who end up testing positive and have to be um by video audio taught. You know so it just there's just been and those are just like just a few there's been so many issues and on top of that, we haven't had a budget, our last budget was vetoed. And so we're working on some sort of a yeah, a muted form if you will almost a budget life. And then on top of that we had all this federal money come in that a tremendous amount of decisions had to be made. So there has been a lot going on this session to say the least and one of the one of the busiest, as far as like decision making and impact on our leadership in a long time. So if we can go to the next slide please, we'll walk through our agenda really quickly. So um first off we want to note that we have an oncologist mentioned this, the child fatality prevention system. Um this was actually put forward in Senate bill 703 and um a big thanks to Senator Bergen who's on our call and also to Senator Edwards who sponsored this bill. Um we have not been able to move this bill yet and we did not see funding in the House or Senate. Um this is when we've really been trying to get unstuck, so to speak. And again, it's just fighting all the other priorities that legislators are trying to manage, but we spent two years building what this system should look like and spent a whole lot of time in a summit bringing folks locally together to talk about what changes needed to be made. And we are going to hear more about this later, So I don't want to talk about this too much, but I really want to emphasize that so much of what we need to do at the state level needs to be driven by data and that data needs to come from our local folks who are actually seeing these cases and they need to be collected and put into a format that can guide policy and practice for legislators and also for the department, we are not built currently the way our system has been put together to actually do that and our system of the child fatality prevention was built over about a 10 year period and during that time where it was being built legislatively it was put in different departments within the divisions and so we have these different groups that are managing different parts of the child fatality prevention system with no leadership, there is no direct head over all of it, sort of where does the buck stop? And there's also not a cohesive way where we collect and share that data that's so important to be able to make good decisions. So at this time we are in a standstill with Senate Bill 703 but we're still holding out some hope so because we just, we just gotta keep hoping all right next slide please. Another one is our statewide firearms safe storage awareness and you just heard there's so many during the pandemic there was a huge increase in the number of first time firearms firearm owners. Part of the concern is the awareness of how to safely store those firearms. And so we felt like this firearms safe storage just could not have come at a better time. We did have a bill that went through, it did pass the house almost unanimously and went on to the Senate um it has not been heard in the Senate, however we did have it in the funding for it included in the house version of the budget. Um right now it is not included in the Senate version. We're hoping in the final budget it will be included there and we'll continue to see more work on this next item. Okay so um safe sleep, this is something that is a recurring thing for us partly because it's one of the leading um issues related to uh deaths for our Children and our infants and so safe sleep is something that we have to continue to press upon. There is some current funding there but the request was to increase that funding to expand awareness and education. Um we had a bill Senate bill 5 37 that asked for the additional 85,000. Currently there's only 45,000 at this and we had Senator Bergen, thank you Senator Bergen and senator critic who um were the folks who who put this bill forward, we didn't have a hearing, I think that was less of an issue, it was really more about funding but we have not seen that funding in the house or the Senate budget yet. And I think this is one of those items when I mentioned that there was a huge amount of federal dollars coming in, like the B word billion, right? Like a big big amounts of money when you're looking at something like $85,000, sometimes it's hard to get that on the radar when you're talking about other numbers that are so big, but this is such a small amount of money that makes such a huge difference. Um that is something that we just keep plugging have um again this is one of the leading causes of infant death and we know how important it is for folks to understand how to have their Children in a position where they are sleeping safely at night or during the day because those of you have had Children, they sleep all kinds of times. All right, so we're gonna move on to our next bill. Next life. Here we go. Um oops, there you go. Okay, thank you, big big big shout out to Representative White who has shepherded and worked on this bill, sat with a room for full of a lot of lawyers talking about very technical stuff. Um a big shout out to Kela who's also been a huge proponent advocate and getting this fixed, so are safe surrender law which already exists, needed some important changes made to it. Household for 73 was put forward by Representative White represented Bradford and riddle and it passed the House unanimously. It has gone to the Senate where unfortunately it is sitting and has not moved. Um We also had Senate bill 5 35 which was extraordinarily close. Um it was sponsored by Senator Bergen and Senator Kravica. Thank you again, Senator Bergen that did not have a hearing. We were really hoping since um 4 73 had passed the House that we could get it moving in the Senate. A lot of this is really technical and I think that's been part of the challenge is when you read through this unless you're an attorney. Oftentimes it's hard to even understand some of the changes. Um, but I will say that these are important and we're still hoping that we can see this, get some attention in the Senate. So moving on to the next flag please. Um, so we had a request as part of our agenda to increase the number of school nurses, social workers counselors, psychologists. Um there has been a huge infusion of money to the schools through covid dollars that have come down to the feds And we saw also that the Senate budget put a recurring funding of 115 additional school psychologists. The house budget had 1.7 million to establish a grant program which would allow schools that felt the need to be able to ask for them. Um but we have not seen across um either budget recurring funding for um school nurses, social workers and counselors. Again, I would note there has been funding going to the schools. Um but as far as the legislative budget, we're not seeing some significance. Um as far as school nurses, social workers and counselors, but we did see them and psychologists, psychologists and we're hoping when the final budget comes through that we'll continue to see money um in that whether it's 100 and 15 or the 1.7. Um we're hoping to see continued attention brought to that and I think this has been particularly important um being that we're seeing an increase in the number of suicides. Um something that we often talk about when we have discussions about suicide is that when we see suicide, it's just the tip of the iceberg of all the attempts that were made that we are not looking at. And we know that isolation do the covid it has has had a huge impact on our youth. Um We're really hopeful now that kids are getting back in school and being able to socialize again play sports all the wonderful things that keep them engaged. We'll see a change on this. Um However, we know that the schools are reporting quite a bit of an increase in crisis and um North Carolina has seen a huge increase in the number of youth that are being admitted to hospitals um because of behavioral health needs. Um, and to the point where we just don't even have enough beds for them. North Carolina is not unique. This is happening across the entire country and a lot of this is being contributed to covid and the impact on socialization for Children next time, please. Um, So there was um requests that there would be legislation that would add abuse and neglect reporting to the required mental health training for school personnel. And there's already um, there's already a bill around mental health training for school personnel and the hope was to add that to it. We didn't have a bill introduced. Um, But there is um, Senate Bill 693, which requires that health and human services develop a plan around a statewide child protective services hotline, and also that public schools are letting um there's another bill around public schools providing students with information to report abuse and neglect and they have to put that information out via posters and um, and other types of documents that they can distribute to the youth and schools. So, um, there were these two other bills, I will say on 6 93. There also was language that directed the Department of Health and human services to be um to really look at the continuum of behavioral health services for youth, particularly those with high acuity needs related to child abuse and neglect and to find a way to address it appropriately being that currently appears that there are gaps in that process. So um again to other bills, nothing that was directly introduced um uh specific to this next slide please. Okay, so ignition interlocks. So um there there were a couple bills for two on the House side and 1 83 3 on the Senate side. Um They didn't expand the development or the usage of the of the interlocks but um which is what we had recommended to all d. Wi offenders but they are requiring um that there would be a study to look at what would happen or what would be the potential outcome of expanded uses. Um So 1 83 passed the Senate went to the House. Um It's sitting in J one and four to pass the House and it's in Senate transportation. Um and it's not moving. One of the struggles is right now. There's not a whole lot of bills particularly on the Senate side being introduced outside of reading redistricting. We've seen on the House, a few more bills outside of redistricting. So I'm just not sure what kind of movement we're gonna see. We haven't gotten a clear picture as far as movement on bills at this time, outside of redistricting and how quickly or even the willingness to take those up because a lot of time and energy needs to be spent on the redistricting piece uh, next slide please. So tobacco prevention funding, which is something we've really been pressing um seven million for youth and three million for the quit line. And we were endorsing that we weren't leading that. Um, so there was a settlement with the jewel labs, um, north Carolina sued and got a pretty significant settlement Um and it is 13 million non recurring. So this is one year. Um, the House put that money in their very specific, um, we did not see that in the Senate budget, not sure if we'll see it in the final budget next slide please. So, um, workplace supports pregnancy and lactation, accommodation and king care and safe days leave. This is another endorsed where we were supporting other groups that were driving these Senate bill 6 33 had a companion house bill 5 14 that address did the pregnancy and lactation accommodations that did not move. Therefore it did not make crossover And 875 did the same and it did not advance next slide please. So I've asked us to look at two bills that we did not directly ask for, but I think they are some of the biggest impact on child deaths and child well being that we probably will have seen in quite some time. And um, and so I just felt it was really important for us to look at these next slide please. So, um, and I just I just want to stop for a second and do a huge shout out to Senator Bergen who led this work and was a champion for it amongst others. Um they're just not enough praise is to be thrown his way right now about this because we're so excited about the potential of of what can happen not only with this bill but the next one we're going to talk about um it is it is just opening the door to so much potential changes in child death and um and being able to plan effectively as far as family planning, there's just so much good out of this to Senator Bergen, I'm just doing a big old shout out to you because you rock this is wonderful, we're so appreciative and I would just note that Senator Bergen actually came and said I need to know more about how do we reduce um you know child death, I want to know how we the disparity that we're seeing. How do we address that? How do we reduce um mother's a pregnant women who are choosing abortion. How do we reduce that? There was a whole series of things that he was looking at and um we brought our co chairs of our are uh are the topicality task force to him out of perinatal health and they gave them some suggestions, he took those and then just went and ran and so Senator Bergen bagel shout out so one is now a lot um session law with House bill 96 related to pharmacists authorization for the delivery of um of self administered oral and transdermal contraceptives. Uh this is just completely open the door, particularly for rural areas where there's not as many doctors available or for folks who don't have a gynecologist or access to positions like others do to be able to go and have a pharmacists be able to prescribe them access to birth control. Just just an absolute game changer. So big shout out, super excited about this massive impact on family planning. Just amazing and if I have not made it clear how awesome this is, I don't know what else to say. All right, next bill please. Next slide please. Which is the next bill. Okay so oh my goodness! Oh my goodness, awesomeness. Here again, Senator Bergen, thank you. Thank you, thank you. So in the senate budget there is Medicaid coverage for pregnant women for 12 months postpartum. I just I don't think there are words to explain how critical this is for women. Um post pregnancy for their health, for family planning, for safety of their newborn child. Um Just an absolute game changer super excited about it. It was not in the house budget, we are really really hoping in the final budget that we see this included because this is this is so powerful and it's so needed if we had a bunch of obese on here, they would all be singing the praises of this because this is just really pretty extraordinary and I'm gonna stop talking from it and see if Senator Byrd and you want to say anything about either one of these bills. Well, first of all, thank you. A lot of people worked on on both of these topics and subjects and there's a ton of folks that are very concerned about it in the House and Senate. And I can't tell we're not discussing what's in the budget, but I hope everybody is very happy when they when they do see the budgets that when they're when they're rolled out in the next week and a half or so. But again, thanks to everybody for not only bringing great information and be willing to talk about a lot of these things, but also the hard work that went into it. There's a there's a lot of folks that are very concerned about health care and especially women's health and Children's health and and thank everybody that worked on it and thank you all for for bringing it to our attention and uh to answering all the questions. I know I have always had a lot of questions, but what I found is is having great information usually yields wonderful results. Thank you all. Thank you, sir. All right, next slide, please. We are now going to move on. That's where wraps up our legislative overview really quickly and we're going to move on and and asked Allah to give us her director's report. Hi everyone. Um I'm gonna try and go through this pretty quickly. Um Try and catch us up a little bit on the agenda. So next slide please j I mean one of the things that I like to always remind us about is really when I try to explain what is the task force, what do we do? What is the child fatality prevention system? It's super complicated as most of you know, national people tell us we've got one of the most complicated systems in the country. But if we just remember this at its core, it's about making kids a priority. And so I just want to remind people that that's what we're doing when we come together, when we look at policy issues, when we look at strategies for prevention, it's up to us to make these recommendations to remind um leaders, policymakers, lawmakers, um what are these strategies that will make kids a priority and what we do in legislation and agency action etcetera. So just that phrase to keep in mind I think is key. And next slide, please. Um very quickly some of you have heard this before, but some of you are new and I just want to give you a sense of what's going on behind the scenes when we are not meeting and what I am doing. Um One of the things that happened since we last met was that we got that 2021 annual report out, you all saw it? Um and it is accessible on our website And it summarizes really everything we worked on last year, so it's an excellent source of information to refer to our reports, also always summarize what we've been doing since 1991. 1 of the things that I do when I'm not working on meetings with all of you as I represent the task force in more than a dozen stakeholder groups and steering committees and um I'm really trying to be that voice to let folks know what the task force is doing and what our priorities are so that we can give those organizations and opportunity to understand the information that we're seeing and be able to react to it. One of the things that I'm doing also is