Guilford and Forsyth are both urban counties with large hospital systems. They have similar demographic profiles — healthier than many rural counties, but lagging behind their more affluent counterparts in the Triangle and Charlotte. Both have sizable elderly populations, and their respective anchor cities of Greensboro and Winston-Salem market themselves as good places to retire.

But since the onset of the coronavirus pandemic, Guilford’s COVID-19 death rate — the number of deaths per 100,000 residents — has quadrupled Forsyth’s. As of Thursday, Guilford County has 49 COVID-19 deaths. With a population of 537,174, that equates to 9.1 per 100,000 residents. Meanwhile, Forsyth County has reported only eight COVID-19 deaths for a population of 382,295 residents, or 2.1 per 100,000.

Only one other large urban county in the state — Durham — has a higher COVID-19 death rate than Guilford, at 13.5. The death rate in Mecklenburg County, home to Charlotte, is 6.2, compared to 2.7 in Wake County, where Raleigh is located.

The variance between death rates in Guilford and Forsyth can likely be chalked up to serious outbreaks in two nursing homes, said Dr. Kimberly Powers, an epidemiologist at the Gillings School of Global Public Health at UNC-Chapel Hill.

“My hunch is that you’ve got some pretty sizable outbreaks in Guilford, and they’re older and more vulnerable, obviously,” Powers told Triad City Beat.

Powers said that it’s impossible to draw a conclusive connection, adding, “There’s an element of chance when you’re looking at two relatively small areas. Maybe over the long run you won’t see a lot of difference.”

A total of 21 residents have died from COVID-19 at two nursing homes — Clapp’s Nursing Center in Pleasant Garden and Camden Place Health & Rehabilitation — in Guilford County, according to a report issued by the state Department of Health and Human Services. There are currently 76 COVID-19 cases and 15 deaths among residents at Clapp’s Nursing Center and 47 cases and six deaths among residents at Camden Place. There are 21 cases among staff at Clapp’s Nursing Center and 14 cases among staff at Camden Place; none of the staff members at the two nursing homes have died from COVID-19. The report is updated every Tuesday and Friday at 4 p.m.

One person has also died of COVID-19 at Heritage Greens, a residential care facility in Greensboro, according to a death certificate on file at the Guilford County Register of Deeds.

Other nursing homes across the state have been hit even harder than Clapp’s Nursing Center. Treyburn Rehabilitation Center in Durham County has lost 21 residents, while Pruitt Health-Carolina Point in Orange County and the Laurels of Hendersonville in Henderson County have each lost 20 residents. A handful of other facilities in Orange, Franklin, Mecklenburg and Rowan counties are are looking at death counts of 18 or higher.

Many of those who died at Clapp’s Nursing Center and Camden Place, along with the Heritage Greens resident, were in their eighties and nineties, based on death certificates reviewed by TCB. Many also suffered from Alzheimer’s disease, dementia and chronic obstructive pulmonary disease before they contracted the coronavirus.

“We have a baseline population that is experiencing other health issues such as chronic illnesses — cardiovascular disease, stroke, diabetes and cancer — and you’re adding another health challenge that is impacting our negative outcomes for COVID-19,” said Dr. Iulia Vann, the Guilford County public health director, in an interview.

“The majority of the deaths, something like 85 percent, is an older population,” she added. “The majority are having a lot of underlying health conditions, from chronic kidney disease to chronic lung disease. Even when you’re looking at multiple factors, only one thing can completely derail the health of that person.”

But the underlying health conditions of the elderly population in Guilford County only tells part of the story.

The state’s report indicates that Forsyth County has only four COVID-19 cases at two different nursing homes in Winston-Salem — two residents and two staff members — at Oak Forest Health & Rehabilitation and Silas Creek Rehabilitation, but no deaths. Forsyth County also reported an outbreak earlier this week at Trinity Elms, a senior living community in Clemmons, but the facility is not currently on the state list for congregate living settings with COVID-19 outbreaks.

Based on the underlying health conditions of the elderly population, Forsyth might be expected to have more COVID-19 deaths per capita than Guilford. A “community health assessment” published by the public health department in 2017 shows that Forsyth County had the worst outcomes for virtually every leading cause of death among the five largest counties in the state from 2012 through 2016.

Forsyth’s “death rates for heart diseases, cancer (all sites), chronic lower respiratory disease, cerebrovascular disease (stroke), unintentional injuries, pneumonia and influenza, and septicemia were greater than all peer counties for 2012-2016,” the report said.

And while urban counties tend to be healthier overall than their rural counterparts, the community health assessment found that death rates for Forsyth County residents exceeded the state average for chronic lower respiratory disease, unintentional injuries, Alzeimer’s, pneumonia and influenza and septicemia.

Joshua Swift, the public health director in Forsyth County, credited the low infection count and lack of COVID-19 deaths in nursing homes to a proactive approach by his office. When schools closed in mid-March, Swift said, the public health department “repurposed” school nurses, organizing them into teams to act as liaisons to various populations, including detention centers, daycares, the Hispanic community and long-term care centers.

“A small team of nurses provided outreach over the phone, by email and sometimes in person, on best practices to try to help them be prepared if and when they had cases,” Swift said. “They helped them be prepared. We have had a few cases so far, at Oak Forest, Trinity Elms and Silas Creek Rehab. Thankfully, so far, the impact has been minimal. I think it has been helpful to have nurses working with our staff.”

This story has been updated with new numbers from the state Department of Health & Human Services’ report on COVID-19 outbreaks in congregate living settings, which was released on Friday, May 22 at 4 p.m.

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