North Carolina Health News
North Carolina Health News. News. Policy. Trends.

Expert: Insurance Pain Coming for NC Businesses, Workers

By Ann Doss Helms

Charlotte Observer

Employees can expect to see more high-deductible health policies as employers try to control costs, a health researcher and former journalist told members of the Charlotte Chamber Friday.

And North Carolina’s economy will suffer from state lawmakers’ decision not to take federal money for Medicaid expansion, said Ceci Connolly, managing director for PricewaterhouseCoopers’ Health Research Institute.

“It’s not a political commentary,”  said Connolly, a former health correspondent for the Washington Post and author of a book on the Affordable Care Act. “It’s pure dollars and cents.”

Connolly was a keynote speaker at the Charlotte Chamber’s health care summit, which drew about 450 people to the Westin Hotel. The event marked the chamber’s Healthy Charlotte fitness campaign and its push to market Charlotte as a national health care destination for patients and businesses.

Hospitals, doctors’ offices and other health care businesses employ more than 116,500 people in the Charlotte region and generate more than $6.2 billion in annual wages, the chamber reported.

But Connolly said those businesses lost out on “a serious revenue opportunity” when the state refused the Obamacare offer to expand Medicaid coverage for low-income residents with federal money. North and South Carolina are among 21 states that opted not to participate this year, leaving 689,000 low-income N.C. residents in a “Medicaid gap” without coverage.

“Your industries are suffering because you’re not getting the increased business,” she said.

Fellow panelist Georges Benjamin, executive director of the American Public Health Association, agreed that this wasn’t a smart business decision: “Business people know the first principle of business is not to leave one dime on the table.”

Benjamin, a physician and former Maryland health secretary, told the chamber crowd that federal Medicaid money could have been used to improve mental health services, a need described earlier in the session by John Santopietro of Carolinas HealthCare System. “The beauty of Medicaid is it is run by the states,” Benjamin said. “They can do this. The governors can be creative.”

Several local speakers talked about efforts to control health care costs while improving care. Connolly said she expects to see employers take a leading role in coming years. One likely strategy, she said, is a continuing shift to high-deductible policies that hold down premiums by requiring patients to pay a bigger chunk of medical bills from their own pockets. Such policies force employees to think about spending their own money more wisely, Connolly said.

Technology is likely to play a role in helping patients take charge of their own health, from insurance companies offering online cost comparisons to a burgeoning industry in devices that monitor vital signs and exercise, several speakers said.

Connolly, who was wearing a wristband that monitors her steps, said she envisions a day when that data would feed to her doctor’s office so the doctor would be aware of changes in activity.

Read more here: http://charobshealth.blogspot.com/2014/08/expert-pain-coming-for-nc-businesses.html#storylink=cpy
Read more here: http://charobshealth.blogspot.com/2014/08/expert-pain-coming-for-nc-businesses.html#storylink=cpy

Survey: Insurance Rates Lag in Health Law Holdout States

By Eric Whitney

Kaiser Health News

A Gallup poll released Tuesday says that the Affordable Care Act is significantly increasing the number of Americans with health insurance, especially in states that are embracing the law. It echoes previous Gallup surveys, and similar findings by the Urban Institute and RAND Corp.

The latest Gallup survey found that, nationwide, the number of uninsured Americans dropped from 18 percent in September 2013, to 13.4 percent in June 2014. States that chose to follow the ACA’s provisions most closely, both by expanding Medicaid and establishing their own new health insurance marketplaces, as a group saw their uninsured rate drop nearly twice as much as states that declined to do so.

“Those states that have not embraced those two major mechanisms have had about half of the decline in uninsured,” said Gallup’s Dan Witters. “So there’s a clear difference in the states that have implemented those mechanisms versus those who haven’t.”

North Carolina’s rate of uninsurance dropped 3.7 percent from 20.4 percent to 16.7 percent, according to the survey. North Carolina did not expand Medicaid. Arkansas saw the biggest decline in its uninsured rate, from 22 percent to 12 percent. Kentucky, Delaware and Colorado also saw significant declines.

“To drop 10 percent in the uninsured rate within really just six months is really an incredible achievement,” said Arkansas Surgeon General Dr. Joe Thompson. Thompson lobbied for his state’s unique, bipartisan Medicaid expansion, which uses federal funding to buy private insurance for low income people. He says about 80 percent of those with new, private insurance in Arkansas purchased it with Medicaid subsidies.

“Clearly we are having an impact that benefits our citizens,” said Thompson. “Those other states that have chosen not to make something good happen out of the Affordable Care Act are missing that opportunity on behalf of their citizens.”

Among the states that didn’t expand Medicaid or set up their own exchanges are Georgia, Indiana and Mississippi, all of which saw their uninsured rates drop less than 2 percentage points.

Sam Mims, a Republican state legislator from southwest Mississippi, said the Affordable Care Act is still not the right way to go for his state.

“Access to health care is not expanding Medicaid,” Mims said.  “I still believe Mississippi cannot afford it for several reasons. Mainly from a financial standpoint we simply cannot afford to expand Medicaid and we will not expand Medicaid.”

He said the legislature is taking steps to expand access to health care, such as allocating more money to federal clinics, expanding mental health clinics and working on programs to get more doctors and dentists to the state.

Not every state that expanded Medicaid saw big drops in the percentage of uninsured. Massachusetts and Hawaii  saw declines of less than 1 percentage point, for example. Gallup’s Witters said that’s because those states already had very low uninsured rates prior to the ACA.  California, which fully embraced the law but has a higher number of uninsured than any other state, saw a decrease of 5.3 percentage points in its uninsurance rate, according to the survey.

Kansas saw its uninsurance rate pop up by 5.1 percentage points, and Virginia and Iowa also saw slight increases in their uninsurance rates that were within the poll’s margin of error of plus or minus 1 to 2 percentage points.

The telephone poll was part of the Gallup-Healthways Well-Being Index, and it included more than 178,000 people interviewed in 2013 and more than 88,000 people surveyed in the first half of 2014.

Jeffrey Hess of Mississippi Public Broadcasting contributed to this report.

This story originally appeared in Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Legislature Will Hold Coal Ash Bill Until November

By Gabe Rivin

The General Assembly will wait until November to try to pass a bill that addresses coal ash, a toxic byproduct of coal-fired electricity that has contaminated subsurface water across the state.

Governor Pat McCrory, at a legislation-signing event in 2013. Legislators have introduced a bill that mirror's McCrory's coal-ash plan. Photo courtesy of the Governor's office

Gov. Pat McCrory at a legislation-signing event in 2013. McCrory will have to wait until at least November to sigh coal ash legislation. Photo courtesy of the governor’s office

Gov. Pat McCrory will have to wait until at least November to sign coal ash legislation. In the meantime, he issued an executive order Friday afternoon to hire personnel and begin groundwater assessments at the state’s 14 coal ash sites.

Legislators, delayed by a lengthy debate on the state’s budget, left little time to finish their work on coal ash. Instead, they will return for a special session in November. In that session, they’ll attempt to finish work on coal ash and a reform of the state’s Medicaid system.

A bill to address coal ash had been a high priority among legislators during this year’s short session, which began in May and will end Saturday. The February spill of coal ash into the Dan River galvanized members of both chambers, who watched as an estimated 39,000 tons of ash turned the Dan a pale gray.

The Senate passed its version of a coal ash bill on June 25, and the House passed its version on July 3. Both bills would require Duke Energy to close its 33 unlined ash ponds by 2029.

Both chambers’ bills have been controversial among lawmakers and environmentalists. The House’s bill, for instance, contains a provision that some said would undermine a judge’s order that Duke immediately clean up its groundwater contamination. The House bill would also allow Duke to request an extension for the closure of its sites, a provision that was not included in the Senate’s bill.

The two chambers had been negotiating a compromise bill for several weeks in a conference committee. But that work fell apart, according to Senate leadership, after three of the four House conferees tried at the last minute to insert new legislative language.

“This last-second surprise provision had not been researched, vetted or debated by the 167 other legislators,” said a press statement from Sen. Phil Berger (R-Rockingham), the Senate’s Pro Tempore, and Sen. Tom Apodaca (R-Hendersonville), the chairman of the Senate’s Rules committee.

A map showing the 14 coal-ash sites across North Carolina. Duke Energy now owns Progress Energy's former sites. Graphic courtesy N.C. DENR

A map showing the 14 coal ash sites across North Carolina. Duke Energy now owns Progress Energy’s former sites. Graphic courtesy N.C. DENR

Environmentalists said that Duke is already obligated to clean up the contaminated groundwater near its ash ponds and that the new legislation would allow the utility to delay its work.

“State environmental officials don’t need any additional action from the legislature to allow them to demand a comprehensive cleanup that stops the rampant pollution of rivers, streams and groundwater, and leaves communities at risk,” said Amy Adams, an organizer with the environmental group Appalachian Voices, in a press statement.

The N.C. Department of Environment and Natural Resources, in fact, has sued Duke, citing current law that requires Duke to clean up contaminated groundwater.

Coal ash is produced when coal is burned for fuel. For decades, Duke has stored its ash in unlined ponds. Those ponds have leached the ash’s elements into groundwater, which nearby residents rely upon for drinking water.

The ash contains a number of toxic constituents that are known to harm humans.

The General Assembly’s debate over coal ash has at times been bitter. In the House, members fought to classify their districts’ ash ponds as highly hazardous, which would have required Duke to close those ponds first.

In the end, both chambers’ bills only classified four sites as high risks, leaving a new commission to approve designations for the remaining 10 sites. The environmental requirements, and the deadlines to close the sites, would depend upon the sites’ classifications as low risk, medium risk or high risk.

Autism Insurance Bill Likely to Die in Session’s Final Days

A bill that would allow children with autism to get health insurance coverage for treatment that passed the House over a year ago looks like it won’t make it across the finish line in the current General Assembly session.

The bill
, which would require treatment called applied behavioral analysis to be covered by insurers, was passed by the House of Representatives in May of last year.

Advocates looking to convince lawmakers to pass the autism insurance measure roamed the halls of the General Assembly to speak to legislators early in July.

Advocates looking to convince lawmakers to pass the autism insurance measure roamed the halls of the General Assembly to speak to legislators early in July. Photo credit: Rose Hoban

Applied behavioral analysis has been shown by research to be one of the most effective treatments in helping children with the disorder to be “mainstreamed” into schools and society.

ABA is covered in more than 35 states, including South Carolina, but North Carolina lags behind.

According to the Centers for Disease Control and Prevention, one in 68 children are diagnosed with autism spectrum disorder, and it’s almost five times more common in boys than girls.

After pushing unsuccessfully both last year and this for Senate movement, House lawmakers rolled the provision into SB 493, a 46-page regulatory reform bill that was referenced to committee after passing the second and third reading in the House.

Advocates had hoped the autism insurance provision would be included in the final budget; but with the release of last night’s document, their hopes were dashed.

“We’re very saddened by that, to be honest with you,” said Jennifer Mahan, vice president for governmental affairs for the Autism Society of North Carolina.

“The services that have demonstrated efficacy are behaviorally based,” said Susan Hyman, a researcher from the University of Rochester in a video interview published today on MedPage Today. She said one recent study demonstrated that “naturalistic” services, such as ABA, which takes place in the home and would have been covered by the bill, are the most effective at helping children with autism.

“We know from new data that’s been published that children who have optimal outcome are diagnosed earlier … and have earlier access to evidence-based behavioral service,” Hyman said.

Mahan said the lack of action has been “incredibly disappointing” for families who have kids who would benefit from getting the coverage.

“It’s looking like it’s not going to happen. I don’t say it won’t happen until everything’s over and the gavel falls,” Mahan said. “But it’s not looking good right now.”

Health Care Budget Briefs: Epi Pens, Tanning Beds, Raise the Age

By Jasmin Singh, Hyun Namkoong, Rose Hoban

As lawmakers worked behind closed doors this week to put the finishing touches on this year’s budget revision, health care advocates and lobbyists were walking the halls, holding conversations with key lawmakers where they could. They were hoping to induce movement on a number of bills that have been parked in obscure legislative committees, some for more than a year.

The final budget bill includes some of the measures of concern to health care lobbyists, but some came away disappointed.

School epinephrine pens

A bill passed by the House last year would have provided for schools to supply epinephrine auto-injector devices in every school.

EpiPen on a thigh

EpiPens are designed to administer a dose of epinephrine into a thigh through clothing, if necessary. Image Greg Friese, flickr creative commons.

The devices allow for quick treatment of severe allergic responses, whether it be to a peanut or the venom of a bee sting. The most serious kind of reaction is called anaphylaxis, a rapid onset of hives, throat swelling and low blood pressure. Untreated, anaphylaxis can quickly proceed to death.

The bill has been waiting for action by the Senate since last year.

The budget released late last night includes a provision to have schools obtain epinephrine injection devices and train several staff members in how to use them in case of an emergency. An earlier version of the budget introduced by the House included the same provision.

The original bill was one of many sponsored by Rep. Jim Fulghum (R-Raleigh), a physician who died earlier this month from complications due to cancer.

Youth skin cancer prevention

Another bill co-sponsored by Fulghum last year and passed by the House would restrict teens under 18 years old from using tanning beds – a measure legislators were convinced would reduce the number of premature cases of skin cancer.

tanning bed, Image courtesy flickr creative commons, Evil Erin

Tanning bed. Image courtesy flickr creative commons, Evil Erin

Initially, the bill faced stiff resistance from the tanning bed industry, but the industry has since withdrawn opposition to the bill.

This bill is a response to the growing number of skin cancer cases in the country’s youth. The Centers for Disease Control and Prevention reports that in 2012, 61,061 people in the United States were diagnosed with melanomas of the skin – 35,248 men and 25,813 women. The research also shows that young people who begin tanning before the age of 35 have a 59 percent higher risk of melanoma, the deadliest form of skin cancer.

Nonetheless, the measure has been languishing for more than a year, and it looks less likely that tanning bed regulation will become law at the end of this legislative session.

Initially, the bill was standalone, but after a year of inaction by the Senate, House budget writers wrote the provision into their version of the budget. That bill stalled, and House lawmakers then rolled the tanning bed bill into a larger regulatory reform bill, SB 493.

In a recent version of the budget, the statutory language banning teen use of tanning beds was included; but in the final version released late Wednesday evening, the language was gone.

“It’s a sad irony that we received the news about the North Carolina tanning bed bill the same week as the U.S. Surgeon General issued a national call to action on skin cancer,” wrote Brent Mizelle, head of the N.C. Dermatology Association, in a statement Thursday morning.

Raise the age

Historic legislation that would allow 16- and 17-year-olds to be charged as minors rather than adults in the criminal justice system passed the House in May after failing multiple times in the past decade.

handcuffsNorth Carolina and New York are the only states in the country that automatically try 16- and 17-year-olds as adults in the criminal justice system.

But almost two months after overwhelmingly passing muster in the House, the bill continues to languish in the Senate. Advocates and lawmakers in favor of the bill argue that North Carolina juveniles are unfairly subjected to the negative economic impact of a criminal record.

They also point to findings from the National Prison Rape Elimination Commission that show that 16- and 17-year-olds placed in adult prisons have the highest risk for sexual abuse, more than any other group of incarcerated people.

Advocates worried privately that the troubles resolving the budget would result in the bill remaining stuck in the House. But they said they were determined to return to Raleigh next year to keep pushing for the measure.

UPDATED: Child Fatality Task Force in the Crosshairs – Again

An amendment to the technical corrections bill sponsored by Rep. Grier Martin (D-Raleigh) that eliminates the language repealing the Child Fatality Task Force was adopted in the North Carolina House Friday morning.

Rep. Paul Stam (R-Apex) supported the amendment, which he said “arose like Aphrodite from the sea foam of the Aegean.”

Stam’s seatmate Rep. Charles Jeter (R-Huntersville) also said he couldn’t understand why anyone would want to eliminate the task force.

“I saw in the newspaper the other day something about child welfare in North Carolina and how poorly we rank,” Jeter said. “I can’t imagine that repealing this is the right thing to do.”

The amendment passed 87-4.

By Rose Hoban

Karen McLeod spent the late afternoon Thursday knocking on doors at the General Assembly.

McLeod, who is the co-chair of the legislative Child Fatality Task Force, was looking for Republican lawmakers to help keep the panel from being eliminated as written into the annual “technical corrections” bill.

That bill, which had its debut Thursday morning, is usually reserved for changing grammatical errors deep in statutes or repealing obsolete local laws. But lawmakers often insert small “poison pill” pieces of legislation into the bill: For example, last year’s technical corrections bill changed the structure and completely changed the board of the North Carolina Institute of Medicine, making all of the members political appointees.

This year’s bill repeals the statute establishing the Child Fatality Task Force, sunsetting the body in July 2015.

graph showing 20 year decrease in child death rates

Graph shows a 20-year decrease in child death rates over the life of the Child Fatality Task Force. Data courtesy NC Child Fatality Task Force

The body has been in existence since 1991.

“It’s a 55-page bill,” said Rep. Paul Stam (R-Apex), when McLeod asked him to help her save the body. “You can’t fault me for missing a line.”

The task force’s elimination was contained in an innocuous line in the bill that reads: “SECTION 22.(a)  G.S. 7B‑1401(4), 7B‑1402, 7B‑1403, and 7B‑1412 are repealed,” and striking through references to the task force in other lines of the statute.

Stam has been a member of the CFTF for the past two years, and he gave McLeod a nod.

The bill will be heard on the House floor Friday morning.

Unexpected

“This was very unexpected,” McLeod said.

During the closing days of the 2013 session, there was also a measure floated to eliminate the task force. But that effort was opposed by several members of the House, including the late Rep. Jim Fulghum (R-Raleigh), who died last week. Fulghum, a physician, was also on the task force.

“Last year, we thought that the legislature had decided that it was of value when the decision was made to continue,” McLeod said. “We were just very surprised to see this language come back.”

McLeod rattled off a list of legislative accomplishments since the creation of the committee in 1991, including regulations around bicycle helmets and seat belts, strengthening the child-abuse response system, anti-poisoning measures and programs to reduce the infant mortality rate.

“It has helped crate a tremendous focus on improving outcomes for kids and reducing fatalities,” she said.

McLeod made the point that all of the members of the task force – including McLeod, who leads a group that advocates for policies to help children and families – are volunteers. The only expenses for the task force are for one employee who has a salary of $62,585.

“We have been able to harness experts from all over the state that give of their time to look at systems and policies and practices to determine what changes are needed to continue to drive down fatalities,” she said. “It would be a huge loss for us to lose the task force.”

Despite a precipitous drop in deaths of children under 17 years old and historically low infant mortality rates, North Carolina continues to lag behind other states in child death.

“To lose the momentum and the energy and the focus that has been created over the years of the task force, would be a tragic loss,” McLeod said.

She also bemoaned the loss of Fulghum, who fought to save the task force last year.

“He was a brilliant man who understood from a medical perspective what was in the best interest of children. In addition, he understood the political as well as the policy components across a myriad of services that drive outcomes,” McLeod said.

“He understood that there’s no silver bullet, you need multiple approaches to change the rate of fatalities in kids.”

Rep. Jim Fulghum Dead at 70

The retired neurosurgeon was a freshman representative who spent most of his time in the legislature focused on health care issues.

By Rose Hoban

Several weeks ago, word started floating through the General Assembly on Jones St. that Rep. Jim Fulghum (R-Raleigh) was seriously ill. But no confirmation of the rumors came until a member of the House of Representatives asked on the floor about Fulghum’s condition.

Rep Jim Fulghum (R-Raleigh) speaks with Cary group home resident Robert Bullock at the rally outside the General Assembly Wednesday afternoon.

Rep Jim Fulghum (R-Raleigh) speaks with Cary group home resident Robert Bullock at a rally outside the General Assembly in 2013. Fulghum became involved in the effort to save funding for group homes for people with mental illness. Photo credit: Rose Hoban

“He is ill, and I would ask you to keep him in your prayers,” responded House Speaker Thom Tillis (R-Cornelius).

The same day, July 3, Fulghum filed a letter with the state board of elections withdrawing his candidacy for this fall.

This weekend, Fulghum’s family announced he died from complications related to cancer. He was 70 years old.

“As a medical doctor, Jim had a professional and personal passion for helping those in his community and state. Wake County and all of North Carolina lost a great man today,” wrote Gov. Pat McCrory in a statement Sunday.

Fulghum was instrumental in pushing through the House a number of bills related to health care, in particular children’s health, which included a bill to assure newborns are tested for heart disease and one restricting access to electronic cigarettes. He also helped save the state’s Child Fatality Task Force from elimination during last year’s budget fight.

In a statement, Tillis wrote that Fulghum’s “leadership as a legislator was second only to his compassion and expertise as a doctor serving his constituents and the state of North Carolina.”

Fulghum also co-sponsored a bill banning tanning bed use by teens and one to provide epinephrine pens in North Carolina schools. Both bills passed the House last year but continue to languish in the Senate.

“Not only did we lose the expertise of our only physician legislator, we lost a strong advocate for North Carolina’s children,” said Annaliese Dolph, a lobbyist who represents advocates for children and people with disabilities. “Rep. Fulghum was a very kind person and will be sorely missed.”

Fulghum was planning a run for the state Senate to replace long-serving Sen. Neil Hunt (R-Raleigh), who is retiring this year. After Fulghum’s withdrawal, Wake County Republicans chose John M. Alexander Jr. as a replacement candidate.

Walking to D.C. to Save Belhaven Hospital

What seemed to be a promising agreement between Vidant Health Systems, the NAACP and the town of Belhaven to keep Vidant Pungo hospital open has failed. Efforts are now underway to re-open the hospital in Belhaven.

By Hyun Namkoong

Adam O’Neal is a man on a mission. The Republican mayor of Belhaven walked for almost 20 miles in the pouring rain yesterday from Plymouth to Merry Hill to get to Washington, D.C., where he hopes to talk to lawmakers about the June 1 closure of the Vidant Pungo hospital.

If everything goes as planned, his 14-day, 273-mile trek on foot will put him in the nation’s capital on July 28.

What had been championed as a “historic agreement” between the NAACP and Vidant Health System to transfer ownership of the hospital from Vidant to a community-based board has fallen through, and the NAACP has re-filed a Title VI complaint to the U.S. Department of Justice.

Both phone and email inquiries to several Vidant representatives were unanswered Tuesday evening.

The NAACP asserts in the re-filed Title VI complaint that the closure of the hospital would affect “poor African American and Latino residents of Beaufort and Hyde counties.”

Portia Gibbs' family maintains she died waiting in an ambulance because the closest hospital, Pungo Regional, has been shuttered.

Portia Gibbs’ family maintains she died waiting in an ambulance because the closest hospital, Vidant Pungo, has been shuttered. Portrait screenshot from YouTube video

Title VI of the 1964 Civil Rights Act “prohibits discrimination on the basis of race, color, and national origin in programs and activities receiving federal financial assistance.”

During a press call on the second day of O’Neal’s walk to D.C., he and Rev. William Barber, president of the N.C. chapter of the NAACP, said that people will die as a result of the hospital’s closure. They asserted that 48-year-old Portia Gibbs was the first person to die from delayed care since the hospital’s doors shut.

“A lady spent an hour in the back of a paramedic’s ambulance in Swan Quarter, North Carolina instead of being transferred to Belhaven,” O’Neal said. He said it would have taken 25 to 30 minutes to get the woman to Belhaven.

According to O’Neal and Gibbs’ family’s statements on a YouTube video, she died waiting for a helicopter to airlift her to Norfolk, Virginia.

With the closure of the hospital in Belhaven, the nearest emergency room to Gibbs’ home in Hyde County is 75 miles away. There is no hospital in Hyde County.

Barber cited delays in both delivering information and the $1 million grant from Vidant to facilitate the transition process, as well as Pantego Creek LLC’s unexpected decision to not cooperate with the transfer of ownership, as key reasons for re-filing the Title VI complaint on June 24.

Pantego Creek LLC is the organization created in 2011 that entered into an agreement with Vidant to assume control of the hospital. The LLC informed the community-based board on June 16, two weeks before the date of the mutually agreed upon transfer of ownership, that it would not transfer control of the hospital to the board.

Barber said that he and O’Neal have signed and sent letters to state leadership including Gov. Pat McCrory and Speaker of the House Thom Tillis asking for help, but have yet to receive a reply.

O’Neal said that he supports Medicaid expansion and that it would’ve helped the hospital and the residents of Belhaven.

“We are serious about this issue,” Barber said. “We are asking for the federal government to use its muscle and stop [Vidant] from doing what will cause irreparable damage onto this community.”

What Bites In St. Lucia Doesn’t Stay In St. Lucia

By Hyun Namkoong

Chikungunya virus is as foreign as it sounds, but the Centers for Disease Control and Prevention has already confirmed seven cases of this unwelcome guest in North Carolina.

Chikungunya outbreaks have been largely confined to Africa, Asia and Europe. But in 2013, the virus made its way over to the Americas, first showing up in the Caribbean and then latching onto unwitting American tourists least expecting a case of chikungunya on their holiday. According to the Pan American Health Organization, the Caribbean outbreak is now at about 355,000 suspected and confirmed cases centered primarily in Haiti and the Dominican Republic, Guadeloupe and Martinique, as well as a handful of cases each in Trinidad and Puerto Rico.

commonly known as the Asian Tiger mosquito, Aedes Albopictus is capable of transmitting chikungunya. Photo courtesy Wiki

Commonly known as the Asian tiger mosquito, Aedes Albopictus is capable of transmitting chikungunya. Photo courtesy Wikimedia creative commons

Aedes Albopictus (commonly known as the Asian Tiger mosquito)  engorged from having a blood meal.

Aedes Albopictus engorged from having a blood meal. A. Albopictus are capable of transmitting chikungunya and are endemic throughout the Carolinas. Photo courtesy Wikimedia creative commons

The chikungunya virus is transmitted through infected mosquitoes. The virus has no known vaccine or cure, and although it isn’t lethal it can be painful. Common symptoms include fever and joint pain. Most people feel better within a week, but for some the joint pain can last months, even years.

Hopping on a plane is easier now than ever before, and public-health officials are cautioning travelers to prepare for more than an exchange of culture when they cross borders. The N.C. Department of Health and Human Services is advising North Carolinians who visit tropical islands or other nations where the virus is known to exist to see a doctor if they start feeling any symptoms of chikungunya within two weeks of returning home.

According to the Trinidad Express newspaper, James Hospedales, executive director of the Caribbean Public Health Agency, said the outbreak appears to be spreading to one new country per week.

According to DHHS, “There is no evidence that any mosquitoes in North Carolina carry the chikungunya virus,” and confirmed cases have been people who traveled to the Caribbean or other infected areas.

But it is possible for the virus to get transmitted into local mosquitoes, which could result in an outbreak of chikungunya across the state. The Aedes albopictus, better known as the Asian tiger mosquito, is commonly found in North Carolina and could transmit the virus to humans.

Though it may be unlikely that the state will be swarmed by chikungunya-infected mosquitoes, the old public-health adage “better safe than sorry” is why DHHS is advising residents to take preventative measures against chikungunya by making breeding conditions less favorable for mosquitoes.

These measures include throwing out standing water, keeping gutters clean and using screened doors and windows. People are also advised to avoid being outdoors in the morning and early evening when the Aedes mosquito is most aggressive.

ASIAN tiger mosquito distribution map

Map courtesy Centers for Disease Control and Prevention, 2013.

UPDATE: On July 17, CDC officials announced the first confirmed case of chikungunya acquired without travel to the Caribbean. A man in Florida was diagnosed with the disease who had not recently traveled outside the country.

“CDC officials believe chikungunya will behave like dengue virus in the U.S., where imported cases have resulted in sporadic local transmission but have not caused widespread outbreaks,” said an agency press release.

“None of the more than 200 imported chikungunya cases between 2006 and 2013 have triggered a local outbreak. However, more chikungunya-infected travelers coming into the U.S. increases the likelihood that local chikungunya transmission will occur.”

Lawmakers Call for Action on Reducing Suicides

By Jasmin Singh

The North Carolina House of Representatives passed a resolution Wednesday authorizing legislative staff to study ways to prevent suicide among minors and veterans in the state.

Lawmakers listened as Rep. Carla Cunningham (D-Charlotte), one of the resolution’s sponsors, struggled to contain her emotions as she described her son’s struggle with mental illness and developmental disabilities.

Rep. Carla Cunningham (D-Charlotte). Official NCGA portrait

Rep. Carla Cunningham (D-Charlotte). Official NCGA portrait

“My experience of my son’s suicidal ideation and unpredictable paranoid behavior at a young age was quite difficult for a young mother like myself,” Cunningham said.

The resolution’s easy passage means it’s more likely the legislature will fund a study of the issue during the interim period before next year’s long session, which begins in January.

In North Carolina, there were a total of 3,536 suicides and 19,754 self-inflicted injury hospitalizations between 2009 and 2011, according to “The Burden of Suicide in North Carolina,” a report prepared by the state Department of Health and Human Services in 2013.

The resolution recommends requiring health care providers to complete training in suicide-assessment treatment and management as part of their continuing-education requirements. Other professionals, such as social workers, educators and coaches who are in contact with people at risk for suicide, would also have to be trained in prevention.

Cunningham said people that care for loved ones with suicidal thoughts go through difficulties on a daily basis.

“I was reminded of the loneliness and the frustration many families endure during these unpredictable times,” she said. “This journey is a difficult walk, and I still today cannot understand what my son experienced in his mind or what his thoughts were day to day.”

A complicated issue

Rep. Grier Martin (D-Raleigh), a veteran of the war in Afghanistan, addressed the issue of suicide among military personnel.

“As you expect, folks deployed to a combat zone are suffering from suicide,” Martin said. “But we are finding out that those deployed to a noncombat zone are also suffering.”

Between 2009 and 2011, a total of 505 North Carolina veterans died from suicide, with a suicide rate 150 percent that of the general population, according to the DHHS report.

Rep. Craig Horn (R-Weddington), also a veteran, said that while leading a first-aid group in the military, he saw too many lives lost to suicide.

“You lift down a guy you’ve just been on parade or maybe worked with just an hour ago,” he said. “I had to take him down from a shower stall where he had taken his own life.”

Horn said war is a terrible thing, but that there was something much worse.

“The most terrible thing is to be without hope,” he said. “There are those out there – friends, family, neighbors, people we meet on the street – that are actually living a nightmare inside themselves.”

About a third of veteran suicide victims were receiving treatment for mental illness at the time they took their lives, the DHHS report said.

Map of suicide rates for ages 10 or older by North Carolina county of residence (2009-2011).

Map of suicide rates for ages 10 or older by North Carolina county of residence (2009-11). Map: NC DHHS

Too many young people

Rep. Beverly Earle (D-Charlotte) said an alarming number of young people are committing suicide.

“Suicide and suicidal behaviors are serious problems in the community,” she said. “They can be devastating and detrimental to the victim and to the families.”

According to the DHHS report, among young people between the ages of 10 and 24 there were 422 suicides and 5,167 self-inflicted injury hospitalizations between 2009 and 2011.

More than half of suicides among youth and young adults were carried out using firearms.

“This isn’t a bill about guns, but it is about guns,” Earle said.

“Even more disturbing, in my opinion, is a survey that shows one in every five high school students has considered suicide and one in 12 has attempted,” she said.

The most common circumstance for victims aged 10 to 24 was a crisis within the past two weeks. Mental health circumstances were also common in youth and young adults, including a depressed mood, with almost a third having a current mental health problem and around a third having had mental health treatment in the past.

‘Many others that walk this journey’

Cunningham said she is still learning from her son’s battle.

“I just know that I was allowed to walk this journey with him to a place of hope, courage, lighthearted laugher, smiles and eventually adulthood,” she said.

Cunningham said she is grateful for the help she received for her son but knows there are “many others that walk this journey.”

“Some finish the journey and survive, and others endure the hurt and loss,” she said.

Rep. Chris Whitmire (R-Rosman) said there is some good news.

“Most suicide victims do illustrate symptoms that if recognized can lead to some interventions that ultimately can mitigate or prevent the devastating effects,” he said. “This is an awareness of a means to potentially prevent great tragedy.”

Cunningham said lawmakers should become “the beacon of light” to protect those most vulnerable – youth and veterans.

“Let us seize the moment to lift the burden of suicide in North Carolina by educating as many health care providers, police officers, educators, social workers, clergy and community advocates that touch the masses of the people of our great state,” she said.

North Carolina suicides 2009-11:
Statewide – 3,536
Youth – 422
Veterans – 505

Self-inflicted injury hospitalizations 2009-11:
Statewide – 19,754
Youth – 5,167

Self-inflicted injury ED visits 2009-12:
Statewide – 38,605
Youth – 13,331

Source: “The Burden of Suicide in North Carolina”

About NC Health Beats
National stories with a Tarheel twist, keeping up with emerging trends, keeping our fingers on the pulse of North Carolina health.
Tweets by @NCHealthNews