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North Carolina is moving into a new attack phase against the novel coronavirus, COVID-19, that has been upending almost every aspect of daily life for more than two weeks.

North Carolina has its first known case of COVID-19 spreading through community contact, Gov. Roy Cooper announced on Thursday. That case is in Wilson County, where local health department workers could find no known contact through travel or an individual who already had tested positive for the contagious pathogen. That means the state will move from a containment strategy to one focused more on mitigating the fast-changing situation in North Carolina.

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“This is an expected, but still unfortunate benchmark in this new pandemic,” Cooper said at an early afternoon news conference.

Because such spread was expected, Cooper said, the state took early actions to put mitigation practices and controls in place last week.

“The decisions we make and the actions we take now will help determine how we fare in the end,” Cooper added. “These are life or death decisions that government leaders pray that we never have to make. … We have to work to see around corners if we are going to combat this virus effectively.”

With expectations of a surge of new cases, Cooper said, the state’s public health experts and emergency management team are identifying additional medical facilities that can be used if needed, finding protective gear for health care workers, as well as pushing out testing supplies and establishing sample collection sites across the state.

“I can’t stress enough how much our state and the rest of the country will need the federal government to step up with testing supplies, equipment and ventilators,” Cooper said. “We are managing our resources and we are ahead of other states, but we can expect many more patients.”

From containment to mitigation

Mandy Cohen, secretary of the state Department of Health and Human Services, explained what will happen as North Carolina enters its mitigation phase, and that could mean people who are experiencing mild symptoms that can accompany COVID-19 won’t get tested.

Many hospitals have stopped doing elective surgeries and Cohen is encouraging all to follow that trend. As Cooper said, the impact of the virus on North Carolina “will get worse before it gets better.”

She urged people to continue practicing social distancing guidelines that were offered earlier this month with expectations that the virus would spread. People 65 and older with underlying health conditions, pregnant women and others considered to be among the more vulnerable should take extra precautions and stay home when possible.

“Our individual actions matter,” Cohen said, adding that the goal continues to be to keep from overwhelming the health care system with too many critically ill patients.

“Testing for people with mild illness will also become less important as we transition to this next phase,” Cohen said. “We will begin to deploy other surveillance methods to understand the spread of virus and drive our decision-making.”

While urging all to heed the public health workers’ advice, Cohen also tried to ease some worries. “I know this can be a challenging time but it’s important to remember that most people who will get COVID-19 will have a mild illness and will recover at home,” Cohen said.

Calling all health care workers

As COVID-19 spreads, Cohen said she will be soliciting help from health care workers who might not typically be on the front lines fighting the pandemic.

“Not everybody works in hospital settings,” Cohen said. “There are other clinics that are going to be closing their doors or just doing telehealth kind of visits, and so we want to know who’s available in this fight.

“We may have to deploy resources, people, to different parts of the state to respond.”

Cohen said she will be sending out a letter in the next day or two to nurses, doctors and other health care workers across the state to gauge how many people will be available as part of a volunteer corps.

That could include recent retirees.

On March 11, the North Carolina Medical Board met to consider rules that would allow any physician or physician assistant who had inactivated their North Carolina license to practice within past two years to be reactivated.

“This rule allows them to say, ‘I want to get a temporary license’ and the board would quickly reactivate them, likely within 48 hours,” said Jean Fisher Brinkley, the communications director for the board.

With the first case of community-transmitted coronavirus, health care systems are gearing up for a potential surge in demand for care due to a rapid spread of COVID-19.

When asked about retirees, who would likely be older and thus in the high risk group, Brinkley said that no one is going to ask someone in the high risk group to be out there caring for potentially infected patients.

“With the move toward telehealth, for example, there will be the opportunities for medical professionals to be offering care, so they’re not in a position where they’d be likely to be exposed,” she said.

Unemployment claims strain system

With bars, restaurants and other small businesses taking a financial hit during the pandemic, North Carolina has seen thousands of new claims for unemployment benefits come in.

By midday Thursday, state officials said they had received 18,000 claims within the past day and a half, up from routine rates of 3,000 per week.

To help process the large increase in claims, the Division of Employment Security tried to enhance its computer servers Wednesday night and plans to hire as many as 50 new workers, at least temporarily, to help clear people for the assistance and get the aid to them as quickly as possible.

Assistant Secretary for Employment Security Lockhart Taylor said Thursday that those out of work and employers can list COVID-19 as a reason for layoffs, and that should expedite things.

Reduce prison population, prisoner advocates plead

A coalition of organizations working in the criminal justice system sent letters to Gov. Roy Cooper and others on Thursday urging the state to reduce its prison population during the COVID-19 pandemic.

The organizations asked the state “to take necessary steps that include releasing people from jails and prisons who are not a threat to public safety, reducing the number of new people entering the system, and protecting the health of those currently incarcerated.”

The coalition includes the American Civil Liberties Union of North Carolina, Center for Criminal Justice and Professional Responsibility at Duke Law, Community Success Initiative, Conservatives for Criminal Justice Reform, Disability Rights North Carolina, Emancipate NC, Forward Justice, North Carolina Justice Center, and North Carolina Prisoner Legal Services.

“People in prisons, jails, and detention centers are uniquely vulnerable in this moment of a public health emergency,” Chantal Stevens, Interim Executive Director of the ACLU of North Carolina, said in a statement. “People in confinement have no control over their own movement and are held in close quarters without adequate resources for hygiene, creating the perfect conditions for the dangerous spread of COVID-19.

“It is essential that all government officials follow the recommendations from public health experts to stem the spread of the coronavirus in our communities by protecting the health and safety of incarcerated people, medical staff, and correctional officers.”

Expand Medicaid, advocates say, as COVID-19 looms

The encroaching pandemic underscores the need to expand Medicaid coverage now in North Carolina, advocates say. More than 150 businesses, local government agencies, advocacy and community groups sent a joint letter Thursday to Gov. Roy Cooper, N.C. House Speaker Tim Moore and N.C. Senate leader Phil Berger.

Cooper, a Democrat and proponent of expansion, has been at odds with Moore and Berger, Republican leaders of the state legislature over the measure, their standoff over the issue has left the state without a budget since July.

Signatories include the N.C. Institute of Medicine, N.C. Alliance of YMCAs and the Child Care Services Association. The letter asked for fast action on Medicaid expansion and warned fatalities could result from people without health care spreading COVID-19 on to others.

“Many of our state’s uninsured are in public-facing jobs such as childcare workers, nursing homes aides, cashiers, farmers, restaurant employees, and those in other hospitality industries,” the letter stated. “Not only are these workers at a heightened risk of infection due to a high-contact environment, but their risk of unintentionally transmitting the virus to others is high as they are uninsured and unable to access critical care and treatment that addresses complications and symptoms if infected.”

North Carolina is one of 14 states that has not expanded Medicaid coverage to low-income, single adults, people largely unable to access affordable health insurance on their own and ineligible for other safety net programs. The state also has the 9th highest rate of uninsured people in the nation, with 10.7 percent of North Carolinians going without health insurance, according to U.S. Census estimates.

COVID-19 freeway signs

North Carolina drivers may have noticed that digital overhead road signs across the state now carry an unusual message that has nothing to do with traffic delays. The North Carolina Department of Transportation debuted the “Latest on COVID-19 NCDHHS.gov” message on Wednesday afternoon, said DOT spokesman Jamie Kritzer.

“We take COVID-19 very seriously and everybody has to do their part,” he said. “And for our part, DOT is using these highway messages as a way to educate the public because we know everyone is wanting as much information as they can get on COVID-19 and we want them to get the right information.”

State and federal guidelines allow the DOT to deploy the signs to transmit information in emergencies, Kritzer said, but it’s the first time in at least 20 years the department has used that prerogative for a national emergency. Other states, including Ohio and California, have rolled out similar initiatives.

The COVID-19 message now appears on overhead boards on interstates, federal and state highways all over North Carolina, he said, and on most department’s 337 overhead message boards.

Flexibility requested for Medicaid

The N.C. Department of Health and Human Services has asked federal authorities for a waiver from certain Medicaid and NC Health Choice policies as COVID-19 bears down on the state.

Read more about how some North Carolina medical providers are handling the switch to telehealth here.

If the request made Wednesday is granted, the waiver would:

  •  Lift length of stay limits and facility access rules, allowing hospitals to have more treatment beds and longer patient stays
  •  Allow alternate settings for care, including home visits

Additionally, the state asked for some temporary flexibility for populations covered by prior Medicaid waivers including the Innovations Waiver program, which serves those with intellectual or developmental disabilities; Community Alternatives for Disabled Adults; Community Alternatives for Children; and Traumatic Brain Injuries.

Those requests included:

  •       Removal of dollar and stay limits
  •       Expand the types of locations where treatments can be administered
  •       Ease requirements for personal care plans and in-person meetings

All of NC DHHS’ waiver requests can be viewed here.

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