Gov. Roy Cooper has stopped short of ordering North Carolinians to “shelter in place,” as other highly populated states have done in their battles to slow the fast-moving COVID-19 pandemic.

Still, Cooper took a giant step on Monday toward forcing more residents to join the “stay at home movement” by announcing his plans to sign an order keeping all public schools closed until May 15.

“I know many parents have been expecting something like this,” Cooper said during an afternoon news conference. “Many of you have become homeschool teachers in the last week, and I know this is extremely difficult for you and your children.”

Barber shops, gyms, salons closing

Cooper’s order also will close barber shops, gyms, salons, health clubs, movie theaters and other businesses by 5 p.m. Wednesday where social distancing can be difficult, if not impossible.

Sweepstake parlors, tattoo parlors, bowling alleys, spas and video arcades also are on the list.

Gov. Cooper at a COVID-19, also known as Coronavirus, press conference
Following a March 14 announcement that all K-12 schools will close for at least two weeks, Gov. Roy Cooper said Monday that school closures will remain in effect till May. Photo credit: Liora Engel-Smith.

Additionally, the new order will give law enforcement officers tools to enforce the size of gatherings to no more than 50 people, down from 100 in a previous order.

Developing pay plans for school workers

While Cooper’s order closes schools for in-person instruction of the state’s some 1.5 million students in kindergarten through 12th grade across the state, some facilities will be used as child care centers for health care and other workers deemed essential as the battle against the novel coronavirus extends into the coming months.

Some school districts will provide online instruction during the next month and a half.

Cooper has asked the state Board of Education to develop a plan for paying all public school employees — including cafeteria workers, custodians, bus drivers, aides and more — during this unprecedented time. He’ll seek aid from the federal government as well as state lawmakers who control the purse strings for North Carolina spending plans.

“Over the last couple of weeks we’ve seen more than ever how connected every part of our society and economy are,” Cooper said at the news conference. “As these dominoes have fallen one by one, so have our spirits at times. But I’ve seen truly amazing examples of people caring for each other. Neighbors, friends, pastors, family and even complete strangers.

“Even though we’re keeping our physical distance our connections to one another are more meaningful than ever. Stay strong in those connections or reach out for help if you’re having a hard time. North Carolinians know how to help each other.”

Call your doctor first

As of Monday, the state Department of Health and Human Services reported that 297 people in North Carolina had tested positive for COVID-19, the highly contagious pathogen upending everyday living for the state’s more than 10.4 million residents. Testing has been completed for 8,438 people, and though more supplies have increased the state’s ability to test more people, public health officials no longer are recommending testing for all.

“The proof is in the numbers that the state has really been a leader in testing,” Mandy Cohen, secretary of the Department of Health and Human Services, said Monday. “We’re in the top 10 states of testing that has been done.

“We have tested more than 8,400 people with thousands more with samples collected waiting for results, and this posture means we now have a snapshot of COVID-19 in North Carolina. And we know with certainty that we have what’s called community transmission, meaning we don’t know how some people are getting COVID-19.”

graphic including an image of coronavirus

The role testing has played in the first phase of the outbreak has helped the public health officials understand the virus, Cohen said, explaining that she spoke with thousands of physicians and health care workers across the state over the weekend.

Cohen stressed that patient-physician conversations may include more telehealth connections either online or over the phone. So now instead of testing every person who has a fever or cough, Cohen said the state is encouraging those people with milder symptoms to stay at home. Health care workers don’t want those people with symptoms, but possibly ill with something else, to risk getting COVID-19 by coming into the community. They also worry about further spreading the virus, if the mildly symptomatic have it.

“You can call your doctor to see if you need to be seen at the office or another setting,” Cohen said. “And remember, the vast majority of people who get COVID-19 will have mild illness and recover at home. Your doctor or your local health department or your community health center can help you determine what is the best course of action for you.”

Some people have complained of waiting four to five days for test results. Cooper said some of the lengthy waits were, in part, because the state was in catch-up mode after initial difficulties in getting supplies from the federal government. He urged people to stay at home while awaiting results.

New COVID-19 high-risk guidelines

The Centers for Disease Control and Prevention issued new guidelines on Sunday for who’s at higher risk of the virus.

“This is a new disease and we continue to learn information as it becomes available,” Cohen said as she elaborated on the information put out by the CDC.

The new higher-risk categories include people who are: 65 and older, those living in a nursing home or long-term care facility, people with chronic lung disease or moderate-to-severe asthma; or suffering from heart disease with complications.

The list also includes people at any age with severe obesity, those who are immuno-compromised including those getting cancer treatments, as well as those with medical conditions particularly not well controlled such as diabetes.

The CDC also recommends the monitoring of pregnant women since they are known to be at risk with severe viral illnesses, Cohen said but added: “however to date, COVID-19 has not shown an increased risk.”

Children, in general, are considered to be at lower risk for the infection, Cohen said, but some studies have indicated a higher risk for infants.

Child care centers weigh staying open 

N.C. DHHS Deputy Secretary Susan Harris Perry sent a letter recently to child care center owners and operators emphasizing guidelines around disinfecting spaces and more. Keeping child care centers open is a priority for DHHS, she said, though acknowledging many have decided to close down in light of the looming public health crisis.

“While we are encouraging families to stay home with their children when they can, so that child care options are available for first responders and essential workers – some families really need you, and our economy needs you,” Cohen wrote in a letter to child care center operators “That’s not a new fact. It is just in the spotlight now because we are in a crisis we have not seen before.”

Cohen reiterated recommendations such as frequent hand washing, separating any children who may become sick during the course of the day from others, and cleaning and sanitizing toys daily.

Hydroxychloroquine disappearing from shelves

People suffering from lupus are having trouble getting prescriptions filled for hydroxychloroquine, a potentially life-saving lupus drug that is starting to disappear from pharmacy shelves because of its potential to fight COVID-19.

In a statement released Sunday, the N.C. Pharmacy Board said a large number of health care providers have been writing high-quantity prescriptions for hydroxychloroquine, chloroquine, azithromycin, Kaletra and other drugs that were being tested in the fight against the coronavirus.

The board said the prescriptions are being written for the health care providers themselves, or for family members or others who have not been exposed to the virus. The board, along with the N.C. Medical Board and the state Department of Health and Human Services, are considering rule changes to stop the practice.

Jenny Price, CEO and president of the North Carolina chapter of the Lupus Foundation of America, said some people suffering from lupus have called their local pharmacies to get prescriptions for hydroxychloroquine filled only to be told that they are out.

More state, county offices suspending or modifying services

Many, but not all, county offices across the state are suspending or modifying services as more government services are moving employees to work remotely to slow the spread of COVID-19.

Each day brings new notifications of suspended or changed services, such as today’s update from New Hanover County letting people know that the county Register of Deeds has suspended in-person services. In many places, such as Lee County, county workers are still expected to report to work and available to the public by phone and email during business hours, but in-person encounters are increasingly rare.

A receptionist in the Nash County manager’s office said several hundred workers are at work, but she reported they are limiting how many customers can come into the county service center at any given time.

Many counties, such as Wake County, are maintaining some level of services in their health and social services departments, however, residents are only being seen by appointment, with walk-in services suspended.

And many counties are keeping “essential” court services operating.

Particularly in large counties with many cases of coronavirus, such as Mecklenburg, Buncombe and Wake, many non-essential or public-facing county services offices are now online only.

Orange County has established a call center to answer residents’ questions about COVID-19 and its impact on services in Orange County.

Call (919) 245-6111 between 8:30 a.m. – 5 p.m. to speak to an operator. Spanish language and other languages available.

Some counties are automating for now. For instance, while Dare county offices are mostly closed, the county is automatically renewing Supplemental Nutrition Assistance Program eligibility during March and April for families whose cases are due for review.

One county service that’s being maintained everywhere – trash pickup and other sanitation services.

County websites have all the details about their levels of service.

New flexibility for mental health providers

Due to the COVID-19 outbreak, the NC Department of Health and Human Services is giving increased financial and policy flexibility for providers of mental health, behavioral health and IDD services to continue to treat existing and new patients.

People with mental health disorders may need additional help at a time of increased stress and uncertainty. State health officials want to keep people out of mental health crisis so the emergency medical resources can be used to address the virus outbreak. Meanwhile, everyone should pay close attention to their own mental health during these unusual times. And state health officials want mental health providers to be as accessible as possible to help.

On Friday, DHHS sent a letter to the head of all the LME-MCOs, which manage the state’s behavioral health dollars, outlining policy changes and authorizing them to use up to 15 percent of their reserve funding to support providers. Additionally, $30 million in state funds has been released to support the state’s mental health system in this public health crisis.

“Telehealth policies have moved 10 years forward in 10 days time,” said Kody Kinsley, Deputy Secretary for Behavioral Health & Intellectual and Developmental Disabilities.

NC Medicaid policy changes include:

  • Payment parity for telehealth visits.
  • Allowing all secure technologies for telehealth visits, such as smartphone apps, tablets, etc.
  • Expanding the types of providers who can use and bill for telehealth visits, such as mental health counselors and addiction specialists.
  • Expanding the location of the patient to include community sites and at home.
  • No need for referrals and prior authorizations.

Providers have expressed the need for these changes because they want to continue supporting vulnerable patients but also want to maintain social distancing to stop the spread of coronavirus, especially to high-risk populations.

These changes will be in effect until the end of the state of emergency declaration. These changes are also retroactive to March 10, meaning providers can bill for nontraditional services rendered to patients between then and now.

NC Health News will flesh out more of these changes in a full story later this week.

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