By North Carolina Health News staff
In search of an accurate disease model
As North Carolina works through its first week of a statewide stay-at-home order, state department of health secretary Mandy Cohen cautioned that it’s hard to predict exactly how the outbreak will play out in North Carolina.
Various models for the spread and disease tolls do exist, but models, she said in a press briefing Wednesday, can be wrong because they depend on assumptions. If the assumptions are wrong, so is the prediction the model makes. The department is working with scientists to create a more accurate projection of what’s in store for North Carolina, taking into account factors such as the overall health of the population.
Coronavirus by the numbers
According to DHHS’ data as of Wednesday afternoon:
- 10 people, total in North Carolina have died of COVID-19.
- 1,584 have been diagnosed with the disease. Of those, 204 are in the hospital.
- More than 26,000 tests have been completed thus far, though not all labs report their negative results to the state, so the actual number of completed COVID-19 tests is likely higher.
- Most of the cases (43 percent) were in people ages 25-49. While 19 percent of the positive diagnoses were in people ages 65 and older, seniors make up 70 percent of COVID-19 deaths in the state.
- There are 2,818 ventilators in hospitals across the state, and 691 ventilators are in use, not just for COVID-19 cases but for patients with other reasons for being in the hospital.
A few things are certain, she added, namely people should stay home as much as possible and wash their hands to reduce the spread of the virus.
Marshaling supplies to fight the virus
Responding to coronavirus, state officials have said over and over, requires the allocation of limited resources: masks, gloves, personnel and ventilators. At Wednesday’s press briefing, Cohen reiterated the state is working to allocate equipment, supplies and personnel in the best way possible.
As the spread of the virus accelerates, officials have shifted their focus from testing everyone with symptoms of COVID-19 to focusing on people at greater risk for complications.
State officials have also worked to increase the pipeline of personal protective equipment for hospital personnel. Though North Carolina received several shipments from the Strategic National Stockpile, the state received fewer supplies than requested, said Mike Sprayberry, director of emergency management.
According to N.C. DHHS data, as of Wednesday, the state requested 500,000 N95 masks, for example, but received roughly 312,000 from the federal government in the first two shipments.
Sprayberry said that unlike after a hurricane or other localized national disaster, in this situation, North Carolina is competing with the rest of the country for a very limited cache of supplies, making it difficult to get the quantities that facilities in the state need.
Several manufacturers in western North Carolina, Charlotte and the Triangle are beginning to produce gowns and other protective equipment that may help alleviate the shortage, in part. The state, he said, has been “persistent and relentless” in securing more supplies. -Liora Engel-Smith
Face masks for healthy people
When asked if healthy people should use masks to protect themselves from coronavirus, Cohen said data on how useful they are has been mixed, especially when it comes to homemade masks, whose materials and construction are variable. Homemade masks, she said, can prevent a person from sneezing viral particles into the air, but they are not proven to protect a healthy person from getting the virus.
She added that face masks do not replace the need for frequent handwashing.
“There is a place for masks once we make sure all our health care workers have the masks they need so that they are protected,” she added. -Liora Engel-Smith
Homelessness and COVID-19
The state is working on ways to support homeless people through COVID-19, state health and human services Secretary Mandy Cohen said at Wednesday’s briefing.
Homeless people do not have to comply with Gov. Cooper’s stay-at-home order, but many of them have underlying health conditions that make them vulnerable to complications associated with COVID-19. Social distancing measures have hampered access to clean water and bathrooms for this population, and Cohen said the state is looking to partner with the Federal Emergency Management Agency on ways to address some of the challenges homeless people face, though she did not share specific plans.
“We have learned the hard way through hurricanes about the importance of housing stability through times of crisis, so our teams are working hard on this issue,” she said. “It’s not easy. Housing is a hard issue in the best of times.”
In the meantime, individual counties and organizations have taken some actions to help the state’s roughly 9,300 homeless people. These include Buncombe and Mecklenburg counties reserving hotel rooms for homeless people with COVID-19 symptoms and the city of Greensboro opening a temporary shelter to help unhoused people through the outbreak. -Liora Engel-Smith
Here’s how NC is tracking the virus
Zack Moore, the state epidemiologist, took time this week to explain to media crews across the state how North Carolina will track COVID-19 now that people with mild symptoms are being encouraged to stay home but not seek testing.
The state will modify evidence-based surveillance tools that have been used for decades to track flu and other seasonal epidemics and pandemics. The Influenza-Like Illness Surveillance Network, or ILINET, gathers data each week from clinical sites in North Carolina and across the country, on fever and respiratory illness that their patients are experiencing.
The data can be tweaked to include such symptoms as cough, fever or shortness of breath.
These sites also submit swabs from some of those patients for testing at the North Carolina State Laboratory of Public Health.
The network will now test for COVID-19 in addition to influenza, according to the state Department of Health and Human Services.
Additionally, 126 hospitals in the state report data in real time to DHHS through North Carolina Disease Event Tracking and Epidemiologic Collection Tool, or also known as NC DETECT, through which the state can track respiratory illness across the state and get a better look at ebbs and flows over time.
Public health scientists also will track hospitalizations related to COVID-19 through a variety of resources. They will look at data that hospitals report directly to the state that include the number of patients either in in-patient or intensive-care unit beds with COVID-19 as well as other detailed data that epidemiologists in the state’s largest health care systems are collecting about admissions for respiratory illness. — Anne Blythe
New practitioner rules come from feds
In the midst of the international COVID-9 crisis, a directive that could change the hierarchy of American medical practice came down Wednesday from the federal agency that regulates Medicare and Medicaid.
The Centers for Medicare and Medicaid Services (CMS) announced Wednesday a number of waivers that would allow U.S. providers to respond more quickly and effectively to the virus pandemic. Among them was a provision that would allow trained professionals such as nurse practitioners, physician assistants and certified registered nurse anesthetists to practice without the approval and oversight of a physician.
“Front line healthcare providers need to be able to focus on patient care in the most flexible and innovative ways possible,” CMS supervisor Seema Verna said in a news release. “This unprecedented temporary relaxation in regulation will help the healthcare system deal with patient surges by giving it tools and support to create non-traditional care sites and staff them quickly.”
Members of these professions, also including midwives and advanced practice registered nurses have long advocated for this change, but many physician groups have maintained that doctors’ oversight remains necessary.
Even though the federal Department of Health and Human Services, which oversees CMS, has allowed for these waivers, state laws and rules are not preempted by the federal directive. Although HHS sent a letter to governors, in North Carolina the change in this state still requires either an executive order from Gov. Roy Cooper, or legislative approval, neither of which have materialized.
“One by one, restrictive states are temporarily suspending their restrictions since HHS announced the new guidance,” said Suzanne Wertman, state government affairs consultant for the American College of Nurse-Midwives, who lives in Wilmington. “Louisiana and Arkansas have both waived their rules, Tennessee has already issued a waiver.”
Even as Wertman was speaking to a reporter at 3:30 p.m. Wednesday, she received word that changes were coming from South Carolina. That state has now waived the requirement for advanced practice nurses from surrounding states, North Carolina and Georgia, to travel to South Carolina to practice without finding a collaborating physician first.
That means North Carolina APRNs will be able to treat patients in South Carolina using telemedicine, prescribe controlled substances, and essentially practice independently if they travel to that state. -Rose Hoban and Thomas Goldsmith
Lots of COVID-19 data, all in one place
If you like maps, charts and numbers, the state Department of Health and Human Services has added a new dashboard to its website that it will feed North Carolina data into during the COVID-19 pandemic.
The page shows more than the number of positive test results for the virus that first presented itself in this state on March 3.
It now also shows the number of cases by county, cases and deaths by age, cases and deaths by gender, the known number of available hospital beds, how much personal protective equipment has been requested and how much has been supplied, the number of ventilators in hospitals and more.
Mandy Cohen, the state secretary of the Department of Health and Human Services, announced the dashboard addition at a news conference on Tuesday.
“As you can see we’re trying to share more data today and in the days going forward,” Cohen said. “Continue to look back to our website as we continue to add additional data points this week and throughout our response effort. Our goal, really, is transparency. We continue to find the right balance between expediency and accuracy.”
“And,” she said lightheartedly, “if someone can find a few more hours in the day that would help us, too.”
As of Wednesday morning, the dashboard showed that 70 percent of the state’s 10 deaths were people who were older than 65, but that age group represented only 19 percent of the people who had tested positive for the virus.
Forty-three percent of the positive tests were for people ages 25 to 49. — Anne Blythe
See a social-distance problem? Don’t call 911
Mike Sprayberry, the state’s director of emergency management, urged North Carolinians on Tuesday to call 911 only in emergency situations.
The centers are extremely busy during this pandemic, Sprayberry said.
“Please do not call 911 to report instances where you think social distancing is not being observed,” he implored. “If we all do our best to stay home and maintain social distancing, these calls will not be necessary.”
The state has set up a 211 call center and text service to provide answers to thousands of questions such as where to get food, where available motels are and how to get help as this pandemic upends everyday living.
As of Tuesday, 60,000 people were signed up for texts about the COVID-19 pandemic, Sprayberry said. — Anne Blythe
Figuring out child care in your house? Here’s some help.
Many health care and other critical workers are struggling to find dependable care for their youngest children during this pandemic, especially with public schools shut down until at least May 15. A third of day care centers are temporarily closed, according to the state health department.
UNC Health polled its medical workers and staff recently and found 80 percent in need of child care preferred to have a babysitter, nanny or volunteer come to their house, if possible.
But that can open up other questions, such as how to protect everyone, from caregivers to families, and how to keep the spread of coronavirus at bay.
To help, UNC Health and infectious disease experts at the UNC Gillings School of Global Public Health developed recommendations to guide parents on the safest ways to bring in outside caregivers to the home. The detailed guide, free to all, helps parents determine if a caregiver is a good fit (Questions to consider include: Are they in a high-risk category? Are they working in other households?) and also what to do if someone in the home develops symptoms consistent with COVID-19.
Not everyone can afford or find in-home child care, of course. To address that, N.C. Department of Health and Human Services Secretary Mandy Cohen released a short video this week encouraging critical workers unable to find child care to call a DHHS hotline, 1-888-600-1685, for help. The state is also covering the cost of childcare for many lower-income families. — Sarah Ovaska
Nurses can get tuition, fees break for online refresher course
Trained and licensed nurses who have been out of the field but want to jump back in to help during the COVID-19 pandemic can do an accelerated refresher course this month at a reduced rate.
The UNC Chapel Hill has waived tuition and fees during the month of April for an online, self-paced Registered Nurse Refresher theory course being offered through the UNC-CH Friday Center for Continuing Education, UNC-CH School of Nursing and the North Carolina Area Health Education Centers Program.
The fees for the clinical portion of the course cannot be waived, according to a UNC-CH news release.
Typically, the theory portion of the class takes nine months to complete, but the time has been truncated as a way to help the state better attack the virus with the needed bolstering of its health care workforce.
The course is not only for retired nurses who want to rejoin the workforce. It’s also for nurses with active nursing licenses looking for a refresher and update on current practices.
Though interested nurses can take the online course at their own pace, they must finish the work within three months.
“This pandemic underscores an urgent need for experienced health care professionals across our state,” said Nena Peragallo Montano, dean of the UNC School of Nursing. “We’re hopeful that by offering this fast-track program and making it more accessible we can help nurses across the state as they continue serving North Carolinians in our fight against coronavirus.”
Recent industry data and projections show North Carolina is expected to have the second-largest shortage of nurses in the nation by 2025, according to the news release. That would be a deficit of nearly 13,000 nurses, according to the release.
Nurses who want to apply for the program and waived fees can visit nurserefresher.web.unc.edu/covid-19 for more information. — Anne Blythe
Fort Bragg coronavirus cases no longer revealed
Fort Bragg will no longer release the number of COVID-19 cases reported at the Army post in Fayetteville.
Fort Bragg officials said in a statement that it and all other military installations are following Department of Defense guidance “to protect Operational Security.”
“The individual services will provide total numbers of service members with COVID-19 at the service level, while the Department will continue to provide the department-wide numbers,” the statement says. “In keeping with our commitment to transparency, we will continue to work closely with our surrounding communities.”
Fort Bragg’s cases will continue to be rolled into counts in the counties where military personnel with the coronavirus live. Fort Bragg plans to restrict visitor access to the post beginning next week. – Greg Barnes