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By Rose Hoban
Lawmakers on the health care working group of the House Select Committee on COVID-19 had another sobering meeting to collect information on the state’s response to the coronavirus pandemic which has upended life across the globe.
Working group co-chair Rep. Josh Dobson (R-Nebo) said the group is still trying to get their arms around all of the ways that COVID-19 has affected parts of the health care system. In text messages to NC Health News, he said there is yet no timetable for action beyond the scheduled April 28 date for the General Assembly to return to Raleigh for the “short” legislative session.
“We definitely have to work with the department to prioritize what can be done on the state level,” Dobson said.
He said there are at least 10 to 15 groups that still want to make presentations to the working group and make them aware of their many challenges in responding to the pandemic.
“We broke the topics down into acute problems and short and long term,” said co-chair Rep. Carla Cunningham (D-Charlotte). “Right now we’re focused on what’s acute, we’re not sure how much we can do about it, but we’re thinking most about things like PPE, ventilators, protecting staff, having enough health care providers.”
Policy changes requested
Once again lawmakers heard from state health and human services Sec. Mandy Cohen who ran down the laundry list of how her departmental workers have been scrambling to respond to the crisis in the past week since the group last met.
“We’re at 1,584 [cases] as of this morning, with a little over 200 hospitalizations, and now up to nine deaths,” Cohen told legislators who were meeting remotely. “I think we have seen a slight slowing in the daily increase in cases which is good, but still, we’re growing.
“We have definitely increased the amount of hospitalizations over the course of this week. We went to very few being hospitalized to now over 200 with a number of them being in the intensive care unit.”
One administrative move the DHHS has accomplished is the submission of waivers to the federal Centers for Medicare and Medicaid Services to loosen requirements for receiving health care services.
The first waiver, called an 1135 waiver, allows for critical access hospitals to increase their number of beds over the statutory limit of 25 and allow for longer lengths of stay by patients. That waiver also allows for easier access to oxygen and other supplies for people discharged from the hospital and gets providers into the Medicaid billing system more quickly.
She also told lawmakers that her department submitted an emergency 1115 waiver that would allow the state to extend Medicaid benefits to people who earn up to 200 percent of the federal poverty level. If the federal government granted this waiver, it would, in effect, sweep in all of the potential beneficiaries who would have received services had North Carolina expanded Medicaid.
“Just to remind you, when we submitted 1115, we were asking for the flexibility and that’s the flexibility to spend money, it is not an allocation of dollars,” she told lawmakers. “We still have to come back to you all and work through the budget pieces of this. So you don’t need to commit to anything in the 1115. But it takes quite some time to get to approval.”
She said that a number of states had submitted such 1115 waivers, but she also said that CMS potentially will sit on the waiver application to see what other states ask for.
“The other use of the 1115 is essentially a disaster relief, a pool of money that would allow for a lot of flexibility and matching of dollars,” Cohen told lawmakers. “As you all are thinking through what you are thinking about your budget… I’ll give it as an opportunity to actually match our state dollars for things we’re likely going to be spending on anyway, whether it’s covering uncompensated care costs, for our hospitals or other kinds of expenses that our health care system is going to need.”
The federal CARES Act, passed last month to provide economic relief to states, temporarily increased the federal matching rate for Medicaid programs. This will lower the cost for North Carolina to provide care and shift some of those expenses to federal coffers.
Models looking dire
Cohen also told lawmakers that her department has been working with statisticians and other mathematicians to model when the surge of coronavirus cases will start hitting North Carolina hospitals, potentially overwhelming them.
“There are a number of models that are circulating out there, some are more rosy, some are very dire,” Cohen said. “I think ground truth is probably somewhere in the middle.”
The team they’re working with has been looking at several models, she said, trying to predict when the surge of coronavirus patients will come, when the peak will come.
“Models are only as good as the data you can feed into it, the assumptions you can make and things are changing so rapidly, that it’s a moving target,” she said. Cohen said she hoped to share some of their assumptions in next week’s meeting of the working group.
“It’s gonna be more like a weather forecast meaning probabilities of things happening rather than precision of like, ‘here’s when the peak is going to be, here’s how many beds we’re going to need’ and the probability of us outstripping our medical capacity, at what time given other factors.”
One of Cohen’s main concerns and preoccupations is the acquisition of enough personal protective equipment for health care workers, especially those in close contact with COVID patients.
She said that the hoped-for federal help is unlikely to come.
“There was an announcement last night that the federal government and the Strategic National Stockpile is essentially out of supplies at this point, which is obviously incredibly worrisome,” she said. “So, we have been working on procuring these items from around the world ourselves. Hospitals have been doing it. It is not an easy task because we’re all competing for those same scarce resources.”
Explosive outbreak in Mecklenburg County
As if Cohen’s update was not sobering enough, Mecklenburg County Health Department director Gibbie Harris presented a grim outlook on the coronavirus outbreak in her area.
“Our first positive was on the 11th of March,” Harris told lawmakers. “As you can see we have accelerated pretty quickly.”
As of Thursday morning, Mecklenburg had 493 cases total with three deaths, an increase from one to close to 500 in only 20 days.
“We have increased by 190 cases over the last four days,” Harris said.
Part of the increased number was a result of increased testing, she said, even as their tests are lagging in getting results back to her department. She also said they were testing people who were most at risk.
One in five of those cases has been hospitalized, she said. “We see a number of folks who were hospitalized, improved and then had to go back.”
Harris said that her department only has seven communicable disease nurses to do contact tracing and other management of the many cases in a population of more than a million. So her department has started training school nurses to do some of the work and conduct investigations.
She also noted that it’s been vital to get people, in particular young people, to take her department’s messaging about social distancing seriously.
“Unfortunately, well, fortunately, the weather was wonderful this past weekend, everybody had the opportunity to get out, but our parks were packed,” she said.
People were playing basketball, which puts them into close contact, children were playing on the equipment, which could be a vector for transmitting the coronavirus. Harris had to make the call to close parks and restrict access.
“We’ve used influencers in social media to get to the younger community around HIV, and we’re starting to use those avenues to try to communicate more effectively with that population,” she said.
‘Needing your help’
Harris said that she’s been working with data scientists from UNC Charlotte to predict what their “epidemic curve” would look like and how much of a patient surge hospitals in the Charlotte/ Mecklenburg area would have and when it would occur.
“We believe that we’re a little bit ahead of the curve that we’re seeing in the state,” she said. “But we also are trying to look at what the stay-at-home order and that social distancing might do to impact that.
“I will tell you the numbers that I’m seeing right now, based on the limited data we have and the fact that this situation is changing daily, it’s what’s keeping me up at night,” Harris said.
At that point in her presentation, Harris began to cry.
“Our ability to serve our community is going to be based on the support that we get from the federal and the state government,” she said through tears. “We are going to be needing your help.”
She noted that soon the rest of the state will catch up to Mecklenburg. Not long ago, Mecklenburg had half of the state’s cases. Now that number is only a third, as more counties in the state identify people infected with the disease.