By North Carolina Health News staff

Health care providers serving the neediest lose out on federal aid

Mandy Cohen, secretary of the state Department of Health and Human Services, echoed what many have pointed out throughout this pandemic.

“This crisis is magnifying cracks that have long existed in our health care system,” Cohen said. “We ignore them now at our own risk.”

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Cohen has written a second letter to Alex Azar, the federal secretary of Health and Human Services, asking him to support the doctors, nurses, hospitals and other clinicians who treat the more than 2 million people that North Carolina serves with its Medicaid program, as well as the 1 million North Carolinians without health insurance.

HHS and CMS Letter 04 28 2020 From NC DHHS (Text)
Almost $100 billion from the first round of provider relief fund for the COVID-19 pandemic response has been allocated, Cohen said.

“But it was divided up in a way that greatly advantaged health providers who mostly see patients with private and employer-based health insurance or Medicare, those patients over 65,” Cohen told reporters in an afternoon briefing. “It disadvantaged those health care providers willing to serve the people most in need, those serving Medicaid and the uninsured.”

The allocation formula established a situation in which providers who see mostly people with private or employment-based insurance received twice as much as those, such as many rural hospitals, who care for those least able to pay for their health care.

“Our safety net providers already operate on the thinnest margins,” Cohen said. “So they are most at risk of closure due to lost revenue and new costs related to COVID-19. The last thing anyone wants during a public health crisis is fewer providers on the front lines.”

In North Carolina, six out of 10 children are enrolled in Medicaid or Health Choice, a program for children and families whose incomes are slightly more than the limit for Medicaid but not high enough to afford private insurance.

Many pediatricians, obstetricians and behavioral health providers across the state take care of these people but are getting less in federal aid.

“These ongoing financial strains are exacerbated because North Carolina has not expanded Medicaid,” Cohen said on a day when the North Carolina General Assembly convened for a brief session to deal with COVID-19-related issues. “That’s the one thing our state could do right now to protect families and to put our rural hospitals and providers on strong financial footing.”

Gov. Roy Cooper, a Democrat, has been in a budget stalemate through last year and this over whether to expand Medicaid. Cooper supports it. The Republican-led General Assembly has resisted expansion.

U.S. Congress has allocated another $75 billion to the provider relief fund, and Cohen has asked Azar to change the allocation formula so $50 billion, 30 percent of the total $175 billion in the provider fund, would go to providers for whom Medicaid and uninsured people make up at least 25 percent of their patient population.

Cohen reached out earlier during the pandemic to Azar to approve an emergency waiver that makes it possible for more people to get Medicaid during a disaster.

“While it would be more fiscally prudent for the state to just expand Medicaid,” Cohen said, repeating a phrase she has said often since becoming DHHS secretary in 2017. “In its absence, we are asking for the federal government to approve a temporary change to cover prevention, testing and treatment related to COVID-19, and for the flexibility to create our own provider relief fund to further assist providers in weathering the COVID-19 storm.”

Cooper told her other governors and health and human services secretaries have similar suggestions.

“We’ll push and see what we can get done,” Cooper told her. — Anne Blythe

Will modeling play as large a role in phased reopening?

When Gov. Roy Cooper extended the statewide stay-at-home order through May 8, he revealed metrics that he and state public health leaders are tracking as they look to ease social distancing measures in three phases.

Cooper and his team want to see the sustained testing of some 5,000 to 7,000 people daily, as well as have 500 contact tracers who can help track down people who might have been close to someone who tested positive for the virus.

One day after the Carolina Community Tracing Collaborative was formed through a partnership with the state health department, Community Care of North Carolina (CCNC) and the North Carolina Area Health Education Centers (NCAHEC), more than 1,000 job applications have been filed, said Mandy Cohen, secretary of the state Department of Health and Human Services.

“When we get this going well, that’s going to allow us to ease these restrictions,” Cooper said. “Because if we get this testing and tracing humming along, which is what we want to do, then that means we can be better protected as we ease restrictions across the state and go through these phases.”

To get to the first phase of easing social distancing restrictions, Cooper and Cohen have said they want to see 14-day declines in the number of people testing positive for COVID-19 over the percentage tested. They also said they wanted to see fewer case numbers for people showing up at emergency rooms with symptoms of the virus.

Additionally, they want to see a steady leveling of the number of hospitalizations or a decline.

In recent weeks, protesters with political or personal motivations have come to the state capital on Tuesdays to urge Cooper to reopen the state while more than 600,000 people have filed for unemployment benefits.

A crowd of people near the General Assembley in Raleigh. They are protesting coronavirus restrictions
Several hundred protesters descended on Raleigh Tuesday to urge lawmakers to “reopen” the state without modifications. After demonstrating in front of the legislative building, protesters moved to the Governor’s mansion several blocks away where a handful of demonstrators were arrested by Raleigh police. Photo credit: Rose Hoban

Some have tried to poke holes in the governor’s decisions by showing modeling changes or questioning the scientific data and evidence.

In early April, scientists affiliated with Duke University, RTI International and the University of North Carolina at Chapel Hill revealed the results from modeling that they had done showing that North Carolina’s hospitals would be overwhelmed with patients infected with COVID-19 by Memorial Day if the state lifted all social distancing measures on April 30, the day after the initial stay-at-home order was to expire.

The scientists, who were not hired by DHHS nor the Cooper administration to do the modeling, have not publicly presented an updated projection, but Cohen said she expected that soon.

Cohen and Cooper stressed that the phased reopening would be based on the metrics and data they are getting from testing and hospitals.

“That modeling is not some of the information that we are using in terms of moving to reopening,” Cohen said. “It does help us for planning purposes, and I think has been helpful as we think about the kinds of things that our hospitals need to do, in particular, in thinking about our surge planning. Luckily we haven’t needed to use those plans, but I think it’s been helpful for us to do that kinds of surge planning that our hospitals have been able to do and now we are going to keep those plans activated so as we move through these phases we can make sure we have the medical capacity we need.” — Anne Blythe

Saluting the National Guard

Gov. Roy Cooper took a moment to thank the National Guard for all the help moving supplies and getting the state ready to handle any hospitalization surges and food supply shortages brought on by the COVID-19 pandemic.

Mike Sprayberry, director of Emergency Management, gave the National Guard a shout-out on Monday.

“Without missing a beat,” Cooper said, “these 939 men and women that I’ve activated have been there when we need them. Always ready, as their mission explains.”

Gen. Todd Hunt, head of the North Carolina National Guard, and Cooper had a call on Monday with Mark Esper, the U.S. Secretary of Defense. They thanked the secretary for the partnership with North Carolina, particularly for their help with food supply and logistics.

“We agreed to continue to work together to keep our military personnel battle ready,” Cooper said.

The National Guard has helped pull in such supplies of personal protective equipment to the warehouses and then getting them shipped out across the state.

So far, they have conducted 242 missions, traveling more than 45,000 miles to reach 77 counties, Cooper said.

Gen. Allen Boyette is leading the food supply chain work group, which meets daily to ensure that grocery stores continue to be stocked. It’s also monitoring the supply of food available to North Carolinians.

Army and Air Guard medical personnel also have been put at the ready to assist if the state needs to use the Sandhills Regional Medical Center for people not infected with COVID-19. That once-shuttered hospital would be used if area health care systems become overwhelmed with infected patients and have too few beds to care for others.

“I’m proud of them. I’m grateful for them,” Cooper said. “I can rest just a little bit easier knowing that they are always ready when we need them.” — Anne Blythe

Coronavirus by the numbers

According to NCDHHS data, as of Tuesday morning:

  • 342 people total in North Carolina have died of coronavirus.
  • 9,568 have been diagnosed with the disease. Of those, 463 are in the hospital. The hospitalization figure is a snapshot of people with coronavirus on a given day and does not represent all of the North Carolinians who may have been in the hospital throughout the course of the epidemic.
  • More than 112,000 tests have been completed thus far, though not all labs report their negative results to the state, so the actual number of completed coronavirus tests is likely higher.
  • Most of the cases (40 percent) were in people ages 25-49. While 24 percent of the positive diagnoses were in people ages 65 and older, seniors make up 86 percent of coronavirus deaths in the state.
  • 85 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities.
  • There are 2,978 ventilators in hospitals across the state and 669 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital.

Coronavirus pandemic drives changes at the NC General Assembly

No public. No lobbyists. No touring school children. Few staffers. Even fewer lawmakers.

Usually, when the North Carolina legislature is in town, hordes of people roam through the General Assembly building in downtown Raleigh. It’s not uncommon to turn a corner to find several dozen fifth graders surrounding an elderly representative, or clutches of lobbyists hogging the tables and chairs in the building’s four courtyards.

But on Tuesday, the building was empty. When both the House and Senate met, their chambers were sparsely attended. Most of the chairs in the two chambers will stay empty through the oh-so-short session taking place this, and perhaps next, week.

In the House, the dozen or so members in attendance voted on temporary rules that will allow for social distancing.

The rules “will also allow members who are in at-risk categories, have spouses, children, parents who are in at-risk categories to still fully participate, even ask questions through the majority and minority leaders, and yet be able to vote from a safe distance,” said House Democratic leader Rep. Darren Jackson (D-Raleigh). Jackson spoke to reporters while wearing a mask that had a North Carolina flag sewn onto the front of it.

Any House debate on the spending and policy bills generated from House COVID-19 working groups will be funneled through a laptop on Jackson’s desk and for Republicans, one on the desk of majority leader Rep. John Bell (R-Goldsboro).

Members can sit on the floor, but for the most part, they will stay in their offices and stream the session. If they want to ask a question or put up a point for debate, they’ll message either Jackson or Bell, who will then present the question to the larger body.

graphic including an image of coronavirus

Instead of votes taking place in 15 seconds, they will last for 40 minutes. Members will be permitted onto the floor of the chamber in four waves, so they can cast their votes in person, or they can message their vote to their party leaders.

“This is like a science fiction movie,” said House Speaker Tim Moore (R-Kings Mountain). “Just as folks in their personal lives, families and businesses, same too in government, we’ve had to make adjustments as well.” – Rose Hoban

Midwives given some latitude during COVID-19 emergency

In a meeting of a committee that regulates certified nurse-midwives on Monday, the midwives were given some ability to continue practicing even if the physician who collaborates is no longer available.

In the weeks since the federal COVID emergency declaration, federal regulators advised states to give so-called mid-level practitioners more latitude in their practices. For instance, in 26 states and Washington, DC, certified nurse-midwives can practice independently, but in states such as North Carolina, these professionals can only practice if they have a contractual relationship with a physician.

Under current North Carolina rules, if a certified nurse-midwife’s “supervising” physician dies or decides to no longer work with the CNM, that midwife’s license is essentially voided.

Such a situation is a concern for Nicole Winecoff, who co-owns the Natural Beginnings Birth and Wellness Center in Statesville. Winecoff’s facility has a relationship with an older obstetrician/gynecologist who she said is at risk for complications from COVID-19 because of his age.

“My partner and I thought we had at least 45 days to find a new physician, but that’s not written into the law anywhere,” Winecoff said.

Winecoff spoke at the meeting of the Joint Midwifery Committee on Monday to urge them to waive the current rule. The committee eventually voted to allow CNMs 45 days to find someone new. However, the waiver will only last through the summer.

“It’s a step in the right direction,” said Suzanne Wertman, a Wilmington midwife who is the state government affairs consultant for the American College of Nurse-Midwives. “Right now, just like always, we have challenges with accessing maternity care and the pandemic has brought that need into sharp focus.”

Winecoff said her practice has been flooded with new patients who are now afraid to go to a hospital to give birth.

“We’ve had calls for people trying to schedule into our practice,” she said. “The fear is that small hospitals will close because they’re not financially sustainable and it will decrease access to care in small rural communities.

“We could lose our physician, or lose our hospital.”

Golden Leaf awards community colleges $500,000

The North Carolina Community College system has helped educate and train some of the nurses, nurse aides, paramedics, cardiovascular sonographers and others so crucial during this pandemic.

A new stream of financial aid is available for students in economically distressed or tobacco-dependent rural counties that are affected by the COVID-19 disruption.

The Golden Leaf Foundation, established in 1999 to distribute half of North Carolina’s share of tobacco settlement money, has awarded the North Carolina Community College System $500,000 to create a pandemic-related scholarship fund.

Students have until June 20 to apply for the funds. They should do so through the financial aid office of the school they attend.

The campuses participating in the program are: Bladen, Blue Ridge, Brunswick, Cape Fear, Carteret, Central Carolina, Coastal Carolina, Craven, Davidson County, Durham Technical, Edgecombe, Fayetteville Technical, Forsyth Technical, Halifax, James Sprunt, Lenoir, Martin, Mayland, McDowell Technical, Montgomery, Pamlico, Piedmont, Pitt, Richmond, Roanoke-Chowan, Robeson, Sampson, South Piedmont, Southeastern, Southwestern, Stanly, Surry, Wayne and Wilson community colleges; Caldwell Community College and Technical Institute; and College of the Albemarle.

The state’s community colleges, as well as universities and K-12 public schools, have moved to online classes during the pandemic. Hardships brought on by that move, as well as the hundreds of thousands of jobs lost through the closure of businesses, have created barriers for some students as they try to continue their education.

“We are grateful to Golden LEAF for its support of our students during this time of great need,” Peter Hans, president of the NC Community College System, said in a statement. “Many students have encountered significant financial hardships resulting from the pandemic. The Golden LEAF Scholarship COVID-19 Funds will help students continue their educational journey and succeed in their career goals.”

— Anne Blythe

UNC-G professor researches link between selenium levels and COVID-19 recovery 

Selenium levels in a person’s body could correspond to the fight against the novel coronavirus, according to recently published research by a UNC-Greensboro biochemistry professor.

Selenium is a  mineral found in soil that is naturally present in many foods. Most healthy people have adequate levels of selenium, but low levels of the trace mineral have been associated with malnutrition as well as poor prognosis in other viral infections, such as HIV.

UNC-Greensboro biochemistry professor Ethan Taylor joined an international group of scholars in publishing research today that found survival rates were higher in cities in China’s Hubei province that had more naturally occurring selenium. The study ran in the American Journal of Clinical Nutrition.

Taylor’s research discovered one Chinese city — Enshi, with some of the highest selenium intake levels in the world —  saw three times as many people recover from COVID-19 infections as in other cities in the Hubei province, where the dangerous pathogen first emerged. The study noted that though the research pointed to an association between selenium and survival from COVID-19, further study was needed.

“A role for selenium may also explain phenomena such as the recently reported blood clotting in COVID-19, because selenium is known to have an anti-clotting effect,” Taylor said in a news release about the study.

He and his China-based co-author, Jinsong Zhang, have long studied the effects of selenium on viral infections, even presenting research in 2003 that suggested selenium played a positive role in how a person responds to SARS, a viral cousin to the COVID-19 pathogen.  – Sarah Ovaska 

Mental health moment

Ever get the urge to dress up just to take out the garbage or put on anything  other than sweats, shorts, yoga pants or pajamas? Try to outdo this rare fashionista.

The Superb Lyrebird, an Australian songbird, owns its reputation of being the fanciest in the world.

YouTube video

Its talents go beyond the showy, too. Its song scope is amazing — from mimicking the kookaburra sitting in the old gum tree  to sounding like a camera shutter and even a chainsaw. Have a listen.  — Anne Blythe

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