By North Carolina Health News staff
Opening too soon?
North Carolina saw its largest daily jump in lab-confirmed cases of COVID-19 a day before social distancing restrictions will be eased slightly.
The Thursday count was 639 more positive cases than Wednesday, pushing the state to a total of 13,397 lab-confirmed cases across 99 of North Carolina’s 100 counties.
Mandy Cohen, secretary of the state Department of Health and Human Services, was asked whether the hike in cases concerned her given that many state parks will be opening over the weekend with more people hiking and visiting outdoor areas.
“We did have our largest day over day increases,” Cohen said. “We continue to watch these trends closely. As you know, we were already trending up in our case numbers. When we earlier in the week put together our overall look at where we are in North Carolina, our scorecard, if you will, there was already a red X on cases. We knew we were trending up. For me, as I think about whether we are ready to ease restrictions, we really have to look at the full picture of all of those metrics.”
Cohen and her team consider more than only the total number of positive cases. She has said they’re weighing that number against the percentage of positives among all the people getting tested.
“We know that we have been ramping up our testing, we’re doing more testing,” Cohen said. “Yesterday was something like 8,000 new tests, and you saw a percent positive of that stay pretty low. Six percent, seven percent for day over day.”
Given the limitations of too few testing supplies and personal protective equipment in the early weeks of the pandemic, North Carolina was not doing as much testing as public health officials wanted. Tests were reserved for those with severe symptoms, as well as workers on the front lines working in health care facilities, emergency management and other critical roles.
Now, Cohen and her team are encouraging anyone who thinks they might have the virus to get tested after calling their doctor or county health departments.
“We know we are not perfect,” Cohen said. “We know this virus is here with us. That is why as we move forward, we didn’t say let’s throw open everything all at once. We said we have to take a measured approach.”
The modified stay-at-home order that takes effect at 5 p.m. Friday allows people to leave their homes for more retail options, such as bookstores, flower shops or clothing outlets where customers will be standing mostly and not sitting in close proximity to anyone for more than 10 minutes.
Parks also are permitted to reopen. The modified order encourages them to do so but does not require it.
When out and about, Cohen and her team remind people to follow the three Ws: wear face coverings, wait six feet apart from one another, and wash their hands. The more vulnerable — those with underlying conditions making them more likely to get serious complications from the virus or people 65 and older — should weigh their personal risk factors before venturing out.
“We want folks to get exercise and get outside,” Cohen said in response to reports that trailheads and parks might be crowded over the weekend. “If you go to a park and you notice it’s very crowded and that makes you feel uncomfortable, maybe there’s another spot for you to check out, to explore.
“I really hope that we can all be good neighbors and citizens to each other,” she added. “If we see there’s a narrowing in a path, you know, step over to the side, let folks pass and try not to be gathering close together. I’ve seen that collegiality already here just as I walk on the greenway here in Raleigh or down the sidewalk in my neighborhood.” — Anne Blythe
Federal relief money flows to health providers statewide
Hospitals and health care providers across the state will get some federal relief for their losses courtesy of the federal government.
The Coronavirus Aid, Relief and Economic Security (CARES) Act, passed by Congress in late March and signed into law by President Donald Trump, has about $100 billion in assistance for hospitals and public health agencies.
In the first wave of payments to hospitals, an initial $30 billion has made its way to states. About $12 billion went to almost 400 hospitals across the country that had provided for more than 100 patients through April 10. In North Carolina, that was four hospitals receiving a total of about $79 million.
The bill also mandated payments to hospitals that treat a high percentage of low income and uninsured patients. In North Carolina, that meant an additional influx of almost $30 million to hospitals meeting those criteria.
Finally, the bill stipulated funding for rural hospitals hard hit by the need to suspend elective procedures and located in areas where residents are typically older, poorer, less well-insured and have more pre-existing conditions. For North Carolina, that meant $282 million went to 254 rural entities providing care, including rural acute care general hospitals and Critical Access Hospitals (CAHs), rural health clinics and community health centers.
This map shows the total allocations coming to North Carolina by Congressional delegation. (For example, a hospital system operating across the state or across several districts may have received a lump sum to the billing organization located in one congressional district, even though the providers are operating across several districts.) – Rose Hoban
Contact tracing contract questions
When Health and Human Services Secretary Mandy Cohen announced a partnership last month with Community Care of North Carolina and the North Carolina Area Health Education Centers for the Carolina Community Tracing Collaborative, she said extensive COVID-19 tracing would be important in the months ahead.
In the first day alone, some 1,000 people applied for the 250 jobs that will be spread out across the state. Tracers will call people who have been in contact with someone who has tested positive for the virus to let them know of a need to get tested. In some cases, tracers might have to visit the homes of people who can’t be contacted by phone or other remote ways.
A question arose about the contract and the vetting process used to assign it to Community Care of North Carolina and North Carolina AHEC, a network of centers that provide continuing education to health care providers, along with clinical support and guidance for health professionals and facilities.
Hugh Tilson, the husband of Elizabeth Cuervo Tilson, the state health director, has been the North Carolina AHEC director since 2018.
Cohen said Elizabeth Tilson was not involved with the selection process nor did she make any recommendations.
North Carolina Health News asked for a copy of the contract on Thursday after questions arose at a media briefing, but has not yet received a response from DHHS.
“The way this organization was selected was through an evaluation committee that looked at a submission of their proposal for the state of North Carolina,” Cohen said. “I believe we compared at least two different organizations that were able to serve all of North Carolina.”
Cohen outlined how the process worked during the briefing and said her team has not yet determined which funds would be used to support the collaborative’s work, saying they were looking at pandemic relief aid provided by the Centers for Disease Control and Prevention, or at a portion of the $1.5 billion in federal aid to be allocated by the General Assembly.
“We haven’t decided,” Cohen said.
Important to Cohen and her team were to have tracers that could be hired in the communities where they lived or were familiar.
DHHS also was looking for partners with experience working with local health departments that were also familiar with DHHS data systems.
“We had a number of organizations that said, ‘Oh, you know, we can serve the west. We can serve the east. We can serve central. We were really looking for a partner that submitted a proposal that could serve the full of the state,” Cohen said. “We asked for them to have experience working with our local health departments, as well as our data systems because we needed to get going so quickly.”
The evaluation committee was formed under the department’s head of procurement. The committee, Cohen said, considered proposals based on the criteria outlined by DHHS.
Cohen said she welcomed questions about the process or scrutiny of the selection.
“I welcome the transparency on this effort,” Cohen said. “Dr. Tilson is obviously an incredibly important member of our team, but she was very aware that she did not want to have any violations of ethics here so she was definitely not part of the selection committee nor the evaluation process.
“So we welcome answering any questions about that going forward.” — Anne Blythe
DHHS list shows more NC skilled nursing facilities with COVID-19 cases, deaths
State health officials added more than a dozen North Carolina skilled nursing homes with COVID-19 infection during the past week, including facilities from Northampton to Henderson counties posting the same low staffing levels as seen in other centers with outbreaks.
A notable exception came with a report that 13 residents and nine employees contracted the virus at UNC REX Rehabilitation and Nursing Care Center of Apex. Instead of the below-average staffing ratio among most infected nursing homes in the state, the Apex center scored top rankings overall and in staffing levels with the federal Centers for Medicare and Medicaid Services.
“The staff members caring for these residents have been trained on CDC guidelines and are following proper medical procedures,” said UNC REX spokesman Alan Wolf. “They are working closely with experts from UNC Health, the Wake County Public Health Department and the N.C. Department of Health and Human Services.”
An additional nursing home listed represented the seventh outbreak in the state in a facility owned by Saber Healthcare. Saber, an Ohio firm, has the most North Carolina facilities with reported COVID-19 cases. The Saber-owned Autumn Care of Cornelius reported 60 cases and 17 deaths related to the virus, an increase of seven cases and seven deaths over prior reports.
The largest increase in overall cases came from Grace Heights, a nursing home in Burke County, with six reported deaths and 67 cases, an increase from 55 cases last week.
Four facilities owned or managed by Kinston-based Principle Long Term Care were listed for the first time. They were Harnett Woods Nursing and Rehabilitation Center, Harnett County; Northampton Rich Square Nursing and Rehabilitation, Northampton County; Ayden Court, Pitt County; and Kerr Lake Nursing and Rehabilitation, Vance County.
The state Department of Health and Human Services reported 28 COVID-19 cases and two deaths at the four Principle-connected skilled nursing homes. The N.C. facilities added in the past week were listed as having 260 new cases and 19 deaths.
DHHS will present any additional facility names and death counts at a 4 p.m. press conference Friday. — Thomas Goldsmith
Will swimming pools be open?
As it gets warmer across North Carolina, some wonder whether swimming pools will be open in the weeks and months ahead.
Mandy Cohen, secretary of the state Department of Health and Human Services, said that while pools will remain closed in the first phase of easing social distancing restrictions, her team was looking into whether they could be open in the following phase, which could begin as early as May 22.
The concern, she said, is people sitting around the pool and how to maintain social distancing out of the water. — Anne Blythe
In the meantime, keep up with vaccinations
During the pandemic, Mandy Cohen, secretary of the state Department of Health and Human Services, wants everyone to make sure they stay up with immunization schedules, particularly for children.
“I know parents may be wondering and trying to figure out how best to keep their children and families safe during all of this,” Cohen said. “Many pediatric practices and family medicine practices have made adjustments to minimize risks, like asking people to call and wait in their cars so that they can go straight to an exam room when it’s ready and to avoid the waiting room entirely.”
Diseases such as measles and mumps remain a threat to children, and vaccines make them preventable.
“I encourage you to call your doctor or clinician or call your local health department to talk about how to safely stay on schedule for all of those important vaccines,” Cohen said. — Anne Blythe
Coronavirus by the numbers
According to NCDHHS data, as of Thursday morning:
- 507 people total in North Carolina have died of coronavirus.
- 13,397 have been diagnosed with the disease. Of those, 525 are in the hospital. The hospitalization figure is a snapshot of people hospitalized 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 171,000 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 (42 percent) were in people ages 25-49. While 22 percent of the positive diagnoses were in people ages 65 and older, seniors make up 86 percent of coronavirus deaths in the state.
- 108 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities.
- There are 3,582 ventilators in hospitals across the state and 745 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital.
Federal government rolls out portal for COVID-19 testing and care of uninsured patients
Beginning this week health care providers and hospitals can request reimbursements for treating and testing uninsured patients with COVID-19 through a new portal, NCDHHS announced today.
The federal government earmarked $1 billion for COVID-19 testing of uninsured people and additional funds for treatment. To access the funds, providers must treat or test eligible patients for free and request reimbursement after the fact. To support providers in the state, North Carolina Medicaid has also compiled a list of all the available federal funding. -Liora Engel-Smith
Cumberland County food giveaway hits capacity before it can start
The reaction Thursday from Cumberland County residents to a free-food program must have stunned organizers. Within 1 1/2 hours from the time the program was set to start, county officials announced that capacity had been met.
Second Harvest Food Bank of Southeast North Carolina had planned to give away 30,000 pounds of food — the equivalent of 25,000 meals — in the parking lot of the Crown Complex beginning at 10 a.m. By 8:30 am, county officials said in an email, the number of people waiting in line would exhaust the organization’s entire food supply.
Second Harvest was working with the N.C. National Guard, Team Rubicon and Cumberland County Emergency Management to distribute food that is expected to provide meals to an estimated 1,200 people for about a week.
Figures from the U.S. Census Bureau show that 17 percent of the county’s residents were living in poverty last year, compared with about 12 percent nationally. The Fayetteville metro area was tied with Rocky Mount for the highest unemployment rate in the state at 5.5 percent in March, according to the latest figures available from the N.C. Department of Commerce. Many more workers have lost their jobs since then.
People still needing food are asked to call Second Harvest at 910-485-6923 or visit its web site, hungercantwait.org, to learn more about available food pantries near them that can assist. -Greg Barnes
Caregivers okay to be with disabled loved ones in hospitals, state says
After families around the state reported being unable to stay with their significantly disabled family members in the hospital, the N.C. Department of Health and Human Services issued a bulletin reminding hospitals of people’s rights to have a caregiver accompany them.
N.C. Health News wrote about this earlier this week, sharing the plight of one Mount Airy mother who was unable to be by the side of her disabled son when he died in early April at Wake Forest Baptist Medical Center.
The NC DHHS bulletin, issued Wednesday night through the state’s Medicaid program, states that visitor restrictions related to the COVID-19 pandemic should make exceptions for caregivers of those with cognitive issues. The bulletin noted the rights people have under the Americans for Disabilities Act and other civil rights legislation.
“For individuals with a cognitive impairment or intellectual disability, it is important to ensure the individual has adequate support for decision making and treatment,” the NCDHHS directive states. “These individuals may need to have a caregiver accompany them in either the ambulance or in the hospital.”
While glad to see NCDHHS weigh in, the directive may not go far enough, said John Nash, the executive director of The Arc of North Carolina, an organization that supports those with intellectual and developmental disabilities.
“We don’t feel that it is strong enough and our fear is that this will continue to happen,” Nash said.
He’s worried hospitals will continue to make case-by-case decisions, and some families will still be shut out. Families that face resistance to accompany disabled loved ones should contact The Arc of NC, Disability Rights North Carolina or NCDHHS, Nash said. – Sarah Ovaska
Mental Health Moment – Tour Kew Gardens
One of the world’s greatest, and well-known, botanical gardens, Kew is part of England’s Royal Botanical Gardens. Located on the outskirts of London on 326 acres (there’s even a palace on the grounds), the gardens are a UNESCO World Heritage site.
Kew Gardens and Wakehurst (located an hour away) have a grand total of approximately 27,000 taxa of plants, over 8 million specimens of plants and fungal herbarium, and a seed bank that contains more than 40,000 species.
The crown jewels of Kew are the old glass houses, constructed during the Victorian era. These towering steel and glass structures include the Waterlily House, the Palm House and the fabulous Temperate House, home to more than 1,200 species of plants.
If you really want to escape for a while, their YouTube channel is wonderful.