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By North Carolina Health News staff
How COVID-19 moves from crowded restaurants to long-term care
Health and Human Services Secretary Mandy Cohen laid out why it’s important for the entire state to work from the same playbook as it battles COVID-19 in response to a reporter’s emotional question about testing for the virus in long-term care facilities.
Kate Martin, a reporter for Carolina Public Press, choked with emotion as she explained that she was interested in knowing more about testing requirements and guidelines for long-term care and rehabilitation facilities because of how her father died in a Kansas facility last month.
“They won’t tell me whether they were testing anybody,” Martin said, echoing a universal frustration of people trying to get answers from such facilities in the middle of a pandemic when visitors have been barred.
If facilities have no one in them who has tested positive for COVID-19, there are no regulations to force proactive testing.
Testing is important, Cohen said, but more important is having a comprehensive strategy for long-term care facilities, congregate-living facilities, as well as the entire state.
“Testing itself is not the only thing we need to do,” Cohen said. “I think it’s really important to connect the dots of what’s going on in restaurants and what’s happening in our long-term care settings. We often can’t see those dots …because the virus is so tiny.”
What happens is the people who work in long-term care facilities, such as those in food delivery, nurses, personal care attendants, go out to restaurants, grocery stores and other places where the virus can spread.
“When there is more virus spreading, that means those folks who work in our long-term care are getting exposed to virus more often in their community,” Cohen said. “Then they bring that virus to those long-term care facilities.”
Testing is only one prong of the strategy to detect the virus in someone who is either pre-symptomatic or asymptomatic, health officials caution, because a test only reflects a moment in time.
“It’s more than testing,” Cohen said. “We had to make sure of a couple of things. … Are folks wearing the protective equipment and the face coverings that they need when they’re doing that work? Are we making sure to do other things, like unfortunately restrict visitors because we know that’s when more virus comes into those settings?”
If there is one case, Cohen said, everyone gets tested, including staff and the residents.
“The question has been are we going to be doing proactive testing when we don’t even see the virus there,” Cohen said.
North Carolina has committed to doing that at nursing homes.
“It’s not an easy lift to do, so it’s not going to get done overnight,”Cohen said “But we’ve already done this in our state-operated nursing facilities.”
Now, the state is working with private nursing homes to figure out how to marshal supplies and people for major testing projects, which also poses financial challenges to pull together and execute.
“I want to make that important connection that it’s not testing alone that’s going to help here.”
Over the weekend, scenes of restaurant-goers crowding the streets of Raleigh’s Glenwood South, a business district with many restaurants, bars and nightclubs, circulated on social media. Many people were not wearing face coverings.
Cohen described restaurants as risky places because diners take off face coverings to eat, allowing for virus spread.
North Carolina is one of the states now being watched nationally as the number of lab-confirmed cases rises quickly and people being hospitalized for COVID-related illness begin to raise capacity questions.
Last week, Cohen and Gov. Roy Cooper implored North Carolinians who are now more mobile not to drop their guard against the virus. They also have admonished open defiance of social distancing restrictions.
“That kind of behavior in crowds really worries the health experts and the epidemiologists and why we continue to tell people to avoid being in crowds if you can and even if you are, whether it’s inside or outside, perform the three Ws,” Cooper said. — Anne Blythe
Face masks could become mandatory
So far, Gov. Roy Cooper has not made it a requirement for people across the state to wear face coverings.
That could change.
A review of 172 observational studies funded by the World Health Organization and published recently in The Lancet concluded that wearing face coverings reduces the risk of person-to-person transmission of COVID-19.
Social distancing of at least a meter also lowers the risk, according to the review.
The Centers for Disease Control and Prevention updated its guidelines recently for protecting yourself and others from virus spread to include: “Cover your mouth and nose with a cloth face covering when around others.”
“It’s absolutely in discussion right now about whether we make cloth face coverings mandatory and in what way we do it,” Cooper said. “Right now they are mandatory for employees of personal care, like nail and hair salons. They’re required for those employees, but our health experts are looking at those same studies showing the effectiveness of cloth face coverings.”
Cooper said his team would like people voluntarily to make wearing face coverings a habit. In an election year, the face covering has sowed political discord with President Donald Trump and other Republicans who have tried to downplay the virus threat while pushing for a flinging open of the doors for free movement and no restrictions.
Mandy Cohen, secretary of the state Health and Human Services department, noted that the studies measured the effectiveness of face coverings specific to COVID-19.
“Before we were looking at studies on how do face coverings look for other viral respiratory illness,” Cohen said. “Now we have published studies with a lot of different methodologies that continue to show us the importance of wearing a face covering to slow the spread.”
The studies show the effectiveness of many people employing the measure together, Cohen stressed.
“That is why we keep harping on the three Ws and saying that we can do this together, we can have individuals take action here and if we do this collectively, the data shows that we can still flatten this curve,” Cohen said. “I know we see things going in the wrong direction, but if we act collectively, we can take control of our fate.”
Cohen acknowledged that some North Carolinians are restless and ready to open such places as bars, gyms, private playgrounds and public schools.
“I know I want to get my girls back to school this August,” said Cohen, the mother of two. “This is the way to do it. It’s to focus on these collective actions we can do, whether we’re an individual or we run a business that is open.
“… The science is becoming pretty powerful to say that if we all do this together we can truly flatten the curve and slow the spread of this virus so we can continue to make progress.” — Anne Blythe
Is NC anywhere close to Phases 2.5 or 3?
Gov. Roy Cooper acknowledged the approaching expiration date for his executive order governing restrictions and allowances during this phase of the COVID-19 pandemic.
The Safer-At-Home order expires on June 26 at 5 p.m.
Cooper has not indicated whether he will allow North Carolina into a phase that allows bars and gyms to open as the metrics and trends that guide such decisions show quicker virus spread and more people in the hospital.
The Republican-led General Assembly passed a bill recently that would allow gyms and bars open too despite his executive order barring that from happening. Cooper has yet to announce whether he will use his veto power to block the bill from becoming law.
Cooper said his public health team continues to monitor the numbers, knowing that they are not trending in the direction that would warrant further easing of restrictions.
“We still want to give this more time and encourage people to perform the three Ws and let’s press to make sure we can flatten this curve,” Cooper said.
“The health experts are looking carefully at the numbers and the science,” he added.”We will let the people of North Carolina know at the first of next week whether we will go into the next phase, and if so what that phase will look like.” — Anne Blythe
Hospitals start to ease up on visitation restrictions
Since the beginning of the coronavirus pandemic, hospitals have clamped down on patients having a visitor or family member by their side as they go through their treatment. But, as COVID-19 threatened to overwhelm hospitals and health care workers, systems forbade all visitors, leading to heartrending episodes of COVID patients dying alone, accompanied only by a nurse they don’t know or family members sitting vigil via FaceTime or other video streaming services.
Recently, that’s prompted a response in the General Assembly, where members of the Senate have been pushing through the “No Patient Left Alone” Act. The bill acknowledges that the pandemic has been extraordinary, but also notes “many patients not diagnosed with COVID-19 have been forced to be alone during their treatment for serious conditions, traumas, illnesses, heart attacks, and routine and emergency surgeries.”
Several Senate Health Committee meetings last week featured heartbreaking stories from patient family members who were unable to be by the side of loved ones as they died, or who needed extra help.
“I spent a lot of my time yesterday working with a wife who was trying to be able to stay in a hospital with her husband who had a 10-hour surgery, had his jaw wired shut, had a [tracheostomy tube] in,” bill sponsor Sen. Warren Daniel (R-Morganton) told the committee. “I was raising the issue to the highest levels of hospital management. So far she’s still there, but she’s wondering, at any moment they could come in and tell her to leave.”
Leah Burns, a governmental affairs director for the North Carolina Healthcare Association, told committee members that her own mother had to be in the hospital by herself receiving treatment this spring.
“This is a 100-year pandemic that none of us have ever seen before,” Burns told the committee. “CMS guidelines change on a daily basis. We are doing anything and everything we can to protect our patients and our staff and so sometimes hard decisions have to be made.
“We have some of the best infectious disease physicians in the country right here in North Carolina, and they have shaped these policies based on the PPE that we have, based on the testing,” she said. “When we have a way that we can safely bring people in, we know it’s at the patient’s best interest for them to have their family.”
But it appears that some hospitals are looking to circumvent a legislative fiat by creating strict guidelines for admitting family members.
Atrium Health announced that starting Monday, patients at their facilities may designate one person to stay with them, under strict guidelines that include:
– only one visitor on a given day who must supply their own mask
– visitors must wear a mask at all times, except while eating in designated areas
– visitors only remain in designated areas and “are not permitted to roam the hospital or facility”
– undergo a temperature screening
– may be asked to leave if they do not comply
Atrium’s rules also allow for more than one visitor in an end of life situation, or for pediatric patients. – Rose Hoban
Coronavirus by the numbers
According to NCDHHS data, as of Monday afternoon:
- 1,118 people total in North Carolina have died of coronavirus.
- 45,102 have been diagnosed with the disease. Of those, 797 are in the hospital. The hospitalization figure is a snapshot of people hospitalized with COVID-19 infections 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.
- 29,219 people who had COVID-19 are presumed to have recovered. This weekly estimate does not denote how many of the diagnosed cases in the state are still infectious.
- More than 638,000 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 (45 percent) were in people ages 25-49. While 14 percent of the positive diagnoses were in people ages 65 and older, seniors make up 82 percent of coronavirus deaths in the state.
- 187 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities.
- There are 3,041 ventilators in hospitals across the state and 889 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital.
Worried about eviction or utility shut-offs? Your Community Action Agency could have aid.
Low-income people and families soon will have access to help paying rent and utility bills once the state lifts the moratorium on evictions and power and water shut-offs.
The state Department of Health and Human Services announced on Monday that funds from the federal Community Services Block Grant are being distributed to Community Action Agencies, organizations created in the 1960s to help individuals and families at or below 200 percent of the federal poverty level.
“Community Action Agencies have helped bridge gaps for low wealth residents and communities for 55 years,” Sharon Goodson, executive director of the NC Community Action Association, said in a prepared statement. “They provide comprehensive services like case management, transportation, housing, employment, education, child care, eviction and emergency assistance programs to ensure low wealth residents increase and maintain their economic stability.”
Hurricane relief, some 500 days after the storm
It might seem like eons ago when Hurricane Florence came ashore in 2018 and left a trail of flooding and damage that many residents in eastern North Carolina continue to try to recover from, even amid this pandemic.
Gov. Roy Cooper announced on Monday that North Carolina now is ready to begin distribution of $542 million in federal funds to homeowners who suffered property damage from Hurricane Florence and Hurricane Matthew, storms that created a one-two punch in a large swath of coastal and eastern North Carolina.
Only recently did the U.S. Department of Housing and Urban Development issue the notice that specified requirements for how the funds could be used.
“Some North Carolinians and their communities are still recovering from the devastation of Hurricanes Matthew and Florence,” Cooper said. “These families are dealing with the threat of COVID-19, while at the same time, they’re trying to rebuild their homes and businesses. Despite the virus, the work of hurricane recovery continues.”
In the wake of the storms, Republicans in the General Assembly criticized Cooper for not getting help to the storm victims in a timely manner.
Cooper pushed back that the delay was caused by the federal government under the leadership of the Republican in the White House.
To date, Cooper said, the state has distributed $3.5 billion in state and federal funding for Matthew and Florence damage, providing relief for more than 1,300 homes.
“The program starting today took the federal government almost two years — 500 days after Florence made landfall — to publish the register laying out the requirements for how this money can be invested,” Cooper said. “But when it was time, North Carolina was on it and turned in an action plan within 24 hours and was the first state to receive approval of our plan.”
Assistance could be available for homeowners who lived in their dwellings during the time of the disastrous storms.
Even if they received relief from other sources, they could be eligible for relief through the Homeowner Recovery Program.
People seeking relief from ReBuild NC can submit an online application at ReBuild.NC.Gov. A phone line has been set up at 833-ASK-RBNC. — Anne Blythe
State health officials would like to see better data, too
In a recent lawsuit, a consortium of more than a dozen journalism organizations sued Gov. Roy Cooper, DHHS Sec. Mandy Cohen and Secretary of the Department of Public Safety Erik Hooks over access to more data on COVID-19.
But some of the state’s data problems will take more effort to get solved.
In response to a reporter’s question during their press briefing Monday afternoon, Cooper and Cohen outlined how much of the ethnicity and race data on people testing positive for COVID-19 is still done at the county level, where it’s often compiled by hand.
“We have a very disjointed independent healthcare system across the state and trying to get all of this data and focus it in one place is a difficult exercise,” Cooper said. “We talk about that frequently in our meetings of how many different places are collecting information about testing, and how many of those we have to bring in to the state.”
Cohen said that her department is looking for more specific data on people who test, but until recently, labs were not reporting much of the race and ethnicity data.
“When we have a positive test then our tracers, and others [in] local health departments will reach out to that person and then collect the additional data,” she said.
She noted the federal government has recently required the collection of demographic data on all people who present to have a COVID test.
“That was hugely helpful to us in the states,” Cohen said. Now her staff is working on an information system to automate data collection, so it’s less laborious.
For example, North Carolina is one of only a handful of states that does not have an electronic death reporting registry, something that other states began implementing almost two decades ago. A website at the Centers for Disease Control and Prevention notes as of June 15, only 576 deaths due to COVID in North Carolina, while the state’s data dashboard lists 1118 deaths by Monday afternoon. – Rose Hoban