By Rose Hoban
It’s simple interventions that could keep North Carolina from slipping backward in its fight against COVID-19. To start, wear a mask, state Health and Human Services Secretary Mandy Cohen encouraged lawmakers at the General Assembly.
“There’s not that many tools” to slow the spread of the disease, Cohen said. “There’s not a vaccine. There’s not a treatment. So the one tool that we know the scientific literature is telling us works is face coverings.”
Cohen spent more than an hour presenting the department’s strategy for restraining the surge of cases being seen currently and then taking questions from lawmakers.
She expressed her concern that hospitals have been seeing a slow, steady surge in cases since the state reopened more businesses and activities at the end of May.
“You’re not hearing me say that today, we need to go backward or just stay at home or, we’re at a crisis point,” she said. “I check in with the hospitals to make sure of that, but I think we need to be very careful because I think that we don’t know how quickly we can get to that point.”
Cohen compared reopening to using a dimmer switch, where the light gets turned up gradually.
“This is something that is now being cited more and more in the literature about easing restrictions on lower-risk activities first, monitoring that viral spread and then trying to again ease restrictions as you go, and slowly go to some of the higher risk activities after you see how do we do with some of the lower-risk activities.”
Can’t stay locked down
Some lawmakers expressed skepticism about the statewide approach to slowly reopening, preferring a more regional approach.
Rep. John Szoka (R-Fayetteville) said he’s been talking to the CEO at Cape Fear Valley Medical Center who has not seen a surge of patients.
“He’s got a total of 44 ICU beds. At the most, filled with COVID patients at any one time since the beginning was eight,” Szoka said, who argued that Cumberland County is not being overwhelmed.
“He’s dedicated another whole isolation floor with 44 beds, he averages 16 to 21 patients a week. Today he has nine.”
Instead, he reported that the CFVMC head’s “biggest concern” was getting about 800 furloughed employees back to work, and ensuring his future finances.
“With multiple companies and businesses going out of work, who have corporate health insurance that’s going to put them into lower paying plans such as Medicaid, Medicare,” he said. “Cape Fear has the worst mix of payers.”
Cohen said that now hospitals have no limitations on doing elective surgeries, to bring in more revenue, and there’s currently excess capacity in the state. But she expressed concern that in other states, such as Arizona, they’re seeing surges in cases, with hospitals starting to fill up.
Cohen explained that hospitalization is what’s called a “lagging indicator,” namely that it’s the metric that goes up late in the course of the epidemic, long after cases have risen and gotten out of control.
“If we just react to the hospitalizations, by the time we get potentially close to maxing out hospitalizations, it could be too late,” Cohen said. “That’s the hard part is that you actually have to react, two to three weeks before you get to that maxing out, and that is the hard part of figuring out these trends.”
“Every decision has been excruciating in terms of how we make decisions, to move forward here because we know that people’s economic livelihood is impacted by all these decisions,” Cohen said.
Dying of loneliness
Lawmakers brought their constituents’ concerns to Cohen, and some of the most heartbreaking were stories of older people who have now been sequestered in skilled nursing facilities for months.
Rep. Perrin Jones (R-Greenville) related a letter he received from a physician in his district who described a couple in their 80s living in a congregate facility where they have been separated because of COVID restrictions for months.
“This couple has been married for over 50 years,” he said. “The husband voiced to his caregiver a desire to ‘hurry this up and die’ because he could not see or touch his wife. He has been clinically depressed since the start of COVID-19 because of the deprivation of social contact.”
Jones accused Cohen of promulgating “inhumane consequences of our state’s public health policies,” by forbidding visitation in nursing homes.
Cohen, for her part, expressed her dismay over what COVID-19 has done in nursing homes, calling stories such as Jones’ “heartbreaking,” but she pointed out that the rules restricting visitation came from the federal government, which regulates skilled nursing facilities.
“This virus is just incredibly vicious and deadly for folks in our nursing facilities, and we’re trying to find that right balance,” she responded.
As of June 17, there have been 5,197 cases of COVID-19 among nursing home and residential care facility residents and staff, with 704 deaths as a result of the virus.
Cohen went on to talk about new efforts at the state level to support nursing homes. DHHS has worked with the nursing school at East Carolina University to get additional staff into the facilities to support them. According to Janet Tillman from ECU, the program has made more than 3,500 referrals for additional staffing across the state.
Cohen also noted her department has recently completed testing all residents at state-operated homes and is moving to help the rest of the state’s 3,500 nursing homes to test all their residents and staff.
But to be effective at detecting the virus’ spread, testing has to be repeated frequently.
“It is a huge financial investment to do the testing every single week of the staff and I will tell you a lot of these staff do not have insurance,” she said. “The expense needs to be borne somewhere.”
According to data provided by a DHHS spokeswoman, skilled nursing facilities in the state have approximately 45,000 staff and 35,000 to 40,000 residents.
“We estimate a cost of $21 million per 60 days of weekly testing,” Amy Ellis wrote in an email follow-up. “The cost could be higher if insurers stop paying or lower if we tested less frequently.”
“The science is not clear about whether that should be every week and is that the right place to be putting our time and resources,” Cohen said. She noted that the state had distributed personal protective equipment to some 3,500 nursing homes.
“One of the big challenges of COVID is the long length of time you could go without having symptoms but you could be spreading your virus to other people,” she said. “That goes back to why the face coverings have become even more important.”