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By North Carolina Health News staff
Face coverings required in North Carolina
It took Gov. Roy Cooper a week to figure out how to snap his fingers.
“You have to be careful about what you’re doing. You have to be specific and you have to have it based on your best evidence. You just can’t snap your finger and say, ‘Hey, it’s a rule. Everybody do it.’”
On Wednesday, Cooper revealed how he plans to get North Carolinians to do that while also waiting another three weeks to decide whether to open up some of the businesses and settings deemed to be a higher risk for infection spread.
Since the state has moved to Phase 2 reopenings, the spread of COVID-19 has surged as North Carolinians became more mobile.
Last week, Cooper said that for a #MaskUp order to be effective, it would have to be “well thought through and something that will be effective with the least intrusion that we can have on people.”
- Retail businesses;
- Personal care, grooming and tattoo parlors;
- Child care facilities, day camps and overnight camps;
- State government facilities that are under the executive branch’s administration;
- Public transportation, as well as private ride-shares, cabs, vans and shuttles, even if they are not all privately owned.
- Construction sites, migrant farms and agricultural settings where social distancing is difficult;
- Meat or poultry processing plants;
- Long-term care facilities; and
- Other health care settings that must follow the Centers for Disease Control and Prevention Infection Control Guidance for Healthcare Professionals about Coronavirus (COVID-19).
The order strongly encourages anyone over the age of 2 to wear face coverings in public, but it does not require that, leaving a question about how the public health push will be enforced in places not listed in the 10 settings.
The order does not authorize law enforcement officers to criminally enforce the requirements against individual workers, customers or patrons of businesses on the list, but it does allow them to cite a business failing to enforce the requirements.
It was adopted in 1953 in reaction to waves of violence perpetrated by the Ku Klux Klan and states:
- 14-12.7. Wearing of masks, hoods, etc., on public ways.
“No person or persons at least 16 years of age shall, while wearing any mask, hood or device whereby the person, face or voice is disguised so as to conceal the identity of the wearer, enter, be or appear upon any lane, walkway, alley, street, road, highway or other public way in this State.”
The statewide order, which is in effect until 5 p.m. July 17, acknowledges that some people might have difficulties wearing masks because of disabilities or health issues and anyone younger than 11 also is not required to wear a mask.
There are exceptions for people who are actively eating or drinking in restaurants and the other settings. People inside their homes or personal vehicles also are not required to wear them. All North Carolinians “will be on the honor system about whether or not there is a reason why they cannot wear a Face Covering,” the order states.
The decision comes as North Carolina continues to see a rise in laboratory-confirmed cases of COVID-19. Not only are the number of positive cases rising quickly day-over-day, the percentage of tests coming back positive is close to 10 percent, twice as high as what public health experts would like to see.
The number of people hospitalized with severe illness has topped 900 for two days this week, a sharp rise from the 550 or so beds filled routinely before the state lifted its statewide stay-at-home order.
“The numbers we see are a stark warning and we must pay attention,” Cooper said. “I’m concerned. Since the beginning of this pandemic, I’ve been clear that data and science would lead the way.”
In keeping with that standard, Cooper said, the numbers do not warrant opening up more businesses, as could have happened at the end of the week when the existing order for the Safer-at-Home Phase 2 expires.
Cooper dangled a carrot for North Carolinians and gym, playground and museum operators hankering to bring in customers again. If the metrics and trends level off or decline over the next three weeks, they could be part of the next phase of easing restrictions.
Bars, though, were not included in that group.
After Cooper allowed restaurants, taverns and breweries that serve food with alcohol to open at 50 percent capacity with social distancing measures in place, the North Carolina Bar and Tavern Association filed a lawsuit against the governor alleging that bars were being singled out unfairly.
A judge in the North Carolina Business Court has heard arguments in that case, and resolution of that executive order challenge could be tied up in the courts for weeks.
Lawmakers in the Republican-led General Assembly have adopted bills in recent weeks designed to weaken the governor’s executive orders. He has vetoed bills that would have opened bars and gyms, and the lawmakers have not voted yet on whether to override those vetoes. This back-and-forth comes in an election year, when few were expecting a pandemic to change campaigning and campaign issues so greatly.
“Overwhelming evidence that is growing by the week shows that face covering overwhelmingly can reduce the spread of COVID-19, especially from people who have it and don’t know it yet,” Cooper said. “Face coverings are a simple way to control this virus while protecting ourselves, our families and the other people around us.
“One important point, here,” Cooper added. “Required face coverings not only cause zero harm to our economy, they, in fact, help our economy by making it safer to shop, do business and keep our small businesses running. We’re adding this new requirement because we don’t want to go backward.”
Dennis Taylor, president of the North Carolina Nurses Association, and Eugene A. Woods, president and CEO of Atrium Health, spoke at a news briefing with reporters advocating for the use of face masks.
“A major spike in cases would be catastrophic to the system, and without your cooperation, nurses and our fellow health care providers will have a harder time caring for sick patients for weeks and months to come,” said Taylor, noting that his organization represents 141,000 registered nurses.
Woods stressed the intersection between a robust public health and the economy. For the economy to buzz, the people need to be healthy and able to work. He also stressed that studies showing the effectiveness of face coverings should be trusted, that they are grounded in science, not politics.
“My sincere hope is that all the people of North Carolina can join forces to make wearing a mask not something we feel we have to do – but something that we want to do to keep each other, our neighbors, our children and our loved ones healthy and safe,” Woods said. — Anne Blythe
Infectious disease expert at UNC Health touts masks for the present and future
Myron Cohen, an infectious disease specialist and the UNC-Chapel Hill associate vice chancellor for Global Health and Medical Affairs, says North Carolina and the rest of the country could do a lot to change the trajectory of COVID-19 through simple behavioral changes.
“If you had said in December that a coronavirus would kind of dominate the planet for the last six months it would have been almost unbelievable,” Cohen said. “The organism, the SARS-COV2 organism, the coronavirus, clearly has emphasized kind of our fragilities and weaknesses.
“That’s kind of the bad news, it’s a new pathogen that we’ve got to learn all the rules about, and we’ve got to understand then how best to deal with this organism in this epidemic.”
As states across the country used varied methods to try to slow the spread of the virus in the early months of the pandemic and make room in hospitals and health care systems for the sickest of the sick, scientists and physicians from around the world studied what helped and didn’t help stave off severe infection.
“The good news is that we’ve learned in the last century a lot about how to use science toward controlling of damage,” Cohen said. “In every epidemic situation, science in the broadest sense is a critical answer.”
With that information, three components have emerged for fighting the novel coronavirus more effectively in the months and perhaps year ahead.
“It cannot be emphasized enough how much behavior change can control the risks associated with SARS-COV2,” Cohen said. “We know that by looking at this carefully over the last six months, we know that most of the transmission is by intimate contact and that this can be prevented by appropriately fitting masks used uniformly. That prevents people from coughing on someone else and you from acquiring what they cough.”
That behavior needs to be supplemented by the hand washing, cleaning and social distancing, all components of the three Ws, the alliterative direction that emerged in late April and is now posted on shop windows, government facilities and health care offices.
“All of this clearly works because we have an experimental model in Asia, where they did these things,” Cohen said. “There were no magic bullets. They’ve benefited from these behavior changes. Dramatically.”
In the U.S., though, for a variety of reasons, the population has had trouble being compliant with risk reduction behaviors, he added.
“The thing to emphasize, the thing that’s available to us today, without any further thought are masks,” Cohen said.
At UNC Health, where Cohen works, the system went to a mask policy very early during the pandemic, requiring all staff, health care workers and visitors to wear face coverings, Cohen said.
Only the health care workers in direct contact with COVID-19 patients and those suspected of having the virus were suited up in the N95 masks, gowns and other protective gear. Visitors and other staff were supplied with cloth coverings.
“I’m not talking about sophisticated space wars masks,” Cohen stressed. “Face masks.”
That action, Cohen said, has worked to stave off the feared spread of COVID-19 from high-risk health care settings where nurses and physicians are in close contact with infected patients back into the community.
“By giving all our employees masks, our health providers masks and our visitors masks, we really know virtually no transmission in the hospital even though it’s an indoor space,” Cohen said. “So masks, masks and more masks need to be emphasized.” — Anne Blythe
Coronavirus by the numbers
According to NCDHHS data, as of Wednesday afternoon:
- 1,266 people total in North Carolina have died of coronavirus.
- 56,174 have been diagnosed with the disease. Of those, 906 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 791,000 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 80 percent of coronavirus deaths in the state.
- 197 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities.
- There are 3,113 ventilators in hospitals across the state and 880 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital.
Child care centers struggle as pandemic slogs on
As the state opens back up to economic activity, child care centers are still struggling to get and stay open. At the same time, as lawmakers heard at the General Assembly today, without child care, it will be difficult for North Carolina’s workers to get back to their jobs.
During a presentation to the House Health Committee on Wednesday morning, Michele Rivest told lawmakers that across the state, a third of child care facilities remain closed due to coronavirus. Capacity is diminished further because larger child care centers are shuttered at a greater rate.
“Child care centers serve so many more children, they have much bigger capacity, and 41 percent of all child care centers remain closed,” said Rivest, who directs policy for the NC Early Education Coalition. “Compare that to family child care homes, which is a child care that happens in a licensed home setting, when they can serve about five children. Seven percent of those family child care homes remain closed.
“So you have far less capacity in family child care homes, but you have more open programs.”
Rivest also told lawmakers that many of the programs that are open are operating below capacity.
When it passed the CARES Act, Congress sent $118 million to North Carolina to cover costs for child care centers, which the legislature passed along when it passed its initial coronavirus relief bills in March.
Rivest said some of that money went to cover 17,000 children of essential workers who received subsidies so their children would be cared for as they went to work.
“This program is no longer available even though these families are still working and still need child care,” Rivest said.
Some of the CARES Act money paid for “hazard pay” for child care workers, along with operating bonuses for some centers, but Rivest said all that funding will be expended by the end of June.
Nonetheless, a number of child care programs have shuttered as a result of the coronavirus pandemic. Rivest cited the closure in recent weeks of Summer Moore Child Development Center in Greenville, which served children with developmental disabilities, and the Early Childhood Education Center at Fayetteville Technical Community College which had served 140 children and 30 staff.
“From a business perspective, it’s just too hard to make the math work,” she said. “For those that have remained open and that will reopen, decreased capacity, fewer children enrolled and the new pandemic related costs mean higher operating expenses and higher losses.”
According to Rivest, the system the state depends on for child care is “broken.”
“Child care mostly operates as a private business and the market approach of supply and demand just doesn’t work well,” she told lawmakers. “The pandemic has laid bare the fundamental flaws in the way child care is financed and funded.” – Rose Hoban
Correction: This story has been changed to remove an extraneous word, to indicate the governor stated his decisions were based in science, not politics.