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By North Carolina Health News Staff
Testing of all nursing home residents, staff as supply shortages loom again
North Carolina’s nursing homes and long-term care facilities have been hit particularly hard by COVID-19 and accounted for almost half the deaths in the state.
On Tuesday, Mandy Cohen, secretary of the state Department of Health and Human Services, announced a partnership with Omnicare, a CVS Health company, to do baseline tests of all residents and staff at skilled nursing facilities.
The testing will begin in July and continue through August in the 400-some nursing homes across the state.
That proactive testing already has occurred at state-run facilities, Cohen said, but the partnership with Omnicare will allow for the testing of nearly 36,000 residents and 25,000 workers in the privately run sites.
From the early days of the pandemic, Cohen and her public health team have stressed the importance of trying to protect the vulnerable populations in nursing homes and long-term care facilities.
A paucity of testing supplies and personal protective equipment from the federal government early on prompted the public health team and Gov. Roy Cooper to quickly impose no visitor rules and call for the shutdown of communal activities inside the long-term care facilities.
As the pandemic wears on, though, there have been calls from families with loved ones in such facilities to ease some of the visitation rules. The isolation of the residents has taken an emotional toll.
“This testing will provide another tool to further protect those who are at higher risk,” Cohen said.
CVS Health will bill insurance companies when possible to help pay for the tests, the state has agreed to cover any additional costs, according to a news release announcing the initiative.
“While testing is a key component of our COVID-response strategy, it is important to remember that the actions we take as a result of that testing are most important,” said Susan Kansagra, the DHHS section chief of Chronic Disease and Injury. “Testing will enable our skilled nursing facilities to identify positive cases earlier and better determine additional infection prevention and control measures necessary to contain spread.”
Cohen raised a cautionary note, hearkening back to the early days of the pandemic when the state had to issue guidelines that discouraged people with mild COVID-19 symptoms from getting tested because of supply shortages.
Widespread testing and contact tracing are crucial to the state’s plan for controlling COVID-19 spread as scientists continue the race to develop a successful vaccine and treatments for severe illness caused by the novel coronavirus.
“While we continue to expand testing, it is important to note that commercial and hospital labs across the country, including here in North Carolina, are again running into shortages of important chemicals called reagents that are needed to process tests,” Cohen said. “As a result, labs are seeing backups in processing samples and are taking longer to provide results. Federal action is needed to help address these supply issues.” — Anne Blythe
Reframing freedom of choice during the pandemic
As North Carolina moves toward the July 4th holiday and weekend Independence Day celebrations, a Duke University professor who was a high-ranking public health official in the George W. Bush administration says this would be a good time to reframe this country’s freedom message.
As more studies show face masks to be an effective tool for containing COVID-19, there continues to be resistance to wearing the coverings across North Carolina and the rest of the country. During an election year when masks have become a political statement, people eschew orders requiring them as infringements on freedom.
“It’s people thinking that this is about themselves and their choices,” Mark McClellan, a physician and economist who led the U.S. Food and Drug Administration from 2002 to 2004 and the Centers for Medicare and Medicaid Services from 2004 through 2006.
“Americans, that’s our culture. We’re about independence, we’re about the right to make our own decisions,” said McClellan, who now leads Duke’s Margolis Center for Health Policy. “A lot of people have looked at this and concluded, ‘I’m not going to get sick.’”
Instead of focusing on one’s individual freedom, McClellan and others encourage people to embrace face coverings as a protection for others that will make it possible to open the country more and give others the liberty to move around more safely and freely.
“With July 4th coming up — and I know a lot of people feel like they’ve had a really challenging time already to get through these last few months — I would just encourage people to take a step back as we look at these statistics like around case trends and hospital admission trends and burdens on health care systems,” McClellan said.
While the numbers currently look grim in many locales, he had an upbeat view of the future.
“I think things are going to be significantly better in terms of the treatments we have available in a matter of months and that means we may be able to relax a bit more,” McClellan said. “In the big picture, the long-term stresses that this country has faced over the years, decades, its centuries, these months are not a long period of time, but for the coming months, in order to contain the outbreak, we’re going to have to do better than we’ve done so far.”
North Carolina continues to see a rise in lab-confirmed cases, COVID-19-related hospitalizations and more people between the ages of 18 and 45 infected with the virus since the easing of the statewide stay-at-home order in late May. Gov. Roy Cooper issued a statewide mask order last week and resisted opening more businesses because trends were going in the wrong direction.
McClellan described what North Carolina and other states are seeing as “still part of the first wave.”
“It’s just the wave that got delayed from places like New York and New Jersey and New Orleans that got hit first,” McClellan said. “That’s happening now and could have similar tough consequences if we don’t act. So the good news is we’ve got better capacity in our health care systems, but it is not unlimited. It does not take many people to overwhelm a health care system.”
In North Carolina, Mandy Cohen, secretary of the state Department of Health and Human Services, told reporters during a briefing on Tuesday that even with 908 people hospitalized with severe COVID-19 illness there remains the capacity to handle more.
Mike Sprayberry, director of emergency operations, and his team have identified surge health care facilities that can be used if the need arises, but both he and Cohen said they hope not to be in such a situation.
“Every day we look at medical surge capacity,” Sprayberry said. “That’s not once in a while. That’s every day.”
Though North Carolina’s numbers are going up and trends are not tracking the way she and her team would like, Cohen stressed that Gov. Cooper has taken a more measured approach to reopening than Arizona, Texas and other states. Those places are now re-closing businesses because of worries about hospital capacity.
“We don’t ever want to be in a place where we have to go to a field hospital,” Cohen said. “That is incredibly challenging, I will say as a physician, to think about caring for folks in a hospital-like setting that is not actually a hospital. That would be a dire circumstance that we’d be in and we want to prevent that.”
The North Carolina case increase has largely been distributed among younger to middle-aged adults, people ages 18 to 49. Some can be tied to work-related spread, some to mass gatherings and a long-recognized sense among that age group of invincibility.
Other cases are evidence of community spread among asymptomatic people.
McClellan suggested that influencers with whom younger people are more familiar could help bring home the messaging that government leaders and others have been less successful at delivering.
“The models show that unless we get quite high rates of people following basic steps — distancing, using a mask, washing hands, staying home — if we did those things at a high rate for the next six months, we would contain the pandemic,” McClellan said. — Anne Blythe
Researchers studied Norway gyms. What does that tell NC?
Mandy Cohen, secretary of the state Department of Health and Human Services, was asked about a study of gyms in Norway that has generated a lot of buzz.
North Carolina closed gyms across the state in late March and has not included the businesses in reopening plans yet.
Cohen has stressed that gyms are deemed high-risk for COVID-19 spread because the virus is transmitted through droplets that can travel farther and faster when the breathing of people engaged in strenuous exercise becomes more forceful.
Cohen said she had not read the study but had seen summaries of it. The research has not been peer-reviewed and was released on a preprint service that has published a number of studies about COVID-19 that didn’t stand up to subsequent scrutiny.
In the Norway study, the researchers recruited some 4,000 people in May and June and allowed half of them to visit five Oslo gyms that adhered to strict social distancing and cleaning regiments.
The study participants encountered no one but themselves at the gyms. The rest of Oslo’s gyms were closed, still.
Those study participants not selected for gym visits went about their daily lives in a country where COVID-19 peaked in early May.
After two weeks in which some of the gym-goers only made one visit, tests were conducted. Only one of the 1,896 gym visitors tested positive for COVID-19. No one else in the study tested positive.
“The important part is that two weeks,” Cohen said. “Two weeks is not enough time for us to have definitive information about how to move forward here. What we have seen is events when you have heavy breathing, whether it’s singing, shouting or heavy exercising, and you have more particles disperse from your mouth and your nose, that is how this virus spreads.”
States such as Arizona, Florida and Texas, which eased restrictions on bars, gyms and other places sooner than North Carolina, have experienced surges in COVID-19 that threaten to overwhelm their health care systems. Now, Arizona governor Doug Ducey is reclosing gyms, as well as bars.
Texas Gov. Greg Abbott told a reporter at KVIA last week that if he could have a mulligan, he would have kept bars closed in late April when he eased restrictions.
“The location in the state that we were able to identify that was one of the most dangerous spreaders of COVID-19 was the bar setting,” Abbott said. “If I could go back and redo anything it probably would have been to slow down the opening of bars.”
North Carolina has faced legal threats from bar and gym owners upset that they remain closed and risk financial ruin.
Gov. Roy Cooper has resisted legislative attempts to weaken his executive orders by legislators and others trying to force the reopening of such businesses sooner than his public health team has recommended. Lawmakers last week were unable to overturn a veto of a bill that would have reopened gyms and bars. A later bill to only reopen gyms was adopted by the General Assembly and sent to the governor, who has not yet taken action on it.
“What you’re seeing in some of the other states that are seeing surges … we’re seeing increases, which is worrisome, but they’re really seeing surges,” Cohen said. “You’re seeing those states walk backward and close different activities. And the things that they close first? Bars and then gyms. I think that’s because they’re looking at some of the same data that we’re looking at — at what are the higher transmission activities that could be contributing to things.”
Cohen held out some hope for gyms that can hold classes and move equipment outdoors.
“Those are lower risk activities,” Cohen said. “So we want to be getting to a place where you can be outside and moving around. Those are what we want to focus on.” — Anne Blythe
Coronavirus by the numbers
According to NCDHHS data, as of Tuesday afternoon:
- 1,343 people total in North Carolina have died of coronavirus.
- 64,670 have been diagnosed with the disease. Of those, 908 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.
- 45,538 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 910,000 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 12 percent of the positive diagnoses were in people ages 65 and older, seniors make up 80 percent of coronavirus deaths in the state.
- 216 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities. An outbreak is defined as being ≥2 cases.
- There are 3,376 ventilators available in hospitals across the state and 822 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital.