By Anne Blythe

North Carolina will require the staff at all nursing homes across the state to be tested every two weeks for COVID-19, strengthening what had been a guideline to an order.

Many Cohen, secretary of the state Department of Health and Human Services, issued the order on Friday, nearly half a year into the coronavirus pandemic.

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COVID-19 has raged through nursing homes across North Carolina and the rest of the country. 

“We have worked to support, guide and hold accountable nursing homes in their commitment to protect residents and staff during COVID-19,” Cohen said at a briefing with the media.

Even before North Carolina had its first lab-confirmed case of COVID-19, Cohen and others on her public health team stressed how quickly the virus could spread through congregate care facilities. They quickly closed these facilities off to any outside visitors, including family members, prompting heartbreaking scenes of family members visiting with loved ones through windows and via technology.

That meant the only people going into and out of facilities complying with the state’s directives were care-givers, employees and supply delivery people.

“Our nursing home residents are amongst the most vulnerable to COVID-19 infections for a number of reasons,” Cohen said. “Many are elderly, and many are medically frail with multiple chronic medical conditions, putting them at higher risk for severe COVID-19 illness and worse outcomes.”

The state set up a five-point plan at the start of the pandemic to try to limit COVID-19 infection in the congregate care facilities, focusing on prevention, staffing, testing, outbreak management and oversight.

Despite early-laid plans, outbreaks, defined as two or more cases, occurred at facilities across the state. As of August 7, North Carolina had 6,792 lab-confirmed cases among nursing home staff and residents, according to data reported by DHHS on their dashboard. 

Of the state’s 2,134 COVID-19 related deaths, at least 886 have been nursing home residents.

As the pandemic has worn on and scientists, health care workers and others have learned how to better treat severe illness caused by COVID-19. Researchers also have pinpointed ways to better control infection through the consistent wearing of face masks, aggressive testing and contact tracing to help isolate the infected and limit further virus spread.

Fewer nursing home residents are now getting sick when there is an outbreak, Cohen said while showing graphs and charts. The percent of outbreaks lasting longer than six weeks also has fallen, according to Cohen.

As the state continues to battle COVID-19, the public health team is stepping up the prevention prong of its attack plan.

“We know that COVID-19 can be brought into nursing homes, by staff and visitors and delivery people and other outsiders, which is why limiting the number of people going into a nursing home was a key priority early on,” Cohen said.

The state has sent personal protective equipment to every nursing home in the state and requires staff to wear face masks.

Persistent staffing shortages

One of the challenges across the country for nursing homes during the pandemic has been retaining staff. The pay is notoriously low for the jobs caregivers are expected to perform and often do not come with health insurance benefits.

The state, Cohen said, has helped get open positions filled during this phase of the pandemic through a partnership with the East Carolina University School of Nursing. The partnership has referred 5,331 registered nurses and certified nursing assistants with facilities urgently seeking staff.

The state also has put in place temporary regulatory changes that have made it so 675 nurse aides from outside North Carolina can work here during the pandemic.

Nonetheless, the larger issues that plagued facilities and the nursing home industry even before the pandemic continue to fester.

Shows a bar graph where the bars each represent a state. North Carolina's rate is at 94.8 cases/ 1000 residents, about on par with Ohio, Kentucky and Colorado.
Graph displayed by Health and Human Services secretary Mandy Cohen indicating that North Carolina’s nursing home death rate is at 94.8 cases/ 1000 residents. This puts the state about on par with Ohio, Kentucky and Colorado.

Low pay puts workers, some of whom supplement their income with second and third jobs, at pressure to work even when sick to make ends meet.

The lack of health insurance for many workers means the costs of routine testing for COVID-19 can fall on facilities reluctant to absorb the extra financial burden.

The state is stepping in with help.

COVID-19 infection in nursing homes started elsewhere

“We are giving nursing homes financial support to make that testing happen,” Cohen said, adding that federal funds allocated to the state for COVID-19 expenses will be used through November.

The testing of all staff every two weeks will make it easier to identify infected caregivers who might be asymptomatic and develop quick plans to help prevent rampant virus spread.

Additionally, the state is adding 10 regional infection control support teams that will be deployed to nursing homes and long-term care facilities to help with prevention measures.

“I want to highlight that every COVID-19 infection that reaches a nursing home started somewhere else,” Cohen said. “That’s why everyone in North Carolina can play an important role in protecting people in nursing homes. Slowing the spread of COVID-19 in our communities means that those who work in nursing home settings are less likely to be exposed to the virus, and thus less likely to bring it back to a nursing home where they work.”

The way to do that, Cohen said, is for others to follow the three Ws — wear a face mask, watch your distance and wash your hands rigorously.

Seven selected to manage Community Health Workers

As different needs emerge during the pandemic, the state’s public health team has tweaked its strategies and developed new programs.

On Friday, Cohen and her team announced the selection of seven vendors that will hire and manage more than 250 Community Health Workers to help in 50 counties where extra support is needed.

The workers will help North Carolinians affected by COVID-19 find testing, get medical support and connect those in need to social and community support systems for mental health care, food assistance programs and other issues that arise.

“Community Health Workers will bolster our statewide COVID-19 response and help North Carolinians navigate the complex impacts of this pandemic,” Cohen said in a statement.

The state set up the Community Health Worker program, in part, to help with communities of color, where there have been long-standing disparities in health care access.

The chosen vendors are:

  • Curamericas Global, which is based in Raleigh but will serve Alamance, Buncombe, Chatham, Craven, Davidson, Davie, Durham, Franklin, Forsyth, Gaston, Granville, Guilford, Harnett, Henderson, Johnston, Lee, Onslow, Orange, Pitt, Randolph, Surry, Warren, Wake, Wayne, Wilkes and Vance counties;.
  • Kepro, a company founded by physicians from the Commonwealth of Pennsylvania Medical Society, that will  serve Cabarrus, Gaston, Mecklenburg, Montgomery, Rowan, Stanly and Union counties;
  • One to One with Youth, a Goldsboro-based organization that will serve Duplin, Greene, Johnston, Lenoir,  Sampson, Wayne and Wilson counties;
  • Vidant Health, the Greenville-based system that will serve Beaufort, Bertie, Chowan, Dare, Duplin, Edgecombe, Halifax, Hertford, Northampton and Pitt counties;
  • Mount Calvary Center for Leadership Development, the Burgas-Based organization that will serve Bladen, Columbus, Duplin, Pender, Robeson and Sampson counties.
  • Catawba County Public Health; and
  • Southeastern Healthcare NC, the Raleigh-based organization that will serve Johnston, Orange and Wake counties.

Coronavirus by the numbers

According to NCDHHS data, as of Friday afternoon:

  • 2,134 people total in North Carolina have died of coronavirus.
  • 132,812 have been diagnosed with the disease. Of those, 1,123 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.
  • 105,093 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. 
  • To date, 1,939,812 tests have been completed. As of July 7, all labs in the state are required to report both their positive and negative test results to the lab, so that figure includes all of the COVID-19 tests performed in the state.
  • People ages 25-49 make up the largest group of cases (44 percent). While 12 percent of the positive diagnoses were in people ages 65 and older, seniors make up 79 percent of coronavirus deaths in the state.
  • 330 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities.
  • There are 3,219 ventilators in hospitals across the state and 866 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital.

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Anne Blythe

Anne Blythe, a reporter in North Carolina for more than three decades, writes about oral health care, children's health and other topics for North Carolina Health News.

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