By Anne Blythe
Now that the first doses of Pfizer and Moderna COVID-19 vaccines have arrived in North Carolina and immunizations have started, the state distribution plan has been updated to better ensure that favoritism and financial means play no part in who gets the doses.
Five days before Christmas, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices updated its interim prioritization recommendations to give more specifics about who the vaccine should be offered to in Phase 1b.
Now, as 2020 comes to a close and 2021 brings the promises of vaccines, Gov. Roy Cooper and Mandy Cohen, secretary of the state Department of Health and Human Services, held their final briefing for the year, the last of more than 110 such briefings in 2020.
To close out the year, they spoke mostly about vaccine distribution.
In Phase 1a of the distribution plan, which is underway in North Carolina, COVID-19 vaccines are available to health care workers on the frontlines in wards and emergency rooms where there are interactions with people sickened by the virus. As more supplies come in, other health care workers will be prioritized, too.
Residents and staff in long-term care facilities and nursing homes also are in the initial phase of immunizations. Those vaccinations began this week with CVS and Walgreens administering the two-dose Moderna vaccine through a federal distribution program.
Nursing home residents have made up 47 percent of the deaths in North Carolina, even as they’re only about 6 percent of the cases.
As happens with many large-scale operations with only two weeks of on-the-ground experience, there has been confusion about how to define essential workers and what to do if a large health care system receives more doses of vaccine in a week than the number of people who step forward for a shot.
“To save lives and slow the spread of COVID-19, the first phases focus on protecting health care workers caring for patients with COVID-19, protecting people who are at the highest risk for being hospitalized or dying, and protecting those at highest risk to exposure of COVID-19,” Cohen said.
Most of the hospitals started receiving their first shipments of vaccines two weeks ago. County health departments began to get vaccines just last week.
“The early data suggests that there still is work to be done to make sure they’re being distributed equitably,” Cohen said.
Atrium Health received a call from Cohen recently after a worker on the communications team, not a medical worker, posted to social media that she and her husband were scheduled to receive the vaccine on Jan. 5.
“When we heard about the Atrium situation our team reached out to their team,” Cohen said. “They were very receptive and adjusted their process going forward, which we appreciated.
“We are very serious about folks following the state’s prioritization. We are updating it today so now folks have clear guidance from us going forward.”
In anticipation of potential problems in the months ahead as the state moves through additional phases, Cohen and Cooper are looking into whether medical, nursing and other health care licensing boards have rules in place to penalize those who do not comply with the distribution plan or perhaps pushing for new legislation.
“We can’t have folks jumping the line or having their family members, board members, donors jumping the line, and importantly [we] cannot see folks profiting financially,” Cohen said. “These vaccines are free. They are meant to be free for those who are getting that vaccine and if we see folks who are trying to profit financially from that, that will not be tolerated.”
Cooper said he spoke with legislators on Wednesday morning to discuss possible legislation that could also establish penalties for such deviance.
When is my shot at a shot?
In Phase 1b, which Cohen said she expected to begin by Jan. 11, possibly earlier, will make the vaccines available to people 75 and older, as well as frontline essential workers. Under the CDC definition that includes first responders, firefighters, police, teachers, child care workers, school staff, grocery store workers, food and agriculture workers, grocery store workers and U.S. postal workers.
- Group 1 in Phase 1b includes anyone who is 75 or older even if they do not have a chronic health condition.
- Group 2 includes health care and frontline essential workers who are at least 50 years old.
- Group 3 includes frontline workers and health care workers of any age, even if they do not work directly with COVID-19 patients.
Phase 2 of the vaccine distribution plan includes adults at high risk for exposure and with conditions that make them at risk for severe illness.
- Group 1 in that phase is anyone from 65 to 74 years old.
- Group 2 is for anyone 16 to 64 with a medical condition that puts them at risk of severe illness from the virus.
- Group 3 includes anyone incarcerated in the state’s prisons or jails or living in other group homes who have not been vaccinated in the earlier phases.
Phase 3 includes college, university and high school students who are at least 16 years old.
Phase 4 opens vaccine distribution to everyone else, an opportunity that Cohen does not expect to happen until at least late spring.
Even with a more detailed plan, Cohen and Cooper expect that questions will continue to arise about whether someone is in an eligible group.
“As this process unfolds operationally on the ground, I know that we will be making some decisions and adjustments as we go,” Cooper said. “There are difficult decisions that are going to have to be made at the local level. We want them to stay within the guidelines as much as they possibly can.”
“We’ll provide help in providing descriptions to them as to precisely who fits in the category,” Cooper added. “But these are broad categories and there are going to have to be some decisions made at the local level by people administering this vaccine as to whether someone falls into the category or not.”
The governor already is getting pushback on the distribution plan from Senate leader Phil Berger, a Republican from Eden.
“I don’t think anybody objects to providing the first vaccines to frontline health workers and people above 75 years old,” Berger, 68, said in a statement posted to Senator Berger Press Shop. He said he had concerns about putting college students ahead of some seniors, including those in their 60s.
“I understand the concern that college students spread the virus — but the whole basis for that concern is they spread the virus to older people who might die,” Berger added. “We should vaccinate those older people first.”
Overcoming systemic racial injustices
In addition to making sure vaccine administrators follow the distribution plan, the state also is working to build trust in communities of color where there have been long standing health care disparities.
The DHHS dashboard shows that among the 63,571 people in North Carolina who received the vaccine from Dec. 14 to Dec. 28, 80 percent of them were white. Sixty percent were between the ages of 25 and 49, while only 6 percent were 65 or older.
“There is work to do here to make sure that we are distributing vaccines equitably,” Cohen said. “There is an unfortunate longstanding history of racial injustice that is built into our medical system and we need to make sure that we are proactively trying to overcome that from the beginning.”
Cohen cautioned anyone looking at the early vaccine distribution data that it only represents one week’s worth of numbers.
Nonetheless, she said the state is working with leaders in communities of color, faith leaders and others to try to tamp down vaccine hesitancy that could lead to COVID-19 circulating through populations that already have suffered disproportionately from the virus during the pandemic.
“That is why we are working closely with partners that are community-based organizations from our historically marginalized populations, working closely with members of the General Assembly and other leaders from the faith community who represent communities, to make sure they are getting good information about the vaccine so they can make informed decisions for them and their family,” Cohen said. “We want to make sure folks know that this vaccine is safe. It has been tested in clinical trials. It is effective. It is 95 percent effective. You cannot get COVID from the vaccine itself.”
‘Very, very worried’
As Cohen and Cooper rolled out the updated vaccine distribution plan, they cautioned that North Carolina is on the precipice of even more dire times.
North Carolina has had 532,830 lab-confirmed cases of COVID-19 since the start of the pandemic and 6,729 deaths related to the virus.
On Wednesday, as many people returned from Christmas travels, there were 8,551 new cases reported. There are record numbers of people in the hospital with serious illness related to COVID-19 — 3,339 on Wednesday, up from 2,023 on Dec. 1.
Intensive care units also have a record number of people battling fiercely for their lives inside them, according to Cohen. Now there are 768 people in those ICU beds. On Dec. 1, that number was only 454.
“I’m very, very worried,” Cohen said.
With such critical spread, the White House Coronavirus Task Force issued a strong admonishment to North Carolinians who are 65 and older or have an underlying health condition such as diabetes, hypertension, obesity, autoimmune disease and respiratory illness.
“The task force cautions that these people should not enter any indoor space where people aren’t wearing masks and recommends having groceries and medicines delivered to avoid having exposure,” Cooper said. “The recommendation stresses that gatherings of people not wearing masks, public or private, simply are not safe.
“That’s how prevalent this virus is right now.”
Additionally, Cohen said, the White House task force warned that anyone under 40 who gathered with someone outside their immediate household over the Christmas holiday needs to assume they have COVID-19 even if they do not have symptoms.
“The task force warns that you are dangerous to others and must isolate away from anybody with increased risk for severe disease and get yourself tested,” Cohen said.
Extended eviction moratorium
North Carolina soon will get more federal assistance to continue its fight against COVID-19 in the months ahead as vaccines are distributed.
The federal stimulus package was approved by Congress last week and signed by President Donald Trump over the weekend.
“Fortunately help from Washington is finally on the way,” Cooper said. “Over the weekend, the president signed legislation that provides funding for vaccine distribution, schools, direct payments to individuals, help for small businesses and hospitals. It includes a badly needed extension of federal unemployment assistance and direct payments to families that qualify.”
The federal package also includes funding for rental assistance. Cooper said North Carolina expects to receive about $700 million for that purpose.
“When North Carolina receives these resources, I plan to work with the General Assembly to help disperse it quickly and effectively,” Cooper said.
Cooper signed an executive order this week that extends a moratorium on evictions through the end of January.
Additionally, he plans to reopen the state’s Housing Opportunities and Prevention of Evictions (HOPE) Program, through which North Carolinians suffering financial hardships can get assistance paying their rental and utility bills.
Nearly 3 million adults in North Carolina have reported difficulty in covering their usual household expenses, according to the governor’s office. Some 485,000 residents have reported being behind on rent payments.
Through the HOPE program, nearly 21,000 renters have been notified that they will receive financial assistance, notices that add up to nearly $37.4 million.
“Too many families are living on the edge, trying to do the right thing, but left with impossible choices,” Cooper said when announcing the order. “This order will help them stay in their homes, which is essential to slowing the spread of the virus.”
Nursing home residents continue to die from COVID
The novel coronavirus has infected some of the state’s skilled nursing facilities more than once — with 314 outbreaks reported among the state’s 427 nursing homes.
As of the state’s most recent count, on Christmas Eve, there were 19 new cases of COVID in three of the four State Veterans Nursing Homes, where 38 older veterans have died of the disease during 2020. In late November, the state Veterans Affairs Commission said the management of the homes should remain in the hands of PruittHealth, the Georgia-based company that has run the facilities for 22 years.
In addition, six nursing homes in the most recent DHHS outbreak report recorded 20 or more deaths from COVID. (Because the Department of Health and Human Services clears cases and deaths from its online database when conditions improve at nursing homes, overall COVID deaths at specific homes may exceed the levels listed here).
Among those currently listed with 20 or more deaths is the Stanley Total Living Center with 111 cases and 25 deaths. The facility is a continuing care retirement community, with residents who are independent, some who require only assisted living and some skilled nursing patients. DHHS lists these cases as having occurred in the skilled nursing portion of the facility.
Other facilities with more than 20 deaths in the most recent report include Peak Resources in Alamance County with 104 cases and 22 deaths; White Oak Manor in Kings Mountain, with 192 cases and 24 deaths; Edgecombe Health and Rehabilitation, in Tarboro, with 120 cases and 22 deaths; the Dan E and Mary Louise Steward Health Center in Wake County with 146 cases and 20 deaths and Universal Health Care/Oxford, with 153 cases and 21 deaths.
Coronavirus by the numbers
According to NCDHHS data, as of Wednesday afternoon:
- 6,729 people total in North Carolina have died of coronavirus.
- 532,830 have been diagnosed with the disease. Of those, 3,339 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.
- 403,488 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. Nor does it reflect the number of so-called “long-haul” survivors of COVID who continue to feel the effects of the disease beyond the defined “recovery” period.
- To date, 6,835,632 tests have been completed in North Carolina. 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 (40 percent). While 15 percent of the positive diagnoses were in people ages 65 and older, seniors make up 80 percent of coronavirus deaths in the state.
- 609 outbreaks are ongoing in group facilities across the state, including nursing homes and correctional and residential care facilities.
- There are 3,591 ventilators in hospitals across the state and 1,172 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital. As of Tuesday, 768 COVID-19 patients were in intensive care units across the state.