A look ahead for health in N.C. for 2022

COVID, Omicron and children

This could be the year that the coronavirus pandemic subsides.

However, as 2021 bleeds into 2022 with the Omicron COVID-19 variant sending case numbers soaring and hospitalizations on a steep incline, the new year starts out much like last year. COVID will continue to play a large role in public health care and policies shaping the state’s virus attack and potential recovery plans.

It should become clear in the first couple of weeks of 2022 whether Omicron will take the same, less intense course in this country as it did in South Africa and Scotland, according to two preliminary studies.

Or is there more ambiguity about the severity of illness and potential for dangerously strained health care systems caused by the variant, as an English study suggests?

Kody Kinsley, who became the acting secretary of the state Department of Health and Human Services on Jan. 1, will be leading the pandemic response, taking over from Mandy Cohen, the former DHHS head, who resigned from her job at the end of December to try something new.

What that “something new” is will likely become clear in 2022 and reveal whether it will occur in North Carolina or elsewhere.

Kinsley will be picking up the baton in the now years-long race against COVID even as testing sites are swamped in the post-holiday crush of people trying to get tested before or after gatherings. He also will be taking the lead as a push for new COVID therapies and treatments becomes stronger.

The federal government has promised to make more home tests available in the weeks ahead, but whether the supply will match the demand is another unknown. And some experts say these newly available tests will come too late to avoid a flood of Omicron cases.

Vaccination against COVID and booster shots are likely to be key refrains from North Carolina public health advocates in an effort to relieve the state from the throes of a virus that has shown its adaptability.

Though many hoped COVID vaccines would be available early in 2022 for children ages 4 to at least 6 months old, Pfizer announced in mid-December that further study was needed to test the efficacy of a three-dose 3-microgram series before seeking authorization for emergency use.

Clinical trial data suggested that two doses of the 3-microgram vaccine provided a robust response of antibodies in children younger than two, but for those from two to four, the dose was likely too small to produce as strong a response as was achieved for teens and young adults.

The setback could mean that vaccines for toddlers and preschool children won’t be available until at least the second quarter of the year.

The number of COVID cases in children rose sharply in 2021 and as the Omicron variant moves so swiftly through unvaccinated populations, there are concerns about long-term effects of the virus on children, according to the American Academy of Pediatrics. The past fortnight brought more pediatric deaths from COVID than at any other time during the pandemic.

Another question that will be explored as the pandemic goes on is whether children, teachers and other school staff can safely stay in classrooms with a “test to stay” approach.

As the new year starts, we will continue to track and answer these and other questions about COVID-19 and how long it will continue to menace North Carolinians in the months ahead.

— Anne Blythe

Tracking changes to the state’s largest insurance provider

Everyone expected issues to crop up during the initial transition to Medicaid managed care. Now that we’re six months into the switch, and those in charge have had some time to learn about and address the most pressing issues, I’ll be keeping my eyes out for problems that persist. Billing and reimbursement issues? Rate cuts? Send me an email to tell me what you’re seeing.

Getting into the weeds of how these programs are administered can be dull. But, what I always try to keep in mind — and what I hope you all will too — is that when these intricate systems become harder to navigate, the people who suffer are N.C.’s low-income residents, primarily children.

I’ll also be keeping a close watch on the Healthy Opportunities pilot, a first-of-its-kind state initiative that aims to save money on medical spending by investing $650 million in projects to address social determinants of health, such as access to food, transportation and housing. I’m out in Buncombe county, and here the project is being led by Impact Health, a creation of the Dogwood Health Trust.

Finally, in their final budget document, legislators created a combined House and Senate committee on access to care and Medicaid expansion “to consider various ways in which access to health care and health insurance can be improved for North Carolinians.” The committee will start its work in the first quarter of 2022 and we’ll be following along closely.

If you’re a provider, or a recipient of services through the Healthy Opportunities Pilot, reach out! We want to hear about your experiences with Medicaid.

— Clarissa Donnelly-DeRoven

Rural communities make changes to care for the ‘whole person,’ will they help improve health outcomes?

There’s about a million and one things to dig into regarding rural health. But two areas in particular that I plan to dig into are integrated care clinics and traveling clinics.

It’s no secret that rural areas often lack speciality providers, and sometimes even basic health clinics. Throughout the pandemic, traveling clinics have provided vaccines and COVID tests to areas that needed them. I’ll be curious to tag along with providers who are using this model to bring different types of primary care — such as dental and vision — to areas that lack them, such as farmworker camps.

Integrated care clinics also are a creative solution to some of these health care desert woes. The providers at these clinics address patient health in a holistic way, looking at the relationship between physical and mental health, and aiming to address both simultaneously.

In my mind, I group this type of whole person health together with initiatives like the Healthy Opportunities pilot. These are efforts that look at our current system and say “Hey, we’ve been treating all of these interconnected problems separately. What would happen if we tried to treat them together?”

— Clarissa Donnelly-DeRoven

Dealing with dueling public health crises in NC’s prisons and jails

As 2021 comes to an end, two things are very clear — both the opioid crisis and the COVID-19 pandemic are not going anywhere any time soon.

These are two issues that disproportionately impact people who are incarcerated or formerly incarcerated.

With the Omicron variant spreading quickly in the United States, the state’s prison and jail response will be crucial to saving lives. Over 70 percent of people incarcerated in the state’s prisons are fully vaccinated, but experts have urged that it might not be enough, if you were vaccinated with the Johnson & Johnson vaccine two months ago or either the Moderna or Pfizer vaccines more than six months ago.

About 11 percent of people incarcerated in the state’s prisons have elected to get a booster, as of Dec. 14, according to the Department of Public Safety.

Prison staff vaccination rates continue to lag behind those who are incarcerated across the country. In jails, where staff and detainees are constantly cycling in and out, it is very difficult to keep track of who is vaccinated and boosted.

Jails and prisons are also dealing with the opioid epidemic. Around 85 percent of people in prison have an active substance use disorder or were incarcerated for a crime involving drugs. Still, treatment for substance use disorder is not widespread throughout the prisons, and inconsistent in the state’s jails.

The prisons are set to start a pilot program to expand medication-assisted treatment in some facilities. How well that works could have wide-ranging implications for how the prison system as a whole treats substance use disorder.

— Elizabeth Thompson

Environmental health issues under scrutiny

Water quality issues will continue to be top of our list in the coming year, as the extent of PFAS and other industrial pollutant contamination is becoming clearer. Both the state budget and the federal Bipartisan Infrastructure Bill have set aside funding to address PFAS and other water contamination issues.

Our long-time part-time environmental health reporter Greg Barnes retired at the end of September. But we have an exciting new development at NC Health News – we were granted enough funding to hire a full-time reporter to cover environmental health and we’re advertising for that position right now! That person will be tasked with following all of these water quality issues closely.

In addition, we’re looking to dig deeper into some environmental issues that have languished for, at times, generations. One of those issues is contamination in Badin Lake, a dammed reservoir on the Yadkin-Pee Dee River. In the past industrial plants, in particular an Alcoa smelter, left the water contaminated.

In December, the national organization, ProPublica, published detailed maps of cancer hotspots across the U.S. that largely affect communities of color. Some of those hotspots are in North Carolina and we’re hoping to dig into that data as the year progresses.

Keep an eye out for an announcement of our new hire, who we hope to have on board in late January.

— Rose Hoban

Following the second year of the state budget biennium

The General Assembly wrapped up the 2021 work session in December, making that the longest legislative session in close to three decades. In November, Republican lawmakers and Democratic governor Roy Cooper reached an agreement over a budget, which was packed with earmarks funded largely by federal COVID relief appropriations.

Part of that budget included a provision to create a select committee on Medicaid expansion, a policy move that has been at the top of Democrats’ wish lists for close to a decade. As that process ramps up in what looks like the first quarter of 2022, we’ll be keeping close tabs on lawmakers deliberations around the policy, which, after many years, received an endorsement from Senate leader Phil Berger (R-Eden).

Even-numbered years typically have shorter legislative sessions, which traditionally have focused on revising the state budget for the second year of the biennium. But other even-numbered years have resulted in plenty of policy and spending changes.

With a vaccinated team, we’ll be back on site at the legislature, keeping track of this process and several study committees, including studies of algal blooms, PFAS contamination in the state’s waterways, direct care worker salaries and more. We’ll also be there to cover what’s likely to be a fight over the coming year’s state budget, now that most of those federal COVID dollars have been appropriated.

— Rose Hoban

Mental health services in crisis, will North Carolina respond?

There is no doubt that the pandemic sparked a mental health crisis as people suffered through immeasurable stress and loss. North Carolina hospital leaders have sounded the alarm, saying we’re in a “behavioral health emergency” as increasing numbers of patients are coming to emergency departments in distress.

Experts say the peak of a mental health crisis hits about six months after a disaster, such as a hurricane, but this one is different. The COVID-19 pandemic has dragged on for nearly two years presenting new challenges, and it isn’t over yet. We expect the pandemic-induced mental health crisis to outlive the virus and to be a key focus of our reporting in the coming year, particularly for young people.

In the fall, Mental Health America’s 2021 report ranked North Carolina 45th overall for pediatric mental health care.

Then, in early December, U.S. Surgeon General Vivek Murthy issued a 50-page advisory calling urgent attention to the issue of adolescent mental health. The document came with a note, saying that Surgeon General advisories are “reserved for significant public health challenges that need the nation’s immediate awareness and action.”

Murthy noted that the number of high schoolers reporting feelings of loneliness and sadness increased 40 percent between 2009 – 2019, before the pandemic even began. He described the many factors that contribute to this problem, including social media and slow progress on issues such as racial justice, climate change and gun violence.

“All of that was true even before the COVID-19 pandemic dramatically altered young peoples’ experiences at home, at school, and in the community,” Murthy wrote. “The pandemic era’s unfathomable number of deaths, pervasive sense of fear, economic instability, and forced physical distancing from loved ones, friends, and communities have exacerbated the unprecedented stresses young people already faced.”

In June 2021, it was estimated that more than 140,000 children across the country had lost a parent or grandparent caregiver to COVID-19, according to the advisory. It also cites emergency department data which shows higher rates of youth suicide attempts — particularly among young females — during the pandemic.

“It would be a tragedy if we beat back one public health crisis only to allow another to grow in its place,” Murthy wrote.

The Surgeon General’s advisory lists several different action steps for health professionals, educators, community members, families and young people to improve the mental health of adolescents, which range from raising awareness to improving access to care.

— Taylor Knopf

Older people continue to compose an increasing sector of North Carolina’s population — 16.7 percent or almost one out every six Tar Heels, according to census estimates.

Way back in 2010, the share of North Carolinians 65 and older was 12.9 percent. That means older people’s piece of the population pie grew by about 30 percent in a little more than a decade. It also means that the state will need many more independent living apartments, caregivers, geriatricians and home health workers, as well as benefiting from the brain trust and energy apparent in many “seniors.”

In 2021 those numbers surely played into what’s being called the most positive legislative session in years for older people— including some recurring state funding for sources of help like Meals on Wheels and transportation. But as always, there’s competition for official attention and the money that comes along with it, given additional needs such as schools funding, continuing COVID response and a recent increase in disaster relief.

As executive director of the North Carolina Coalition on Aging, Heather Burkhardt keeps up with news and reports from government agencies, nonprofit groups, and businesses with a stake in the health and welfare of older people. Advocates have said that a key to better outcomes for this group lies in better wages and treatment for state’s direct care workers, a focus of the coalition that should show results in 2022.

“It’s been a cornerstone of the work we’ve done over this last year,” Burkhardt said Dec. 3 at a statewide gathering of leaders in aging. “We really focused our energies on wages and collaborations, not just within aging, but across all service industries.”

Members will push in 2022 for a state study on the aging boom to look comprehensively at the generation’s specific problems, solutions and opportunities, some of which may not reveal themselves at first glance.

“The state needs a road map of how to address the implications of an aging baby boomer population,” Burkhardt said.

— Thomas Goldsmith