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Anne Blythe

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Your dentist can see you remotely

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Your dentist can see you remotely - North Carolina Health News

North Carolina lawmakers establish standards for the practice of teledentistry. Gov. Roy Cooper signed the bill into law last week.

 By Anne Blythe

Shaun Matthews, an evangelist for telehealth in the United States and abroad, was giving a presentation to the International Association of Dental Research on a Zoom call last week when he learned that North Carolina lawmakers had just approved a bill formalizing the use of teledentistry.

As part of his presentation on “The Rise of Teledentistry in Clinical Practice: An Inevitable Response to a Global Pandemic or a False Dawn,” Matthews mentioned work he had done in North Carolina while at the UNC-Chapel Hill dental school.

During his Zoom segment, Jane Weintraub, former dean of the UNC Adams School of Dentistry and the woman who recruited Matthews to Chapel Hill from Great Britain, dropped a message into the chat discussion for her colleague.

She had just received word that Senate Bill 146, an act establishing standards for the practice of teledentistry in North Carolina, was sailing through the General Assembly with broad support in both chambers.

On Friday, Gov. Roy Cooper signed the bill into law.

Matthews, a clinical professor in Oral and Maxillofacial Surgery and Hospital Dentistry at the Indiana University School of Dentistry since August 2020, swelled with pride.

For two of his five and a half years at the dental school in Chapel Hill, Matthews was director of telehealth while juggling his clinical and teaching work.

Teledentistry, Matthews and other supporters say, can help expand basic oral health care to people in areas where it can be difficult to see a dentist, to underserved children and to the aging. With special cameras, audio and visual technology, clinicians can do consultations and some follow-up visits with patients remotely, often saving the patient the cost of traveling to the appointment and the need to take time off from work.

Power of telehealth

During the pandemic, telehealth visits rose sharply, especially in the spring of 2020. In an Oct. 2020 report posted on the Centers for Disease Control and Prevention website, a team of scientists concluded that there was a 154 percent increase in telehealth visits during the last week in March compared to the same time frame in 2019. 

“Telehealth could have multiple benefits during the pandemic by expanding access to care, reducing disease exposure for staff and patients, preserving scarce supplies of personal protective equipment, and reducing patient demand on facilities,” the researchers concluded. “Telehealth policy changes might continue to support increased care access during and after the pandemic.”

Some estimates put the adoption of telehealth even higher. The management consulting firm McKinsey estimates that beyond an initial explosion of telehealth use in early 2020, telehealth use has stabilized at 38 times higher than pre-pandemic levels.

“After an initial spike to more than 32 percent of office and outpatient visits occurring via telehealth in April 2020, utilization levels have largely stabilized, ranging from 13 to 17 percent across all specialties,” the McKinsey authors found. 

In the early days of the pandemic, when Matthews was still in North Carolina, he worked with Weintraub and others at the Adams School of Dentistry to create the Carolina Dentistry Virtual Oral Health Care Helpline.

COVID-19 had spread across the country and state with a vengeance.  

The UNC dental school had held its second teledentistry summit in early March of 2020, hoping to persuade others that the use of such technology could expand oral health care access to underserved populations and remote parts of the state.

When many dental offices across North Carolina were forced to close except for emergency services, Matthews and others built on their teledentistry models to set up a system in which people who perhaps cracked a tooth or had some other oral health issue could call into the hotline.

Putting ideas into action

If necessary, the caller could get a virtual assessment through a video or Zoom call.

In the first month, 337 telephone calls were answered, according to an article the dental school colleagues published in the Journal of the American Dental Association about the hotline. Dental pain was the reason that more than half of the people called. Seventy-nine of the callers received consultations from virtual providers, the authors stated, and 33 of those callers did not require follow-up.

Using teledentistry to connect dentists and oral health care providers to their patients virtually during the pandemic underscores many of the benefits that advocates have been touting for years.

They include:

  • Virtual consultations in which dentists can assess a patient quickly and remotely to determine whether to recommend medicine, a trip to an emergency clinic, hospital or their dental offices.
  • Saving patients the expense of travel and unnecessary time off from work for a check-up after an operation if it can be done online.
  • Through the use of intraoral cameras, a hygienist or nurse can share images from inside the mouth of a patient they’re seeing at a nursing home, school or other remote site and discuss a treatment plan with a dentist.

Hygienists and local anesthesia

Zachary Brian, director of the North Carolina Oral Health Collaborative, has long advocated for teledentistry as a way to provide more public health care at schools, nursing homes, rest homes and facilities for people with special needs.

North Carolina dental hygienists have been urging dentists and others in this state to give them the freedom to clean teeth and screen patients for cavities and other problems even if a dentist is not in the room or office with them.

Masked male dentist and masked female hygienist drill inside a patients mouth
Dentist Bill Milner of Access Dental Care and hygienist Mary Elizabeth Andreyev extract a patients broken tooth at Moses Cone Infectious Disease Clinic. Photo credit: Anne Blythe

Additionally, they have argued that they could take X-rays, apply sealants, and in some cases prevent further tooth decay with silver diamine fluoride outside the physical presence of a dentist.

In early 2020, the state legislative rules commission amended the scope of practice for licensed hygienists in North Carolina, making it possible for them to work without a dentist on-site in federally qualified health care centers, some public schools, and special-needs and some elder-care facilities.

The new law establishes standards for the practice of teledentistry that will make it possible for hygienists to work in such facilities without a dentist there with them.

The law also authorizes registered hygienists to administer local anesthetics, another expansion of their scope of practice in a state that is among the most restrictive in the country for what a hygienist can do outside the presence of a dentist.

North Carolina hygienists now will join the ranks of their peers in 44 other states and Washington, D.C., already authorized to give injections. The change, Brian said, could help improve efficiency and perhaps reduce the cost of care.

“This is an important step toward a more equitable oral health landscape in North Carolina,” Brian said in a statement.

There are challenges, though.

There’s a paucity of broadband infrastructure in much of rural North Carolina, making telehealth visits less likely in just the regions such programs could better serve.

Questions remain, too, about whether insurers will continue to cover teledentistry and other online health care visits after the pandemic.

The stakeholders who brought together lawmakers from both parties to show broad support for teledentistry in North Carolina say it was important to bring many to the table and educate them about the public health benefits and business advantages for dentists.

The North Carolina Dental Society played a crucial role, too.

“It is always great to see bipartisan support for common-sense health care reform,” Ben Popkin, political strategist for the Foundation for Health Leadership and Innovation, said in a statement.

‘Over the moon’

Matthews, the former UNC dental school professor recruited to Indiana University to help advocate for telehealth in the Hoosier State, was still jazzed several days after the North Carolina law was adopted.

“I am absolutely thrilled, over the moon,” Matthews said during a telephone interview.

The Indiana governor signed a bill into law in April that authorizes dentists, hygienists and other health care providers to use telehealth with their patients, a change that came, in part, because of Matthews.

Though approval of the law in North Carolina came several months after the Indiana action, Matthews said this state’s establishment of standards for the practice of teledentistry is a step further.

“To hear it literally coming through hot off the presses as I was giving my presentation was so impressive,” Matthews said.

Weintraub, who has been busy looking up teledentistry activities in the corporate world now that this state will be able to offer it as a service, summed up the law after the international conference.

“This bill is a major step forward in aligning our state with the rest of the country to improve the accessibility and efficiency of dental care,” Weintraub said in a statement. “It clarifies the provision of teledentistry that benefits those who can’t easily get to a dental office because of geography, disability, a pandemic, or who desire greater convenience.

“It makes it possible for people to obtain preventive services from qualified dental hygienists in many community settings without on-site dentist supervision.  NC is one of the last states to allow trained dental hygienists to provide local anesthesia. The first state did so 50 years ago in 1971.”

shows a freckle faced boy in a mask to prevent coronavirus transmission sitting at a school desk with a notebook and pen.

Coronavirus Today – July 21 – New COVID recommendations for schools: Mask up in K-8, more leeway for vaccinated high school students.

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Coronavirus Today – July 21 – New COVID recommendations for schools: Mask up in K-8, more leeway for vaccinated high school students. - North Carolina Health News

As the Delta variant pushes case numbers up in North Carolina, new guidance issued for K-12 schools.

By Anne Blythe

Gov. Roy Cooper and his health and human services secretary issued new coronavirus guidelines for schools on Wednesday in which they strongly recommend face masks for children in kindergarten through eighth grade as districts reopen their classrooms next month for in-person learning.

The StrongSchoolsNC Public Health Toolkit has been updated as North Carolina is seeing a surge in cases over the last three weeks fueled largely by the Delta variant. Delta, the latest of the coronavirus mutations which have bedeviled public health officials worldwide, has become the dominant strain in the country, according to the Centers for Disease Control and Prevention.

“The most important work our state will do next month is getting all of our children back into classrooms safely for in-person learning,” Cooper said. “That’s the best way for them to learn, and we want their school days to be as close to normal as possible, especially after the year of disruption they have had.”

Elementary school children are not yet eligible for COVID-19 vaccines. No vaccine has been approved for children under 12.

Cooper’s executive order requiring masks on public transportation, in child care settings, schools and camps expires on July 30. The governor said he did not plan to issue a new order to extend those measures.

North Carolina will remain in a state of emergency because of the coronavirus pandemic, but most masking and social distancing restrictions are no longer required by order of the governor.

Masks all around

Nonetheless, Cooper and Mandy Cohen, secretary of the state Department of Health and Human Services, are recommending masks for all students and staff while inside elementary school and middle school facilities, even if adults or students 12 and older have been fully vaccinated.

Only about 24 percent of North Carolina’s children 12 and older have been vaccinated, according to Cohen and Cooper, leaving a large segment vulnerable to the Delta variant or other strains of COVID-19.

Shows a man standing at a podium in front of a room with reporters scattered among the desks asking questions about state coronavirus guidance
Gov. Roy Cooper and Health and Human Services Secretary Mandy Cohen held a press conference at the Emergency Operations Center in Raleigh, Wednesday, July 21 where Cooper pleaded with North Carolinians to get vaccinated. The two announced updates to their school reopening plan during the conference. Photo credit: Rose Hoban

“In a middle school situation you have students who are eligible and who aren’t,” Cohen said. “There’s been pretty good research around, not just making sure that we are protecting those who have no eligibility for vaccination, but also around bullying in a school. So we actually think it’s important for us to include middle school in this universal school requirement. We do feel differently for high school.”

The DHHS guidance suggests that students and staff who are fully vaccinated don’t have to wear masks inside. The public health officials recommend mask-wearing for anyone not yet vaccinated while inside classrooms and other indoor facilities.

“All high school students and their teachers are eligible for vaccines,” Cohen said. “We want to show that when you do get vaccinated, you are able to take off your masks. …We hope that will be an additional incentive for our high schoolers to go get vaccinated.”

In North Carolina, nearly 12 percent of the lab-confirmed COVID cases have been in children 17 and younger, according to the DHHS dashboard. An unknown number of children may have had COVID without having any symptoms. 

Delta dominant

As of Wednesday, North Carolina has had more than 1.028 million confirmed COVID cases, according to the governor. There were 1,434 new cases reported on Wednesday and 694 hospitalizations related to the virus, the highest numbers reported in two months, Cooper said.

Cohen said that the Delta variant has become the dominant strain in North Carolina, as it is in the rest of the Southeast. She noted that 80 percent of the cases for which the state is performing genomic sequencing are the Delta variant. 

Sixty percent of North Carolinians 18 and older have received at least one shot, and research is showing that vaccines have been protective against this new variant. But Delta spreads aggressively and there is the possibility of some “breakthrough” cases.

Eric Topol, a scientist from the Scripps Research Institute in San Diego, California, noted that the recent research shows the Delta variant produces 1,000 times more “viral load” in patients, meaning that it likely spreads easier between people.

“When you transmit [virus] so much more broadly, you’re going to have more deaths, you’re going to have more hospitalizations,” he said during a webinar with the Association of Health Care Journalists this week. It’s still an open question as to whether the Delta variant is more “deadly” on its own, but with more cases will come more deaths. 

“You’ve already seen that vaccinations are remarkably protective,” Topol said. “I want to reinforce that it’s the most important thing that the public needs to know right now. 

Rod Jenkins, the Durham County public health director, told participants in a Zoom call for the Partnership for a Healthy Durham, that while some might think the finish line is near that’s not the case.

“We are in a race against the variants and a race against the seasons,” Jenkins said. “We don’t want another winter, which we had like last year. Last winter was brutal. And those of us in public health around the squares know exactly what I’m talking about. The month of January was the worst on record for us during the pandemic and we certainly don’t want that to happen again.”

Cooper reiterated Jenkins’ thoughts later that afternoon.

“This pandemic is not behind us yet,” Cooper said. “We will continue listening to experts as we share health recommendations and the tools that people need to stay safe. If the pandemic worsens and additional action is necessary, we’ll take it.”

Cooper reiterated a plea he has made since late last year, to try to get the state vaccination rate to 75 or 80 percent.

“We’ve made so much progress against this virus and now is not the time to ignore it,” Cooper said. “Even if you have been vaccinated, take it upon yourself to get others a shot. I’m confident that we can clear whatever hurdles remain and emerge from this pandemic stronger than before.”

State, local school tension

The North Carolina Association of Educators, a powerful voice for teachers, expressed a lack of confidence in the school safety guidance issued by Cooper and his team on Wednesday. The American Academy of Pediatrics issued school guidelines on July 18 recommending that masks be kept on in schools while also urging all eligible students and staff to get vaccinated. 

“In the face of dramatically rising COVID infections among unvaccinated North Carolinians in the past several weeks due to the Delta variant, and schools preparing to open for the new school year, this seems a very poorly timed decision,” Tamika Walker Kelly, the NCAE president, said in a statement issued while Cooper and Cohen were in a briefing with reporters.

There are Republicans in the General Assembly, though, who are pushing for the “Free the Smiles Act,” a bill that would give local school boards and governing authorities of private schools the decision-making power to determine whether masks are mandatory.

If a school board votes for mandatory face coverings, members would have to put the requirement to a vote at least once a month to determine whether the requirement should be continued.

“I think it’s a pretty bad idea,” Cooper said, adding that it’s pretty obvious from the state guidance that the public health team considers masking the best way to protect students and teachers from the coronavirus.

Coronavirus by the numbers

According to NCDHHS data, as of Wednesday afternoon:

  • 13,550 people total in North Carolina have died of coronavirus.
  • 1,028,131 have been diagnosed with the disease. Of those, 694 are in the hospital, up from 391 people on July 1. 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.
  • 1,001,590 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 coronavirus who continue to feel the effects of the disease beyond the defined “recovery” period.
  • To date, 14,152,860 tests have been completed in North Carolina. As of July 7, 2020, 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 (39 percent). While 14 percent of the positive diagnoses were in people ages 65 and older, seniors make up 82 percent of coronavirus deaths in the state. 
  • 86 outbreaks are ongoing in group facilities across the state, including nursing homes and correctional and residential care facilities.
  • As of Wednesday, 192 COVID-19 patients were in intensive care units across the state.
  • As of July 21, 5,119,340 North Carolinians have received at least one dose of a coronavirus vaccine.
pictures the Juul nicotine delivery system. The next generation in e-cigarettes

Juul settled with North Carolina for $40 million. Now what?

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Juul settled with North Carolina for $40 million. Now what? - North Carolina Health News

A High Point mother whose teenage son suffered from nicotine addiction and now speaks out against e-cigarettes, researchers and others make their pitches for how the millions should be spent.

By Anne Blythe

Kelly Kinard knows firsthand how quickly a teenager can become addicted to nicotine after experimenting with e-cigarettes and the flavored pods.

Her son Luka was just 14 when he started vaping in his first year of high school in High Point. That would get him to the front row of the bleachers at football games and give him a sense of belonging when he walked up to a group of students who also were smoking.

Luka recounts his naivety about what was in the Juul pods as he gives speeches to teens and others about the risks of vaping and his addiction to a chemical compound that he says sent him spiraling downward toward a grand mal seizure. Eventually, he had an extended stay in a California substance abuse treatment center.

Kelly Kinard was set to testify in Durham County Superior Court about the ill effects that she contends Juul, the multi-billion dollar e-cigarette company, caused her family.

Then on Monday, Attorney General Josh Stein announced that Juul had agreed to a $40 million settlement with the state of North Carolina in lieu of going forward with a trial. What would have been tested at trial was the argument that the company’s marketing and advertising tactics were designed to attract middle and high school students to the flavored pods and other products.

“I’m glad that Juul settled,” Kinard said. “Hopefully the state will do something good with this money.”

Terms of the settlement

That money will come to North Carolina state coffers over the next six years where the General Assembly will control how it is allocated.

The first $13 million are to come to the state by July 28, according to the consent order accepted by Judge Orlando Hudson on Monday. The next $8 million are to come no later than one year later, according to the order, with $7.5 million the year after that, another $7 million within three years and $2.25 million for each of the final two years.

The order states that settlement funds are to go toward education programs focused on strategies that have demonstrated effectiveness in preventing e-cigarette use among young people. Some of the funds should go to cessation programs designed to help people stop vaping and some are to go toward evidence-based research.

Juul also committed to:

  • Stop marketing, social media advertising and influencer campaigns in North Carolina targeting people younger than 21.
  • End outdoor advertising near schools in this state and forgo any sponsorships at sporting events and concerts.
  • Stop making claims comparing the health effects of using JUUL to the health effects of using combustible cigarettes in its marketing materials.
  • No more online sales to anyone not age verified through an independent verification system.
  • No retail sales to anyone not age-verified using a barcode scanner.
  • Ensure that its products are sold behind counters, limiting shoppers access without the assistance of an employee.
  • Maintain a secret shopper program in North Carolina to ensure such measures are followed. Retailers not in compliance should be held accountable.
  • No new pod flavors or nicotine content levels without approval from the U.S. Food and Drug Administration.
shows a young man sitting on a fence next to a horse after his treatment for addiction to Juul
Luka Kinard at his grandparents house shortly after he got out of treatment. Photo courtesy: Kelly Kinard

Too much flavoring

In January, Stein joined other attorneys general from 19 other states, the District of Columbia, the Northern Mariana Islands and Puerto Rico asking the FDA to ban menthol cigarettes.

On Monday, the attorney general sent a letter to acting FDA commissioner Janet Woodcock asking the FDA to prohibit all “non-tobacco flavors,” including menthol, in e-cigarettes. Additionally, he asked the FDA to limit the amount of nicotine in e-cigarette products and to impose marketing restrictions on e-cigarette companies so they cannot try to entice youth toward their products.

“North Carolina will continue to exercise its jurisdiction under state law to do everything possible to keep our kids safe,” Stein said in the letter. “But the FDA has the authority to effect broader systemic change in response to the youth nicotine epidemic. An entire generation of youth is —right now— being introduced to nicotine through e-cigarettes, and we must protect them. Now is the time for the FDA to take decisive action to rein in these harmful practices before more irreversible damage to public health is done.”

Landmark agreement?

North Carolina led the way in taking legal action against Juul in May, 2019. California, Illinois, Massachusetts, and New York followed Stein’s path and sued Juul, raising allegations similar to those in the North Carolina lawsuit.

In February 2020, Attorneys General from Connecticut, Florida, Nevada and Oregon announced that a 39-state coalition had launched a bipartisan investigation into Juul.

Stein also has filed lawsuits against eight other e-cigarette companies using the North Carolina Unfair or Deceptive Trade Practices Act as he did with Juul. The other companies are Beard Vape, Direct eLiquid, Electric Lotus, Electric Tobacconist, Eonsmoke, Juice Man, Tinted Brew, and VapeCo.

The FDA also is in the process of reviewing marketing applications from Juul and other e-cigarette companies that were submitted in September as required by Congress. Though their applications are under review, the companies have been allowed to remain on the market for at least several more months.

The months and years ahead will determine what impact the Juul settlement with North Carolina has on other e-cigarette companies and other states.

“This win will go a long way in keeping JUUL products out of kids’ hands, keeping its chemical vapor out of their lungs, and keeping its nicotine from poisoning and addicting their brains,” Stein said in a statement announcing the consent order. “I’m incredibly proud of my team for their hard work on behalf of North Carolina families. We’re not done – we still have to turn the tide on a teen vaping epidemic that was borne of JUUL’s greed. As your attorney general, I’ll keep fighting to prevent another generation of young people from becoming addicted to nicotine.”

Lawmakers hold the purse strings

In North Carolina, it’s unclear how much power Stein, a Democrat, will have over how a state legislature, whose chambers have Republican majorities, distributes the settlement funds.

“Our expectation is the legislature will comply with the court order,” Stein said in a phone interview on Monday.

But history shows interpretations of settlement agreements can vary depending on who’s doing the allocating.

More than two decades have passed since North Carolina and other states reached a sweeping settlement with the country’s four largest tobacco companies, seeking to recover health -care costs to their Medicaid and public health systems for tobacco-related illness.

As part of the 1998 Master Settlement Agreement, the industry agreed to settle with North Carolina and 45 other states to pay out $206 billion over the next 25 years. North Carolina and 13 other states would receive $5 billion as compensation for potential harm that communities producing might suffer.

North Carolina’s total portion was estimated to be some $40 billion over the next quarter century. This year, the state will receive a $167 million payout from the settlement.

Legislation for how that money would be distributed was adopted in 1999 laying out that:

  • 50 percent would go to the Golden LEAF Foundation to spur economic development in communities dependent on tobacco;
  • 25 percent what is now known at the Health and Wellness Trust Fund; and 
  • 25 percent to a trust fund established by the general assembly for tobacco producers, allotment holders and others engaged in tobacco related businesses.

‘Can’t play whack-a-mole’

Some of that money went to tobacco cessation and prevention programs, such as one that Adam Goldstein, director of Tobacco Intervention Programs (Tobacco Treatment Program and Tobacco Prevention and Evaluation Program) at the UNC School of Medicine, helped build.

On Monday, after the Juul settlement was announced, Goldstein took a brief break from finishing up a report studying the impact that interacting with patients virtually during the pandemic had on efforts to stop smoking.

Goldstein’s heartened that there will be more funding in the pipeline for smoking cessation programs, but he cautioned against focusing only on e-cigarettes.

“We can’t play whack-a-mole with any one product,” Goldstein said.

Studies show that many young people who report using e-cigarettes also are what he calls “dual users,” meaning they might also smoke combustible or more traditional cigarettes and cigars, while quite possibly being drawn to the thinner, flavored cigarillos.

“Flavors play a huge role in encouraging participation in youth,” said Goldstein, whose research focuses on tobacco regulatory science and its relationship to health policy, disparities in tobacco use and patient-centered tobacco cessation.

Over the past year, Goldstein said, UNC opened its cessation program to e-cigarette users, too. Many of the patients that come to the program want to quit but because of the addictive hold the nicotine has over them have been unable to stop using.

Still, as noted by Goldstein and Kinard, the mother in High Point whose son had to go across the country for treatment for his nicotine addiction, North Carolina lags on providing centers that are available to abusers of other substances.

“There are no residential programs in North Carolina,” Goldstein said.

There could be more money, too, for cognitive behavioral therapy that many smokers need and for pharmaceutical support such as nicotine patches, gum and more.

GOP cuts prevention funding

North Carolina was creating what Goldstein described as “a quiet success” through the first decade of the tobacco settlement funds coming to the state, seeing the youth smoking rate hit an all-time low in 2011.

Then in 2013, when the Republicans held newly gained majorities in both General Assembly chambers and the governor’s office, lawmakers slashed funding for tobacco prevention programs.

In 2011, $17.3 million was allotted in the budget for such programs. In 2013, nothing was included in the budget for teen tobacco prevention programs geared toward youth and that hasn’t changed. Since then, North Carolina has received more than 1.2 billion dollars in settlement money. 

That corresponded with the time when North Carolina started seeing a rise in e-cigarette use, a trend that has continued on that trajectory since then.

According to the Campaign for Tobacco Free Kids North Carolina report card, 8.3 percent of high school students smoke.

The organization’s data suggest that nationally the high school smoking rate was at 4.6 percent with 19.6 percent of high school students reporting using e-cigarettes. Years of research have shown that most adult smokers picked up the habit when they were young.

One e-cigarette pod, Goldstein pointed out, contains nearly as much nicotine as an entire pack of cigarettes.

‘Our kids are worth more than zero’

A look back over the 22 years since the tobacco settlement done by The Campaign for Tobacco Free Kids shows that North Carolina spent  $2.2 million on tobacco prevention over the past budget year, or just 2 percent of the $99.3 million that the Centers for Disease Control and Prevention recommends.

James Davis, a physician at Duke who is the medical director for Duke Center for Smoking Cessation, director of the Duke Smoking Cessation Program and co-director of the Duke-UNC Tobacco Treatment Specialist Credentialing Program, said it can be difficult to get funding for smoking- related research. Some 480,000 people die each year from tobacco-related disease, according to the CDC, but competing for grant funding to study the issue can be difficult.

“We’ve known the problems, they’re well documented,” Davis said. “It’s almost like we’ve become numb to it.”

The Juul settlement funds could help fill some of that research void, as well as be put toward the development of youth programs.

The Quitline in North Carolina has been poorly funded for years, Davis said, and that should be considered as the settlement funds are allocated.

Ultimately, Davis would like state lawmakers to realize that reducing tobacco use in the state ultimately could save a lot of health care costs.

The American Cancer Society Cancer Action Network issued a statement on Tuesday calling out Senate lawmakers who passed their recommended spending plan last week with no funding allocated for tobacco prevention programs.

“Our kids are worth more than zero,” Derwin Montgomery, ACS CAN Government Relations Director in North Carolina, said in the statement. “With our state budget in surplus and an estimated $140 million collected from the tobacco industry annually, offering no support to prevent our kids from starting to use tobacco is shocking and downright dangerous. Failing to include such funding will cost our state more financially in the long-term and result in thousands of preventable deaths.”

Montgomery urged the House, which has not yet released its proposed two-year spending plan to approve the End Youth Nicotine Dependence Act, a bill sponsored by Sen. Mike Woodard, a Durham Democrat, that would dedicate $17 million from the nearly $140 million North Carolina receives from the Master Settlement Agreement payments.

Kinard, who was ready to pitch her case in state court for why she wants the e-cigarette providers to stop marketing their products to young people, hopes state lawmakers put settlement funds toward an effort that could go a long way.

“Prevention is key,” Kinard said. “If kids don’t ever start, there won’t be a problem.”

Coronavirus Today – June 10 — Your chance to win!! NC has a vaccine lottery with million dollar prizes and college money.

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Coronavirus Today – June 10 — Your chance to win!! NC has a vaccine lottery with million dollar prizes and college money. - North Carolina Health News

While fighting to move beyond the coronavirus pandemic, North Carolina’s public health team has been transforming the Medicaid system, too.

By Anne Blythe

North Carolinians who have received a COVID-19 vaccine and are 18 and older could be one of four people this summer to win $1 million.

Gov. Roy Cooper announced on Thursday that he was taking a page from Ohio Gov. Mike DeWine’s pandemic playbook, and from other states, too, for a different way to use federal funds to fight COVID-19. 

The plan in NC: Creating a lottery incentive program to push up vaccination rates.

“We’re pulling out all the stops,” Cooper said during a briefing with reporters. “After studying how similar efforts have boosted vaccine rates in other states, today we are announcing that North Carolina will launch cash drawings for our residents who have gotten a vaccine.”

Through the program, “Your Shot at a Million: Summer Cash Drawings,” all adult North Carolinians who have been vaccinated will automatically be entered into four drawings for a chance to win $1 million cash prizes.

All North Carolina residents who are 12 through 17 and have received at least one vaccine dose will be entered into four drawings in which they could win $125,000 for college or other post-secondary education at a school of their choice.

“Regardless of who wins, there is no way to lose. A chance at a million dollars or a college scholarship is pretty good motivation,” Cooper said. “But even if your name isn’t drawn, the worst you’ll do is get strong protection from a deadly virus.”

DeWine, Ohio’s governor, grabbed big headlines on May 12, when he announced that his state would use federal coronavirus relief funds to establish a Vax-A-Million lottery.

In an opinion piece written by DeWine and published May 26 in The New York Times, the governor said the results of his experiment exceeded his “wildest expectations.”

By mid-April, he was seeing demand for the vaccine dip below the supply numbers. After his announcement, according to his analysis, vaccinations for adults were up 49 percent.

The demand for vaccinations in North Carolina hit its peak on April 5, according to the DHHS vaccine dashboard, and almost immediately began to decline. The rate of people rolling up their sleeves hit a lull in May.

The state’s public health team stopped planning large vaccine events that had drawn long lines earlier this year and shifted to more targeted clinics in communities, churches and other smaller gathering places.

At the end of May and into June, the state Department of Health and Human Services, started offering incentives such as $25 Summer Cash Cards to people who got vaccinated or drove someone to get vaccinated at specific sites in Guilford, Mecklenburg, Rockingham and Rowan counties.

Some 2.5 million adults in North Carolina still have not gotten vaccinated.

“There are many reasons why 45 percent of adults in North Carolina have not taken their shot,” Mandy Cohen, the DHHS secretary, told reporters on Thursday. “Some people may need help covering the cost of taking time away from work or transportation costs.”

$25 Summer Cash cards

Cohen and Cooper said Thursday that they are considering expanding the cash program to other counties, too, even with the lottery up and running.

In addition to trying to remove the cost barrier that has kept some from getting vaccinated, Cooper and Cohen know some people still have questions about the safety and effectiveness of the vaccines and feel more comfortable sorting through that with their doctor or family members.

“Already, we’re seeing these vaccines are helping us do the things we love to do safely,” Cooper said. “Gathering with friends and family, eating indoors at a restaurant, going to a game, hugging a grandchild. All of that is a testament to just how safe and effective these vaccines are, and the more North Carolinians who get vaccinated, the sooner we can put this pandemic fully behind us.”

Lagging, not bragging in NC

The stated goal in North Carolina has been to get at least 66 percent, or two-thirds, of the population vaccinated, far above the 40 percent of the total population currently vaccinated.

“We want to go beyond that,” Cohen said of the stated goal. “We just want to make sure that folks know there are incentives out there, that vaccinations are safe and effective. We want to answer people’s questions, make it convenient for them. That’s what we’re focused on.”

In New England, the vaccination rates are higher than in other regions of the country. By late May, more than 70 percent of the adult population in every New England state had received at least one COVID vaccine dose. In North Carolina, only 54 percent of adults have gotten at least one vaccine dose.

“If you look at North Carolina compared to some other states, we are starting to lag behind,” Cohen said. “I’m proud that we are doing well compared to a lot of other states in the South, but there are many states who are now seeing 70 percent of their adults vaccinated. We can get there, too. I hope today’s announcement will help us launch forward even  faster.”

Anyone who gets vaccinated after Thursday will be entered twice into the lottery drawings, which will be held every other week beginning June 23.

“A lot of people are not opposed to getting a shot but simply have a busy life, don’t realize it’s important to themselves and their families, and we are seeing in other states, the things that have motivated people to say, ‘Okay, I was going to do that anyway. Hey, maybe I can win a million dollars or maybe I’ll get this $25 cash card,” Cooper said. “Whatever motivates people, we want to do what works because it’s not only important for that person and their family, but it’s important for our entire state.”

The numbers of people hospitalized and in intensive care units battling severe illness related to COVID-19 has continued to drop since vaccines became available in late December.

Daily case counts have dropped significantly, too.

“It’s because of the vaccine,” Cooper said. “But every day, we have people still going into the hospital. Every day, we have people going into the ICU. Most every day people are still dying from COVID. So it’s still here.”

Transforming Medicaid in a pandemic

As Cooper and Cohen try to move North Carolina beyond the COVID-19 pandemic, the public health team is working on another major shift.

 North Carolina is in the process of transforming the Medicaid system from a fee-for-service program to a managed care system in which Medicaid recipients will be matched with insurance providers.

“This is a significant change in the administration of Medicaid that the legislature put in place several years ago,” Cooper said. “Dr. Cohen and her team have been working constantly on this to make this change as smooth as possible for both the Medicaid recipients and the health care providers.”

While the changeover is likely to create many questions from recipients, Cooper said Thursday that his administration was looking for “positives” to tout such as the Healthy Opportunities Program.

Through that program, Cooper said, some Medicaid funds could be used to prevent illnesses and chronic problems. For example, for a person with asthma, the solution might be to replace the moldy carpet or reduce other environmental hazards so the recipient won’t have to make as many visits to a health care provider.

The transformation goes live on July 1.

“What is essentially happening, for those that don’t follow closely, is the Medicaid insurance program going forward is going to be administered by private insurance plans,” Cohen said.

The process for choosing the private plans has happened, and if someone did not select a plan, DHHS made sure the recipient was enrolled in one anyway.

“During the month of June is when they are getting in touch with their new plan,” Cohen said. “That is still happening right now. So we want to make sure if beneficiaries have questions, one, they can call their doctor that they’ve seen or they can call our Medicaid helpline and we can be sure to answer their questions.”

Have issues with your Medicaid plan? Call: 1-833-870-5500 (TTY: 1-833-870-5588). The call is toll free.

Policies and parameters are in place, Cohen said, to protect beneficiaries in the early months of the transformation.

“If they don’t like the plan, they either chose, or we enrolled them in, they can change for up to 90 days,” Cohen said. “There’s a lot of flexibility to both protect our doctors and our hospitals in this change, as well as our beneficiaries, and give folks flexibility so hopefully this can be a smooth transition.”

Coronavirus by the numbers

According to NCDHHS data, as of Thursday afternoon:

  • 13,246 people total in North Carolina have died of coronavirus.
  • 1,007,273 have been diagnosed with the disease. Of those, 548 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.
  • 985,048 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, 13,455,767 tests have been completed in North Carolina. As of July 7, 2020, 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 (39 percent). While 14 percent of the positive diagnoses were in people ages 65 and older, seniors make up 82 percent of coronavirus deaths in the state. 
  • 164 outbreaks are ongoing in group facilities across the state, including nursing homes and correctional and residential care facilities.
  • As of Wednesday, 163 COVID-19 patients were in intensive care units across the state.
  • As of June 9, 4,600,568 North Carolinians have received at least one dose of the coronavirus vaccine.

Gloved hands grasp a test tube holder and a swab during a coronavirus test.

In Pitt County, they’re saying yes to home COVID testing

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In Pitt County, they’re saying yes to home COVID testing - North Carolina Health News

As the COVID-19 vaccination rate slows, and cash incentives are offered, researchers are studying the impact of home testing to stave off further virus spread.

By Anne Blythe

You can get free beer, burgers, cash cards, Krispy Kreme doughnuts, a paid day off from work, shots of booze, tickets to an Asheville Tourists baseball game and other incentives these days for getting a COVID-19 vaccine.

Gov. Roy Cooper even is weighing the possibility of pulling a page from Ohio Gov. Mike DeWine’s pandemic playbook and creating something akin to the Vax-A-Million lottery to push the percentage of vaccinated North Carolinians higher.

Even as the focus shifts to getting vaccines in the arms of the hesitant, there’s still a need for continued testing for COVID-19.

The rate of testing crashed from 73,092 one day in December to 15,466 completed on June 8. That’s way down from the winter peak, shortly after vaccine distribution began, when North Carolina reported more than 10,000 new cases a day several times. 

As headlines highlight the creative array of incentives that states and businesses across the country are offering with a vaccine, it’s rare to see the same kinds of gestures offered for the unvaccinated and the vaccinated with COVID-19 symptoms to continue to get tested. 

In Pitt County, though, residents are taking part in a pandemic experiment as Greenville looks ahead to days when the presence of COVID-19 is not as powerful a menace as it has been for most of this past year. Nonetheless, with only 40 percent of North Carolinians fully vaccinated, the virus remains a threat.

In North Carolina, the number of COVID vaccines being administered per week peaked on April 5 at 684,785 doses, according to the state Department of Health and Human Services vaccine dashboard, 345,983 of which were second doses. Since then, there has been a steady drop to just 120,472 vaccines administered from May 31 to June 6. Only 45,532 were first doses, according to the dashboard. 

As of June 9, just 54 percent of adults over the age of 18 have received one dose of vaccine, and 50 percent have received both doses. That’s far short of the rate required for “herd immunity.”

How will home testing work?

Pitt County is lagging behind some of the more metropolitan counties such as Wake, Durham and Orange, which have at least 50 percent of their populations fully vaccinated.

Orange County has the highest vaccination rate in the state with 59 percent of the population fully vaccinated as of June 7. By comparison, on that same day, only 37 percent of the Pitt County population was fully vaccinated.

“I think we’re all looking forward to the day when we can kick COVID in the fanny and chase it out of Pitt County,” John Silvernail, Pitt County health director, said May 20 during a Zoom call with reporters shortly after Cooper ended the statewide mask mandate. “The virus is still out there, and there are a lot of people who still are not immune to the virus.”

In late March, the Centers for Disease Control and Prevention and National Institutes of Health launched “Say Yes! COVID Test,” a program that encourages at-home testing even as vaccines are available.

Shows a picture of a box with the test materials sitting on a wood counter in front of the box. The box reads: QuickVue At-Home OTC COVID-19 Test
The QuickVue test developed by San Diego-based diagnostic company Quidel will be used throughout Pitt County to allow residents to do at-home COVID testing. The test received emergency use authorization for at-home use with a prescription by the U.S. Food and Drug Administration in March. The Centers for Disease Control and Prevention announced on March 31 that Pitt County would be one of two test sites to receive the test kits for county residents. Image courtesy: Quidel

Pitt County and Chattanooga, Tennessee were the two places selected for distribution of the 2 million tests for 80,000 households.

The program was designed so residents who work outside the home could themselves and others in their household for COVID-19 three times a week. The designers especially encourage the at-home testing for people who work in nursing homes, schools, prisons and other settings where many congregate.

The tests are relatively simple to conduct, program advocates say.

Quidel, a diagnostic health care product company based in San Diego, makes the home kits being used in the Pitt County study. It’s the same company that makes rapid flu tests used by physicians across the country.

The QuickVue COVID test kit comes with enough swabs and solution for someone to conduct 25 tests. Participants are asked to swab both nostrils three times a week and then wait the 10 minutes for results — either a blue strip, which means there was no detection of COVID-19, or pink, which means that person should isolate themselves and check with their health care provider about what to do next.

Depending on how many individuals in each household are being tested, some participants could be testing for several weeks.

Collecting data for a clearer picture

Pitt County and Hamilton County in Tennessee were selected because of high local infection rates during the pandemic, the public availability of accurate COVID-19 tracking data, available infrastructure to support the project and previous relationships with the federal agencies.

During Pitt County’s battle against COVID-19, the public health team quickly realized how the virus could sweep through a household and then back out into the community.

“Many of the clusters that we found were family clusters,” Silvernail said. “If we can put this test into the home, identify the source case in the home sooner, then maybe we can prevent transmission in the home. If we prevent transmission to other family members, then maybe we prevent transmission outside of the home, as well. That was sort of the fundamental thinking behind this study.”

Additionally, Silvernail said his public health team and the Say Yes researchers hope to learn from the program whether “this testing can be effectively done in the home.”

Image is words that read: Say Yes! COVID test. The O in COVID is in the form of a coronavirus.
Image courtesy: National Institutes of Health

The participants in the program can volunteer to take part in a research study. Through routine surveys of the participants, researchers at the UNC Center for Health Equity Research and the Duke Clinical Research Institute will gather data and compare COVID-19 infection rates from the home testers to similar populations that are not testing at home for the virus.

Those findings are expected in the coming months, perhaps the fall.

“You give an intervention to a large population and compare that population to other populations,” Silvernail explained. “That’s kind of a simple way of thinking about it, where you’re probably more familiar with, like a randomized control trial, where we have a group who gets drug A and a group who gets a placebo and we look for differences between the two groups. Well here we’re looking for differences between populations where one received an intervention and one didn’t.”

The home medicine cabinet

In Pitt County, at least 23,564 tests have been distributed — by community groups, the health department and through online orders.

In Tennessee, 32,000 kits have been distributed.

The tests aren’t just sitting in a box on a shelf somewhere in Pitt County households.

“We’ve had folks actually test positive and call us, and say, ‘What do we do?’”  Silvernail said. “So we know people are using the tests and they are having an impact, at least on an individual basis.”

It’s possible, public health advocates say, that home COVID testing kits could become a regular household item as we ease out of the pandemic and afterward.

“I think we’re going to see more of these things move into the home for self care,” Silvernail said.  “For COVID, I think this probably does become part of the home medicine cabinet at some point. The question of what are they going to cost varies from manufacturer to manufacturer, but as time goes by, I think that cost would go down and there may be some provision of these kits to at-risk groups through health care systems or public health entities.”

shows a man at a podium gesturing. In the corner to the upper right is a American Sign Language interpreter gesturing

Coronavirus Today – June 2 — Cash for COVID-19 vaccines; Staving off evictions; GOP panel nixes governor’s environmental pick

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Coronavirus Today – June 2 — Cash for COVID-19 vaccines; Staving off evictions; GOP panel nixes governor’s environmental pick - North Carolina Health News

Gov. Roy Cooper discusses vaccine incentives, housing aid and his nomination for DEQ.

By Anne Blythe

North Carolina’s daily number of coronavirus cases have dipped to the lowest they’ve been since last year, with only 268 cases reported on June 1, in contrast to more than 1,800 just a month ago.

Even as cases are dropping, the rate of vaccination has been lagging. 

In an effort to get shots into the arms of unvaccinated North Carolinians, the state is offering financial incentives through a recently launched pilot program in four counties.

As the governor and his Health and Human Services Secretary Mandy Cohen work to wind down their pandemic response, politics over Gov. Roy Cooper’s choice for secretary of the state Department of Environmental Quality have revved up quickly. 

And Cooper announced on Wednesday that his administration just opened applications for a new round of rental and utility assistance to help North Carolinians who lost income during the coronavirus pandemic and continue to struggle to pay the bills and stay in their homes.

A lot is happening at once.

Housing crisis ahead?

As Democrats and Republicans argued about the future of North Carolina’s environmental quality, Cooper raised concerns about the potential for a housing crisis on the horizon, given the possibility of a wave of eviction cases crushing the courts in the months ahead.

Cooper’s executive order putting a moratorium on evictions is set to expire on June 30, along with a similar moratorium issued by the Centers for Disease Control and Prevention. The governor said Wednesday that he is considering what to do after that.

During the coronavirus pandemic, many North Carolinians lost jobs and steady income, putting them at risk of becoming homeless at a time when sheltering away from one another was key to stopping virus transmission and saving lives.

North Carolina launched the N.C. Housing Opportunities and Prevention of Evictions (HOPE) Program in the fall using federal emergency assistance to award more than $133 million to landlords and utilities to cover requests from 36,000 applicants.

The federal aid did not cover all the requests in the fall.

In June, after the state poured more federal funds into the program, the North Carolina Office of Recovery and Resiliency opened the program for a new round of applications.

On Wednesday, Laura Hogshead, chief operating officer of NCORR, said that more than 8,000 people have applied for financial assistance during the past two weeks. Since then 924 checks have been issued for a total of $1.1 million.

“I strongly encourage landlords and utilities across our state to lend a hand to their communities and to participate in these programs so that we can keep people in their homes with their lights on,” Cooper said Wednesday. “I am proud that North Carolina is taking steps to support families who need it as we emerge from this pandemic.”

Get a shot and $25

To ease out of the coronavirus pandemic with a stronger response against COVID-19, the state Department of Health and Human Services is focused on getting vaccines to the unvaccinated.

From May 26 through June 8, DHHS is offering $25 Summer Cash Cards to people who get a vaccine or drive someone to specific sites in Guilford, Mecklenburg, Rockingham and Rowan counties.

“We have a strong supply of COVID-19 vaccines, and we want to make it as easy as possible for people to get their free COVID-19 vaccine,” Cohen said. “We also want to support those who have made the effort to help family members, friends and neighbors get vaccinated.”

Cooper has been weighing other ideas to incentivize the unvaccinated to join the ranks of those who are, putting the state in a better position to emerge from the pandemic without pockets of coronavirus continuing to crop up and cause severe illness.

Just over 49 percent of North Carolina’s population that is 18 and older is fully vaccinated, according to the DHHS vaccine dashboard. Just over 53 percent of adults have one shot on board.

Now that vaccines are available to children as young as 12, many parents have been getting their middle and high schoolers vaccinated. Nearly 40 percent of the total population in North Carolina is fully vaccinated, the dashboard states.

Since the first lab-confirmed case of COVID-19 was detected in early March of 2020, North Carolina has amassed more than a million cases. As of Wednesday, the total case count stood at 1.003 million. Though the number of deaths from illness related to COVID-19 has dropped dramatically, there have been 13,110 deaths during the pandemic.

Nonetheless, people who are vaccinated are able to do more and more without wearing face masks. Sports arenas have opened to larger crowds, as the Hurricanes hockey team takes to the ice for playoff games against the Tampa Bay Lightning.

Restaurants, bars and other places are welcoming back diners for indoor seating and many employers are talking about bringing their employees back into the offices.

As activities pick up, Cohen had advice for North Carolinians.

“Mask up or vax up,” she said.

Tussle over appointments

The politics playing out in the North Carolina Senate over the Democratic governor’s nomination for secretary of the state Department of Environmental Quality was a quick reminder that even as lawmakers and Cooper talk about building North Carolina back stronger after the pandemic, what’s past can quickly become prologue.

A North Carolina senate committee on Wednesday voted to reject Dionne Delli-Gatti, who has been acting DEQ secretary since February, to lead the department under Cooper’s administration.

Senate Republicans, who frequently sparred politically with Cooper in the years leading up to his 2020 re-election, argued in a news release posted to Sen. Berger Press Shop on Wednesday that Delli-Gatti had not articulated the governor’s position on the expansion of natural gas in North Carolina when asked during a previous hearing.

Delli-Gatti was nominated earlier this year by Cooper to replace Michael Regan, DEQ secretary, after President Joe Biden tapped the North Carolinian to lead the federal Environmental Protection Agency.

The former Environmental Defense Fund director of regulatory and legislative affairs was at the meeting of the Senate Agriculture, Energy and Environment Committee meeting on Wednesday. But Republicans leading the meeting did not ask her any questions and refused to let Democrats follow through on requests to let her speak.

Sen. Mike Woodard, a Democrat from Durham, described the hearing process as “a total sham.”

Cooper, when asked about the situation during a news conference held to update North Carolinians on COVID-19, said he hoped the full Senate, scheduled to take up the nomination on Thursday, would delay a vote.

“This doesn’t have anything to do with her knowledge or qualifications,” Cooper said about the nominee who would become the first woman to lead the department if selected. “She is imminently qualified to do this job. It has everything to do on whether we’re going to have a clean energy future and whether we’re going to protect our air and water.”

If the Senate does not confirm Delli- Gatti, Cooper said he had no plans to change course on the direction that he wanted for DEQ.

“Whatever happens here, I’m going to remain committed to protecting our air and water and to a clean energy future in North Carolina,” Cooper said. “I would hope the Senate would delay this vote. She was there in the meeting today to answer any questions that they have. She testified five weeks ago, and they said they were going to bring her back but they never did.”

Coronavirus by the numbers

According to NCDHHS data, as of Wednesday afternoon:

  • 13,101 people total in North Carolina have died of coronavirus.
  • 1,003,508 have been diagnosed with the disease. Of those, 610 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.
  • 979,410 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, 13,281,908 tests have been completed in North Carolina. As of July 7, 2020, 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 (39 percent). While 15 percent of the positive diagnoses were in people ages 65 and older, seniors make up 82 percent of coronavirus deaths in the state. 
  • 182 outbreaks are ongoing in group facilities across the state, including nursing homes and correctional and residential care facilities.
  • As of Wednesday, 180 COVID-19 patients were in intensive care units across the state.
  • As of June 2, 8,307,696 North Carolinians have received at least one dose of the coronavirus vaccine.
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