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shows a woman in an orange jumpsuit, sitting on a bed, shackled. she's in a cell that has a sink and toilet.

Beyond ending shackling, a new bill opens up questions about children born to incarcerated moms

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Beyond ending shackling, a new bill opens up questions about children born to incarcerated moms - North Carolina Health News

The Dignity for Women Who are Incarcerated bill would end the practice of keeping women in chains during labor. But what happens after they give birth?

By Hannah Critchfield

Fifteen minutes outside Durham, an abandoned hospital stretches across a bed of verdant land. The concrete-potted plants lining the entrance have begun to crumble, with erosion and wear visible on the walls of the red brick building.

Long before a global pandemic descended upon the state and its correctional centers, even before Barack Obama was elected as the nation’s first Black president, North Carolina planned to create a home out of the abandoned facility, where incarcerated women could live with their infants and toddlers.

“It really is outside of the box,” said Melissa Radcliff, a program director at Our Children’s Place of Coastal Horizons Center. When the organization was created, the intent was to partner with the state to help allocate funding for the renovation and programming of the center in the 2000s. 

“The moms would have still been incarcerated, they just would have been serving their incarceration in this residential facility off-site,” Radcliff said. “It is about as radical as you can get, I think, short of not incarcerating to start with.”

Then the 2008 financial crisis hit, and North Carolina clawed back the funding earmarked for the project and shuttered its plan for a child care center for incarcerated mothers. 

Today, birthing women serving time or awaiting trial behind bars are often restrained using shackles while receiving medical care at hospitals and health centers. Once they give birth, new mothers behind bars typically have about 72 hours to spend with their newborns.

House Bill 608 would end shackling of pregnant women behind bars. The bill passed in the House on Monday and heads to the Senate for final ratification before heading to Gov. Roy Cooper’s desk for a signature. 

Although it’s still early in the lawmaking process, HB 608 has strong bipartisan support and is expected to become law. Child advocates and law enforcement alike are reflecting on future reforms for incarcerated women, including the child care model from North Carolina’s recent history.

“I think it’s also our motivation to say, but where do we go from here?” said Radcliff. “This is a huge first step, emphasis on first. Let’s not forget when kids are born, and what they need and what their parents need and how to keep them and that relationship strong.”

Restrained throughout labor and delivery

In 2019, Dr. Kerianne Crockett watched as a young woman was brought into her care at Vidant Medical Center in Greenville, North Carolina from a local detention center.

Her ankle was cuffed to the side rail of the stretcher, and she was visibly upset. Though she’d given birth while in transit, she still needed to deliver her placenta. 

Her newborn had died on the way to the hospital.

“Part of what was so terrible about her story is that she was restrained through the whole labor [and] delivery process,” said Crockett, an obstetrician-gynecologist, through tears. “All of my efforts to get the restraints removed once she was in my care – it took a lot of calls, and by the time the restraints were removed, the delivery was already done and a lot of the really sad things had already happened.”

The experience led her to advocate for different treatment of pregnant women who come into contact with the criminal justice system.

“In the days, weeks, months, followed, I couldn’t make sense of what had happened to her,” Crockett said. “I felt like I had failed to protect her from something really terrible. I tried to figure out, had something gone wrong, or was this just the way things are? And if this is the way things are, how do we change it?” 

Proponents of such reform have focused on setting guidelines for a standard level of care to be provided to pregnant women in the custody of correctional facilities throughout North Carolina. 

“There’s a lot of reasons why shackling is dangerous,” said Amanda Brown, a certified nurse midwife who works exclusively with pregnant and postpartum people at the University of North Carolina Hospital in Chapel Hill. “There’s space for interpretation from hospital to hospital, which is really problematic.”

Brown said there are policies around shackling in place at UNC Hospitals, but the many different correctional officers are not always operating from the same playbook. 

And, at times, Brown said she has ended up in conflict with those officers. 

“Correctional officers are wonderful human beings, but sometimes may have limited experience caring for incarcerated people in the postpartum period,” she said. “Most of them are very well-meaning, sometimes even very supportive, even helping with breastfeeding or helping to change a diaper, but there shouldn’t be any reason to have a discussion because there should be just a standard understanding of how we care for people.”

‘A no-brainer’

The Dignity for Women Who are Incarcerated bill would require prisons and jails to limit the use of shackling after the second trimester, during labor, and in the six weeks after delivery. 

While the bill was being drafted, Crockett personally called each of North Carolina’s 100 sheriffs, who oversee county jails as elected officials, to speak to them about the importance of the legislation and solicit their support. 

At first, the North Carolina Sheriffs’ Association opposed the bill.

Law enforcement officials Terry Johnson, a Republican sheriff from Alamance County most recently in the spotlight for his policies around the treatment of detained immigrants and Black Lives Matter and voting rights demonstrators, and Garry McFadden, a Democratic sheriff who ran on a platform of liberal reforms in Mecklenburg County, got on board. 

“A child didn’t ask to come into this world,” said Johnson. “We need to keep that child’s welfare a top priority. There’s a bond between mother and child, and if that child is separated from his mother, their chances of making it good in the world, I would say, are slim to none.”

With compromise language, the sheriffs’ organization fell in line.  

“This brought people together who will probably agree on nothing else this year,” said McFadden. “The thing that sticks with me is you have the moment of birth, and then you have to give your child up right after. And we’re taking away their dignity by putting them in chains and cuffs while expecting. It was a no-brainer for me to fight for these young ladies.”

In addition to banning shackling for pregnant women receiving medical care, the proposed HB 608 would formalize allowing women who have just given birth to bond with their child for the duration of time they stay in the hospital. 

The bill would also mandate that women be placed in correctional facilities within 250 miles of any of their children under the age of one and allow for visits with newborns twice a week. 

It would additionally set basic requirements for providing menstrual and nutrition products, establish guidelines for body inspections that limit interaction with male officers and prevent pregnant or postpartum women from being held in restrictive housing, such as solitary confinement or isolation.

Mother-infant care program

While many other states have passed legislation banning shackling, some have taken reforms a step further. 

Back in the aughts, Radcliff and her team visited California, which has for decades used an innovative model known as the “mother-infant care program.” 

Also called the Community Prisoner Mother Program, mothers in the custody of the state who are serving time for nonviolent, non-serious offenses have the opportunity to live at a child-safe rehabilitation center with up to two of their children under the age of six.

The program serves a dual purpose of reuniting mothers with their children and preparing them for reintegration into the larger community upon their release.

North Carolina planned to adopt a similar model for its state prisoners. The original Our Children’s Place facility would have housed 20 women and 40 children at a time, according to Radcliff and program pamphlets. Located on the old John Umstead Hospital campus in Butner, a mother and her children would have had their own bedroom and shared a common space with other families.

“It would almost be like a dorm-type arrangement, where there will be separate space for some quiet if a mom was nursing, for example,” said Radcliff. “There was classroom space and a huge kitchen, and that led to lots of conversations about whether we could eventually start to do some culinary classes there so women could learn job skills, in addition to feeding their children.”

A child would have been able to live with their mother at the facility until they start preschool. 

“A weekly visit is amazing, but it’s not day-to-day,” said Radcliff. “It ties in to the question: If mom gives birth and then a child is taken, who is caring for the child? Is it going to be the other parent, grandparents, or social services? And is whoever’s caring for the child going to be able to bring the child to visit?”

Underlying both the mothballed child-mother center initiative and the proposed anti-shackling bill is an understanding of the importance of early childhood attachment and bonding with caretakers. 

“I don’t know if we’ve gone full circle, but it feels like we’re having some similar conversations with the anti-shackling bill,” said Radcliff. “So much of what we do focuses on kids who are in our schools, but this really brings it back to, ‘But what about really, really young kids who’ve just been born, or haven’t even been born at this point?’”

The idea of a center for incarcerated new mothers and their kids lives on — Sheriff Johnson of Alamance County, unprompted, also voiced his support of such a home.

“I would love to see, somewhere down the road, the government — since we’re giving away money left and right — build a facility, so if we do have a lady that is pregnant in our jail, we can send her to this home to have that baby, and the baby and the mama can be together,” he said. “It may be a facility that you can’t leave, but that child needs that mother during those formative years when they come into the world.”

Strengthening mother-child bonds

Health care professionals who work with incarcerated women during and after pregnancy said the bill could be a springboard for other manageable, cost-effective reforms.

“I think there’s sort of four main areas that I feel like could be improved upon once this bill is passed: visitation, medication-assisted therapy for people who have a substance use disorder in the postpartum period, contraceptive options, and lactation support,” said Brown. 

She said she’d like to see increased visitation options apply beyond the first year of a child’s life. 

“We know that about 75 percent of women are serving for less than two years, and after people are leaving the prison system, they’re going to be caring for their babies,” she said. “It’s really essential that they have a bonded relationship — both the parent’s health and probably even more, for the baby’s health. Increased visitation allowances all through childhood are appropriate.”

The shackling bill passed in the House on May 10 with unanimous support and is now parked in the Senate Committee on Rules and Operations. 

“I am acutely aware of the fact that the absolute worst day, and the worst thing to happen to my patient, has become a springboard for something for a lot of people to celebrate – like an accomplishment  – in moving this bill forward,” said Crockett. 

“I don’t want to lose sight of the fact that she and a lot, a lot, a lot of other unrecognized, unnamed women have endured really hard things without the gain of being able to celebrate,” she added.

a woman in fatigues wearing a mask inspects a syringe of COVID vaccine

Awaiting trial, and the vaccine: What about people in jails?

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Awaiting trial, and the vaccine: What about people in jails? - North Carolina Health News

ICE detainees. Inmates awaiting trial. Overflow prisoners. Where do people in jail fall in North Carolina’s vaccine plan?

By Hannah Critchfield

The westernmost jail in North Carolina sits in Cherokee County, a lush, mountainous area on the Tennessee border with several tracts of sovereign land belonging to the Eastern Band of Cherokee Indians.

A few weeks ago, Joe Wood, chief officer at the Cherokee County Detention Center, got a call from a staffer who said he’d tested positive for COVID-19. Shortly after, an inmate in his 50s noticed he couldn’t taste his coffee — he made it stronger, but still nothing.

Then a member of the command staff tested positive. The jail instigated mass testing.

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In February, 29 inmates – at the time, a little over a quarter of the county’s active cases – and six staff tested positive for the novel coronavirus.

“They’re higher risk because they’re all together,” said Wood. “Like the nursing homes, everybody’s living in one place, so when it gets in it becomes an issue.”

It’s the first time the jail had experienced an outbreak since the pandemic began almost exactly a year ago.

As the vaccine rollout continues in North Carolina, so does the spread of the novel coronavirus in county jails. Outbreaks in these facilities are often linked to spread in the larger community, as correctional staff must go in and out of jails and return to their families each day.

Last month, 38 jails within the state had COVID-19 outbreaks, more at a single time than at any other point in the pandemic. Thirty of them still have active outbreaks.

Correctional staff have begun to get vaccinated through their local health departments. Over three-fourths of Durham County Sheriff’s Office staff have received doses of the vaccine, as have many employees at the Alamance County Sheriff’s Office.

But for the various groups of people who end up incarcerated, it’s not so simple.

Local law enforcement partnerships with federal and state agencies, coupled with varying allocations to local county health departments, mean some jailed people may receive the vaccines at different times, even if it’s “their turn” under North Carolina’s rollout plan – and sometimes, even if they’re inside the same jail.

People awaiting trial

Jails are not the same as prisons. It’s a common misconception, and an understandable one: The United States criminal justice system is complicated.

Generally, jails are designed to hold “pre-trial detainees” – people who have not yet been convicted of a crime and are awaiting their day in court.

Many of these people could be released while they await trial – if they can afford it. Approximately 30 percent of all pre-trial inmates in jail are there because they cannot pay bail, often for low-level offenses such as drug or property crime, according to the American Bar Association.

People of color are often disproportionately represented in jails, partially because Black people and Latinos are more likely to be held on cash bail than white defendants, and they receive bail amounts that can be up to twice as high.

Only incarcerated people who are 65 and older can currently receive the vaccine. That will change next week. On Thursday, Gov. Roy Cooper announced that people in Group 4 at higher risk – including inmates in correctional facilities – will become eligible on March 17.

People in jails are typically younger than people in prison, who have been found guilty of a crime, meaning many of them likely will not be eligible for the vaccine until the opening of this group, which includes “anyone who is incarcerated or living in other close group living settings who is not already vaccinated due to age, medical condition or job function.”

The oldest Cherokee County Detention Center inmate, for example, is 60, according to Wood.

Inmates in this older age group have begun to get vaccinated in other facilities. Several incarcerated people have been vaccinated at the Mecklenburg County Detention Center in Charlotte, according to Sheriff Garry McFadden.

Local health departments get their doses from the state, which determines how many vaccines a county should get weekly based on population and how efficiently the local jurisdiction administered previously allotted doses.

“As with previous statewide group eligibility changes, some providers in some parts of the state may not be ready to move into Group 4 on March the 17th,” Cooper said.

Durham County Detention Center has not yet begun vaccinating eligible inmates, for example, though staff vaccinations are underway.

“Durham County Department of Public Health has not informed us when they, and Wellpath [our medical provider], will begin offering the vaccine to inmates,” said Sheriff Clarence F. Birkhead. “Sheriff’s Office staff vaccinations began in January 2021.”

Their jail is reliant on the county health department, Birkhead said — meaning it’s up to them to vaccinate inmates.

While there is one inmate over the age of 65, according to Birkhead, this individual was not scheduled to receive a vaccine until the rest of the people incarcerated in the jail became eligible in Group 4.

“According to Durham County Public Health, it is our understanding no inmate 65 years or older has been vaccinated,” said Birkhead. “This is because all those who are incarcerated fall under ‘Group 4,’ which will begin March 24, 2021.”

At this point, the county has vaccinated all jail detention staff who wish to receive the doses, according to Alicia Smith, Durham County Department of Public Health spokesperson.

“We are working closely with the jail medical staff to identify which detainees would like to receive a vaccination as part of NC DHHS prioritization Group 4,” she said.

And COVID-19 outbreaks, which spread rapidly in carceral facilities that make it difficult to socially distance, could further delay this process.

At least two of the eligible inmates at the Mecklenburg jail were not able to get vaccinated because they had an active coronavirus infection, according to McFadden.

But that’s not the full picture.

ICE Detainees

Some jails partner with Immigration and Customs Enforcement to house migrants on behalf of the federal government.

The most notable of these is Alamance County Detention Center in Graham. Under Sheriff Terry Johnson’s leadership, the jail has entered into a $2.3 million agreement with ICE to temporarily hold immigrants before the federal agency can transfer them to a long-term detention facility outside the state. The facility also temporarily houses prisoners who have been convicted of a federal crime on behalf of the U.S. Marshals Service.

The partnership, instigated in 2019, has been renewed for 2021.

These stays are short – the Alamance jail cannot hold ICE detainees for longer than 72 hours under the contract.

But if the vaccine comes to the jail during this time period – the correctional health care provider Southern Health Partners will be vaccinating Alamance inmates – people in the custody of ICE won’t receive it without sign-off from the federal agency.

“For our ICE and Marshal detainees, it is up to their administration to give permission for them to be vaccinated,” said Michelle Mills, spokesperson from the Alamance County Sheriff’s Office. “That would be a decision on their end.”

Lindsay Williams, spokesperson for ICE, referred NC Health News back to the Alamance Sheriff’s Office for specific details on whether immigrants in their custody were receiving the vaccine.

The Department of Homeland Security, ICE’s parent agency, has not received any vaccine allocations itself, he said.

“At this time, a limited number of ICE detainees have begun to receive the COVID-19 vaccine based on availability and priorities for vaccinating individuals in the state where they are currently detained,” he said in an email. “Vaccines that detention facilities receive from their state may be administered by ICE Health Service Corps or contract facility medical staff or through other processes as defined by the state and/or local vaccination implementation plan.”

However, he noted that in most states, local health departments have not distributed any of their vaccines to ICE.

In contrast, federal prisoners in the custody of the U.S. Marshals at the Mecklenburg County jail are receiving the vaccine at the same time as pre-trial detainees, according to McFadden.

“The USMS is not administering the COVID-19 vaccine nor handling any aspect of the plan,” Lynzey Donahue, spokesperson for the U.S. Marshals Service, said in an emailed statement, noting vaccination of its prisoners would be handled by local jurisdictions.

State prisoners 

There’s a final group of incarcerated people in North Carolina jails – people who have been convicted of a crime and are awaiting transfer to the state prison system.

This is known as “jail backlog,” and it’s an issue that has become more complicated during the pandemic due to outbreaks in both county jails and state prisons.

Currently, 451 prisoners are on jail backlog, according to John Bull, spokesperson for the Department of Public Safety, which oversees state-run prisons.

While eligible prisoners inside the state prison system have begun to get vaccinated, those awaiting transfer from jails must rely on their individual facility’s rollout.

shows people on a dias who are wearing masks to prevent the transmission of COVID

Coronavirus Today – Nov. 23 – Mask mandate tightened; Greensboro toughens enforcement

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Coronavirus Today – Nov. 23 – Mask mandate tightened; Greensboro toughens enforcement - North Carolina Health News

Gov. Roy Cooper tightens mask order as NC COVID-19 case counts jump quickly. "We are in danger," he said as he ordered stricter enforcement of mask mandates.

By Anne Blythe

Gov. Roy Cooper minced no words on Monday when he gave an update on North Carolina’s COVID-19 trends and metrics.

“We are in danger,” Cooper told reporters during an afternoon briefing. “This is a pivotal moment in our fight against the coronavirus. Our actions now will determine the fate of many.”

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The state reported 2,419 new lab-confirmed cases of COVID-19 on Monday, a positivity rate of 7 percent and 1,601 hospitalizations.

As health care systems, particularly in the Triad region of Greensboro, Winston-Salem and High Point, worry about capacity limits, Cooper strengthened his statewide mask mandate.

Three days before Thanksgiving, Cooper issued a new executive order that makes it clear that anyone who is in the presence of someone outside their immediate household needs to wear a mask.

And as the holiday shopping season begins, the order also requires any business with more than 15,000 square feet to post an employee near the entrance to ensure that occupancy limits are followed and anyone shopping there is masked.

“Our statewide mask requirement has been in effect since June,” Cooper said. “It is still our best weapon in this fight. Today’s executive order will further tighten the mandate making it clear that everyone needs to wear a mask whenever you are with someone you don’t live with. That means wearing a mask when you’re at home, with friends or family visiting, and it means a mask at work, at the gym, at the store, at school.”

Cooper and Mandy Cohen, secretary of the state Department of Health and Human Services, stress that a mask is most effective when it covers the mouth and nose, not just one or the other.

“Masks, distance, small gatherings,” Cooper said. “All of these are critical during the holidays and cold months ahead.”

The order takes effect on Wednesday and extends the protections through Dec. 11.

Dire alerts in 20 counties

The North Carolina public health team rolled out a new tool last week to highlight the counties with viral hotspots.

In the color-coded system, which designates red for the highest level of concern, the state has seen the number of counties in that classification double in just one week from 10 to 20.

The public health team had intended to issue the alert system map monthly but updated it on Monday, less than a week after presenting the first report because the virus is spreading so rapidly in some counties.

Alamance, Alexander, Avery, Bertie, Catawba, Columbus, Davie, Gaston, Guilford, Hoke, Mitchell, Montgomery, Perquimans, Robeson, Surry, Swain, Vance, Wilkes, Wilson and Yadkin counties are now all designated as in the red zone. They could have COVID-19 case rates of more than 200 per 100,000 people over the past 14-day period, or at least 42 cases in that two-week period. They might have a positivity rate greater than 10 percent or a caseload that has a high impact on county hospitals.

Counties classified as orange have had a case rate of 101 to 200 per 100,000 people over the past 14 days, or at least 21 cases in 14 days, a positivity rate in the 8- to 10-percent range or caseloads having a “moderate impact” on hospitals.

shows a map of North Carolina with many counties colored in yellow, some counties colored in orange and a handful of them red, to denote critical levels of COVID activity
A new mapping tool created by the Department of Health and Human Services looks to highlight which parts of the state are seeing critical increases in the number of COVID-19 cases and hospitalizations. This screenshot from DHHS shows the report from Nov. 17. Red counties have “critical” community spread, orange have “substantial” and yellow have “significant” community spread.

 

shows a map of North Carolina with many counties colored in yellow, some counties colored in orange and a handful of them red, to denote critical levels of COVID activity
A new mapping tool created by the Department of Health and Human Services looks to highlight which parts of the state are seeing critical increases in the number of COVID-19 cases and hospitalizations. This screenshot from DHHS shows the updated report from Nov. 23. Now, 20 counties are designated as having “critical” community spread, 42 with “substantial” spread with the rest experiencing “significant” community spread.

Forty-two counties were in orange zones, according to Cohen, with  “substantial community spread.”

Thirty-eight counties were classified as yellow with “significant community spread.”

Simple actions, profound effects

“Remember, we still have a high level of concern for our yellow counties,” Cohen said. “People who are in counties that are yellow should take action to ensure they don’t become orange or red.”

This comes as Cohen and Cooper urge North Carolinians to keep Thanksgiving gatherings small, outdoors and travel-free.

“Our statewide metrics and county alert map show that we are on very shaky ground,” Cohen admonished. “I do not want to see the bottom fall out. I’m particularly concerned about our record number of people in the hospital.”

Some health care systems have begun to scale back elective surgeries again to ensure that they have an appropriate number of workers and beds for quality care of all patients.

“The coming weeks will be a true test of our resolve to do what it takes to keep people from becoming sick, to save lives and to make sure you have hospital care for whether it’s a heart attack, a car accident or COVID-19 when you need it,” Cohen said. “We know so much more about this pandemic than we did back in March when we had our first case. We need to put that knowledge to use, particularly when the actions are simple and the effects are profound. Masks work.”

Greensboro declares state of emergency

Greensboro Mayor Nancy Vaughan spoke at the briefing with Cooper and Cohen to share with the state actions that the Guilford County city is taking to try to tamp down COVID-19 spread.

“Our positivity rate is increasing and our hospital beds are decreasing,” Vaughan said.

Guilford is one of the red zone counties and Cone Health is one of the systems groaning from the weight of caring for a high number of patients suffering serious illness related to the virus.

In the early days of the pandemic, Cone Health put its recently decommissioned Women’s Hospital in Greensboro back into use.

The facility has 118 beds and is the place where people with illness related to the novel coronavirus have been segregated.

“In essence, it became our field hospital,” Vaughan told reporters at a briefing with the governor on Monday. “Without these additional beds, we would already be over capacity.”

Two months ago, the mayor said, there were an average of 36 patients in the Cone Health system with severe illness related to COVID-19. That number jumped to an average of 81 cases a month ago.

This past weekend, there were 133 patients hospitalized, 27 of whom were in intensive care units.

“Based on Cone’s internal projections, we are on track to have 200 to 300 people by February or March,” Vaughan said. “Our numbers are doubling every 27 days.”

Cone Health reports that 230 people have died in Guilford County since the start of the pandemic.

“At the rate we are going, they predict we could have 100 more by the end of this year,” Vaughan said.

North Carolina passed the 5,000-death milestone over the weekend, and it was only a month ago that the death toll topped the 4,000 mark.

Vaughan, the Greensboro mayor since 2013, issued an executive order on Friday declaring a state of emergency in the city.

‘We all need to do our part’

Through the order, Vaughan directed local officials to enforce Cooper’s statewide mask order while also setting up the possibility for civil fines and temporary closures of businesses for those out of compliance.

Businesses can be fined $100 for every person inside the establishment who is not wearing a mask or violating the occupancy limit.

City officials fanned out over the weekend to let businesses known for their non-compliance that enforcement was going to tighten. Initially, businesses will get warnings. If enforcers return and the order is being violated still, the business could be forced to close for at least 24 hours, and perhaps as many as 72 hours.

“It’s simple, in a time of a health emergency, we all need to do our part,” Vaughan said. “Supplies are limited. Frontline health care workers are doing a great job, but their capacity is limited. Many business owners have expressed to me their fear of another shutdown. I don’t want that either. I want to keep them in business.”

Cooper held up what Greensboro is doing as a model he would like to see duplicated elsewhere.

“We want people to follow the safety guidelines to slow the spread,” Cooper said. “If they don’t, the rules need to be enforced and we’re working with state and local governments to do just that. We don’t want to go backward, but we will if it’s necessary. The next seven to 14 days will tell us whether we are stemming the tide or whether we need to ratchet it up even more.”

With the promise of vaccines in the works, Cooper noted that “the other side of this pandemic is not very far off.”

“Until then,” he said, “our safety measures will save lives and keep our economy going until we get across the bridge.”

Coronavirus by the numbers

According to NCDHHS data, as of Monday afternoon:

  • 5,039 people total in North Carolina have died of coronavirus.
  • 339,194 have been diagnosed with the disease. Of those,1,601 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.
  • 293,555 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, 4,965,564 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 82 percent of coronavirus deaths in the state.
  • 419 outbreaks are ongoing in group facilities across the state, including nursing homes and correctional and residential care facilities.
  • There are 3,477 ventilators in hospitals across the state and 923 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital. As of Monday, 242 suspected COVID-19 patients were in intensive care units across the state.
shows the back of a wheelchair, with an old and wizened hand on the arm of the chair

COVID-free nursing homes fought hard to keep virus out

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COVID-free nursing homes fought hard to keep virus out - North Carolina Health News

More than 200 North Carolina nursing homes have succeeded in totally excluding COVID-19 infections. What did they do right? This is the first of two stories exploring what skilled nursing facilities can do and have done to prevent COVID infections for the people in their care.

This story has been supported by the Solutions Journalism Network, a nonprofit organization dedicated to rigorous and compelling reporting about responses to social problems, http://solutionsjournalism.org.

By Thomas Goldsmith

Even as more than 1,800 of North Carolina’s nursing home residents have died from COVID since March, thousands more of these most vulnerable have escaped the horrific grip of COVID-related related infection or death during the pandemic.

That positive outcome stems from countless hours of planning and execution by caregivers, facilities, administrators and public health leaders, say business and government officials.

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Attention from aging-sensitive quarters in the state has tended to focus on the more than 16,508 cases and 1,906 COVID-related deaths of nursing-home residents. The more encouraging news is that more than 200 skilled facilities in North Carolina have experienced no deaths from COVID.

(The state’s 593 assisted living facilities typically have less critically ill residents; 99 centers have seen cases or deaths and 86 residents have died.)

Bob Willson, 77, a retired engineer, visits the nursing home at Moneta Springs Memory Care in Alamance County every day to see wife Susan, 78, a retired nurse who had a stroke seven years ago. He tends to her daily needs and meets the requirements for such “compassionate care” visits, knowing that the nursing home has tight disease controls. The facility has had five COVID cases and no deaths, according to federal regulators. (Three people have died of COVID-19 at the related Twin Lakes Community senior living locations, not the center where Susan Willson lives, according to CMS.)

“They are very proactive in infection control,” Willson said of Moneta Springs in a phone interview. “So when I go visit my wife, for instance, I obviously wear a mask, I wear a disposable gown, and wear disposable gloves.

“In compassionate care visits, we don’t have to be six feet apart and touching is allowed, but I still wear the mask the whole time. And she does, because I’m helping her eat, but then when we’re done eating, her mask goes back on.”

Like employees in health care settings across North Carolina, Twin Lakes staff check visitors’ temperatures and quiz them on any possible contact with people who are positive for the coronavirus, he said.

‘Our biggest factor’

Two aspects of the coronavirus have caused particular problems, said Adam Sholar, president of the North Carolina Health Care Facilities Association. These are the level of infection in the areas around the nursing home and the virus’s ability to survive in an infected person’s body without transmitting it.

“Our biggest factor in whether a facility has a case of COVID is community transmission in the area,” Sholar said in a phone interview. “The asymptomatic transmission and asymptomatic positives is another huge factor.”

Infection control is a given as a regulatory requirement in long-term care, but the number of cases and deaths makes clear that the wall built against the coronavirus is sometimes too low.

NC Health News has found some themes and techniques among skilled nursing facilities, here and across the country, that have completely or almost entirely kept the disease at bay.

These approaches emerged in interviews with caregivers, administrators, state officials and public health experts. We also looked at recent academic research, which has arrived steadily since the days in which the pandemic gained widespread attention.

What works

Some experts and administrators were reluctant to speak too definitively about solutions that have allowed no cases or deaths or didn’t respond to queries. They also may have been unwilling to sound too proud of their efforts at a time when others in the industry were working hard on infection prevention and control.

Among the mostly COVID-free facilities unwilling or too busy to respond were the western N.C. facilities Smoky Ridge Health & Rehabilitation in Burnsville, and Elderberry Health Care in Marshall, as well as the high-end Forest at Duke in Durham, which has had five cases since the initial reporting of this story..

Many more facilities across the state had had one or fewer COVID cases and no related deaths. Of course, given the continuing level of outbreaks across North Carolina, new cases and deaths could occur in days and months ahead at virtually any nursing home. (This occurred in some of the facilities in which we first found no COVID cases.)

First: Keep virus out

As did Sholar, North Carolina’s public health-care professionals cite the surrounding community’s level of infection prevention and control as a prime factor in keeping long-term care facilities free from COVID-19.

That was the emphasis of Dr. Susan Kansagra, chief of the state Division of Public Health’s Chronic Disease and Injury Section. Like Gov. Roy Cooper and NC public health officials, Kansagra has insistently placed importance on mask-wearing, social distancing, and mask-wearing, known as the three Ws.

“In preventing COVID-19 from entering into a facility in the first place, we see a pretty close tie to community transmission,” Kansagra said in an interview. “The reason for that is that, obviously, staff are also members of the community and they may inadvertently bring it into a facility. So what the transmission rates are in a community and prevention from that standpoint is really important and makes it less likely for an outbreak to happen within a facility.”

A broad range of actions by the state must support a nursing home once COVID-19 has intruded, but it’s perhaps more important to keep it from entering the door, Kansagra said.

“Obviously we don’t want that outbreak to happen in the first place, so we’re really working to strengthen that infection prevention,” she said. “We know, for example, that there continues to be a turnover in facilities. And we really want to make sure all staff are comfortable with all the different infection and prevention control procedures.”

‘The clamp came down’

Keeping infection out of nursing homes quickly led to North Carolina’s decision in March to bar all visitors. That applied to spouses even when they were essential caregivers, a move opposed by Willson and others across North Carolina.

“When the clampdown came, they clamped down hard,” Willson said. “Right there in the middle of March, I’d taken her out for one doctor’s appointment.

“And when we got back, they said, ‘Okay. This is it. She’s in here now and you can’t come back.’”

Under pressure from politicians, advocates and residents’ relatives, the state Department of Health and Human Services and the federal Centers for Medicare and Medicaid Services have revised policies to allow compassionate caregivers to visit once a day.

The drive to keep infection out and to control it if it enters a nursing home got reinforcement in June from the early release of a COVID-themed edition of the Journal of the American Medical Directors Association, or JAMDA. Triangle long-term care experts Dr. Philip Sloane and Sheryl Zimmerman planned and edited the JAMDA articles, which urged facilities to use specific means to keep everyone on the same page while fighting infection:

Tips for facilities

  • Devise easy-to-read ID cards so that residents can match staff members with their names and titles, even when they are wearing masks and other protective equipment.
  • Use video devices or windows to let residents meet with families without risk of contamination.
  • Use posters with clear directions to remind residents and others of necessary infection-control measures.
  • Mark doors with different colors that show staff which PPE should be worn within.
  • Understand that a higher rate of impaired hearing comes along with old age. That means many will have trouble understanding or lip-reading from medical staff or others who are trying to speak through a mask.
  • Supply writable communications boards in residents’ rooms to allow for questions in writing.

What’s the big picture?

Another thought-provoking article in the same Triangle-led issue of JAMDA suggested solutions from the 30,000-foot level, including some pointed ideas for national policymakers.

The paper notes that many nursing homes were designed years ago, when residents were on the whole younger and not as sick as they are today.

“Staffing levels have stayed fixed, while residents’ needs and medical complexity have increased well beyond this minimal capacity,” the authors write. “Buildings themselves are older, with smaller rooms, often 2 to 4 individuals to a room, narrow hallways, and old heating, ventilation, and air conditioning systems.”

First, the paper recommends that policymakers draw on people with expertise in post-acute and long-term care — clinical specialists, health care operators, and families affected by the disease.

“We are discussing state-level policy here because another thing we have learned is that, in the absence of clear leadership at the Federal level, states, counties, and localities have stepped into the vacuum,” the authors write.

In North Carolina, for example, state DHHS planners used a panoply of sources in devising a telehealth strategy announced July 28. Keeping in mind the need for distance communications with long-term care residents, the plan included partners such as NC Medicaid, the state’s Area Health Education Centers and Community Care of North Carolina, as well as consumers, patients and academic papers on telehealth’s merit.

In light of exigencies

“The new NC DHHS telehealth section gives technical assistance, education and resources to providers to help them implement and expand telehealth,” said Dr. Shannon Dowler, DHHS’s chief medical officer for NC Medicaid. “It also allows consumers and patients to find resources that answer their questions, making telehealth easy to use.”

The paper further recommended that health care providers continue to work closely across lines that might divide clinicians, public health and emergency management agencies, operators of long-term care centers and chains, long-term care residents, hospitals, and researchers.

Perhaps more controversially, authors Christopher E. Laxton, David A. Nace and Arif Nazir recommend that regulators adopt a framework that recognizes ongoing changes in long-term care — low staffing and flagging physician reimbursement. Dealing successfully with the pandemic and other pressure points means that long-term care policies built by legislators, government leaders and private administrations must offer support as well as potentially devastating penalties from federal regulators.

“In light of the extraordinary exigencies nursing homes have faced in this public health emergency, it is difficult to justify measures that are tantamount to setting our homes up to fail and which implicitly suggest that they themselves may be the cause of COVID-19 in the home,” the authors say.

But they don’t leave it there, advancing the idea that the harrowing pressures of the pandemic should lead in time to overall improvement of the continuum of services for older citizens not only in North Carolina but across the country. The authors give a summation with an inspirational tone:

“It is now up to us to turn this deadly crisis into something that makes these deaths, this misery, and this heroism contribute to a greater value beyond the immediate: namely, the reinvention of how we provide care and support to our parents and grandparents; how we honor their sacred needs and wishes; how we celebrate and lift up those who have chosen the aging professions as a career; and how we build a just culture of true accountability.”

Coming next: Testing, staffing, maintaining supplies of personal protective equipment — all must play a role when a nursing home’s goal is to exclude COVID-19 entirely.

A Graham polling center in Alamance County. Photo credit: Hannah Critchfield

In an election with unprecedented turnout, health care issues loom large, but can’t overcome economic concerns

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In an election with unprecedented turnout, health care issues loom large, but can’t overcome economic concerns - North Carolina Health News

Voters split their tickets on Tuesday, retaining Democratic Gov. Roy Cooper, while the presidential contest remains too close to call, with more than 100,000 absentee ballots still outstanding.

By Anne Blythe, Hannah Critchfield and Rose Hoban

Ballots in North Carolina did not list Medicaid expansion, the Affordable Care Act, the coronavirus pandemic response or the economy as something registered voters could mark as for or against.

In the outcome of the 2020 elections, it appears that North Carolina voters were willing to have Democratic Gov. Roy Cooper continue to lead the state response to the COVID-19 crisis while giving more seats to Republicans to lead on fiscal policy in the legislature.

“Voters made a clear choice in support of the Republican platform of low taxes, expanded school choice, and large investments in education and teacher pay,” said Senate leader Phil Berger (R-Eden) in a statement released late last night. “The Senate Republican majority will continue to deliver on those promises.”

North Carolina saw an unprecedented number of registered voters cast their ballots early, either in person or by mail with absentee ballots.

As a result, many polling places across North Carolina were filled with more poll workers and observers than voters at times during the day.

In Vance County, turnout was light at several polling sites in Henderson, where party partisans said they were seeing only 10 or 20 people an hour. Many folks at Perry Memorial Library walked out of the polling place with a print out of the correct precinct for their votes. A Democratic party observer who declined to give his name said that by mid-afternoon about 30 people had been redirected to other polling sites.

Some voters said that health care wasn’t really at the top of mind as they walked into their voting places, but for those who were thinking about the issue, it loomed large.

Ashley Boone-Roach perked up when asked about health care.

“Sometimes when I hear  ‘Affordable Care Act,’ I just want to cry, because it saved my life, having it,” she said.

Standing in front of her polling place at the Richard Thornton Library in Oxford, Boone-Roach told of being a 26-year-old who had just gotten off of her parents’ insurance policy when she discovered she had blood clots. Then, when she got married, she wasn’t able to get insured through her husband’s policy because of her pre-existing conditions. Because of the ACA, she was able to get covered.

Now that she has a job and has health insurance through her employer, she said she hasn’t been held back because of that pre-existing condition.

“I’m a living witness, I wish I could write to the founders of that piece, and say, ‘It saved my life, I wouldn’t be alive today.’”

Chatham County sees high turnout

By the time Election Day got here, Chatham County already had seen 75 percent of its registered voters vote early or cast absentee ballots — the highest percentage in the state.

Man and woman at a campaign site wearing red Make America Great Again hats
Toby and Maggie Considine, Bynum residents, outside a Chatham County voting site. Photo credit: Anne Blythe

In Chatham County, Maggie Considine and her husband Toby Considine stood outside a voting site in Pittsboro wearing red Make America Great Again caps and face masks.

He voted Tuesday morning because he likes the excitement of casting a ballot on Election Day. She voted early. The Bynum couple was on the same page, though, when it comes to who they think should lead the country for the next four years.

Maggie, a realtor, said Trump represents “prosperity, freedom, hope.” “The Democrats seem to be selling recession, repression and fear,” she added.

Toby touted the pre-pandemic economy when asked why he wanted four more years. At 62, he downplayed the pandemic, and pointed to his stomach as his biggest COVID-19 problem, hinting at a weight gain he hoped to soon shed.

Maggie said she thought the president’s response to the pandemic “could have been better.” “I don’t think anybody else could have done better,” she added. “His job is to be a cheerleader.”

Pandemic response spurs votes

In the same parking lot, Ana Carlson-King, a 37 year old who lives in northern Chatham County, gathered with other Democrats handing out information about their recommended candidates.

Woman wearing a dark-colored face mask and hat
Ana Carlson-King, a Chatham County resident, outside a voting site on Election Day. Photo credit: Anne Blythe

The 2020 election, to her, is about access to health care, the disparities she’s seen for the Special Olympics swimmers she coaches in Orange County, especially those who live in group homes, the Republican resistance to expanding Medicaid and her concern about the repeated attempts to overturn the Affordable Care Act.

“To me, it’s coming down to the pandemic and it’s coming down to health,” Carlson-King said, voicing her support for Democrats.

Johnny Shaw, a 69-year-old retired educator who lives in southern Chatham, was outside the same Pittsboro voting site, handing out candidate recommendations for Democrats.

He’s flummoxed, he said, by Republicans’ unwillingness to expand Medicaid and had heard no reason from state legislators who refuse to take federal funds for a program that could help expand health services.

“It’s just sort of a party thing,” Shaw said. “It’s just, ‘We’re going to show you we’re not going to expand.’”

As a former teacher and school administrator, Shaw also said it is time to expand broadband, especially in a pandemic when so many schools have moved to online teaching to keep students, teachers and staff safe from COVID-19. He was critical of Republicans for the access issues plaguing many.

Man wearing a blue vest, face mask and ball cap stands under a blue tarp
Johnny Shaw, a Chatham County resident, discusses the 2020 election. Photo credit: Anne Blythe

The fight for state House and Senate

How the vote comes down for state legislative races will be crucial in determining whether access to care in North Carolina is expanded.

Since 2013, Republicans have had control of the General Assembly, initially with a supermajority and a simple majority since 2018. Party leaders have staunchly resisted expanding Medicaid to some half-million low-income workers, a policy made possible because of the Affordable Care Act.

Democrats were hoping to pick up more seats in the chambers, to break that logjam. Instead, the party lost at least four seats in the House and several in the Senate. Many races remain too close to call with as many as 136,000 absentee ballots unaccounted for.

Erica Palmer Smith leads Care4Carolina, a coalition that’s been pushing for expansion for years. She said she hoped the legislature would make it “a number one priority” going into 2021, that more than 500,000 North Carolinians gain access to affordable, quality health insurance.

Palmer Smith said she thought there could be a “solid chance” that something similar to earlier bills, which have included employment requirements or screening requirements for recipients, would be likely.

She noted that Care4Carolina’s polling has shown strong support for expansion among voters.

“A whopping 75 percent of North Carolinians in a statewide poll conducted in August ringingly declared that they want to close NC’s health care gap,” she said in an email to NC Health News.

Some voters echoed that support.

“I just need for that Medicare, Medicaid to be a little bit better than what it is now,” said Henderson resident Roselyn Fields. “You know, younger folks can’t get Medicare or Medicaid. So it’s kind of hard with people who got heart problems like me.

“That’s the only reason why I’m voting.”

But getting the legislation passed may be a heavy lift especially as Democrats have lost seats, and with it, leverage.

shows a Black woman in a mask worn against COVID standing in front of a polling station
Henderson resident Roselyn Fields came to the Perry Memorial Library in town to cast her ballot on Tuesday. She said that she has a heart problem so health care is a big part of her decision making when she thinks about voting. “I need for the Medicaid to be better than what it is,” she said. “It’s kind of heard when people who got heart problems like me… I think that’s the only reason I’m voting.” Photo credit: Rose Hoban

In the House, many of the Republican champions of the policy have moved on. Representatives such as Josh Dobson (R-Nebo), who co-authored Republican bills to expand, won’t be returning. He ran for state labor commissioner, a race he appears to have won.

Another expansion proponent, former state Rep. Greg Murphy (R-Greenville), has moved onto Congress, where he was reelected, and other Republicans, such as Rep. Craig Horn (R-Weddington), who publicly supported the policy, recently retired.

Resistance to Medicaid expansion has been fiercest in the Senate, where Berger has made it clear for the past few years that he’s against the policy and no such bill would have a chance in his chamber.

Palmer Smith said it’s been difficult to have conversations with leaders in the majority for the past several months leading up to the election.

“But a lot of the private conversations we’re having, legislators recognize that this is an issue and I think that we’ll see enough… to show that this is a major issue for voters,” she said.

Race, health intersect

In Alamance County, Miguel Tatum, age 36, and his son, a first-time voter, cast their ballots at the Graham Civic Center in Graham on Tuesday.

“This pandemic showed that health care really is important,” said Tatum. “A lot of black and brown people are dying. It’s important to get people in that really care.”

Miguel Tatum, 36, and his son, a first-time voter, cast their ballots in Alamance County today. Photo credit: Hannah Critchfield

Dreama Caldwell, who is both a voter and a candidate for county commissioner, said she voted to improve local responses to the pandemic.

“I’m a formerly criminal justice-involved individual, and that particular part of the population needs a voice,” said Caldwell. “Our Sheriff, Terry Johnson, has not enforced masks. So him and his law officers have not worn masks, and as a result the jail had 120-plus cases of COVID. It was only after that outbreak, in my understanding, that inmates were given masks. We’re a very reactive county, we’re not a proactive county.”

Caldwell finished last in a field of six.

Frontline workers explain their votes

Veretta Hatley, a 48-year-old Carrboro resident who works at the Croasdaile retirement community in Durham, cast her ballot in person after work on Tuesday at Carrboro Town Hall for Democrats.

Hatley, a Black woman wearing a pink Black Lives Matter face mask, said health care and what happens if the ACA is gone were on her mind when she voted.

Woman wearing a pink Black Lives Matter face mask outside a building
Veretta Hatley, a Carrboro resident who works at a Durham retirement community, outside a voting site. Photo credit: Anne Blythe

“Personally, my mother battled cancer last year, and I don’t want her not to continue with her care because she has pre-existing conditions,” Hatley said, mentioning others in her family who might be more reluctant or unable to afford care if they lost their insurance.

She also supports Medicaid expansion as someone who could benefit from it.

As an essential frontline worker, she praised Gov. Roy Cooper’s handling of the pandemic.

“I love him,” Hatley said. “He got a lot of criticism for not opening up some things as fast. They were saying, ‘Why don’t you open this? What about this?’ But I’m saying, ‘People are dying. I’m out here on the front line. I see it.’”

A certified nursing assistant from Oxford who only gave her name as Mary who worried about her older patients.

“I know if they take their Medicaid and Medicare away, they won’t be able to survive,” she said.  “That’s not fair to any American of this United States, Black, white, Hispanic part of this United States. They have helped make the United States great, they deserve their benefits with the work that they put in.”

We see Jayla, age 11, hugging her sister Bailey, age 5, before they were pepper sprayed at a voting rights rally on Oct. 31 in Graham, North Carolina.

Pepper-sprayed on their way to the polls: What is pepper spray’s impact on children?

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Pepper-sprayed on their way to the polls: What is pepper spray’s impact on children? - North Carolina Health News

The effects of the chemical may be more dangerous for children and medically vulnerable people — and the pandemic might just make things worse.

By Hannah Critchfield

On Halloween Day, Melanie Mitchell brought her two daughters and her 61-year-old mother to what she believed would be a family-friendly event — a march to the polls in her hometown of Graham, North Carolina.

“I don’t take my kids to protests, but this was only for voting. That was our whole purpose of being there — because people are scared to come to Graham, especially people of color,” she said. “Everybody said bring your parents, bring your grandparents, bring your kids.”

At one point, marchers stopped in front of the Confederate monument that stands in front of the county courthouse for a moment of silence for George Floyd, a Black man killed by Minneapolis police earlier this year. After it concluded, local law enforcement ordered people to clear the road.

Then, the Alamance County sheriff’s deputies and Graham police pepper sprayed members of the mostly Black voting rights march encouraging people to get to the polls, including children as young as 5 years old, like Mitchells’ daughter Bailey.


Members of a voting rights rally, including children, are pepper-sprayed by Graham police and Alamance Sheriff’s deputies on Oct. 31. Video courtesy: Melanie Mitchell

“Both of my kids were throwing up,” she said. “My youngest’s eyes were still puffy and red underneath that night, but that could have been from crying. They were coughing pretty much all night long. My 11-year-old asked me if she was going to die.”

“My 5-year-old keeps asking me, ‘Why would they do this, why would a cop do this, Mom?’” said Mitchell. “‘We’re just kids.’”

A Black woman in a motorized wheelchair was also hit by the chemical agent.

A spokesperson from the Graham police department said they chose to use pepper spray because of its “ability to disperse crowds with minimal force.”

He added that they have no knowledge of their officers deploying pepper spray “near any children at the rally,” but cannot speak for deputies from the Alamance County Sheriff’s Office.

The Sheriff’s Office has not responded to requests for comment.

“The spray was directed toward the ground by our officers and only affected those in the immediate vicinity,” said Daniel Sisk, Graham Police Department spokesperson, who noted they are investigating the incident. “The application requires little to no decontamination and has little to no lasting effect.”

But researchers said the health impacts may be more dangerous than police let on, particularly for children and medically vulnerable protesters.

Physical and mental damage

Pepper spray, like tear gas, is a chemical irritant that acts on the inflammatory system. People who are exposed to it experience difficulty breathing, coughing and eye irritation. While often intended to break up riots, in the last few months, law enforcement across the country have also deployed pepper spray during peaceful demonstrations.

NC Health News spoke to physicians who said its use can have lasting negative health effects on children.

“Any chemicals in your eyes, nose or lungs isn’t good, but it’s especially worrisome for kids because their organs are still developing,” said Purvi S. Parikh, an immunologist who specializes in pediatric health at New York University Langone Health. “It has the potential of causing long-term effects.”

We see marchers, including children, sitting during a moment of silence for George Floyd during a voting rights rally in Graham, North Carolina, on Oct. 31. Law enforcement released pepper spray on the crowd shortly therafter.
Marchers, including children, sitting during a moment of silence for George Floyd during a voting rights rally in Graham, North Carolina, on Oct. 31. Law enforcement released pepper spray on the crowd shortly thereafter. Photo credit: Melanie Mitchell

A child may develop neurological effects, such as nerve or brain damage, she said.

They may develop lung problems from the exposure such as asthma, according to Parikh, or allergies if the chemical enters their upper respiratory tract.

“There might be other effects that we don’t even know about, because it hasn’t been studied that much,” she added. “It’s not a common situation where people would spray kids.”

Immediate physical effects are only a piece of the puzzle, according to Rohini Harr, an emergency physician who specializes in health and human rights and a professor at the University of California Berkeley.

The mental health effects of being pepper-sprayed as a child “cannot be overstated,” she said.

“Children who are exposed to violence, especially violence on behalf of law enforcement, that has an incredibly chilling effect on that relationship,” said Harr. “It has an incredibly traumatizing effect on children in general to experience violence at young ages.”

Mitchell said this is her biggest concern.

“They’re okay physically, but they’re traumatized. They’re never going to forget that day. You’re supposed to be able to want to call the cops to protect you. And my kids are gonna be scared of the cops now cause of this.”

Spreading coronavirus

There’s another potential health impact of deploying pepper spray, particularly during a pandemic that causes a respiratory infection.

“Pepper spray, tear gas, they force compliance by making you feel like you can’t breathe and that you’re suffocating,” said Harr.

“So when you’re wearing a mask and it’s saturated with pepper spray, the first instinct people are going to have is to decontaminate – to take it off,” she added. “Which can of course exacerbate the spread of coronavirus.”

Exposure to the chemical also makes an individual more likely to get sick, according to Parikh.

“Having any type of chemical irritation unfortunately predisposes you to getting sick, because it affects your immune system,” she said. “If your lungs and nose are inflamed, you’re more likely to catch an infection. And that’s not great during a pandemic.

“Chemicals are especially bad for children, again, because their immune systems are still developing,” she added. “Particularly if they’re very young children.”

‘Family-friendly’

Alamance is one of several key counties Democrats are trying to flip in the state legislature during this year’s election. It sits within a state that holds 15 electoral votes, a battleground in determining the next president of the United States.

Gwen Frisbie-Fulton, communicators director at Down Home NC, a community organization that advocates for working people in rural North Carolina, was also at the march with her child. She said many people didn’t make it to the polls that day because of the incident.

“We have not received any calls from voters who did not have a chance to vote because of Saturday’s incidents in Alamance County,” said Patrick Gannon, spokesperson for the North Carolina Board of Elections. “It is our understanding that early voting was not disrupted Saturday.”

But Mitchell echoed Frisbie-Fulton’s sentiment.

“A lot of people didn’t get to vote because they were either pepper sprayed, arrested or scared and went home,” she said. “I feel like it was voter intimidation.”

Mitchell said her family is dealing with the aftermath of law enforcement’s use of force on her children.

She’ll return to march in solidarity with Graham voters today — but this time, she’ll go alone.

“I never would have brought them if I would have thought anything like this would have happened,” said Mitchell. “I’ll be going, but I’m not letting my kids go. Not that they would — my 11-year-old is afraid to go downtown.

“I have some people on social media saying ‘you’re such a terrible parent,’” she added. “But it wasn’t even a protest, it was a rally for voting. It was supposed to be a family-friendly event.”

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