2021: COVID still looms large - North Carolina Health News

By North Carolina Health News staff

Rural broadband infrastructure funding moves forward, with limited impact

The pandemic highlighted long-standing weaknesses in the internet infrastructure of rural counties across the state. From telehealth to working to learning from home, residents in rural areas discovered that what was once an inconvenience now became a hurdle which, in places, is insurmountable.

There have been plenty of short-term attempts to narrow the gap. Libraries, schools and health centers set up Wi-Fi hotspots in communities with limited internet access. Some providers even gave people who don’t have internet at home Wi-Fi hotspots and cellphones. But none of these fixes fully addresses the lack of broadband connections in many rural areas.

It’s hard to know exactly how many people lack internet access at home because federal data on the problem is inaccurate at best. What we do know, however, is that hooking even a handful of customers in some remote communities to the internet could cost tens of thousands of dollars for rural miles and as much as a thousand dollars for an individual household.

Earlier this year, lawmakers in Raleigh earmarked $30 million of the $4.1 million coronavirus relief package toward matching grants that would expend the broadband infrastructure in underserved areas. That special grant cycle had more than 70 applications, with plans of giving the money to 18 projects.

By November, a North Carolina Department of Information Technology spokeswoman said federal guidelines prohibited the use of those CARES Act funds for rural infrastructure improvements. The spokeswoman said the department would look for alternative funding sources, suspending the special grant cycle in the meantime.

In December, lawmakers said they would use money from the state’s general fund to finance the grants. Advocates have said the state and federal support makes a costly rural project financially feasible. But even with money for these projects, infrastructure improvements may take months or even years to connect rural residents to the internet.

And though $30 million is more than the program got in the past, most of the proposals on the list will not be funded. There’s no doubt that the 18 projects that will be funded will make an impact in some rural communities. But for residents who would benefit from the roughly 50 projects that won’t get funded, broadband barriers will likely continue. –Liora Engel-Smith 

Long road ahead as NC takes on COVID-induced mental health challenges 

The coronavirus pandemic has had devastating implications for our mental health — from stress to isolation to great loss. Though the vaccine has provided some much-needed hope, the tail of this COVID-induced mental health crisis is expected to outlast the virus.

“We usually see the peak of mental health need about six months after a disaster is over,” said Kody Kinsley, deputy secretary for Behavioral Health & Intellectual and Developmental Disabilities at DHHS. “Again, what makes this one so hard is that it’s nowhere near over.”

“The impact of the trauma of this experience is going to play out for quite some time,” he said.

Looking forward to 2021, Kinsley discussed what his mental health priorities are for North Carolina.

First, we need to pay attention to our youngest generation, he said. They’ve been home from school, missing educational and social outlets. They’ve felt the household stress of parents working from home or losing work and being unable to provide meals. And they’ve mourned the loss of friends and family to the virus.

Kinsley noted that the U.S. Census Bureau’s weekly household surveys during the pandemic show a tripling in rates of anxiety and depression, and young people account for a big part of that increase.

“Experience shapes perspective, and young people don’t have as much experience with traumatic events like this, so they don’t have as much confidence that we will rebound,” he said.

A big priority for DHHS in the coming year will be supporting children and helping them work through the effects of the pandemic, Kinsley said. That will mean more investment in baking an understanding of trauma and its short- and long-term effects into schools and classrooms, including support for teachers, he said.

A second focus priority for 2021 will be continuing the work of detangling the mental health system from the criminal justice system, Kinsley said. More pre-arrest diversion for those with substance use disorders and jail-based addiction treatment is needed, he said.

The opioid crisis has not gone away even as the coronavirus pandemic has deepened. North Carolina saw a spike in overdoses earlier this spring and summer. When fewer people were going to the emergency room as the virus took hold in the state, Kinsley noted that the number of visits to the ER due to opioid overdoses increased.

While still higher than the previous year, the number of overdose emergency room visits are coming down, and Kinsley thinks it’s due to a greater availability of naloxone, an overdose reversal drug.

Addressing the state’s mental health needs throughout and after the pandemic will take more funding, Kinsley said. DHHS received and spent the additional $88 million appropriated by the state legislature to address mental and behavioral health needs during the pandemic, he said. He’s looking forward to more potential grant money from the federal Substance Abuse and Mental Health Services Administration.

Kinsley’s third mental health priority for 2021 is continued access to mental and behavioral health care.

“We’ve seen a lot of commercial private health insurance step up in the last year providing pretty much unparalleled access to behavioral health services in a way that had never been done before, waiving copays and increasing payments for telehealth services,” he said.

This led to more North Carolinians being able to use outpatient mental health health care.

“Many private insurers made modifications to increase behavioral health services during the pandemic, and we need to see that will continue into the new year,” Kinsley said. “It needs to be the new normal.”

While a focus on the state-funded behavioral health system is important, it’s equally important to ensure access for those with private insurance to stay healthy and stable so they don’t end up needing state-funded care, Kinsley said.

“For every person waiting in the emergency room for a psychiatric bed, there’s multiple people upstream who never got the preventative outpatient services that they needed,” he said. — Taylor Knopf

Will NC’s communities of color embrace a COVID-19 vaccine?

As the number of coronavirus cases and deaths continue to escalate, the newly approved Pfizer and Moderna COVID-19 vaccines offer the best hope for somewhat normal 2021. Due to limited initial supply and based on national and state guidance, the first batch of the Pfizer vaccine is being given to workers in high priority, patient-facing areas such as emergency departments and medical intensive care units, and other areas where health care workers are at a higher risk for COVID-19 exposure.

Even as the state works to scale up vaccine distribution across the state, health officials anticipate significant roadblocks. The North Carolina Interim COVID-19 Vaccination Plan Executive Summary anticipates rates of vaccine hesitancy to be high, especially among historically marginalized people who are highly represented in prioritized populations.

Leaders of anti-vaccine groups are exploiting the conditions under which the vaccine was developed and are working to undermine trust in the vaccines. In some quarters, their efforts appear to be working.

“This is a new vaccine that we don’t know enough about,” one friend told me, explaining why she won’t get the vaccine. “I’ve heard messenger RNA changes your DNA.”

That claim has been widely debunked. The messenger RNA acts more like computer software that instructs the hardware of your cells to do something specific for a short period of time then degrades once it delivers the message.

“Your genome, the DNA, is in the nucleus of the cell. It’s not in the cytoplasm of the cell. And it’s virtually impossible for the messenger RNA to get into the nucleus,” said noted vaccine researcher Paul Offit from the University of Pennsylvania.

While Blacks are not generally defined as anti-vaxxers, they tend to be vaccine-hesitant, which the World Health Organization lists as one of the top 10 global health threats.

The Tuskegee syphilis experiment inevitably comes up when discussing the distrust of a COVID-19 vaccine as well. Many mistakenly believe that the men in the study were injected with something harmful. In fact, they were denied a simple injection of penicillin that would have saved their lives. Researchers watched as the men died, went blind, became psychotic or experienced other severe health problems due to their untreated syphilis.

So, when mistrust leads Blacks to refuse widely accepted medicine, they could be doing to themselves what racist public health officials did to them decades ago. – Melba Newsome

Biden nominates state DEQ chief to head EPA

In December, President-elect Joe Biden nominated Michael Regan as administrator of the U.S. Environmental Protection Agency.

Regan, now secretary of the N.C. Department of Environmental Quality, would become the second Black person, and the first Black man, to hold the nation’s top environmental post.

Environmental groups quickly hailed the selection. The national Environmental Working Group said in a statement that it “shows Biden’s commitment to rebuild EPA, protect public health and advance environmental justice.”

Although his name may not be universally well known, Regan has years of experience. He started his career at the EPA during the Clinton administration and spent eight years at the Environmental Defense Fund before taking over as secretary of the state DEQ in January 2017.

At the DEQ, Regan has helped oversee Gov. Roy Cooper’s executive order to cut the state’s carbon footprint by 40 percent from 2005 levels by 2025.

Regan has also worked to force the Chemours Fayetteville Works chemical plant to stop polluting the air and the Cape Fear River with per- and polyfluoroalkyl substances, known as PFAS.

It’s too early to know what direction Regan would take the EPA if Congress approves his nomination. But Biden has said he plans to make climate change a centerpiece of his agenda, promising to reduce greenhouse gases while restoring the economy and creating jobs.

Shortly after his nomination, Regan took to Twitter.

“Climate change is the most significant challenge humanity faces,” he wrote. “We’ll make meaningful progress together by listening to every voice—from our youth & frontline communities to scientists & our workforce. I will be honored to be part of that work as EPA Administrator.”

Biden has said he will also designate PFAS as a hazardous substance, which would allow the federal government to set enforcement standards for PFAS under the Safe Drinking Waters Act.

As it is now, PFAS, which may cause cancer and other adverse health effects, are not regulated at the federal level, leading some states to individually place health advisories on certain types of the substances.

North Carolina is said to have the third-worst PFAS contamination in the country. But the state has not set a health goal for any of the compounds except GenX, a type of PFAS found in high levels downstream of the Chemours chemical plant in Bladen County.

Regan helped draft a consent order approved in February 2019 that requires Chemours to rid PFAS from the air and the Cape Fear River below the plant. An estimated 4,000 private wells surrounding the plant are contaminated with PFAS.

It is also too early to know who Gov. Roy Cooper might select to replace Regan as secretary of the DEQ. The department has been hamstrung by funding cuts since Republicans took control of the General Assembly in 2010.

Looking ahead to a related environmental issue, a lawsuit filed by state Attorney General Josh Stein against DuPont and spin-off Chemours could be heard this year in Cumberland County Superior Court. Stein says the chemical companies put profits over people and must pay “for the mess they created.”

Readers of NC Health News can also expect more stories related to environmental justice issues. In December, The Andrea Harris Social, Economic, Environmental, and Health Equity Task Force released its first biannual report, which outlines policy recommendations to address disparities in minority communities disproportionately affected by COVID-19. — Greg Barnes

Will on-campus classes and living work in 2021?

As COVID-19 case counts hit record highs just a week after Christmas, college campuses across North Carolina are looking to bring students back later this month for spring semesters.

UNC Chapel Hill, which reversed course on a two-week experiment in the fall semester to try in-person classes with students living on campus, is giving it a go again this semester.

Though UNC-CH faculty resisted in an open letter published in the Daily Tar Heel late last semester about coming back on Jan. 19 with more people on campus, about 3,500 students are expected to return to dorms.

Twenty-percent of the classes, with a reduced number of students, will be in-person unlike in the fall.

A big change this spring, Robert Blouin, the UNC-CH provost told faculty at a meeting late last year, is the university’s decision to stand up its own testing program for students, faculty and staff.

Students who return to campus and the area will have to undergo mandatory and re-entry testing, taking a page from Duke University.

Last year, Duke required all students to self-quarantine for 14 days before arriving on campus. Once there, they had to sign a code of conduct pledge to wear masks and follow social distancing guidelines as well as submit to regular COVID-19 tests.

Duke was able to run lab tests, using pooled resources, thus conserving reagents and other costly chemicals needed. If a test rendered a positive result, then those people were informed and isolated while rigorous contact tracing ensued.

Students who lived on campus, conducted tests on themselves twice a week, using kits provided to them. Duke staff members roam the campus in the evening, enforcing masking and distancing rules.

Students in off-campus housing conducted tests on themselves at least once a week.

Test collection sites were strategically located across campus. The swabs were then pool tested with five samples in a group and analyzed for the presence of virus. Any batches that showed a positive result were then broken apart and tested individually to home in on the source of the result.

Between August and October, Duke processed some 80,000 samples. Overall, according to a summary of a case study published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report in November, 84 cases were identified among Duke students, slightly more than half of whom were asymptomatic.

“Our experience at Duke shows that combined risk reduction strategies and surveillance testing can significantly lower transmissions on college campuses and beyond,” Thomas Denny, professor of medicine at Duke University School of Medicine and chief operating officer at the Duke Human Vaccine Institute, said in a statement at the time.

North Carolina’s historically black colleges and universities also were able to keep a tighter lid on COVID-19 cases than some of the other larger UNC system campuses across the state.

As vaccines are distributed in the coming months, college students are in Phase 3 of North Carolina’s equitable distribution plan. It’s not clear what month the vaccines will be available for them, but if the inoculations amp up as President-elect Joe Biden states, it could be during the spring semester. — Anne Blythe

Getting the vaccine and slowing the spread behind bars

The vaccine is coming to North Carolina’s correctional facilities – but not all at once.

The current working plan, which the state updated on Dec. 30, is to prioritize anyone 75 or older in the first round of vaccine distribution in Phase 1b, once front line health care workers have received the vaccine.

This should likely include elderly incarcerated people – the plan states individuals in this age bracket will be prioritized “regardless of medical condition or living situation.”

Prison staff will come next, receiving the vaccine in either the second or third round of distribution in this phase.

Correctional officers are defined as “frontline essential workers” under Centers for Disease Control and Prevention guidance, which North Carolina’s new plan mirrors. Staff who are 50 or older will be offered the vaccine in the second round of Phase 1b, followed by staff of all ages when more doses become available in round three. This should begin in early January, according to the plan.

Thousands of remaining inmates, who make up the majority of the state prison population, will have to wait until the next phase, known as Phase 2. People who are between 65 and 74 years of age, including incarcerated people, will be next to receive shots; anyone between 16 and 64 with a medical condition that increases the risk of severe illness from COVID-19 will come later.

The third group in this phase, and the first time people behind bars are specifically mentioned in the plan, includes, “anyone who is incarcerated or living in other close group living settings who has not already vaccinated due to age, medical condition or job function.”

Other changes may come as a judge has recently mandated a slew of actions in an ongoing lawsuit against the state over its ability to protect incarcerated people in its custody in state prisons from the virus.

In mid-December, Judge Vinston Rozier Jr., who ruled conditions inside these prisons were likely unconstitutional in June, ordered prison staff to be tested every two weeks and told the state it needs to release more prisoners. He also appointed Thomas Maher, the director of Duke University’s Wilson Center for Science and Justice, as a special master to oversee this process and ensure the agency complies with these court orders. — Hannah Critchfield