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A screenshot of Medicaid managed care website

Almost 1.5 million consumers have been moved to NC Medicaid’s managed care. Now what?

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Almost 1.5 million consumers have been moved to NC Medicaid’s managed care. Now what? - North Carolina Health News

NC health department concluded the state’s first-ever Medicaid open enrollment period earlier this month. As the July 1 go-live date for these plans draws near, consumers and advocates say there may be challenges ahead.

By Liora Engel-Smith 

Fallin McCoy’s new Medicaid insurance card came in the mail earlier this week. Marked with a red and white logo from WellCare — a private insurer — the connection to the state’s largest public insurer is almost easy to miss. 

The old card, a paper document with the North Carolina state seal, lists the state Department of Health and Human Services on top. McCoy’s new card relegated a mention of Medicaid to a small inscription under the massive insurer’s logo.

The plastic is an improvement from the paper, the 39-year-old Carteret County resident said, but it remains to be seen if the improvement would extend to McCoy’s quality of care.

Next month, two-thirds of the safety net program’s enrollees — currently some 2.5 million people — will get their care from one of five commercial plans managed by private insurance companies (a sixth plan will be run by the Eastern Band of the Cherokee for tribal members). The first phase of that transition process, the open enrollment period, ended last month. 

By all accounts, the transition was a major undertaking. By the end of May, a little over 200,000 enrollees had selected their own plan, while the remaining 1.4 million got assigned to a program automatically, the state health department said in an email. The department’s enrollment hotline fielded more than 280,000 phone calls from enrollees. Roughly 55,000 enrollees signed up on the Medicaid website.

That percentage of self-enrolled versus auto-enrolled is about on par with what’s played out in other states as they transitioned their Medicaid programs to managed care. 

State health department spokeswoman Cait Armstrong said in an email this week the effort was “generally successful.” The transition comes after more than five years of efforts by legislators and health officials to reconfigure Medicaid, the largest public insurer in the state, into something that looks and acts more like private health insurance.

distribution of Medicaid members among 5 plans.
Credit: NCDHHS

Open enrollment hasn’t been seamless for McCoy, whose epilepsy and other health conditions require care from several specialists. Some providers signed contracts with WellCare, and some with rival UnitedHealthcare. WellCare was the better of two imperfect choices, but McCoy still lost a crucial provider. The nearest replacement in her network is in Raleigh, a roughly three-hour drive one way.

With the selection process over, WellCare is responsible for all aspects of McCoy’s care. The state health department will pay the company a flat fee of $1,158 a month regardless of how many tests or prescriptions McCoy needs. It’ll be up to WellCare to pay for services that will enhance and improve her health without losing money. Managed care companies such as WellCare have done well in the Medicaid market. For example, WellCare earned 8 percent profit on Medicaid revenues of almost $4.9 billion in the third quarter of 2019.

The five plans of NC’s Medicaid Managed Care

Tying payments to health outcomes should make the state’s Medicaid spending relatively flat and promote better care, proponents say. But exactly how that balance will play out remains to be seen. WellCare did not respond to email and phone inquiries this week regarding this story. 

McCoy, for her part, is gearing up for hurdles to come. She wonders if the smaller WellCare network would mean longer wait times for appointments, referrals and other services. 

“So far, my providers seem confused and stressed out,” McCoy wrote in a text message this week. “My [primary care provider] seems excited … My specialists seem anxious and concerned.”

Built-in protections

During an interview with NC Health News last month, Medicaid director Dave Richard acknowledged that the transition to managed care may be bumpy at first. State health officials are allowing beneficiaries to continue seeing their existing providers — even if they are out of network — for a few weeks after the plans go into effect. Insurers will also honor existing preauthorizations. And the state designated the NC Medicaid Ombudsman, an independent nonprofit to educate and advocate with enrollees should problems arise.

These safeguards may not cover every situation, however, said Doug Sea, senior attorney and program manager at the Charlotte Center for Legal Advocacy. Enrollees with significant mental health needs are particularly vulnerable, he added. 

The state plans on transitioning these enrollees to managed care plans at a later date, but some beneficiaries who didn’t need to select a plan yet accidentally signed up in the rollout last month. If they don’t switch back to state-managed Medicaid before the deadline, these enrollees will lose some crucial benefits such as rides to and from appointments from the Department of Social Services or placement at drug and alcohol rehabilitation programs. 

Sea said the enrollment brokers have reached out to enrollees to discuss these options but worries that the state hasn’t reached everyone in that group. 

NC Medicaid Ombudsman: For questions or concerns regarding Medicaid managed plans, enrollees can visit https://ncmedicaidombudsman.org/ or call  877-201-3750

Some enrollees, Sea said, moved and haven’t updated their addresses with the state and haven’t received information about the upcoming change or their insurance card. And even enrollees who received their cards — particularly those who didn’t pick a plan — may think they no longer have Medicaid. 

With providers, enrollees and sometimes even enrollment brokers sharing misinformation on a complicated change, Sea worries that some people won’t know how to navigate their new insurance. 

“DHHS is really trying to get the word out,” Sea said. “But it’s an inherently complex system and North Carolina has one of the most complex versions of this in the country.”

A digital image of an ad for Medicaid managed care

As NC’s Medicaid managed care transition draws near, consumers express concerns and confusion

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As NC’s Medicaid managed care transition draws near, consumers express concerns and confusion - North Carolina Health News

North Carolina is in the process of transitioning more than 1.5 million Medicaid recipients into managed care. But in a pandemic year that’s chock full of crisis, some consumers are already experiencing growing pains.

By Liora Engel-Smith

Come July 1, North Carolina’s Medicaid program is being placed into the hands of commercial insurers, and this time, state officials say, the transition is all but guaranteed.

The move will change Medicaid, the largest public insurer in the state, into something that looks and acts more like private health insurance.

North Carolina has been managing the care of its Medicaid beneficiaries since the state-federal program began in the 1960s. Starting in June, roughly two-thirds of the state’s Medicaid enrollees — currently some 2.5 million people — will be divided into one of five commercial plans managed by private insurance companies (a sixth plan will be run by the Eastern Band of the Cherokee for tribal members).

The remaining beneficiaries will transition to the commercial plans at a later date.

At a five-year average of  $14.83 billion in combined state and federal spending, Medicaid is one of the state’s biggest budget items. Legislators pushed  for making the transition back in 2015, arguing that it would  give the state more budget predictability while keeping enrollees healthy. The idea is to pay insurers based on health outcomes, such as controlling a patient’s cholesterol or blood sugar rather than paying for each test, prescription or doctor’s visit.

It’s a big change in the way Medicaid works, particularly for enrollees, some of whom have never had to choose an insurance company or provider network. The process was supposed to take place in 2019, but a budget impasse that year between Democratic Gov. Roy Cooper and the Republican-lead legislature tangled up funding for the transition, forcing the Department of Health and Human Services to suspend work on making the changeover.

Information gap

As  happened in 2019, the state — and the insurers themselves — are reaching out to beneficiaries with digital, television and radio ads as well as mailings about the change.

But that may not be enough in a year where coronavirus response has drowned nearly all other messages.

“I’m a little worried that it might not be on everyone’s radar in the level that it was before the pandemic,” said Jennifer Greene, public health director at AppHealthCare, a health department and community health clinic that serves Alleghany, Ashe and Watauga counties. “[Back then] we were talking a lot about it. We were educating patients, and I think we’re gonna have to work pretty hard to return to that status.”

Dave Richard, who oversees the state’s Medicaid program, acknowledged the transition may confuse some beneficiaries. The state health department estimates that roughly 15-20 percent of enrollees in that first batch will choose a plan, while the rest will be enrolled automatically. It’s a trend that’s played out in other states that have converted to managed care.

Everyone — including those who chose a plan — can switch to a different plan in that first year, Richard said.

Open enrollment started on March 15 and ends on May 14. Despite rolling out for weeks, some beneficiaries say they are already confused and anxious about the transition.

Jereen Wells, a hairstylist in rural Wayne County, did not recall getting any letters from Medicaid about the transition. The 34-year-old did not know about open enrollment and confused the upcoming move to managed care with Medicaid expansion, the separate policy debate that brought the state budget process to a standstill in 2019.

The state health department’s previous attempt to transition only added to her confusion

“I haven’t got anything from Medicaid,” she said. “I remember getting something months ago, but you know, they stopped everything. I’ve heard they started sending out, you know, things again, but I hadn’t got anything this time around.”

Wells, who is generally healthy, was recently diagnosed with a polycystic ovarian syndrome, a hormonal imbalance that can cause unusually heavy periods and puts her at risk for diabetes and heart disease. Medicaid transformation isn’t at the top of her mind, she said, especially in a pandemic year that required the single mom to homeschool her children while also caring for her grandparents.

Richard said the state will step up its outreach with postcard mailers and increased advertising with the slogan “choose your path to care.”

Losing trusted providers

The process of choosing the right path may not be as straightforward for everyone.

Fallin McCoy of rural Carteret County will likely have to lose at least one of her specialists when she settles on a plan. The 39-year-old, who receives Social Security Disability payments because of a seizure disorder, sees a neurologist, gynecologist, cardiologist and a slew of other specialists regularly. All of her doctors have signed up for one or two plans, but as of this week, there isn’t one plan that includes all of them, she said.

Of the five available plans, she said, only United and Wellcare include some of her specialists, but she’d either have to lose her gynecologist or neurologist in the process.

For McCoy, who is having gynecological surgery later this year, either choice is a blow.

“I’m probably going to have to go with whatever my neurologist takes,” she said.

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The difficulties of finding a specialist who takes Medicaid already has McCoy traveling to New Bern or Wilmington to see most of her providers, a trip that usually takes an hour or two each way. With an even narrower provider network to choose from, McCoy worries she’d have to drive three hours or more to Raleigh to see a specialist.

Medicaid head Richard acknowledged that the move to managed care will likely cause frustrating changes for some consumers. He said, however, that each insurer is required to meet their patients’ needs, even if it means referring some patients to an out-of-network provider at the insurers’ expense.

Some of these issues, however, may resolve before the transition as individual providers and health systems continue to join the plans, a process that he said has slowed down because of the pandemic. In order to build their provider networks, the managed care companies need to contract with each hospital, practice group and physician office to get them into their network. The process is time-consuming and continuous.

“We’re not even halfway through open enrollment right now,” he added. “If [consumers] come back in a week or two to take a look and see [that specialist availability] has changed. … If there are people that are getting into a place where they’re unable to find a plan that meets their needs, I would like to know about it.”

This story has been updated to correct the end date of Medicaid’s open enrollment. 

We see a hand holding a cardboard sign that says, "#Free Them All" sticking out the passenger window of a compact white car passing the Durham County Detention Facility. The car is part of a caravan of protestors calling for the release of inmates who are unable to pay bail during the pandemic. It's Father's Day, 2020.

Even as NC’s COVID numbers stabilize, jail outbreaks spike

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Even as NC’s COVID numbers stabilize, jail outbreaks spike - North Carolina Health News

Cases have risen at nine local jails; at least one outbreak is connected to a transfer from the state prison system.

By Hannah Critchfield

Nine jails in North Carolina have reported new COVID-19 outbreaks since August 1.

The infections have occurred just as the state has begun to see a hint of stabilization in its overall COVID-19 cases.

The vast majority of these jails — in Avery, Carteret, Catawba, Gaston, Orange, Rutherford, Stokes and Wilkes counties — had no previous outbreaks, making this their first correctional outbreak since the pandemic began. Rutherford County Jail in particular has been particularly hard hit, with 21 inmates and five staff infected.

Durham County Detention Facility, where an outbreak in April killed one staffer, reported eight new cases among inmates on Sunday.

“Our worst fear has come true inside the facility and we are taking immediate and corrective steps to get in front of it,” Sheriff Clarence F. Birkhead said in a press release announcing the outbreak.

What caused the outbreaks?

It’s difficult to completely prevent outbreaks in congregate settings such as jails, as staff must enter and exit facilities each day.

However, one jail’s outbreak, Avery County Detention Center, resulted from the transfer of an inmate from a state prison under the Misdemeanant Confinement Program, a partnership in which county facilities hold low-level, convicted prisoners on behalf of the state. Like other types of transfers, the program has not ceased during the pandemic.

Because the Department of Public Safety, the agency that oversees the state prison system, is currently the subject of a lawsuit over COVID-19 conditions, people who are transferred must now either undergo quarantine upon arrival or receive a COVID-19 test prior to entry, according to Citlaly Mora, communications strategist at the the American Civil Liberties Union, one of the plaintiffs in the case.

This inmate was asymptomatic, according to Avery County Sheriff Kevin Frye.

A detention staffer at Orange County Detention Center, who contracted the virus from a significant other, similarly did not show symptoms in their initial days with COVID-19. Two more staff tested positive in late July (these cases did not appear on the Department of Health and Human Services website until August), and after mass testing was conducted, one incarcerated person had the virus.

Arrangements were made “immediately to remove him from the facility,” according to Alicia Stemper, director of public information at Orange County Sheriff’s Office.

“As a congregate living facility, we feel very fortunate to have only had one inmate with COVID 19 and we are pleased to report our staff members are recovering,” Stemper said in an emailed statement.

It’s possible this inmate already had the virus — he too had been transferred from another facility days earlier.

“That inmate had been in a different facility since April and arrived at the Orange County facility on July 20,” said Stemper, noting this was the same day the officer’s COVID-19 test result came back positive. “As is protocol, the new inmate was in isolation the first three days at our facility. He or she showed no symptoms and was transferred into a regular cell.”

When the local health department engaged in mass testing of all inmates on July 23, this person was the only one who tested positive, according to Stemper.

We see Andréa “Muffin” Hudson, director of the North Carolina Community Bail Fund of Durham, wearing sunglasses and a mask as she waits to bail out black fathers outside the Durham County Detention Facility. Her organization raised $100,000 for bail funds on Father's Day 2020.
Andréa “Muffin” Hudson, director of the North Carolina Community Bail Fund of Durham. Photo credit: Hannah Critchfield

Carteret County Jail, where two employees have the virus, also said a detention staffer likely infected other staffers. One inmate has since tested positive and is in isolation; they’re awaiting results from mass testing of all staff, according to Carteret County Sheriff Asa Buck.

The Durham County Detention Facility has engaged in contact tracing with the local health department, according to AnnMarie Breen, public information officer for the Durham County Sheriff’s Office. She declined to comment on any suspected origin of the outbreak at this time.

Other sheriff’s offices whose jails are experiencing new outbreaks have not yet responded to requests for comment.

‘If they had money, they’d be free’

Not everyone who is eligible for release has been let go within the 99 county jails across the state, as criminal justice reform groups have pointed out since the novel coronavirus virus hit the United States in full force in March. Some individuals remain incarcerated because they’re unable to pay bail fees — advocates claim these fines serve as a “poll tax” that denies the person’s right to a healthy, safe living environment amid the pandemic.

“It’s a lot of folks who are here only because they’re poor,” Andréa “Muffin” Hudson, director of the NC Community Bail Fund of Durham, previously told NC Health News in a June interview. “It’s not a public safety issue — because if they had money, they’d be free.”

Jails and prisons have been called incubators for COVID-19. As in other congregate settings such as nursing homes, these environments place large numbers of people in relatively small spaces where it can be difficult to socially distance.

In North Carolina, the burden of pretrial detention disproportionately falls on black and brown people and those living with disabilities, according to Luke Woollard, staff attorney at Disability Rights NC.

“Folks with disabilities of all types are overrepresented in North Carolina jails,” he said. “And people with specific disabilities are at heightened risk for serious complications or even death if they contract COVID. Medical services provided in jails varies county to county, and is often inadequate to meet the growing need, especially during a pandemic.”

On nearly every Friday since April, Decarcerate Mecklenburg, a local coalition of attorneys, advocates and community members, has led demonstrations outside the Mecklenburg County Detention Center to call for the release of people incarcerated inside. During an August 7 protest, the group accused the jail of “disregard for human life,” according to the News & Observer. The facility currently has 59 jailed people who are infected with the virus.

“There’s a difference between a COVID outbreak in a jail and a COVID outbreak in a prison,” said Kristie Puckett-Williams, a statewide campaign manager at the ACLU of North Carolina who helps organize the Friday protests. “It’s actually more dangerous in a jail because people are coming in and going out. If they go in without COVID and come out with it, now they’re back in the community with the disease. Not just inside a facility with it. It’s a public health issue, like we’ve been saying all along: Correctional health is public health.”

The coalition is asking for jails in the state to release all people who are awaiting trial for a misdemeanor crime, according to Puckett-Williams.

“Our research team, along with others across the country, is seeing a push to lessen the populations within jails,” said Felicia Arriaga, an anthropologist and professor at Appalachian State University who has studied North Carolina sheriff’s offices’ responses to COVID-19. “For organizers, I think it’s also an opportunity to push decarceration, and to maintain populations at a low level, because of the issues of social distancing within jails.“

To date, there have been no confirmed deaths of jailed people due to COVID-19-related causes in North Carolina.

 

UPDATE: This story has been updated with an additional quote from the ACLU of NC.

shows three politicians who are usually at odds on the same dias, they're there in order to sign bills to provide COVID relief

Coronavirus Today – May 4 – Pandemic politics, slow re-opening, prison COVID plan

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Coronavirus Today – May 4 – Pandemic politics, slow re-opening, prison COVID plan - North Carolina Health News

Gov. Roy Cooper joined with rival legislative leaders to get a coronavirus relief plan across the finish line.

By North Carolina Health News staff

Kumbaya pandemic politics

The COVID-19 pandemic has swept so much abnormality through this state that North Carolinians could be forgiven if they failed to do a few extra blinks of astonishment when Gov. Roy Cooper signed a $1.5 billion relief pandemic package into law midday.

The Republican House and Senate leaders, who only several months ago could not find enough common ground on policy with the executive branch to push through a $24 billion state budget, were there at the side of the Democratic governor as he signed two bills passed by the legislature over the weekend, making them law.

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Phil Berger, the Eden Republican leading the Senate, and Tim Moore, the Cleveland County Republican, at the head of the House, led their legislative chambers to unanimous votes on two bills that change policies and allocate federal funding sent to North Carolina for mounting pandemic-related costs.

“This is a time that North Carolina truly has come together to fight this disease,” Cooper said. “These two laws were passed unanimously. Every Democrat and every Republican supported them. I appreciate these leaders reaching consensus with each other and our office to move quickly so that we can test and trace this disease while we also get relief to people and businesses that need it.”

The package includes:

  • $125 million for small business loans to be administered through the Golden LEAF Foundation;
  • $95 million for hospitals, many of which have taken financial hits by stopping elective surgeries that help fill their coffers;
  • $85 million for vaccine development, antibody testing, community testing and related research at Campbell University, Duke University, East Carolina University, UNC-Chapel Hill and Wake Forest University;
  • $75 million for school nutrition programs;
  • $70 million for summer learning programs;
  • $50 million in health support for underserved rural and African American communities hit hard during the pandemic;
  • $50 million for personal protective equipment and sanitation supplies;
  • $30 million for local schools to purchase computers and other technical devices necessary for the online learning in place since the halt of in-person classes;
  • $20 million for the county health departments and State Laboratory of Public Health;
  • $9 million for broadband in rural areas with spotty WiFi; and
  • $6 million for food banks.

“North Carolinians have come together, and what you have seen is the leadership in the General Assembly and all members of the General Assembly together with the governor and various executive branch agencies come together as well,” said Berger, whose Senate initially pushed for a $1.2 billion plan. “I believe this bill gets us on the right path and I am looking forward to continue to work, governor, with you, and with my colleagues in the General Assembly.”

In legislative sessions of recent years, it has been the House that typically moves closer to Senate plans during compromise sessions. The four-day session last week that closed on Saturday ended the opposite way with the Senate moving closer to the House’s initial $1.6 billion spending plan.

A House plan would have expanded Medicaid eligibility temporarily to some low-income North Carolinians eligible unable to get the benefits in this state because of a long-standing political battle over the expansion program. The Senate did not agree to that temporary relief, with some lawmakers contending that other federal aid would cover COVID-related treatment.

During the legislative compromise session last week, the House did not agree to a provision proposed by the Senate to increase the weekly state unemployment benefit to $400, a $50 increase over the current rate, once federal aid is exhausted. The number of claims filed for unemployment benefits topped one million over the weekend.

The legislative leaders, including Sen. Dan Blue and Rep. Darren Jackson, both Wake County Democrats, and Cooper all agreed that more pandemic-related funding would be needed in the months ahead. They lauded the Senate and House bills.

“It’s been very refreshing to see everybody put aside differences they had or thought they had and be able to work together for the common good and be able to make sure this legislation went forward,” Moore said. — Anne Blythe

More relief, more parks and shopping options ahead

Gov. Roy Cooper said he would reveal more detailed plans on Tuesday or Wednesday of what businesses could be reopened during the first phase of easing social distance restrictions.

Cooper’s stay-at-home order is set to expire on Friday. If the data show what his public health team wants to see that could mean a reopening of closed parks and more shopping options.

“We’re still analyzing our indicators, our testing, tracing and trends, talking with health care experts,” Cooper said. “We’re getting a lot of advice from businesses about what we can do.”

Easing social distancing restrictions is not the only thing that will happen in phases.

Cooper and legislators acknowledged that more relief packages will come in phases, too.

“I’m already thinking about what’s going to be in the next bill that will be coming down the pike,” said Darren Jackson, a Wake County Democrat and the House minority leader. 

“Science tells us there will be peaks and there will be lows, but this virus is not going away. And no matter how things change, there are some issues we need to continue to constantly have on the forefront and address going forward — the need to expand health care access and close the insurance gap, the need to protect our frontline health care workers and other workers and make sure they have the protection that when they get sick, they can stay home, that safety net. We need to protect the unemployed who lost their jobs that may find that job not coming back in the near future,” he said. “Today we take a good step, but I hope it is just that — the first step.”

Without using the words ‘Medicaid expansion,’ a phrase that caused the budget standstill during the last session, Cooper, too, said he would be advocating for more to help the state’s uninsured.

Sen. Dan Blue, a Wake County Democrat, gave a brief history lesson and focused on the 1918 flu pandemic that continued to cause deaths in North Carolina in 1919 and 1920 to caution that there also might be some unforeseen COVID-19-related costs.

“The pandemic is unlike anything we’ve seen before,” Blue said. “A little more than a century ago, we had the same experience and we practiced social distancing. But as is sometimes the case, we got a little restless and the second and third phases were more deadly than the first phase.”

“I think we will learn the lessons and get through this pandemic all working together,” he continued. — Anne Blythe

Predicting revenue shortfall

Tim Moore, the Cleveland County Republican presiding as speaker of the House, noted that because so many businesses have closed down and unexpected pandemic costs have caused the state lawmakers to dip deeper into reserves, there could be some belt-tightening requested across state agencies.

“We were getting projections that our state budget, we could have a deficit of $3.5 to $4 billion dollars as a result of this,” Moore said. “So we know that while we’ve taken care of these critical needs right now, there certainly are more critical needs to take care of, but then going into next year’s budget when schools open back up, when things are running back, and we have to pay for all those things. So we need to make sure we are prudent how we spend this money so we have funds there should the shortfall continue on into the fall and into the spring.”

A $4 billion shortfall, Moore pointed out, would be 16 percent of a $24 billion budget.

“We all understand that we’re going to have to look at some potential fiscal cuts to get where we need to be with our constitutional mandate of a balanced budget,” Gov. Roy Cooper said. “But also important is the bipartisan request made by the National Governors Association of Congress and the president for $500 billion to help states across the country — and local governments across the country — avoid bankruptcy and making sure that people can backfill their budgets.

white man in a suit stands at a podium, another white man in a suit stands behind him. They're talking about providing financial relief for the state from COVID issues
House Speaker Tim Moore speaks as Gov. Roy Cooper looks on during a briefing on North Carolina’s COVID-19 pandemic response Monday, May 4, 2020 at the NC Emergency Operations Center in Raleigh. Photo credit: NC Dept. of Public Safety

 

“There’s a strong movement for that to happen,” Cooper added. “I hope we can get help from the federal government for this because we do have a constitutional requirement for a balanced budget. We’re all going to have to figure out how to get there.” — Anne Blythe

Don’t forget to disinfect those pens

Gov. Roy Cooper told lawmakers who came together that he had pens for each of them after he signed Senate Bill 704 and House Bill 1043 into law.

“Okay, we have two new laws that will help the people of North Carolina, that this leadership has come together with consensus to move our state forward and we’re grateful for that,” Cooper said. “I’ve got a pen for each of them after we wipe it down with disinfectant.” 

In medical studies, pens and other common instruments have been found to contribute to the spread of hospital-acquired infections. 

— Anne Blythe

Indoor vs. outdoor activities

Secretary of Health and Human Services Secretary Mandy Cohen addressed a question about whether there will be recommendations from public health leaders in the coming phase about relative risks for certain activities.

Physical distancing will continue to be important and wearing face coverings when that is not possible or when you are with other people will be, too. Hand-washing will remain important throughout.

“As far as activities, in terms of risk and not, we certainly know that indoor activities are higher risk than outdoor activities,” Cohen said. “And activities where you sit — stand or sit — for a prolonged period of time, but generally sitting for more than 10 minutes, that’s the things that are going to increase our risks.”

The Centers for Disease Control and Prevention, Cohen noted, has defined risk as anyone within six feet of someone for a period of more than 10 minutes.

In the first phase of loosening social distancing restrictions, Cohen said North Carolinians will see more commerce open and more park activity allowed.

“We’re looking to minimize that in-close-proximity, less than six feet for more than 10 minutes of time,” Cohen said. “And then when you do that if you have to be in closer contact, again, wearing face coverings, and to be washing your hands very frequently.” — Anne Blythe

Coronavirus by the numbers

According to NCDHHS data, as of Monday morning:

  • 430 people total in North Carolina have died of coronavirus.
  • 11,848 have been diagnosed with the disease. Of those, 498 are in the hospital. The hospitalization figure is a snapshot of people with COVID-19 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.
  • More than 146,000 tests have been completed thus far, though not all labs report their negative results to the state, so the actual number of completed coronavirus tests is likely higher.
  • Most of the cases (41 percent) were in people ages 25-49. While 23 percent of the positive diagnoses were in people ages 65 and older, seniors make up 87 percent of coronavirus deaths in the state.
  • 99 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities.
  • There are 3,217 ventilators in hospitals across the state and 704 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital.

Judge orders NC prison officials to present COVID-19 plan 

A North Carolina Superior Court Judge ordered prison officials to present specific plans for how they are containing COVID-19 in prisons and preventing the spread of the contagious virus between inmates. Prison officials must submit their plans by 5 p.m. on Friday. 

This order came in response to a lawsuit by prison legal advocates asking for relief for inmates with underlying health conditions that make them more susceptible to COVID-19 complications. The legal advocates contend there are too many inmates to properly socially distance within prisons, creating a prime breeding ground for the virus. 

The judge also asked prison officials for a list of the facilities that are providing the following: 

  • More than one facemask per inmate of the same quality of those provided to staff
  • Unrestricted access to sanitation supplies, including soap and alcohol-based sanitizer 
  • Living conditions designed to prevent the spread of COVID-19, including moving bunk beds at least six feet apart and altering schedules to limit the mixing of inmates between housing units.

These are problematic areas in facilities across the state, according to inmates from several facilities who testified in sworn statements about the conditions in prisons during the pandemic. They wrote that their beds are not six feet apart. They’re given a limited amount of soap, which some say they use to wash their one cloth facemask. Many said they are not allowed to have hand sanitizer because it’s considered contraband. And inmates wrote that there is mixing between facilities and dorms with little attempt to separate prisoners with symptoms. —Taylor Knopf

Carteret Health resumes elective surgeries

Carteret Health Care has joined the list of hospitals across the state that have resumed elective surgeries in the midst of the COVID-19 pandemic. Effective today, the county-owned hospital will take steps to resume elective procedures and inpatient care, according to a press release. 

The decision to resume elective surgeries and some inpatient care came after the hospital prepared for a large surge of COVID-19 cases, said president Harvey Case in a press release. But newer models predict that need is far lower, he added.

Hospital staff will resume care in stages, according to the press release. Patients whose surgeries were delayed will receive calls from the hospital to reschedule beginning today. Inpatient care will also ramp up slowly with some safety measures in place. All patients and staff will be required to wear face masks and everyone will be screened for symptoms of COVID-19 before they enter the Carteret County facility. The hospital will also continue to implement visitor restrictions. 

shows a hospital building with big fluffy clouds behind

Hospital officials will continue to monitor the needs of the community, according to the news release, and will make sure resources are available for COVID-19 response.

“We clearly understand we cannot let our guard down, however, we believe we are ready to safely begin moving forward with caring for patients with needs that have been delayed,” Case said in the news release. – Liora Engel-Smith

UNC delays start of fall semester

 Mecklenburg County health authorities say the coronavirus outbreak is projected to peak in mid-June in Charlotte. As a result, UNC Charlotte has moved the beginning of the fall semester back two weeks from August 24 to September 7. 

“Given our unique location in North Carolina’s largest city, these two weeks allow additional time between the projected peak of the virus in Charlotte and Mecklenburg County and the start of the academic year,” said Chancellor Phil Dubois in a statement. 

The university will assess any additional campus safety protocols and release a complete schedule for the semester soon. — Melba Newsome

Mental Health Moment – See some spring flowers!

The New York Botanical Garden is currently closed, but you can take a virtual tour of the profusion of spring blossoms there. Just feel your blood pressure drop as you watch.

 

A COVID-19 (coronavirus) testing site at the motor speedway in Charlotte

Coronavirus Today – March 25 – NC reports first deaths, stay home orders

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Coronavirus Today – March 25 – NC reports first deaths, stay home orders - North Carolina Health News

As North Carolina reports its first coronavirus deaths, communities have set their own shelter in place orders. Meanwhile, state officials hinted that stricter social isolation measures may be on the horizon.

North Carolina Health News staff

Note: North Carolina Health News has chosen to report the official daily DHHS tallies of positive tests hospitalizations and deaths. We are using our limited resources to bring you in-depth stories about the impact of COVID-19 rather than spending our days chasing numbers that individual municipalities release.

North Carolina reported its first COVID-19 deaths on Wednesday and Gov. Roy Cooper said “it was with a heavy heart” that he must tell the state that he expected to see more as the battle against the highly contagious virus continues.

A Cabarrus County man in his late 70s with several underlying medical conditions died on Tuesday, according to the state Department of Health and Human Services.

Got a question about COVID-19? You can ask us and we’ll try to find an answer! Click here.

Additionally, a man in his 60s from Virginia who was traveling through North Carolina also died, according to state officials.

North Carolina now has 504 cases of the virus spread across 53 counties, according to state officials. Labs have completed 12,000 tests and have almost 15,000 additional collected samples in the queue for testing, Cooper added at a news conference on Wednesday afternoon.

“It is a day of mourning for North Carolina,” Cooper said, extending his condolences to the families who lost their loved ones.

Cooper said others afflicted with COVID-19 are hospitalized and seriously ill, some in critical care units.

“They are fighting for their lives and it’s awful for their families who know their loved ones are suffering, but because of this cruel and contagious sickness, they cannot even be with them,” Cooper said, referring to newly enacted hospital policies limiting or restricting visitors to keep them from becoming infected.

“Today is a stark reminder that we must take this disease seriously,” Cooper added. “All of us. Young and old. Employers and employees. This virus can be deadly and that’s why our daily lives have had to change so dramatically. I know it’s hard, but it’s necessary.”

Hints of more statewide limits coming

Cooper reeled off actions he has taken in recent weeks to try to slow the spread of the virus. He has closed schools and businesses. He has restricted how many people can gather, which pushed many churches, synagogues, mosques and other places of worship to online services. He limited visits to nursing homes and long-term care facilities.

“We know that further action to protect our state will be necessary. We’re in the process of working on additional statewide guidance that we will be announcing soon,” Cooper said.

“It’s imperative that we keep North Carolinians safe while at the same time doing everything that we can to limit the economic impact of this virus on businesses, workers and their families. These are difficult, deliberate decisions and it is important that we get them right.”

Cities, counties and towns with stay-at-home orders

As calls for a statewide order for all North Carolinians to shelter in place increase, many larger counties and cities are proceeding on their own with orders to restrict their residents.

Durham Mayor Steve Schewel issued a stay-at-home order for the city’s residents that will go into effect at 6 p.m. Thursday.

graphic including an image of coronavirus

At the time of his announcement, Durham County had 74 cases of COVID-19, only eight of which were community spread.

Schewel said he has been in talks with other county, city and town leaders across the state who have worked together to develop orders that can serve as a patchwork of barricades to further spread while the governor mulls the possibility of a statewide measure.

Durham follows Mecklenburg County, which issued an order of its own earlier this week.

Across the state, communities have taken different tacks, ranging from issuing stay at home recommendations, as is the case with Madison County, to full-out orders like the one enacted in Mecklenburg County.

“We want people to stay home and local communities are doing what they think is right and I understand that,” Cooper said.

With each municipality taking its own action, limits on gathering differ from county to county and even within cities of the same county.

Pitt County’s order, for example, covers only the unincorporated areas of the county, leaving incorporated areas, such as the city of Greenville, to pass their own proclamations. Pitt County’s order went into effect at 5 p.m. today and will last until April 8, 2020. The county’s order prohibits gatherings of more than 10 people and limits travel, except for providing or accessing essential services. Ayden, an incorporated town of roughly 5,000 in Pitt County, has also approved its own shelter-in-place proclamation today. The proclamation will go into effect at 5 p.m. Thursday. Meanwhile, the city of Greenville is mulling its own stay-at-home order.

Beaufort, a town of roughly 4,200 in Carteret County, has issued a stay at home proclamation that went into effect this morning and will remain in place until April 22. But a county spokesman said on Wednesday that Carteret isn’t currently planning a shelter-in-place order of its own.

Other large municipalities, including Wake County, are weighing their own orders.  Orange County said in a news release today that they too are working on a stay home order, with details being announced later.

Meanwhile, Buncombe County, another densely populated area in Western North Carolina, has issued a stay at home declaration that also goes into effect Thursday.

Calling all Durham poets and musicians

Durham’s mayor acknowledged the toll that social distancing, whether mandatory or recommended, was having on the city he leads.

Schewel, in his late 60s, pointed to his own gray hair and acknowledged that he was in a high-risk category for COVID-19. He encouraged others in his age group and above not to view themselves as victims as they were being encouraged to stay home. Instead, he suggested that they reach out to their grandchildren or younger people who might be struggling financially because of the shutdowns and help them if they were in a position to do so.

His message for the city’s younger residents was to reach out to older people if they were making a trip to the grocery store and ask if they could shop for them.

Schewel had a request for the city’s many artists and musicians.

He said he was waiting for a group of poets to start something up on Zoom or some other online site, maybe having readings every night at 7 p.m.

Then musicians could follow, he suggested, with virtual performances at 8 p.m.

“We need our artists,” Schewel said. “They can help feed our souls like no one else can.”

How much longer?

As North Carolinians stay at home, either by order, guidance or choice, questions linger without hard and fast answers.

Mandy Cohen, secretary of the state Department of Health and Human Services, said she and other public health officials are working with data scientists to try to gauge when North Carolina might see peaks of cases in health care facilities.

“As I keep saying, things are changing so rapidly,” Cohen responded at a news conference on Wednesday. “We’re trying to learn lessons from around the world and around this country to understand what trajectory North Carolina is in so that we know how to prepare for the exact kind of resources that we need and where we need them.”

With its first case reported on March 3, Cohen said, the state is not following some trajectories that have taken place elsewhere.

“North Carolina was later in the course of seeing our first case, later in the course of seeing our hundredth case, and a trajectory that is lower than we’re seeing in other states,” Cohen said. “We want to be modeling this out so that we can be best prepared, but these are data models with a lot of assumptions that are challenging to make with the limited information that we have.”

Cohen said the answers her team comes up with will help them know how to move resources around the state.

Charlotte Motor Speedway drive-thru testing

Atrium Health opened a drive-thru COVID-19 testing site at the zMax Dragway in the Charlotte Motor Speedway complex, the hospital chain announced in a news release this week.

Atrium has already opened several other drive-thru testing sites across the region and is processing the results at the organization’s in-house lab. The health system said it can process approximately 1,000 samples per day, with test results being available in approximately 24 hours, the press release said.

Patients need a doctor’s approval to be tested and can learn more at Atrium’s coronavirus page or at 704-468-8888.

COVID-19 sickens state official

N.C. Treasurer Dale Folwell announced Thursday that he is among the North Carolinians to come down with COVID-19. Folwell, a Republican elected to the statewide office, is the first N.C. Council of State member known to be affected by the pathogen.

In a press release, Folwell said he was tested Monday by his doctor after a cough became worrisome. He received a positive diagnosis the following day. He’s currently in quarantine. He announced that only those workers necessary for continued business would remain working at the N.C. Department of State Treasurer building in Raleigh.

Need Child care?

The state launched a hotline this week for people in need of child care because of school and day care closures.  The hotline – 1-888-600-1685 – is for health care workers and others with children up to age 12 who are unable to work from home.

Staff from the state Department of Health and Human Services will match families with open child care facilities and will take calls from 8 a.m. to 5 p.m., Monday through Friday.

Priorities will be to health care workers and other critical workers such as first responders, food service staff and assisted living home staff. Children involved in the child welfare system or who are homeless or facing housing insecurity will also have priority.

The child care won’t be subsidized by the state at this point, and families will need to pay their share or use existing child care subsidies, according to DHHS.

Health care providers ask the governor for tougher measures

In a letter to Gov. Roy Cooper sent today, physicians and physician assistants asked him to consider more stringent social distancing measures to arrest the spread of COVID-19 throughout the state.

“COVID-19 is a public health crisis,” reads the letter written by leaders of the North Carolina Medical Society. “Health care systems, physicians and their teams are at the front lines caring for our exposed and infected citizens. Already, many are working around the clock to limit community spread, infection and deaths of North Carolinians.”

The letter expresses concern about the lack of personal protective equipment, the masks, gloves and eye shields used to keep frontline health care workers from being infected with COVID-19.

The group also expressed concern about shortages of beds and ventilators, especially as the number of patients requiring hospitalization is projected to grow.

“Now is the time to take decisive action to limit the spread and preserve our precious resources to fight this pandemic,” they wrote. “If action is delayed, we fear we will not be able to handle the surge in the health care needs.”

we see the top of a woman's face. She has on a mask agains the novel coronavirus

Coronavirus Today – Friday, March 20 – Call for medical professionals, testing ramps up, closures and postponements

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Coronavirus Today – Friday, March 20 – Call for medical professionals, testing ramps up, closures and postponements - North Carolina Health News

North Carolina completes the first full week of working from home and kids being home from school, all while the number of coronavirus cases starts to climb.

North Carolina now has 137 confirmed cases in the novel coronavirus in 38 counties, according to the Thursday morning update by the N.C. Department of Health and Human Services. Those include two cases of community spread, meaning cases where a person came down with COVID-19 with no known contact with an infected individual. Four people are hospitalized with the disease caused by the coronavirus, said Elizabeth Tilson, N.C. DHHS’ state health director and chief medical officer. She expects those numbers to rise and said the importance of testing will go down as North Carolina sees more cases and begins to switch to caring for the estimated 10 percent of people who contract the coronavirus and end up with severe complications.

Some members of the N.C. National Guard were also called up to help with warehousing and transportation, said Mike Sprayberry, the N.C. Emergency Management director.

And, again, Sprayberry urged people to stop clearing off grocery shelves.

“Please resist the urge to buy in excess,” Sprayberry said. “Grocery stores will remain open and there is not a food shortage.”

State officials also outlined some resources for members of the public looking for more information: 

  • Those in need of food can call 2-1-1 for help.
  • Get regular updates on COVID-19 from the state emergency officials: Text “COVIDNC” to 898211.
  • Want to volunteer? Go to the “Disaster relief” section on volunteernc.org.

NC needs you, health care workers

To prepare for the coming impact of COVID-19, North Carolina needs more people with medical backgrounds to help handle the expected influx of severely ill individuals, state officials said Friday.

N.C. DHHS Sec. Mandy Cohen sent out a letter asking for volunteers to deploy to affected areas to help with patient care. Cohen asked for volunteers with clinical backgrounds (physicians, advanced care providers, nurses, EMS); clinical supports (pharmacy, imaging and respiratory care); and non-clinical support (administration and facility management). Volunteers can register through the NC Training, Exercise, and Response Management System (NC TERMS), available here.

NC manufacturers to make protective equipment for health workers? 

One of the major challenges facing North Carolina, and the United States as a whole, is finding enough personal protection equipment, called PPE, to protect front-line workers from the novel coronavirus. Supplies across the nation are down, after runs on N-95 respirator face masks and more depleted supplies. North Carolina is trying to buy more, Sprayberry said, even talking to neighboring states about splitting up any large orders they might be able to jump on.

Meanwhile, state leaders are talking with manufacturers and others in the state about retrofitting existing factories to begin making in-state supplies of products such as N-95 masks and more.

“We are in those discussions right now,” Sprayberry said.

New Hanover Regional pauses its advisory group

As New Hanover County contends with its first COVID-19 case, the county hospital announced Friday it will temporarily stop its meetings surrounding the hospital’s future. New Hanover Regional Medical Center created an advisory group to study options for its future, which could include a sale or an affiliation to a larger hospital system.

“Our intent is to resume the public review process as soon as we are able,” Spence Broadhurst, Partnership Advisory Group co-chair, said in the press release.

The county plans to hold meetings at a future date before a decision on the future of the hospital has been made.

graphic including an image of coronavirus

UNC drive-thru testing sites 

The FDA is now allowing UNC Clinical and Molecular Biology to use its COVID-19 testing capability on UNC Health patients, a UNC spokesman said Friday. UNC is now seeking approval from the FDA to extend use of the test, which is based on a World Health Organization method. The health system has set up drive-thru testing sites across the system’s 13 campuses and at various satellite clinics this week, but patients need a doctor’s note to get tested.

More information about testing locations is available at UNC’s COVID-19 helpline, 888-850-2684.

LabCorp says it’s ramping up testing 

In a press release, Burlington-based LabCorp announced that starting today, it will be able to perform more than 20,000 COVID-19 tests per day.

A company spokeswoman said this “represents a significant increase in capacity since the company released its COVID-19 test two weeks ago,” and expects testing capacity to increase in the coming weeks.

The company is intently focused on making coronavirus laboratory testing available to patients who are symptomatic and should be tested.

Hands wearing rubber gloves spread bacteria on an agar gel plates.
A bacteriology researcher at the Institute of Medical Research swabs an isolated sample of streptococcus pneumonia. Image courtesy: U.S. Air Force/ Staff Sgt. Marcus Morris

In the release, a company vice-president said LabCorp has added staff, equipment and is able to do more high-throughput testing as a result of approved emergency use authorization (EUA).

COVID-19 testing is being done at labs in Phoenix, Ariz., Burlington, N.C., and Raritan, N.J.

Patients still need to see a health care provider, such as a doctor, advanced practice nurse or physician assistant, for them to collect the sample (usually with a swab into the nose or the back of the throat), patients should not be sent to a LabCorp location to have a specimen collected, the company requested.

It will take three to four days from the pickup of the specimen to release of the test result.

Nursing licensure exams postponed

Now there’s another glitch for nursing students graduating this spring besides the cancellation of ceremonies, the National Council of State Boards of Nursing has postponed all nursing licensure exams scheduled from this week until at least April 16.

Prospective nurses usually congregate at a testing site where several dozen at a time sit at computer consoles to complete the exam, known as the N-CLEX.

For exams scheduled to be administered between March 17 and April 16, the testing administrator Pearson VUE is unscheduling appointments and extending students’  Authorization to Test for six months.

Better hold off on that beach trip

Now that spring is here and many schools are on break, a day trip to one of North Carolina’s many beckoning beaches might have allure.

But hold off on throwing a beach towel in a bag and heading straight to the coast.

Some beaches are being closed to visitors and residents as the coronavirus pandemic lingers as the unwelcome traveler it has become.

As news feeds showed Florida beaches packed with spring break revelers violating recommended social distancing rules almost every way they could, North Carolina beach towns put limits in place to prevent similar occurrences here.

The Town of Wrightsville Beach declared a state of emergency on Friday and closed the oceanfront beach strand and sound-side beaches to residents and visitors until March 31. Restroom facilities will be closed, too.

Surf City also closed all public beach access on Friday for the unforeseeable future.

The Carolina Beach Town Council also approved a state of emergency and closed beach accesses, town parking lots and Freeman Park.

Bald Head Island declared a state of emergency on Thursday, which limits who can get onto the island, but not who can leave it.

Emerald Isle and Carteret County also have closed off many public beach accesses and parking lots.

UNC graduation ceremonies postponed

Many of the University of North Carolina’s 17 system schools have decided to cancel May graduation ceremonies and solicit advice from their degree-earners for how to celebrate the milestone.

UNC System President Bill Roper left the decision on how to proceed with alternate commencement ceremonies to individual campuses.

Crowd-size limits and social distancing guidelines in place now discourage any gatherings with more than 50 people and even frown on smaller ones. As COVID-19 begins to spread through unknown community contacts, Gov. Roy Cooper and public health officials caution that things are likely to get worse before they get better.

So campuses are holding off on bringing students and their families to North Carolina to celebrate graduations.

“In accordance with the latest public health guidelines regarding travel and interpersonal contact, the University is postponing the doctoral hooding ceremony on May 9 and Commencement in Kenan Stadium on May 10,” the UNC-Chapel Hill commencement web page states. “Carolina will send a survey to all members of the Class of 2020 to ask their opinions about alternative dates and other options.”

Philip Dubois, the UNC-Charlotte chancellor, sent out a message to Niner Nation on Friday, too.

“Around the world and here in Niner Nation, the unprecedented disruption and increasing impact of this pandemic are unfolding at a precious time for our University —  graduation, final examinations, and major events,” Dubois said in the statement. “At the same time, we know that our priority remains preserving and protecting the health and safety of our Niner family and continuing to support the ongoing education of our students.”

Check with the administration university at each of the other 15 UNC-system schools, to see what they have in the works.

 Gyms, hair and nail salons, theaters shuttered in Charlotte 

Mecklenburg County’s public health director ordered gyms, health clubs and theaters to close as the number of coronavirus cases inches up. “The main focus here is to protect our community and to continue to reduce the amount of people who are exposed to this virus,” health director Gibbie Harris told county commissioners Tuesday night.

The owner of three major Charlotte-area shopping centers, SouthPark mall, Concord Mills and Charlotte Premium Outlets, said they would voluntarily close through March 29.

Ohio and Minnesota announced closures of hair salons, nail salons and barbershops in executive orders. They follow states such as Washington, Kentucky and Nevada already putting a stop to businesses considered to be nonessential. In Mecklenburg County, hair salons are still allowed to operate as long as there are not more than 50 people there at the same time.

Coronavirus affecting cancer treatment at Atrium

Atrium Health is further tightening restrictions on visitors at Carolinas Medical Center, Levine Children’s Hospital and its 17 other Charlotte-area hospitals and care centers to prevent the spread of the novel coronavirus. Starting Thursday, only essential patient visitors will be allowed, including visitors to patients in intensive care or who are at the end of life.

The Levine Cancer Center is moving many consultations and visits to telemedicine, a step to protect vulnerable patients with compromised immune systems.

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