child safety

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Coronavirus Today – Monday, March 16

March 16, 2020 by Editor

Coronavirus Today – Monday, March 16 - North Carolina Health News

This last weekend saw changes in North Carolina’s public life, but for many, changes in the state became real when their kids remained home from school.

By NC Health News Staff

North Carolina has been in a state of emergency for nearly a week in response to the novel coronavirus, and with the declaration came novel lifestyle changes for many across the state.

The new normal for everyday life is very abnormal, instilling child care headaches for many families, ramped up anxiety and public panic about who should get tested for the novel contagious pathogen, and uncertainty about what constitutes a crowd.

Last week, North Carolinians were urged, then ordered not to gather in crowds with more than 100 people. On Monday, the Centers for Disease Control and Prevention issued new guidelines reducing that number to 50 people. North Carolina followed suit issuing similar guidelines. Later in the afternoon, President Donald Trump suggested the limit should be 10 or 15 people, but it was not clear whether those were official guidelines.

As of midday Monday, North Carolina had 33 COVID-19 cases confirmed in 14 counties, according to Elizabeth Cuervo Tilson, the state health director. One person was hospitalized.

North Carolina had conducted 329 tests in the state lab with supplies to test 1,300 people. Private labs and universities have been testing, too, and not all their results are reported to the state.

Tilson said Monday that she knew of no positive results at this time that had come from the virus spreading through community contact, but added that she would not be surprised to learn of any.

Child care for health care workers

School Superintendent Mark Johnson said on Monday afternoon that his team is prioritizing work on opening up child care centers in schools for the children of health care workers who are needed at the front lines of coronavirus treatment.

He said it will take time as it’s “not just something you can do quickly.”

More testing capacity at UNC

The UNC Medical Center and UNC School of Medicine have received clearance to use a diagnostic test developed there based on a World Health Organization assay.

Initially, the test will be available only for inpatients at UNC Health main and affiliate hospitals across North Carolina as well as a select number of UNC Health clinic locations.

The additional test, UNC Health officials say, will help increase the capacity for testing at the state lab and LabCorp, a Burlington-based company, that has stepped up to help fill a void in testing ability across the country.

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

“Quickly creating and validating tests for emerging pathogens has always been part of my passion and commitment, ever since I was a fellow here during SARS,” Melissa Miller, PhD, director of the Clinical Microbiology and Molecular Microbiology Labs at the UNC Medical Center, said in a statement. “We have developed a high-quality test, we have the infrastructure to roll it out, and are ready to help the people of our state.”

Help coming for small businesses?

Children are home from school across the state, and no one can say for certain how long that will last. Universities and college campuses have moved to online classes. Many parents are working from home while workers in the service, retail and gig economies are finding their schedules upended and income disrupted.

Gov. Roy Cooper’s call to work from home and stay away from crowds has put a crimp on small businesses across the state. With that in mind, Cooper announced Monday that he has asked the U.S. Small Business Administration for a disaster declaration so federal financial assistance is available to those affected.

“This state is currently sustaining severe economic impacts from this pandemic,” Cooper stated in a March 13 letter to Kem R. Fleming, director of the U.S. SBA Office of Disaster Relief in the Field Operations Center East. “Many of our schools and universities have limited operations and major events have been canceled. These economic injuries and losses to businesses have just begun and will continue through this crisis.”

Based on what is already known about the losses, Cooper added, the businesses will “need financial assistance not otherwise available, on reasonable terms.”

shows a smiling little girl at a table with flowers, a little boy is in the background, just out of focus. they're both at a summer school lunches program — Children on Fr. Bragg partake in summertime meals, 2017. Photo courtesy: NC Department of Instruction.

Feeding kids without schools in session

The state’s 115 public school systems worked to get plans in place of how to remotely teach children and then also feed them given Gov. Roy Cooper’s decision this weekend to close public schools for at least the next two weeks.

Nearly 60 percent of North Carolina’s students live in low-income households qualifying them for free or reduced lunches. In Dare County, on the Outer Banks, the school system received a waiver from federal authorities to serve breakfast and lunch to all children, from babies to 18-year-olds, according to the Outer Banks Voice. The meals will be available at elementary schools in Manteo, Kill Devil Hill and Buxton. In Chapel Hill, meals for children will be delivered by school bus to several locations throughout the area. Guilford County is also tapping its yellow buses to deliver meals to the 2,000 children in the district who are homeless or living in temporary housing such as motels.

Ronald McDonald House in need of help

It’s not just schoolchildren in need of help getting food. The Ronald McDonald House of Chapel Hill typically serves a home-cooked meal every night for those staying at the 53-room facility while their children receive care at the nearby N.C. Children’s Hospital.

The nonprofit typically depends on groups of volunteers to provide those meals, including many UNC student groups. The global organization that runs Ronald McDonald Homes decided to stop volunteer visits at its locations during the coronavirus pandemic in order to keep families and their hospitalized children safe from the virus, according to Heather Shanahan, the executive director of the Chapel Hill Ronald McDonald House. The group is asking for financial contributions to cover the cost of meals as well as cleaning supplies such as Lysol spray, disinfectant wipes and paper towels. Anyone interested in donating can do so here.

Duke graduate students test positive

Three graduate students attending Durham’s Duke University contracted COVID-19 on an overseas university trip to an unnamed country, according to a message sent to Duke staff from Duke’s Vice President for Administration and Emergency Coordinator Kyle Cavanaugh.

The three had been traveling overseas as part of a group and are now receiving treatment outside the U.S. They’ll remain overseas until they have recovered. Other students from that group are back in Durham and will self-isolate off-campus for at least 14 days while staying in touch with Durham’s public health department, according to the message.

Banks ask customers to socially distance themselves

North Carolina banks are now making changes to adjust to social distancing guidance to avoid coronavirus infections for both customers and workers. In a press release Monday morning, the NC Bankers Association released information about changes people may see at local branches:

Banks would prefer customers use drive-through services, ATMs, internet and mobile banking rather than walking in. (Either clean keypads before using or your hands immediately after using!)
If you need to come into a bank, make an appointment.
Banks are stepping up their cleaning regimens.
Wherever possible, people should use debit and credit cards, which can be cleaned off, rather than coins or cash. (And take the time to clean your cards!)

Finally, the NCBA noted: “Customers facing financial hardships as a result of COVID-19 should contact their bank to discuss their situation.”

Charlotte now affected

For more than a week after the state’s first case was confirmed in Wake County, Charlotte seemed to be out of the line of fire. But health officials who predicted it was only a matter of time were soon proven right when on Thursday, two people in the Charlotte-area tested positive for COVID-19 — one in Mecklenburg and another in Cabarrus county.

On Sunday, Mecklenburg County declared a state of emergency after two more residents tested “presumptively positive for COVID-19,” bringing the number of county residents infected to four.

Prison visitation suspended for 30 days

The N.C. Department of Public Safety has suspended all inmate visitation for 30 days, starting Monday, March 16. However, state officials said there are no confirmed COVID-19 cases in the correctional system at this time.

The 30-day suspension includes all volunteer activities inside and outside the facility, but legal and pastoral visits are exempt for right now.

Inmates will not be charged a copay for medical visits due to fever or respiratory issues, according to a DPS memo issued on Monday. Inmates will also be allowed two free five-minute phone calls each week while the visitation suspension is in place.

DPS’ Corrections Enterprises is making hand sanitizer for the prison facilities and placing educational posters about personal hygiene and sanitation during coronavirus in inmate housing.

More restaurant closings

A line of cars wrapped around a Chick-Fil-A restaurant on Ramsey Street in Fayetteville on Monday. The day before, the national restaurant chain announced that it was closing inside dining at all of its restaurants.

Cars line up at a Chick-Fil-A drive-thru in Fayetteville. The restaurant is among the first to close inside dining as a precaution because of the coronavirus — Cars wrap around a Chick-Fil-A on Ramsey Street in Fayetteville. The restaurant is among the first to close inside dining in Fayetteville as a precaution against the coronavirus.

“As we navigate the evolving impact of coronavirus on our communities, we are temporarily closing our dining room seating to help limit person-to-person contact,” the company said in a news release.

Starbucks, another popular national chain, also announced that its stores in high-risk areas will temporarily close or provide only to-go orders. McDonald’s is also restricting its business.

North Carolina has yet to follow other states, including New York, Michigan, California, Connecticut, Washington, Illinois and Ohio, that have required restaurants and bars to close as a prevention against the coronavirus.

a little boy drinks at a water fountain that appears to be in the hallway of a school. Children are particularly vulnerable to lead exposure, and they can get it through drinking contaminated water.

Lawmaker will again attempt to get lead out of water in schools, daycare centers

January 24, 2019 by Greg Barnes

Lawmaker will again attempt to get lead out of water in schools, daycare centers - North Carolina Health News

North Carolina does not test for lead in drinking water in schools and child care centers. State Rep. Harry Warren hopes to change that soon.

By Greg Barnes

Parents of students at Red Oak Elementary School in Nash County were never notified after federal officials found excessive levels of lead in the school’s water in July 2015.

Instead, school administrators posted a notice on a brick wall in the school’s kitchen. Under state law, it was the only notification they were required to provide, despite the dangers that lead poses to children.

According to the U.S. Environmental Protection Agency, even low levels of lead exposure to children can damage their nervous systems and cause learning disabilities, stunted growth, hearing loss, low IQ and impaired formation and function of blood cells. And a new study published this week in JAMA Psychiatry adds to the growing body of research that lead exposure can have adverse mental health effects as children grow.

But the children at Red Oak Elementary were out for summer break when the high lead levels were detected. By the time they returned to classes, the Asheville Citizen Times reported, subsequent tests showed that the lead levels had dropped to below 15 parts per billion, the level the EPA sets as the threshold for safe water provided by public utilities.

Nothing else was done at the school. Nothing had to be.

North Carolina has no law requiring testing and remediation of excessive levels of lead in the state’s more than 100 school systems. It has no law saying parents have to be told when high lead levels are found.

State lawmakers in the North Carolina General Assembly tried to change that in 2016 and again in 2017. House members introduced bills that would have required testing for lead in schools and daycares and remediation when the levels exceeded the 15 parts per billion threshold. Both bills died in committee.

Former state Rep. Mike Hager, the primary sponsor of the initial bill, blames a lack of commitment and concerns over funding.

Hager said lawmakers, school administrators and others thought it would cost too much to test all of the schools and childcare centers and remove faucets and fixtures — possibly even entire plumbing systems — in those facilities where excessive lead levels were found.

Before a federal law took effect in 1988, schools, homes and other buildings commonly used lead solder to join pipes. They also used brass fittings, faucets and fixtures that contained lead. The lead can — and often does — leach into drinking water.

Hager estimated that it would cost roughly $4 million to $5 million to test and remediate the lead in schools and daycares, a small price to pay, he said, in a $22.2 billion budget.

“To me, it’s a no-brainer,” Hager said. “I couldn’t figure out why it didn’t catch fire. Three years and Flint, Michigan, later, and still nothing has been done that I know of.”

Echoes of Flint

School systems and state governments across the country began to take a second look at lead in schools in 2015, at the start of the Flint water crisis.

That city had changed its water source from Lake Huron and the Detroit River to the less expensive – and more polluted – Flint River. Changes in water processing caused lead to leach from the water pipes, exposing more than 100,000 people to potentially harmful levels. The pipes continue to be replaced today. A state report in 2016 estimated that it would cost $80 million to replace about 10,000 lead water lines in the city. The entire cost of fixing the problems was estimated at $216 million.

No requirement for action

In July, the U.S. Government Accountability Office released a report that said only 43 percent of school districts nationwide tested for lead in school drinking water in 2016 or 2017. Those schools tested serve 35 million students. An estimated 41 percent of the nation’s school districts, serving 12 million students, had not tested for lead at all, and another 16 percent of systems did not respond to the government survey.

Many of the school districts that did not test were in rural areas.

According to the report, elevated lead levels were found in an estimated 37 percent of the school districts tested. All school districts with excessive lead levels took steps to reduce or eliminate exposure, including replacing water fountains, installing filters or new fixtures, or providing bottled water, the report said.

Citing the EPA, the report said at least eight states require schools to test for lead as of 2017. The rest of the states, including North Carolina, have no such provision.

But that could soon change.

State Rep. Harry Warren, a Republican from Salisbury, said he plans to reintroduce a bill he co-sponsored in 2017 that was almost identical to the bill Hager wrote.

Like those before it, Warren’s new bill would require the state’s child care centers and public schools to test for lead and remediate it when found above the 15 parts per billion threshold. Warren said he plans to reintroduce the bill in February.

Only this time he plans to have a better analysis of the costs involved.

Warren believes his original bill died because of concerns about costs, who would pay and pressing unrelated issues facing the General Assembly in 2017. Before reintroducing the bill, he said, he plans to glean information from the Charlotte-Mecklenburg and Guilford County school systems, both of which tested their water in the past several years.

Warren said he hopes the results from those school systems will give lawmakers a better understanding of the money that would be needed should his bill pass.

Some districts taking action

In the Charlotte-Mecklenburg school system, lead tests were voluntarily conducted in 2017 on more than 1,600 water fountains and fixtures at 58 of the system’s 176 schools.

The tests, targeting elementary and K-8 schools in old buildings, found 27 schools with unsafe lead levels, including one where the level at a sink in a school cafeteria measured 28 times higher than the 15 parts per billion threshold, according to The Charlotte Observer. The school system paid a consultant about $230,000 to conduct the tests. Additional tests are planned.

In Guilford County, voluntary testing found three schools with elevated lead levels. That school system is replacing fountains and faucets where lead is known to have been used and plans to test many more of its schools this year. Testing for 10 schools initially sampled cost $14,000, according to the Greensboro News & Record.

Warren said the new bill’s sponsors are wondering “can we project an average cost? Can we develop a grant program or funding? How does it work if we assist counties?

“I don’t think it will be all that much money when you get right down to it,” he said.

Warren could soon have additional ammunition to help him get his bill passed.

On Jan. 7, Gov. Roy Cooper’s office sent the EPA a notice of intent to participate in a federal grant program authorized by the Water Infrastructure Improvements for the Nation Act. The grant designates $20 million in funding to states. If approved, the state Department of Health and Human Services would be the grant recipient.

The lead debate

Despite a renewed push for legislation, a question remains as to how serious of a threat lead poses in schools’ drinking water.

While the EPA stresses that any lead exposure can be harmful, Dr. Michael Beuhler, medical director for the Carolinas Poison Center, counters that lead standards in water are based on an entire lifetime of consumption by vulnerable people, such as young children and pregnant women.

Students’ water intake at school each day is likely less than 1 percent of their total consumption of fluids, Beuhler said.

“Lead is part of our environment,” he said in an email. “We try to limit it, but it is there at very low levels. This water isn’t likely adding anything significant to their underlying exposure unless there is a very strange type exposure, like a child living in the school and consuming just the school water.”

Beuhler questioned whether legislation to test for lead “could be a veiled attempt to drive small schools/daycare out of business due to the cost of testing their water unless there was funding offered and the testing scheduling made sense. Or maybe a lab in N.C. that is going to make money hand over fist with more water samples being done?”

According to DHHS, about 150,000 children in North Carolina are tested for lead exposure every year. That includes nearly half of the state’s children between the ages of 1 and 2. The most common exposure is from lead paint.

A state report in 2014 — North Carolina Childhood Blood Lead Surveillance Data — illustrates the pervasiveness of lead in children in this state. The report, the most recent available, shows that 122,481 children between the ages of 1 and 2 were tested for lead exposure in 2012-13. Of those, 1,643 had blood lead levels above 5 micrograms per deciliter.

New Rules Could Open More Homes to Foster Kids

January 3, 2019 by Pew Trusts

New Rules Could Open More Homes to Foster Kids - North Carolina Health News

The new national rules are seen as more flexible, written to enable more foster families to get licensed while protecting the safety and well-being of children.

By Teresa Wiltz

Stateline

Amid an opioid crisis that has increased the need for foster care, states are struggling to find enough foster families to take in kids. A shortage of affordable housing in many places is making the problem even worse.

But some foster care advocates hope new federal guidelines will make it easier for many foster care parents to get licensed, giving a boost to recruiting efforts, particularly among extended family members.

Daniel Bell, who spent years in the foster care system, came to the legislature to support several new bills to make the lives of foster kids better. — Daniel Bell, who spent years in the foster care system, came to the North Carolina legislature in 2015 to support several new bills to make the lives of foster kids better. The state has adopted some rules similar to those that national agencies are now promoting. Photo credit: Rose Hoban

The new proposed regulations, which the U.S. Department of Health and Human Services collected public comment on for several months this summer and fall, don’t include a square-footage requirement or a minimum number of bedrooms — rules that many states have enforced for years. Instead, they talk about “sleeping spaces” that apartment-dwelling foster families might carve out of their living rooms.

The suggested standards also propose that states not require foster parents to own a car, as long as they have access to reliable public transportation. That change would make it easier for city residents to become foster parents.

Many of the suggested rules are more flexible, and will enable more foster families to get licensed while protecting the safety and well-being of children who’ve already been traumatized, said Ana Beltran, special adviser for Generations United, a Washington-D.C. based advocacy and research group.

“Standards will be more focused on common-sense safety requirements, rather than standards based on some suburban, middle-class ideal of a home, that’s not necessarily the best home for a child,” said Beltran, whose group suggested some of the changes to HHS.

To be sure, many foster care advocates and state agencies praised some of the new flexibility but also raised concerns in their public comments about some of the proposed rules, including specifics on swimming pool barriers, languages spoken, immunization schedules, transportation options and physical and mental health exams for foster parents.

“The proposed national model includes standards that will create a barrier for many applicants,” wrote the California Department of Social Services. “Additionally, due to the critical shortage of available foster homes, we urge HHS to reconsider the requirements … to encourage, not discourage, those interested in becoming foster parents.”

The public comment period ended in October, and states and 12 Native American tribes will have until April to explain how they are aligning their foster care standards to the federal model.

California and South Carolina already have revamped their licensing standards to make it easier for more families to qualify as foster parents. Last year, in a massive overhaul of its child welfare system, California sped up the process for grandparents and other extended family members — so-called kinship caregivers — to become licensed and therefore eligible for the same benefits as non-relative foster parents.

In 2016, South Carolina increased the maximum number of children that can be placed with a foster family from five children, including the foster family’s own children, to eight.

Washington state child welfare officials also raised the maximum number of children that can be placed in a foster home in an emergency. Now, the state will allow more than six kids in a two-parent foster home when a relative or siblings need to be placed immediately.

Arizona lawmakers in January introduced a bill to fast-track licensing for kinship caregivers. The bill, still in committee, includes a provision that would allow child welfare officials to “waive any non-safety licensing requirement if compliance with the non-safety requirement would be a hardship on the kinship foster-care parent.”

More Children, Fewer Homes

Nationwide, the number of children in foster care is up 10 percent over the past five years, HHS data shows, further straining an already overburdened child welfare system.

Between 2016 and 2017, more than half of the states experienced a decline in the number of available foster homes, and between 2017 and 2018, 15 states saw a decline, according to the online news site Chronicle of Social Change, which focuses on children, youth and families. Thirty-one states placed more children in group homes in 2016 than they did in 2012.

Housing Affordability

High housing costs prevent many would-be foster families from taking in kids, according to recent research by the Field Center for Children’s Policy, Practice & Research at the University of Pennsylvania.

In California, child welfare workers in expensive cities such as San Francisco and Los Angeles often can’t find local foster families.

Instead, they sometimes place children in other counties or towns where housing dollars stretch further — but where the kids are separated from their schools, friends and familiar surroundings. Doing so can complicate contact and eventual reunification with their biological parents, officials from Los Angeles County said.

High housing costs are an especially strong disincentive for grandparents and other extended family members who don’t qualify for foster care payments because they aren’t licensed, said Ioana Marinescu, an assistant professor of economics at the University of Pennsylvania and a co-author of the study.

Marinescu said her research suggests that increasing the financial support from states — even by as little as 10 percent — would encourage many more families to take in kids.

“If you want to encourage more kinship placements, increasing foster care payments would be a fruitful avenue,” Marinescu said.

shows a total of 165 cases of AFM across the US

Polio-like virus affecting children confounding medical world

December 19, 2018 by Sarah Ovaska

Polio-like virus affecting children confounding medical world - North Carolina Health News

North Carolina is one of 36 states with reported cases of acute flaccid myelitis, which leaves children partially or wholly paralyzed.

By Sarah Ovaska-Few

A medical mystery is confounding national medical experts: The increase of a rare polio-like condition in children, where sudden paralysis or weakness of the limbs can set in following an otherwise unremarkable respiratory virus.

Two children in North Carolina came down with confirmed cases of acute flaccid myelitis, or AFM, in 2018 with two additional cases from this year under review, according to the N.C. Department of Health and Human Services. State health officials declined to release additional details about the children’s conditions, locations and ages, citing medical privacy laws.

How to spot symptoms of acute flaccid myelitis in your child Acute flaccid myelitis, or AFM, is a rare but serious condition that affects the nervous system. Symptoms of AFM [Illustrations of 4 physical symptoms] Difficulty moving the eyes or drooping eyelids Facial droop or weakness Difficulty with swallowing or slurred speech Sudden arm or leg weakness Nervous System [illustration of parts of human body affected: brain, spinal cord, nerves] Seek medical care right away if your child has any of these symptoms. — CDC infographic on acute flaccid myelitis.

Nationally, there have been 165 confirmed cases of AFM this year that the federal Centers for Disease Control and Prevention are tracking. AFM began appearing in the United States in 2014 but has seen increasing numbers since, with 36 states seeing cases this year. Only one fatality, in 2017, has been linked to the illness, according to Dr. Thomas Clark, an infectious disease researcher at the CDC, in a presentation on the federal agency’s campus to journalists earlier this month.

The CDC launched a new effort this month to understand what’s behind the rise in AFM cases with the formation of a task force that met in early December.

Characterized by a sudden weakness of the limbs, AFM can be incredibly serious for those who contract it, with most children needing to be hospitalized and some in need of ventilators to assist breathing, Clark said.

“Most of the kids have deficits even if they recover some function,” Clark said.

Their long-term prognosis is unclear, given that medical experts don’t know what causes AFM or how to treat it.

“We really don’t know how these kids are doing after AFM,” he said.

AFM affects the part of the spine called gray matter and leads to diminished muscle response. Other symptoms include facial drooping, difficulty moving the eyes, drooping eyelids, difficulty swallowing and slurred speech. While it may resemble the paralysis seen in polio cases, no signs of the polio virus have been found in specimens taken from AFM patients, according to the CDC.

No one yet knows exactly what is causing the disease, said Justin Albertson, an epidemiologist with the state DHHS.

“This is something that’s a little unusual because the cause isn’t known,” Albertson said.

Experts like Clark, Albertson and others are befuddled by why a small number of children are developing AFM after having respiratory viruses that most children recover from easily.

Among the connections medical experts at the CDC are exploring are if there’s a direct infection of viruses on the nerves that move muscles, indirect infections where viruses can trigger inflammatory responses that in turn leads to AFM, or if there’s a genetic connection that leaves some children more susceptible than others.

Here is more of what’s known about AFM, according to Clark and the CDC:

Nearly all – 95 percent of cases – occur in those under 18.
The average age of AFM patients is between 5 and 6 years old.
More than 90 percent of cases were preceded by a respiratory virus or fever.
Most cases occurred between August and October when many viruses are circulating.

Also perplexing medical experts is a two-year cycle in the number of cases. The disease spikes every other year with 100 to 200 cases seen nationally in one year and only a few dozen in the following years, according to statistics provided by the CDC.

AFM_periodicity — Graph shows the number of acute flaccid myelitis cases over the past four years. Graph courtesy: Centers for Disease Control and Prevention

Unknown cause, but AFM remains rare

Parents and caregivers hearing about AFM shouldn’t panic, Albertson said, pointing out that there have only been two confirmed cases in North Carolina’s 600,000-plus children under five this year and fewer than 200 cases nationally.

“The most important thing is for parents to know that AFM is still extremely rare,”

he said. “It really literally is one in a million.”

But for those it does impact, AFM can be a serious illness, with children facing sudden paralysis and, in some cases, lengthy rehabilitation that may or may not lead to recovering mobility in their arms and legs, Clark said.

Any medical care professionals, whether in a pediatrician’s office or a hospital setting, should contact state health departments with possible cases, said both CDC and state officials.

Clark and others at DHHS will help get specimen samples to the CDC to help scientists there figure out what might cause AFM, as well as determine ways to treat or even prevent it.

But doctors in hospital settings treating children with AFM-like symptoms should treat it as an emergency if there are signs of paralysis, he said. While letting the CDC and local and state health departments know about possible AFM cases is important, it shouldn’t stop doctors from helping their patient.

“Don’t delay treatment based on waiting for a confirmation from the CDC,” Clark said.

His suggestion came despite there being no recommended treatments at this point. Some doctors have used treatments such as corticosteroids, intravenous immunoglobulin treatments or plasma exchange which are helpful in other neurological conditions.

While some in the academic realm including experts at Johns Hopkins University have theorized that it could be related to Enterovirus D68, which is in the same family as the polio virus. Clark said the CDC isn’t yet ready to pinpoint a cause.

“We’re trying to not get ahead of the data,” he said.

shows children looking frightened as they tumble down a slide

Advocates See Potential for Child Death Prevention in Connecting State Data

December 11, 2018 by Rose Hoban

Advocates See Potential for Child Death Prevention in Connecting State Data - North Carolina Health News

Child welfare advocates say that to improve North Carolina’s child death rate, there’s a need for better coordination and data collection on deaths that do occur.

By Rose Hoban

Any time a child dies it’s a tragedy, but in 2017, 1,313 children younger than 17 in North Carolina died. For each of those tragedies, local and state health officials, medical examiners and child health experts review the circumstances around each child’s death in an attempt to learn how to prevent the next child from dying.

But too often, those reviews are not coordinated across counties, and lessons that could be learned from looking at child death data on a statewide level get lost in a system that’s become too disconnected.

That’s the conclusion reached by members of the legislative Child Fatality Task Force, who spent the past year examining North Carolina’s Child Fatality Prevention System. The system features review teams based in each of North Carolina’s 100 counties, along with the state’s chief medical examiner and a state Child Fatality Prevention Team.

chart shows the leading causes of child death in NC with complications of pregnancy and child birth at the top — Leading causes of child death in NC, 2016. Table courtesy: NC Child Fatality Task Force

There’s one big flaw in the system, said Karen McLeod, a lobbyist who advocates for child safety issues at the General Assembly. She’s also co-chair of the Child Fatality Task Force.

“The buck doesn’t stop anywhere,” she said. “It was here, here, here… the buck didn’t stop anywhere, nobody was responsible.”

At a meeting of the task force last week, McLeod presided as the group voted to ask the General Assembly for a half million dollars to create a centralized office to streamline collection on child deaths, do better analysis, and coordinate the system.

“The intent is to have better communication, getting better information from the locals to the state level so that we’re getting timely and complete information to inform policy and legislative recommendations and hopefully reduce the number of deaths that are in this state,” she said.

‘We don’t know why’

“A lot of people when they think of… a child death, they think it’s something related to [the Department of Social Services],” McLeod said. “DSS is actually a tiny, tiny, tiny fraction of the number of youths who die, the bulk of it is premature babies.”

For example, of the 1,360 child deaths that took place in 2016, almost two-thirds of those deaths were infants under the age of one.

“A lot of the deaths that take place, we don’t know why this is,” she said.

Although North Carolina infant mortality rate has crept downward, the state still ranks in the bottom third of all the states in the U.S. for infant death. McLeod said that worse, there are areas of the state where rates are much higher.

“Many local teams are doing an excellent job of using what they learned to implement local strategies and local prevention initiatives,” said Kella Hatcher, a state employee who is the executive director of the Child Fatality Task Force. “We can do a better job at getting data to inform state level policy.”

Many counties also have disparate ways of recording, examining and analyzing data on child deaths, Hatcher told the task force. If everyone would use the same system, then someone at the new statewide office could more easily spot trends.

Another improvement could come if North Carolina participated in the federally funded national child fatality data system. Forty-six states across the U.S. contribute to the National Center for Fatality Review and Prevention, but North Carolina is not one of them.

“It’s the kind of system that is free to us,” Hatcher said. “We participate, we use the system to basically use our data and pull information out and aggregate and analyze it and disaggregate it and be able to produce meaningful reports.”

Too many cases

A further suggestion coming out of the task force is to reduce the number and types of teams performing child death reviews. Instead, Hatcher explained that the combined, streamlined teams should be more focused on reviewing fetal and infant mortality.

Used widely in 28 states, these programs use a standardized process of looking at medical records, interviewing family members, doing multidisciplinary reviews of fetal and infant deaths, finding gaps in the community system that may have contributed to the death, and then working to improve the local systems.

In the past, North Carolina had such a program located in the western part of the state, but the funding was eliminated in the late 1990s.

TrendsInDeathRates_0-17 — 2007-2016 Trends in North Carolina child death rates for selected cause of death, ages birth through 17. Data courtesy: NC Child Fatality Task Force

Hatcher’s initial suggestion to the task force was to ask the legislature to fund three such mortality review programs, at an annual cost of $300,000 each. But Rep. Craig Horn (R-Weddington) said he didn’t think the full legislature could be convinced to find almost a million dollars for three new teams.

“We are going into a new budget year and we are recommending substantive changes already,” he said. “I recognize that if you don’t ask for it you don’t get it, but as an appropriations guy, I know the process well enough to tell you I think this is an overreach.”

Instead, the task force voted to ask for funding to create a pilot fetal and infant mortality review program and include some accountability measures.

“The accountability measures must be clear,” Horn said. “How do we know it’s working? How do we know it’s not working? How do we get to a touch point to know that?

“What happens is that we get a pilot program, people get hired, no one wants to fire anybody and things just are continued until someone gets angry or we run out of money. Accountability measures are critical to make this work.”

Michelle Hughes, who heads the advocacy organization NC Child, said this is an evidence-based program used in other states that will be a core piece of the child fatality review system.

”I think the piloting is part of a much larger overhaul of the whole system and learning what is the best way to implement that,” she said, referring to efforts to overhaul the foster care system as well as improve social services and child abuse and neglect monitoring.

Local, National Barriers Leave Millions of Child Feeding Dollars on the Table

August 3, 2018 by India Mackinson

Local, National Barriers Leave Millions of Child Feeding Dollars on the Table - North Carolina Health News

As the Summer Food Service Program wraps up its 50th summer, participation rates remain low. Here’s why that matters.

By India Mackinson

Every day in Charlotte, an air-conditioned school activity bus full of free lunches turns into a church parking lot. Within minutes, 60 children cross the street from a mobile home park with their friends and neighbors to receive a meal.

A child enjoying a free meal at a Fort Bragg meal site in the summer of 2017. Photo courtesy: NC Dept of Public Instruction

“It was just miraculous to see,” said Tamara Baker, communications and project director for No Kid Hungry North Carolina, a nonprofit dedicated to helping children access nutrition programs. “The families just came up in droves. They spread out their own blankets underneath trees in the parking lot, and the kids immediately grabbed their food and went into the bus to eat it or sat down on a picnic blanket with their parents.

“It was a beautiful day.”

The church parking lot is one of more than 2,500 meal sites across North Carolina serving free meals to children as part of the national federally funded Summer Food Service Program. Last summer, the program distributed over 4,470,000 free meals in the state, funded with nearly $12.5 million from the U.S. Department of Agriculture.

But that only scratches the surface of what the program can do to address hunger in North Carolina.

N.C. Summer Nutrition Programs serve meals at no cost to children and teens, ages 18 and younger, at more than 3,000 locations across the state.

To find a site, visit www.fns.usda.gov/summerfoodrocks and enter a location.
Or call 1.866.348.6479 (English) or 1.877.842.6273 (Spanish).

The 50-year-old program has long-standing bipartisan support, yet participation remains low nationwide. Only 12 percent of the nearly one million eligible children in North Carolina, ranked 24th in participation nationally, use the program, according to the USDA.

The money–up to millions more a day– is there, but local hurdles and federal regulatory barriers keep communities from accessing it.

Reaching hundreds of thousands of children left out of the program could boost their physical, mental and academic well-being year-round as well as bring in spending to local economies.

“Logistics is the biggest barrier,” said Maureen Berner, from the School of Government at the University of North Carolina at Chapel Hill. “Not due to need, not due to willingness of people to meet the need.”

More than a meal

The program is an extension of the National School Lunch Program, continuing free meals from cafeterias during the school year to community spaces during the 10-week summer break.

State agencies administer the program and recruit sponsors, such as school districts and private organizations, to prepare and distribute food to meal sites in areas where 50 percent of children qualify for free and reduced-priced lunch. Any child under 18 years old can receive a meal, no registration or identification required. Sponsors are reimbursed for each meal served with federal dollars.

Without the summer meals program, students from low-income families lose access to often their only source of fresh, nutritious food until school starts again.

“We hear a ton of stories of children who come into meal sites, and it’s the only time they ever see fresh fruit or fresh vegetables all summer long,” said McCamy Holloway, a summer nutrition consultant at the N.C. Department of Public Instruction. “It’s a costly food item in a lot of areas, especially because some of these sites are in food deserts.”

map of county participatino and outreach in summer nutrition programs — Only a handful of North Carolina counties feed about a third of the children eligible for the Summer Nutrition Program. Most counties barely scratch the surface of summer hunger. Map/ data courtesy: NC Dept. of Public Instruction

Good, ongoing nutrition sets the foundation for a healthy diet that helps prevent chronic illnesses down the road, such as heart disease, diabetes, some types of cancer, and osteoporosis, according to the Food Research & Action Center.

Nutrition and enrichment activities provided at meal sites also support mental wellness and brain development, which translates into success in the classroom, said Holloway.

While most students slide back in academic achievement over the summer, low-income students fall back two months farther than their more affluent peers, according to a No Kid Hungry report. In the long run, these students are less likely to graduate high school and attend college.

Entangling local logistics

Even with thousands of meal sites scattered throughout North Carolina, geographic diversity and large rural expanses make getting meals to kids difficult. Transportation is the program’s biggest barrier.

“Especially down east and especially the more west you go, we have a lot of extreme poverty,” said Baker. “You know you might be a mile away from a site in the mountains, but it’s gonna take you a long time to wind through those mountain roads.”

Spreading awareness

Often, families simply don’t know.

“The majority of the people I meet have no idea that this program existed even though it’s been around for 50 years,” said Holloway.

DPI, which administers the program on a state level, began partnering with No Kid Hungry in 2011 to increase outreach to eligible families, potential sponsors and volunteers.

Tools to find nearby meal sites include an online map and a text and phone hotline.

The hands of children attending a summer nutrition program, they're playing with sand. — Children at a Chapel Hill meal site playing with kinetic sand, a part of daily enrichment activities provided at all 15 of Chapel Hill-Carrboro Food for the Summer program’s meal sites. The enrichment activities help slow the summer slide in academic achievement and promote socialization. Photo credit: India Mackinson

At a local level, engaging the community can be tricky, said Carolyn Brandt, program director of Food for the Summer, an organization that runs 15 meal sites in Chapel Hill and Carrboro. She’s working to promote more buy-in to reach those that historically have been left out.

“Chapel Hill and Carrboro is usually looked at as a well-off community, so many aren’t aware that there are food insecure families in our community,” said Jessica Soldavini, a graduate research assistant with No Kid Hungry, which is a part of a UNC-Chapel Hill initiative. “This helps open [volunteers’] eyes to that and really makes them more aware of certain issues in their community.”

The participation rate in the Chapel Hill-Carrboro Food for the Summer program is 30 to 35 percent of eligible children, well above both the North Carolina and national average of 12 percent.

“Some of the biggest barriers to the program are at the policy level, so that’s something we can’t really change,” said Brandt. “It’s about figuring out what we can change and what we can capitalize on to keep growing that percentage.”

National roadblocks

To control fraud and abuse in the summer nutrition program, federal regulations require children to come to meal sites and eat the entire meal without leaving. Any flexibility in innovation ends with driving buses out to meal sites, like the Charlotte program.

“While that [regulation] sounds great if you have an established place where the kids can get there and that works for them, the reality is that many established places are just that blanket in a parking lot,” said Baker. “What do you do when it rains, and what do you do when it’s really, really hot?”

shows a man dressed as a smiling sun, wearing brightly colored pants. — N.C. Summer Nutrition Programs mascot, “Ray F. Sun” is used to promote the Summer Nutrition Program to kids. Photo courtesy: NC Dept of Public Instruction

This rule prevents any kind of door-to-door delivery or drop off, such as a food truck or Meals-on-Wheels model, that could solve the program’s transportation problem and help more families participate, said Holloway.

Because of the logistical challenges, the reimbursement rate per meal is higher than the National School Lunch Program, but more per meal could make the summer program more affordable for smaller sponsors, said Holloway.

The stigma around taking help also keeps some families, especially teenagers, from the meal sites.

“I’ve heard stories of families walking by a site with several children and saying ‘No, that’s not for us,’” said Holloway.

Vidya Canales, who brings her 2-year-old daughter to a meal site in Chapel Hill everyday, agreed.

“Don’t be ashamed. That’s why a program like this exists. Everybody comes here. If you want to save on your food budget or if you just want your kids to socialize, this is great,” said Canales. “It encourages teenagers to come out as well. It’s not just for babies.”

Innovation moving forward

After decades of change in schools, neighborhoods, technology and learning, it’s time to reflect the new state of summer in the nutrition program, said Berner.

“It would be exciting to go back to the drawing board, in a way, to say ‘How can we best feed hungry kids in the summer in today’s world?’” said Berner.

She said there are several new approaches that state agencies and sponsors can take, including:

Partnering with organizations that already work with families, such as clinics and hospitals. Atrium Health in Charlotte recently became a summer meal site, the first hospital in the state to do so.
Enrolling more children in camps to streamline meal distribution with the added benefit of consistent enrichment and socialization.
Expanding mobile meal site models, such as the one in the Rowan-Salisbury Schools summer nutrition program.
Highlighting the available funding and partnering with local restaurants and businesses to provide healthy meals.

Feeding all the eligible children in the state, even for one day, could purchase several million dollars of North Carolina products, such as sweet potatoes, blueberries, meat and bread.

“That’s money that would go directly into these local economies,” said Berner. “There would be a multiplier effect from that to all the businesses. It’s a win-win-win situation for the kids, for the businesses and for the farmers if there’s a way for the local government to coordinate this.”

While Baker isn’t worried about funding for the summer nutrition program going anywhere, she said child nutrition–a critical component to long-term health and success–is undervalued.

“If Congress does start thinking ‘We need to cut this, we need to cut that’, they don’t necessarily make the connection to what they’re doing to the well-being of the whole child and their potential for the future,” said Baker. “That’s part of what we try to do–to try and help people understand that incredible connection.”

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