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HIV Cases are up in NC, even as testing is down amid the pandemic

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HIV Cases are up in NC, even as testing is down amid the pandemic - North Carolina Health News

“There are a lot of other diagnoses out there waiting to happen.”

By Hannah Critchfield

Even as vaccines temper the spread of the novel coronavirus in the United States, North Carolina advocates gathered to remind lawmakers that the country remains in the middle of another pandemic.

The South is ground zero for new HIV cases within the United States, and the Tar Heel state is no exception.

“After last year, there are a lot of people out there who are probably walking around with an STI, hepatitis, or HIV who are not aware of it,” Jacquelyn Clymore, HIV, STD, and hepatitis director at the Department of Health and Human Services. She spoke during “HIV Virtually Speaks on Jones Street 2021” on Tuesday, an HIV and hepatitis advocacy day hosted by the NC AIDS Action Network (NCAAN) and the Southern AIDS Coalition.

HIV, also known as human immunodeficiency virus, has continued to spread during the pandemic in North Carolina, but significant changes may be coming to how the state attempts to provide access to people living with the virus in the near future.

Ground zero for new cases

Just over half the people who are diagnosed with HIV in the United States each year reside in the South, despite accounting for just 38 percent of the country’s overall population. 

As the southern U.S. is the fastest growing area for the virus, about 50 percent of all deaths among adults and adolescents living with HIV also occur here. While North Carolina fares better than some of its neighboring states, it still ranks 12th worst among states for the highest rates of HIV.

Black Americans are at the greatest risk, accounting for 52 percent of new diagnoses in the South in 2018, the year for which Centers for Disease Control and Prevention data is most recently available. Black southerners have higher rates of HIV than Black people in all other regions of the United States.

Chart credit: The Centers for Disease Control and Prevention

Cases up, testing down in NC

In North Carolina, efforts to combat the novel coronavirus at times subsumed HIV prevention and outreach initiatives over the last year, as many health officials were forced to shift their focus to pandemic-related work.

“A lot of our resources at the state health department, just like in the local health departments, have had to work on COVID,” Clymore said at Tuesday’s virtual event. “It didn’t mean that our HIV and STI and hepatitis work stopped, but it did mean that some things we thought we would be doing just had to be put on hold.”

When last year’s public health crisis hit, one of the state’s most important resources was people power. But public health agencies across the state had bled resources for years and many were under-resourced.

Many county health agencies shuttered their HIV testing entirely in the early months of the pandemic, and struggled to balance the tasks required of the often minuscule number of staffers — in some places, an entire local health department can have a staff of three. 

“The people who would normally be offering HIV or STI testing in local health departments were fully pulled into COVID, so those resources – those human beings – were moved to other work,” said Clymore.

Testing for sexually transmitted infections in North Carolina dropped significantly in 2020, according to Clymore. In some counties, STI and HIV testing was down by 50 percent.

Early evidence suggests that HIV infection has nevertheless increased within the state over the last year.

“Unfortunately, we’ve seen the numbers for STIs and HIV have gone up,” said Clymore. “Not a lot, but they have gone up some, even while testing has gone down. What that tells us is that there are a lot of other diagnoses out there waiting to happen. We know there has to be more HIV and STIs and hepatitis out there than is currently being diagnosed.”

Increasing access

As COVID vaccines become widely available and accessible throughout the state, advocates and health providers alike say they hope to move forward in the fight for better treatment for people living with HIV.

“At this point, we’ve said that if you’re a community-based organization funded by us for [STI] testing, it’s time to get back out there,” said Clymore. “Get on your PPE, you should be vaccinated, you should be able to do this testing now. 

“We’ve told our local health departments that if they can’t do that work because they’re still completely entrenched in COVID, please lean heavily on [these organizations] to do testing,” she added. “Because we need to get back to it.”

Even before the pandemic, a person seeking to determine if they are HIV-positive could face barriers to getting tested. Though people with HIV can now live long, healthy lives if they have access to treatment, stigma around the diagnosis remains pervasive in many communities.

A historical lack of cultural competency in the medical field, as well as a documented history of systemic racism, may lead some individuals –particularly people of color, LGBTQ community members, and those with substance use disorders – to be wary of trusting a provider with confidential information about their HIV status, or fearful of the experience they’ll have at a testing site.

“This is still part of the ongoing problem that people living with HIV experience,” said Clymore. “There’s still a lot of judgment, and unfortunately some of it is affecting people as they come to clinics and as they come to care.”

To address this problem, the state aims to have home testing kits, where a person can conduct an HIV diagnostic test themselves, approved and available by the end of June. 

Currently, only Mecklenburg County offers home testing through a direct agreement with the federal government, according to Jeffery Edwards-Knight, supervisor at the Mecklenburg County Health Department and longtime AIDS activist, who spoke at the event.

“This is another access opportunity – removing barriers, whether they be transportation barriers or cultural barriers, and putting the power back to the person,” Peggy Weil, public policy and grants coordinator at Western North Carolina AIDS Project, said about home kits during the meeting. “There’s evidence out there that once people know their status, that even if they don’t immediately engage in care, it does alter their behavior.”

DHHS is also developing a “cultural humility” training that, starting in August, will be mandatory for organizations that receive state funding for HIV testing, in hopes that it will improve the experience of people arriving for HIV testing.

“We heard loud and clear that people really wanted that addressed,” said Clymore.

Other changes ahead

The same day “HIV Virtually Speaks on Jones Street 2021” was held, lawmakers introduced a bipartisan bill in the House that would amend the state’s “Good Samaritan Law,” which is intended to provide protection from prosecution to a person who calls 911 in the event of an overdose.

“Our [current] law is actually one of the most limited in the country,” Lee Storrow, executive director of NCAAN, who helped lead the push for this legislation alongside members of the DHHS opioid overdose prevention team, said at the summit’s closing event. 

“When the Good Samaritan Law was enacted, our drug supply looked very different,” he added. “Right now the main case of drug overdose in North Carolina is fentanyl – but possession of fentanyl is not protected under our Good Samaritan Law, so it’s a real barrier for people calling 911.”

House Bill 852, proposed by Reps. Donny Lambeth (R-Winston-Salem), Gale Adcock (D-Cary) and Vernetta Alston (D-Durham), would expand those protections to people using a broader range of substances. 

Organizations like NCAAN are also advocating for a bill that would make it easier for people to access HIV prevention medication, following on the heels of states like California and Colorado. House Bill 691, sponsored by Rep. Wayne Sasser (R-District 67), would eliminate the need for a prescription to obtain PreP (pre-exposure prophylaxis) or PeP (post-exposure prophylaxis), medication that prevents infection after possible HIV exposure if taken within a few days.

“It is 100 percent designed to allow someone to walk in the door and say, ‘I need post-exposure prophylaxis,’ and the pharmacist has the capacity to administer that without a prescription,’” said Storrow.

Throughout the day, participants discussed another bill currently working its way through the legislature — one that could threaten syringe exchanges across North Carolina. Senate Bill 607 would, among other things, ban mobile exchanges, require programs to use engraved needles and force people using their services to undergo treatment.

“Obviously there’s a lot of concern about what’s been introduced in the legislature to limit what syringe service programs can do that are absolutely not friendly to people who use drugs, people who are considering recovery, people who are actively needing the work of syringe services programs,” said Clymore. “We [at DHHS] have had the opportunity to comment on those and to say why we think they aren’t going to work, why we’re concerned about them, why they are not in the best interest of the people who those bills were created to help.”

Next year, the state anticipates it will be ready to adopt an electronic portal for its North Carolina HIV Medication Assistance Program (NC HMAP), a federal and state-funded program which provides financial assistance for medications specifically used to combat HIV. Once implemented, Clymore said, case managers should be able to determine a client’s eligibility and quickly enroll them for assistance online.

DHHS hopes to release its updated “Ending the Epidemic” plan for combating HIV in North Carolina in June, according to Clymore.

Army Pvt. 1st Class Lucas Ternell, a volunteer firefighter, and a member of the 20th Military Police Company, Maryland National Guard, puts out a small debis fire in the yard of a house fire in Salisbury, Md., Aug. 27. Ternell was aboard Rescue 16, which was one of several fire and rescue engines that reported to the fire inside a residential neighborhood. Guard members and civilian first responders are providing area support during the Hurricane Irene response. U.S. Army photo by Sgt. Darron Salzer

Similar bills to help first responders with health issues are in front of legislators. They’re likely to have different outcomes.

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Similar bills to help first responders with health issues are in front of legislators. They’re likely to have different outcomes. - North Carolina Health News

A bill to help firefighters with cancer returns with a new way to pay for their care, while another bill to help first responders cope with trauma may have a harder road.

By Rose Hoban

In a year when the important role of first responders has become increasingly visible to members of the public, several bills to provide enhanced benefits to public employees such as police, firefighters and EMTs who sustain illness or injury related to their jobs have been introduced at the legislature.

One bill, House Bill 535, addresses an issue that’s been advocated for by firefighters’ organizations for several years, namely, a higher incidence of some forms of cancer experienced by firefighters. Long-term studies conducted by the National Institute for Occupational Safety and Health confirmed that firefighters more often develop digestive, oral, respiratory, and urinary cancers, along with mesothelioma, a cancer that’s related to exposure to asbestos. 

A second bill, House Bill 492, would provide coverage for first responders who suffer trauma on the job, whether they were participants in a traumatic event or they witnessed some of the horrors that humans can inflict upon one another in the course of their workdays. 

And while both bills received favorable treatment in the House Health Committee last week, their fates are likely different, in part because of how the different groups are asking for their coverage to be paid. 

Witnesses to suffering

For half a decade, the advocacy group Blue HELP has been collecting data on law enforcement personnel who take their own lives. According to their records, 645 law enforcement personnel, including corrections and federal officers, have died by suicide since the beginning of 2018.

Law enforcement are not the only first responders to have large numbers of suicides, according to Rep. Donna White (R-Clayton), who is a sponsor of HB 492 and who introduced the bill last week in committee. 

“In 2020, according to Firefighter Behavioral Health Alliance, 97 firefighters 26 EMTs, and one communication specialist, a 911 dispatcher, committed suicide,” she reported. “The Alliance believes those statistics are 65% reporting.”

And those statistics don’t even represent those first responders killed in the line of duty.

“When you drive along the highway and you see a wreck, do you stop?” White asked. “Our police officers are patrolling and they have no choice. They stop. They see decapitations. They see limbs that are missing and they don’t even know where they are in the pile.” 

She went on to describe some of the traumatic scenes witnessed either in person, or sometimes, in the case of 911 dispatchers, over the phone.

“When you do this 365, many times several shifts a day or a week. You don’t get over it. You can’t just brush it away,” she said. 

The bill would allow those responders who have developed post traumatic stress disorder from some of the things they’ve witnessed and experienced to claim workers compensation for their treatment. 

“Every shift, when you see it day in and day out, it does take a toll,” said Rep. Mike Clampitt (R-Bryson City), a retired firefighter. “I’m here to tell you, it does take [a toll] and I never think about it till something like this comes up. And it’s all that scene and all that emotion, everything flows back through me again.”

Personalized treatment 

Treatment for post traumatic stress is complicated and varies according to what works for each person, said Cherene Allen-Caraco, a mental health provider and head of Charlotte-based Promise Resource Network. 

While many people think of therapy as something that happens while the patient lies on a couch and talks, there are now many forms of therapy specifically geared towards helping people heal from both physical and psychological traumas. 

Some therapies are in the experimental stage, such as those being studied by local researchers who use injections to block nerve pathways to calm the body’s reactivity to stress.

Allen-Caraco, who both practices trauma-focused therapy with clients and has been through the therapy herself said that other forms of trauma therapy involve helping people get in tune with what is happening in their bodies. Once patients identify the places where they are tense, they can then increase their awareness and work toward releasing that tension; that can involve learning deep breathing techniques or movement to reduce muscle tightness. Other forms of therapy use eye movement to defuse the memories of trauma. 

“It could be sensing, so it could be more of a grounding, hearing, smelling, seeing,” she said. “It could be engaging your senses, you’re learning how to regulate your nervous system or calm your nervous system down.” 

She said that it’s important for first responders to have done this work if they’ve experienced trauma in their past. They frequently walk into complicated and tense situations and need to be aware of the unconscious forces playing inside themselves, especially if people’s lives are at stake. 

“What you want to do is be grounded enough in that moment,” she said “You want your thinking brain online, not your primitive brain, you’re not just reacting based on fear and feelings. 

“You don’t want fight flight or freeze to take over.”

The problem, Allen-Caraco said, is that frequently, insurance doesn’t cover enough treatment.

“Sometimes what happens is insurance will pay for three sessions, five sessions, you know, they’re going to pay for very short term treatment,” she said. “It doesn’t mean people are gonna have to do it for years. But to think that we could just cure people in three sessions… there has to be flexibility to choose a modality based on what you’ve experienced. And based on what would work for you.”

Scott Mullins, head of the Professional Fire Fighters and Paramedics of North Carolina, spoke to lawmakers last week to press for the firefighters about the psychological toll his line of work takes on people. “Every year, it just gets worse and worse and worse,” Mullins said. “PTSD and depression rates among firefighters, EMS personnel, and police officers are nearly five times higher than the general population. Even when suicide doesn’t happen, untreated mental illness occurs and it has a great impact on our physical health and impairs decision making.” Screenshot courtesy: NCGA Youtube channel

Higher cancer incidence

In the past, the state’s firefighters have also pushed to be paid through the state workers compensation system to have their cancer treatment reimbursed and to be paid for their time off while they’re sick.  

“North Carolina is the only state in the country who’s not taking care of our firefighters on the issue of cancer,” bill sponsor Rep. Destin Hall (R-Lenoir) told the committee. “We’re the only state again, the only state without any presumptive cancer coverage for our firefighters.”

This year, the Firefighters Fighting Cancer Act of 2021 is finally predicted to pass, because the firefighters and those opposed to the bill in the past have negotiated a way around having reimbursement come via workers comp. 

Spokesman Scott Mooneyham from the North Carolina League of Municipalities said that previously, his organization – and others – opposed paying for these treatments with workers’ compensation.  

“Our organization saw that as both creating a situation where the costs would be undetermined, and it wouldn’t solve the problem,” he said. Even if workers compensation paid the bills, a municipality could still be sued. 

The current bill was hammered out when all of the stakeholders sat down and gave a little. For one thing, Mooneyham said that this year’s firefighter bill includes volunteer firefighters, who were not included in previous years’ bills. 

And this new bill provides a firefighter diagnosed with cancer with a $25,000 lump sum upon diagnosis, as much as $12,000 to cover deductibles, copays and other out of pocket costs and a monthly benefit that’s tagged to the firefighter’s salary. Volunteer firefighters would receive the same lump sum benefits along with $1,500 each month. For both kinds of workers, the benefit tops out at $50,000. 

Mooneyham predicted that the bill would have an easy trip through the legislature and would land on Gov. Roy Cooper’s desk for a signature. 

But the PTSD treatment bill? Mooneyham predicted that HB 492 didn’t have a chance, because it – like previous iterations of the firefighters’ bills – relied on the workers compensation system for reimbursement. 

“There are a lot of interest groups beyond the league that are not comfortable with making substantial changes to the worker’s comp system,” he said. 

“I think that any entity that wants to pass a piece of legislation to provide some type of benefit needs to look beyond the workers’ compensation system, if they want to achieve that. And I think this cancer firefighters bill is evidence of that,” he said. 

“I think that’s where this state is right now.”

State, federal laws may shield long-term care from liability beyond pandemic

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State, federal laws may shield long-term care from liability beyond pandemic - North Carolina Health News

2020 laws passed to protect health care providers during the pandemic could be blocking efforts to pursue potential negligence cases in long-term care.

By Thomas Goldsmith

When COVID-19 first appeared in early 2020, legislators in North Carolina and other states wanted to make sure providers weren’t unfairly penalized for treating the unknown new disease. Lawmakers addressed this by passing the Emergency or Disaster Treatment Protection Act as part of a COVID omnibus bill in May.

Now the state’s pandemic-driven emergency act is under attack from plaintiffs’ attorneys and others in North Carolina and nationally. They contend that the law may be shielding residential care interests from liability for harm to residents — even those who didn’t contract COVID-19. 

One example came in a recently filed lawsuit against the owners of a Wilmington assisted-living center where a former state official died after a reported violent beating from another resident. Opponents of a broad interpretation of the law say the facility shouldn’t be able to “hide behind” its language. In the Wilmington case, the family and attorneys of the victim say that’s not what legislators intended in the 2020 COVID-19 Recovery Act. 

“They didn’t expect that it was going to be far more broad than that and extend to literally anything that happens inside, as long as a nursing home can say that it was a result of a staffing or resource shortage,” said Martin Ramey, a lawyer with the Rhine Law Firm of Wilmington.

The Emergency or Disaster Treatment Protection Act portion of the 2020 statute (starting on p. 25) aims to support public health by “broadly protecting the health care facilities and health care providers in this State from liability that may result from treatment of individuals during the COVID-19 public health emergency under conditions resulting from circumstances associated with the COVID-19 public health emergency.”

‘Our hearts go out’

The Rhine firm and others are bringing suit against Spring Arbor of Wilmington in connection with the death of former state transportation secretary Garland Garrett, 80, who was allegedly beaten by another resident with whom Garrett shared a bathroom. Lawyers for Garrett’s family are claiming wrongful death as a result of negligence on the part of the long-term care center. 

Randy Jackson, regional director of Spring Arbor Senior Living, sent North Carolina Health News a videotaped statement in response to questions: “Our hearts go out to the family members of Mr. Garrett,” he said in part, noting that care and safety is a responsibility the facility takes “very seriously.”

“Our policies and privacy laws prohibit us from discussing any of our individual residents or their needs,” the statement continues. “We can however adamantly state that the accusations Mr. Rhine has made about our care and our communities is untrue.”

When should emergency rules apply?

Spring Arbor had not filed a legal response at press time, but Garrett’s lawyers have already contested any use of the Emergency or Disaster Treatment Protection Act to exempt long-term care facilities from liability in egregious cases during the pandemic.

“It is expected that Defendants will shamefully attempt to shield themselves from Mr. Garrett’s death by hiding behind a strained interpretation of the Emergency Act,” Garrett’s lawyers say in a lawsuit filed April 15 in Superior Court in New Hanover County. 

“The Emergency Act does not limit liability for health-care providers and health care facilities in circumstances in which a resident of such a facility is murdered by another resident known to have a long history of violent propensities toward others.”

Similarly intended changes in federal law are fueling a national debate over when it’s appropriate to curtail liability in lawsuits in long-term care. The dispute ultimately concerns how much protection the law could offer providers who saved thousands of North Carolinians’ lives during the pandemic but may have shown negligence in other instances.

“The law is not very specific,” said Greg Garrett of Wilminton, a son of Garland Garrett. “Things like this happen, and there needs to be accountability for it.” 

Facilities wracked by COVID-19

Speaking generally as a health care defense attorney, Greensboro lawyer Terri Harris said the Emergency or Disaster Treatment Protection Act provision makes sense in the context of the pandemic. Throughout 2020, long-term care facility operators did everything they could to keep residents safe from the virus, Harris said. 

“It is not something that they cause, so it’s not something necessarily that they should be liable for,” she said. 

The advocacy group National Consumer Voice claimed in a news release that federal immunity laws that protect long-term care could make it harder to bring charges under Medicaid and False Claims Act law as well as in cases of disability discrimination. 

“Advocates are gravely concerned that Congress may attempt to bar cases under federal law that seek injunctive relief to protect residents against civil rights violations, discrimination, and violations of the Medicaid Act,” National Consumer Voice officials said. “Further, whistleblower suits brought against entities for fraud or abuse may be placed in jeopardy.”  

Blood-splattered death scene 

Both Thomas Gunter, identified as Garrett’s attacker, and Garrett lived with dementia in a secure memory care unit at Spring Arbor. Garrett’s name may be familiar to people who kept up with state government in an earlier era. After rising through the ranks and serving as transportation secretary under Gov. Jim Hunt, Garland Garrett pleaded guilty to federal illegal gambling charges in 2002 and spent time in federal prison.

According to a state Department of Health and Human Services investigation, another resident attacked Garrett, identified as Resident #2, in Garrett’s room on Sept. 6. Garrett had a gash on his forehead, according to a state DHHS investigation.

“There was so much blood on Resident #2’s head it ‘looked like a murder scene,’” the report said. “The (medication aide) could not determine the amount that Resident #2 was injured due to the amount of blood.”

show Garland Garrett's hand wrapped in gauze, there's a blood stain on the gauze from injuries sustained while Garrett was in long-term care
Photo included in a video produced by Garland Garrett’s family’s attorney. Screengrab courtesy: Rhine Law Firm

Again according to the DHHS report, the attacker, whom staff had previously described as acting combative and aggressive, was found lying on the floor of Garrett’s room with blood on his hands and forehead. 

Durham negligence suit dismissed 

The Garrett family’s lawsuit against Spring Arbor came in the wake of another family’s litigation against a different long-term care facility, Treyburn Rehabilitation. Durham resident Palestine Howze died from complications of a pressure sore that daughter Liza Howze charged in a lawsuit had not been timely or properly treated. 

“Defendant Treyburn Rehabilitation Center and its employees and agents who were healthcare providers, among other things, negligently, carelessly, and heedlessly caused Ms. Howze to suffer painful and permanent injuries and death,” Palestine Howze’s estate charged. 

National trade publications have described the Howze suit as an early challenge under the increased immunity for health-care providers under laws such as North Carolina’s Emergency or Disaster Treatment Protection Act. Superior Court Judge Orlando F. Hudson Jr. dismissed that case on Feb. 12.
The Howze family had failed to state a claim that would entitle them to relief, Hudson wrote.

Shows girls on a climbing apparatus, they're wearing masks against the coronavirus, COVID-19

Coronavirus Today – Apr. 28 — Peeling back the mask mandate for outdoors

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Coronavirus Today – Apr. 28 — Peeling back the mask mandate for outdoors - North Carolina Health News

As North Carolina works to get more adults vaccinated, outdoor gatherings can be larger and masks can come down.

North Carolinians will soon be able to go outside without wearing face coverings and not be in violation of the state’s mask mandate.

Gov. Roy Cooper announced on Wednesday that after 5 p.m. Friday face masks will no longer be required in outdoor settings, though public health officials continue to recommend them for people not yet vaccinated against COVID-19 or in close proximity to others at large gatherings. 

The mask mandate remains in place for indoor settings and is likely to stay in place until two-thirds of the adult population have rolled up their collective sleeves for a jab, Cooper said.

The number of people who may gather indoors will increase to 100 from 50, according to the order. Two hundred people may gather together outdoors, double what it has been most of April.

Occupancy limits currently in place remain the same, though.

The new executive order takes effect at 5 p.m. Friday and remains in effect until 5 p.m. June 1.

The news comes as nearly 49 percent of North Carolinians 18 and older have been at least partially vaccinated and nearly 40 percent are fully vaccinated against COVID-19.

Cooper also told reporters during an afternoon briefing that he expected to lift gathering limits and other capacity and social distancing restrictions on June 1 if North Carolina’s trends and metrics continue to go in the right direction.

“That is the plan,” Cooper said. “It would be great if we had two-thirds vaccinated by then, but we probably won’t.”

On Tuesday, the Centers for Disease Control and Prevention issued new guidance for fully vaccinated Americans on when and if masks are needed outdoors.

“Over the past year, we have spent a lot of time telling Americans what they cannot do, what they should not do,” CDC director Rochelle Walensky said during a briefing by the White House COVID-19 Response Team. “Today, I’m going to tell you some of the things you can do if you are fully vaccinated.”

As a reminder, Walensky underscored the CDC’s definition of “fully vaccinated” as 14 days after receiving a second dose of the Pfizer or Moderna vaccine or a single-shot Johnson & Johnson vaccine.

“There are many situations where fully vaccinated people do not need to wear a mask, particularly if they are outdoors,” Walensky said. “If you are fully vaccinated and want to attend a small outdoor gathering with people who are vaccinated and unvaccinated or dine at an outdoor restaurant with friends from multiple households, the science shows if you’re vaccinated, you can do so safely unmasked.”

Nonetheless, the CDC director and Mandy Cohen, secretary of the state Department of Health and Human Services, continue to recommend masks in crowded outdoor stadiums, concert arenas and other venues where it can be difficult to keep a safe distance apart.

The new executive order means that youth sports teams playing outdoors no longer are required to wear masks while on the field.

“I do want to remind folks that folks under 16 are not able to get vaccinated so they are an unvaccinated population,” Cohen said in response to a question about youth sports. “For all of our unvaccinated population, whether it’s children or adults, we continue to recommend that folks wear masks outdoors when they can’t be distant from other people. So the unvaccinated population, we continue to recommend wearing masks.”

COVID charts, graphs and vaccines

Cohen provided an update on the state’s trends and metrics on Wednesday, showing that North Carolina continues to see 1,500 to 2,000 new COVID-19 cases per day, a higher number than public health officials prefer as more contagious variants are detected.

“I will note that we are seeing some of our lowest levels of COVID testing and that context is important when interpreting this metric,” she added.

The rate of positive COVID tests for those North Carolinians getting tested is slightly higher than 5 percent, a goal of the public health team.

The number of people who are visiting emergency departments across the state with COVID-19 symptoms has dropped dramatically and has remained steady at a baseline level for weeks.

“As you can see, while our numbers are mostly stable, we have more work to do to beat back this pandemic,” Cooper said.

One metric that Cooper and his public health team would like to see go up swiftly is the number of people getting a vaccine.

That weekly number has started to plateau and even decline, a trend that is prompting the public health team to shift tactics for trying to get more people immunized against COVID-19.

“No longer are we thinking about large, mass vaccination sites, but rather making sure that it’s easy for folks to access very close to their homes,” Cohen said.

More and more, vaccines are being allocated to pharmacies, physicians’ offices and even to dentists who want to administer shots to their patients. Many counties are relying on mobile clinics and smaller community events to bring shots to reluctant or difficult to reach populations.

Departments such as the Rockingham County Division of Public Health have started services to get vaccines to the homebound.

“We now know that most folks, not only here in North Carolina, but around the country, can access vaccine within five miles of their home,” Cohen said. “We want folks to know, there aren’t long lines. There isn’t a scramble to get appointments. There’s supply here in North Carolina, it’s easy for everyone to access, and they’re completely free.”

DHHS also has launched a “Bringing Summer Back” get out the vaccine campaign.

During two weeks in May and two weeks in June, community organizations will rally together across the state to promote vaccination.

Elizabeth City, a public health issue

The push for vaccination comes as Elizabeth City residents and others from across the state and around the country are wrestling with the death of Andrew Brown Jr., a Black man who died last week after Pasquotank County sheriff’s deputies opened fire while serving drug-related arrest warrants on him.

The case quickly renewed chants of “Black Lives Matter,” less than a week after Derek Chauvin, a former Minneapolis police officer was convicted of second-degree murder, second-degree manslaughter and third-degree murder in the death of George Floyd.

The cases of Black men dying at the hands of police have been described by past leaders of the American Medical Association as a public health issue that no longer can be ignored.

Cooper, who gave his State of the State address to the state House of Representatives on Monday, called for stamping out long-standing institutional racism. 

“We must all stand together to stop racial injustice in North Carolina,” Cooper told House members earlier this week. “In all the areas that are important for people’s success — health care, education, economic strength, the justice system — we must confront systems that favor some and harm others and we must fix them.”

On Wednesday, Cooper was asked about the Brown case during his briefing with reporters.

A Superior Court judge ruled earlier in the day to delay any public release of law enforcement body camera footage for at least 30 days as requested by the Pasquotank County District Attorney.

Brown’s immediate family members and their lawyer will have access to the footage within 10 days, according to the judge’s ruling.

Cooper was asked whether the delay was healthy for a city, state and country hungering for answers.

State law, adopted in 2016, requires a court order for the release of law enforcement body camera footage, a statute that can leave the public in the dark about what happened while tensions are high.

Cooper had not seen the court proceedings on the potential release of the camera footage before the briefing with reporters and did not want to comment on the judge’s ruling.

“I continue to support a change in the law that would presume these kinds of videos are public record and that a court would have to come in and find reasons not to have them released to the public,” Cooper said Wednesday. “The law is the other way now, they can only be released unless a judge says they can be released. I’ll just continue to say I believe that for trust in the system and confidence that these videos should be released as quickly as possible.”

Any U.S. Senate runs planned?

As North Carolina continues to plot its way out of the pandemic, neither Cooper nor Cohen has plans to seek the U.S. Senate seat that will be on the ballot in 2022.

Sen. Richard Burr, a Republican from Winston-Salem, has announced that he will not seek another term, leaving many in the political arena to speculate about who might be in the field of candidates.

Cooper has said already that he did not plan to seek the office. On Tuesday, he added that he had no plans at this point in the process to endorse anyone who had announced their campaign.

Cohen came to the podium after that to respond to a question about whether she would be launching a campaign.

“I have no plans to run for the United States Senate,” Cohen said. “I love my job here, working for the governor and for the people of North Carolina.”

Cohen could be heard laughing in the background as the governor responded to the news when back at the podium.

“Well that’s a relief,” Cooper said.

Coronavirus by the numbers

According to NCDHHS data, as of Wednesday afternoon:

  • 12,538 people total in North Carolina have died of coronavirus.
  • 965,536 have been diagnosed with the disease. Of those, 1,117 are in the hospital. The hospitalization figure is a snapshot of people hospitalized with COVID-19 infections on a given day and does not represent all of the North Carolinians who may have been in the hospital throughout the course of the epidemic.
  • 924,490 people who had COVID-19 are presumed to have recovered. This weekly estimate does not denote how many of the diagnosed cases in the state are still infectious. Nor does it reflect the number of so-called “long-haul” survivors of COVID who continue to feel the effects of the disease beyond the defined “recovery” period.
  • To date, 12,322,425 tests have been completed in North Carolina. As of July 7, 2020, all labs in the state are required to report both their positive and negative test results to the lab, so that figure includes all of the COVID-19 tests performed in the state.
  • People ages 25-49 make up the largest group of cases (39 percent). While 15 percent of the positive diagnoses were in people ages 65 and older, seniors make up 82 percent of coronavirus deaths in the state. 
  • 250 outbreaks are ongoing in group facilities across the state, including nursing homes and correctional and residential care facilities.
  • As of Wednesday, 148 COVID-19 patients were in intensive care units across the state.
  • As of April 28, 7,017,344 North Carolinians have received at least one dose of the coronavirus vaccine.
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Early childhood education advocates worry Senate bill could erode quality of care

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Early childhood education advocates worry Senate bill could erode quality of care - North Carolina Health News

As the child care industry works to rebuild after the pandemic, there’s debate about how best to help child care centers.

By Anne Blythe

When Carmen Morrison closed the doors of Marizetta Kerry Child Development Center for nearly a month a year ago, the executive director of the Charlotte facility had no idea how much COVID-19 would alter the lifestyles of her staff, the children they care for and their families.

“We didn’t know what we were dealing with back then,” Morrison said in a recent telephone interview.

Morrison and her staff spent that downtime during the early lockdown in 2020 figuring out how to reopen a business that was so essential to the children whose parents and caregivers could not work from home.

There would be no more shared Play-Doh and arts and crafts. Each child would be given their own bucket with supplies inside after temperature checks at the door. Staff wore gloves and two face masks. There was rigorous hand-washing and other safety measures.

“Everybody was nervous,” Morrison said, noting that 50 to 60 of the 170 children enrolled before the pandemic returned to the center.

Most of the 27 employees came back, too, Morrison said. The bonuses and state subsidies helped, but nonetheless, the five star-rated center has taken a financial hit.

As COVID-19 vaccines provide hope of getting to the other side of the pandemic, Morrison and other child care center operators are looking to the federal and state government to help them stabilize their businesses and provide quality care as more parents go back to work.

North Carolina lawmakers put forward a proposal on April 7, Senate Bill 570, that has been touted as a measure designed to help the child care industry get back on its feet.

But parts of the bill that would drastically change how child care centers are rated trouble Morrison and others in early childhood education.

Lowering education standards

Senate Bill 570, sponsored by Sen. Joyce Krawiec (R-Kernersville), Sen. Jim Burgin (R-Angier), and Sen. Jim Perry (R-Kinston), has three sections related to the Environmental Rating Scale, or star rating system, that has been in place for more than 20 years.

In 2000, the North Carolina Division of Child Development and Early Education moved to a star-rated licensing system that evaluated centers on staff education levels, program standards and compliance levels.

The system was changed in 2005 to include only education levels and program standards. The state Department of Health and Human Services assesses compliance every six months, and each facility must maintain a grade of at least 75 percent to remain open.

The bill proposed this month would lower the standards of post-high school education that a center’s staff must have in order to receive the top-tier five-star rating but does not alter how program standards are rated in the star system.

Star rating license sample, courtesy NC DHHS

As it is now, 75 percent of the lead teachers in a program must be working toward an associate, bachelor’s or master’s degree in childhood education for the program to earn enough points to get that coveted five-star rating.

Senate Bill 570 would lower that measure to 50 percent of the lead teachers, a change that child advocates say could weaken North Carolina’s child care system.

“It undermines parents’ ability to make an informed decision,” Muffy Grant, executive director of the NC Early Childhood Foundation, said in a recent telephone interview. “A center could be a two-star today and become a five-star if this passes.”

‘It ignores the science’

The bill proposed keeps the lowered threshold in place until 2027. It also postpones any environmental review assessments for up to six months after Gov. Roy Cooper declares North Carolina no longer is in a state of emergency related to COVID-19.

The six-month postponement largely has been accepted as a sensible measure to pursue after the pandemic showed the frailty of a child care industry that operates on thin margins.

Many centers shuttered. Some that didn’t close had to cut staff because they lost income from parents who themselves might have lost jobs and no longer could afford day care or who kept their children home for other reasons.

“Hopefully as this time moves forward, we can rebuild the workforce again, gird up more workers in this field,” Morrison said.

When that happens, though, Morrison says it’s important to maintain an educated staff because of the little minds they are helping to shape at such a crucial point of a young child’s life.

“Why are we doing this?” Morrison said. “To educate. When we have that mindset it’s important to learn what we can about early childhood education.”

Grant, of the NC Early Childhood Foundation, echoed that thought.

“The negative ramifications of this bill is really that it ignores the science,” Grant said. “Children need teachers skilled in healthy development.”

The General Assembly in 2012 recognized that connection and tied state subsidies to the star rating system, saying that state funding should go to facilities that had at least three stars.

‘We’re seeing classrooms closed’

Sherry Melton, a lobbyist for the N.C. Licensed Child Care Association, has advocated for the changes proposed in SB 570.

In a telephone interview on Monday, Melton explained why her client thinks some of the changes are warranted but noted that there is flexibility on certain timelines and on any unintended consequences of the legislation as currently written.

The question she has for parents and others worried about lowering the percentage of lead teachers who must have an associate degree or higher to get five stars is this: Is it better to have child care teachers with degrees or keep classrooms open at centers that are having a difficult time recruiting such educators to their classrooms?

Melton said the child care industry was in crisis before the pandemic but is in a more dire situation now as centers try to rebuild the workforce.

“While we’re so desperate to protect those star ratings, we’re seeing classrooms closed,” Melton said.

Lauren Hayworth, chief operating officer for A Child’s World Learning Center, which has two five-star centers and two four-star centers in Forsyth and Davie counties, has been able to stay open throughout the pandemic.

“In the beginning, I thought we were going to have to close,” Hayworth said Tuesday during a telephone interview.

That didn’t happen, though. Occasionally, a center had to close a classroom after a staff member or, in some rare cases, a child tested positive for COVID-19.

Though the number of children in their care dropped in the early months of the pandemic, in April they brought back 500 of the 600 students for which the centers have capacity.

Before the pandemic, A Child’s World Learning Center had about 110 staff members.

“We have 75 staff members now,” Hayworth said. “The main problem I’m having right now is the good quality staff I have now, the stress is starting to wear on them.”

Higher pay elsewhere

In her search to bring more people on board, Hayworth has trouble persuading applicants with associate degrees to take a job for the $10 to $13 an hour that the centers can pay.

“When I get people in, who have a degree, they want $16 to $17 an hour,” Hayworth said.

Hayworth said Senate Bill 570 could provide centers time to rebuild their workforces without being penalized in the star rating system if 75 percent of the lead teachers don’t have at least an associate’s degree.

Though Hayworth understands the concerns about whether the quality of care would be eroded if the star rating system is changed, she contends that her centers with four stars provide the same quality of care as those with five stars. The only difference between them, she said, is that two of the centers have more team leaders with degrees.

“At this time, I’m looking for people with good hearts,” Hayworth said.

‘A poison pill’

Sen. Mike Woodard, a Durham Democrat, tried to pull back the curtain on the genesis of the bill during a Senate committee meeting earlier this month but couldn’t satisfy his curiosity.

Efforts to reach Krawiec, a sponsor of the bill, by email and telephone were unsuccessful.

“We understand these are extraordinary times,” Woodard said. “This way this bill is written, it’s a really bad piece of legislation.”

Woodard said he’s OK with the section of the bill that delays the environmental review assessment for a short time period after the state of emergency is lifted. But the part of the bill that would lower the education requirement for early childhood educators was unacceptable.

“That’s a poison pill,” Woodard said.

Melton, the lobbyist who advocated for the legislation, said that section is designed to give people interested in joining the child care workforce time to get degrees.

“The six years came from trying to give somebody new to the field time to get to that point,” Melton said. “If an early childhood educator can only take a course a semester, then it’s going to take them about six years to get an associate’s degree.”

Others questioned whether the motive is to phase out the star rating system.

‘The problem comes back to compensation’

It’s no secret that many centers are having difficulty attracting workers whose pay is not always commensurate to the importance of the job they are being asked to do.

They point out that McDonald’s and some of the big box retail chains pay $15 an hour, putting many day care providers in an untenable position.

Instead of lowering the education standards for providers, early childhood advocates suggest investing more in the workforce.

“We want to professionalize the workforce,” Grant said.

Michele Rivest, senior campaign director for the North Carolina Early Education Coalition, described SB 570 as a conversation starter that attempts to address the workforce crisis but does not do what it should to get at the heart of the issue.

“In the end, the problem comes back to compensation,” Rivest said Monday during a telephone interview. “We know that 40 percent of all our educators before the pandemic were living in poverty.”

In 20 counties, the average pay for early childhood educators was barely $10 an hour. In some counties, it’s $11 or $12 per hour, according to Rivest.

Rivest would like to see the conversation about rebuilding the child care industry to shift to how to use federal and state funds to supplement the early childhood education programs that more than 60 percent of North Carolina families rely on to care for their little ones while they’re at work.

Instead of changing the five-star rating system to lower the percentage of lead teachers that need to have a post high school degree for the top rating, Rivest would like to see legislators and others tackle how to invest more in the child care workforce without making tuition and fees even more exorbitant for parents.

“What I think is really the opportunity in this bill is now legislators realize that there is a workforce crisis,” Rivest said. “If we just reverse course and say all of what we’ve done for the last 20 years in North Carolina doesn’t matter, then shame on us.”

Child care providers and advocates would like to see some of the $1.3 billion coming to North Carolina from the American Rescue Plan used to address the compensation problem. The White House announced on April 15, while releasing $39 billion in funds, that states should use the allocations to “address the child care crisis created by COVID-19.”

“We definitely think this $1.3 billion coming from Congress will help,” Rivest said. “We are going to face this big crisis where there’s not enough child care for working families. We need to build it back. That’s what this federal money is for, it’s to allow us to do that.”

Melton wouldn’t argue against using the federal aid to help child care centers get back on their feet, but she pointed out that it’s not an unlimited supply of funds.

“What happens at the end of three years?” Melton asked.

Despite their differences, Melton said she hoped the many organizations interested in the child care industry and early childhood education could come together to create something that addresses common problems.

“I hope we can all work together,” Melton said.

Hayworth, the chief operating officer for A Child’s World Learning, echoed that sentiment.

“I don’t want everyone in this industry to be on opposite sides of the fence, because we all need to work together,” Hayworth said.

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‘I believe we can roar into the future together,’ governor tells lawmakers

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‘I believe we can roar into the future together,’ governor tells lawmakers - North Carolina Health News

In his State of the State address, Roy Cooper urges compromise, not partisan bickering.

By Anne Blythe

Gov. Roy Cooper stood at the front of the state House of Representatives chamber on Monday night and provided lawmakers his take on the state of the state.

As North Carolina begins to emerge from the coronavirus pandemic that laid bare many of the state’s systemic inequities, Cooper offered notes of optimism as he tried to strike a chord with a General Assembly chamber with which he has often been at political odds.

Cooper hit on many of the themes that he campaigned for a  second term as governor in a state where voters elected a Democrat in the statewide race to lead the executive branch of government and sent more Republicans than Democrats to the Senate and House of Representatives in district races.

After acknowledging the 12,560 coronavirus deaths in North Carolina and calling out the sacrifices of health care workers and teachers in the face of unprecedented challenges, he expressed his belief that the people of the state are “strong, resilient and ready to face the challenges of the future.” 

“I believe that we will rebuild from this pandemic to be even stronger than before,” Cooper said. “And I believe that we can roar into the future together, creating a shared recovery that ensures our best days lie ahead.”

Cooper called for:

  • Expanding Medicaid to cover more than half a million North Carolinians who are low-income workers without health insurance, people with disabilities and others who don’t now qualify for the federal program but could under a provision in the Affordable Care Act.
  • Raising teacher pay.
  • Investing more in higher education, workforce training programs, early childhood education and more so that North Carolinians will be eligible for new jobs offered by Apple and other companies either coming to or expanding in this state.
  • Putting an infrastructure bond on the ballot that brings high-speed internet access to all corners of the state, modernizes school buildings, and invests in clean energy jobs and businesses.

The Biden administration inserted a tempting carrot into recent legislation which would provide close to $1.7 billion to North Carolina over the coming years in exchange for expanding Medicaid, the state- and federally funded health care program. 

Cooper pointed to people who would benefit from the move, such as child care center owner Cassandra Brooks who has facilities in Clayton and Garner. 

“Cassandra had a friend and a coworker die from a stroke when she could not afford treatment for her high blood pressure,” Cooper said. “She has seen people without health insurance get sick with COVID-19 and not be able to get the care they needed. One in five child care workers don’t have health insurance.”

Cooper said that expanding Medicaid would achieve goals agreed upon by a health care council that he convened over the winter that included some Republican lawmakers, business owners, and health care and insurance providers. 

“It uses tax dollars wisely and reduces health care costs for businesses. It makes health care more fair. It reaches rural areas,” he said. “Let’s make a deal.”

Stamp out systemic racism

Cooper said the state must confront and fix systemic racism that has plagued North Carolina for centuries and led to poorer health outcomes for people of color.

Shows a formal wood paneled legislative chamber with a man, Gov. Cooper, standing at the podium, others seated watching him.
North Carolina Governor Roy Cooper delivers his State of the State address before a joint session of the North Carolina House and Senate on Monday, April 26, 2021 in Raleigh, N.C. N.C. Pool photo by Robert Willett/ News & Observer

 “We must face head-on the stark reality of systemic racism, and how it hurts people and leaves them behind — who gets to see a doctor, who gets hired for a job, who gets charged with a crime, who gets prison time, who gets killed,” Cooper said.

Late last week, an Elizabeth City Black man died after Pasquotank County sheriff’s deputies opened fire while serving drug-related arrest warrants on him while he was in his car in his driveway, according to his family’s account after seeing 20 seconds of law enforcement body camera footage on Monday.

Many questions remain about how and why Andrew Brown Jr.’s life ended as it did.

“Over the past year, and just in the past week, we’ve seen the ​harm suffered by too many people of color in our state and across the country,” Cooper said. Some of that harm included a disparate number of Latino and Black residents of the state stricken and dying from COVID. 

 “We must all stand together to stop racial injustice in North Carolina,” Cooper added. “In all the areas that are important for people’s success — health care, education, economic strength, the justice system — we must confront systems that favor some and harm others and we must fix them.”

Finding common ground

Cooper acknowledged past stalemates between him and the Republicans leading the state House and Senate that led to unorthodox spending plans for the past two years. 

The state budget process ended in a stalemate in 2019, after the governor refused to sign a budget without Medicaid expansion as part of the spending plan. Republican legislators instead sent Cooper a bevy of “mini-budgets” which got most of the state’s budgeting accomplished, but froze overall spending at 2018 levels while not accomplishing Cooper’s stated goal of getting more people health care coverage. 

The crisis of the pandemic, however, forced the two camps together. 

The governor highlighted how they came to an agreement more recently to compromise on legislation they all could buy into to reopen North Carolina’s school districts to in-person learning.

He mentioned lawmakers’ bills that allocated federal aid during the pandemic that he signed into law.

When he sent over his recommended spending plan for the coming two years, Cooper again called for a spirit of compromise.

“There are some really good ideas in there,” Cooper said with a smile. “There’s going to have to be some give and take in order for us to get this done. I don’t want to have to veto the budget, and I will do my part to see that we have a budget and I expect you to do yours. And I want to see a budget that has three signatures — Speaker Moore’s, Senator Berger’s, and mine. Our people deserve it.”

Tim Moore, the Kings Mountain Republican who has been Speaker of the House since 2015, provided the GOP response to Cooper’s state of the state. It’s clear that not everything on the governor’s wish list is going to be met with bipartisan enthusiasm.

Differing philosophies

“We all want North Carolina to be a place where people can have good jobs, safe homes, and provide their children with the very best educational opportunities,” Moore said. “We may have very different views on how to achieve those goals. But I and my fellow Republicans intend to try and find as much common ground as possible. In North Carolina, we’re not afraid of our differences. Rather, we view our differences as a part of the rich fabric of our great state as we work together to move North Carolina forward.”

shows a man in a suit and tie standing in front of a podium, looking at the camera after Cooper's address. There's a large brass medallion on the wall behind him
Speaker Tim Moore (R-Kings Mountain) from the House of Representatives gave the Republican response to Democratic Gov. Roy Cooper’s State of the State address Monday night. Screen capture courtesy: PBS NC

Cooper and Moore said North Carolina is in a good position to emerge from the pandemic stronger.

Moore said that was because Republicans had cut taxes and reduced spending while in the majority since 2012, amassing a surplus that Cooper wants to dip into the reserves to fund some of the proposals in his budget.

“One major area of disagreement between the governor and Republicans is how to handle the good fortune of this major budget surplus,” Moore said. “While the governor will push for large increases in state programs, bureaucracy and spending, we know that this is a recipe for unsustainable budgeting that will eventually lead to painful cuts or tax hikes in the near future.”

Republicans, like Cooper, want to invest in rural broadband access, which became so vital for school and health care access during the pandemic, along with water and sewer infrastructure and roads, bridges and highway building. They also support a summer school program for children, many of whom have been in remote learning situations for much of the past year.

Republicans and Democrats will have to work hard together, Moore said. “And we won’t always agree on the best way to do things. But I assure you that we all agree we want North Carolina to be the very best it can be.”

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