Guilford County

Two yellow figures emerge from behind bars and start walking down a path. At the end of the path is a house, but there is a roadblock in the way.

COVID-19 creates additional challenges for those leaving incarceration in NC

July 16, 2021 by Elizabeth Thompson Leave a Comment

COVID-19 creates additional challenges for those leaving incarceration in NC - North Carolina Health News

Citizens reentering society after incarceration already faced challenges before the COVID-19 pandemic, which exacerbated directionlessness and isolation.

By Elizabeth Thompson

When Jeff Walker came out of incarceration, all he had were the clothes on his back. He was directionless, stigmatized. He didn’t have support. He didn’t have anything.

That was five years ago.

People leaving jails and prisons and reentering society during the COVID-19 pandemic faced the same stigma, the same lack of direction — all while attempting to navigate a global pandemic.

For those leaving prison, vital in-person connection is hard to come by, even in regular times. Finding a job has proven more difficult due to the pandemic-generated lag times for identification and Social Security cards, not to mention broadband disparities that make WiFi moot in some rural areas.

Walker gets those struggles. After reentering society but still experiencing substance use issues, he was able to find solace in transitional housing and the connections he made there five years ago.

Now, he works to give other formerly incarcerated people another chance as the programs manager for Wilkes Recovery Revolution in North Wilkesboro, and a member of the Peer Justice Initiative, a group of formerly incarcerated people who advocate for others reentering society and within the jail and prison systems.

Returning in a pandemic

Personal connections are very important for those returning to society after a period of incarceration. Peer-to-peer support is what Walker and others in the Peer Justice Initiative are all about.

But as the COVID-19 virus claimed the lives of thousands in the state, businesses and nonprofits closed their doors and most North Carolinians stayed in their homes. Peer support was hard to find.

The pandemic forced many support groups and mental health services to shift to online. After reemerging into society after years behind bars, some formerly incarcerated people reentering society don’t know how to use the technology that has been vital to pandemic-era communication, such as cellphones and computers.

On top of that, people released without IDs or social security numbers were unable to work for weeks after reentering society, Walker said, especially at the height of the pandemic when the Department of Motor Vehicles was shut down.

Existing inequities such as spotty broadband access were also thrown into high relief during the pandemic, said Philip Cooper, economic and workforce development at YMI Cultural Center in Asheville and a member of the Peer Justice Initiative.

“I was recommending to people: don’t go back to your rural counties right now, go somewhere else,” Cooper said.

People leaving jails and prisons were left feeling directionless — and that can be deadly. One study from the University of North Carolina at Chapel Hill found that formerly incarcerated people were 40 times more likely to die of an overdose in their first two weeks after release than someone in the general population.

Many formerly incarcerated people say their drug or alcohol use ultimately landed them in jail or prison, said Walker.

“[If] individuals don’t have some kind of support when they’re being released to do something different,” Walker said, “then they’re gonna go back to doing what they know how to do.”

In North Carolina, some 98 percent of people currently incarcerated will eventually be released back into society, according to the North Carolina Department of Public Safety. Reentry is still a challenge for many formerly incarcerated people battling both physical and mental illnesses.

Health problems

Reentering society after a long jail or prison sentence is already an anxiety-inducing experience, Cooper said. They are worried about where they will live and find work.

Additionally, they aren’t linked to the substance use treatment or mental health services that so many justice-involved people need. In 2017, DPS found that 71 percent of inmates screened for substance use disorder needed long-term treatment. At that time, 17 percent of the prison population had a mental health diagnosis, many had more than one.

“A lot of times these guys don’t even properly get engaged for substance use and mental health treatment,” Cooper said.

He said the often formerly incarcerated people don’t trust the counselor or social worker they have been connected with because they view that person as working for the system.

“And they already got this distrust with the system,” he said.

By the time they come home, the combined anxiety and unstable plans could lead them to self-medicate with drugs or alcohol, Cooper said.

Incarceration may be the place where someone starts using substances for the first time, said Earl Owens II, a peer support specialist in Mecklenburg County, and a member of the Peer Justice Initiative.

“I know it’s hard for people to believe, but sometimes people go to prison and create a drug habit. One that they didn’t have before they were incarcerated,” said Owens, who called substance use and mental health issues “collateral consequences” of incarceration.

In addition to mental health problems and substance use disorders, people in prison have higher rates of chronic disease like diabetes and hypertension and communicable diseases such as hepatitis C and HIV, according to the American Academy of Family Physicians.

Reducing recidivism

In an attempt to combat recidivism rates and ease the transition of prisoners back into society, Gov. Roy Cooper established the state’s Reentry Action Plan in 2018.

“North Carolina is a better and safer place when those who take responsibility for and learn from their mistakes can get another chance to live productive, purposeful lives,” Cooper said at the time. “ … We owe it to everyone to make sure they’re successful.”

The plan established State Reentry Council Collaborative workgroups, which include stakeholders such as businesses, faith-based agencies and representatives of state agencies, across the state. The plan also encouraged local reentry councils and formal partnerships with community organizations doing the work on the ground.

The Guilford County Local Reentry Council is one of those local groups. While the program has been around for years, it opened its physical Reentry Center in June. Edward “Chap” Williams, reentry director at the center, said it gives people the ability to “change their narrative, their story,” as he peered at the Wall of Fame at the center during an Open House in June.

A man watches a TV behind conference tables and chairs. The Guilford County Reentry Council's — The Guild County Reentry Council’s “Wall of Fame” featured formerly incarcerated citizens who have successfully re-entered society. PHOTO CREDIT: Elizabeth Thompson

With the help of reentry programs, Williams said formerly incarcerated people can fight the narratives in their heads, such as “You’ll never be anything” or “You’ll be just like your mom or dad.”

“Now they have some substantial things, some information,” Williams said. “They have a job, they’re able to pay their rent. Their self esteem has increased, and for me that’s one of the biggest to see — a man or a woman feel like a man or a woman.”

Co-director KJ Powe, said she has seen how incarceration can be a “generational thing,” through her experience as a detention officer. While experts debate some research that points to a higher risk of incarceration for children of incarcerated parents, children of incarcerated parents may also face stigma and are more likely to experience mental health problems, such as anxiety disorders.

“I got to see firsthand the revolving door of how people will come in and out constantly because they didn’t know,” Powe said. “They didn’t have the skills that nobody ever told them there’s something different.”

A brightly covered letter puzzle is on the floor of the children's play corner. In the corner is a red table and chairs, with a map of the United Stated on the wall. — The children’s play area in the Guilford County Reentry Support Center. PHOTO CREDIT: ELIZABETH THOMPSON

Many returning citizens also need a medical reentry plan, whether it be for physical health conditions, drug addiction or mental illness. Some 80 percent of formerly incarcerated people reenter society without health insurance, according to Health Affairs.

While people have access to health care in prison, since many formerly incarcerated people don’t have their own insurance or qualify for Medicaid once they’re released, they end up on their own.

A medical reentry plan

Evan Ashkin, the director of North Carolina Formerly Incarcerated Transition Program (NC FIT) said he initially made the “incorrect assumption” that prisoners would be linked to medical care upon release.

“Even if you didn’t care about the person, from a fiscal standpoint, diabetes, hypertension, you’re going to wind up in an emergency room with terrible complications,” said Ashkin, who is also a professor at the UNC Chapel Hill School of Medicine,

“However, that is exactly the case.”

In order to prevent formerly incarcerated people from going without necessary medicine upon their release — which could lead to worsening illness — NC FIT’s Community Health Workers, who have a lived experience of incarceration, connect people with health resources upon their release.

NC FIT is a partnership between UNC Family Medicine, the North Carolina Department of Public Safety, the North Carolina Community Health Center Association, federally qualified health centers, county departments of public health and community-based reentry programs and councils.

The program has sites in Durham, Orange, Wake, Mecklenburg and Guilford counties, according to its website, but it still “cannot even come close to meeting the need,” Ashkin said.

Ashkin estimated that about 80 percent of people who participate in NC FIT are uninsured and uninsurable. Because North Carolina has yet to expand Medicaid, people who earn more than about $6,400 and less than $14,500 a year fall in the Medicaid “coverage gap,” and are ineligible for either Medicaid or Affordable Care Act subsidies.

NC FIT is able to fundraise to get its clients into primary care, but it does not have the funds to get those with serious medical conditions into specialty care.

“Medicaid expansion would be enormously impactful to the quality of their lives, to them getting the appropriate medical care that anybody else is entitled to who has chronic disease, and for prevention,” Ashkin said.

Because of the pandemic, the prison system released some people who were medically vulnerable early, so they could stay with family or in a transition home, to be at less risk of contracting COVID-19. But Ashkin pointed out a related problem, namely, that these medically vulnerable people lacked access to care.

“I know there’s no connections to health care,” he said. “How are they getting their meds? Follow up? Everything is closed.”

NC FIT’s solution was FIT Connect, a program that got the medical records from people who were released early, so they could connect them to an appointment at a federally qualified health center in the state, using a network of agencies the program made.

“It’s been tricky,” Ashkin said. “It’s hard to track down people, and we certainly haven’t been 100 percent successful. We have gotten hundreds of people appointments, so that’s good, but paying for it is very challenging.”

This story was updated to add more context about children of incarcerated parents.

The entrance to a red brick building with a sign that says "The Moses H. Cone Memorial Hospital"

Public comments on Cone-Sentara merger roll in

May 25, 2021 by Editor

Public comments on Cone-Sentara merger roll in - North Carolina Health News

Commenters from Virginia and North Carolina fear that bigger isn’t always better while some see the benefit to combined resources the merger would bring.

By Taft Wireback

UPDATE: On Wednesday June 2, Cone Health and Sentara made a joint announcement that the merger of the two systems was being called off, with few available details. NC Health News is reporting a follow-up story.

As North Carolina Attorney General Josh Stein considers whether to intervene in the proposed merger between homegrown Cone Health of Greensboro and Virginia-based Sentara Healthcare, he has gotten plenty of input on both sides of the issue.

The state Department of Justice’s month-long public comment period drew more than 40 responses between late March and April 28, including one from a Cone Health physician telling Stein the proposed marriage of the two major health systems is a bad idea.

Stein and his DOJ staff are mulling whether to file a lawsuit that could torpedo the merger if they determine it would not be a good deal for North Carolina residents.

Stein’s formal approval of the proposed Cone merger is not required by North Carolina health care law. But state law does empower his department to review mergers involving charitable corporations such as Cone Health when they seek to sell or otherwise bargain away a majority of their assets.

If he objects, Stein can file a suit against the merger in civil court.

Two years ago, Stein allowed HCA Healthcare to purchase Asheville-based Mission Health without a legal challenge, but only after negotiating changes to the proposed transaction aimed at further protecting public health. Among other things, his changes to the $1.5 billion deal doubled the length of time new owners were required to continue providing an array of medical services at five rural hospitals in western North Carolina.

Community activists expressed disappointment that Stein didn’t take a more aggressive stance against the Mission takeover, while others noted that the attorney general had only limited ability to do more.

Administrative overload?

Critics of the Sentara-Cone proposal told the attorney general in a variety of ways that bigger does not necessarily mean better, especially when it comes to delivering medical services in an effective and caring way.

“I oppose this merger and respectfully argue that the merger is not in the best interest of our community nor North Carolina,” Cone Health physician Kurt Lauenstein wrote in an April 23 email to the DOJ. “I would add that ‘nonprofit’ organizations that pay 6-figure salaries do not deserve the designation of ‘nonprofit.’”

Lauenstein said he was offering his perspective “from the trenches of primary care,” making the case that as health systems get ever larger and more complex the quality of care they deliver suffers at the hands of administrative complexities and what he described as a “one-size fits all approach.”

“As Cone has grown, so has the administrative burden,” Lauenstein said. “Just check out the number of ‘management’ and ‘IT’ staff ratio to health care delivery staff . . . Where I work we have 3-4 providers working with 3 managers. This overhead diminishes flexibility, profitability and staff morale.”

Cautionary comments also included a protest from hospital officials in Randolph County who claim that Cone has neglected to “seek or obtain” their required approval of the merger’s impact on a jointly owned cancer center.

Another broadside came from a Virginia resident who also submitted copies of his separate complaints to two federal agencies against the proposed merger because of its alleged potential to drive up patient costs by stifling competition.

The public input also featured somewhat contrasting viewpoints from two elected Greensboro officials who are facing off in the community’s upcoming mayoral race.

Commenters who supported the Sentara-Cone plan made similarly impassioned pleas that smaller, Greensboro-centered Cone Health would benefit greatly from its combination with the Sentara network that they depict as having a like-minded approach to “value-based” health services.

“Sentara has committed to investing strongly in our communities – providing much needed capital to the system to assist it in meeting community needs that it simply could not do itself,” former Cone Health CEO Tim Rice said in a comment he sent April 14.

Rice, who retired at Cone Health six years ago, asserted that in addition to improving Cone’s financial outlook Sentara had promised to invest in “existing health-focused foundations that serve Guilford, Rockingham and Alamance counties” where Cone dominates.

Proponents also included Greensboro Mayor Nancy Vaughan who said the two health systems’ “combined resources and knowledge will only lead to providing high quality, affordable and accessible health care in more ways and more places.”

Differences in scale

At issue is a proposed merger between two systems that together own about $11.5 billion in assets and generate roughly $8.5 billion per year in revenue, according to the corporate pair’s most recently available Form #990 financial reports for 2019.

In terms of sheer size, Cone ranks No. 6 among North Carolina health systems with about $2.2 billion in annual revenue and 13,000 employees. Sentara’s yearly income is roughly three times greater and it employs 30,000 people.

Sentara is known for its political clout in Virginia, where it has headquarters in Norfolk and also oversees the in-house Optima Health and Virginia Premier insurance plans — products that insure nearly 1 million Virginians.

In contrast, Cone’s health insurance plan, Health Team Advantage, is a Medicare Advantage program that insures only about 15,000 people.

The Sentara network already serves a sizable population in North Carolina’s northeastern sector, a Tar Heel presence that includes one of the Virginia-based system’s 11 hospitals. That hospital is in Elizabeth City where the health care giant plans to build a replacement for the current, 60-year-old Sentara Albemarle Medical Center.

Other OKs required

In addition to getting the green light from Stein, the merger also must pass muster with the Federal Trade Commission, which reviews such transactions and generally takes a dim view of the nationwide trend toward consolidating health care systems into larger conglomerates.

The federal agency believes that by reducing competition, health-system mergers ultimately result in higher consumer costs. But because Cone and Sentara’s existing service areas do not overlap, that could be a difficult case to make in this instance.

The merger plan calls for Cone Health to essentially become a satellite division of the Sentara network with the Greensboro-based leadership having a proportional number of seats on the combined system’s governing board.

The merger plan initially called for current Cone Health CEO Terry Akin to remain in charge of the Greensboro division. Akin later announced he would be leaving after the merger for personal reasons that he said did not stem from any dissatisfaction or disagreement with the impending Sentara-Cone marriage.

Sentara also plans to bring its Optima Health insurance plan to Triad consumers, something the Greensboro mayor and several other supporters mentioned as a plus.

“This new insurance option will be tailored to the needs of local consumers and businesses – something Cone Health could not do on its own without a partner experienced in those markets,” Vaughan said.

The North Carolina Department of Insurance recently approved the part of the merger that would give Sentara oversight of Cone’s Health Team Advantage plan. Insurance Commissioner Mike Causey signed off on that part of the deal May 6, a spokesman for Causey said recently.

“Sentara currently has no plans to make material changes in Health Team Advantage’s business operations or corporate structure or management, other than as may arise in the ordinary course of business,” Sentara vice president Louis Patalano IV said in the health system’s application submitted to the Department of Insurance in February.

Green lights

Stein’s more broad-based examination is continuing without a timetable for completion, DOJ spokeswoman Laura Brewer said last week.

“Our office is still conducting the review,” Brewer said. “It’s always challenging to set a timeline; the review will take as long as it takes to be thorough.”

The state Department of Justice responded to North Carolina Health News’ request for the public submissions Stein had received during the recent comment period, providing letters and email messages submitted by a total of 42 people.

All but six of the commenters expressed opinions for or against the proposed merger, with 19 in favor and 17 expressing doubts or opposition.

The great majority of comments supporting the merger – 13 or 68 percent – came from people with such ties to Cone Health as current or prior employment in executive positions, service on the Greensboro health system’s board of trustees, or membership on related supervisory panels such as the Cone Health Foundation or the health system’s Cancer Center Advisory Board. (Disclosure: Cone Health Foundation has provided support for mental health reporting at NC Health News)

“Cone Health’s mission will not change, and the expertise and resources brought by our partnership with Sentara will prove to impact the community that we all serve,” said Lenora Campbell, a Cone Health trustee and dean of NC A&T State University’s College of Health and Human Sciences in Greensboro.

“The significant capital investment brought by this new partnership with Sentara will expand access to traditional and digital health programs and build new health-care facilities, and enhance access to health care for some of our most underserved populations,” added the health-school dean at the nation’s largest HBCU.

Including Campbell’s remarks to Stein, six of the 19 supportive comments came from members of the Cone Health Board of Trustees that voted unanimously in favor of the Sentara deal announced in August with an unspecified “mid-2021” target date for completing the transaction.

And warning signals

One of the cautionary comments came from a Black member of the Greensboro City Council who is challenging Vaughan for the mayoral seat in the upcoming citywide elections.

Council member Justin Outling, a Greensboro lawyer, urged Stein to make sure that “vulnerable and marginalized community members receive the medical care they need and are not harmed by the requested merger or acquisition.”

Outling noted that Novant Health pledged $50 million toward such ends in January when it acquired New Hanover Regional Medical Center in Wilmington and that HCA Healthcare similarly had committed about $90 million “to the Asheville area” in its earlier Mission Health purchase in western North Carolina.

“To date, there is no publicly available information on the financial contributions Sentara Healthcare-Cone Health will commit to Greensboro area endowments/foundations to benefit the Greensboro community,” Outling wrote, suggesting that Stein should look into that aspect of the merger and tell the public what he learns.

Another red flag came from a lawyer representing Randolph Health in Randolph County on the southern border of Cone Health’s current domain. The two systems jointly own and operate a cancer treatment center on Randolph Health’s hospital campus in Asheboro.

The center’s operating agreement requires either party to get the other’s consent for any transaction that would change the facility’s ownership ratio by more than 25 percent. As it stands now, Randolph Health is the 60-40 majority owner of the Asheboro treatment center.

But Sentara’s senior-partner status in the proposed merger would introduce new ownership and trigger the cancer center’s required approval clause, Randolph Health attorney Robert L. Wilson, Jr. said in an April 14 letter to Stein.

“Cone Health has not sought or obtained such written approval from Randolph,” wrote Wilson, who is based in Raleigh. “Cone Health has not provided Randolph any information regarding Cone Health’s merger with Sentara.”

He added that his client “only learned of this merger through published reports and is unable to make an informed decision regarding approving the transfer of membership interest” in the joint cancer center.

Contacted recently, Wilson said he could not comment on an “ongoing matter.”

Cone and Randolph Health have a complicated relationship. Cone had been considering a merger with the Asheboro-based system last year, but the talks fell apart in March 2020 about five months before the Cone-Sentara deal was announced.

Financially troubled Randolph Health later unveiled plans to sell its assets including a 145-bed hospital to the Dava Foundation, a nonprofit health care provider based in Manchester, Tenn.

Voices of business, government

In addition to comments that Stein received from those professionally linked to Cone Health, other support for the proposed merger came from what might be called “the usual voices” who participate in such proceedings – elected local officials, leaders of business groups and current or former foundation officials that look to health care systems for support.

“Their mission of providing high quality health care resonates with employers looking to invest in our community,” Brent Christensen, president and CEO of the Greensboro Chamber of Commerce, said of Cone Health’s local track record. “We believe this partnership will surely continue the strong tradition of great health care for the citizens of Greensboro.”

Critics of the proposed merger included Triad physicians and nurses, former Cone patients and several residents of Virginia who either loved or hated Sentara. Seven of the 18 commenters who disagreed with the proposed merger identified themselves as medical professionals, including Lauenstein and three other doctors.

“My concern is that Sentara will be responsible for allocating resources to address the medical needs of the Greensboro community,” said Dr. Jeffrey Medoff, a Greensboro gastroenterologist who has practiced in North Carolina for 44 years. “These will have to compete with other demands on Sentara, a Virginia-based organization with far greater investment and commitment in their home state.”

Medoff is currently affiliated with Wake Forest Baptist Health, but said he also has been on the medical staff at Moses Cone, Duke and Wesley Long hospitals.

Two Triad-area physicians – Drs. James Maxwell of Greensboro and Yun Boylston of Burlington – said the merger would be good for residents of the region. Both also are members of Cone Health’s board of trustees.

“By building on Sentara’s Optima health plan experience, we will (be) able to provide an affordable option for health insurance that will be tailored to our community, improve wellness and keep healthcare costs manageable,” wrote Boylston, an Alamance County pediatrician.

Virginia critique

Commenters from Virginia included James Sherlock, a retired U.S. Navy captain and architect who included in his submission complaints against the merger that he also had filed with the FTC Bureau of Competition and the U.S. Department of Justice’s antitrust division.

Sherlock, of Virginia Beach in the heart of Sentara country, alleged that the health care giant relies on an aggressive business style that uses its lucrative insurance arm to reward Sentara-linked providers with high payments while starving medical practices that are not part of the system.

Meanwhile, other insurers cannot compete with Sentara health plans because of Optima’s cozy relationship with the health care branch of the Norfolk nonprofit’s business model, he said.

“N.C. has to my knowledge never seen the combination of integrated market power in both healthcare services and health insurance that Sentara brings,” Sherlock said in an email to NC Health News. “They wield that combination as both sword and shield against competitors in both industries in ways you may not be able to imagine.”

But proponents say the economic realities of the healthcare industry make mid-size systems such as Cone Health particularly vulnerable: They can remain independent for only so long in the face of rising costs, increased patient expectations, tight-fisted insurers and wealthier competitors.

Cone Health has responded by choosing its best available option to create “a great outcome for our region and communities we serve,” said Ed Cone, a longtime board member from the family whose textile-industry wealth and largesse gave birth to the hospital system that now bears its name.

“Consolidation in healthcare is a reality, and Cone is one of the last independent systems in a state full of hungry giants,” Ed Cone said in a March 26 email to Stein and his staff. “We chose to partner with a like-minded system – nonprofit, community focused – that will allow us to continue to offer lower prices than our big competitors while focusing on wellness and value-based care for all people.”

Overcoming his COVID vaccine skepticism at FEMA clinic

March 19, 2021 by Anne Blythe

Overcoming his COVID vaccine skepticism at FEMA clinic - North Carolina Health News

The federally sponsored high-volume vaccine clinic in Greensboro administers 3,000 vaccines seven days a week.

By Anne Blythe

Juan Diggs scrolled through his phone while he was being monitored with a dozen or so others inside a former department store after getting a first dose of the Pfizer COVID-19 vaccine.

The 47-year-old Greensboro resident was among the more than 3,000 people who booked and showed up for an appointment Monday at the federally supported mass vaccination clinic at Four Seasons Town Centre in Guilford County.

Diggs, who makes car parts for a living, thought long and hard about whether he even wanted a vaccine.

“I was nervous,” he said through the blue face mask covering his mouth and nose, its straps looped around his ears. “You know all the basic stereotype of Black America.”

As Diggs sat in a folding metal chair, waiting for a member of the National Guard or Air Force staffing the Federal Emergency Management Agency site to bring him his second-dose appointment card, the Black father of two elaborated on what gave him that extra nudge to overcome his vaccine hesitancy and join the nearly 2 million people who have been partially vaccinated in North Carolina.

“I just kind of went with my gut,” Diggs said.

Hope to attract diverse crowd

Even before the state began rolling out vaccines in late December and early January, health care advocates cautioned that people in communities of color might be hesitant to get a shot.

In North Carolina, there has been a persisting mistrust of institutional medicine among Black people. They often cite a state-sanctioned eugenics program, which sterilized nearly 7,600 men and women from 1929 to 1974. Many bring up the Tuskegee Syphilis Study in which adequate treatment for the sexually-transmitted disease was withheld from a group of infected poor Black men.

Even as such episodes have sowed suspicion and possibly suppressed turnout for a jab, the Rev. William J. Barber II, former head of the state NAACP, has urged public health officials to question whether a lack of access to trusted resources and vaccine clinics might be a larger driver of why the numbers were lower in communities of color.

Man wearing blue face mask, black ball cap sits in chair with his phone out — Juan Diggs, a Greensboro resident, received a first dose of the Pfizer vaccine at the FEMA mass clinic at Four Seasons Town Centre. Photo credit: Anne Blythe

In Hispanic communities, some have raised concerns about having to show documents or IDs that might draw the attention of immigration officials.

Mandy Cohen, secretary of the state Department of Health and Human Services, has repeated many times that information being gathered at vaccine sites will not be shared with immigration officials.

At the FEMA site in Greensboro, which Cohen visited on Monday, no ID is required to sign in for an appointment.

Spanish speakers are on site to share important information and respond to questions.

By staging a massive vaccine clinic that is equipped to administer 3,000 doses each day of the week until late April, state health officials hope it might provide a missing piece to an accessibility puzzle that has long stymied health equity advocates.

“What I’m particularly proud of, not only are we getting vaccine out quickly, which is clearly, clearly top priority, but we’re also getting it out equitably,” Cohen told reporters gathered in the parking lot of the Four Seasons Town Centre in Greensboro, where FEMA staged the indoor and drive-thru clinics.

The Four Seasons Town Centre is nearly midway between Murphy in the far reaches of western North Carolina and Manteo at the eastern edge of the state. The shopping center is right off Interstate 40, where it intersects with Interstate 85.

Man in face mask, blue medical gown, purple gloves gently rocks Pfizer vaccine vials — Air Force member gently rocks Pfizer vaccine vials at Four Seasons Town Centre clinic. Photo credit: Anne Blythe

“We are seeing such a high rate of folks from our underserved communities being served here in Greensboro,” Cohen said. “We’re seeing more than 25 per

cent of our African American communities here. We’re seeing more than 15 percent of the appointments for the Hispanic or Latinx communities.”

The Black population in North Carolina is about 22 percent of the state’s nearly 10.5 million people. Hispanic and Latinx people make up 9.8 percent of that tally.

Cohen and her staff look at the daily numbers from the Greensboro site, as well as the information fed into the state’s newly created database, to closely monitor the race and ethnicity of those getting vaccinated in North Carolina.

Conversation in communities of color

“Fast and fair” is the mnemonic motto adopted by Gov. Roy Cooper and his public health team for their vaccine distribution plan.

The idea is to leave no distributed doses on the shelf between the weekly federal government shipments while also ensuring that doses go into arms representative of the state’s diverse population.

Cohen has been having Fireside Chats with pastors (called “cafecitos” in Spanish), civil rights advocates and leaders from underserved communities, answering questions and listening to ideas in hour-long sessions often posted to YouTube or social media channels.

Men and women in military fatigues enter information into computers — National Guard and Air Force members at the FEMA vaccine clinic in Greensboro collect information for the North Carolina COVID-19 database. Photo credit: Anne Blythe

On March 12, Cardra E. Burns, senior deputy director of the state Division of Public Health, moderated a discussion between Cohen, the Rev. T. Anthony Spearman, head of the state NAACP, and Barber, whose list of jobs and projects includes co-chair of the Poor People’s Campaign, president of Repairers of the Breach, architect of North Carolina’s Moral Monday movement.

Barber and Spearman both shared their vaccine experiences.

“I had the opportunity to get the Johnson and Johnson, the one shot,” Barber said. “I’d been studying the two.”

Barber has a daughter who has a public health doctorate and he discussed the different options with her before getting vaccinated at a mass vaccination clinic in Raleigh’s PNC Arena in early March.

“She said, ‘Daddy, you know all of the three have great efficacy, and move forward.’ I was surprised by how once you get in line, it’s really not a long time,” he said. “I did not have any side effects. Just a little soreness for about an hour or so. The staff was great. You know, we did it outside.”

Recognizing fear of needles

Beyond the concerns of the often cited eugenics and Tuskegee experiments, Barber mentioned that there are many people who don’t like the idea of getting jabbed with a needle.

“You know, we need to take that seriously,” Barber said. “Many people are petrified of needles. I didn’t know when they stuck me. Literally, I was like, ‘what,’ because I was doing something else and the lady was talking to me and she said, ‘finished,’ and I mean literally it was that quick.

“You think about that. That quick so you don’t end up on a respirator for that long. That quick so you don’t have to go see are your oxygen levels staying at a rate that can keep you alive. That quick so that other variants of this disease can’t touch you. Just that amount of time to extend your time, to extend your time with others around you.”

Man in blue medical gown loads COVID vaccine into a syringe — Air Force team members pay close attention to detail while loading the Pfizer vaccine into syringes at the FEMA mass COVID vaccination clinic in Greensboro. Photo credit: Anne Blythe

Spearman initially had a vaccine appointment scheduled in late January, but it was a week in which the state sent Guilford County’s vaccine allotment to a large event in Mecklenburg County.

“Here in Greensboro, about 10,000 people, their appointments were cancelled,” Spearman said. “We didn’t know when they would be getting back to bring another allotment into the Greensboro area so I was calling around — I was really acting like a chicken with his head cut off — calling around to Raleigh and the neighboring counties to see if I could get in there and get my shot because I was ready to go out and do the work encouraging people, having had a vaccination, to be able to encourage them to go forth and do the same.”

On Feb. 4, Spearman got his first dose at the Mt. Zion Baptist Church in Greensboro. It was a very cold day. He sat in his car for nearly five minutes before his appointment and then waited 15 minutes after the inoculation to be observed for any potential adverse reaction.

Blue and white syringes for Pfizer vaccine — Syringes for Pfizer COVID-19 vaccines. Photo credit: Anne Blythe

“I experienced a little soreness in my arm, but nothing more than that,” Spearman said.

When he got the second shot, three weeks later, Spearman again felt nothing.

“I was joking with the nurse about the needles that I had seen on television, and the needle, if it was as long as the needles that they showed on television, it didn’t feel as though there was a needle at all,” Spearman said. “So by the time she was finished, I didn’t even know I had had the vaccination. …I have not had one symptom.”

Spearman and Barber have committed to sharing their experiences with others while also incorporating information into their church services to build vaccine trust in trusted places.

‘Get on fire about getting these vaccines’

For the more than half a million people across the country who died from illness related to COVID-19, with more than 11,700 in North Carolina, Barber called on the living to go forward with a goal of making things better.

“We really, in the face of all this death, I think have a moral calling to live, and then I would add to live better, not just live, but live better,” Barber said. “The pandemic had its chance. Now we have to take our chance. It’s been on fire for a year. Now, we’ve got to get on fire about getting these vaccines.”

The flame needs to burn brighter if such efforts are going to bring true equity.

North Carolina has improved on its goal of getting Black North Carolinians vaccinated, now up to 16.5 percent of the population.

Greater strides are needed in Hispanic communities, with only 3.8 percent at least partially vaccinated.

Dark-haired woman wearing face mask talks with blond-haired woman — Mandy Cohen, secretary of the state Department of Health and Human Services, stops for a chat while touring FEMA vaccine site in Greensboro. Photo credit: Anne Blythe

Only .8 percent of the 166,400 people in North Carolina who identify as American Indian or Alaskan Natives have been partially vaccinated, even as they represent about 1.6 percent of the population.

Many more women than men have been getting vaccines, some 58 percent to 40 percent.

It was a woman who persuaded Diggs, a once hesitant 47-year-old Black man at the Greensboro FEMA clinic, to take a shot.

“My wife got it Saturday and she talked me into it,” Diggs said shortly before getting his second-dose appointment card. “I wanted to do this for my sons, too.”

Diggs has two adult sons. One is 27 years old. The other is 21. Now that he has gotten a shot, he plans to encourage them to get an appointment when their turn comes.

“It’s not bad,” Diggs said. “It doesn’t take too much time.”

A peek Inside the FEMA clinic

At the entrance to the clinic, a bank of National Guard and Air Force members collect all the necessary information for the state’s vaccine database, an archive system that North Carolina built so it would not have to rely on the federal government to give public health officials hard numbers that help them pinpoint communities where vaccine administration could be better.

In a smaller room of the former department store, a team from Langley Air Force base in Virginia filled syringes with the Pfizer vaccine.

It’s a well-coordinated process that takes into account the thawing time for the vials that have been kept in an ultra-cold freezer at 60 to 80 degrees below freezing.

While sitting at a folding banquet table with a black cloth draped over it, members from the Langley team collect several vials of vaccine in their gloved hands and gently rock them back and forth 10 times to mix the white to off-white solution inside.

A rigorous shake could destroy the delicate mRNA molecules in the vaccine.

The Air Force team then tries to get six doses from each vial into syringes, which must be used within six hours.

Woman wearing military fatigues checks in man in red hooded sweatshirt at a vaccine table — National Guard and Air Force members staff the federally supported FEMA vaccine clinic in Greensboro. Photo credit: Anne Blythe

The injection is the swiftest part of the process. Once sleeves are rolled up or jackets come off, an arm is swabbed and jabbed in seconds.

The FEMA site hopes to add the one-shot Johnson & Johnson vaccine to the mix toward the end of April, but until then they’re taking appointments for the Pfizer shots.

The mass clinic could see even more demand this week since the state has opened eligibility to people with chronic health conditions, such as asthma, autoimmune disorders, cancer, diabetes, heart disease and obesity.

People who have smoked at least 100 cigarettes in their lifetime, even if they are former smokers, also are eligible for vaccines.

North Carolina opens eligibility on April 7 to even more people — those essential workers in Group 4 who were not included in the frontline essential workers eligible in Group 3.

Last week, President Joe Biden said he expected all Americans, 18 and older, should be able to be vaccinated beginning May 1.

Though vaccine distribution got off to a bumpy start in North Carolina and elsewhere, the supply chain has improved under the Biden administration and states are notified earlier and more routinely about how many doses will be allocated on a weekly basis.

“We think we’re very much in line with President Biden’s announcement that we’re going to make every adult eligible by May 1,” Cohen told reporters at the FEMA clinic after thanking workers there and posing for photos with some of them. “We are very much on track to do that here in North Carolina, but we have a lot of work to do.

“This site is part of the reason we can be successful here in North Carolina and it takes that federal, state, local partnership to be able to ramp up our ability to vaccinate everyone.”

The Federal Emergency Management Agency vaccination center is open at the Four Seasons Town Centre in Greensboro for seven more weeks.

Vaccines will be available seven days a week with an expectation that up to 3,000 doses will be administered each day.

Appointments are required. No ID is required. Spanish speakers are on site to help.

You can schedule an appointment online or call the COVID-19 Vaccine Help Center at 888-675-4567.

man wearing mask sits behind desk with naloxone kits in a line in front of him

COVID-19 stressors fuel surge in overdoses of contaminated street drugs

February 5, 2021 by Liora Engel-Smith

COVID-19 stressors fuel surge in overdoses of contaminated street drugs - North Carolina Health News

We talked to health workers on the front lines of the opioid epidemic across the state to hear how the coronavirus pandemic has affected people who use drugs.

By Taylor Knopf and Liora Engel-Smith

Though attention has shifted to combating the coronavirus pandemic, the opioid crisis in North Carolina has not gone away. The stressors caused by COVID-19 — such as homelessness and job loss — have contributed to an increase in drug overdoses in the last year.

North Carolina saw a spike in overdoses in the spring and early summer months of the pandemic. When fewer people were going to the emergency room as the virus took hold in the state, the number of overdose-related visits shot up. Preliminary state data from 2020 shows a 23 percent increase in overdose-related emergency room visits over the previous year.

Though still elevated, the number of overdose emergency room visits are coming down as more naloxone — an opioid overdose reversal drug — has been pushed out into communities.

Nationally, more than 81,000 Americans died from drug overdoses between May 2019 and May 2020, according to the Centers for Disease Control and Prevention. The CDC noted that this was the highest number of overdose deaths ever recorded in a one-year period.

On Thursday, NC Attorney General Josh Stein announced a $573 million multi-state settlement with consulting firm, McKinsey & Company, as a result of the group’s alleged role in advising opioid manufacturers on how to promote their drugs. North Carolina will receive $19 million from that settlement, which Stein said will be used to address the consequences of opioid addiction in communities across the state.

More fentanyl, more overdoses

Meanwhile, the street drug supply has become more contaminated and more dangerous. Fentanyl — a synthetic, highly potent drug often added to street drugs — was the “primary driver of the increases in overdose deaths,” the CDC said.

Nearly everyone NC Health News interviewed for this story said fentanyl became an even bigger problem over the course of the pandemic. Those who work with people who use drugs say that fentanyl is being cut into all street drugs — heroin, cocaine, marijuana and even pressed into pills disguised as drugs such as Xanax.

“Anecdotally, 2019 and 2020 were pretty rough in terms of reversals and overdose deaths,” said Jesse Bennett, executive director of the NC Harm Reduction Coalition, the largest network of syringe exchanges in the state.

Harm reduction strategies aim to lessen the damage caused to a person by their use of drugs by providing naloxone, clean needles and other drug use supplies, HIV and hepatitis C testing and other resources. In 2020, the coalition distributed 25,062 naloxone kits across the state. Bennett said there were 3,241 successful overdose reversals and 30 unsuccessful attempts reported to the coalition.

man with heavily tattooed arms puts a box into a plastic bag to build a naloxone kit, which helps treat opioid overdoses, as others stand around hime, looking on. — Jesse Bennett, now director of the NC Harm Reduction Coalition, demonstrates how to assemble a naloxone kit to a group of volunteers. Photo credit: Taylor Knopf

“These are primarily drug user to drug user reversals, which indicates that PWUDs [people who use drugs] can perform reversals successfully even while using drugs,” Bennett said.

He added that people using drugs reported fentanyl in the drug supply throughout N.C. And harm reduction workers themselves have reversed more overdoses than past years. Several participants using drugs told the coalition that they needed to use four or more doses of naloxone to reverse an overdose, a result of the extreme potency of the added fentanyl.

Health workers on the front lines of North Carolina’s drug epidemic share stories about how the pandemic has impacted people using drugs across the state.

Want to help?

To maintain social distancing, the NC Harm Reduction Coalition suspended its monthly naloxone kit assembly events. The group has scrambled to keep up with the demand for kits and needs volunteers who are willing to do some remote work. If interested, email volunteer@nchrc.org to receive the volunteer newsletter.

Wilmington and Fayetteville: fighting evictions

Many people who use drugs have been unable to find work and pay their bills, and they’re facing eviction.

“Because of the evictions, the tent cities have grown exponentially,” said Becca Rose, who oversees Wilmington and Fayetteville syringe exchanges for the NC Harm Reduction Coalition.

Rose’s clients have worked with legal aids who have been successful at pushing off housing evictions for a time, but usually only a few weeks or months. Due to these added stressors, people who had previously been in recovery from drug use or had manageable drug use have been using drugs more chaotically, she said.

“There’s just not enough resources for people to pay their bills. So if you’re a drug user or have substance use disorder, and you lost your job or you don’t have housing, it can trigger a substance use disorder,” she said. “People are looking to self medicate. And because of fentanyl and how strong the opiates are nowadays, they’re overdosing very easily.”

At the beginning of the pandemic, the syringe exchanges were mobile only. Now brick and mortar sites have opened back up with masks, sanitizer and capacity restrictions. Rose said participants are very willing to take COVID-19 prevention supplies and are careful and considerate. One day when Rose was delivering clean supplies to one house, she found a note on a door warning her that someone inside had COVID.

“It’s nice that my participants are at least making efforts to keep each other safe,” she said.

Never Use Alone

Because people are isolated during the pandemic and still using drugs, harm reduction workers are encouraging folks to call (800) 484-3731. Someone from the Never Use Alone initiative stays on the line with the person using drugs to make sure they are OK. If there is no response after they use drugs, someone calls EMS.

Hyde County: heightened demand for needles, supplies

Further up the coast, in rural Hyde and surrounding counties, demand for syringe exchange services ballooned with the pandemic, health department spokeswoman Anna Schafer said in an email.

“We know that almost all of our clients have overdosed at least once — almost half having overdosed three or more times.” But the majority say they have not gone to a hospital or called for help after overdosing, she said.

“We know overdoses are occurring regularly, but ‘the data’ does not always accurately depict the true extent of the issue,” Schafer said.

The health department staff check-in with most clients by phone or online. But many clients need that in-person support, she said, so department staff decided to continue with some face-to-face support in the pandemic.

Wake County: Navigating recovery, racial injustice and COVID-19

The rapid response team with the addiction recovery program Healing Transitions in Raleigh has been a lot busier during the pandemic, reporting a 64 percent increase in referrals from 2019 to 2020.

The team is responsible for making contact with people who overdosed the day before, referred to them by the Wake County EMS system. Alex Peacock, a graduate of the Healing Transitions program, joined that team last April. His job is to go out with EMS to check-in on these folks and offer support, presenting them with recovery options, detox, medication-assisted treatment, harm reduction supplies or simply a listening ear.

A grab bag with cottons, cookers, alcohol wipes, syringes and a list of treatment resources put together by North Carolina Harm Reduction Coalition to help people who use opioids reach all available resources. — A grab bag with cottons, cookers, alcohol wipes, syringes and a list of treatment resources put together by North Carolina Harm Reduction Coalition. Photo credit: Taylor Knopf

“Just so they can have someone in their life who is in recovery, and we can just be there for them,” he said. “If they eventually decide to get recovery, we can be there.”

Peacock, who is three years into recovery, said many people are more interested in seeking help immediately after a life-threatening overdose. He says it’s best to “strike while the iron is hot.”

“We’ve also seen an increase, not just in people needing substance use treatment, but needing a lot of help with mental health,” he said. “A lot of people are really struggling with being furloughed and being at home, having this unemployment money and a lot of time on their hands.”

Peacock said the need peaked in May and leveled off, seeming to subside a little in the fall. However, overdoses and the need for services spiked again during December, he said. Holidays are always harder as people return to family and old friends, and sometimes old habits.

As the virus swept across the country this summer, so did the movement to end racial injustice which emerged after George Floyd was killed by police. As a young Black man, Peacock said he felt “anger and sadness” at the former president’s “lack of support for the African American community.”

As Peacock worked to process his own emotions in response to the death of Floyd and others who died at the hands of police, he wondered how Black men who were just starting their recovery journey were doing. So he formed a support group for Black men at Healing Transitions.

two men wearing masks talking next to an EMS vehicle — As part of his job on the rapid response team with Healing Transitions, Alex Peacock, left, goes out with EMS workers to the homes of people who overdosed the day before to offer them peer support. Photo courtesy of Healing Transitions

“What that looks like is guys sitting around talking about their feelings and relating and talking about what we can do,” Peacock said.

They’ve had discussions on how to talk to their children about these issues. They read and discuss literature and share experiences. After the pandemic, Peacock hopes to invite leaders in the local African American community to talk with the group.

Piedmont Region: Tainted drugs, shuffled priorities and prolonged stress

The clearest sign of the pandemic’s impact on opioid use came to Louise Vincent when two people overdosed right in front of her organization’s Greensboro headquarters.

Vincent, herself in recovery, is the executive director of North Carolina Urban Survivors Union, an advocacy organization that seeks to represent the interests of drug users and alter policies that affect them. The organization serves hundreds of people from Guilford, Alamance and Mecklenburg County.

Before the pandemic, Vincent would have been able to invite people into the building. And if they had overdosed in the bathroom, she would have been ready with naloxone nearby.

But the office is empty. Staff at the Guilford County organization can’t let anyone in because of coronavirus restrictions. Indoor gathering restrictions were a huge blow to people who use drugs who might have sought help, Vincent said.

“Addiction is the opposite of connection,” she said. “Connecting with people and being connected, that’s all of what harm reduction is about.”

That loss of community also coincided with a shift in the local drug supply. As travel restrictions tightened, dealers had fewer drugs to sell. That, in turn, created a scarcity that led to some of the overdoses.

“For a minute, everything was insane,” Vincent said. “The price rose, it was a dog-eat-dog kind of world … just horribly contaminated drugs.”

That chaos seemed to have settled down, she said, but many people’s lives remain unstable, making it difficult for people seeking recovery to get help or support that will keep them alive.

Vincent said the pandemic compounded some of the barriers that face people who use drugs. Though attention shifted from the opioid crisis, it didn’t go away. HIV and other STD outbreaks brought on by drug use also didn’t go away.

“We weren’t out of the woods there,” she said. “But yet, when we had the pandemic we were focused on [that].”

shows a bin with plastic bags filled with naloxone and other supplies — Naloxone kits at North Carolina Harm Reduction Coalition. Photo credit: Taylor Knopf

Elsewhere in the region, Karen Lowe, co-founder of Olive Branch Ministries, a faith-based harm reduction organization that spans several counties, said as the pandemic wears on, people’s resilience is waning. Lowe said some of the services they’re accustomed to, such as peer support, groups, just face-to-face conversations with sponsors are no longer there.

“You had people who, because they had jobs or because they had activities, were able to disguise the fact that they were dealing with addiction issues.”

In some cases, employment and other activities may have also kept the addiction from escalating, but when these activities stopped, some people turned to drugs for comfort.

“We’ve seen an increase in overdoses,” she said. “We’ve seen an increase in people needing supplies. It wasn’t like it was rocket science. People knew that it was going to happen. … Two weeks [of social distancing] was bad enough and then it stretched on.”

Western North Carolina: Peaks and valleys

Blake Fagan, a family physician at Mountain Area Health Education Center in Asheville, oversees the organization’s office-based treatment program for substance use disorders. Between Fagan’s practice and MAHEC’s telehealth and other initiatives, such as the program for pregnant women, the organization treats roughly 500 people with substance use disorders.

Providers stand around a bed in a training about opioid use disorder at MAHEC in Asheville last year. — MAHEC opioid educators Dr. Blake Fagan and Dr. Shuchin Shukla, far right, train North Carolina physicians to treat opioid use disorder at a statewide trainer-the-trainer event in June 2019. Shukla is part of an initiative that will create a ‘hub and spokes’ network for opioid use disorder treatment. Photo credit: MAHEC.

In the first stages of the pandemic last spring, Fagan noted, some patients responded to the isolation, job loss and uncertainty by returning to drug use. Following that first wave of coronavirus, some — but not all patients — have stabilized, he added. That overdose spike coincided with a nationwide increase in diagnoses of depression and anxiety and an overall erosion in mental wellness.

“When [people] have time on their hands, and they’re anxious or scared, they unfortunately return to use,” he said. “And when some of them did.”

At the same time, providers across the state and the country have worked to transition most of their support services online and the advent of telehealth in the region has been a boon for the recovery community.

With fewer overdoses in recent months, especially compared with last spring, Fagan said these virtual support services appear to be working.

Macon County: Homelessness and isolation

Outside of Asheville in rural Macon County, Stephanie Almeida, founder and CEO of Full Circle Recovery Center, has a different take. Almeida works with people who live in their cars or in the woods, offering basic necessities such as socks, blankets and coats alongside syringe exchange services.

A woman with black wavy hair and reading glasses on her hair is looking at the camera. She is sitting on a black chair and her hand is resting on a wooden table. — Stephanie Almeida, founder and CEO of Full Circle Recovery Center in Franklin. Photo credit: Liora Engel-Smith

She noted that it’s almost impossible to remain clean while living outdoors, adding a hurdle to a long list of barriers that prevent homeless people from seeking recovery.

“For people who are unsheltered outside and freezing, they would rather be high than to be suffering,” she said. But even people with stable housing have ramped up their use.

Almeida, whose organization is one of two syringe exchanges in the mountainous county, also contracted coronavirus and had to shut down services for roughly two weeks right after Christmas.

Two weeks later, two volunteer construction workers who helped with renovations at Full Circle also got coronavirus, forcing the center to close yet again for 10 days.

In the meantime, Almedia does what she can.

“I help keep them alive,” she said, “and I help keep them healthy and I make sure they know they are loved and that they have a place in this world and that they don’t have to die just because they use drugs.

shows hands, black and white clasped as a proxy to talk about the pain that comes from domestic violence.

No state oversight of where sexual assault nurse examiners work in NC, but models for change exist

January 30, 2021 by Carolina Public Press

No state oversight of where sexual assault nurse examiners work in NC, but models for change exist - North Carolina Health News

Some other states have laws in place or are adopting new legislation to ensure access to SANE nurses. Some community-based solutions in NC also offer promise.

By Kate Martin, Carolina Public Press

Editor’s note: This article is Part 2 of a two-part investigative series.

Carolina Public Press is an independent, in-depth and investigative nonprofit news service for North Carolina.

For years, if sexual assault survivors in Cumberland County sought care, they could count on going to Cape Fear Valley Medical Center in Fayetteville, where the hospital’s highly trained and certified sexual assault nurse examiners would provide treatment and gather the forensic evidence needed for law enforcement to build a criminal case against their attacker.

About a year ago, advocates for sexual assault survivors noticed a staffing change, said Deanne Gerdes, executive director of Rape Crisis of Cumberland County.

“We’re going to the emergency room … and ER nurses, not SANEs, were doing (rape) kits,” Gerdes said. “Which, I get by law, a regular ER nurse can do that, but there’s so much more into a rape kit that they need to be trained on.”

SANE nurses provide comfort during what may be the most traumatic events of a person’s life. They know to provide emergency contraception, to look for hidden injuries and to prevent HIV and hepatitis from taking hold. They guide victims to resources if they are being abused or trafficked. Many victims are also suicidal after their encounters, and the SANE nurse knows to look for that, too.

Prosecutors consider the work of a SANE nurse the gold standard in evidence collection for criminal cases, but not every county has a hospital with a certified SANE nurse, a Carolina Public Press survey of 130 hospitals and community programs shows.

The survey asked hospitals whether they had a SANE nurse program, how many certified SANE nurses worked there and when SANE services were available.

When told that Cumberland County’s Cape Fear Valley Medical Center said it did not have any SANE nurses in its November survey response, Gerdes paused for a heartbeat. Then another.

“How can they not have? How?” she then sighed. “What it used to be is, we had a SANE program. … There was always 24-hour coverage. It was a team effort, between law enforcement, advocacy, health care and the DA’s office. It was a great team.

“I knew it was bad,” Gerdes said. “I didn’t realize that the number was zero.”

Advances made in recent years

Not long ago, North Carolina had the nation’s largest backlog of untested rape kits. Throughout the state, nearly 16,200 untested kits (revised upward from around 15,000 kits, after a more recent accounting of untested kits) sat in police departments, hospitals and universities — some for decades.

North Carolina lawmakers changed the law to require tracking for all sexual assault kits. Victims who choose to pursue justice through the legal system can track theirs on a state website to view the status of their kit to see if it has been tested by the state crime lab and whether law enforcement has received the results.

In 2019, state Attorney General Josh Stein and several lawmakers unveiled a plan to eliminate the rape kit backlog and create new deadlines for testing them. Lawmakers approved millions of dollars to eliminate the backlog. Thousands of kits, each one representing a deep violation from a moment the victims cannot forget, were unearthed, cataloged and examined.

Biological material wrested from garments and swabs, at times decades old, now revealed their DNA code and, uploaded to a federal database, might match the code to a suspect’s name.

In 2019, announcing his push to hold rapists accountable and to ask lawmakers to provide millions to do it, Stein said untested kits are a “critical public safety issue.”

“To the rapists in North Carolina: No matter how long ago your crime was, we are coming for you,” Stein said then.

As of October 2020, nearly 7,000 older kits that once languished throughout the state have been or are in the process of being tested. Around 2,100 of those kits have been tested. Of those, DNA from 764 has been uploaded to a federal database — and 40% of those, around 300, have matched with others in the federal DNA database called CODIS.

Across the state, the past came rushing forward. Some 25 years after a Wilmington store clerk was robbed and assaulted, her kit was processed in 2019. The foreign DNA left behind matched the DNA record in a federal database.

Testing of old kits solved a 1993 rape and kidnapping from Winston-Salem, pointed toward a common suspect in nine sexual assaults from a decade ago in Fayetteville, identified a suspect in a 2008 Asheville sexual assault and led to 11 arrests in Durham connected to 15 cold sexual assault cases.

With more funding, the attorney general’s office estimates, the rest of those rape kits could be tested by 2023, and due to increases in the cost to process rape kits, it will take another $9 million to do so, according to an October 2020 report.

Police officers and prosecutors have recently become more aware of what the trauma from a sexual assault does to a victim’s brain. Both approach questioning victims in different ways and have become adept at explaining to juries why stories may appear disjointed or why a victim will freeze instead of fight.

A victim’s first meaningful contact with anyone after the assault may be a nurse, and prosecutors value SANE nurses because they help victims understand their options and build a rapport with them about the trauma that occurred.

“Every hospital system in North Carolina should have nurses trained to deal with these types of crises to serve people in need,” Stein said in an interview with CPP last week.

“I think a requirement that they have them would address the situation. That’s something we should talk to the legislature and talk to the health systems about.”

Such a requirement does not currently exist in North Carolina. Gerdes said hospitals should do the right thing, and a mandate should not be necessary.

“Why aren’t these hospitals that concerned about their victims — their neighbors, their daughters, their mothers or grandmothers?” Gerdes said.

Rep. Billy Richardson, D-Cumberland, said he, too, is committed to changing the law to help alleviate the SANE nurse disparity in North Carolina.

“The rapists don’t just rape one time. Studies have shown over and over that they rape multiple times,” Richardson said.

“So, if you catch them, you’re not only helping victims of this particular crime, you may be preventing numerous other crimes from occurring. Plus, and not to mention, it’s the right daggone thing to do!”

SANE training and retention

CPP sent the survey to hospitals because no agency in North Carolina was able to say where SANE nurses are located.

The state Department of Health and Human Services doesn’t track that information, nor does the state Department of Justice. The state Board of Nursing tracks nurse licenses but not SANE certifications, and the International Association of Forensic Nurses has a SANE list, but it isn’t kept up to date if someone relocates, lets the certification lapse or a program is eliminated.

According to the CPP survey, as many as 150 SANE nurses work throughout the state. Some hospitals did not say whether their SANE nurses had the specific credential, but it is not uncommon to have nurses trained in at least some forensic techniques.

Training a SANE nurse is a financial investment for hospitals. To meet the standards of the International Association of Forensic Nurses, candidates must take at least 40 hours of classroom instruction. Classes are often in person, requiring the nurse to take time away from regular job duties. Someone has to pay for travel, food and lodging. Sometimes hospitals pay for these expenses when a nurse seeks SANE training. Often the hospitals do not provide that financial help.

Many hospital systems had the same complaints regarding the availability of SANE training near them.

“SANE training is not readily available, is costly and is difficult to complete while working full time,” said Brandy Popp, spokeswoman at CarolinaEast Medical Center of New Bern in Craven County.

“Our organization is extremely supportive of staff attending SANE training and receiving this education, but once the classroom piece is complete, there are clinical requirements that must be done within a specified time frame, and oftentimes, those requirements can be a challenge.”

Clinical requirements include spending at least 16 hours documenting and performing at least three exams.

“Training and education of SANEs is difficult because it requires not only the didactic class but additional clinical hours,” according to the November survey response for UNC Medical Center in Chapel Hill.

“In essence, a nurse training to be a SANE has to wait for someone to get raped to complete their training.”

To maintain certification, a SANE nurse must complete at least 300 hours of SANE-related practice within three years, including peer review of cases, taking on-call shifts to respond to patients and providing direct patient care.

“In our area, the biggest challenge in serving sexual assault victims is the recruitment and education of staff to become SANE-certified,” said Teresa Bowleg, director of operations/associate chief nursing officer for Erlanger Murphy Medical Center in Cherokee County. The Western North Carolina hospital has one certified SANE nurse, she said.

National problem

Nationwide, SANE nurses are in short supply. A 2016 study by the U.S. Government Accountability Office found that in six states studied, a shortage of SANE nurses existed compared with the number of sexual assault exams being completed. This varied by state. Wisconsin officials said nearly half of its counties had a sexual assault examiner program. Nebraska officials said most counties in the state had no programs.

“As a consequence, officials said victims may need to travel long distances to be examined by a trained examiner,” a 2018 GAO report said.

Retention was also a deep concern, the report said. In one of the six states, the state trained 540 SANE nurses over a two-year period. At the end of that period, only 42 of them were still practicing.

Unlike other professions, SANE nurses work largely alone, often with the patient as the only other person in the exam room, and may be the only person in the hospital with that certification.

“This extrapolates to poor retention rates when SANEs are vicariously being exposed to trauma after trauma with no way to debrief,” UNC Medical Center in Chapel Hill’s November response stated. “We are slowly making gains with getting buy-in from key stakeholders who may be unaware of the prevalence of this problem.”

UNC Medical Center in Chapel Hill said it had 11 nurses who are “trained as SANEs,” of whom three are certified. Another seven have completed classroom work and were working on their clinical training, the survey response said.

Survey responses indicate rural areas are left with few or no SANE-certified nurses. Urban areas are the most likely to have around-the-clock coverage at area hospitals.

“There should be staffed nurses that are trained in every major hospital in the state prepared to help those victims of these horrible crimes,” Richardson said. “It’s just awful what a child or a woman goes through in that situation.”

Possible solutions

Sometimes victims travel to multiple hospitals before they find a SANE nurse — or they give up searching. Hospital systems are not obligated to have SANE nurses in North Carolina, and Stein said that needs to change.

“It is a reasonable expectation for a victim of sexual assault who walks through the doors of an emergency department that he or she will be seen within a relatively short period of time,” Stein said in an interview with CPP.

Other states are approaching the problem differently from North Carolina, and some are able to point to success.

Massachusetts’ Department of Public Health runs the certification program for its SANE nurses, the only state to do so. Of the geographically compact state’s nearly 100 hospitals, 30 of them are designated as “SANE site hospitals,” where anyone can go to the emergency room and expect to have a certified nurse treat them. The hospitals are listed on the state’s website.

When a victim arrives, the hospital pages a SANE nurse and a local rape crisis center, said Katia Santiago-Taylor, policy director for Boston Area Rape Crisis Center. An advocate from the rape crisis center arrives to help the victim. The statewide, state-supported program has a victim-centered approach, she said.

SANE nurses are there to make sure rape kits are collected “in a trauma-informed way where we are not going to cause more harm,” Santiago-Taylor said. “That is what survivors need.”

There are still times when SANE nurses might not be available at a Massachusetts hospital designated as having SANE staff, such as when multiple rape victims arrive at a hospital at once, she said. In those cases, the advocate can be there to help a nurse without a SANE certification

Massachusetts also developed the TeleSANE program to videoconference into rural, military and tribal hospitals so that experts could help clinicians serve patients in the absence of a SANE nurse.

Lawmakers in Illinois recently passed legislation that requires every rape victim to be served by sexual assault nurse examiners starting in 2022. Hospitals must also respond to rape victims within 90 minutes of the patient’s arrival at the hospital.

Unique models in North Carolina

Creative approaches are also underway in parts of North Carolina.

Victims in Wake County can go to a central location, away from an emergency department, to see a qualified nurse.

Most hospitals in Wake County send patients to the Solace Center at InterAct, a nonprofit organization in Raleigh. The Solace Center has 18 certified and in-training SANE nurses, said Lauren Schwartz, director of sexual assault services and the director of the Solace Center, located at InterAct Family Safety and Empowerment Center in Wake County.

UNC Rex Healthcare spokesman Alan Wolf said the Raleigh hospital has three SANE nurses and one in training. If a victim arrives there when a SANE is not available, the hospital can transport him or her to the Solace Center.

“All of the SANE nurses in our emergency department also contract with the Solace Center,” Wolf said. “They are on call through InterAct, making themselves available for cases that have been set up with the crisis line.”

In neighboring Johnston County, Sahari Center of Harbor is a new community-based SANE program that opened around the new year. The group is working with the director of the county health department and other community leaders, said Laurie Mayenschein, SANE coordinator for Sahari Center of Harbor.

Sahari Center has two credentialed SANE nurses, a SANE coordinator and several other registered nurses who have taken 40 hours of classroom training and a 16-hour clinical curriculum, Mayenschein said. The center also has an exam room where it helps assault victims at Johnston UNC Health in Smithfield.

“There are many challenges to developing and sustaining a SANE team, particularly in rural settings,” Mayenschein said in response to the November survey.

“Funding sources are always a priority and essential for the sustainability of any SANE program. I believe one of the biggest challenges facing any SANE program is ensuring that the volumes are enough for the SANEs to maintain their skills.”

Beyond emergency rooms

Many hospitals said they could serve assault victims better if they had a separate area to treat them, away from the emergency room.

Cape Fear Valley Medical Center in Fayetteville is among the busiest emergency departments in the nation, with more than 130,000 visits in 2018.

“In most cases, victims of sexual assault do not have immediate life-threatening injuries and may be forced to wait until the patients with more acute problems are cared for,” said Chaka Jordan, vice president of marketing and communications, in her response to the survey.

The majority of SANE programs are based out of emergency departments, said Catherine Rossi, president of the Academy of Forensic Nursing and the forensic nursing program coordinator for Cone Health in Guilford County.

“That is not usually a very sustainable model, because the needs of the emergency department are always going by volume,” Rossi said. “You’re not going to get the funding; you’re not going to get the support.”

It can take multiple hours for a nurse to perform a sexual assault kit exam on a victim.

If served in the emergency department, victims may be left aside until patients with more life-threatening problems are helped. In addition, a crowded emergency room may feel intimidating to victims, or they may see someone they know.

As for where victims who have questions of where to go after an assault to make sure they reach a SANE nurse, Stein, the state attorney general, said victims should call their local rape crisis center.

While generally good advice, sometimes even those in a position to know aren’t aware of changes in their county.

Gerdes, with Rape Crisis of Cumberland County, said she had no communication from Cape Fear Valley about the hospital no longer having certified SANE nurses.

“When we had a SANE program, that is not how we ran things,” Gerdes said, speaking of Cape Fear Valley Medical Center.

“Victims did not sit out in the lobby. They didn’t. We had a SANE room that they were immediately brought back into. … We would all convene and be an advocate — the nurse, law enforcement — not necessarily in the room, but it was a team effort.”

CPP sought an interview with a Cape Fear Valley Medical Center official last week. Jordan said none were available, however, the hospital’s answers to the SANE survey had already been provided.

Then late Friday, as CPP was speaking to several sources in Cumberland County about the hospital’s response, Jordan sent a modified survey, increasing the number of certified SANE nurses from zero.

“Because of our commitment to sexual assault requirements, we have 8 nurses that have recently completed the SANE training requirements and are awaiting their certification,” the new response reads in part. Jordan did not answer follow-up questions.

Richardson, the state lawmaker from Cumberland County, said he is concerned about his hometown hospital.

“I am concerned that there appears to be some ambiguity with the answers, and we need to sit down and figure out where we need to go,” Richardson said. “I intend to call such a meeting.”

Christian Green and Casey Morris also contributed to this report.

An older woman wearing a mask and face shield sits in the front seat of a passenger vehicle holding papers and talking to an RN who will be giving her a COVID vaccine shot.

Coronavirus Today – Jan. 26 Clearing vaccine backlog; Clash with providers, distribution tweaks; Find your vaccine group

January 26, 2021 by Anne Blythe

Coronavirus Today – Jan. 26 Clearing vaccine backlog; Clash with providers, distribution tweaks; Find your vaccine group - North Carolina Health News

After facing criticism for slow vaccine administration, North Carolina clears backlog and tweaks its distribution process.

By Anne Blythe

The push to get large numbers of COVID-19 vaccines administered in North Carolina to signal to federal authorities that the state can and will deplete its allotted weekly doses created friction with health care providers over the weekend and led to another distribution plan tweak.

Mandy Cohen, secretary of the state Department of Health and Human Services, outlined the vaccine distribution changes in a briefing with reporters on Tuesday.

After facing criticism several weeks ago from Republican lawmakers for the bumpy start to the vaccine rollout that left many doses on provider shelves in late December and early January, Cohen and her team turned their focus to large vaccination events to improve their numbers.

At first, DHHS allotted vaccines to counties based on population, with smaller counties receiving less, and larger counties more.

“But as we needed to move to this posture of speed and make sure we could clear our backlog because we saw that we did have vaccine building up here in North Carolina,” Cohen said. “We wanted to demonstrate to the federal government that we are ready to take on more vaccine and we want that vaccine here, we shifted our posture to one of speed.”

By the end of Monday, Cohen said, 95 percent of all first doses of the Moderna and Pfizer COVID-19 vaccines sent to the state are in someone’s arm. Cohen expected the remaining 5 percent of first doses to be administered by the end of the day.

“North Carolina vaccine providers have given more than 810,000 doses,” Cohen said, adding that 260,000 doses were given in the past week alone.

“After the federal government put all states on notice that future vaccine allocations would be based on how much supply our state had on hand, we charged our vaccine providers with exhausting North Carolina’s supply of first doses and our partners stepped up,” Cohen said. “That demonstrates to the federal government that North Carolina is ready to take on more vaccine and that we need those vaccines now.”

Taking that approach, though, meant some hospitals such as Cone Health in Guilford County and county health departments across the state were forced to cancel or postpone thousands of vaccine appointments that many older people eagerly awaited in the week ahead.

The North Carolina Association of Local Health Directors and the North Carolina Healthcare Association showered swift criticism on Cohen and Gov. Roy Cooper in letters dated Jan. 24 and Jan. 25.

Cohen on Tuesday worked to smooth it over with ruffled partners as she thanked health care providers and local health department workers many times during the Tuesday briefing for being significant frontline allies as the pandemic in North Carolina nears the one-year mark.

“These women and men have been working overtime, day in and day out, to slow the spread of the COVID-19 and save lives,” Cohen said. “They’ve cared for the thousands of North Carolinians that have needed to be hospitalized, created a testing infrastructure that has created more than eight and a half million tests. They have conducted contract tracing for a virus that has now infected more than 723,000 North Carolinians.”

“They’ve borne a weight that would break many,” Cohen added. “Yet not only have they stood firm, they have continued to rise to the occasion.”

Strive for stability in an unstable environment

The coming week, Cohen said, could “feel like a big change” to providers that have cleared vaccines from their shelves.

Based on an allocation set up by the federal government under the Trump administration, North Carolina receives 120,000 first doses of the Pfizer and Moderna vaccines each week.

“This coming week, a number of those doses are committed to a large scale event planned several weeks back, when we were addressing that backlog in vaccines,” Cohen explained. “So this week is going to feel particularly tight with many providers getting small or no allocations.”

Second dose allotments will still go where they need to go to complete people’s vaccine series.

With lessons learned from the criticism over the weekend, Cohen says her department realizes that providers need as much stability as her team can give them “in what is a very unstable environment.”

The state has shared the process it plans to follow in the coming weeks with providers that include a hybrid model that incorporates mass vaccination events while continuing to supply counties with vaccines based on population and the speed with which the first doses are administered.

Of the 120,000 first doses of vaccine allotted to the state each week, 84,000 will be distributed to the counties based on population. The remaining 36,000 doses, Cohen said, will be used to bring some counties back into the dose-per-population balance that was skewed because of the mass vaccination events.

Not only is the public health team bringing its focus back to more equitable geographic allocation. Cohen said getting shots to Black and Latinx residents and historically marginalized communities remain important.

“We will continue to reassess this as we learn,” Cohen said. “I think we will be at different moments in time as we get different information from the federal government in terms of supply, but at this moment, we’re making that shift from that push to get rid of the backlog to this more steady state, where we can give our partners some certainty.”

shows a line up of passenger cars around a large raceway track as people wait to get t he COVID vaccine. — A line forms around the racing oval at Charlotte Motor Speedway as people await the opportunity to receive their COVID-19 vaccination during a mass vaccination event held at the speedway. Image courtesy: Atrium Health

‘Give us more vaccine’

One thing remains certain, and Cohen underscored the point numerous times. Though many are ready to move beyond the pandemic, vaccine supplies remain limited.

President Joe Biden, who was inaugurated almost a week ago, has rolled out a COVID-19 pandemic plan that calls on government agencies to use the Defense Production Act, if necessary, to increase supplies of vaccines, personal protective equipment and other necessities in the fight against the virus.

“We do need multiple strategies to make sure we can get this vaccine out quickly,” Cohen said. “We need to continue to demonstrate to the federal government that week over week, we are getting that vaccine out quickly so that we are at the front of the line to be the one to say, ‘Give us more vaccine.’”

The state typically finds out from the federal government on Tuesday what the weekly allotment will be. DHHS updated its vaccine dashboard this week to include how many doses the federal government had allocated, how many of those doses had actually arrived in the state and how many had been administered.

As part of its new guidance to vaccine providers, Cohen’s public health team plans to let county health departments, hospitals and partners know on Thursday what their weekly allocations will be for the coming week. The providers, in turn, must get back to the state by noon on Friday with their willingness to accept all or a portion of the allotment.

If the doses are accepted, the state expects first doses that typically arrive at health care provider offices on Tuesday or Wednesday to be fully administered by the following Monday evening.

Cohen assured providers that second doses would be available based on the number of first doses administered.

“As we look ahead, because of the amazing work of our provider partners, our maximum capacity in NC will continue to outstrip our anticipated state allocation,” Cohen said in a Jan. 26 letter outlining expectations moving forward. “Despite the drop in the coming week, I cannot emphasize enough how critical it is that we stay on pace to meet our goal of using all our first doses during the week we receive them.”

Cohen recommended against scheduling appointments for first doses of vaccines on Tuesdays or Wednesdays because of the variability that providers have experienced in shipping from the federal government.

“Part of this is hard because we are working on a Wednesday to Tuesday cycle,” Cohen said. “Most shipments come on Wednesday, but sometimes it comes Tuesday or sometimes it comes Thursday, and that’s really hard for our providers to really plan clinics.”

What Cohen and her team are pushing now is for providers to get on an “operational cadence” so they get their first dose shipments quickly into arms and use Sundays, Mondays and Tuesdays to get second doses completed.

“We are all learning this together as we go,” Cohen said. “We are learning the best practices directly from our providers that are working through this on the ground. I think it’s been an incredibly collaborative process.”

Cohen reiterated that the state has set up a transfer process for providers who realize they will not be able to administer all the vaccines they received in one week.

“We’ve seen a lot of that in the last week, and I want to thank folks for being such collaborative partners,” Cohen said. “We’ve had transfers of more than 100,000 vaccines from one provider to another in order to get it out that same week. That is always going to be a part of the strategy, that is to make sure we can match vaccine with the partners who can get it out in that quick and equitable manner.”

‘All hands on deck’

Under the North Carolina plan, all health care workers and anyone 65 and older are eligible for the vaccine, a total of close to 2 million people.

Earlier this week, the state posted a new tool on the DHHS website through which residents can find the vaccine group they are in and enter contact information to be notified when they are eligible for a shot.

Many seniors have expressed frustration about trying to get vaccine appointments through their county health departments and other providers.

Public health teams across the state have borne the brunt of a pandemic that has highlighted how depleted their workforces have been over the past decade.

Now many are being overwhelmed by calls from older residents in search of appointments and confounded by online scheduling portals that can seem glitchy and difficult to navigate even for generations that are far more tech savvy.

“Now we receive more than 15,000 calls per day,” wrote Granville-Vance Health Public Health director Lisa Harrison in an email. Her department covers two counties with a combined total population of about 105,000. She noted she had as many as eight people answering phones on a given day.

Mike Sprayberry, the state director of emergency management, highlighted on Tuesday how North Carolina National Guard teams, the Civil Air Patrol, public health employees and Community Care of North Carolina workers have joined forces to tackle some of the logistical problems of vaccine distribution and administration.

“It’s all hands on deck,” Sprayberry said.

Eighteen National Guard strike teams and 18 National Guard administrative support teams, a total of 256 members, were in counties this week helping with such efforts, he said.

The Biden administration also has offered additional support for vaccination efforts through the Federal Emergency Management Agency.

Sprayberry, often referred to as “Uncle Mike” for his avuncular style during briefings throughout the pandemic and disastrous weather events, welcomed feedback from county health departments and others involved with vaccine distribution and administration.

“We value your shared input as to how we can put a better operational product out on the field,” Sprayberry said. “You continue to make a difference. We’ve had bumps along the way, but if we stay together and maintain solid lines of communications, we’ll achieve success. Just reflect on your amazing body of work over the last year. Incredible.”

On Day 323 of activation of the state’s Emergency Response Team to the pandemic, Sprayberry had a piece of personal news.

“I want to encourage everyone to get the vaccine when your turn comes,” Sprayberry said. “It’s safe and it’s free. I’m 66, and I was able to get my first shot last weekend, and I’m looking forward to getting the follow-up shot in a few weeks.”

Before closing out by telling all listening to “call your loved ones daily, they will appreciate it,” Sprayberry reminded all that it remains important to wear masks and comply with social distancing recommendations.

North Carolina’s trends and metrics have been leveling off some since post-holiday spikes. Nonetheless, the state reported 3,978 new lab-confirmed cases of COVID-19 on Tuesday and 3,368 people hospitalized with serious illness related to the virus that day. There have been a total of 8,776 COVID-related deaths.

“With kindness and cooperation, we will all get through this together as one team, one mission, and one family,” Sprayberry said.

Coronavirus by the numbers

According to NCDHHS data, as of Tuesday afternoon:

8,776 people total in North Carolina have died of coronavirus.
727,423 have been diagnosed with the disease. Of those, 3,368 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.
635,543 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, 8,533,507 tests have been completed in North Carolina. As of July 7, all labs in the state are required to report both their positive and negative test results to the lab, so that figure includes all of the COVID-19 tests performed in the state.
People ages 25-49 make up the largest group of cases (39 percent). While 15 percent of the positive diagnoses were in people ages 65 and older, seniors make up 83 percent of coronavirus deaths in the state.
770 outbreaks are ongoing in group facilities across the state, including nursing homes and correctional and residential care facilities.
As of Tuesday, 696 COVID-19 patients were in intensive care units across the state.
As of January 21, 573,130 North Carolinians have received at least one dose of the coronavirus vaccine.

Additional Thanks

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