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A cross stitched pattern of the novel coronavirus, COVID-19,a round shape with spikes coming out of it.

A look back at 2020’s biggest story: The COVID-19 pandemic

December 30, 2020 by Editor

A look back at 2020’s biggest story: The COVID-19 pandemic - North Carolina Health News

NC Health News staffers have published more than 350 stories about COVID in 2020. We take a look at the many ways, large and small, that COVID has affected North Carolina and its population and pull out some of the larger themes we saw emerge.

By North Carolina Health News staff

COVID’s ascent in rural areas sheds light on longstanding disparities

The pandemic may have begun in cities and population centers, but as the months wore on, it took hold in rural areas across the state in various ways. The first shockwaves of the pandemic in rural North Carolina began long before the first confirmed case there. In early spring, as bars, restaurants and hair salons closed, unemployment in some already economically depressed rural areas across the state soared.

Abrupt school closures and the move to virtual doctor’s appointments highlighted yet another disparity in rural areas: the lack of adequate broadband coverage. The pandemic also prompted a wave of innovative stopgap measures from health care providers, libraries, businesses and foundations. Some providers installed Wi-Fi hotspots in their parking lots to help people without an internet connection at home meet with their doctor safely. Other organizations gave out free phones to people with serious mental health needs in hopes that this lifeline would reduce the number of crisis-driven hospital visits in these patients.

By summer, the pandemic touched every rural county in the state. As the number of cases per capita mounted, the impact of coronavirus on rural areas became clearer. Many rural residents are older and sicker than their urban counterparts and they tend to have less access to health care and are more likely to be uninsured.

The disparities have made the ascent of coronavirus in rural North Carolina even more deadly. Rural areas nationwide have the most pandemic-related deaths per 100,000 residents, a trend that plays out in North Carolina as well.

None of the disparities that make coronavirus more deadly are new. Rural areas have struggled with provider shortages, hospital and unit closures, and economic decline for decades. But the spread of the virus gives urgency to addressing these needs sooner rather than later. The first stage of the pandemic saw many stopgap measures from sending Wi-Fi-equipped buses to rural areas to serve as hotspots to stepping up testing efforts in hard-hit areas to designating special coronavirus funds for smaller hospitals.

Rural areas are likely to need more support and resources to weather the next stage of the pandemic. -Liora Engel-Smith

COVID-19 exacerbated existing health disparities for incarcerated people

COVID-19 laid bare what people who work and live within the criminal justice system have said for decades – serving time behind bars exposes North Carolinians to added health risks.

This year, the novel coronavirus pandemic tore through – and continues to spread within – prisons, jails, and detention centers, exacerbating existing health challenges that incarcerated people in North Carolina and their loved ones face. By the end of the year, more than one in five prisoners in the state system have been diagnosed with the virus, according to an NC Health News analysis, it’s likely more have been infected, but not diagnosed.

The loss of in-person visits created added barriers for children with an incarcerated parent in North Carolina, some of whom have now not seen their mother or father in almost a year. It paused the state’s plan to bring medication-assisted treatment (MAT) to people with substance abuse disorder who are incarcerated inside state prisons this year – studies show people are 40 times more likely to overdose after release from a North Carolina prison or jail, according to North Carolina researchers who published in the American Journal of Public Health in 2018.

shows a very basic prison cell with a sink, toilet, bed, plastic chair adn a pile of books — A typical cell at Central Prison in Raleigh. Cells in the solitary unit are more sparse, and smaller. Close quarters, lack of airflow, multiple inmates in small rooms have all contributed to the spread of COVID-19 in North Carolina’s prisons and jails. Photo credit: Rose Hoban

And there was the threat of the virus itself. Many incarcerated people in North Carolina’s federal and state prisons and county jails spoke about difficulty accessing routine medical care amid rising COVID-19 cases within their facility, as well as fears about getting testing and treatment for suspected COVID-19 infections.

Inmates are more likely to have chronic health conditions than the general population, making them more at-risk for the worst outcomes of the virus. The structure of many carceral institutions, where many people live in relatively tight spaces and have little control over their ability to social distance, heightened the risk of spread.

To date, 29 people incarcerated within the state prison system, 27 people in North Carolina’s one federal prison, Butner Correctional Complex, and at least one person in jail have died of COVID-19-related causes. Two inmates who were transferred out-of-state to Immigration and Customs Enforcement detention centers also died shortly after contracting the virus. – Hannah Critchfield

Covid-19 races through North Carolina’s meat and poultry processing plants

In the tiny town of Tar Heel, people began paying close attention in early April to what was happening at a Smithfield Foods hog-processing plant 1,400 miles away.

There, in Sioux Falls, South Dakota, nearly 1,000 plant workers had contracted COVID-19 and two had died. On April 14, the plant temporarily shut down.

Workers and management of a Smithfield Foods slaughterhouse in Tar Heel, near the Cape Fear River in Bladen County, began to wonder whether the same fate could await them.

we look through a chain link fence into an industrial complex / poultry plantwhere multiple workers have tested positive for COVID-19 — Trucks unload chickens at the Mountaire Farms plant in Siler City. The company processes 400 million chickens a year. Photo credit: Victoria Bouloubasis

It didn’t take long to find out. By late April, meat and poultry processing plants in North Carolina reported that a total of 118 workers had tested positive for COVID-19. Two days later, that number had jumped to 190.

By the end of April, the coronavirus had infected so many workers at Smithfield’s Tar Heel plant that it almost shut down. The plant may well have closed if not for President Donald Trump’s order that the nation’s meat and poultry plants stay open to protect the nation’s food supply.

Trump’s order was met with harsh criticism from union leaders and other advocates of plant workers, who are predominantly Black and LatinX.

The advocates complained of unsafe working conditions in an industry in which workers stand close together on processing lines for hours at a time. Companies did install Plexiglass partitions on the lines and in cafeterias. They initiated many other safety precautions, as well, including taking workers’ temperatures every day and spacing them farther apart on the lines.

But worker advocates said the companies didn’t respond quickly enough or rigorously enough to fully protect the workers.

By May, a ZIP code that encompasses a Mountaire Farms poultry-processing plant in Chatham County had the highest per capita rate of COVID-19 of any of the more than 1,000 Zip codes in the state.

“When this pandemic started, Mountaire was doing nothing. They just started giving employees face masks/shields & putting up glass between people about two weeks ago,” a worker told NC Health News in mid-April. “The distance between people on the lines is literally elbow to elbow. The risk of the virus spreading is extremely high because of this.”

In mid-December, North Carolina’s meat and poultry processing plants reported 4,180 cases of COVID-19, according to figures from the state Department of Health and Human Services. That is far higher than any other category of COVID-19 clusters recorded by DHSS, including religious gatherings and colleges and universities.

A study released in July by the Centers for Disease Control and Prevention found that 87 percent of the 16,233 COVID-19 cases reported in meat and poultry processing plants were among racial or ethnic minorities. — Greg Barnes

Disproportionate impact on LatinX residents

COVID-19 has had a disproportionate impact on communities of color, highlighting how many Black and LatinX workers are essential to keep grocery stores, meat processing plants, construction projects, farms, nursing homes, long-term care facilities, hospitals and other engines of the economy and health care systems humming.

North Carolina’s LatinX residents represent nearly 10 percent of the population, but early in the pandemic, they had more than 30 percent of the lab-confirmed cases of COVID-19.

Outbreaks in meat processing plants infected workers who then brought COVID-19 into multi-generational homes.

Others were getting sick simply by going to work.

As the case numbers grew through the end of 2020 to more than 520,000, LatinX residents continued to test positive for COVID-19 at a disproportionately high rate, now representing 25 percent of the state’s cases.

The pandemic has highlighted systemic racial disparities to health care access and underscored how many LatinX residents fear seeking the attention of a physician or nurse for fear that personal information might be passed along to immigration officials.

Advocates for LatinX workers and families have worked the past 10 months to bring free community testing sites to neighborhoods, churches and trusted community centers to eliminate some of the barriers.

They have stressed the importance of communicating public health messages in Spanish and tried to tackle thorny questions as transparently as possible to assuage fears of seeking care and treatment.

LATIN-19, a group formed in March by Duke physicians Gabriela Maradiaga Panayotti and Viviana Martinez-Bianchi, has been instrumental in highlighting longstanding disparities in the LatinX communities. They also have been the force behind many initiatives designed to close such gaps.

After a LatinX child died from COVID-19, LATIN-19 shared stories of parents not wanting to bring their sick children to the hospital for care because of pandemic visitation policies that could separate them from their parents.

shows a woman in a white coat, holding up a paper surgical mask used to prevent COVID-19 transmission in front of her face — Viviana Martinez-Bianchi, a family physician from Duke University, shows off mask wearing technique during a press conference at the emergency operations center in Raleigh. Martinez-Bianchi gave her presentation in Spanish and in English. Screenshot courtesy: UNC TV

Duke Health changed its visitation policy afterward to all the parents or caregivers of children to join them inside pediatrics facilities.

Now, as COVID-19 vaccines become available, there are efforts underway to show LatinX leaders being immunized on social media platforms and the network Univision to try to head off any hesitancy about their safety. – Anne Blythe

Another epidemic – childhood loneliness

When the pandemic lockdown was new enough to be somewhat novel, 11-year-old girls, Evyn and 12-year-old Vivian talked about their struggles with isolation and loneliness. Their intense longing to be with friends and classmates took a toll on both. The virtual classes allowed them to see their teachers and classmates but didn’t allow them to engage.

the photo shows two young girls posing with their arms around each other. Friends Evan and Vivien haven't been able to spend time together because of COVID-19 — Friends Evyn Lumsden (left) and Vivian Dixon (right) haven’t been able to spend time in person thanks to coronavirus. Researchers are only beginning to understand how being separated from their peers affects children. Photo courtesy: Erika Gantt

A rapid review in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) concluded that loneliness is associated with mental health problems for young people aged 4 to 21, including depression and anxiety, potentially affecting them years later. In fact, young people who are lonely might be as much as three times more likely to develop depression in the future. They also concluded that the impact of loneliness on mental health could last for at least nine years.

“As school closures continue, indoor play facilities remain closed and at best, young people can meet outdoors in small groups only, chances are that many are lonely (and continue to be so over time),” said lead author, Maria Loades, senior lecturer in clinical psychology at the University of Bath, UK.

Even before the COVID-19 pandemic, health experts were concerned about what they termed an epidemic of loneliness. she gained a new appreciation for the toll that could take on her overall mental health. While isolation takes a toll on all of us, it may be particularly hard on children still learning to regulate their emotions.

Experts say that while kids are generally resilient, mental health and behavioral issues can be exacerbated by the stress, strangeness and stagnation of the pandemic that mandates continued school closures with no end in sight. – Melba Newsome

Seniors bear the brunt of COVID mortality

By Christmas Eve, 2,356 people had died of COVID-19 in North Carolina’s nursing homes this year — making up more than one in three of pandemic deaths across the state. For the sake of comparison, that’s about the population of the rural/suburban town of Green Level, in Alamance County, population 2,386.

More than 69,000 people aged 65 and older had contracted the disease by late December, according to the state Department of Health and Human Services. That meant older people made up 15 percent of the total state COVID caseload of 516,828, not far from the 16.7 percent of population they make up across North Carolina.

But as of the same time period, people older than 65 represented about 36 percent of North Carolina residents’ deaths from COVID.

Early on in the global pandemic, state residents and caregivers had trouble getting information on the diagnosis and lack of treatment for people with the frightening new disease.

Andrea Hummel, of Huntersville, was allowed little contact with Stanford Hummel, 88, her father, after he had moved into Autumn Care of Cornelius to recuperate following treatment for pneumonia. After he received a COVID-19 diagnosis, Korean War veteran Hummel was sent to a nearby hospital, where he died in March.

Sanford Hummel, who served in the Air Force in the Korean War, enjoys a visit to the Wright Memorial in KItty Hawk. Hummel died at 88 after contracting COVID-19 at a Cornelius nursing home. Photo courtesy Andrea Hummel Gorman.

“I got a phone call from them, telling me that he had to go to the hospital because his oxygen levels were down to 60,” Andrea Hummel told NC Health News. “And he was having a hard time breathing.

“So I asked them, ‘Did you guys get his COVID results?’ And they said, ‘What? Nobody called you? It was positive.’”

Hundreds of more deaths among nursing home residents have kept coming, from every corner of the state. Chances to get the disease rose calamitously as staff, health professionals and caregivers may have introduced infections to nursing homes without knowing it.

That means lockdown or masking programs in the greater community help nursing home residents, too.

The virus, marked by a scary resilience, from the first cases attacked older people in nursing homes and other congregate living sites across North Carolina. By early April, COVID-related deaths were occurring in nursing homes.

However, in the months since, the proportion of older people among the fatalities has declined as treatment has improved and young people have begun dying at higher rates. – Thomas Goldsmith

COVID treatment – hypes and successes

As the pandemic ripped through the state, North Carolinians, along with other Americans, sought for treatment and relief from the ravages of the disease caused by COVID-19.

Even as North Carolina-based researchers were racing to get approvals for remdesivir, a drug developed and tested with significant input from scientists based at the University of North Carolina at Chapel Hill, others sought treatment with an old malaria drug, hydroxychloroquine.

That medication received a boost from an unlikely quarter, President Donald Trump, who latched onto early reports out of France that the drug could be useful in fighting the disease.

David Kroll, a pharmacology professor who made his name studying biologic-based pharmaceuticals such as hydroxychloroquine, said that the mechanism of action of the drug made it potentially useful against a variety of viruses. But he also disparaged the by-the-seat-of-your-pants touting of medications.

“For a leader of a country to say something like that,” Kroll said, “the data are not there.”

”Unless you’re studying it, you don’t know if the drug really was effective or not,” he added. “When you do that, open the flood gates, collecting and interpreting that data really depends on the other things that people are getting.”

Nonetheless, the genie was out of the bottle. Soon, members of the public were scrambling to obtain prescriptions of the drug, and the medication became hard to obtain for many lupus patients, who depend on it. At NC Health News, we fielded an angry call from one physician who criticized the publication for disparaging the use of the drug. She finished the call by stating that she would be getting hydroxychloroquine for herself and her husband.

Actions such as those by physicians across the state prompted the North Carolina Board of Pharmacy to issue emergency rules to stop the hoarding of the drug by physicians.

Meanwhile, by May, the Food and Drug Administration issued an emergency use authorization for remdesivir, an antiviral medication developed at the UNC lab of Ralph Baric in conjunction with pharmaceutical company GIlead. While not a slam-dunk, remdesivir is most effective in reducing viral loads in patients if given early in their COVID infections.

Researchers at the state’s academic medical centers also collaborated with intensive care researchers across the country to pool data to find answers for what treatments work best. For instance, that collaborative approach quickly found that an old drug, dexamethasone, was effective in treating people with severe cases of the disease.

“If there’s any change that has happened that should continue going forward, it has been these large, rapid, start-up platform clinical trials, like the ones that informed the use of dexamethasone and discouraged the use of hydroxychloroquine,” said Shannon Carson, an ICU physician who is head of pulmonary medicine at UNC Hospital in Chapel Hill.

a man in a mask worn against COVID looks at the camera. He's standing in a hospital ward. — UNC pulmonology chief Shannon Carson talks about the many adjustments to practice required by his staff in response to COVID-19. Photo credit: Rose Hoban

shows a pink piggy bank wearing stethoscope and the listening end of the stethoscope is on a dollar bill, spending, money

How much will a hip replacement cost? UNC Health has a new estimator tool for that.

December 17, 2020 by Anne Blythe

How much will a hip replacement cost? UNC Health has a new estimator tool for that. - North Carolina Health News

Weeks before a new US hospital price transparency rule takes effect, UNC Health introduces a new app that can help consumers know what they’re likely to be charged for services and care.

By Anne Blythe and Rose Hoban

As 2020 turns into 2021, and health care is on the minds of many looking forward to brighter days and backward at a year like no other, all hospitals within this country will have a new task.

A new rule from the Centers for Medicare and Medicaid Services mandating hospital price transparency takes effect Jan. 1, despite legal challenges from the hospital industry over the past year that fell short of persuading the courts to overturn the change by the Trump administration.

All hospitals in the United States will be required to provide the public with a list of standard charges for health care services and do so in an easily accessible, easily searchable format for consumers. They also will be required to include the costs of supplies, as well as any room, board and facility fees.

Not doing so could result in civil monetary penalties if corrective action is not taken. That could result in the fines being posted on the CMS website.

UNC Health, North Carolina’s largest academic health system, did a soft rollout of its new cost transparency tool last week, an app and website that officials there say are works in progress.

The tool currently makes it possible for consumers, those with insurance and without it, to estimate how much an office visit, simple procedure or some inpatient services will cost at UNC Health Triangle providers such as UNC Rex Healthcare and the UNC Medical Center.

You can look up your out-of-pocket expense for a CT scan of the abdomen and pelvis, for example. Or you can get an idea of the bill you’ll get for more than 50 services at the cardiologist, for a broken bone or other orthopedic visit, even sleep studies.

This comes at a time when many with insurance are seeing high deductibles, many in the thousands of dollars, at a time when COVID-19 has reminded people of the importance of health care access.

Averting surprises

“Especially during this pandemic when so many people are seeking medical care for the virus and any other reasons, I think it’s important for hospitals to be as transparent as possible,” Alan Wolf, a UNC Health spokesman, said in a telephone interview late Wednesday afternoon.

Along with the price transparency rule, CMS also will require insurance companies and providers to disclose to patients in an as easily accessible format negotiated and cash contract prices.

You can take a peek at the UNC Health estimator through the My UNC Chart mobile app or on the website. The plan is to add more hospitals affiliated with UNC Health and more services over time.

“We understand the importance of price transparency in health care,” Wesley Burks, CEO of UNC Health, said in a statement issued last week. “This estimator is about improving our patients’ experience and giving them more control in managing their health.”

In recent years, reports of so-called “surprise medical bills” have been on the rise. Huge costs are tacked on to bills when people with insurance get socked with out-of-network charges they were not expecting if they go to a facility not covered by their insurance.

Though such scenarios often occur in emergency situations, when the patients have little ability or time to access cost tools, they could be helpful in trying to negotiate with an insurer.

Efforts ongoing

The federal government has been pushing for more transparency in the costs of health care for about a decade. In 2013, CMS released data on physician payments for the first time and the Affordable Care Act mandated that hospitals publish prices of their services.

Insurance companies have long encouraged their members to use price transparency tools, too, urging patients to shop around ahead of having elective procedures such as CT scans and blood tests.

All of these initiatives have had mixed success in getting patients to use them, in no small part because of the complexity of health care pricing and the complexity of the tools themselves.

In 2007, the state of New Hampshire created a website that would provide negotiated out-of-pocket costs and the negotiated payment prices for several dozen common procedures and services. An analysis published in 2014 found that only about one percent of patients in that state actually used the service over the course of three years, despite nearly one-in-five state residents being in a high deductible health insurance plan.

In the same year, New Hampshire revamped the site to make it easier to use, nonetheless, it took time to get people to use it. A later study, done in 2019 found that consumers saved five percent and insurers saved four percent when people used the website. After five years, out-of-pocket costs for consumers had dropped by 11 percent, saving $7.9 million for consumers over the course of that five year period.

Cracking the nut

In a commentary published in Health Affairs in March 2020 after the rule was finalized Cindy Ehnes, an attorney who led California’s Medicaid managed care program for Gov. Arnold Schwarzenegger argued that the biggest advantage would go to large institutional payers, rather than individual consumers.

“This requirement creates a competitive advantage for large purchasers of health care services—such as insurance companies, large self-insured companies, and labor unions—by providing a low floor from which to negotiate,” the authors wrote. “With the help of in-house analytics experts, large health care purchasers will be able to use data provided through price transparency to reduce their medical spending to the lowest common denominator.”

They noted that about three-quarters of hospital care is unplanned, reducing the ability for patients to comparison shop for care. And they predicted that in the short run, prices for some services, such as X-rays and MRIs would drop, while other hospital services would be increased to make up hospitals’ losses in those more discretionary services.

“There might be more disruption than there is benefit at the end of the day,” said Markus Saba, a professor of marketing and the business of health at UNC Chapel Hill’s Kenan-Flagler School of Business. He argued that in the past, consumers didn’t comparison shop because their health insurance plans insulated them from the true costs of care. Between Medicaid, Medicare and employer-sponsored plans, most consumers haven’t been exposed to the high costs of care. So there’s been little incentive to use a tool like UNC’s.

“I think it’s a big burden. I don’t think it’s going to solve the problem. It’s not going to crack the nut,” Saba said. He argued that waste, fraud and abuse in the health care system are much bigger problems than consumers paying too much for an individual procedure.

Nonethelss, more people are exposed to the costs of care. Fewer than half of all North Carolinians get their insurance from an employer and more people are in high deductible health plans. According to the Kaiser Family Foundation, the average deductible for an employer plan with family coverage is upwards of $4,000. So, such price transparency initiatives may finally get more attention from consumers.

But Saba was unconvinced.

“It’s nice, it looks good. It doesn’t hurt. I don’t mind it, go ahead, but it’s not going to fix the problem,” he said. “I don’t know how we get out of treatment and into prevention, because all we’re doing is trying to fix things once they’re broken.”

shows two women in aprons, gloves, masks and goggles opening up a cardboard box filled with vaccines

Coronavirus Today – Dec. 15 – Vaccine distribution war room; Pfizer allotments are here; Federal allotment scheduling trouble

December 15, 2020 by Anne Blythe

Coronavirus Today – Dec. 15 – Vaccine distribution war room; Pfizer allotments are here; Federal allotment scheduling trouble - North Carolina Health News

North Carolina celebrates the opening of its vaccine distribution plan as COVID-19 Thanksgiving surge gets ‘staggering.’

By Anne Blythe

As the battle against COVID-19 heats up in North Carolina, the state’s public health team has set up a war room inside the state’s Emergency Operation Center where they’ve spent much time lately figuring out how to distribute new weapons against the coronavirus.

This week the latest weapon was deployed. It was the vaccine created by Pfizer and BioNTech, a much-anticipated tool that first arrived in North Carolina at 7:20 a.m. Monday at Wake Forest Baptist Medical Center.

Gov. Roy Cooper told reporters at a Tuesday briefing that he spoke with Danny Parson, the UPS delivery driver who dropped off that first allotment of vaccines that public health teams tout as the weapon needed to bring the deadly coronavirus pandemic to an end.

Since early March, North Carolina has had 446,601 lab-confirmed cases of COVID-19, 5,881 which have led to deaths, as of the Tuesday afternoon count.

“There’s real hope that we can stop those painful losses,” Cooper said. “Vaccinations are underway in North Carolina.”

In addition to Wake Forest Baptist Medical Center, 10 other sites have been selected to get the state’s initial allotment of the Pfizer vaccine, an expected 85,800 doses that are to go first to health care workers on COVID-19 wards and in emergency rooms, where the risk of exposure to the virus is high.

Duke Health also received vaccines on Monday, as well as Atrium Health, which began the administration of vaccines on Monday, going first to health care workers in the intensive care units and emergency departments.

“This has been a year that has tested all of us, and after fighting in the trenches 24/7, I am so happy that the cavalry is finally starting to arrive,” Eugene A. Woods, president and CEO of Atrium Health, said in a statement released Monday.

First shot in the arm

First in line at Atrium was Katie Passaretti, medical director of Infection Prevention.

“This is a moment of hope as this vaccine has the potential to change the course of where we are with the pandemic,” Passaretti said in a video that has been shared widely. “I couldn’t be more excited. I feel perfectly fine and I haven’t had any issues or complications with the vaccine. I would highly encourage everyone to talk with your doctor and consider getting vaccinated when it is available for you.”

Mandy Cohen, secretary of the state Department of Health and Human Services, described Monday as “a historic and emotional day for many as we finally have a new tool to protect people from this virus.

Eight hospitals received vaccine shipments on Tuesday, bringing the total number of health care sites with Pfizer shipments to 11 in North Carolina. Forty-two hospitals are expected to receive shipments on Thursday.

Loc Culp, the clinical manager of the medical intensive care unit at UNC Hospital in Chapel Hill, was the first person in the UNC Health system to receive the vaccine. Culp, who was promoted to her job only two months before the pandemic struck, said getting the vaccine was emotional.

“The last 10 months have been really hard,” she told reporters during a Zoom call. “I think of situations like, families getting it, two brothers that got COVID and they passed away. And a husband and wife, they got COVID and passed away within days of each other. And I remember a gentleman that went on a golf trip with his friends, and out of all his friends, he got COVID. I think they all got COVID, but he ended up passing away, and the others did not.”

Hoping to change the federal cadence

The state’s vaccination plan has been in the making for months, and though it could be late spring or as late as early summer before vaccines are widely available to people without predetermined high risk factors, the state is testing the mettle of its preparations.

One issue that already has come to the fore and caused Cooper to put in a special request to Vice President Mike Pence is a tight notification and delivery timeline. Each week, the federal government will inform states on Friday morning how much vaccine they can expect to receive the following Monday. The states must get back to federal officials by 8 p.m. that same Friday with the sites in North Carolina where they want the shipments to go.

This gives the states “just a few hours to direct where those shipments will go,” Cooper said.

He and other governors raised the issue with the vice president during a call on Monday.

“I asked for more time to plan, which is critical as our vaccines roll out across the state,” Cooper said. “They said they will work on it.”

As has been the case more often than state officials would like, the federal government has not always provided concrete answers about the quantity of supplies the states can expect in their war against COVID-19.

In the spring, testing supplies and personal protective equipment for health care workers and others on the frontlines were not coming fast enough, so states had to take it upon themselves to obtain the needed tools to help limit the spread of the disease.

Adding to the complicated logistics, the cadence, as federal leaders call the timing of vaccine rollouts to states, could soon include a second vaccine.

Moderna vaccine in the mix soon?

Moderna, which put in an application to the federal Food and Drug Administration a week behind Pfizer, could find out this week whether the pharmaceutical company will also be given emergency use authorization for distributing its vaccine.

The Vaccines and Related Biological Products Advisory Committee, or VRBPAC, an advisory committee made up of scientists not affiliated to the FDA or the company seeking authorization, is scheduled to meet Thursday to review and discuss safety information and data provided by Moderna.

If the approval is granted, North Carolina could see an additional 175,000 Moderna vaccines next week to complement its Pfizer supplies.

Half of those vaccines would go to nursing homes and long-term care facilities, whose residents and staff also are near the top of the list for inoculation against COVID-19.

“We will have very limited supply of the vaccine at first,” Cohen stressed.

Holiday surge upon Thanksgiving surge?

For weeks, Cohen and Cooper have tried to get North Carolinians to forgo holiday traditions of the past and celebrate Christmas and the end of 2020 and beginning of 2021 with their immediate households only.

Despite their pleas and guidance from the Centers for Disease Control and Prevention recommending against traveling for the holidays for multi-household gatherings, North Carolina expects some residents to ignore the cautions.

Because of that, the state is setting up 300 free community testing events in the coming weeks, urging anyone who travels to get tested several days ahead with full knowledge that a negative result is not a free pass to forgo masks or other social distancing measures.

Excerpt from an NC Department of Health and Human Services press release:

The North Carolina Department of Health and Human Services will offer more than 300 no-cost, walk-up or drive-through COVID-19 testing events over the next two weeks to help North Carolinians protect themselves and their loved ones during the holidays. This includes testing in partnership with new retailers in seven counties across the state.

In addition to existing testing events throughout North Carolina, retailers in Buncombe, Durham, Harnett, Iredell, Lee, Mecklenburg and Wake counties are offering testing Dec. 18-20 and Dec. 26-27 in the parking lots of select Agri Supply, Carlie C’s IGA, Home Depot, Piggly Wiggly and Wegman’s stores.

For a full list of all testing event times and locations throughout the state, visit the No-Cost Community Testing Events page on the NCDHHS website. More locations are being added each day, and additional testing sites can be found at Find My Testing Place.

Thanksgiving, not quite three weeks ago, contributed to record case counts, hospitalizations and intensive care unit admissions in North Carolina.

Now, public health officials worry about a surge atop that surge, and too few nurses and other health care workers to tend to the ill.

“We are experiencing a staggering increase in our pandemic trends, and I am particularly worried about our hospital capacity,” Cohen said. “Just one month ago, we had 1,395 people in the hospital with COVID-19. Today we have 2,735 people in the hospital right now. That’s twice as many people hospitalized than we had on Nov. 15.”

One month ago, Cohen said, 350 people were in intensive care units across North Carolina, battling illness related to COVID-19. On Tuesday, there were 643 people in the ICU, she added.

“I know we’re all getting so numb to these numbers so I’m asking you to take a moment to think about who these people are,” Cohen said. “They’re our neighbors. Our friends. Our family members. They are people we love.”

For many months, Cohen and Cooper have been pleading with North Carolinians to embrace face masks as a necessary weapon in the battle against COVID-19.

Public health advisors continue to stress their importance even as inoculations against the virus begin.

Enforcement help from cities, towns and counties?

On Friday, Cooper, Cohen and Erik Hooks, secretary of the state Department of Public Safety, sent a letter to governing officials of towns, cities and counties across the state, letting them know that Josh Stein, the state attorney general, had issued an advisory concluding that municipalities had legal authority to adopt civil penalties for violators of the governor’s pandemic-related orders.

“Now more than ever we need help with enforcement from our local partners to fight this raging pandemic,” Cooper said at the time. “Taking steps now to protect our communities by enforcing safety precautions will help reduce transmission of the virus and save lives.”

Cooper stressed his support for that on Tuesday, too. He highlighted that penalties for violations in his order can be criminal offenses, although he said civil penalties and fines could be more effective.

“Our aim is not to get people in trouble,” Cooper said. “It’s to get people to do the right things to slow the spread of this virus and to keep it from overwhelming our hospital systems.”

‘Logistically complex’

Juggling the distribution of vaccines and the continued rage of the pandemic with so many unknowns could lead to some unexpected bumps down the road, Cohen and Cooper cautioned.

The state built a database in which they can keep track of where vaccines are distributed, which kind went to which location and when second doses of two-dose vaccines are due.

The Pfizer vaccine spaces the doses 21 days apart. The Moderna doses are administered 28 days apart. For them to be effective people must get both shots from the same pharmaceutical company.

“This is logistically complex,” Cooper said.

The state will have to have good communication with health care providers to make sure the distribution is successful. As the state moves beyond the initial phase of distribution, the plan gets more and more complex.

The Moderna vaccine, which comes in smaller allotments and does not require ultra-cold storage like the Pfizer drug does, is likely to be sent to rural areas.

“As we get more and more vaccine and spread it out further across the state, it will get more complex because there are more people who are going to be involved in it,” Cooper said.

“I know that Dr. Cohen and the team there have been working on this, really on an hourly basis here. They’ve set up a war room, where they are taking questions from health care providers and providing answers, as you can imagine, as the trucks roll in and put the vaccines out, there are some questions by providers,” he added. “We’re trying to communicate and making sure they know exactly what to do and that we don’t waste a single dose.”

Currently, North Carolina is only receiving first doses of the Pfizer vaccine. Two weeks from now, Cohen said, the same places that received the initial allotments will get the second doses so they can administer the second shot to all who received the first one within the 21-day window.

“As the governor said, this is going to get complex because we will be sending out first doses and second doses as soon as a couple of weeks from now,” Cohen added.

Cape Fear Valley Health system restricts visitors

The Fayetteville-based Cape Fear Valley Health system announced its facilities will be closed to visitors until further notice, with the following exceptions:

Labor & Delivery: Laboring mothers may have one support person/coach for the duration of their stay. If that person leaves the premises for any reason, he or she will not be allowed back into the building.
Pediatric patients: A legal minor may have one parent or guardian with them.
Patients who need a health care decision-maker or require communication assistance may have one assistance person with them.
End-of-life patients may have one one-hour visit with up to four people.

“Even in the above situations, visitors with symptoms of a fever or respiratory illness symptoms, including cough or shortness of breath, should remain home. Hospitals will screen visitors for signs and symptoms of illness,” the hospital system said in a news release dated Monday.

— Greg Barnes

Coronavirus by the numbers

According to NCDHHS data, as of Tuesday afternoon:

5,881 people total in North Carolina have died of coronavirus.
446,601 have been diagnosed with the disease. Of those, 2,735 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.
365,273 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, 6,066,204 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 (40 percent). While 15 percent of the positive diagnoses were in people ages 65 and older, seniors make up 82 percent of coronavirus deaths in the state.
493 outbreaks are ongoing in group facilities across the state, including nursing homes and correctional and residential care facilities.
There are 3,551 ventilators in hospitals across the state and 1,084 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital. As of Tuesday, 580 COVID-19 patients were in intensive care units across the state.

Sheriff removes leg cuffs from a psychiatric patient after transporting the man from one hospital to another

More NC psych patients are ending up handcuffed in a police car. Why?

December 14, 2020 by Taylor Knopf

More NC psych patients are ending up handcuffed in a police car. Why? - North Carolina Health News

North Carolina’s use of involuntary commitment for mental health patients increased by 91 percent over a decade. This is the first in an occasional series of stories where we’ll explore what factors are contributing to this rise and what it means for patients.

By Taylor Knopf

When Sonia Padial’s grieving son swallowed too many Tylenol, she took him to the hospital for help.

She says her son, Andrew — whose name has been changed to protect his identity — has autism. He struggles to process emotions, especially around loss. He’s an introvert and forms stronger bonds with animals than other people. So when his dog died a week after his 18th birthday last year, Andrew took it harder than most.

The staff at the UNC Hospital Emergency Department in Chapel Hill decided that Andrew needed to be checked into a psychiatric hospital. They began the process to involuntarily commit him, even though Padial said that her son was willing to get treatment and had been cooperative with the medical staff.

Involuntary commitment (IVC) is a legal process in which a layperson or medical professional asks a judge to order mental health or substance use treatment for an individual against their will. It’s supposed to be used when a person is an immediate “danger to themselves or others.” It results in the temporary loss of an individual’s right to make their own health decisions and forces people to have treatment.

Read other stories in this series:
NC didn’t track the data on mental health commitments, so some advocates did it instead

Despite pitfalls, counties leave psych patient transport in sheriffs’ hands

When a psychiatric bed became available for Andrew at Holly Hill Hospital in Raleigh, Padial said she and her son were shocked and unprepared for how he would be transported there.

Andrew was put in a sheriff’s vehicle with handcuffs on his wrists and shackles on his ankles. A deputy drove him and two other middle-aged male patients — all in restraints — to Raleigh, while Padial followed behind.

Starting the IVC process triggers a custody order to be sent to local law enforcement who then pick up and transport the patient to the hospital. Padial said she pleaded with hospital staff to allow her and her family to drive Andrew instead, as she had been allowed to do in the past when he needed inpatient psychiatric care.

Hospital staff apologized, but said, “this is the way it’s done,” Padial recalled.

“I told them that this would be traumatic and was going to make it worse,” she said.

And it did. A few weeks after Andrew came home from the hospital, Padial said he was struggling again. This time he displayed signs of PTSD, including flashbacks, nightmares, panic attacks and withdrawal from others.

The handcuffs dredged up memories of childhood trauma and seclusion, which Padial said occurred during a previous encounter with the medical system.

“And what I did not do was take him back to the hospital,” she said. “I was not going to put him through it again.”

“This is not health care,” she added.

In North Carolina, stories like Andrew’s are becoming more and more common. In the last decade, there’s been a 91 percent increase in the use of involuntary commitment (IVC) in the state.

Forced psychiatric treatment is on the rise nationally as well. A recent study found that the rate of involuntary commitment is climbing three times faster than the population growth in 25 states for which IVC data is available.

Everyone interviewed for this story — state health officials, doctors, social workers, policy experts, lawyers and mental health advocates — agreed that involuntary commitment should be used as a very last resort. So why has there been such a huge increase?

It’s complicated. But some common themes emerged when talking with those who work in and around North Carolina’s mental health system.

More patients need a ride

Because of the waning number of community mental health resources, more behavioral health patients are showing up at their local emergency rooms. And they are showing up sicker.

When Angela Strain, head of emergency psychiatry at UNC Hospital, did her residency in Chapel Hill more than a decade ago, most behavioral health patients could be evaluated and admitted to the hospital for inpatient treatment fairly quickly. Today, Strain said that so many more patients show up to the ER for psychiatric help that UNC cannot treat them all on-site. She has to refer them out to other hospitals.

“Unless you have a very solid family unit that’s going to transport a very willing patient, really the only safe way to get someone from one hospital to another hospital is involuntary commitment with a sheriff’s deputy,” Strain said.

In her experience, patients 12 years and older who leave UNC Hospital with an Orange County Sheriff deputy are cuffed. Strain said she often sees the same two officers, who have experience transporting IVC patients, and they use some discretion in regard to restraints.

Type a county name into the search box to find out what’s happening in your county.

It’s not uncommon for hospital staff to initiate an involuntary commitment because the patient needs safe, reliable transportation to another facility, according to Mark Botts, a University of North Carolina at Chapel Hill School of Government professor who specializes in mental health law.

He’s done IVC training with hospital staff around the state for 25 years. During these sessions, some have told Botts that it’s difficult to arrange transportation for a patient without initiating an involuntary commitment.

“Under the IVC process, law enforcement is obligated to provide the transport,” Botts said. “If it’s voluntary admission, there’s no obligation on any party to transport the patient.”

Why not use ambulances?

If you’re in the emergency room due to a heart attack and you need to be transferred to a special cardiac program, an ambulance will likely take you there. So why doesn’t North Carolina use them to transport mental health patients?

“We provide transportation for all manner of other health crises. But when it comes to behavioral health, we act as if it’s this big mystery of how we move people from one place to another. And that’s absurd,” said Disability Rights NC lawyer Corye Dunn.

“We have a ridiculous number of IVCs,” she said referring to the 91 percent increase over the last decade. “And a lot of it is that it’s the default setting for the hospitals.”

Most counties reserve ambulances for patients with acute medical needs who may need fluids or oxygen on the way to the hospital, said Carrie Brown, Chief Medical Officer of behavioral health at the state Department of Health and Human Services. “That’s always going to have to be the priority.”

But using law enforcement for involuntary commitment transfers isn’t unique to North Carolina.

“The entire country has reverted to law enforcement for transportation of IVC, which on principle doesn’t make a lot of sense because there’s no crime being committed,” Brown said. “But it’s a very secure way to get people from one point to another safely.”

Recent changes to North Carolina’s IVC law required behavioral health management organizations (LME-MCOs) to work with the counties they cover to create community crisis plans, which include transportation of IVC patients.

In short, counties are not required to use law enforcement.

In a new IVC training developed by DHHS, Brown said the department has gone on record saying that involuntary commitment should never be used just because someone needs a ride.

“That’s not what involuntary commitment is about,” she added. “Involuntary commitment must be a last resort. And oftentimes, you can accomplish a voluntary admission, it just takes a little more time.”

Misconceptions

Another reason voluntary patients are being involuntarily committed is the misconception that the inpatient psychiatric facilities require it.

Last year when a teenage girl in Chapel Hill was having thoughts of suicide, she agreed to go to the UNC Hospital emergency department for help, her father told NC Health News. He recalled doctors telling him and his wife that they could transport their daughter once a psychiatric bed opened up.

“Based on the current evaluation, if receiving facility allows (sic), it would likely be appropriate for parents to transport patient to another hospital given that patient has a good relationship with parents and is seeking help,” the attending psychiatrist wrote in the patient’s records, which the father provided to NC Health News.

The very next line in the patient’s medical chart says that a bed became available and commitment papers were filed. The father felt blindsided when he learned his daughter had been involuntarily committed and that a law enforcement officer was there to drive her an hour and a half drive to the next hospital.

At multiple IVC training sessions throughout the state, Botts has heard hospital workers say that the psychiatric hospital will not take the patient unless the IVC process has been initiated.

Strain, the UNC Hospital psychiatrist, said that the state hospitals — Central Regional, Cherry and Broughton — “won’t accept a patient who is voluntary. Some of the community hospitals would potentially take a patient voluntarily if we had a safe way to transport them there.”

In Mecklenburg County, public defender Bob Ward said he frequently represents clients in involuntary commitment hearings who willingly seek help.

“So I’ve had situations where the doctors don’t like it, the patients don’t like it, and they’re cooperating with treatment, but then they want to go to Broughton to get the help that they need,” he said. “But Broughton will not accept you unless you are committed.”

“You basically have to agree to say, ‘Yes, I’m a danger to myself or others,’ which is pretty discouraging if you think about it,” Ward said.

However, DHHS’s Chief Medical Officer Brown denied this, saying an IVC is not required for admission to the state’s psychiatric hospitals.

Fear of liability

In some ways, involuntary commitment is the safest path of least resistance.

“IVC gives them the ability to streamline this process and guarantee no hiccups from the patient side, even if that might not be entirely necessary,” said Botts, of the UNC School of Government.

There’s a concern that if the patient is transported by family, someone may change their mind on the way to the second hospital, he added. And the patient may not arrive or be admitted safely.

IVC is also the path with the lowest risk of liability. There is a common fear that a patient will jump out of a car on the drive from one hospital to another, according to several people interviewed for this article.

Strain said that while there are situations where family members of psychiatric patients from UNC Hospital drive them, it’s not the most common route.

“There’s a lot more liability putting someone in a personal vehicle,” Strain said.

At Disability Rights, Dunn said she often hears from health providers with concerns about a patient’s ability to give “informed consent.”

“Which is troubling,” she said. “That’s because they’re worried about liability. But because they’re worried about liability, our clients can’t get the services they need and want without losing their rights, which is a huge disincentive to seeking treatment.”

Criminalizing mental health

Forced treatment under involuntary commitment can deter people from seeking future mental health care.

Young people report feeling more depressed and distrustful of the mental health system after being involuntarily committed, according to a 2019 study out of the University of South Florida. USF behavioral health researchers interviewed 30 teens and young adults about their experiences being treated under IVC.

The majority said that they would be hesitant to get help next time.

“After the first time I was [IVCed], I felt like if I confided in someone that I was upset, that they would — even if I wasn’t suicidal — that they would [hospitalize] me,” one study participant said. “I felt almost like I was being punished for my feelings. You should be able to feel confident in saying that you’re sad without fearing that you’re gonna be locked up.”

And though there are sheriff’s deputies who work with mental health patients who are experienced and trained in de-escalation techniques, that’s not always the case.

Earlier this year, WBTV reported a story with a video of a teenage boy who was tased and beaten by security guards and a Lincoln County sheriff’s deputy after his mother took him to the hospital for psychiatric help. His mother told WBTV that her son had been treated for mental health issues in the past and was already reluctant to go to the hospital that day.

At UNC Hospital, Strain said that the default for transportation has been the sheriff. She added that UNC is currently working on an alternative transportation plan for their mental health patients.

psychiatric patient walks from sheriff's car into the hospital in hand and leg cuffs during an involuntary commitment — Andrew, an 18-year-old psychiatric patient, walks in leg and handcuffs from a sheriff’s car into Holly Hill Hospital in Raleigh after being transported under an involuntary commitment order. Photo credit: Sonia Padial

“We don’t want to be criminalizing mental illness,” Strain said. “Nobody likes the idea of putting someone who is in a psychiatrically fragile state into shackles in a police vehicle. We definitely hear about it from parents when kids have to go. And we hear about it from adult patients who have a history of trauma, with police or having been confined.”

Compounding trauma

Taking someone’s rights away and tying their wrists and ankles together in the course of mental health treatment can be an extremely traumatizing experience.

“And to take somebody who’s experienced powerlessness through trauma, and then to remove their power, through involuntary commitment is like compounding trauma on top of trauma,” said Cherene Allen-Caraco, CEO of Promise Resource Network, a peer-run mental health services agency in Charlotte.

Allen-Caraco speaks from experience as a survivor of complex trauma.

“[Involuntary commitment] for me, personally, would be more excruciating, more harmful than anything that could possibly be helpful that came from it,” she said.

Caring for people with complicated mental health issues requires the time and skills to navigate tough situations and conversations, including those about self-harm and suicide, Allen-Caraco said.

“You can’t go to the default of ‘go to the hospital,’” she said. “To do this kind of work well, you need to establish relationship and trust and be comfortable with uncomfortable situations.”

For Padial’s son Andrew, the trauma evoked by the IVC process was so severe that he moved to live with a family member in another state. He feels better now that he’s far away from the place where it all took place, Padial said.

“Though he did nothing wrong, he felt criminalized and humiliated for having a mental illness,” she said. “That experience changed all of our lives. We have a different kid now.”

Padial is working to complete her social work degree and advocates to change the IVC process in North Carolina. And though the last year was tough for Andrew, Padial said he’s attending community college classes and wants to help people like himself someday.

This article includes sources who North Carolina Health News chose to grant a degree of anonymity. We verified the identities and stories of those whose names were changed through interviews and reviews of video and medical records. We changed Sonia Padial’s son’s name to Andrew to protect his identity and blurred his face in the photos. Andrew agreed to the use of his story and photos under these conditions. NC Health News also granted anonymity to a Chapel Hill father and his teenage child due to the sensitive nature of their story.

Mental health patients fill the ER, waiting weeks for help

October 13, 2020 by Taylor Knopf

Mental health patients fill the ER, waiting weeks for help - North Carolina Health News

Due to a lack of mental health community services, more patients are languishing in emergency departments — sometimes for weeks — waiting for an inpatient psychiatric bed to open up somewhere in North Carolina.

By Taylor Knopf

Bridget Narsh said she was unhappy that her son, Mason, spent 26 days this summer in a “windowless room” at UNC Hospital’s Emergency Department in Chapel Hill.

Mason is a 15-year-old with autism, ADHD, anxiety and PTSD. The changes and disruptions generated by the coronavirus pandemic have been difficult for him and the whole family, she said. He’s had angry outbursts, ran away from his parents in public and at home, and refused to take his medications.

When things get really bad at home, Narsh said she has no other option than to take Mason to the hospital to be evaluated and admitted to an inpatient psychiatric facility for treatment. Narsh recalled at least eight times she’s taken Mason to the hospital for mental health care over the last few years.

“When I go to UNC, I know it’s just a holding spot for him,” she said.

During his last stay, Narsh said her son was put in restraints multiple times because the staff does not always know how to help him.

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shows a boy with rosy cheeks laying on the floor, looking over his shoulder at the camera and smiling. — Wyatt Barron was 11 years old in 2017 when he spent 10 days waiting for a psych bed. He was back in the ER this fall. Photo courtesy the Barron family.

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Families Still Pushing for Access to Autism Therapies

For 11-year-old in ER, The Wait for a Psych Bed is 10 Days

“I’m tired of hearing that they are not equipped for Mason,” she said.

Emergency departments were never designed to board behavioral health patients for long periods of time, said Jane Brice, a physician who’s head of UNC Hospital’s emergency medicine service.

“Our behavioral health population is enormous,” she said. “These folks languish in our emergency department for days and weeks and sometimes — unfortunately — months, waiting for a bed to open up or somewhere for them to go.”

“That is so wrong,” Brice said.

But this is how inpatient psychiatric care works in North Carolina. Patients go to the emergency room to be evaluated. Then they wait.

COVID-19 increases already long wait times

Though the number of mental health patients seeking inpatient psychiatric care dropped immediately after Governor Roy Cooper’s stay-at-home order in March, wait times for admission to the state’s psychiatric hospitals were higher this spring, averaging just over one week.

Over the last fiscal year, a total of 2,646 patients waited an average of six days for admission into one of the state’s three inpatient psychiatric hospitals. Average wait times vary by facility, ranging from three days for admission to Cherry Hospital in Goldsboro to 14 days for admission to Broughton Hospital in Morganton.

Additional pandemic safety measures could be a factor in the increased wait times. At each facility, state hospital officials designated quarantine units for new admissions, as well as units for COVID-19 positive patients and for those with possible exposure to the virus.

While state psychiatric hospitals didn’t close beds, admissions have been delayed as patients are safely admitted through a quarantine unit, N.C. Department of Health and Human Services officials said in an email.

In general, patients were more reluctant to go to the hospital this spring due to fear of contracting coronavirus. And those who delayed care often showed up at the emergency room sicker, including those with mental health issues. Hospital officials across the country reported this phenomenon, one that Brice said held true for UNC as well.

As North Carolinians have learned about the virus and become more comfortable wearing masks and practicing other prevention measures, Brice said her emergency department numbers have returned to normal.

So, why the wait?

When Brice took charge of UNC Chapel Hill’s emergency department five years ago, she began to see a steady increase in mental health patients. Her counterparts across the country reported similar trends.

“We decreased outpatient resources so people who are struggling don’t get the care they need, and then they get worse,” Brice said.

Despite federal laws passed more than a decade ago calling for mental health to be treated on par with physical health, it’s still difficult to get comprehensive mental health insurance coverage. North Carolina has failed to treat mental illness the same as other illnesses, such as heart attacks or strokes. So patients go to the option that should be their last resort.

“Then it becomes an emergency, and they come seeking emergency psychiatric help because they are really psychiatrically ill,” she added. “And then we don’t have anywhere to place them for inpatient care because we decreased those services too.”

Brice became alarmed as she watched more mental health patients waiting longer and longer in her emergency department.

“We didn’t have a safe environment for those people,” she said. “The patients were injured, our staff were injured. Everyone was distressed on multiple levels, morally, ethically, clinically.

“We all saw it was just wrong.”

The emergency department was not built or intended to board mental health patients, and the regular staff was not equipped for this kind of care, Brice said. So she went to the top and asked UNC leadership for help.

“This is a population that’s often overlooked in our society and many people don’t care,” she said. “I didn’t know what kind of reception I was going to get from UNC leaders, but I was shocked at how much they cared once they understood the magnitude of the problem.”

UNC making changes

First Brice was given resources to hire psychiatrists, as well as psychiatric social workers and nurse practitioners to work in the emergency department.

Then last month, UNC opened a new unit in the emergency department to provide more space for behavioral health patients. The new unit is divided into three separate areas with 12 beds each. The 12-bed pods can be further subdivided if needed, Brice said.

Two women hold giant pair of ribbon cutting scissors — Jane Brice, chair of Emergency Medicine at UNC Medical Center (left) and Catherine Madigan, chief nursing officer at UNC Medical Center (right) present UNC’s new Emergency Department Transition Unit at a ribbon cutting ceremony in September. Photo courtesy of UNC Health

This will allow for the grouping of patients so that geriatric patients can be kept together in one area and pediatric patients can be held in another.

“Cohorting patient populations is not only about safety. It’s also therapeutic,” Brice said. “It allows for group therapy with groups of people who have similar problems.”

UNC is fortunate to have the resources to make these changes, and Brice acknowledged that. She said several departments were moved to make space for this new unit at UNC Hospital, and it will not make the hospital any money.

“We lose an enormous amount of money in the care of these patients. Many cannot work due to their illness, or they are uninsured or underinsured, and our state didn’t expand Medicaid,” Brice noted.

Most emergency departments around the state cannot provide this level of care for psychiatric patients, particularly in rural areas. Many rural hospitals run in the red each year due to the large number of uninsured patients they treat in their emergency departments.

In a meeting with the governor last year, the CEO of Northern Hospital in Mount Airy said his emergency department sees between 50 to 60 mental health patients a month who are waiting for a psych bed. The hospital doesn’t get paid for treating these patients, he said, adding that North Carolina needed to expand Medicaid.

Finding solutions

In the end, these hospital stays are only a Band-Aid for most patients with a mental illness.

Mason has already been hospitalized twice this year. In the spring, he spent 78 days at Central Region Hospital, one of three state-run psychiatric hospitals, according to his mother, Bridget Narsh.

Earlier this month, state health officials announced $7 million in COVID-19 relief funds to connect people to preventative care and mental health supports, particularly in marginalized communities. By providing more community services, state officials hope to prevent behavioral health patients from ending up in the emergency department.

After watching her son cycle in and out of hospitals, Narsh requested the reserved capacity Innovations Waiver, a North Carolina Medicaid program for people with disabilities who need regular assistance to continue living independently.

But these services are extremely difficult to get. The typical Innovations Waiver has a waitlist that can be up to 10 years long. However, the reserve capacity slots are for emergency situations when there is an “imminent risk of immediate harm,” according to the application.

After 26 days of waiting in the UNC emergency department for a psych bed for the second time this year, Narsh got the call that Mason was approved for the emergency waiver services and she took him home.

Mom and son sitting on a front porch — Bridget Narsh has been fighting for mental health services for her son, Mason, who has autism. He’s been in and out of psychiatric hospitals over the last few years and finally has in-home services that have been life changing for him. Photo courtesy of Shannen Speer Photography

“He went from having no services to everything you can imagine for life,” Narsh said. “It’s extremely rare to get this at age 15. Things have to be pretty serious to get something like the reserve capacity.”

She said she was shocked to hear the list of services available to Mason and her family, everything from a therapy dog, to a certified aid for her son, to respite hours for her and her husband.

Just in the first few weeks, Mason is doing much better with a three-person intensive home team that shows up several days each week, and ABA therapy twice a week, she said. The waiver services got off to a rocky start as fewer aides are available right now, but Narsh said she feels as though her son “hit the mental health care jackpot.”

“In the long run, I’m hoping that he’ll never have to go back to the emergency department,” she said.

we see an industrial complex / poultry plant where multiple Latino workers have tested positive for COVID

Latino North Carolinians infected with COVID-19 ‘simply by going to work’

June 11, 2020 by Anne Blythe

Latino North Carolinians infected with COVID-19 ‘simply by going to work’ - North Carolina Health News

Duke professors, physicians and state leaders eye ways to slow the spread of COVID-19 in Hispanic communities, where it's hit hard.

By Anne Blythe

Many Latino North Carolinians have felt the disproportionate impact of COVID-19 because they have been essential workers during the pandemic, working at meat processing plants, on construction sites or in grocery stores and other places where it can be difficult to avoid the virus.

A nursing professor, a pediatric physician and doctor in family medicine at Duke University held a media briefing on Wednesday to discuss how the state could provide more resources and health protections for these communities.

Viviana Martinez-Bianchi, a professor of family medicine, Rosa Gonzalez-Guarda, a nursing professor, and Gabriela M. Maradiaga Panayotti, a pediatrics professor, ticked off a list of interventions that could push down the infection rates for Latinos.

Those included such things as more targeted health education campaigns, expanding access to health insurance, making sure employers provide paid sick leave so they won’t feel the pressure to work when infected, and insisting that workplaces make it possible for them to follow social-distancing measures while on the job.

Latinos, the coronavirus and a single ZIP code

“The primary way the Latinx community is becoming infected is simply by going to work,” Gonzalez-Guarda said. “If we think about prevention, it’s important for us to do more around providing appropriate protections in the workplace.

“This means not only providing masks and social distancing measures in the workplace but putting pressure on business owners to provide paid sick leave … so people don’t have to make the decision between going to work while they’re sick and potentially infecting others, or paying rent and providing food at home.”

Testing for COVID-19 also is important, Gonzalez-Guarda said, but just as important is letting the community know who will pay for it and how to gain access to health insurance.

Confusion about testing costs

The state has created a program to ramp up testing and tracing efforts in Latino and African American communities, which have felt the brunt of the virus in large part because of long-standing health access disparities.

Data, graphics courtesy: NC DHHS

Martinez-Bianchi said it is important for all the public health departments to release ethnicity data and all demographics to better inform and prepare a pandemic response.

One interesting phenomenon has been that even though Hispanics are about 10 percent of the population, they have comprised some 42 percent of cases as of June 10 but only 7 percent of the deaths. Ethnicity data is missing for about a third of the state’s cases.

“Many of them are younger,” speculated pulmonologist Shannon Carson from UNC Hospital during an interview with NC Health News on June 5. At that point, Latinos had comprised about 40 percent of the cases treated at UNC Hospital in Chapel Hill.

“Many of these patients did have some comorbidities whether it be diabetes or hypertension … but otherwise being working people, active, came in with some strength and reserve, which is what it takes to endure multi-organ failure and the recovery time that’s required.”

Building trust

Mandy Cohen, secretary of the state Department of Health and Human Services, was also in on a conversation with advocates for the Latino population on Wednesday and mentioned it at a media briefing in the afternoon.

She mentioned the testing, tracing and surging work that the state plans to do, but acknowledged that additional focus would be needed.

Gonzalez-Guarda, who is doing research on COVID-19 and the Latino community, said that she has been hearing from some of her research participants their fears for reaching out for help. Some are worried their immigration status could be compromised, she said, and others are worried about the bills they could rack up getting tests or care.

“There’s so much work to do,” Cohen said. “We’re always wanting to get better as a state to make sure that we are appropriately responding, particularly as we see our historically marginalized communities more disproportionately impacted by COVID-19.”

Isolation at home challenging

One of the issues that has come up with workers around meat processing plants, farms and construction crews is how to prevent virus spread in a household, especially when it can be difficult to isolate someone who has been exposed.

“This is very challenging,” Maradiaga said. “Anybody who lives with any other person knows how much contact one has with each other. We are recommending a few basic things but also recognizing this can be hard. If possible, the person who is sick should be isolated in a separate room and a separate bathroom.

“Often, that’s not possible so we’re trying to say, in whatever way you can, minimize contact with that person. That person should wear a mask, and the other people in that house, including children two and up, should wear a mask. Good hand washing, not quick hand washing, good hand washing, 20 seconds or more. And being especially careful with anything that touches the mouth.”

Mike Sprayberry, director of emergency management, told reporters on Wednesday that the federal government had granted a 30-day extension for a program through which counties can tap into federal money to pay for motel rooms for people with the virus who are homeless or who otherwise cannot isolate themselves from people in their homes.

Federal resources available

Forty counties have used the program, according to Sprayberry.

Cohen said she hoped others would use it, perhaps to help in communities of color where isolating and social-distancing can be difficult.

“I’m excited to see as many as 40 taking advantage of it,” Cohen said. “I want to see even more take advantage of this federal support. It’s federal dollars that support non-congregate sheltering. I think that’s going to be really important as we continue to go forward here.”

Cohen also wants people to take advantage of the increased testing opportunities across the state to help identify and slow the spread of the virus.

“We have 400 testing sites, but it’s not like we have lines out the door or we have waits at our labs,” Cohen said. “We need to make sure folks know there is capacity. We want them to get tested, that these kinds of occupations can lend themselves to more exposure.”

Rose Hoban contributed to this report.

Additional Thanks

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