Disparities in Latinx patients receiving COVID-19 treatment ‘blatantly appalling’ says NC health official

Dr. Shannon Dowler

Latino residents of North Carolina are likely not getting access to a COVID-19 treatment promoted as preventing hospitalization and death.

Dr. Shannon Dowler, chief medical officer for the state Medicaid program, called the disparity between Latinx patients and others receiving monoclonal antibody treatment “so blatantly appalling.”

DHHS officials presented information that showed that not all residents have the same access to the therapy, and Latinx patients likely being underserved.

Dowler spoke to LATIN-19, a group of Latinx doctors, other medical professionals, community outreach workers, and health program managers who aim to improve access to COVID-19 information, testing, and treatment in Latino communities. Dowler and Angela Cullicutt, a public health nursing manager with the state Department of Health and Human Services, asked those in the meeting for ideas to improve access to monoclonal antibodies.

Monoclonal antibodies are made in labs and work like antibodies the body makes. Monoclonal antibodies attach to viral particles and prevent them from infecting cells.

Monoclonal antibodies are not a substitute for COVID-19 vaccinations, health officials say. The treatment is available to people 12 and older and who are at high risk of serious illness. It is given by IV or injection. The treatment must start within 10 days of the onset of symptoms. It is used for people who have mild to moderate symptoms.

The patient data Dowler presented covered the first half of this year and applied only to people who used Medicaid.  About 25% of the state’s population, or about 2.6 million people, use the government health insurance. Information on people who used private insurance or were uninsured was not presented.

A chart Medicaid of claims for monoclonal antibody treatment showed more than 700 were submitted for non-Hispanic patients, while Hispanic patients represented a small fraction of the claims.

Dowler said one of the Medicaid managed care providers supplied updated numbers that were better, with Latinx patients representing about 25% of the claims.

The numbers were closer for Black and white Medicaid patients. Between 400 and 450 Medicaid claims were filed for white Medicaid recipients, and between 350 and 400 were filed for Black recipients.

Dowler called it “a small disparity… but pretty close.”

The disparity for Native Americans was “significant,” and consistent with the lack of access to testing and vaccines, she said.

Policy Watch reported last month on significant gaps in information about monoclonal antibodies and lack of access in some parts of the state. No federally-qualified health centers in the state, which are important in providing healthcare in rural areas and to marginalized populations, were offering the therapy.

Not all counties have providers offering the treatment, according to a DHHS map presented Wednesday.  Most counties have at least one or two. Large counties have more. Wake has six, according to the DHHS map, and Mecklenburg has 16. But about 20 counties have none.

Dowler said, for example, there is no place in Madison County to get the treatment, the closest location is an hour’s drive, and the wait is more than 10 days. There’s a “real need” for geographic equity, she said.

Information about the therapy has been slow to get to patients and healthcare providers.

A map derived from Medicaid claims data showed that no residents in some western counties, no residents of counties surrounding Rowan County, in a cluster of five counties in the south-central part of the state, and a few other others, had residents using Medicaid who had received monoclonal antibody treatment.

DHHS was preparing a big plan to get monoclonal antibodies to more locations that included using vendors at rural health care centers, Callicutt said. But the federal government changed the rules for distribution last week in the face of sudden high demand. Medical centers and states can no longer put in their own orders. The federal government determines how much each state receives.

“We realize there is a vast need out there,” Callicutt said.

There can be financial hurdles, too. The monoclonal antibodies themselves are free to patients, but providers can charge fees for administration. Medicaid and Medicare pay those fees, but uninsured people or insured people with high deductibles could be billed around $500, Callicutt said.

“It’s a costly service to provide,” she said.

Patients must be observed for an hour afterward after the infusion.

Federally-qualified health centers aren’t paid soon after they provide the service, but are reimbursed once a year. The health centers cannot afford the upfront costs involved with offering the therapy, Dowler said. DHHS is trying to think of a way to help with those expenses, she said.

“We think it’s a critical tool,” she said.

Mecklenburg Co. Manager to suspended, unvaccinated employees: You put yourself in this situation. (with video)

Mecklenburg County Manager Dena Diorio didn’t mince words Tuesday when it came to the status of 86 employees who have failed to follow the county’s COVID protocol.

The county announced in August that government employees would be required to show proof of vaccination or undergo weekly testing in September. As of last week, 322 of the more than 5,800 employees were not in compliance.

That number had dropped to 86 by Tuesday.

“And the people who got jammed-up are the people who didn’t read the information, didn’t follow-up, didn’t have a plan, and they got snagged,” Diorio told county commissioners.

Diorio said county workers who have submitted the appropriate documentation are no longer on the suspension list, but will not receive back pay for the time they were suspended. .

“There are people who have not submitted anything – who have not submitted a vaccination card, who have not submitted any information at all. Nothing. They have been silent,” Diorio said. “Those people are in trouble.”

Those employees who have failed to respond now risk termination.

“That’s an indication to me that they’re not going to follow the policy, and that not following the policy is more important than keeping your job.”

To date, 75% of the county’s employees have complied and received the COVID vaccine, according to Diorio. Countywide, 55% of residents are fully vaccinated.

More than 1,100 residents of the county have died from COVID-19 since the pandemic began in March 2020.

Click below to hear an excerpt of Diorio’s remarks:

“None of this belongs in our public schools.”

NC Governor calls for civility as school boards continue to draw fire over COVID precautions

Governor Roy Cooper said he is troubled by the fevered pitch many school board meetings have reached in recent weeks with parents and politicians fighting mask mandates and COVID precautions.

“Threats, bullying, intimidation. None of this belongs in our public schools particularly by adults,” said Cooper at a Tuesday press conference.

The governor said it is a small but vocal minority of adults showing up to fight mask requirements, and his administration is continuing to encourage all districts to keep the mask requirements in place while the spread of the coronavirus remains high.

“Being civil and respectful of others is more important than ever. Let’s behave the way we want our kids to act.”

North Carolina’s COVID-19 cases have been relatively level over the last few days. But the state is averaging 6,000 new cases each day with roughly 900 North Carolinians requiring intensive care unit beds for more than a month now.

Sec. Mandy Cohen

One-third of all COVID hospital admissions in the past week have been in North Carolinians under the age of 49.

“Our hospitals are strained. And in other states we’ve seen care is not readily available for people experiencing non-COVID life-threatening health crises,” cautioned Health and Human Services Sec. Mandy Cohen.

“We don’t want that to be the experience here.”

Secretary Cohen says vaccination remains the best tool for protection against the highly transmissible virus.

While 86% of North Carolinians 75 and older have now been vaccinated, that number drops down to 38% for the 12-17 age bracket.

“Those of us who interact with schools, need to get vaccinated if you are eligible, and need to wear a mask to prevent the spread of virus. Because the more virus that’s circulating, the more that’s going to end up in our schools,” warned Dr. Cohen.

While the focus remains on keeping students in the classroom for in-person learning during the pandemic, the governor said local districts can present a virtual option to the state school board before October 1st for consideration.

On Tuesday, Gov.Cooper also issued an open letter to the state’s faith community seeking their help in getting more people to roll-up their sleeves and get a COVID shot.

The letter encourages the faith community to sponsor events at their houses of worship and become “vaccine ambassadors.”

The letter reads in part:

Direct your congregation and faith community to trustworthy sources about COVID-19  vaccines, like doctors, other medical providers, and the NCDHHS website YourSpotYourShot.nc.gov. Good people are being misinformed. As a trusted spiritual leader, you can help those who have questions get accurate information. Help educate your community on why  and how to get vaccinated by:
• Posting and sharing vaccine information in common and highly visible areas in your house of
worship.
• Sending a letter or email to your congregants sharing resources that provide accurate
information about vaccines and encouraging people to avoid sharing misinformation on social
media.
• Talking to your congregation about why our faith calls upon us to protect our health and those
around us be getting vaccinated.
• Adding a message encouraging people to get vaccinated to your organization’s voicemail.

The appeal to churches comes as the latest CDC map still shows all North Carolina counties in the red zone with the highly transmissible Delta variant.

Things could be worse — you could live in Florida

Gov. Ron DeSantis reacts to Gainesville city employee Darris Friend’s suggestion that COVID vaccines change people’s RNA (actually, it doesn’t) during a news conference on Sept. 13. 2021. Source: Screenshot/Florida Channel

Columnist explains how Sunshine State COVID craziness keeps getting deeper

“Human kind,” said the poet, “cannot bear too much reality.”

Many Republicans seem especially resistant, preferring to dwell in a miasma of Deep State conspiracies and Internet nonsense inspiring them to believe that Hillary Clinton drinks babies’ blood, Trump won the 2020 election, and that ingesting over-the-feed-store-counter tablets for deworming horses is a better way to protect themselves against a deadly pandemic than getting a thoroughly tested, highly effective, FDA-approved vaccine.

I guess they’re no longer doing Clorox shots.

Gov. Ron DeSantis is Florida’s chief reality-denier. Last week, he threw a tantrum disguised as a press conference in Gainesville, flanked by Attorney General Ashley Moody and CFO Jimmy Patronis. He ranted against the federal vaccine mandate, threatening to fine cities and counties requiring employees to get the COVID jab $5,000 per infraction.

I mean, how dare the government try to save people’s lives?

Then, a couple of characters who were either disgruntled city employees or escapees from the local psych ward got to air their anti-vaccine foolishness. One woman implied that the vaccine might kill her and she didn’t want her children left motherless: “My body, my choice, my business,” she said. “I will not comply.”

Darris Friend, who said he’d worked for the city of Gainesville for 22 years, asserted, “The vaccine changes your RNA.”

Pro tips: The vaccine does not change your RNA. Nor will it kill you.

Want to know what will kill you? The Delta variant. And the cruel cynicism of Florida’s Republican leadership.

The governor could have politely corrected these poor deluded souls. Instead, he looked at the floor and grimaced.

Ashley Moody, who’d clearly left her brain in her car, applauded.

She’s running for reelection, and can’t win without Florida’s Dim Bulb vote.

But here’s the thing, y’all: Moody, Patronis, DeSantis, the governors of vaccine-recusant states like Texas, Mississippi, and Arizona, plus the entire Trump family, have all been vaccinated. They have not grown an extra head. They will not (sadly) be unable to reproduce.

Nevertheless, these Republicans are happy to gamble that they can keep the base braying and snarling and ready to fight the libs over their “free-dumbs” while not losing too many of their clueless-and-proud voters to the virus — which could turn out to be: 1) A fascinating illustration of Darwinism in action; and 2) An electoral problem for Republicans, whose old, white stalwarts are already dying off.

Florida’s COVID rate is appallingly high. Hospitals are grossly over-stretched and ICU beds hard to come by. Undertakers are working double shifts to keep up.

DeSantis’s response to this epic heath care mess is to fight the school boards that have mandated that students wear masks; fight local elected officials who want their employees vaccinated; and fight the president of the United States, who’s told business owners to either get their workers vaccinated to test the hell out of them.

If DeSantis hears that you have mandated your teenaged children get the vaccine, he may come to your house and fight you, too.

Belligerence is his brand and ignorance is his friend. Read more

To avoid possible legal action, Union County resumes COVID quarantine measures

Union Co. Board Chair Melissa Merrell

The Union County Board of Education reversed course Monday, one week after rescinding COVID-19 quarantine measures and contact tracing for students and staff.

Dr. Many Cohen, state Sec. of Health and Human Services, advised the school board last week that their action posed an “imminent threat of serious adverse health consequences.”

Dr. Cohen made it clear in her letter the district could face legal action if it failed to protect the public’s health.

On Monday, a more subdued board issued a statement clarifying that the district will adhere to the quarantine measures directed by the State and local health departments. The new policy also shortens the duration of quarantine, based on further testing or if they are asymptomatic.

Masks will remain optional for all students and staff.

Here’s an excerpt of the new policy:

According to state law, our local health department has taken over primary responsibility of contact tracing and has reduced the length of the quarantine period of asymptomatic individuals, I move that:

  • UCPS will continue to follow its legal obligations of reporting positive cases to the local health department and providing relevant information to the local health department;
  • UCPS will require students and staff who are symptomatic or who have tested positive for COVID-19 to stay home in accordance with state law;
  • UCPS will recognize quarantines, in accordance with state law, of students and staff who are considered close contacts with a COVID-19 positive case.

Based on this motion, UCPS will continue adhering to the quarantine measures directed by the State and local health departments. However, if a student or staff member has been identified as a close contact to a positive case, they will not need to quarantine for 14 days if they remain asymptomatic, rather their quarantine period will be shortened to 10 days and could be shortened to 7 days if the individual has received a negative antigen or PCR/molecular test on a test taken no earlier than day 5 of quarantine. During the quarantine period, students will not be allowed to come to school. When a student or staff member returns to school after 10 or 7 days, they will need to wear a face covering through the 14th day.

Rev. Jimmy H. Bention, Sr. was the only member to vote against the new policy.

“This motion will cause healthy children to be sent home. I vote nay.”

Union County has 352 active COVID cases involving students and staff with 1,822 in quarantine, based on the most recent data on school district’s dashboard.

Click below to watch the board make their decision: