“A return to normalcy” and COVID vaccinations for adolescents

Increased availability of COVID-19 vaccines and falling infection rates hold the promise of a return to typical summer activities, said Mark McClellan of Duke University.

“We should see a lot of progress on reopening in the summer,” McClellan told reporters Thursday. “It will be a good opportunity to test out how much we can start going back to going to sporting events and concerts.”

McClellan, director of the Margolis Center for Health Policy at Duke, anticipated that Pfizer and Moderna vaccines will soon be approved for adolescents, which would help contain outbreaks in fall and winter.

There are some unknowns, including how far variants are spreading.

The United States doesn’t have a good system for finding variants of the virus that causes COVID-19, McClellan said.  As a result, most states don’t know how many people have been infected with them.

The CDC announced this week that it is working to increase the number of specimens that have their genetic codes examined, a process called sequencing, as part of a national surveillance program.

“This is a technology we have in place and can apply widely,” he said. “We just need to get the infrastructure in place.”

Mark McClellan, MD, PhD – Photo: Duke University

The CDC says that the variant first identified in the United Kingdom has been responsible for 40 of North Carolina’s COVID-19 cases, and the variant first identified in South Africa was responsible for three of the state’s cases. The CDC says that these variants are more easily spread, and that the variant identified in the United Kingdom likely makes people sicker.

The increased pace of vaccinations in the country has slowed the spread of variants.

“The more people get vaccinated, the fewer opportunities there are for the virus to spread,” McClellan said. That means the virus doesn’t get a chance to create more copies of itself and there are fewer opportunities for variants to emerge.

North Carolina has seen a big decline in new COVID-19 cases since peaks in December and January, though the numbers of new cases reported daily has started to level off. COVID-19 hospitalizations dipped below 1,000 this week for the first time in months.

Gov. Roy Cooper said this week that he anticipated that every adult in the state would be eligible to receive COVID-19 vaccinations by early May.

The country will need to continue to monitor for variants and determine whether they respond to vaccines, and whether people infected with those variants respond to therapies, McClellan said.

“I do think we’re going to have to be vigilant for a while,” he said.


One year later: UNC health experts reflect on ‘shining examples’ and moving past the pandemic

Today marks exactly one year since the first COVID-19 patient was identified in North Carolina.

An invisible virus no one had ever heard of 12 month ago has registered more than 865,000 cases and stolen 11,363 lives.

Dr. Wesley Burks

Dr. Wesley Burks, the CEO of UNC Health and Dean of the UNC School of Medicine, said Wednesday’s anniversary was a time to reflect on the hard work, the fear, and the sense of purpose borne out of the pandemic.

“We weren’t sure what was going to happen. We definitely didn’t think we’d still be here today talking about it, ” confided Burks.

“But through all of this work, we are different – both collectively and personally.”

Dr. Alexa Mieses Malchuk, an assistant professor in the UNC Department of Family Medicine, said the COVID crisis underscored for her the struggle many marginalized communities face.

“What this COVID pandemic has done has shone a spotlight on health inequities that have existed in this country for decades,” explained Dr. Malchuk. “But it is the first time a global illness has brought these things to the forefront and grabbed everyone’s attention.”

Dr. Alexa Mieses Malchuk

Malchuk says she is now using her position as a woman and a person of color, who grew up in a lower socioeconomic background, to educate her patients about COVID and encourage them to get vaccinated.

Dr. Samantha Meltzer-Brody, chair of UNC’s Department of Psychiatry, said her takeaway
over the last 12 months was the promise and impact of tele-psychiatry in reaching those in crisis.

“We are now able to provide mental health care broadly across the state, to reach people in ways never [seen] before,” Meltzer-Brody said.

“Collectively we are able to take care of behavioral health needs much earlier, with experts, to hopefully decrease suffering and prevent long-lasting damage.”

Dr. Melissa Miller, director of UNC’s Clinical Molecular Microbiology lab, shared her concerns for the toll this has taken on her own colleagues.

Dr. Melissa Miller

Not only did they play a leading national role in developing accurate COVID-19 testing, they have conducted more than 250,000 tests.

“For the first time people are really seeing what the lab does, and how important to patient care laboratory tests are,” Miller shared.

“It’s with great sadnesss and pain that I look back at what we’ve been through in the last year, but also with hope that we have in front of us going forward.”

Dr. David Weber, UNC’s Medical Director of Infection Prevention, reflected on how little we really knew about the virus last March, and how scientists like Dr. Ralph Baric have helped pave a way out of this pandemic.

Weber believes that leading research will help North Carolina and the nation return to some sense of normalcy later this year.

Dr. David Weber

“With the current ability to give everyone the vaccine by May and the given current number of people who have already been infected, it’s likely we’ll begin to reach community protection levels by the end of May or June,” Weber offered.

But this is not a get out of jail free card.

Health professionals still worry about the variants that may escape the protection of the vaccines.

“But both the drug companies working on new therapies and the vaccine companies working on booster doses that cover these variants, give us hope that by the end of the year, life will return mostly to normal.”

Dr. David Wohl, a professor of infectious disease, says pathogens often find a way to take advantage of those who are marginalized, ignored or maligned in a community.

Dr. David Wohl

But he was struck by leaders on all levels to change the direction of ‘a horrible year.’

“Being the first to go in, the first to use PPE and show everyone else how to do it…and almost never saying ‘no,'” said Wohl in praising the tireless efforts of essential health workers.

Moving forward, Dr. Wohl says they will be focused on reaching into the community to accelerate vaccination rates among those who do not have access to high-speed internet or transportation and are challenged to make an appointment.

Over the past year, UNC Health has treated more than 1,700 COVID patients and administered 200,000 doses of vaccine across the state.

To learn more about getting vaccinated against the COVID virus, visit yourshot.org.


Drug overdose ER visits in NC increased 22%

Image: AdobeStock

While the state and the nation have been overwhelmed by the COVID-19 pandemic, the opioid epidemic has marched along its shadow.

Preliminary data from the NC Department of Health and Human Services says that hospital emergency room visits for drug overdoses in 2020 increased 22% over the previous year.

According to DHHS, heroin overdoses were the top reason people were treated in hospital ERs for drug overdoses. “Commonly prescribed opioids” were the third-most common reason for overdoses that led to trips to the hospital.

Ben Powell of SouthLight Healthcare, a substance abuse and mental health treatment non-profit in Wake County, said he considers the COVID-19 pandemic the overarching reason for the increase, and the anxiety and social isolation that have resulted as secondary factors.

Powell is a physician assistant who runs the SouthLight opiate treatment program under the guidance of the medical director.

Another factor is the rising prevalence of fentanyl, a strong synthetic opioid, being mixed with other drugs, Powell said.

There’s increasing concern “about the mix of drugs that are being placed into illicit substances that people are buying now,” he said. Many times, people don’t know that they’re using fentanyl, he said.

Powell referenced a 2017 paper out of the National Bureau of Economic Research that said that for every 1% increase in unemployment, the opioid death rate per 100,000 increases 3.6% and the rate of opioid overdose ER visits per 100,000 increases 7%.

Information on drug overdose deaths in 2020 was not available, but the CDC said in a December press release that the COVID-19 pandemic appeared to be leading to increased deaths.

More than 81,000 people in the country died of a drug overdose in the 12 months that ended in May 2020 the CDC said, more deaths than in any 12-month period in recorded history.  The data suggested that overdose deaths were increasing with the pandemic, the CDC said.

Complete data on overdose deaths over those 12 months in North Carolina was not available.

Before COVID-19 killed more than 2 million people worldwide and devastated economies, opioid addiction was the most prominent public health challenge that focused the attention of the state and the nation.

The week’s top stories on Policy Watch

1. Experts warn of pandemic-relatedeviction tsunami

Another round of stimulus payments or more creative solutions are essential to thwart a social crisis

With the first shipments of a second COVID-19 vaccine arriving as early as next week, many North Carolinians are feeling a new kind of hope as the pandemic stretches into 2021. But without swift government action at the state and federal levels, the new year could usher in an “eviction tsunami” and economic devastation, according to experts who gathered to discuss the problem Tuesday.

The virtual discussion, sponsored by the Duke Law Global Financial Markets Center and the North Carolina Leadership Forum, brought together subject matter experts from across the ideological spectrum to discuss the crisis of rent moratoriums and aid programs expiring in the new year.[Read more…]

2. DEQ’s Michael Regan is Biden’s nominee for EPA administrator

NC Department of Environmental Quality Secretary Michael Regan is the President-elect Joe Biden’s nominee for EPA administrator, according to multiple news sources.

Policy Watch reported yesterday that Regan was the leading contender for the job. A Goldsboro native, Regan has been DEQ secretary since 2017; he was appointed by Gov. Roy Cooper.

A DEQ spokesperson could not be reached for comment.

Regan worked at the EPA for nine years in the late ’90s and mid-’00s before joining the Environmental Defense Fund.

EDF issued this statement from Hawley Truax, Southeast Regional Director of Environmental Defense Fund (EDF). Regan previous served as EDF’s Southeast regional director. [Read more…]

Bonus read: Supporters, detractors grade Regan’s performance as NC DEQ secretary

3. Treasurer’s office, state auditor eyeing 100-plus cities, counties, utilities on “Distressed Unit” list

In a budget crisis, these entities can lose control of their finances to the state 

Janet Gerald, mayor pro tem of Kingstown, knew high sewer costs were a financial strain for the town when she was took office three years ago. Still, the realization that the town needed to relinquish control of its spending hit her hard.

“I was a little disappointed,” she said. “I was sad. I was heartbroken. I was embarrassed. I was crushed.”

Like dozens of towns and a couple of counties in North Carolina, Kingstown landed in financial trouble over problems paying for sewer services. The town, whose 680 residents live in a two-square-mile rectangle in Cleveland County, owes the city of Shelby upward of $200,000 for sewer services, Gerald said.[Read more…]

4. Black Americans are reluctant to take a COVID-19 vaccine. Efforts to build trust are underway.

A history of unethical medical experimentation on Black people has raised vaccine concerns among communities of color.

Coronavirus vaccines were a topic of the day for volunteers at Global Scholars Academy in Durham last Saturday. The church across the street, Union Baptist just north of downtown, was hosting a coronavirus testing site on one side of the school, and volunteers were distributing meals and Christmas gifts on the other side.

The FDA had authorized the Pfizer vaccine for emergency use the night before. Public officials and some residents have turned their hopes to science to help lift the country out of the deadly and economically devastating COVID-19 pandemic.[Read more…]

5. COVID-19 vaccine could be less effective in people with high PFAS levels in blood

The COVID-19 vaccine could be less effective in people with high levels of perfluorinated compounds — PFAS — in their blood, several scientists announced today.

High levels of PFAS exposure is known to be linked to a “plethora of adverse health effects,” including immune system disorders, said Linda Birnbaum, a toxicologist and former director of the National Institute for Environmental Health Science.

That means people with high levels of PFAS in their blood could have a weaker response to the COVID-19 vaccine, and build up fewer antibodies to the vaccine.

“It’s not that you won’t get any response, but that it could be decreased,” Birnbaum said.[Read more…]

6. Vaccine miracle offers model for tackling another giant crisis (commentary)

There are a lot of important lessons that Americans should glean from the mostly awful year that will soon and mercifully come to an end – some of them quite sobering.

We must recognize, for instance, that we still have many miles to travel in conquering the nation’s original sin of racism and that the ground on which our democracy rests is not as rock-solid as we long assumed.

And then there’s the painful reminder that mass willful self-deception — in which millions of humans are driven by fear and mistaken perceptions of self-interest to believe and repeat demonstrable lies —  must still be combated at every turn.

Happily, however, we’ve also received some more hopeful lessons, most notably about the power of truth and love and coming together as a community. [Read more…]

7. Education Secretary Betsy DeVos heads for the exits, leaving a legacy of turmoil

WASHINGTON— During her four years in office, U.S. Education Secretary Betsy DeVos failed to broaden her appeal beyond the moment she won a wild Senate confirmation fight by the closest of margins. She didn’t even try.

Instead, the billionaire Michigan native and Republican megadonor championed private and charter schools, often trying to funnel federal funding toward them. Her full-throated support outraged Democrats in Congress, riled the nation’s powerful teachers unions and never registered as a major priority for the Trump administration.

In higher education, she resuscitated for-profit colleges and wrote sweeping regulations on campus sexual assault to give more weight to the accused, generating an onslaught of criticism.[Read more…]

8. Mark Johnson’s rocky tenure comes to a close in familiar fashion

State Superintendent Mark Johnson will end his tenure this month the same way he started it four years ago – at odds with the State Board of Education.

The state board’s decision to require high school students and some middle school students to take End-of-Course exams in person during the pandemic is the most recent point of contention between the controversial superintendent and the board.

Johnson believes the tests should be waived, along with the rule that makes the exams 20% of a student’s grade.

“[SBE] Chairman Eric Davis and the next State Superintendent, Catherine Truitt, disagree with my position and have declared that the State Board’s EOC rule is in effect regardless,” Johnson wrote in an email he shared this week. “This has put your local superintendents, school boards, and principals in difficult situations without consistent guidance on how to proceed.” [Read more…]

9. Gov. Cooper’s pardons correct wrongful convictions of five innocent men

Gov. Roy Cooper issued pardons of innocence to five men, Ronnie Long, Teddy Isbell Sr., Kenneth Kagonyera, Damian Mills and Larry Williams Jr., according to a release from his office yesterday. It marks the first time he has used his constitutional power to pardon during his governorship.

Long, whose case has received the most public attention, spent the longest time — 44 years — incarcerated among the five clemency recipients. He was originally convicted of rape and burglary by Cabarrus County Superior Court in 1976 has already been released from custody but expected the pardon of innocence. The pardon clears his name and makes him eligible to seek compensation under state law. [Read more…]

10. Contamination prompts Colonial Pipeline to buy three homes near Huntersville gasoline spill

11. Weekly radio interviews and commentaries:

Click here for the latest newsmaker podcasts and commentaries from Rob Schofield

12. Weekly Editorial Cartoon:

Task force recommends new environmental justice positions at four key state agencies

The task force was named after celebrated North Carolina civil rights activist Andrea Harris, who died in May at age 72. (Photo: task force report)

One of the most striking disconnects between state agencies occurred last year when the Department of Commerce announced at a legislative committee that it supported the Atlantic Coast Pipeline.

Meanwhile, the NC Department of Environmental Quality, although it ultimately approved the permits, was concerned about potential damage to the environment and the communities that lay in in the pipeline’s path.

Duke Energy and Dominion eventually killed the project; DEQ has since rejected permit applications for an unrelated Mountain Valley Pipeline Southgate proposal. But there has been a consistent lack of continuity among agencies in considering environmental and social justice implications of their projects.

In a report issued this week, a task force told the governor that permanent environmental justice and inclusion positions should be created at the departments of Commerce, Transportation, Natural and Cultural Resources, and the Office of Emergency Management.

The Department of Environmental Quality already has such a position.

If the four agencies create new positions, that would require funding, likely through the legislative budget process. Or an existing position could be converted or expanded to address environmental issues.

The group, officially named the Andrea Harris Social, Economic, Environmental and Health Equity Task Force, was created earlier this year by Gov. Roy Cooper to study how the COVID-19 pandemic is disproportionately harming communities of color. The task force spent the fall pinpointing how the state needed to advocate for and assist these North Carolinians. Among them were expanding rural broadband, job creation, health care and environmental justice.

Polluting industries commonly locate in low-income neighborhoods and communities of color. And this pollution, particularly in the air, can cause or worsen respiratory illnesses. A Harvard study showed that exposure to fine particulate matter known as PM 2.5 increases the severity of COVID-19 symptoms and risk of death from the disease.

At dozens of public meetings about various environmental projects, community members have clamored for clean jobs rather than those created by polluting industries. The task force posed a similar question: Could we improve the economic development and health outcomes of a Tier 1 county without causing additional environmental burdens?

The four agencies that would create an EJ position routinely make decisions that can further burden these communities with pollution — or in some cases alleviate it.

For example, the Department of Transportation’s new toll road extension, I-540, routes through a low-income mobile home park.
Active Energy, a wood pellet plant in Robeson County, received a $500,000 building reuse grant from the Department of Commerce.

The Office of Emergency Management is key to helping these communities after a hurricane or flood; many of these neighborhoods are located in areas vulnerable to the effects of climate change. The Department of Natural and Cultural Resources is consulted when major projects route through Native American land; that agency is also over state parks and the Division of Land and Water Stewardship.

A second recommendation is for state officials to conduct an inventory of aging buildings — schools, senior centers and hospitals — that have radon, asbestos, mildew and mold contamination. Cleanup of those buildings could create jobs, the task force wrote.

Schools in Robeson and Edgecombe counties have been selected to test the proposal.

The “sick building” problem caused by legacy pollutants is due to delayed maintenance. “Nowhere is this problem more apparently than in NC’s public schools, especially those in hyper-segregated, concentrated poverty communities,” the presort reads. “Due to aging and poorly functioning HVAC systems, young people attending these schools are exposed to a host of chemical and biological contaminants that adversely affect their health and overall well-bing and their ability to learn.

“Reopening these schools amid the pandemic is likely to exacerbate the problem,” the report continues, “as buildings with poor ventilation, already a crucible for building-related diseases, can potentially become hotbeds for the spread of the coronavirus.”

The task force also recommended what is bound to be a heavy lift: that the legislature change statutes and rules to incorporate environmental justice into regulations. Since conservatives gained control of the General Assembly in 2011, environmental justice has been eroded, not strengthen, particularly in the annual Farm Acts.

“Legislation will be paramount to ensure our environmental justice ideals come to fruition,” the report reads.

The legislature convenes Jan. 13.