Environment, public health

Here’s something else to worry about: more mosquito days

It’s not your imagination. Mosquitoes are worse than they used to be.

In central North Carolina, mosquito season is nearly two weeks longer now than it was 35 years ago, according to a Climate Central report.

In Asheville, there are 18 more mosquito days; Greensboro has an additional 16.Climate conditions in Greenville add 12 days to the season, and an extra week in Charlotte. In Wilmington, where it is already warm and humid, there are just three more mosquito days per year, for a total of 214.

Almost half the year is now suitable for mosquitos to thrive in western North Carolina, and 59%  along the coast.

The number of mosquito days was calculated based on studies from the National Institutes of Health, which found mosquitoes survive best at temperatures between 50-95 degrees and a relative humidity of at least 42%.

According to Climate Central, these conditions are increasing in nearly two-thirds of the 239 sites analyzed in the contiguous US, from the 1980s to the 2010s.

Mosquitos aren’t merely an annoyance. They can carry diseases, such as Zika, malaria, Chikungunya virus, dengue and West Nile.

West Nile virus, in particular, is projected to spread with climate change, as temperatures increase and warm seasons lengthen.

The Centers for Disease Control and Prevention reports that the rate of disease in humans as a result of mosquito, tick and flea bites tripled in the US from 2004 to 2016. Researchers have identified nine new germs carried by mosquitoes in the last 15 years.

COVID-19, Housing, News, Policing, public health, race, What's Race Got To Do With It?

Experts: “There has to be a shift in how society functions” in wake of pandemic recovery, racial justice movements

The COVID-19 pandemic has devastated the U.S. economy — shuttering businesses, eliminating jobs and disrupting everything from education to the nation’s food supply chain. But it has been most devastating to Black Americans, who already face a host of historical economic and social disparities that have been highlighted by the Black Lives Matter movement even as the country continues to struggle with the worsening pandemic.

On Tuesday a panel of experts gathered by UNC-Chapel Hill’s Kenan-Flagler Business School, its Kenan Institute of Private Enterprise and the Institute of African American Research held a virtual discussion of the problems disproportionately facing Black people in the current environment — and possible solutions.

“Talk about us living in a very, very unique time,” said Majestic Lane, deputy chief of staff and chief equity officer for the city of Pittsburgh. “We’re living in essentially 1928, 1918 and 1968 all in the same year, which has never quite happened. How we respond to it is really important. For us, in looking at what’s happening in our community, what’s happened in terms of social unrest as a result of state sanctioned violence and what’s happening as a result of COVID and the impacts of the pandemic really are two sides of the same coin.”

Majestic Lane

The American system disrupted by both the pandemic and mass protests over police violence against Black people was designed to work exactly the way it was working, Lane said. In charting a ‘new normal’ the goal should not be to reconstruct that system, he said, but to address long-standing problems in a system that chose winners and losers based on a legacy of racist ideas and practices.

“There has to be a shift in how society functions,” Lane said.

In Pittsburgh, that’s meant examining very basic assumptions about policing, Lane said. The idea that not every 911 call means police should be sent to the scene may be new to some people, he said. But for those who understand how racist policies in everything from education and banking to health care can see how bringing police into over-policed communities every time there is something like a family argument will likely make situations more dangerous.

In the 2021 budget in Pittsburgh, the city is creating an office of Community Health and Safety. Working with non-profits, the community will work to minimize the presence of police in situations where trained social workers, psychologists or addiction specialists might be a better fit. People in the community who are already trusted and invested will also be utilized in getting to the roots of violent incidents, Lane said.

But there are broader structural challenges as well, Lane said — and they’ve been made even more apparent by the pandemic.

Black people in America have been systemically shut out of the building and maintaining of wealth since before the beginnings of the Republic, said Nikitra Bailey, executive vice president with the Center for Responsible Lending. The current health and financial crises are making that more apparent, she said — and call for a response that takes that into account.

Nikitra Bailey

“Our nation is facing a reckoning over structural racism,” Bailey said. “The inequality it has produced is being exacerbated by the coronavirus. The COVID-19 pandemic is both a profound public health crisis and an equally profound economic crisis. The virus has devastated families across the nation and has fallen disproportionately on Black families.”

“Systemic discrimination in the housing sector left Black families more vulnerable going into the 2008 housing crisis,” Bailey said. “And that crisis and the response to it left them worse off. This crisis has likewise hit Black families hardest again. And the response so far is not equitable nor is it sufficient.”

The COVID-19 crisis threatens to become a foreclosure crisis in which the Black community has not had the same opportunity to build up home ownership and home equity, Bailey said. They didn’t have the same economic cushion many white families did at the beginning of the pandemic.  That’s due to historical inequities, like Black families being shut out of New Deal programs that gave access to federally supported credit. Those programs led to an explosion of white homeownership, a swelling middle class and generational wealth for white families. Only about 2 percent of the loans available in that period benefitted Black families, she said.

Black families were making ground after the historic homeownership lows of the Great Recession, Bailey said — with Black homeownership reaching 44 percent. But the current COVID-related economic crisis means a tightening in the mortgage market that is requiring much higher down payments and higher credit scores for families to qualify for loans. That threatens to erase the gains of Black homeowners in the country, Bailey said.

Because of the historic and current-day process of racial redlining, most Black communities don’t have as much home equity, Bailey said — something many white homeowners can use to withstand tough economic periods.

For Black homeowners and Black renters (a disproportionately large population), the pandemic is leading to greater dangers.

“There are reports that one in five renters are saying they missed or deferred a rental payment in June, “We know 31 percent of Black renters are reporting this as well, which is twice the rate of white renters. And 13 percent of homeowners overall are saying they’ve needed to defer a mortgage payment and again 23 percent said they missed or deferred their payment, which is twice the rate of white homeowners.”

Congress needs to react accordingly, Bailey said. The CARES act had a moratorium on evictions and foreclosures, she said, but that expired last week. With around 23 million families likely to fall behind on their rent, Black families will be hardest hit.

Housing is an important pillar of the overall economy, Bailey said — critical not just to those who are most impacted, but to the entire nation.

“We need the House’s bill, the HEROES act, to be passed in the Senate and we need the President to sign it immediately,” Bailey said. “There is $100 billion of rental assistance in the HEROES act. If that legislation moves, we know that this crisis can be averted. We also need the HEROES provisions around homeownership protection. There’s $75 billion in homeownership protections. We also need those protections to be enacted.”

But beyond those immediate treatments for immediate ills, Bailey said, there needs to be movement on longstanding inequities and systemic racism.

“What we need is a federally guaranteed restorative justice program,” Bailey said, whereby Fannie Mae and Freddie Mac take proactive action to increase Black homeownership and we enforce fair housing and fair lending laws already on the books.

“We have really effective tools in place,” Bailey said. “If we use them we can root out that discrimination that is dragging down the economy overall.”

public health

Wake County Commissioners declare racism a public health crisis

Six weeks after the death of George Floyd in Minneapolis, Wake County Commissioners are poised to pass a resolution that acknowledges the harm racism and discrimination poses to individuals and our community.

Commissioners will vote on a resolution at Monday’s meeting that details how racism perpetuates poverty through intentional and unintentional policies, creating barriers to upward mobility.

Here are two excerpts:

WHEREAS, structural racism has resulted in race as a social determinant of health,
with persistent racial disparities in housing and food security, criminal justice, education,
healthcare, employment, worker protections, climate, and technology; and that data
shows race, income, and ZIP Code have a bigger impacts on health than behavior,
medical care, or genetic code; and

WHEREAS, social determinants of health have a disproportionate impact on communities of color, including food deserts, lack of safe places to recreate, lack of mental health services and lack of equitable educational and career opportunities;

WHEREAS, the COVID-19 pandemic has further exposed systemic issues in our
society related to health access, housing and food insecurity. As of June 30th
, our Latinx/Hispanic population makes up about 10% of our population but 45% of our
confirmed cases. Our Black population comprises 20% of our population but 24% of our
confirmed cases. Accordingly, Black and Latinx/Hispanic persons account for
approximately 30% of Wake County’s population but yet 69 % of our confirmed cases;
and

WHEREAS, Wake County strives to serve vulnerable populations in an equitable
manner–as demonstrated by our investments in public education, housing affordability, social and economic vitality programs, and our recent initiatives on maternal and infant mortality, the WakeWorks program, and Live Well Wake–we are committed to the ending systemic racism and discrimination in our communities; and

WHEREAS, Wake County is a model employer, providing benefits such as parental
leave, paid family illness leave, a living wage policy, in addition to strong health
insurance and retirement benefits, which help lower-income and underserved populations. In the pursuit of social justice, Wake County has also enacted policies
such as “Ban the Box” and a strong anti-discrimination and equal employment
opportunity policy; and

WHEREAS, although there is no epidemiologic definition of “public health crisis,” the
health impacts of racism clearly exemplify the definition proposed by experts from the Boston University School of Public Health, which is that “The problem must affect large numbers of people, it must threaten health over the long-term, and it must require the adoption of large scale solutions”; and

NOW, THEREFORE, THE WAKE COUNTY BOARD OF COMMISSIONERS RESOLVES that racism is a pubic health crisis and must be treated with the same urgency and funding as any other public health crisis. The Wake County Board of Commissioners is committed to dismantling racism and discrimination by promoting racial equity through board goals and policies developed through a lens of diversity, inclusion, and equity and encourages other local, state, and federal entities to do the
same.

Read the full resolution on racism here.

Board members are also expected to approve a second resolution at the meeting that would adopt Juneteenth (June 19th) as an official holiday. If approved, the holiday will become a paid day off for all county employees.

Juneteenth commemorates the ending of slavery in the United States.

COVID-19, public health, Trump Administration

Citadel nursing home in Salisbury using Trump administration rule to avoid COVID-19 lawsuit

Image: Adobe Stock

The owners of the Citadel nursing home in Salisbury have invoked a new federal law that could allow them to avoid being sued by patients who contracted or died from COVID-19 while under its care.

Recent court documents show that Accordius Health, LLC, a for-profit company that owns 90 nursing facilities in nine states, has petitioned a judge to toss a lawsuit filed by two residents’ powers of attorney.

Instead Accordius is arguing that before being admitted to the Citadel, residents — or their legal representatives — signed documents agreeing that all disputes would go to confidential arbitration proceedings rather than be publicly heard in court.

The Citadel is also known as the Salisbury Center.

Wallace & Graham and Gugenheim Law are suing Accordius Health on behalf of Thomas Del Marshall and Robert Leroy Whitlach “seeking a comprehensive view of the facility’s policies” to prevent further neglect. The firms and their clients are not asking for monetary damages.

Since early April, the Citadel has reported 113 cases of COVID-19 among its residents, the highest number of all nursing facilities in North Carolina, according to state records. Eighteen residents have died. Of the staff, 44 have tested positive for the disease.

A one-star facility — a “much below average rating” — the Citadel was cited for abuse by the Centers for Medicare and Medicaid Services last fall.

“Despite the company being responsible for significant nursing home outbreaks, the company filed documents in court attempt to enforce arbitration agreements upon residents who want justice – preventing residents from having their day in court before a jury,” attorney Mona Lisa Wallace wrote in a prepared statement. “The company seeks to keep the proceedings confidential and to keep information hidden from the public.  The company further seeks to keep the lawsuit out of the state court or in the county where the facility is located, where loved ones and elders are sick and dying even today.”

Under the Obama administration, CMS banned such pre-admission arbitration agreements. According to the Illinois Law Review, CMS passed the regulation because it believed “it is fundamentally unfair and almost impossible for residents or their decision-makers to give fully informed and voluntary consent to arbitration before a dispute has arisen.”

The nursing home industry sued and a federal court suspended the rule. Then in 2017, under the Trump administration, CMS proposed a different rule, according to the American Bar Association, that “went to the other extreme.” That proposal allowed not only nursing homes to take cases to arbitration but made signing the agreement a condition of admission to the facility.

Finally, a rule enacted last September allows for arbitration, but not as a requirement for admission to a facility.

Arbitration proceedings are confidential, so no evidence can be publicly disclosed; nor is there a jury trial. It is also difficult to appeal an arbitration.

Even if residents could sue nursing homes on COVID-19 claims, it would now be difficult to win. North Carolina lawmakers passed, and the governor signed, an omnibus COVID-19 bill last month that gives immunity from civil lawsuits to these and other health care facilities. They could still be sued for criminal acts related to COVID-19, such as willful neglect, but the burden of proof in criminal cases is much higher.

COVID-19, public health

As state nears 25,000 COVID-19 cases, rural NC infection rates are the highest

On Monday, North Carolina reported 24,000 positive COVID-19 cases. Twenty percent of those infections are in the state’s two most populous counties, Mecklenburg (3,403) and Wake (1,478). The country and the state have focused a lot of attention on the virus’s rapid spread in population-dense and urban spaces. This framing, coupled with an initial lack of testing, has created the perception that rural North Carolina has not experienced COVID-19 like the rest of the country.

This is untrue.

In the North Carolina context, it appears that the rural counties have been harder hit. By examining COVID-19 infection and death rates instead of solely infection and death counts, one is able to scale impact relative to county population.  Once viewed through this context, the conclusions change.

The state rate of COVID-19 infections is 229 per 100,000, while the crude death rate is 7.5 per 100,000. Counties classified as rural by the NC Rural Center’s methodology show an infection rate of 257 per 100,000 and a death rate of 8 per 100,000. For comparisons sake, urban/ suburban counties have an infection rate of 204 per 100,000 and a death rate of 7 per 100,000.[1]

While these rate differences are not extreme, several hot spots in rural North Carolina are cause for concern. Duplin and Wayne counties lead the state with 1,121 and 837 COVID-19 cases per 100,000 people.

In terms of crude death rate (deaths per 100,000), Northampton and Vance counties lead the state with 62 and 40 deaths per 100,000, respectively.

These are all rural counties, but the trend does not stop there.[2] The 15 counties with the highest COVID-19 infection rate are rural, and 18 of 20 counties with the highest COVID-19 death rates are also designated as rural.[3]

There are several reasons that rural North Carolina is ill-positioned to respond to a pandemic. After North Carolina refused to expand Medicaid, seven rural hospitals closed, leaving 17 counties without a state-licensed facility.[4]

These same rural counties generally have higher rates of uninsured, making it less likely that people get treated for any disease, let alone COVID-19. Duplin, Greene, Swain, Sampson, Graham and Robeson counties lead the state in the percentage of county population uninsured, further complicating efforts to reduce the cases and spread of COVID-19 infections.[5]

A potential contributor to NC COVID-19 infections in rural North Carolina are occupational trends — how people work in community. In places where economies without a significant number of highly skilled jobs, meat processing plants offer many residents the opportunity to earn a steady income and stability. However, in a pandemic, the close nature of meat processing work creates a liability for the workers, their families and entire communities.

While one would offer caution in arguing that a scientific relationship exists between communities with meat processing plants and COVID-19 infection rates, policymakers should be aware of potential impact.

Last week, NCDHHS announced that 13 counties had meat processing plants with COVID-19 outbreaks.[6] Twelve of the 13 counties are considered rural.

After mapping these communities and the percentage of the county workforce employed in production jobs, four rural county clusters emerge as plausible connections between the concentration of meat processing plants and higher rates of infection per 100,000.

Cluster 1 — Duplin, Sampson, Wayne, Wilson, Lenoir, and Greene
Cluster 2 — Bertie, Northampton, and Halifax
Cluster 3 — Chatham and Lee
Cluster 4 — Wilkes, Surry, and Yadkin. [7]

As the number of COVID-19 cases climb toward 25,000, let us not lose focus on the particular pain rural communities in North Carolina are experiencing. All it takes is a deeper look.

William Munn is a policy analyst with the North Carolina Justice Center’s Health Advocacy Project.

[1] Internal analysis from NCDHHS COVID-19 Dashboard data

[2] Internal analysis from NCDHHS COVID-19 Dashboard data

[3] NCDHHS Dashboard

[4] “A triple disaster: Uninsured, living far from a hospital, and sick with COVID-19”, Lisa Sorg, NC Policy Watch – https://bit.ly/2V1uTaY

[5] Small Area Health Insurance Estimates – https://www.census.gov/data-tools/demo/sahie/#/

6] “N.C. has 23 meat processing plants with COVID-19 outbreaks, more than 1,300 cases” WBTV 3 – https://www.wbtv.com/2020/05/12/nc-has-meat-processing-plants-with-covid-outbreaks-more-than-cases/

[7] Internal analysis from NCDHHS COVID-19 Dashboard data