NC legislators aim to reduce Black maternal deaths

Democrats in the NC legislature are sponsoring bills meant to improve Black maternal health that mirror parts of the federal Momnibus Act championed by U.S. Rep. Alma Adams, a Charlotte Democrat.

The United States has one of the worst records for maternal death in the developed world. Black women in the U.S. are three times more likely to die from pregnancy-related health problems as white women.

“The U.S. is one of only 13 countries where maternal mortality is on the rise, and racial disparities drive this crisis,” Sen. Natalie Murdock, a Durham Democrat, said at a news conference Monday.

According to the NC Maternal Mortality Review Committee, 63% of maternal deaths in North Carolina from 2014-15 were preventable.

Senate bill 632 and House bill 507 would set up a task force looking at maternity care and births in the COVID-19 pandemic; study cooperation between military veterans’ health care facilities and non-veteran facilities in delivery of maternal care; set up a task force that would recommend ways to address how  transportation, housing, environment, and other factors influence maternal health; and develop a grant program for community organizations focused on preventing Black maternal deaths and severe illnesses.

Dr. Narges Farahi, leader of the Maternal Child Health program at UNC Family Medicine, said she has seen how illnesses in mothers lead to illnesses in children “and lost opportunities for families.”

The pregnancy-related mortality rate does not improve for Black women with college degrees as it does for white women, she said. Black women with college degrees are five times more likely to die than white women with college degrees.

Studies have shown that “being pregnant while Black is more likely to be a fight for health, wellness and life for mothers and for their children. This shines a light on the tremendous impact racism has on the health of Black women before, during, and after pregnancy,” Farahi said.

The Senate bill was assigned to the chamber’s Rules Committee, an indication that it is unlikely to pass. Murdock said she’s talked to leading legislators about the importance of reducing Black maternal mortality, and wanted to go “big and bold” with the proposal.

She noted that Senate Republicans have filed a bill that would have women who use Medicaid while they are pregnant stay on the government insurance plan for 12 months postpartum rather than getting cut off after 60 days – a bill that supporters of the Black maternal health bill had considered putting in their package.

Rep. Julie von Haefen, an Apex Democrat and a sponsor of the House bill, said the hope is to get some of the provisions included in the state budget the legislature passes.

“We do have some support for some provisions across the aisle,” she said.

North Carolina’s leadership serves as a model other states can emulate, said Breana Lipscomb, senior manager of the U.S. Maternal Health & Rights Initiative at the Center for Reproductive Rights. Few other states are looking at the impact of COVID-19, addressing access for women in the military to pregnancy and postpartum care, and acknowledging the role of community organizations in reducing maternal deaths, she said.

“Research shows that for Black and white women with the same risk factors and the same pregnancy complications, Black women are still more likely to die,” Lipscomb said. “This indicates that there is some factor other than an individual’s health condition that influences mortality risk for Black women.”

Responses to COVID-19 offer the chance to address racism in healthcare, experts said

The COVID-19 pandemic has brought into stark relief how the health care system fails people with low incomes and people of color, panelists at a Duke University Margolis Center forum said last week.

Longstanding inequities in health care put people of color at greater risk of severe COVID-19 symptoms and death. The inequities continue with the COVID-19 vaccine roll-out, with white people getting disproportionate share of vaccines.

“Our health care system doesn’t work well for low income, low health literacy, undocumented – that didn’t start with COVID,” said Abner Mason, founder and CEO of ConsejoSano, a company that works with health care providers and insurers on patient engagement that is multicultural and multilingual.

“It shocked people out of their relative acceptance of a horrible system,” he said.

Building trusting relationships with communities and individuals is essential to  improving health, the panelists said.

Students in the Margolis Scholars Program at Duke  organized the event.

Kumbie Madondo is director of Community Partnerships & Policy Solutions at the New York Academy of Medicine, which works with the New York City Department of Health. She said the city’s health department is addressing disparities and racism in healthcare.

“We need to call things as they are,” she said. “If there is racism in health care, call it for what it is. In the communities we serve, health disparities are borne out of racism.”

In North Carolina, Latinx communities get confusing information about vaccines, said doctors and community health workers.

Dr. Edith Nieves Lopez, a pediatrician at Lincoln Community Health Center in Durham said CDC information about COVID-19 does not translate well into Spanish.

“Sadly, there are few things that you find online that are culturally sensitive that can relay information in a few sentences,” she said.

Lopez said it was her job to get people in the community to trust her.

Increasing access to care and making sustainable change is important, said Onyi Ohamidike, a third-year medical student.

“Community members need to see people who look like them” and share their experiences, she said. Often blame is put on communities for not being able to trust, she said, taking the focus off institutions that should become trustworthy,

“We might all look at ourselves at great, kind, empathetic people,” Ohamidike said. “We need to recognize that we are attached to an institution that has harmed a lot of people.”

Griselda Alonso, a community health worker, said it is important to get people in the Latinx community clear and accurate information.

It’s hard for the Latinx community to trust medicine when last year, they heard about a doctor sterilizing women held in an ICE detention center, Alonso said.

“Try to be empathetic with my community,” she said. “Leave your privilege to the side.”

“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.