NEW HANOVER COUNTY — While the battle against the spread of Covid-19 pushes onward in Raleigh and Washington, D.C., health officials in New Hanover County have similarly been engaged in a mission to curb the spread locally. Health experts in the local scene will serve a critical role during the upcoming holiday season.
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Mirroring national trends, N.C. surpassed its previous all-time high for new daily cases Thursday, at 4,296, which eclipsed the previous record of 3,885, the daily total reported Saturday. In New Hanover County, as in other localities, health officials juggle a wide array of roles, serving as the final stopgap between national guidance and individual communities.
“I’m continuously impressed by our staff here,” Carla Turner said. “To continually get up every morning, and come into work and hit the front lines, working hard to take care of the community, following up on contact tracing, doing case investigation, doing everything we can to keep the community safe.”
Turner is the assistant health director for New Hanover County Public Health. Her department has previously guided educational institutions — like New Hanover County Schools and the University of North Carolina at Wilmington — through their reopening processes.
Public health additionally coordinates the county’s contact-tracing operations. The office works with state and federal authorities to increase testing access locally, such as the mass-testing operation underway at UNCW, organized with help from the National Guard.
Turner and her colleagues have made vaccines for the flu more widely available, anticipating this season will be exacerbated by the ongoing pandemic. Working with communications staff, public health has strategized outreach programs focused on safety measures that have been ubiquitous since the spring: washing hands, social distancing and mask-wearing.
“We’ve been doing this for a while now,” Turner said. “We have staff on board that have consistently been doing this. And they’ve figured out what works best for them.”
Adding to an already robust list of responsibilities, public health and other authorities in New Hanover County will assume a new role in the near future: helping to manage the dissemination of a Covid-19 vaccine.
“Even when that vaccine comes, those safety measures will still have to be in place because it will be a many, many months process to distribute it,” a spokesperson for the county said.
The vaccine plan
Donna Fayko, health and human Services director for New Hanover County, added: “We know we have certainly two, maybe three vaccines on the horizon that have shown very promising results on their efficacy. Of course there’s some challenges in the different types of vaccines and how we’re going to manage those.”
Fayko said the vaccines under consideration require storage at very low temperatures.
“We have to figure out how to safely administer the vaccine and store it,” she said. “We have lots of challenges that we’re working out all of the details. And again, as things change rapidly, we are also changing our plan.”
The current plan is a four-phased approach, which local health authorities said could take up to nine months to fully implement.
- Phase 1: The first step will be vaccinating “medical direct care providers” and “long-term care staff,” Fayko said. Part two of Phase 1 involves vaccinating long-term care residents 65 or older, those who have two or more chronic conditions, and staff of long-term care facilities.
- Phase 2: Focusing on congregate-living residents younger than 65, and who do not have two or more complicating conditions. Outreach to marginalized communities will be included in Phase 2, as will vaccinating adults older than 65 who have no chronic conditions.
- Phase 3: Focusing on frontline workers considered essential in various industries of societal functioning. Attention will also be given to college students during this phase.
- Phase 4: The remaining general population.
Fayko emphasized the plan is subject to change, as information about vaccines continues to develop.
“All of the vaccines that are currently being looked at, they are a two-dose vaccine,” Fayko said. ‘So if you get the vaccine, the first dose, I think there’s a 21-day wait period to get the second dose, and that’s going to be really critical for us to track that, and people follow up to get that second dose as well.”
Public health and its authority
In late October, officials in Raleigh urged 36 counties, New Hanover included, to consider taking compliance actions more stringent than those already mandated from Raleigh.
Examples given of these potential measures included imposing a higher “state of emergency” standard than what was already present statewide, and imposing fines for businesses that did not enforce mask requirements.
Further, the state implored counties to look at imminent hazard abatement orders, a tool that existed within the arsenal of county health departments since before the onset of the pandemic. These orders can be levied on business, entities or individuals whose behavior creates a demonstrable threat to public safety.
“What’s been novel in Covid-19 has been applying that authority in the communicable disease context,” said Jill Moore, a professor of public law and government in the UNC School of Government. “What we’re seeing with the pandemic is different entities, with different regular responsibilities plus emergency responsibilities, are interacting with each other around this disease.”
Turner and other New Hanover County officials said leveraging their ability to impose the penalties is a last resort.
Turner emphasized the role of public health is to provide education and consultation on best practices, rather than to impose punitive actions.
In practice, this means public health offers expertise to entities like the school system and UNCW, serving an advisory role, but it will not make specific demands regarding a particular course of action.
Public health and UNCW
At UNCW, select administrators held a Zoom meeting with resident advisors following the university’s decision to “de-densify” first-year residence halls in September.
In a recording of the meeting, an administrator — who an RA on the call identified as Peter Groenendyk, director of housing and residence life — talked about public health’s involvement in the decision to convert double-occupancy rooms into single-occupancy spaces.
“In a public health crisis, those two groups together, our local health officials and the state officials really are in charge of everything that we do. And so they came to us and asked us to take additional measures to help limit the spread of the 18-to-24-year-old group, and we discussed it and this is what was agreed to do in terms of course of action,” the administrator said on the September Zoom call. “I would say, after a conversation, as I was in it, it was kind of agreed upon by all parties. That’s how I would characterize it.”
New Hanover, once a ‘county of concern,’ now placed within the tier of lowest severity
Shortly after state authorities sent the letter, which identified New Hanover as one of 36 counties of concern, County Commissioner Rob Zapple told WECT, “I don’t believe there’s any appetite at all from our county staff — and I can only speak for myself as a commissioner — for increasing any restrictions or ordinances to what we already have.”
In an email to county leaders sent the day after receiving the state memo, Fayko, referencing the prospect of additional action, wrote: “NHC has a range of legal tools available to assist with enforcement of state and local laws, including authority to declare a specific circumstance or environment/facility an imminent health hazard and order abatement of such hazard. However, we are not considering such action regarding any particular establishments at this time.”
The email continued: “Circumstances that could prompt examining such action may include broad indicators such as sharp case count rises and hospitalizations increasing to a threatening level, or specific documented gross disregard and violation of the governor’s orders by identifiable establishment(s).”
Commissioner Jonathan Barfield said in an interview Thursday he considers the enforcement of state orders to be the responsibility of the state, and that increasing county-level ordinances would put more pressure on local law enforcement. Zapple added the county’s success in future months is largely in the hands of the citizens, and their willingness to practice social distancing and mask-wearing as requested by health authorities.
On the topic of law enforcement, Turner, the assistant health director, said: “We’re not telling them how to do their jobs. The sheriff’s office gets the same information that we get. They get the governor’s orders just as we do and they know what falls under their jurisdiction, and we leave that up to them.”
On Tuesday, Gov. Roy Cooper’s office released a county-by-county map that color-codes all counties, using one of three designations, based on metrics relevant to Covid-19 spread. New Hanover is grouped among the counties showing “significant community spread” — which, despite the title, is the tier of lowest severity.
“I know that there’s a fine line between balancing the rights of individuals, on both hands, with public safety, as well as people’s liberty,” Barfield said. “I think our goal is really to help educate and inform. At the end of the day, you hope the people do the right thing.”
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