Latino votes drop in N.C.: Why it happened and why some Latinos are voting Republican
How Black Farmers Are Navigating Climate Change With Limited Federal Support
Six months ago, Anthony “AJ” McKenzie, a 30-year-old cool vegetable crop and livestock farmer in North Carolina, stopped farming on his 40 acres. Last year, a drought killed at least 85% of his crop, which caused him to lose income. Usually, he’d grow his cabbage and turnip, mustard, and collard greens twice in the fall […]
Warmer seas drive more bacterial infections, threatening fishermen, public health
By Will Atwater
Last month, three people died as a result of infections from a category of bacteria you’ve likely never heard of: Vibrio. It is commonly present in coastal and brackish water, especially during warmer months.
“There are almost 80 described species of Vibrio that live in the water,” said UNC Chapel Hill Institute of Marine Sciences researcher Rachel Noble. But Noble also noted that as the seas warm through to climate change, there’s more Vibrio in North Carolina’s waterways.
According to a news release from the N.C. Department of Health and Human Services, there have been 47 recorded cases and eight deaths from infection caused by Vibrio microorganisms since 2019.
One way that people get infected with the bacteria is through eating undercooked seafood. Another way is the bacteria getting into a cut or scrape in the skin when exposed to water containing Vibrio. In people with weakened immune systems, a Vibrio skin infection can all too quickly lead to a systemic infection that can lead to loss of limbs or, left untreated, death.
Noble is among the experts who predict that in the future, Vibrio cases will pop up in places that previously had no issues, and they indicate that there will be more infections in December and January, for instance, since coastal waters are not cooling as much as in the past. .
Noble said that when she began testing the Neuse River estuary for Vibrio two decades ago in the winter, she found anywhere from three to ten microorganisms per 100 milliliters (a tenth of a liter) of water.
“Twenty years later, those numbers are closer to 100 to 200 per 100 milliliters in January.”
“There has definitely been not only an extending of the summer infection season,” she said, “but there’s also been a trend that it’s no longer true that our estuaries go down to almost zero in concentration in the winter months. They don’t. The Vibrios [bacteria] are still very much there.”
Climate change and Vibrio
Vibrio bacteria thrive in warmer, brackish waters where blue crabs live, especially when they’re molting and losing their hard outer shell. And one of the prime ways people get infected is when the bacteria gets into small cuts and scrapes.
Those small nicks in the skin have the potential to be a big issue for people like commercial fisherman Keith Bruno.
Bruno migrated to North Carolina from Long Island, where he once fished for lobster. After an outbreak of West Nile virus in New York in the 1990s, the regions around Long Island Sound aggressively sprayed for mosquitoes that carry the virus. Bruno is among those who blame the spraying for the collapse of the lobster fishery there. But around the same time, the waters in Long Island Sound began to warm, likely delivering the lobsters a fatal blow.
Now, the waters off the North Carolina coast, where Bruno harvests blue crab, are warming. The Vibrio bacteria threaten commercial fishers and those who work and play in or near coastal estuaries and marshes. In the wake of Hurricane Florence in 2018, there were a number of Vibrio incidents.
And with that warming water comes more risk to Bruno and other fishers, who often get cuts and scrapes over the course of their work day.
Zachary and Benjamin Bruno are setting crab pots. Crabbers and other anglers can get nicks and cuts on the arms and hands from handling wire mesh pots, which, they say, is part of the job. Credit: Zachary Bruno
Because of a medical condition, Bruno leaves most of the handling of crab pots to his son these days. But, he said, the risk of infection is part of the job.
“We are constantly getting scratched and cut and bit and jammed and poked,” said Bruno, who recounted being scratched from handling crab pots and fishing gear and being poked by bones protruding from buckets of bait.
“If anybody gets a wound in the water, they need to get medical attention right away,” said Dr. Michael Somers, an emergency medical physician at Carolina East Medical in New Bern. “We can … treat the infections, but better than that we can give medication to prevent the infection.”
If people who may have been exposed to Vibrio seek immediate medical attention, they can be prescribed an antibiotic such as doxycycline to protect themselves against developing the infection, Somers said.
Bruno said to save time, he and other fishers rely on bleach to prevent infection while out on the water.
“The down and dirty is ‘throw some bleach on it and get back to work,’” he said. “We live to work and work to live … We’re not going up to the walk-in clinic for antibiotics every time we get scratched — we’d live there and never make any money.”
There’s something in the water
A research article published in March 2023 supports the idea that Vibrio is spreading northward along the Atlantic Coast. That study bolsters a growingbody of research showing that warming seas are driving more bacterial infections in more northern climes.
To better track the bacteria, the CDC partnered in 1989 with the Food and Drug Administration and four Gulf Coast states — Texas, Louisiana, Alabama and Florida — to develop the Cholera and Other Vibrio Illness Surveillance. The surveillance has now expanded and includes Vibrio data for the Atlantic Coast states.
Noble said that two forms of Vibrio are of particular interest to researchers and public health officials in the state: Vibrio vulnificus and Vibrio parahaemolyticus. V. vulnificus infections usually occur from exposure to brackish water, and V. parahaemolyticus is associated with eating undercooked shellfish.
The Centers for Disease Control reported in an email that in 2019, there were 158 Vibrio vulnificus infections. Twenty-one percent of the infections resulted in deaths — roughly one-half of V. vulnificus infections occurred in Gulf Coast states, and about one-third were in Atlantic Coast states.
When it comes to V. parahaemolyticus, the agency estimates about 52,000 people contract it annually from shellfish. While it will make a person miserable, with vomiting and stomach cramps, it has a very low death rate.
One of the three North Carolina deaths was someone who both ate seafood and waded in brackish water, so it’s unclear whether food or water exposure killed them.
Typically, healthy individuals infected with Vibrio have mild reactions. However, the CDC reports that individuals with underlying health conditions “are more likely to develop V. vulnificus or severe complications such as septicemia,” according to the email.
Protective measures
Sheila Davies, director of public health with the Dare County Department of Health & Human Services, understands the challenges faced by crabbers and fishers, but she strongly advises anyone to seek medical attention as soon as possible if they have scratches or cuts that have been exposed to brackish water.
“If you’re getting cut on a fishing hook, or crab pot or barnacles hanging … it increases your risk of infection,” she said. “So [I’m] strongly promoting how important it is to seek medical attention.”
Echoing Davies’ concern, NCDHHS included the following suggestions designed to help people avoid a Vibrio infection:
If you have a wound (including from a recent surgery, piercing or tattoo), stay out of saltwater or brackish water, if possible. This includes wading at the beach.
Cover your wound with a waterproof bandage if it could come into contact with saltwater, brackish water or raw or undercooked seafood.
If you sustain any type of wound while in salt or brackish water (e.g., cutting your hand on a boat propeller or crab pot) immediately get out of the water and wash with soap and water.
Wash wounds and cuts thoroughly with soap and water after contact with saltwater, brackish water or raw seafood.
Mental health agencies agree to consolidate amid delayed launch of specialized Medicaid plans
By Jaymie Baxley
Two organizations that manage behavioral health services for people with Medicaid and for some uninsured people in different areas of North Carolina have agreed to merge into a single entity that will serve more than 100,000 people across 21 counties.
Eastpointe, an organization that coordinates care for low-income residents in 10 eastern counties, on Thursday said it intends to consolidate with the Sandhills Center, which operates in 11 southwestern counties. The consolidated entity is expected to be the second-largest of its kind in the state “based on population,” according to a news release from Eastpointe.
Sandhills Center and Eastpointe are part of a network that currently consists of six state-supported managed care agencies, commonly called LME-MCOs, that serve people with mental health needs, substance use disorders and intellectual or developmental disabilities. These people tend to require more extensive care and support than the average Medicaid participant.
The LME-MCOs play a critical role in the N.C. Department of Health and Human Services’ vision for the future of Medicaid, which includes moving many of the residents served by the agencies onto specialized health care plans that are tailored to their complex needs. DHHS had originally hoped to launch the tailored plans in December 2022. After multiple delays, the department announced last month that the rollout would be postponed indefinitely to give the LME-MCOs more time to prepare for the transition.
In a statement to NC Health News on Friday, DHHS said the decision to delay the launch of tailored plans was “influenced in part by the need to ensure LME/MCOs readiness and focus on providing services to populations they are best positioned to manage successfully.”
“Ensuring that all North Carolinians have access to quality whole-person health care is central to the Department’s mission,” a DHHS spokeswoman said in an email. “This is especially true when it comes to management of the Medicaid Tailored Plans that will serve people with complex behavioral health conditions, Intellectual/Developmental Disabilities and traumatic brain injury.”
The spokeswoman added that DHHS will “evaluate the intent to consolidate” Sandhills Center with Eastpointe, and “work with the entities on a path forward that best serves improving outcomes for the people of our state.”
‘The best opportunity’
The department has saidabout 150,000 people, or 5 percent of the state’s Medicaid participants, will eventually be moved to tailored plans. The LME-MCOs will be responsible for coordinating care for tailored-plan enrollees by acting as intermediaries between patients and providers, who will work under contract with the agencies.
In the news release announcing the consolidation agreement, Sarah Stroud, CEO of Eastpointe, said combining with Sandhills Center will “give us an unmatched ability to deliver quality benefits and support our provider partners while also meeting the objectives of the state’s policymakers.” Stroud will also serve as CEO of the consolidated entity, which has not yet been named.
Anthony Ward, who earlier this year became CEO of Sandhills Center, added that consolidation “offers the best opportunity to preserve local management of services for individuals in our communities.” In an email to NC Health News, Ward said he will serve as executive vice president of the consolidated organization.
No layoffs are expected in connection with the consolidation. The new entity will employ nearly 900 people and oversee a budget of about $1.4 billion, according to the news release. It will be based out of Sandhills Center’s facility in the Moore County town of West End.
In addition to Moore, the Sandhills Center covers Anson, Davidson, Guilford, Harnett, Hoke, Lee, Montgomery, Randolph, Richmond and Rockingham counties. Eastpointe covers Duplin, Edgecombe, Greene, Lenoir, Robeson, Sampson, Scotland, Warren, Wayne and Wilson counties.
The boards of Eastpointe and Sandhills Center, which are made up of 19 commissioners from the agencies’ respective counties, will be condensed into a single board. The consolidated organization will “draw about half of its board members from each LME-MCO,” according to the news release.
Harry Southerland, a Hoke County commissioner who chairs the Sandhills Center board, said the agreement “presents a tremendous opportunity to promote superior services to our members and meet the goals of the Department of Health and Human Services and our legislature.”
His comments were echoed by Jerry Jones, a Greene County commissioner who chairs the Eastpointe board. Consolidation, Jones said, “ensures our approach to service delivery reaches more members at exactly the right time as North Carolina looks to expand its Medicaid program.”
The proposed consolidation must still be approved by DHHS. In its statement to NC Health News, the department said it does not know how long that will take.
“Without having seen the specific proposal at this time, it is hard for NCDHHS to comment on the consolidation,” the department said.
If approved, the new consolidation will reduce the number of LME-MCOs in North Carolina to five. The other agencies are Alliance Health, Partners Health Management, Trillium Health Resources and Vaya Health.
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A partir de este año los votantes deberán presentar una identificación del estado para poder votar, y existe una lista de identificaciones válidas que pueden presentar, pero dos de ellas (licencia de manejar e identificación estatal) requieren ir a una oficina del NCDMV
Delayed testing, limited access to care, and lack of sexual health literacy contribute to rise in syphilis cases in newborns, health officials say
By Jennifer Fernandez
More North Carolina babies are being born with syphilis, and state health officials are urging women to get tested before they give birth to help catch the sexually transmitted illness early.
Reported cases among women rose 538 percent between 2012 and 2021, DHHS said in that alert. During that same time period, there was an associated 4,100 percent increase in babies born with congenital syphilis.
Health officials say a rise in riskier sexual behaviors, especially among younger adults, coupled with a drop in overall concern or awareness about sexually transmitted infections, has led to increases in STIs such as syphilis. Syphilis is a bacterial infection transmitted by sexual contact.
They also stress that syphilis is treatable. The earlier the infection is addressed, the better — especially for babies.
“Congenital syphilis can have long-lasting effects on a child’s health and development,” said Matt Jenkins, HIV/STD director for Mecklenburg County Public Health.
More North Carolina children are getting syphilis, a sexually transmitted infection that can be passed to a fetus during pregnancy. Cases of congenital syphilis increased from one in 2012 to 55 last year, according to the N.C. Department of Health and Human Services. Credit: NCDHHS
Newborns at risk
Sexually transmitted infections had all been rising for several years, even before the COVID-19 pandemic led people to delay or skip testing and treatment, according to the Centers for Disease Control and Prevention.
While it isn’t seen with as much frequency as other STIs, such as chlamydia and gonorrhea, syphilis more often leads to severe health issues or death when passed on to a baby.
Easily transmittable, syphilis presents initially as sores in the genital area and later as a rough, red rash, according to the CDC. Later stages can have no symptoms, but left untreated, syphilis can cause damage to the brain, heart and other organs.
A newborn may not show any signs of infection but can develop serious problems within a few weeks — or even years — if not treated. Likely health issues include developmental delays, hearing loss, vision problems, bone abnormalities and neurological issues, among others.
In pregnant people, syphilis can lead to premature birth, low birth weight, stillbirth or a newborn’s death shortly after birth.
Mecklenburg County accounted for 12 of the state’s 55 cases of congenital syphilis last year, Jenkins said. Through June this year, seven cases have been reported in the county, he said.
Kimberly Newton, a family medicine doctor and OB-GYN with Cone Health who also serves as medical director for Alamance County, didn’t have exact numbers for Alamance or Guilford counties, where she works.
She did say she has seen more cases in recent years.
CDC statistics show that men account for most syphilis cases, with the majority of those cases among gay men, bisexual men and other men who have sex with men.
However, the number of cases in women and newborns has been rising in recent years — a worrying trend, health officials say.
“The good news is that sexually transmitted infections are preventable,” said Evelyn Foust, chief of NCDHHS Division of Public Health’s Communicable Disease Branch, in a statement in April during STI Awareness Month. “We need to empower ourselves to learn about them, how to talk about them, when to test for them and where to go for care and treatment.”
Effects of congenital syphilis
Congenital syphilis is when the highly contagious bacterial infection passes from the mother to the fetus in the womb or to a newborn at birth.
It can lead to:
Miscarriage.
Stillbirth.
Premature birth.
Low birth weight.
Death shortly after birth.
Babies born infected with syphilis can have:
Skin rashes.
Jaundice (yellowing of the skin or eyes).
Severe anemia (low red blood cell count).
Deformed bones.
Enlarged liver and spleen.
Meningitis (infection/inflammation of tissue surrounding spinal cord and brain).
Brain and nerve problems (including blindness or deafness).
Source: Centers for Disease Control and Prevention
Barriers to care
A variety of factors put pregnant people at risk of contracting syphilis, according to the CDC. They include having sex for compensation, with multiple partners or while using drugs; getting late or no prenatal care; using methamphetamine or heroin; being incarcerated (or having an incarcerated partner); and having unstable housing or being homeless.
Kimberly Newton is a family medicine doctor and OB-GYN with Cone Health who also serves as medical director in Alamance County.
Lack of knowledge about STIs may also be playing a role, Newton said. She said generations of people have now had only abstinence-only or non-comprehensive sex ed classes in the state’s public schools, so they may not have complete information about how these infections get passed around and how to protect themselves.
Multiple screenings are important if there is a chance a mother may have contracted syphilis during the pregnancy. One of the hardest conversations is having to tell someone who previously tested negative that they are now positive during their pregnancy, Newton said.
“The most common question is, ‘Is my baby going to be OK?’ with any prenatal diagnosis,” she said. “With congenital syphilis, it’s really hard to know until your baby is born. And that is really hard (to share) as a practitioner and really hard to hear as a family.”
There are several reasons women may be delaying a syphilis test while pregnant, Jenkins said.
It could be lack of knowledge about the importance of early prenatal care, limited access to health care services, financial constraints, fear, stigma associated with seeking care, or even logistical challenges in scheduling appointments, he said in an email to NC Health News.
Newton added that even in areas where there are plenty of providers, access may still be limited if they are not accepting new patients. And she agreed that financial constraints often delay care.
“The economic reality of all of our patients is when you have your prenatal visit, you basically have to take a half day off work,” she said. “And for an hourly worker, that is huge.”
Historically marginalized communities may be more hesitant to get care because of bad experiences with health care among members of their communities, Newton said.
“If you are a transgender man walking into an OB-GYN office, it might not feel the most welcoming,” she said.
Language can be another barrier, Newton said.
“How do you explain how bacteria work when people have never even heard the word in their language?” she asked.
Newton said people may want to just blame the patient for not getting care earlier, but there are usually barriers keeping them away.
“There is no patient that I have ever met that is positive for syphilis that was volitionally trying not to get care,” she said.
Jenkins said addressing the many barriers and promoting early and consistent prenatal care is “crucial in preventing congenital syphilis.”
With the General Assembly approving Medicaid expansion, more people will be covered for routine testing and treatment, including STIs, once the policy goes into effect.
Missed opportunities
In 2021, 43 percent of congenital syphilis mothers in North Carolina had little or no prenatal care before delivery, DHHS reported.
Earlier care would have allowed for earlier detection and treatment for both mother and baby.
The overall number of congenital syphilis cases in the country increased from 462 to 1,306 between 2014 and 2018, according to the study published in Pediatrics, the journal of the American Academy of Pediatrics.
The authors found reports of 67 children with symptoms of congenital syphilis a month after their birth during that four-year span.
As the number of congenital syphilis cases in the country is higher than it has been in more than 20 years, “many pediatric providers may be evaluating and treating infants with [congenital syphilis] for the first time in their careers and should be prepared to do so,” the authors wrote.
Among their recommendations, the authors said pediatric providers should review maternal records and confirm maternal syphilis status, advocate for maternal testing at delivery, and consider a congenital syphilis diagnosis regardless of maternal history.
Funding cut
While cases of STIs rise across the country, funding to stem that growth is decreasing. During the pandemic, Congress funneled more than $1 billion into strengthening the public health workforce over a five-year period. In June, as part of a debt limit deal to avoid defaulting on U.S. obligations, lawmakers clawed back $400 million of that health funding, even as the Biden administration had recently issued a multi-agency plan to combat rising STI rates.
The money had been used to hire 3,000 disease intervention specialists — public health workers who do contact tracing, investigate disease outbreaks and connect people to testing and treatment services.
Newton didn’t have an exact number on the local impact of those cuts. But she said a systematic defunding of public health over the past three decades has trickled down to local health departments, which are indirectly funded by these federal programs.
Yet, as public health departments, they’re mandated to provide the care, even when they do not have the staffing or other resources, she said.
David C. Harvey, executive director of the National Coalition of STD Directors, called the funding cut a “devastating blow to the fight against rising STI rates” and pledged to fight to get the funding back.
“This will be an uphill battle,” he said in a statement, “but it’s a battle the nation needs us to fight.”
