Cohen discusses pandemic, vaccine distribution with NC lawmakers
Dr. Mandy Cohen, secretary of the state Department of Health and Human Services, talks with lawmakers about the coronavirus pandemic in North Carolina and the state's vaccine distribution process.
Thank you, sir. Mr. David Lynch. This Linthicum. Did I say that? Right. Thank you. On Reggie Fils. Yes. Thank you so much. Appreciate your being here and, um, keeping us in line. Um, I want Thio. Thank um, the staff on, um are clerks, um, for getting this meeting together. Um, those of you are on WebEx. I just want to remind you, thio mute your microphones. Um And, um, when you do have questions, if you'll send them to the clerks and we will try and keep in order of getting all the questions here in person and from WebEx Andi Then, um uh, I want to also note that we've had, ah, bit of a modification of the agenda. Um, the good news is, we've been doing lots of good work and have a lot of great things going on. And that's part of what has added to this. So, as you know, we're heading into, um from the Bill bill from last week in person learning, um, passed in the house and the senate, and so we're looking to get our kids back in school, and we're very grateful toe. Have, um, Secretary Dr Mandy Cohen. with us today talking about our next steps With starting tomorrow, we're gonna, um, move to group three. Um, the top level of that for the vaccine. So we appreciate her being here and describing that to us. Meanwhile, there is actually a bill that's gonna help, Um, some of our Children, um, with autism. And so, um, we're going to be breaking, um, that's the new part of the agenda. Um, we're gonna be breaking at 10. 50 for that purpose. Um, So the agenda currently will now be that we will have a question and answer session with Dr Cohen. Um, until 10. 50. And she's been kind enough to offer us that time. She has to go to another meeting at 11. And so we will then break for the press conference. And so, um, bill sponsors can go participate in that, and we will attempt to reconvene around 11. 30 toe, actually discuss, um h B 91 house Bill 91. So, um, that's that's ah, flexible time. But we will try and and get back in here by that time so we can hear the bill and have a discussion on it s Oh, that that is the That is the plan thus far. And, um, so today's session currently will be question and answer with Dr Cohen, and she doesn't have a presentation, but I do wanna offer her the opportunity she wanna wants to make any opening statements. Um, and then we will go to taking questions. I'll start with the chairs on Ben. We'll go to questions throughout the committee. Um, the one thing I would ask for the sake of time is that at least for the first round of questions, for your first question, we'll have a singular question with an opportunity for a follow up. And then we'll go to the next member for the next question. And then if we get everybody, um, through, then we can go for second questions from the same individual, if that makes sense. So all right. Yes, I'm sorry. Okay, Alright. Eso with that? I will recognize, um, Secretary Cohen. Good morning. Uh, represented Baker. Thank you. Good morning. Uh, members of the committee Thank you for having me this morning. I know you want to get to question, so I'll just be very brief just to share in terms of our overall Covad trends. They've been heading in a very positive directions. We see our cases down. We see our percent of test positive down. We see our hospitalizations down. That's all good. I want to remind folks at the wild card in all of this is we know that there are new variants that are more contagious, that cause more severe disease that have the potential to evade our new vaccines that are on the, uh that are out there. Luckily, they're not dominant here in North Carolina. We are detecting them and picking them up. So that are Those are the things that we are weighing as we move through this, uh, this period of time, great to see our trends moving in the right direction, wanting to understand how the variants will impact the next number of months. I'm sure we're going to talk about vaccines. A lot of incredible work. More than 2.1 million doses of vaccines have been given in North Carolina at this point. That represents about 1.5 million people who have initiated at least their first vaccine. That's incredible. A Z. You know, we are vaccinating those who are 65 up and our healthcare workers um care women. As you mentioned, starting tomorrow, we will be opening to the next group Are frontline essential workers. We know that's a big group. These are folks who cannot be home to do their jobs were starting with school personnel. That's teachers, but also our cafeteria workers and bus drivers, as well as all of our child care workers who have been working throughout this pandemic. Eso we We know that there is ah lot to do on vaccine. We have had weather delays in the last week. We're just receiving our shipments today and tomorrow for last week. So this is going to be a big week of vaccinating because we're essentially doing two weeks in one. In addition to doing a lot of second doses who are vaccine providers. I'm so grateful for their work. They're very busy, particularly this week. Um, and, uh, you know, what I would say is that even though we're gonna have a big week, we're doing two weeks in one. Supply continues to be our constraint. I wish we had more vaccine for everyone, but supply continues to be our constraint. I'm excited that the FDA is reviewing a third vaccine this week. Johnson and Johnson. Um and so we hope to see a third vaccine approved that can improve our supply again. So that's very positive. Eso I'm looking forward to reviewing that data and seeing that, uh, that assessment by the by the FDA, but again worried about supply. Still, I'm very proud of the equity work that we have been doing. I think you may have seen Bloomberg News rated North Carolina's equity data best in the country were getting raised in ethnicity data for 100% of our our vaccinations. And we are reporting that on our dashboard, um, not just by state, but by county. And we're holding ourselves accountable. And I'm sure we'll get into talking about how we have embedded equity in nearly every aspect of how we're doing our vaccination process. And I would, I commend, are vaccinating providers for really embracing, uh, that equity work as we've gone along, and just last week or the week ending On the 15th of February, 23% of our vaccines went to our African American, uh, to folks who are African American. I think that's great. They are represented about 22% of the population 20. They got 23% of vaccines. But we know we have so much more work to do in that space. That's that's one week great that we saw parody there. But we need to see that week over, week over week on dso. We know that takes a lot of important work that that many of you are have been involved in. And so thank you for facilitating a lot of important partnerships with that represented Baker. I'm happy to answer questions. Thank you, Secretary Cohen. And again, we appreciate your hard work and oversight and all the work of all of our frontline workers, um, to get these vaccines into people's arms. And so we'll start with questions now and I'll go first. Onto are Chair chairman Pots. Thank you, Dr Colin, for being here. I wanna be brief because a lot of people have questions in the recent state auditor's report of the DHHS E just read over it. Last night, a p A without a license was paid 1.6 million, Another pH without a license treated 564 patients on 11. See a doctor who had been previously charged with improper sexual and professional conduct was still treating women on 11 e one provider You syringe over and over on multiple patients. And on page 27 you agreed, or department agreed that there was $13.4 million in wrongful payments that you were attempting to recover. Uh, I guess how do you respond to these and to these allegations? And are the people responsible still working for DHS Secretary Cohen? Well, thank you, representative. So a couple things to clear up. So those air providers, uh, that they do not work for DHS. But I think what you are talking about is our auditor's report. And again, we appreciate the auditor always working with us to strengthen our Medicaid program. You know, we've taken immediate steps to put to respond to her audit. Those steps are already being implemented, and that builds on years of work that we've been doing to strengthen our our Medicaid program. I think it's important to understand that the audit did not find any issues related to the initial applications. This is the audit was related to our ongoing monitoring off are enrolled providers in the Medicaid program. And I had a feeling that this would be a topic of conversation here and not just co vid. So I actually have my deputy secretary for Medicaid, Dave Richards and Chairman Baker. With your permission, would you mind if I recognize Dave Richard to further respond? Thio representative pots Question. Absolutely, Mr Richard, You recognized. Thank you, ma'am. Thank you, Chairman Baker, and represented parts for the for. The another question and let let me first start out by saying is that we take this very seriously. There is absolutely no excuses on our part where we want to make sure that our program is always doing the best that we can for our North Carolina residents who use Medicaid. Um, the audit report was secretary go mentioned. We appreciate the auditor's work. We believe that this is part of government is when the auditor looks at certain things in our organization and finds them that we should correct them. A secretary mentioned there, you know, there were providers that were have a license to build Medicaid and some providers who had limited license and Bill Medicaid and the other issue that the order to raise it was a question around credentialing For a large number of providers. It's important to note, you know, we have 90,000 providers in North Carolina the licensed for Medicaid, the license providers that, um, that had their license removed. We were relying opponent Automated system that didn't work. Frankly, we have corrected that, and we're doing a manual system to make sure we're pulling from each one of those, uh, licensing boards to when there is someone who is not license that we will remove them from the program. For those who had limit license limitations, we're doing the same thing pulling from the licensing boards themselves. And we've established a policy and internal committee inside of Medicaid where reviewing those, you might imagine that license limitations should not result in somebody not being able to provide Medicaid services. ASL Long is the license that they hope allows them to do that for the larger body of the 90,000 providers that have to be credential to be in the Medicaid program. Uh, this was a issue with our automated system. We recognize that it really related toothy those organization those those providers who are organizational type providers that our system did not catch as we would like them to. We're in the process of making system changed to be able to connect those, and we'll have that done within the next several months. I would anticipate no later than three months and we will have that system in place in the final. The other issue that the order to recognize saw was that when we have ownership issues with providers are making sure that we verify ownership. We go through a process where providers have to tell us that same thing is what happens if the secretary of state's office, where they let us know that our difficulty is that there aren't a lot of systems that actually do much more detailed review than that. We're working right now to try to figure out what those systems are that we can automate for us again to look at those providers. But I can assure you we will have a recommendation back to the secretary within three months on how we will trust that issue. I just want to reemphasize that, you know, we we take this very seriously. We have a large program We believe that for the vast majority of things that we do way do well on DAT. But any time the order to find something or anyone else finds these issues, we will correct them immediately. I think the order to recognize that in her report that our response was immediate and that we are make sure that these issues do not happen again in the future. I don't have a follow up. In fairness to everyone here, I'll limit my question to give more people the opportunity. Thank you. Thank you, Chairman. Lambeth, you're recognized. Thank you, Madam Chairman. And again, thank you for being here. Um, yeah, I have a whole serious question, but I'll try to limit too few Azul go around, get more people in for questions. Um, thank you. I certainly support the caution during the pandemic, but I'm little concerned about all these signs. Scientists who are experts and they're getting different opinions about things. But my question really focuses on trying to understand why some businesses air singled out why some gatherings air so inconsistent. And, for example, I would like some help in trying to understand these inconsistencies. For example, the gaming centers. Some people refer to him as gambling sites. I rode by three of them over the weekend, and they were packed full of cars into these little sites where folks were in there with the slot machines and so forth. But then again, the bar's air closed. And so I'm really wonder about the inconsistency. You know, not allowing Spectators and sporting events for these large arenas where you certainly could social distance, even at a 25 or 30% capacity. And so I'm back to the scientists because I hear and read all kinds of things that these scientists say. And, quite frankly, they all say different things at times. And I wondered what advice you'll get when you make a decision to allow, uh, bars to be closed. But then these, uh, recreational sites where these sites where they go toe to gamble, literally being open and full of people on particularly weekends. Curious Secretary Cohen, you recognized, uh, Chairman Linda. Thank you for that question. So there's a number of things that we look at in terms of the overall restrictions and trying to slow the spread of this virus, and I think that we have tried over this entire year. Um, Thio base our decisions on the trends that we're seeing as well as our recommendations from our epidemiology team on how this virus friends, What are those activities that are the highest risk? Yeah. Sorry. Were you trying to jump in? I'll keep going s Oh, sorry. Looking at the setting itself, looking at whether it's indoor or outdoor looking at the activity and whether or not that is something that spreads virus. And I think importantly whether or not folks can consistently where their mask is in an activity that requires you to take off your mask while you're doing that activity. And unfortunately, things like drinking and eating are things that require you to take off your mask and the times you need to take off your mask. That is when risk goes up when you are indoors and you are sitting and you are in one place for a longer period of time. Those air when risks go up. So we have restrictions really across the board, you know that our restaurants are at 50% are gaming, I believe, is that 30% with some with some additional caps on that, Aziz. Well, so if parking lots are full, those air folks who are not following the executive orders because there are no places that are allowed to be fully opened and packed in anyway. So I'd be happy to look into that particular situation. I will say, Look, our trends are moving in the right direction and we know we want to reassess where we are in terms of easing restrictions. I know the governor is considering that right now with input from our scientists on DSO. I know he will be making announcements later this week on that and you know, again we will continue to look at our trends. Look at the science. Look at the settings as well as the activities within them. Onda, whether or not they are, are higher risk or not. And again, it is really both the setting and the activity. So things like singing, yelling, cheering, Um, taking off your mass. Those are all things that increase the risk of heavy breathing those kinds of things when you're when you're exercising, dancing on others, those air things that increased risk on DSO. That's how we want to balance as we make decisions going forward. I will say I think North Carolina is done a tremendous job. If you look at our other Southeastern state partners, we have less cases, less deaths, less hospitalizations. And I think it's because off the work that we've done over this year, so we'll continue to use that same strategy of this of this dimmer switch approach that we've been been using to protect everyone going forward. Chairman Sasser. Thank you, madam Chair. Thank you, Madam Secretary. Uh, following up on the comments that I made two weeks ago with a question, uh, at this time, or is there any vaccines and drugstores? Okay, Secretary Cohen, you're recognized. Thank you. Thank you. Representative Foster. Yes, there are. So I think now that we're into our second week where the federal government has turned on the federal retail pharmacy program and we have activated that here in North Carolina, that means 300 Walgreens all have vaccine coming into it. They come directly from the federal government. It is in addition to the states allocation. And then I also know that we have been on boarding pharmacy providers, and I I have to find one second um that so we have the 300 Walgreens. But then we also have another about 60 or 70 pharmacies, um, that are also receiving vaccine are already receiving vaccine directly from the state from our allocations. So that is above the Walgreens one as well. Thanks. Follow up. Follow up. Are any of those 60 drugstores in minority communities? Secretary. I'm sorry, man. Sorry. Oh, no. You're recognized. Um, I will have to go back to look to see where there are. The reason we chose Walgreens as our first partner was because of its geographic reach. Across the state, they had more than 300 stores and across the footprint of North Carolina. And that was particularly why we chose Walgreens. I hope to bring on even more providers. I think they're unimportant. Uh, location, uh, for vaccines. As you know, our issue a supply. We continue to be very low on supply. I could barely get enough supply to our vaccinating providers. As as it is, they're doing a terrific job of getting vaccine at within 2 to 3 days of receiving first doses on guy. No, they're all, uh, sharing with us. They have more capacity and that that's great for us. As a state, I'm hopeful with Johnson and Johnson vaccine on the way that we can very much utilize that capacity. That is sort of waiting in the wings, if you will. Eso In addition, Teoh, you know the 60 or 70 pharmacies I know we have, you know, more than 1000 additional providers who are enrolled and are waiting to be vaccinated providers. We very much want their health. We just need more supply. Thank you, ma'am, for what you're doing with the pharmacies. Thank you, sir. Care woman White. Thank you, Madam. Chair. Thank you for being with us. Uh, Secretary Cohen, we appreciate your what you're doing, and we appreciate your team. Um, I just received a notice from the minority health Council that I serve on, uh, that you have released another tool kit called Supporting North Carolina Vaccination efforts for partner organizations. Congratulations. Because I imagine that was part of the national recognition that you've received for for doing this work. Are we going to? So my question is, are we going toe have a tool kit to change the vaccination rate of approximately 40% to 100% off the aging population, the most vulnerable for severe chronic complications with co vid and death. As we all know, um, since there is, um, more people 60 and over in North Carolina than 17 and under. Uh, this is a critical mass. And according to the last statistics that I received on Lee, about 40% of the people 65 over have received the vaccination prior to this week. And that was when my last update. Waas. Um so thank you for for responding to this question. Secretary Cohen. Representative. Thank thank you for that. We agree. It is why we we prioritize vaccinating those who are 65 older in these first number of weeks here. We've been vaccinating them for as you know, um, now for since the first week, Second week of January. Andi, I believe the last statistics I saw we were we were, um over 50% of our 65 plus have been vaccinated, but we can follow up with you on exactly the penetration. But what I wanna remind folks is we don't close the door to those who are 65 up. Starting tomorrow. We layer on to that. We are opening the door to our our school personnel and our child care personnel. But that does not mean that we're going to close the door to anyone 65 up. And and continue to think that that is incredibly important to make sure that we are are continuing to get those who are 65 vaccinated on DSO. You know, we have been very clear with our vaccinating providers and others to say that well, our school personnel in childcare personnels are going to become eligible tomorrow. We That does not mean they're all gonna be vaccinated tomorrow or this week or even in the next two weeks because of your exact point is that we have to keep vaccinating those who are 65 up. We know we have wait lists of those who are waiting still for that, and I'm hopeful as we have more vaccine supply which has been improving week over week, I do want to say that we have almost double the amount of vaccine now than we had just five weeks ago. So that is that is good on dime hopeful with the J and J vaccine. So I'm you know, we want to just keep vaccinating at at the high pace that we are. Every dose that comes to us gets in an arm within a few days on DWI. Wanna be vaccinating those who are at the highest risk those over 65 up and then now adding on those who can't stay home for their job and have a high risk of exposure. So we're layering those on. Thank you. Follow up. Follow up. Thank you. Dr. Cohen is a Do you have concern that, um when we are now opening the door when I think he's quoted a moment ago that you had vaccinated about 23% of African American population and there's 22% of the population in North Carolina. Um, And now we are opening the door to other, uh, I guess what we would call the third category with teachers and so forth and other frontline workers, which I'm very glad for it. We need that. But are you concerned because I think your first statement today was that in regards to the supply of vaccines, that that is the major problem right now, so it just Maybe I'm Maybe I'm too country, and maybe I'm thinking the stats more than I should. But when When we know that we have a less amount of vaccine coming in. And yet we are still targeting particular populations and we and we even if it's 50% of the 65 over, they were in the first category. And so I just can't understand how we can keep adding on other layers when we know the vaccine is not here for various reasons. Maybe supply, maybe delivery because of the weather in other states and so forth. But I'm just help me understand how we can balance that out or how we are if you are concerned about that balance, Secretary Cohen. Well, thank you, Representative White. So there's a couple of things. So one we have been surveying our vaccinating providers every week to try to understand about what they are seeing in terms of demand on the ground. And are they ready to move on to the next group of vaccinators? Um, and now everyone is not ready. Um, and in fact don't need to be ready to move tomorrow to the next group. and we have said that. But many are where many have told us that they are ready to move on to the next group of wanted to give them the opportunity. And I think to your exact point, we knew that Frontline essential workers is a very large group. Not only was the teachers and childcare, it was also our our police and firefighters and clergy and other front line workers again, who are agriculture workers who can't stay home to do their job we knew was a big group. And to your point, when were our supply is so limited. It is exactly why we're stepping through this frontline, essential workers in some groups to try to manage a bit of the funnel. And what we were anticipating was this additional vaccine with Johnson and Johnson, um, in the next coming weeks. So I'm hopeful by March 10th what we hope to be able to open to other frontline essential workers, that we will actually have a third vaccine and thus more supply here in North Carolina. So I'm hopeful at that time would work out. I still need to see the data from the FDA and has to go through that process. But we're hopeful that that timing will align as getting more vaccine and moving on in the additional prioritization. I just want a chairman bigger to to clear up one thing. When I said 23% off vaccines went to African Americans, that was in a particular week. So the week ending February 15 23% of the vaccine given that week went thio are those in the African American community? That was just one week. So if you look overall, we still have a disparity there in terms of lower vaccination rates for our African American communities. And I wanna point out, and we still have a lot of work, and we recognize that to do with our Latin X Hispanic community. We still see you no very low rates of vaccination there, and we're working very hard to make sure that we're making improvements there as well. Thank you for that clarification. All right. And representative Shepard. Yes, thank you, Madam Chair Secretary Cohen. My question is, I, like many residents, have a mother that sent a nursing facility. She's been there over a year we've not been able to touch. See each other. We talked through a window. Her sister passed away last year and I had to call her and tell her on the phone about that. We couldn't go in and personally discussed that. I'm getting inundated with questions from people. When are we gonna be able toe work out something so that families and friends can go in and see their loved ones that are in nursing homes and pretty much have been imprisoned there for over a year? Um, I know that we have concerns about spreading the virus, but at the same time, other avenues are opening up in venues, and that's a big concern for a lot of people in my area. And so I'd like to know when we can see that. And I was told last summer that they were working on something where you could go into a specific room and visit that's never transpired. Never happened at our facility. My mother is doing very well. I'm appreciate for the care that she's getting, but she is really suffering mentally from not being able to talk to family and friends and spend time with them, and so that's a big concern for me as well as my constituents. And the next question is, uh, we were 40 night that one time getting the vaccines out. Where are we now? In regards to that statement that came out earlier about being 49th. And thank you so much for answer my questions, Secretary Cohen. All right, Thank you for both of those, Um, on, you know, our long term care. This has been such a hard year for for everyone. But we know, particularly in our long term care in particular, are nursing home are most vulnerable. This has been incredibly incredibly challenging year. It's the place we saw a a lot of very severe disease and death. Unfortunately from this virus, Um, it was the perfect storm of the congregate living settings as well as incredibly medically frail on DSO. We had to really work hard to protect folks on. Do you know, we We've worked very, very hard for a year to do this, and I'm really excited that we were able to prioritize vaccinating those who live in our long term care facilities. And what we're seeing is a really great uptake rates. We're seeing about 80 to 90% off, the residents are getting vaccinated. And that was through the federal program through CVS and Walgreens, there now finishing up their second round, about to be on their third round of coming and doing vaccination. So we're finally at that place where nearly all folks have gotten who are residents have gotten the two doses. So I think it is exactly the right time to be asking that question about about changes in visitation policy. You know, the nursing home visitation policy is very much tied to some federal rules. The Centers for Medicare and Medicaid services govern Ah, lot of the visitation rules and the way that we need Thio to move forward on that. And right now we are. We're in accordance with their rules, which allow for outdoor visitation. But I hear you about indoor visitation as well, and I actually we're just talking as a team to say we need to make sure we're asking CMS to understand When are they going to make those updated the visitation policies? And then we need to look at some of those other settings, like adult care homes and others that are not regulated by CMS. So I think it's a well timed question. I think it's right to be asking it now. I think we're just at that place where vaccinations are are finally in place. But it's not without risk to do this, because remember, new people come into, uh, to nursing home settings and long term care settings all the time. So we need to make sure we have those protections in place and vaccinations to keep going. So we're trying to make sure that we are getting that foundation of safety there, and I think it's it's the right time for us to be reevaluating that. So let us come come back as we look at the science, uh, confirm with our federal partners and we'll come back with more on that soon. Oh, and then your second questions are about Where do we rank? Um, you know, what I would say is that things have been bounced bouncing around, but we were somewhere in the teens. So So I see. I saw this be 15th yesterday. If you look at total dose is administered, we were somewhere like eighth or ninth, and total dose is administered. But if you look at when you normalize for populations. I saw something 15th, but again, that bounces around each day. But what I could say is we're the top of the pack because our vaccine providers have done a fantastic job when they receive those first dose vaccines of getting it out immediately. Things maybe a little off in the numbers because of our weather delays. Remember, we got late shipments that from last week that are just coming today and tomorrow. So we're basically doing two weeks in one week here. So please just know, as as the numbers bounce around, day to day, things may look a little off over the next week as we sort of recalibrate after the weather delays. But like I said, I looked at something yesterday. We were 15, so I'm pretty proud of that. Thank you, representative. Um, and represent Dixon, you're recognized. Thank you, madam. Thank you, Madam Chairman. Uh, Madam Secretary, why have you been hesitant to talk about the value of and potential of herd immunity as being our friend in this situation? Secretary Cohen. Well, thank you represented Dixon. I think what? The issue with herd immunity is really understanding. What does that mean? in the context of cove it because it is a new virus. I don't know that we have a precise number of knowing what does what does that mean on don't think we're We are afraid of talking about it. I think we want to be sure that we understand what our goals are we are aiming for. I think we want to get as many folks vaccinated as possible as quickly as possible. And you can see if we had more supply, we'd be vaccinating more people. So right now we're just completely limited by supply in terms of vaccine. But I do think that we you know that that is where we want to head the You know, the question in the debate in the scientific community has always been like, Well, what is that point? What does that mean? And how long do these vaccines confer immunity for when we say herd immunity? How long does this vaccine confer immunity to someone since we're still studying the longevity of that. So I don't think we're don't wanna talk about it. I think we wanna make sure that we're understanding the science and setting the right goals and targets for ourselves. Follow up. Follow up. Thank you. Uh, Dr Marty Makary, a surgeon and professor at John Hopkins, has recently made some observations. That sounds to me to be very scientifically sound and logical. And his idea about herd immunity is that we're far advanced from what folks normally might put us at. And he even talked about the issue of the underprivileged communities and stuff like that and the amount of people that have already had this. We didn't know it. They haven't been tested. Only a very few has been tested. And so his his comments seemed to be, uh, at a level understanding herd immunity. Far beyond what? You seem to understand it. Wow. Secretary Cohen, uh, representatives. And thank you. So, actually, the General Assembly has funded a number of studies toe. Look at the prevalence of of Cove it here in North Carolina. To your point, you're right. We we only capture from testing. What we what we capture. We know we're missing some of that. And so we actually went out with with our academic partners and studied to try to understand what is the true total prevalence of disease here in in North Carolina and look. Part of our success is that we don't have the penetration of prevalence that a number of other states have seen, which is, I think, a success here, um, in North Carolina. So we're nowhere near herd immunity here in North Carolina by those prevalence studies that have been done again by our academic partners will be happy to share those results with you. But I think it's the combination of those who have had Covad before as well as now. Our ability to vaccinate together, I think, is what's going to confer immunity toe to a population. The question is, how long does immunity last both for those who have had covert before and for those who are getting the vaccine? And do these new variants change the calculus at all? I think it's It's, uh, you know, we just need more science as we go through here, and that's why you're going to continue to hear, say things, you know, we will, you know, move forward and ease restrictions. But you're going to continue to hear us talk about the three W's and the importance of it just because of that is because we We do still have a low ultimate prevalence of disease here in North Carolina. We still are limited in the number of people were able to vaccinate it at, uh, given our supply and these variants sort of our wild card for us, and we don't really know what that will mean as well as how long are people gonna be immune? I think these are all the right questions we should be asking. And we're gonna be asking them of ourselves day over, day week over week as we understand the science. Better know that we're doing that, know that we're looking at at at advice and science from across the country and across the globe to really understand this. But I think, you know, we just don't have all the answers quite yet. Um, to know exactly how this full year will play out represented Szoka. You're recognized. Thank you, madam. Share. Thank you, Madam Secretary. When this began not quite a year ago, the initial goal national goals and state goals were to flatten the curve to prevent overloading, hospital emergency rooms and overloading. Our resource is in our I c use. Um I understand it Over the past months, there have been times when various icy use have been stressed and they have been strained. Our my understanding now is that there aren't any I see use or E r s in the state that are really under what you would call stress and strain under whatever metric you choose. So my question here is with all this science that we've been hearing about the initial goal, I have not heard that the initial goal of not overcoming our hospitals has ever been changed. We've heard a lot of other things about percentage of vaccinations and this and that and the other thing, which are certainly important. But when I look at other states across the nation and see different policies that have been done from the extreme policies in California, two policies much more liberal, for example in Florida and I look where we are, the question here is is the primary goal still to flatten the curve? And if it is, what is the exact metric that you, as a medical professional, will use to determine when that curve has been flattened? That will then allow the easing of restrictions to more along the lines of Florida than where we are now. Thank you. Secretary Cohen. Uh, representatives Oka Thank you for that question. And so, you know, we've been very consistent in both the metrics on the the things that we have been doing in order to slow the spread of the virus. And you are right that that it has taken a lot of hard work over this year to not overwhelm our health care systems. Florida was shipping patients out of their state because they couldn't handle them. They had hundreds of hospitals that close to being able to take patients they overwhelmed There. I see you. And they had more deaths because of it. We did not have that situation here. The tightest we ever got was about the second week of January. We had nearly Maybe it was a first or second week of January. Nearly 4000 people in the hospital at one time on DWhite we needed to do at that point. Waas Teoh a basically stop all other urgent procedures. So are hospitals needed to and we're doing this across the board where they couldn't do other things because they had so many cove in patients to take care of. But we never overwhelmed our system, meaning that we never turned anyone away. We never had to divert anyone out of state on. I think that is, that is a success and you're right. That is what we were protecting against on DSO. Now, as we see, we're or only six weeks away from that that moment. But it's great that we have. We have moved away from that peak and then that is exactly why I think the governor is looking at ways in which we can ease restrictions going forward. I think he'll be announcing those later this week and again. But I don't think that we can way certainly still have more work to do in order to keep that virus level low and again. I think the wild card for for me as well as our you know, other the scientific community is these variants and what will that mean? And will there be an uptick in viral spread because we know these variants arm or contagious and what are the things we need to still be vigilant about as we go forward and so we'll look at those same metrics cases. Percent of positive hospitalizations. A swell a czar surveillance, early detection mechanism. All right. And we have Ah WebEx. We have representative Cunningham. You're recognized. Thank you, Madam Chair. Thank you. Secretary Cohen for your staff and what you all have done to improve the vaccinations and the marginalized in underserved community and especially the African American community. And I recognize it's a fluid situation. I just heard the reference to the hospital staff. Um, not being strained. Um, and I would say they continue to be strained because of staff exhaustion. From what we have been through. And also, travel nurses continue to be used in certain areas of the state. I'm very much aware of that, um, and my concern. And I'm looking for what we're looking at for the next season. Once we flip over into spring with the issue of the virulent, um, that issue has been spoken about on the national level of expectation of another way. Eso I'm interested in your thoughts on that particular issue. Secretary Cohen. Uh, thank you, Representative Cunningham. For that, I think we are still trying to understand what the impact will be. What we what We are doing is studying what's happening in other countries. So the UK variant, which is the dominant variant here in North Carolina, were actually, Obviously, we're looking at what happened in the UK and if you look at when they first identified a small number of variants there, they saw a huge increase after that point and that don't that variant became very dominant. Now they had other compounding factors. One, They did not have vaccines at that time, right? It was just a different moment in time. Vaccines were not out, so we were in a different moment in time. So that is good. And it was also a They were heading into the winter holidays as well. On DSO there were some confound er's there, so I don't I am hopeful we will not see that same pattern that the UK saw. And again they took some incredibly dramatic measures to try to ward that off. I don't know if we all remember back in like the end of November time frame. They went back down essentially into lock down to get their numbers back under control. I hope that that will not happen for us for two reasons one is that we we, uh you know, like I said, we are. We are vaccinating, Um and that is good. We're protecting our our most vulnerable right now. Um, and and second, I am hopeful that we have done well enough to keep viral spread low. That this this virus, that the strain of that virus or Sorry, the variant does not become dominant here in North Carolina. But again, this is what the science needs to show us. I think is why, though we want to make sure that we continue to be vigilant during this time to keep that virus level low. So those strains do Sorry. Those variants do not become the dominant here in North Carolina on DSO. I think that's why we want to make sure we are. We're balancing the right preventive measures and the vaccinations as we go into into March and into April 1. Follow up, Metal chair, Follow up. Um, the the media at the national level represent that the Verrill unde is more apt to be more serious in Children and that it spreads more easily. Can you elaborate on that? Just a little bit, Secretary con. Thank you. for that. I think we're seeing it be more contagious and and cause more severe disease and adults. And I think the the assumption is, if it's more, uh, contagious and and severe and adults that that would also carry forward to Children. Now we know in Children covert overall is it spreads less frequently and Children get less severely sick. So I think we're already starting from a good place. So even if it was a bit worse, the question is, Well, how much worse? And I don't think we really know that yet. I still see if again, going back to the UK and you look at what happened there. They still did see a very low level of viral spread within their within those who are under the age of 10. So I do still think that there is something protective about being a child, which is good, Um, even in the context of of these variants. But again, that is just why we need to continue to keep up our vigilance here as Aziz, you know, Representive Cunningham. The vaccines are not yet available to anyone under the age of 16. Um, so they are doing trials Right now, I am hopeful that vaccine will be available for down down to age 10, um, in the near future. But, you know, we're still waiting for that as well. So just a lot of reasons to continue to be cautious as we go into these next number of months, I think we're gonna learn a lot of things both about the variants and about the vaccination. Uh, effectiveness. Azzawi, go forward. Thank you. And thank you. Secretary Cohen. I know we're closing in on your time availability. I think we did have, um if you can indulge us. One more question from, um Chairman Lambeth, are you available for that? Yes. Okay. It's short. Secretary Cohen, there's there's rumors flying around about the Pfizer vaccine is more effective. Shot one. Then they thought. And as a result, there are people that are not going back for their second shot. What's the scientists telling you all about the first shots? Effectiveness. And also, what do you all seeing as faras people not returning for the second shot? There's also the rumors that the second shots side effects are a lot worse than the first shot. All that's bubbling around. Secretary Cohen. Yes, sir. Let me start with our people coming back for their second shot. The answer is very much. Yes, actually. Right way. Right now, we only have about 3%. 3.5% of folks who are late for their second shot. So vast vast majority of folks are getting their second dose on time. Which is exactly what, um, the scientists recommend the CDC FDA unanimously recommend getting both of your shots, as the clinical trials said they should be given, Um, And when folks do have a slight, more, more of a reaction to their second, that is right. That means your your immune system is strengthening right when you get some of those side effects, like feeling crummy after the second dose or getting soreness. Um, at the site of the injection that is your body building its immune system. That is, You getting an immune reaction, which is good. Which means if you encounter the rial cove it your immune system's gonna be ready to fight it. So I encourage everyone to get both doses on time, and I will say, uh, right, But 97% of folks who are We're due for their second doses have gotten it. We are trying to make sure we're following up with that small group that isn't calling them, making sure that they're coming back understanding any concerns. But as we've gone through this again, we have not seen any severe adverse reactions from the cove vaccine, which is great again, given that we've given up on, you know, almost 22.2 million vaccine doses. I think that is a tremendous success that we're seeing here. So again, hopefully the recommendation. Everyone should be getting both doses on schedule. And that is what we're seeing from our data. Thank you, Secretary Cohen. And we appreciate your time and availability, um, to us today during what we know is a tight schedule. Um, so we thank you for that, and we'll let you head on to your next meeting. And, um, members here and on WebEx Um um and those listening I will remind you that we're going Thio, resume our meeting at 11. 30. Um and so we will now recess until 11. 30. Thank you, German