It’s Monday and time for your

NCMS Morning Rounds.

  April 13, 2020

The COVID-19 Surveillance Network Needs You!

In order to show the effectiveness of the Governor’s Stay-at-Home order, the NC Department of Health and Human Services (NCDHHS) Division of Public Health will need to be able to demonstrate the COVID-19 virus is not widely circulating. The Department is using its influenza surveillance strategy or Influenza-Like Illness Network (ILINet) as the most reasonable way to determine the virus’ spread. If you are in a medium to large primary care clinic or urgent care center and currently seeing patients, please consider joining this surveillance effort. There is particular need in Wake and Mecklenburg counties.

New ILINet providers will be asked to collect samples from patients to send to the State Laboratory of Public Health (SLPH) for influenza and SARS-CoV-2 testing. Samples would need to be collected from up to 10 patients with an influenza-like illness (fever >100F and cough or sore throat) and from 10 patients who do not meet influenza-like illness criteria (e.g. patients being seen for other reasons such as well child visits, chronic disease follow-up visits, non-respiratory illnesses, etc) each week. Swabs, shipping boxes and shipping labels are provided by SLPH.

All swabs will be tested for influenza and SARS-CoV-2. Please note that these samples are for surveillance purposes and have a longer turnaround time than samples sent to SLPH for diagnostic purposes. In situations where the result would change patient management, ILINet swabs should not be used and diagnostic testing should be ordered.

If your clinic can assist with this critical COVID-19 surveillance, please go to this webpage and fill out the ILINet provider application at the bottom of the page. For any questions, please contact Anita Valiani at [email protected] or Erica Wilson at [email protected].

NC Medical Board Acts to Help State’s COVID-19 Response

During a special meeting on Thursday, April 9, the North Carolina Medical Board (NCMB) took additional actions to ease some licensure requirements for PAs and nurse practitioners, who are jointly regulated with the North Carolina Board of Nursing. The NCMB also extended the term of Limited Emergency Licenses, which are used by out-of-state and recently inactive clinicians to practice in North Carolina during a state of emergency, and approved a provision that will allow NCMB to be more nimble in response to Gov. Cooper’s Executive Order #130. These and other actions provide flexibility to practices and health systems across the state addressing the COVID-19 pandemic.

The Board’s actions include:

  • Extending the expiration date of Limited Emergency Licenses to 30 days after the state of emergency is lifted.
  • Approved an order allowing new PA graduates who have not taken the required PANCE testing to be issued a temporary license. The license will be valid for up to six months and will allow a PA to practice under the supervision of an on-site physician.
  • Approved several provisions related to Nurse Practitioners (NP) that mirror provisions approved for PAs. The North Carolina Board of Nursing (NCBON) is expected to approve the same orders, which are effective only during the current declared state of emergency. These provisions include:

o Restrict prescribing of chloroquine, azithromycin and other medications to ensure that these drugs are available to patients who need them. The rule was requested by NC Department of Health and Human Services (NCDHHS) Secretary Mandy Cohen, MD, MPH, to reduce the occurrence of reported stockpiling or inappropriate prescribing of these medications.
o Permit NPs who have inactivated professional licenses within the last two years to quickly reinstate their licenses. The temporary license will be jointly approved by NCBON and NCMB and will expire on August 1, 2020.
o Allow recent NP graduates who have not taken the required testing to be issued a temporary license. The license will be valid for up to six months and will allow an NP to practice under the supervision of an on-site physician.
o Allow NPs to be temporarily reassigned to a new practice area within the same facility to meet a critical need without formally notifying NCBON of the new practice setting. NPs can only be reassigned to perform medical tasks they are trained and competent to do and must have reasonable access to a physician should a medical need arise. The NP must meet all other requirements, including conferring at least monthly with a physician to ensure meaningful supervision and quality assurance within the new practice setting.

The NCMB is working in partnership with many stakeholders and working quickly to identify opportunities to support the state’s response to the COVID-19 pandemic. Learn more at the NCMB’s COVID-19 webpage.

NCMS’ Dr. Karen Smith Reflects on Impact of COVID-19

Longtime NCMS member and leader Karen Smith, MD, recently shared her reflections on the impact the current COVID-19 pandemic is having on patients at her family medicine practice in Raeford and reiterating the importance of social distancing in the community’s newspaper the News-Journal.

“I ask people to please, please be patient. Be patient. We recognize and appreciate that every individual is of value, but be patient with your doctors, nurses, hospitals, be patient with your family,” Smith says in the article. “Please don’t push back but accept that life is not what it was in January, and if we are to get through this with as little loss of life as possible, follow the guidance, follow the recommendations. They are to preserve the life of the entire community and also to preserve our life.”

Read the article.

In the News

Thousands of Coronavirus Tests are Going Unused in US Labs, Nature, 4-9-20

Learning Opportunity

The next NCMS Foundation and NC Medical Group Management Association Lunch & Learn Webinar on Tuesday, April 21 from noon to 1 p.m. will focus on NC Medicaid Response to COVID-19: The State of Things and will feature Shannon Dowler, MD, FAAFP, CPE, chief medical officer for NC Medicaid. Learn more and register.