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Battling barriers to protect Latinx residents from COVID-19

This summer, a Latinx family welcomed a newborn in the midst of a pandemic. As the baby girl lay in the nursery of Duke Regional Hospital, mother and father shared worries with Dr. Rushina Cholera, a pediatrician-epidemiologist.

Because the father works in construction — an industry with some of the highest rates of COVID-19 among Latinx men — they feared for the family’s health. 

The father said he wears a mask every day, but Cholera soon realized he did not know he was at risk because his coworkers do not.

“Wearing a mask protects the people around you,” she said. “You are not protected from getting it from them.”

More than four months into the coronavirus outbreak in Durham County, members of the Latinx community still don’t have all the information they need to protect themselves and their families. 

“We missed the boat on that early on,” Cholera said.

At highest risk

Latinx residents are disproportionately affected by COVID-19. Despite representing only 14% of Durham County’s population, they make up 61% of reported cases in Durham. Statewide, Latinx people are 10% of the population and 42% of confirmed cases.

Doctors, community advocates and experts say there are still many misconceptions about the spread of COVID-19 in Latinx communities, as well as a lack of testing. That’s because people have not always received Spanish-language and culturally relevant messaging about the virus, they say. 

“There has to be factual, culturally appropriate messaging in Spanish,” said Cholera, who is in the National Clinician Scholars Program, a training program for clinicians working to address health disparities. 

Latinx residents are also vulnerable because they make up a large portion of essential workers in Durham. They often don’t receive paid-sick leave, and they can be wary of accepting government help when they aren’t yet citizens.

“Public services for safety net programs can essentially be used against you or your family members in immigration proceedings,” said Cholera, referring to immigration regulations. “Folks are nervous about seeking testing. They’re nervous about seeking care, because they’re worried that may lead to immigration enforcement, family separation or deportation.” 

In Durham there is now a more concerted effort to address this disparity through targeted testing and communication about immigration policies that may be preventing Latinx residents — especially those who are undocumented — from seeking care. But there is much to overcome. 

Addressing fears, misinformation 

In March, doctors Viviana Martinez-Bianchi and Gabriela Maradiaga Panayotti, who are Latinx, started Latin-19 in Durham with a dozen people to address the disproportionate rate of COVID-19 among the Latinx community.

They now have 140 members, including volunteer doctors, professors of medicine, deans, lawyers, social health workers and community members, said Martinez-Bianchi, a Duke-based family medicine doctor and advisor to the North Carolina Department of Health and Human Services.

A patient held an umbrella for Dr. Viviana Martinez-Bianchi while she administered a coronavirus test last Thursday. Martinez-Bianchi is a founder of Latin-19, a group responding to the high rate of COVID-19 among Durham’s Latinx residents. Photo by Henry Haggart

Along with local government officials, they are trying to educate Latinx residents about misconceptions regarding regulations that affect immigration decisions, such as Public Charge, associated with COVID-19. There is a need to ensure that “real information” is presented to the community, according to Martinez-Bianchi. 

Fearful of being deported or that accessing care will affect their likelihood of being granted permanent resident status, many Latinx residents in Durham are hesitant to get tested and give information to contact tracers, said Martinez-Bianchi.

The Trump administration has promoted hostile rhetoric against undocumented immigrants and expanded  restrictive immigration policies. Under the Obama administration, interior removals focused on people who posed a threat to national security and individuals with serious criminal convictions. Trump overturned these priorities by executive order and instituted policy that now targets any undocumented immigrant, regardless of social, economic or family ties to the U.S.

In February, the Trump administration expanded the federal public charge rule to consider an applicant’s receipt of federally funded benefits like Medicaid, Supplemental Nutrition Assistance Program and housing subsidies in determining whether to grant a green card. That has made people without legal immigration status more reluctant than ever to accept government services, said Cholera.

In March, the U.S. Citizenship and Immigration Services stated that it will not count COVID-19 testing, treatment or preventative care against immigrants seeking legal status.

“Number one, having to go to the hospital is not going to cost your citizenship,” Martinez-Bianchi said.

But too few people know that.  

Sharing expertise

Lawyers with Latin-19 are working to quell concerns about accepting care and resources. Doctors assure patients that they can go to the hospital without it being counted as a public charge. Community members translate important pandemic safety messages like the three Ws — wear a mask, wait six feet apart, and wash your hands — for public service announcements, videos and posters. 

Another issue is pandemic-related financial support that some immigrant families can’t access, including government stimulus checks under the CARES Act passed by the federal government on March 27. 

Those without a social security number are ineligible for money from the federal Coronavirus Relief Fund. Mixed-status families, where one member is a U.S. citizen or permanent resident and another is not but pays taxes with an individual tax identification number to the IRS, are also prohibited from receiving money.

“Immigrant families were put in a position where they were extremely economically dependent on keeping jobs throughout this, and were not able to pay for basic needs like food and housing without a stimulus check,” said Cholera. 

Latinx flea market vendors protested downtown Friday after Durham planning department staff threatened food truck operators and others with fines and law enforcement for setting up a market on state-owned land. Photo courtesy of Alexandra Valladares

Latinx vendors recently protested their treatment at a local flea market, where some make income they depend on during the pandemic, said Italo Medelius, vice chair of the Durham Mayor’s Hispanic-Latino Committee. They alleged that City-County Planning Department staff threatened them with fines and law enforcement for doing business on a lot owned by the state Department of Transportation.

The City-County Planning Department issued a statement Friday saying the staff followed departmental procedures, but the situation could have been handled differently. Department members have offered to help find alternative locations for the vendors.

Making testing more accessible  

Commercial and hospital testing sites, in red, are mainly on the west side of Durham County. But Latinx residents are more likely to live on the east side, says Italo Medelius, vice chair of the Durham Mayor’s Hispanic-Latino Committee. Map by Bella Caracta with data from Durham County Department of Public Health

According to the Durham County Department of Public Health statistics,  the two zip codes in the county with the highest COVID-19 rates are 27704 and 27703 on the east side, with infection rates of 28.25 and 18.61 per 1000 persons respectively. These areas are where many Latinx residents live, according to Martinez-Bianchi. 

“Testing is a problem, especially when it is not present where the most vulnerable communities live,” Martinez-Bianchi said. 

Director Rodney Jenkins of the Department of Public Health said otherwise in his update about testing in Durham during the Recovery and Renewal Task Force meeting on July 17. 

“Durham continues to do a very good job with our testing,” said Jenkins, referring to the number of tests administered. 

The number of tests in Durham County is not the problem. It’s where testing sites are located, said Martinez-Bianchi.

On July 11, the county did set up a new three-day testing site in zip code 27703, located in the parking lot of Holton Wellness Center on North Driver Street.

Staff and volunteers there try to test from 50-75 people, by appointment only on Saturday from 9 am to 11:30 and on Tuesday and Thursday from 4:30 to 7:30 pm to accommodate people who work, especially construction workers, Jenkins told the Recovery and Renewal Task Force on July 17. 

People seeking testing are given educational materials, in Spanish where needed, and enough food to support a family of four for about two weeks in case they test positive and must quarantine themselves, according to Jenkins. Jenkins also reported that the site had about a 50% success rate for testing on July 11, meaning nearly half the tests taken that day returned positive.

People getting coronavirus tests outside Holton Wellness Center last week received food too, in case they needed to remain home to reduce spread of the virus. Photo by Henry Haggart

Martinez-Bianchi said she would like to see mobile testing in Durham that targets neighborhoods with rising COVID-19 diagnoses, specifically in the Latinx community. That is happening in Mecklenburg County, home to Charlotte, she said.

Jenkins said his department’s current plan is to replace testing at the Holton parking lot with testing at El Centro Hispano, a non-profit that supports the local Latinx community.

Spanish-language messaging 

At the beginning of the pandemic, none of the messaging from the local government was in Spanish, said Martinez-Bianchi.

In addition to inaccessible messaging, it was also not culturally appropriate, Cholera and Martinez-Bianchi said. 

Many Latinx households are multi-generational, with more than five people living in the home, Cholera said. Much of the guidance for social distancing was “not practical and not specific” to how these households should protect themselves and each other, she said.

“Togetherness is usually a big part of the resilience of the community. And in this case, it has actually acted against them. Because the virus loves that kind of environment,” said Martinez-Bianchi. 

Martinez-Bianchi also highlighted the lack of public and private resources to help people once a family member tests positive to move out of residences housing multiple generations. 

There has been hope that the state or organizations would fund hotel rooms to quarantine individuals who live in small homes with multiple people, said Cholera, though this program is not yet instituted in Durham County.

Some local organizations like the Immigrant Solidarity Fund and El Centro Hispano work to financially support immigrants regardless of documentation.

These advocacy groups cannot guarantee that ICE won’t seek information about undocumented residents from all who are trying to help them, said Pilar Rocha-Goldberg, president of El Centro Hispano, in the Recovery and Renewal Task Force meeting on July 17. 

As officials continue to work on accessible testing, Martinez-Bianchi said it’s also important to give people peace of mind. 

“What has to be promised is that data is not going to be shared with those who can damage this community,” said Martinez-Bianchi.

9th Street Journal reporter Bella Caracta can be reached at isabella.caracta@duke.edu

At top: Dr. Alex Cho administers a coronavirus test during a thunderstorm on Thursday outside Holton Wellness Center in Durham. Photo by Henry Haggart

How Steve Schewel put muscle into Durham’s “weak mayor” system

On March 13, the nation was just beginning to realize the danger and rapid spread of the coronavirus, but “Les Misérables” was still scheduled to play that night at the Durham Performing Arts Center. That made Mayor Steve Schewel uneasy. 

In New York, Broadway was shut down. The World Health Organization had just declared COVID-19 a pandemic. And Schewel had just learned of Durham’s first COVID-19 case. 

The show couldn’t go on in Durham, he thought. 

So Schewel called DPAC’s leaders and asked about their plan. They said the 2,712-seat venue couldn’t close without a government order, which would allow it to get out of contracts without paying damages, according to Schewel. He called people in Gov. Roy Cooper’s office, but they weren’t ready to make that call.

Schewel was. 

DPAC leaders wanted to stay open for a couple more shows, Schewel said. But he felt they had to shut down.

Without consulting the City Council, Schewel declared a state of emergency that banned large gatherings effective at 5 p.m. that day, effectively turning off the lights at DPAC. 

“That was the big moment where it all became clear where my role had to change,” Schewel said last week. 

In ordinary times, Durham’s mayor has more ceremonial than actual power. The mayor runs council meetings and makes committee appointments, but in many ways, the city manager actually wields more power.

Yet Schewel’s declaration of emergency, which is allowed under the city’s Code of Ordinances, gave him powers that put muscle into Durham’s “weak mayor” system. Using that authority, plus a keen understanding of county and state politics and a mastery of the media (he is the former publisher of Indy Week), Schewel has taken a firm grip on Durham’s COVID-19 response, issuing an aggressive stay-at-home order and mandating masks before any other North Carolina locality.

“He’s been out front. He’s in the news,” said Robert Korstad, a professor in Duke University’s Sanford School of Public Policy who has studied the history of Durham. “I live in Chapel Hill and I barely know who the mayor is. That’s not true in Durham.”

Unmasking Schewel’s face-covering, other COVID-19 policies 

Schewel’s newfound muscle can be seen in his bold actions to mandate mask-wearing in public. 

After issuing a stay-at-home order for the city March 25, Schewel worked with the county to update the order, the second time requiring Durham residents to wear masks in places such as grocery stores when it’s not possible to have a social distance. 

Working with Wendy Jacobs, chair of the County Board of Commissioners, Schewel’s mask mandate came more than two months before the governor issued a statewide order. Even Mecklenberg County, home to the state’s virus epicenter, Charlotte, waited for the state to require mask-wearing. 

In a reversal from its previous position, the Centers for Disease Control had recommended Americans wear masks in early April, but few jurisdictions required face coverings when Schewel enacted his requirement. 

Since April, the evidence has mounted in that mask mandates make a significant impact in slowing the virus’ spread. A June 1 analysis of 172 studies found face mask use could cause a major reduction in the risk of infection. Most Durhamites wear masks and socially distance properly, Schewel said. 

“I think that was a good call. Everyone’s doing it, even the vice president of the United States,” Schewel said (before Trump wore a mask in public for the first time last week). 

Schewel has filled a leadership vacuum not just locally but also at the national level, City Council Member Mark-Anthony Middleton said. 

“We’re seeing the numbers now go in the wrong direction in many states around the country because of a dearth of national leadership, so many state and local leaders have been left to fend for ourselves in many cases,” Middleton said. “It has placed leaders like Steve Schewel front and center to save our own lives at the municipal level.”

To be fair, Schewel hasn’t done all of this on his own. He has worked closely with Jacobs and has often consulted the City Council and health experts, City Council Member Charlie Reece said. Earlier in the pandemic, Reece said Schewel would talk with him and other Council members every few days. Middleton said Schewel kept the Council well-informed on his decisions with regards to his emergency powers. 

Still, Schewel has been the face of the city.

“Mayor Schewel has also been especially good at making difficult decisions in a clear and direct manner,” Reece said. “He has done a great job with the impossible task of weighing the various needs and interests of all the people of our city, and of charting a course through the COVID-19 pandemic that offers our community the best chance of emerging on the other side of this unprecedented public health crisis in the best possible shape.”

How Schewel got Durham on board with his COVID mandates

Schewel, a public policy professor at Duke, has been very strategic in explaining his bold policies.

When he announced the mask mandate, he got videos from Duke men’s basketball head coach Mike Krzyzewski, Duke football coach David Cutcliffe and North Carolina Central University men’s basketball coach LeVelle Moton that showed them wearing masks and encouraging others to do the same. He knew the coaches were popular role models in the Bull City.

“If this is going to work, voluntary compliance is what’s going to make it work,” Schewel said. “We need to explain to people why it’s important, for them to believe it, and then for them to do it.”

With his messaging on masks, Schewel struck a good balance between personal freedom and people’s responsibility to protect each other, Middleton said. 

“We didn’t turn Durham into a police state making sure people were indoors or social distancing,” Middleton said. “He appealed to our sense of community not just for ourselves but to each other and for one another. We didn’t have to do it with the force of fine or imprisonment and people just complied.”

His actions haven’t been universally popular. Schewel recently got an unsigned letter at his home written in purple marker calling him a “sanctimonious little dictator.” 

“They hurt my feelings when they said I was little!” Schewel quipped. 

Schewel’s stay-at-home order also caught the attention of Liz Wheeler, a host on the conservative One America News Network. 

“Now, the lockdown is indefinite. This happens if you give politicians power. They abuse it,” Wheeler tweeted

Schewel says he hears a lot of opinions from across the spectrum. 

“There has been lots of criticism,” Schewel said. “But also I feel a lot of support. Most people in Durham understand the importance of social distancing, face coverings and the actions we’ve taken when we needed to shut down businesses in Durham.”

Middleton is among his supporters. 

“We were fortunate to have a leader whose temperament was led by science and compassion to be making decisions during this time,” Middleton said. “I give him very high marks in what was an impossible situation, where there’s no pamphlet or textbook on how to handle these things.”

Lessons of history

The few modern mayors that have brought strength to Durham’s mayor system have shared several key traits, according to Korstad, the Duke professor who has studied the city’s history. 

One of those traits is charisma and strong networks, shared by Schewel and three others. 

The first was Emanuel Evans, a Democrat who served from 1951 to 1963. The first Jewish mayor of Durham, Evans was able to bring together Black and white labor unions and the white business elite towards desegregation, unlike many other Southern mayors, Korstad said. 

His successor, Wense Grabarek, who served from 1963 to 1971, also used his strong personality and community ties in support of the Civil Rights movement, Korstad said.

After Grabarek left office, Durham didn’t see a mayor last in office more than four years until Schewel’s predecessor, Bill Bell, took office in 2001. He brought deep ties to Durham after serving on the school board and had been Chair of the Board of County Commissioners. Bell had more of a political presence than his predecessors, Korstad said, allowing him to strength ties with Duke, build coalitions and tackle issues like poverty and inequality. 

Schewel follows in the mold of a “strong” Durham mayor in part due to his charisma and deep ties in Durham, but has also brought policy chops to the table. 

A faculty member at Duke’s Sanford School of Public Policy and formerly a faculty member at North Carolina Central University, Schewel brings a deeper level of engagement to policy issues than even Bell, Korstad said, and could handle the city manager role easily.

The Duke alumnus also has another advantage that Bell didn’t always have: a supportive City Council and a strong ally in Jacobs, Korstad said. 

“He’s got a lot of capital. Folks know that he’s invested,” Middleton said. “Even if you disagree with him on policy, there’s no question as to his love for the city. When you’ve built up that reservoir of capital, it’s time like these you can draw on it.”

At top, photo of Steve Schewel by Henry Haggart | The 9th Street Journal

Durham schools will be online only until October

When Durham Public School students resume school on Aug. 17, there will be no bus rides or hallway chats about summer. Instead, over 32,000 students will open Chromebooks and tune into online learning at home. 

The first nine weeks of the 2020-2021 school year school will be online, Board of Education members voted unanimously on Thursday.

Schools statewide are free to open with a combination of online and in-person learning, Gov. Roy Cooper announced Tuesday. However, after teachers voiced concerns about the safety of returning to school during the pandemic, Durham will wait to bring students and over 5,000 staff to school buildings. 

“My conversations with our teachers and hearing their concerns tipped the scale,” Superintendent Pascal Mubenga wrote in an online statement announcing reopening plans. “They assured me that they were up to the challenge of remote instruction, and I know they will deliver.

Although online instruction is the safest option, the district will face two major hurdles in teaching children at home: ensuring online access for all students and providing food. In the Durham school district, 64% of students qualify for free and reduced-price lunch. 

To address the digital divide, Board of Education members purchased over 20,000 Chromebooks for students in May. Next, they must find ways to ensure all students and teachers have internet access through the distribution of hotspots.

School reopening plans have been evolving since fears about spreading COVID-19 illness abruptly shut Durham school building doors on March 13. All mandatory studies ended then too. 

Cooper had asked school districts to develop three separate plans for re-entry following varying guidelines. Plan A allowed schools to reopen at regular capacity with minimal social distancing enforced. Plan B called for a limited reopening, where schools could operate at 50% capacity to enforce social distancing. Under Plan C, all instruction is online. 

Durham’s Spark Reopening Task Force, a group of administrators and teachers working on plans to reopen schools, had recommended a very specific Plan B. If selected, it should include in-person instruction for kindergarten through eighth grade students, but online instructions for high school students, members said.

To ensure the space needed for social distancing, high schools would house some K-8 classes because they are bigger than elementary and middle schools. If students did not feel safe coming to school, they would have the option to stay home and enroll in Ignite Online Academy, the district’s new online school platform.

 School board members approved this option unanimously on June 25. 

Teachers were not given the same flexibility as students. Although some teachers would teach online at Ignite, not all could. 

A survey the Durham Association of Educators (DAE) conducted through May and June drew responses from 34% of teachers. Among that group, 46.8% indicated that they would prefer to teach online. 

The DAE, an educators’ advocacy organization, published a statement on July 13 asking for more funding to make in-person instruction safer so that educators would not have to choose between their health and their jobs. 

“So far, the state and federal governments have not provided public schools with the human or capital resources we would need to ensure a safe and equitable return,” the statement says. “We are not prepared to bury our students or colleagues.”

DAE also hosted a virtual town hall discussion with Mubenga on Wednesday. Over 100 educators joined the Zoom meeting, with over 400 questions submitted ahead of time. 

In the meeting, Mubenga’s message was clear. He and his staff were trying their best to meet teachers’ requests for a safe, in-person reopening. However, the district does not have the money it needs to properly do so, he said.

Although the district could provide sanitizer for each room, for example, there is not enough funding to hire additional nurses. Instead, schools would call nurses via a telehealth service if someone in the building needed medical attention.  

During the town hall Arsai Adkins, assistant superintendent for human resources, announced 3,822 students had enrolled for Ignite, the online program. Adkins also reported that 331 teachers submitted accommodations requests, with 232 of those requests relating to personal or family underlying health conditions. 

If schools reopen for in-person learning in October, students will have the ability to continue learning online if they choose. The date that could happen is not yet clear.

9th Street reporter Michaela Towfighi can be reached at michaela.towfighi@duke.edu

At top: Durham public schools teachers, staff and students will remain apart at the start of the school year, just like they did last spring. File photo by Henry Haggart 

Pandemic litter? It’s here

If you’ve walked down almost any well-traveled street in Durham during the last four months, you’ve likely seen wadded up masks or disposable gloves along with typical roadside litter like candy wrappers and soda bottles. 

The coronavirus pandemic has brought environmental benefits such as reductions in air pollution, carbon emissions and environmental degradation. But littering, with pandemic-linked waste in the mix, has increased.

Across the country, cities have reported higher rates of discarded personal protective equipment like gloves and masks, or PPE, along roads, in parking lots, by bus stops and in waterways. 

“We’re really trying to discourage people from doing that because it’s not fair to whoever needs to come along and pick it up afterwards,” said Tania Dautlick, executive director of Keep Durham Beautiful.

In addition to PPE litter, Durham has seen an uptick in all types of trash tossed where it should not go. The city collected 30 tons of litter a month since the pandemic started — four tons more than average, said Phillip Powell Sr., assistant director for Durham’s Department of Public Works Operations and Street Maintenance Division. 

People concerned about litter have observed an increase in illegal dumping of household goods and other trash too, according to Dautlick, whose nonprofit group has organized volunteer cleanups of public and private land across the City of Durham and Durham County for decades. 

In March, the city’s Waste Disposal and Recycling Center closed to the public, restricting trash and recycling services to curbside pick-up. Residents have been disposing of more items, sometimes leaving trash along roadsides or in the woods. 

“People have likely had some extra time to clean up their homes and clean out, and they’ve been looking for a way to get rid of things,” Powell said. 

Keeping up with this has proven difficult. In the earlier months of the pandemic, Powell said. That is because operations were scaled back. Employees only cleaned up bus stops, city streets, curbsides and sidewalks along the over 3,000 streets that Public Works maintains when essential. 

Keep Durham Beautiful volunteers took a break, too. The nonprofit, which helped mobilize 3,290 cleanup volunteers last year, only recently started handing out its pickup kits again, which contain protective gloves, neon vests and trash bags. 

“We had stopped for a little while because we just wanted to support everybody staying home,” said Dautlick. “We also weren’t sure what sort of exposure people could have from litter because we were still learning more about how long the virus lasts on surfaces.”

Keep Durham Beautiful is encouraging residents via social media, bi-weekly newsletters, and their website to get out and collect litter on their own.

For the environmentally conscious, cleaning up litter on roads or trails is a habit. But uncertainties about the new coronavirus pandemic brought a degree of fear to that practice. 

Today guidance from public health organizations, including the Center for Disease Control and Prevention, says SARS-CoV-2 spreads most easily from person to person rather than from contaminated surfaces. But the true risks that objects and surfaces pose were not clear at the start of the pandemic.

Luckily research suggests that the virus does not last long in direct sunlight, a fact that quelled some of Keep Durham Beautiful’s members’ fears around picking up roadside litter, Dautlick said.

Still, Dautlick encourages volunteers picking up other people’s trash to “handle it as little as possible, to wear gloves and put it straight into a trash bag, and then don’t sort through it.” 

Her organization also urges social distancing and volunteer outings close to home. “We are having a lot of family groups or small friend groups or neighbors going out, up and down their street, but staying socially distant,” she said. 

Powell and Dautlick are hopeful that the amount of litter, PPE and illegal dumping will decrease again as more Durham businesses open back up. As people return to work, they will spend less time at home cleaning. And as recycling and trash services get back to normal, litter hauls should return to pre-COVID-19 numbers, they said.

“My hope, certainly, is that people continue to become more aware of the negative impacts of littering and begin to reduce,” Dautlick said.

9th Street reporter Cameron Oglesby can be reached at cameron.oglesby@duke.edu

At top: A discarded mask on the ground not far from Duke Health’s coronavirus drive-up testing site off Erwin Road. Photo by Henry Haggart

COVID-19 by the numbers in Durham

Reporting by Chris Kuo, graphics by Henry Haggart

COVID-19 cases continue to rise across the nation, including in North Carolina. As of July 11, 83,793 cases and 1,499 deaths have been confirmed in this state. Drawing on Durham County and North Carolina data, The 9th Street Journal created a snapshot of the outbreak in Durham today.

Durham is the sixth most populated county in North Carolina, but it has the highest number of cases per 10,000 people among counties with the most residents. A large COVID-19 outbreak at a federal prison complex in Butner, part of which sits in northern Durham County, contributes to Durham’s rate. Graphic by Henry Haggart

The impact of the coronavirus on racial and ethnic groups is evolving but has hit three groups hardest in Durham. When Mayor Steve Schewel first instituted a stay-at-home order in March, white residents made up the largest percentage of coronavirus cases. In April, it was Black residents. By June, the percentage of white and Black residents had fallen, while the percentages of new cases among Latinx residents had skyrocketed. Graphic by Henry Haggart

Nursing homes and other residential care facilities are linked to a small fraction of COVID-19 cases in Durham County and across the state. But they account for the majority of COVID-19 related deaths. In Durham, the contrast is even more striking: over 73% of COVID-19 deaths in Durham are linked to nursing homes and residential care facilities such as adult care homes. Graphic by Henry Haggart

Age disparity: In Durham and statewide, people younger than 50 make up the majority of confirmed COVID-19 cases. Yet 95.5% of people who have died so far were age 50 or older. Graphics by Henry Haggart

9th Street Journal reporter Chris Kuo can be reached at christopher.kuo@duke.edu 

Contact tracers fight the pandemic, one phone call at a time

When someone is sick with COVID-19 or suspects they may be, the Centers for Disease Control and Prevention says they should isolate themselves in a single room at home. One Durham parent took it a step further.

Worried about infecting children under the same roof, the parent moved into a car parked outside, despite the North Carolina summer heat. The kids delivered food and drinks there.

Katy Roys knows this because she is a contact tracer, a public health worker who finds and coaches people at risk of spreading the coronavirus. This time-tested outreach helped reduce deaths during the HIV/AIDs outbreak in the 1980s, SARS in 2003, swine flu in 2009 and now COVID-19.

Here in Durham and around the world, tracers have front-row seats to ways the new coronavirus disrupts lives. 

“You can read everything about coronavirus in the newspaper and reports, and it’s another thing to call people yourself and see how they’re doing,” said Edwin Lee, who like Roys became a county contact tracer while training to be a physician assistant at Duke University.

A dangerous illness

During Lee’s first week tracing in May, he called a Hispanic man who had recently tested positive for the virus. Like Lee, the man was in his twenties. “I feel horrendous,” was the first thing he said.   

On paper, the young man had no known chronic illnesses. During an interview the day before with another contact tracer, he reported a fever, cough and slight chest pain.

But on the phone with Lee and a Spanish interpreter, the man was struggling to speak, pausing mid sentence to catch his breath. In response to Lee’s scripted questions, he said he had significant chest pain, chills and fevers. 

“Hearing his voice and how sick he sounded, I just told him to hang up and call 911,” Lee said. 

It was only his second or third day on the job and Lee wondered whether he overreacted. When he asked a nurse on the county health department staff, she was more concerned with whether the man called 911. 

Contact tracers have observed that some Hispanic residents can be reluctant to do so, Lee said, even though new cases of the coronavirus recently were mostly detected among Latinx people in Durham County.

“If he didn’t call 911, this was certainly a person that we would have sent someone to do a welfare check on. But thankfully, he did,” said Lee, adding the man was admitted to the hospital.

Public health detectives

The county Health Department uses social media to brief residents on differences between contact tracers and phone scammers. This lesson was posted on Twitter.

On the the third floor of the Durham County Human Services Building downtown, tracers each day check a whiteboard for their duties, grab case files from a basket and get to work making calls, the students said.

Some on the job have medical backgrounds, some are health department employees pulled from jobs with lower demand during the pandemic, including restaurant inspectors.

Much like detective work, contact tracing requires creativity to fill in gaps. When Lee pulled a file that described a woman who fainted at a local business while trying to pay a bill, he had to figure out who else she may have exposed. 

“We had to make a lot of phone calls,” said Lee.

The first obstacle was finding the store’s telephone number. Despite having a physical location, the business did not have a listed phone number. So Lee dialed a restaurant in the same shopping plaza. 

A hostess answered but declined to walk only several yards to tell the store manager that the health department was trying to get in touch. When he called a nearby retail store, a helpful employee agreed to deliver the message.

But even after connecting, the situation was murky.

The first employee Lee spoke to said employees weren’t adhering to social distancing protocols that day, a payday, because it was busy. That suggested several people might have been nearby when the women dropped to the ground. Then a manager said the store was adhering to social distancing protocols and there were at most two or three customers in the store.

After six to seven hours and over a dozen calls, including four to the same person, Lee and coworkers determined none of the customers required their help. All of them, including the woman who fainted, were wearing surgical-grade masks, they learned. 

To protect people’s confidentiality, tracers do not publicly disclose names or any information that could identify individuals they work with. Contact tracing can get personal quickly.

Roys recently opened a case whose file listed an adult patient’s parent as a designated contact. When Roys called the parent, she learned patient and parent no longer lived together and no longer spoke. Still, the worried parent asked to be updated on the patient’s status.

When Roys reached the patient, she mentioned the parent’s concern. The patient told her not to talk to that parent again. 

“At the end of the day, if the patient says they don’t want us to contact their parents anymore, we don’t. We can’t,”  she said.

An expanding need

Local health departments collaborate with the state Department of Health and Human Services with contact tracing. More than 1,500 full-time and part-time staff support contact tracing efforts at the local level across North Carolina, 398 of which are contact tracers hired through Community Care of North Carolina, according to Kelly Haight Connor, communications manager at DHHS.

“As cases continue to increase we know we need more and continue to ramp up hiring,” she said in an email. 

Roys and Lee entered contract tracing after enrolling in a Community Health course created by Quincy Jones, an assistant professor in the Department of Family Medicine and Community Health. The Duke class is a service-learning elective that allows students to help with the COVID-19 response in Durham County. 

Had the pandemic not happened, Roys and Lee would have likely learned about this work through textbooks and in the classroom. Now they see the importance of what the health department and contact tracers do in a public health crisis, they said.

“They play a huge role in the control of communicable diseases and outbreaks like COVID, and their work is essential in guiding a safe transition into normal operations,” Lee wrote in a reflection assigned by Jones, his instructor.

And it’s likely they will be needed for the foreseeable future.

“I think it’s even more important now that things are opening up, that contact tracing is happening. Because there’s going to be a lot more exposures,” Roys said.

9th Street Journal reporter Bella Caracta can be reached at isabella.caracta@duke.edu

At top: Katy Roys and Edwin Lee outside the downtown Durham County Human Services Building. Photo by Henry Haggart

Drive is on to get more of Durham counted in 2020 census

Durham County ranks last in the Triangle for its response to the 2020 census, with 56.4% of residents having submitted census forms as of June 28.

During a typical census-taking year, the U.S. Census Bureau would have sent door knockers to find those who have not responded on their own. But with the coronavirus’ unexpected arrival, efforts to count everyone have shifted. 

How many Durham County residents are tallied will dictate many important things in the next 10 years. Public school funding, congressional representation, and millions of federal dollars are some of what is at stake.

For every person uncounted in Durham, the county loses more than $1,600 a year. This amounts to more than $16,000 per person missed over a decade, according to Kate Fellman, co-chair of the Durham Complete Count Committee. 

“It’s really important that we get this right,” said Aidil Ortiz, an East Durham resident and volunteer member of the Durham Complete Count Committee. 

Aidil Ortiz, an East Durham resident and member of the Durham Complete Count Committee, at the recent Juneteenth celebration. 9th Street Journal file photo by Henry Haggart

Census enumerators, better known as census takers, will begin a soft launch next month in six yet-to-be-announced regions, according to the Census Bureau. Each will be trained on social distancing protocol and provided with personal protective equipment (PPE).

Enumerators start by interviewing people in households that haven’t yet responded to the census. The effort to count people experiencing homelessness will begin in September. 

Some communities are harder to count than others during a census. Immigrants, especially those without legal immigration status, Latinx and Black people, non-English speakers, people with low incomes, and people who are homeless tend to be less likely to respond to the census unless someone reaches out, according to Ortiz. 

Ortiz emphasized the need for institutions to leave the four walls of their office and do more than just electronic outreach. With Durham’s ever-growing population, accounting for everyone living here is a top priority.

“Doing distribution of anything is very hard work and taxing, and it carries risk,” Ortiz said. “You have to do the work with more than one mission in mind, to try to be as efficient as possible.” 

Creativity has shaped a lot of the ground effort for getting the word out on the census here, especially with social distancing requirements in effect. 

A Juneteenth car parade in East Durham on June 20 combined a celebration of African American freedom, handouts on coronavirus safety information and masks, voter registration information, and census information.

Local organizers supporting a full count in Durham sent out 1,000 flyers last Friday to food pantries and organizations that provide meals to people in need. These flyers explained how to vote in upcoming elections and how to fill out the census.

Ortiz and other organizers plan to work with grocery stores like Compare Foods and Los Primos to get census flyers in grocery bags and park outreach vans outside the stores.

Local and state groups are publishing messaging in Spanish about the need to answer the census. Source: NC Counts Coalition

Ortiz says that these groups, which include SpiritHouse NC, El Centro Hispano, and My Black Counts NC, are considering replicating the Juneteenth parade in another location if response to the census along the original parade route increases within the next few weeks. 

Outreach at places like neighborhood parades and grocery stores allow people who are local and known in the community to apply their expertise, Ortiz said. Part of this work is myth-busting, especially among people who are suspicious that any information they share could be used against them. 

“People want to know what is going to happen with their information and how it is tracked,” said Ortiz. That includes whether social security numbers or citizenship status are required when answering the census. (They are not.)

The census “is a way of putting in a vote for resources if [you] can’t actually vote,” referring not only to undocumented immigrants, but to young residents and other non-citizens as well, says Ortiz said. 

Due to the new coronavirus outbreak, the deadline to respond to the census has been extended to Oct. 31, 2020. For more information, visit https://census.nc.gov/.  

9th Street Journal Reporter Veronica Niamba can be reached at veronica.niamba@duke.edu

At top: Due to the coronavirus outbreak, participants in the Juneteenth parade encouraging people to fill out the census drove rather than walked the East Durham route. 9th Street Journal file photo by Henry Haggart

Duke germ doctor putting a microscope on COVID-19

When the NFL needed help to stop the spread of the MRSA bacteria in 2013, the league called Dr. Deverick Anderson, a Duke infectious disease specialist, who established new locker room protocols and disinfection routines. Now, Anderson is tackling a bigger problem, helping health care workers combat the spread of the coronavirus.

Anderson, the director of the Duke Center for Antimicrobial Stewardship and Prevention Program, said his primary concern is making sure that health workers who work with patients who have the virus don’t end up sick themselves. 

Deverick Anderson (Duke University photo)

Anderson received his undergraduate degree from University of North Carolina and later “stumbled down the path” of infection prevention while at the Duke School of Medicine, where he knew he wanted a specialty that focused on the body as a whole, rather than a single organ. He liked focusing on infections because they typically have a cure. He liked the idea of identifying and then eliminating a problem, which led him to infection prevention. 

His research on infection prevention has earned him grants to study infection control in community hospitals, multi-drug resistant organisms, and device-related infections. He led a study that compared four types of hospital cleaning protocols and found those that utilize ultraviolet machines are the most effective. In April, he studied the role of chest imaging in patients with the coronavirus. 

Doctors who have worked with him describe him as unflappable and a great mentor. 

“He’s got a remarkable ability not to show stress and to be fun to be around and work with, regardless of how the day or week is going,” said Dr. Arthur Baker, a Duke assistant professor of medicine who worked with Anderson on the early detection of infection outbreaks in surgical sites. “I think that combination of things has really made him a fantastic mentor for me.” 

Duke Assistant Professor of Medicine Dr. Sonali Advani, who recently published an article with Dr. Anderson titled “Universal masking in hospitals in the COVID19 era,” said, “I left a very good position at Yale to come here just to be mentored by him.” She spoke of how caring he is, setting aside 10 minutes at the end of each mentor session to discuss families, house remodeling, and other things outside of work.

He is nationally known and has been quoted by National Public Radio, The New York Times and The Washington Post. 

So what does the germ doctor advise about the coronavirus? 

He says the prevention measures you’ve heard about are still a good recipe: wearing face masks, practicing social distancing, and frequent hand washing. “I think it’s safe to say that all those together are certainly going to be much more effective than one of them individually,” he said. 

Along with that trifecta of things to protect yourself, Anderson also has a simple mindset for society’s overall approach for the virus: “It is all for one and one for all,” he said. “You’re not just wearing a mask for yourself. You’re wearing a mask for others in your community as well.”

He says you’re more likely to get the virus from another person than from picking it up from a surface. “It’s not a 50 one way and 50 the other. It’s probably much more weighted towards person-to-person.” So should we still be wiping everything down? He says that’s a good precaution, but in-person contact is the most likely way to get the virus.

As a consultant for the NFL, he feels the league has a good foundation for preventing the spread of infection. But the league needs to continue to build on that approach in this new age of the coronavirus. 

He says professional sports teams need to be asking themselves the same question as other businesses: “How can you be innovative about keeping people apart? How can you make sure that people wash their hands routinely or make it easy to do what’s right? And how can you get them to wear a mask? All of those same interventions are going to be useful in athletic training facilities as well.”

As lockdown regulations are loosened, it can be difficult to decide which situations are safe and which are not. Although Anderson can’t tell you which situations are worth the risk, he says, “In the end all of this is about risk-benefit. There is no such thing as a zero risk scenario in our society right now until there is an effective vaccine. . .It is a personal decision about what is considered to be an acceptable risk or the potential benefit that might be reaped.” 

Durham book lovers find no place to browse

Suddenly book browsing has become a hazardous pastime. Durham’s libraries and bookstores have closed their doors, so book lovers have no place to wander through the stacks or pluck an interesting-looking tome off a shelf. 

The Regulator Bookshop, Letters Bookshop and Golden Fig Books have closed their doors. The libraries are open for takeout only. These are challenging times if you want to read the first page of a novel before you buy or check it out. 

The Regulator’s website explains the hesitation: “Rather than setting any date and possibly raising false expectations we will withhold any announcement until we have a firm date.” 

It’s the same for the other stores, which haven’t set a date to reopen. Until they do, the book browsing experience will, like so many things we have come to know, be done through a screen. For now, the smell of freshly printed pages and the satisfying sensation of flipping through a paperback won’t occur until the box arrives by UPS – or you pick it up curbside. 

Golden Fig owner David Bradley, says they’ve been “overwhelmed by the outpouring of support we’ve seen from the community” as they ship books throughout Durham and operate a curbside pick-up service. 

Durham libraries closed their indoor spaces to the public in response to county stay-at-home ordinance, but residents now have two ways to get new books. They can get ebooks through a newly expanded online program, or actual books through a new pick-up service.

Last week the libraries launched a “Take-Out!” book station at every location, a curbside pick-up service much like a restaurant. Book lovers can just order ahead and swing by when the books are ready. 

This virtual inventory has been well received by parents adapting to home schooling, with an increase in kids ebooks and e-audio of 88% from February to March and 55% from March to April . 

For physical materials that had been in limbo since the stay-at-home order, the library system opened up an automatic book return system June 1 outside the newly renovated Main Library at 300 N. Roxboro Street. 

Bradley said that, as the national conversation has shifted, so has the demand for new books. 

The New Jim Crow’, ‘How to Be an Antiracist’, ‘Me and White Supremacy’, and ‘White Fragility’ are so popular they’re now on backorder with publishers,  Bradley said. 

Likewise, Stephanie Bonestell, a spokeswoman for the Durham County libraries, said they also have seen a similar increase in interest with titles related to Black Lives Matter, civil rights, and racism in America.

The interest in books by Black authors has prompted important discussions in Durham.  

“It’s been our story,” said Victoria Scott-Miller, the owner of Liberation Station, a Durham based “Pop-Up” bookstore. Their website says their mission is centered on “making representation accessible and amplifying Black voices.”

As conversation around systemic racism continues throughout the city, many are asking Scott-Miller and her staff how to educate themselves on the Black experience. Liberation Station has updated its website with resources, but Scott-Miller said this is still a time of grieving for many in the Black community.

“This is a moment for you to learn, for you to gather, for you to do the research and understand the impact,” Scott-Miller says to like-minded community members. She says that provides them time “so we can have the conversation but we’re not having to show up both grieving and teaching at the same time.”

Throughout the pandemic, the store has transitioned from hosting pop-up events (which were like a new take on the Scholastic book fairs) to an almost entirely virtual platform that even includes online storytimes. Still, Scott-Miller and her husband, who co-own the business, insist on hand delivering all orders within the city (they wear a mask and gloves). 

Victoria Scott-Miller, owner of the Liberation Station Bookstore, carries a full load of books to deliver in Durham. Photo by Henry Haggart | The 9th Street Journal

The couple feels that the personal delivery is a way to connect with customers and provide a special experience.  

“There are a lot of children of color that are seeing themselves in these books for the first time,” she said, “we want them to know that they are of value.” 

Their packages are wrapped in chalkboard paper, tied in red twine, and accented with a green notecard — and a handwritten note.

Photo above: Letters Bookshop in downtown Durham remains closed to the public, but the owners have online ordering. Photo by Henry Haggart, The 9th Street Journal

Schools spend $7.8 million to gear up for digital learning

When the school day ended on March 13, Durham teachers and staff packed their bags, turned off lights and locked doors as if it was any other weekend.

Instead, it was an unplanned last day of school for students, one without celebrations or yearbook handouts. Efforts to control the spread of coronavirus shut down Durham’s public schools for the rest of the year.

Although schools mailed or handed out supplemental learning packets to students, none of the work within was required. Final grades were awarded based on the coursework finished before March 13.

Uncertain what the start of the new school year will look like, Superintendent Pascal Mubenga knows one thing for sure: Every student will participate in online learning. The district has purchased 20,016 new Chromebooks to make this goal possible. 

“The COVID-19 pandemic made it clear that we have to aggressively attack the digital divide in our community,” Mubenga said in a press release

Finding ways to expand access to digital learning is not a new conversation in the district. Durham has lagged slightly behind the average performance of North Carolina public schools on its supply of digital devices.

A 2018-2019 state report card counted one digital device per 1.1 students in Durham schools, compared to a state average of one device per 0.9 students. The district’s five-year strategic plan calls for 100 percent of all “teachers, leaders, and staff” to use technology to advance student learning by 2023.  

When schools closed due to coronavirus, that expedited the conversation to find a way to make sure every student in grades K-12 had access to a school computer. 

The price tag to purchase the Chromebooks and charging carts is $7,848,357. Board of Education members authorized these purchases unanimously at an emergency meeting on May 28. 

Staff handed out learning packets and food at Easley Elementary School not long after Durham schools abruptly shut down in March. Photo by Corey Pilson

The first step was buying the devices. The second challenge will be ensuring that all students can connect to the internet at school and at home. The scale of the digital divide in Durham is significant, and one that the school district hopes to not tackle alone.

Board members will look to the county for assistance in what they estimate will be an additional $3 million project.

DPS will also be looking to the public to help cover some costs. The DPS Foundation will announce a campaign shortly to raise money for implementing a curriculum with the devices.

Without instruction for parents and students, devices serve no purpose, said Magan Gonzales-Smith, executive director of the foundation, a nonprofit that supports DPS. 

“Realizing digital equity for students goes beyond providing everyone with a device and internet, we must think about the holistic picture,” she said.

That includes training teachers, providing tech support to students and families, and reinforcing learning conditions in homes, Gonzales-Smith said. Another factor to consider is support for non-English speaking students. 

The Chromebook order needed to be placed before June 1 to ensure they arrive before the start of the 2020-21 school year, which is so far scheduled for August 3. Reserve funds were used to make the purchase. 

The district will receive $11.8 million from the federal CARES Act, according to Mubenga’s comments in the May 28 meeting, to partially fund the project. When DPS receives the CARES funding, it will replenish the reserves spent. 

The number of Chromebooks needed at schools varies, Benjamin Brown, executive director of IT for DPS, said at the meeting. The School for Creative Studies, a magnet school in northeast Durham, and the City of Medicine Academy, a magnet school near Duke Regional Hospital, have indicated they will not need any new purchases.

Six schools, however, will need over 1,000 new Chromebooks each. That includes C.E. Jordan High School, Durham School of the Arts, Hillside High School, Northern High School, Riverside High School and Southern School of Energy and Sustainability.  

The district purchased all Chromebooks from Lenovo Solutions for $360.75 each and 566 laptop charging carts from CDWG for $1,128 per cart. 

The Chromebooks are portable laptops with a touch screen. While kindergarten students might be learning to write their names on touchscreens, seniors might be typing lab reports on keyboards. 

In addition to discussing broadband access, board members expect to discuss implementing systems for teaching online later this month.

At top: After Durham schools closed in March, teachers and staff reached out to students they were suddenly separated from where they could. Photo by Henry Haggart