On the first day of April, when confirmed cases of COVID-19 had barely broken 1,500 in North Carolina, Marisela Martínez started a housekeeping job through a subcontractor at the Mountaire Farms poultry plant in Siler City.
The sole income-earner of her household, Martínez said she lost a construction job she had held for years due to the pandemic. Ineligible for unemployment benefits, she turned to a reliable, but high-risk source of income for Mexican immigrants like herself.
"At that moment, the pandemic was already very strong inside that plant and people asked me how I would go to work there knowing the risk," Martínez, 67, told a reporter in Spanish. "Because of the need to work and cover my expenses, I didn't care."
She spent about two weeks disinfecting the cafeteria area in the plant before she was given a mask to wear. At home, her husband began showing COVID-19 symptoms in mid-April.
By May 1, her husband tested positive for the virus at a hospital after becoming gravely ill, Martinez said. She had to quarantine herself. Soon she began experiencing symptoms, too.
"I got my husband sick because he was staying at home and I was working," Martínez said.
The day her husband was diagnosed, state health department officials floated an idea to their county-level counterparts. As they had done for the first time days before for nursing homes, state regulators pitched the publication of a list of known COVID-19 cases by individual meat processing facilities, emails show.
Unlike for nursing homes, such a list was never made public. Instead, emails show the suggestion prompted concern from county health officials over expected pushback from meat-processing companies like Mountaire.
Mountaire did not respond to requests for comment from the NC Watchdog Reporting Network for this story.
N.C. Department of Health and Human Services Secretary Dr. Mandy Cohen says she stands by the decision not to publish outbreaks by facility. She points to her agency's lack of regulatory authority as one of the main reasons she and her department have had to find common ground with private industry, instead of acting as more of a watchdog regulator.
Putting Cooperation Above Public Information
Martínez said she didn't think she'd get sick, but this was before Latinos, almost one half of the nation's meat packing plant workforce, would become the ethnic group with the most COVID-19 cases in the state.
Though the job paid less than half of what she made before, it was only a short drive from her home in Randolph County and has helped her stay afloat.
Other housekeeping workers were getting sick, too, Martínez said. Just how many workers were sick at Mountaire was unknown by the people on the chicken production line and those like Martínez who cleaned up after them.
Within a month of Martinez going to work at the Mountaire plant, at least 153 workers had tested positive for infection, emails from DHHS officials show. At least 74 cases had been made public at that point, WRAL reported on April 29.
Martínez still lauds Mountaire for the company's virus precautions and for being a financial lifeline for her in the pandemic.
On the morning of May 1, Erica Berl, with DHHS Public Health, sent an email to local health departments with a list of COVID-19 case numbers by individual facilities with outbreaks, notifying them that DHHS was considering publishing these counts on the DHHS site to be updated on a weekly basis.
Less than 90 minutes later, at least two local health department leaders fired back concerned emails.
"Layton and I do not agree with this going out," wrote Lee County Health Director Heath Cain, referring to himself and Chatham County Health Director Layton Long. "We need to discuss further asap."
Both health directors oversaw counties where case counts had rapidly increased inside poultry plants.
In a separate email, Long added that releasing the facilities' case counts would be "very detrimental to any cooperative relationships that we have with the plants."
"It is important that they continue to work with us for contact tracing and access to their staff," Long wrote, adding that the public release about testing numbers would go in a "negative direction."
"I would like an emergency call set up between the meat processing county health directors asap," he wrote.
The emails come from a trove collected through public records requests by the Documenting COVID-19 project at the Brown Institute for Media Innovation.
Long has retired from the health department and Cain did not respond to follow up questions about his emails. It's unclear if that emergency call ever took place. Ultimately, DHHS did not publish a list of outbreaks in meat-processing plants.
In an interview last month, Cohen said her team decided against publishing in part because of concerns raised by local health departments, and in part because the information would have been incomplete.
Unlike nursing homes – another hot spot for outbreaks – these facilities are not required to report COVID-19 numbers to DHHS, so any information about coronavirus outbreaks is reported voluntarily or discovered by officials through contact tracing and other measures. "We want it to be a complete and accurate picture," Cohen said. "We did not feel like that we had a full and complete picture because of that lack of requirement on their side for reporting and if anything we were saying, 'Oh, if you actually come forward to us and work with us, you might end up on the website.'"
But worker advocates say public disclosure is just as important for meat processing plants.
"Why should we know in a senior home how many people are infected and we cannot know in a plant?" said Ilana Dubester, director of El Vinculo Hispano/The Hispanic Liaison.
Her organization, which advocates for Hispanic communities in the central Piedmont, has gotten dozens of calls from concerned workers since March at a single plant – the Mountaire Farms chicken plant in Siler City.
"They're risking their lives to cut up chicken and it's not fair that somebody should withhold that information – that the county should withhold this information, that the state should withhold this information," Dubester said.
Derek Kravitz, a journalist and lecturer with Columbia University's Brown Institute for Media Innovation, argued that more openness would only help stem the spread of the virus.
"Public disclosure of outbreaks are a matter of public interest, and a public health concern," he said. "Greater transparency leads to greater awareness and knowledge of what's happening in local communities, and better strategies for people in either avoiding or preventing further community spread."
But because DHHS has little direct regulatory authority, Cohen said the agency has to find ways to work with private meat processing companies, instead of dictating to them how they should behave.
"Our priority is, again, is for them to self-identify; to come to us and work with us," Cohen said.
None of this is to say that meat processing facilities don't fall under any regulatory authority at all. The N.C. Department of Agriculture and N.C. Department of Labor both provide oversight, the former covering food and the latter watching out for worker safety.
Cohen said she would like to work more closely with either or both of those agencies.
But that regulatory authority has prompted confusion even from the health officials closest to the plants themselves.
In the town of Wilkesboro, where nearly 600 workers tested positive at the Tyson poultry plant, a fifth of its workforce, in late May, the county health department faced pressure over the growing outbreak.
On April 24, Wilkes County Health Department director Rachel Willard wrote to DHHS asking for clarity about who is responsible for information related to the plant. The subject line of the email read simply, "Help."
"I am needing a favor. We are getting major push back from our town officials. Can you send me a 'follow up' email and state that public health has no regulatory authority over Tyson (but it is) USDA and other agencies?" Willard wrote.
In another email the same day to town staff regarding confusion and pressure in dealing with a then-rapidly growing outbreak, Willard lamented that the state wasn't directing plants to conduct mass testing.
After the health department learned that Tyson wanted to test the plant's roughly 3,000 workers, the health department still lacked state guidance.
"I am not really sure what our next steps are to be honest. What do we need to do officially to request help from the state for testing and resources?" Willard wrote in an April 30 email to DHHS. Erica Berl responded by setting up a phone call with Willard.
Tyson publicly announced on May 20 that after mass testing, 570 workers at the plant tested positive, the only meat-processing company to reveal its outbreak totals in the state.
However, a June investigation by ProPublica into meatpacking plants including the Tyson plant reported that the total cases were actually 599.
The day of the announcement, Willard emailed town staff that the number released by Tyson omitted some numbers. "I am thinking that they did not include contract workers in this release," she wrote.
Contract workers are paid and managed by a subcontractor separate from the company.
While counties scrambled to coordinate mass testing, the state labor department was letting workplace complaints from affected plants pile up.
It received 75 COVID-19-related complaints through July 15, but not a single one of those complaints prompted a site visit, according to previous reporting from the NC Watchdog Reporting Network.
The relationship between the health and labor departments is different in North Carolina than almost every other state. In all but four states (Georgia, North Carolina, Oklahoma and Oregon), the labor secretary is appointed by the governor. But in those four states, the labor secretary is an elected position. Complicating matters, Labor Secretary Cherie Berry is a Republican, while DHHS Secretary Cohen was appointed by Democratic Gov. Roy Cooper.
Similarly, Agriculture Secretary Steve Troxler is a Republican. North Carolina is one of 12 states where that position is elected. In the other 38, it is also a governor's appointee.
Both Cooper and Cohen have argued that not only does DHHS not currently have enough regulatory power, but that if anything, Republicans in the N.C. General Assembly and Council of State are working to take more power away from them.
In July, Lt. Gov. Dan Forest, who is running against Cooper in the gubernatorial election this fall, filed a lawsuit against Cooper in an attempt to loosen restrictions Cooper issued in executive orders aimed at reducing the spread of the coronavirus. Also in July, the General Assembly passed a bill that would have limited the DHHS secretary's authority to mitigate imminent hazards. Cooper vetoed the bill, and the General Assembly could not override the veto.
Cooper could still issue executive orders, but generally, these don't offer incremental changes that would give Cohen more oversight.
"Generally the governor's executive powers here are quite blunt," Cohen said. "It's a criminal statute; we don't have the kinds of regulatory tools that my department would use if I was regulating a nursing home, for example, which is more the kind of business we tend to regulate where you have survey teams, you have corrective-action plans, you have fines."
Correction: A previous version of this story incorrectly reported that Tyson Foods did not respond to a request for comment. The company was not contacted until after publication.
This story was jointly reported and edited by Ames Alexander of the Charlotte Observer; Aaron Sánchez-Guerra, Jordan Schrader and Lucille Sherman of The News & Observer; Nick Ochsner of WBTV; Emily Featherston of WECT; Tyler Dukes of WRAL; Jason deBruyn of WUNC; and Frank Taylor of Carolina Public Press.