By Anne Blythe

March Madness is a familiar phrase in North Carolina, typically thrown around as college basketball seasons come to a close and heated rivalries bring fandoms to fevered pitches.

This year, COVID-19 and the upheaval the pandemic is wreaking in financial markets, sports arenas, mass gatherings, college campuses and more brings a whole new meaning to the time-worn expression.

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Consider what happened in a span of less than 24 hours on Wednesday:

  • President Donald Trump announced a 30-day travel ban from Europe;
  • Atlantic Coast Conference and NCAA tournament officials decided games would be played without fans;
  • The NBA suspended its season and the University of North Carolina notified students that most classes for the foreseeable future would be held online only, a call Duke University made earlier this month.

By Thursday morning, the ACC tournament had been canceled. By afternoon, the governor issued guidelines that included the cancellation of any concerts, meetings and faith-based gatherings that included more than 100 people.

As maddening as it can be to try to keep up with the onslaught of new coronavirus cases, restrictions and social distancing recommendations, state health officials have been increasingly maddened by their inability to test as many people as they would like.

“The lack of testing supplies from the CDC has been a concern now for several weeks,” Gov. Roy Cooper said on Thursday. “This does remain a top priority for now to get as many people tested as possible.”

Kits to test 700 people

As of Thursday morning, the State Laboratory of Public Health had enough kits to test 700 people, but that is just a fraction of what will be needed in the coming weeks as the virus is expected to spread, state health officials cautioned.

“Our testing capacity is better than it was at the beginning of the week,” Mandy Cohen, secretary of the state Department of Health and Human Services, said. “We’ve had some great partnership with our academic and private partners here in the state that they’ve been able to bring up their capacity. Our state lab capacity is better than it was in terms of supply. But the kinds of supplies we need are still on backorder with the CDC.

“So I am very concerned about our long-term capacity to sustain this. But at least in the short-term, meaning days, we are able to ramp up our capacity to test and you will see us do that.”

graphic including an image of coronavirusWhen Cooper declared a state of emergency on Tuesday giving health care and emergency workers more flexibility to respond to the growing crisis, North Carolina had fewer than 200 test kits in the state lab.

Many state labs across the country have raised similar concerns about shortages as the infection of pandemic proportions continues to stretch the supply side.

“There’s been a number of issues related to tests that have been widely reported,” Cohen said at a Tuesday news conference. “The first was the first round of kits sent out [by the CDC], there was an issue with them. I think understanding the supply chain wasn’t clear and the FDA hasn’t been as fast at approving the alternative testing methods, but I think that folks are talking now.

“I know everyone understands the urgency of it and are working hard together. This is not about blame. This is really about us making sure we can protect folks here in North Carolina.”

Forsyth, Johnston and Durham county cases

By Thursday, Cohen was praising Scott Shone, the state lab director, for developing creative solutions for expanding the testing capacity.

North Carolina, a state with a population of more than 10.4 million people, had tested 119 people for the virus as of Thursday morning with results for 21 of those tests pending.

So far, the lab has returned presumptive positive results for 14 people. Among the most recent cases were a Forsyth County couple who had returned from a cruise where others had tested positive and a Johnston County resident for whom state and county officials are doing contact tracing.

Another person, a Durham County resident who was out of the state when the tests were done, also shows up in the North Carolina count for people with COVID-19.

No deaths have been reported in North Carolina.

The only thing state leaders have been able to say with any certainty about COVID-19 is that they continue to deal with much uncertainty.

“Things are moving exceptionally quickly,” Cohen said Thursday, “which is why we need to move exceptionally quickly as well.”

Lessons from elsewhere

Other states and countries have provided examples for what works, what doesn’t and what could work better.

As of midday Thursday, more than 1,300 people in the United States had been confirmed to have the virus first detected in late December in northern China. As of midday Thursday, 30 of the U.S. deaths were in the state of Washington. Sixty percent of those deaths were tied to an outbreak in a long-term, 190-bed nursing home.

“One of the advantages that North Carolina has right now is we have seen other states that have seen a rapid spread of this virus, and we are learning things minute by minute of steps we should take, Cooper told members of the Novel Coronavirus (COVID-19) Task Force gathered Thursday morning at the State Emergency Operations Center in Raleigh. “We have a team involved here who knows about public health, who knows about how this virus is spread and we need to do everything that we can to work to prevent the spread of the virus and also to mitigate. We know that lives are at stake.”

While acknowledging that many of the changes being called for over the next few weeks and months might be met with frustration, inconvenience, loss of income and other hardships, Cooper said protecting the public’s health is foremost in any decision.

“This is a constantly evolving situation here,” Cooper said in the morning Thursday. “We have been working through the night, looking at steps that other states have taken. It is important to make our decisions based on science, data and fact and to err on the side of making sure that we protect the public.”

In addition to the paucity of testing kits, task force members raised the specter of needing more personal protective equipment for emergency responders and people working in nursing homes and long-term care facilities.

At the top of the supply list needs, though, remains the chemicals to complete testing.

Not talking about swab shortages

North Carolina has extended the testing protocol beyond the initial CDC recommendations that reserved use of the limited tests for people who not only had a fever and the deep cough associated with the infection but also had traveled from one of the hot zones or been in close contact with someone who had.

Cohen said Thursday that tests now can be given to people who exhibit the symptoms without any known travel connections.

State health officials are encouraging providers across the state to test for flu first before ordering COVID-19 tests. But if flu tests come back negative and there are no known travel or close contacts, to err on the side of precaution and proceed with COVID-19 tests.

It’s not the nose and throat swabs that are in short supply, Cohen, Shone and Zack Moore, the state epidemiologist, explained.

Test for coronavirus (COVID-19) in padded box. Aside from handwashing and social distancing, there aren't many specific measures for coronavirus.
A test kit for COVID-19.Photo credit: Centers for Disease Control and Prevention

What remains hard to come by are the reagents, or chemicals, used to extract any COVID-19 RNA from the swabs and open a window into the genetic footprint of the contagious pathogen.

“What we are looking for are the reagents needed in the lab,” Cohen explained. “I will say that is something everyone is struggling with across this country.”

State leaders have asked the North Carolina congressional delegation for help getting more testing materials.

Robert Redfield, the CDC director, told Politico earlier this week that he was worried about a disruption in testing because of the scarcity of supplies.

Private companies and academic institutions have stepped up efforts to fill in the gap.

LabCorp, a national testing company based in Burlington, has developed COVID-19 tests and made them available for distribution on March 5. Quest Diagnostics also has developed tests.

“All countries can change the course of this pandemic,” Cohen said, late Thursday, repeating the words of the head of the World Health Organization. “North Carolina will help lead the way.”

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Anne Blythe, a reporter in North Carolina for more than three decades, writes about oral health care, children's health and other topics for North Carolina Health News.