By Liora Engel-Smith
From case numbers to deaths to the number of open intensive care beds in the state, there isn’t a lack of numbers when it comes to discussing the coronavirus pandemic in North Carolina. But all data is limited in what it can and cannot tell us.
If you want to understand how the new virus is affecting the Tar Heel State, context is important. We’ve gathered several key pieces of data with explanations that can help you make sense of it all.
Let’s dive in:
How many coronavirus cases are there?
We don’t know exactly. Here’s why: there’s a nationwide shortage in testing kits, so not everyone who has coronavirus or who had coronavirus symptoms has been able to get tested.
There’s also a waiting period between when patients get tested and when they get results. Some drive-thru testing sites using commercial tests have told patients that they may have to wait as many as four or five days for an answer. According to state Health and Human Services Sec. Mandy Cohen, the state public health lab can return a test in about 24 hours, but there are fewer of those tests available. Finally, some hospital systems, such as Duke and Atrium, have in-house testing capabilities with quicker turnaround times.
The North Carolina DHHS releases positive results as they get them, but because of the testing challenges, that number is not an accurate representation of coronavirus cases in North Carolina. Amy Ellis, an NCDHHS spokeswoman, said in an email Friday that while there’s no lag in reporting of positive test results to the state health department, some labs have had delays in testing the samples they receive.
The state recently released data that illustrates that point.
On any given day, the count NCDHHS releases is lower than the actual number of people who later tested positive. According to the data, NCDHHS is still missing some test results for people who were tested after April 2.
There’s also under-testing of coronavirus cases. When the new disease first hit North Carolina, officials concentrated testing on people with known histories of travel to affected places. When the virus began to spread to people with no known travel histories or ties to previously infected people, state health officials revised their testing recommendations to prioritize testing of people who are at high risk for COVID-19 complications, along with health care workers. That means that not everyone with coronavirus gets an official diagnosis.
The state began tracking cough and fever-related emergency room visits and hospital admissions to get a better sense of coronavirus trends, but those numbers exclude people who haven’t sought medical help, state epidemiologist Zack Moore said in a March 30 briefing. Research groups across the state are conducting phone surveys to try to capture that number, Moore said at the briefing that the data isn’t yet available.
Ultimately, he said, state officials will have projections that approach the true prevalence of coronavirus, but that figure isn’t necessary for tracking trends in how the virus spread.
Ellis said on Friday the state was aggressive in its response to coronavirus. Preparations for coronavirus in North Carolina began long before the state’s first positive case and began employing strict control measures even before community transmission was documented in the state.
“Lab-confirmed case counts will never capture all COVID-19 infections,” she wrote. “This is true everywhere, not just in North Carolina. This is why we are using other surveillance tools, like syndromic surveillance, to give us a more comprehensive picture.”
How many deaths are there?
That’s also hard to say. The state health department gets information on COVID-19-related deaths from local health departments. A death only counts as coronavirus-related if the person who died tested positive for coronavirus, but there are people who likely died of the disease who didn’t get tested.
The Centers for Disease Control and Prevention also points out other potential barriers for getting accurate death counts, such as delays in reporting and misattributing coronavirus cases to look-alike diseases such as flu and pneumonia.
People who die from coronavirus but didn’t get tested before their deaths will eventually be added to the tally once death certificates become available, Ellis said. In these certificates, doctors note the probable cause of death, and no COVID-19 test is needed. But death certificates take time to process, she added, and are not available until weeks after they are submitted.
Even if the full extent of coronavirus deaths in North Carolina is not documented right away, the tally the state does have shows why the novel virus is a cause for concern. Compared with the average daily deaths from the leading causes of death in the state, daily death counts from coronavirus are beginning to rival some of the most prevalent killers, including kidney disease and diabetes.
It’s important to remember however, that total deaths from coronavirus are nowhere near annual death tolls from any of those leading causes of deaths. As of April 10, more than 70 people died from coronavirus across the state. Diabetes, the 7th leading cause of death in 2018, killed roughly 3,000 North Carolinians that year.
But in places such as New York, where the virus raged out of control until state and local leaders imposed strict social distancing regimens, the daily, and likely annual death rates will likely compare to killers such as heart disease and cancer.
The full extent of deaths from coronavirus may not become clear until after the outbreak passes and people who compile health statistics look back. They’ll examine the “excess deaths” present in the population. They will calculate how many people should have died from heart disease, stroke, cancer, diabetes and all the other causes of death and look at whether there are more deaths in a day, or week, or month than expected and then work to attribute them to a cause. That’s how we calculate deaths from flu every year, and it will provide insight into the coronavirus death rate in retrospect too.
How many people have been hospitalized thus far?
We don’t know. The state health department releases a daily tally of COVID-19 hospitalizations on any given day. That number is not cumulative.
NC Health News asked NCDHHS for the total number of people who were hospitalized with COVID-19 since the pandemic began. We will update as more information becomes available.
Ellis said on Friday that the state will be releasing a graph of hospitalizations over time in the coming days.
Are there enough hospital beds?
For now, it appears so, but with a few caveats. The state publishes a daily tally of empty beds at facilities across the state. An empty bed is a bed for which the hospital has staff, but no patient. The number of open beds fluctuates from day to day because hospitals are still responding to other needs, such as performing urgent surgeries and helping people with heart attacks. However, on any given day, most, but not all, of the hospitals report their statistics to the state. NCDHHS notes what percentage of hospitals have reported their open beds stats, and those numbers vary widely. For example, on April 9, the state noted that 81 percent of the hospitals reported their bed stats, but that figure was 62 percent on April 5.
Though that limited number reflects that there are open beds in the state, it does not break down the numbers by hospital or region, so the bed numbers the state publishes say nothing about regional bed shortages. These numbers also do not represent the total number of open beds the state can have in the future, according to NCDHHS.
The state is preparing for a possible surge in patients by reserving hotel rooms and dormitories and reopening an old hospital. Gov. Roy Cooper has also signed an executive order that would allow the state to create temporary hospitals more easily. As those expansions come into play, the total number of beds in the state will increase, and depending on the number of COVID-19 cases and the overall need for beds, so will the open bed statistics.
Rose Hoban contributed to this report.