By Anne Blythe and Sarah Ovaska
Gov. Roy Cooper revealed plans for a phased easing of social distancing measures during the coronavirus pandemic in which North Carolinians have been clamoring for knowns in the new world of so many unknowns.
The stay-at-home order in place for the past three and a half weeks has helped slow the spread of COVID-19 through communities and health care systems lacking enough capacity to handle large surges of people infected with pneumonia ravaging their lungs.
The data and science show North Carolina is “flattening the curve” of people who end up in the hospital, Cooper said. But graphs and charts showing the number of positive lab tests are still ticking up more than his team wants to see and the state continues to lack enough protective gowns and N95 masks to ramp up testing to a sustained 5,000 to 7,000 each day.
Cooper acknowledged the pressure to open businesses so people pushed out of work by the highly contagious virus could get their livelihoods back. Still, he said, it was too risky to ease the restrictions set to expire on April 29.
“I will not risk the health of our people or our hospitals, Cooper said. “Easing these restrictions now would do that. This decision is based on data that we can see in our critical categories. I know people want their lives and their livelihoods back, and I have a plan to do that, but first we need to hit certain metrics.”
Mandy Cohen, secretary of the state Department of Health and Human Services, displayed charts and graphs to highlight the trends and metrics guiding decisions.
Watching the metrics
The governor said his team would look at 14-day periods for:
- COVID-like syndromic cases reported through a surveillance system that also helps track flu across the state.
- The number of lab-confirmed cases.
- The percentage of positive test results compared to the number of overall tests; and
Those metrics show the percent of visits to emergency departments for COVID-like illness is declining, according to Cohen.
Though new cases in North Carolina continue to rise, that is occurring more slowly over time. Still there has not yet been a downward trajectory over the past 14 days, one of the factors that led to the extension of the stay-at-home order, Cooper said.
Additionally, the percentage of positive tests to the number of total tests is not declining.
Though the trajectory for the number of hospitalizations has not declined over a two-week period, it has remained level while not overwhelming the state’s health care systems.
For instance, Atrium and Novant health systems in early April asked officials in Mecklenburg County to convert dorms at UNC Charlotte into a 3,000-bed field hospital. Then the two systems revised their request to make that a 600-bed temporary facility. Now, they’re saying they won’t need a field hospital at all.
To move into a phase where social distancing restrictions can be eased, Cohen said her team would like to see a continued decrease in the number of COVID and COVID-like cases, a decline in the percentage of positive tests, and a decrease or sustained leveling off of the number of hospitalizations.
Her team is trying to find a partner to help double the contact tracing workforce and enough personal protective equipment to double the number of tests conducted each day.
“What I want to leave you with is a hopeful note,” Cohen said. “I want to make sure you know that the hard work you’ve been doing has meant that North Carolina is in a very good place. We have flattened the curve, but we’re not there quite yet. So hang in with us as we continue to look at these metrics, we look at building our capacity and with working together as a state, we’re going to get there and we’re going to be able to move into some phased re-openings.”
An unusual summer ahead
In announcing his three-phase plan for a gradual lifting of restrictions and reopening bars, restaurants and other places closed through his executive orders, Cooper stressed that statewide restrictions could be extended beyond May 8 if the metrics were not showing the trends desired.
Cooper’s extension of the order bucks the trend emerging in some southern states such as South Carolina, Georgia and Tennessee, where Republican governors are beginning to ease restrictions.
“We need our indicators to be moving in a positive direction as we approach May 9, as we make a decision potentially to go into phase one shortly thereafter,” he said.
Gradual easing of restrictions would include:
- Phase 1: Limiting gatherings to no more than 10 people, allowing people to leave home to shop at retail stores that can be opened with social distancing measures for workers and customers, reopening parks with the same provisions and recommending face coverings in public in places where people cannot be six feet apart. This would last for at least two to three weeks and could be longer, depending on metrics and any outbreaks.
- Phase 2: Would lift social distancing restrictions for all but the most vulnerable populations; allow larger gatherings; limited opening of restaurants, bars, barbershops, salons and personal service businesses that can follow safety protocols; allow gatherings at places of worship and some entertainment venues at reduced capacities; and open playgrounds. This would be a four- to six-week phase.
- Phase 3: Lessen restrictions for vulnerable populations with encouragement to continue practicing physical distancing and minimizing exposure to settings where distancing isn’t possible; give restaurants, bars, other businesses, houses of worship, and entertainment venues increased capacity; and allow for larger gatherings, but continue rigorous restrictions at nursing homes and other congregate care settings.
If the markers were hit for each phase, it could be early- to mid-summer before North Carolina gets to the third phase.
On Friday, Cooper plans to outline what happens with the schools after the order ending on-campus classes expires on May 15.
Praise, criticism and a nurse’s reality
Two major health care organizations representing the state’s doctors and hospitals — the N.C. Medical Society and the N.C. Healthcare Association — backed Cooper’s staggered approach, and in a joint statement Thursday said using data to prompt different phases will allow commerce in the state to come back online while not setting off sharp spikes of cases.
“We understand that restoration of broader economic activity is critical; however, to safeguard our common health goals, we must be prepared to reinstate stricter limits on social and commercial activity (including health services) in geographic areas where the spread of COVID-19 is not controlled,” the organizations stated.
Not everyone was happy with Cooper’s approach, including his frequent policy opponent state Senate Leader Phil Berger.
Berger said he’d heard from small business owners upset and afraid they would be bankrupt if they were unable to open until June.
He urged Cooper and Cohen to release more data on numbers of people recovering from the virus, whether those who died had pre-existing conditions and the names of nursing homes experiencing outbreaks.
“Collaboration and transparency will yield better results than command-and-control,” Berger said in a statement. “Hopefully, today marks a transition.”
From the front lines
Schquthia Peacock, a nurse practitioner at Cary’s Preston Medical Associates, doesn’t want to see the state re-open businesses on a large scale any time soon.
“I’m frustrated and upset considering I’m trying my best to protect my patients in the community,” she said. “We’re still seeing more than we saw the previous day, it’s not as if we are decreasing.”
Peacock, a co-owner of her practice, is worried about COVID-19 cases rising again at exponential rates, while she and other frontline workers are still struggling to find the gowns, goggles and masks needed to protect themselves from the illness.
She’s had trouble ordering basic supplies, in particular, the personal protective equipment that’s been in such short supply in order to safely conduct COVID-19 tests. A find early on in the pandemic in a local hardware store of N95 masks had her feeling as if she’d won the lottery.
Scrambling to find basic protective gear is something Peacock never thought she’d have to deal with, having worked as a nurse and nurse practitioner for the past 28 years in both private practice and hospital settings. She used to throw out PPE after each patient, now Peacock reuses her PPE as much as possible, disinfecting her masks when she can to extend her supply.
But during a recent examination of patients in her practice’s parking lot, she was coughed on while trying to swab for a coronavirus test. That meant the gown and other gear could have been contaminated.
“I had to toss it, as precious as it is,” Peacock said.