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By North Carolina Health News Staff

Uptick in COVID-19 symptoms in ER

Mandy Cohen, secretary of the state Department of Health and Human Services, pulled out her graphs and charts again to highlight the metrics her team is using to monitor when to begin easing social distancing restrictions.

“The overall picture is mixed,” Cohen said. “But we remain optimistic that these trends will be stable enough to move into phase one next week.”

Gov. Roy Cooper has extended the statewide stay-at-home order through May 8, but cautions that data and evidence must show the trends that Cohen and public health leaders want to slightly open the door for more movement.

The number of people showing up at emergency rooms across the state with fever, cough and shortness of breath, symptoms of the virus, have ticked up during the past seven days.

“We want to be looking at this metric over 14 days,” Cohen said. “So if you look at an average over 14 days, we’re generally level. But obviously, we’re going to be following this one closely because this last seven days sees that upward tick.”

Cohen cautioned that each indicator has its limitations, a reason that she and her team will look at the overall picture of metrics in the coming week.

The number of new laboratory confirmed cases has ticked up, too, with 561 new cases reported earlier in the day, the largest one-day increase in North Carolina.

“We know there is more COVID-19 out in our communities than gets captured by what’s in our lab data,” Cohen said, stressing the limitations with the specific metric. “As we test more, which has been our intention all along, we want to increase testing, we know there is more COVID-19 out there, so we know we’re going to pick up more cases.”

Given that, Cohen showed the next graph with the percentage of positive tests related to the total number of tests conducted. The state has seen a downward trend for that metric.

In recent days, the state has gone from an average of 2,500 tests per day to 5,000. On Wednesday, there were 6,000 tests reported, Cohen said.

The number of people hospitalized with COVID-19 complications has stayed fairly level with 400 to 500 people in hospital beds on a given day with COVID-19 complications.

The state still needs gowns and N95 masks to ramp up testing and contact tracing to support the easing of the social distancing restrictions. — Anne Blythe

Governor calls Gaston confusion ‘dangerous’

Gov. Roy Cooper took a moment to discuss what happened in Gaston County on Wednesday when commissioners there sowed confusion about whether people there could buck the statewide stay-at-home order.

Commissioners issued “The Gaston Promise,” saying they would allow businesses to reopen despite the stay-at-home order, then backtracked from that later in the day.

The county manager clarified that Gaston County was not telling people to break the law. Even in the document posted, it noted that the statewide order was in effect and what the commissioners were advocating was “not in lock step with the Governor’s executive order.”

The town of Stanley posted a clarification on its website that included language from the promise, while also letting residents in the Gaston County community know that the statewide order ruled.

“That action created confusion in a pandemic and that’s dangerous,” Cooper said. “They acknowledged in their own order that our state order was still in effect. So there was no need to cause that kind of confusion.”

Cooper stressed that he is eager to get the economy reignited, especially at a time when the state has sent more than $1 billion in unemployment benefits to some 400,000 people during the pandemic.

“We need to do it in the right way,” Cooper said about getting people back to work. “I was pleased to see all the municipalities in Gaston County come forward and say they will continue to abide by the order and do the right thing. I think if we continue to work hard to flatten this curve and keep our trends where we want to go, we can begin this phase one process next week.” — Anne Blythe

How do you define COVID-19 recovery?

During the pandemic, North Carolina public health officials have struggled to define when someone has recovered from COVID-19.

“While we know folks are recovering from COVID-19, I have my own family members in other states that have recovered,” Health and Human Services Secretary Mandy Cohen said. “The hard part about creating a recovery number is that it’s hard to know because every case is so different in terms of how long people are sick for, it’s hard to know how to judge recovery.”

State teams have been talking with partners at the Centers for Disease Control and Prevention so recovery can be defined consistently across the country.

“We’ve seen some studies that some people can be sick for as few as five to seven days, where there are others who are sick up to 40 days,” Cohen said. “So how do you define when the majority of folks are recovered?”

That’s math and work that Cohen and her team are going through with data scientists now as they look to add more data to the dashboard.

“Stay tuned. We hope to be able to share more on the recovery front as we work with the CDC and get their guidance on how to best define this number,” Cohen said. — Anne Blythe

What gives the governor hope

Gov. Roy Cooper was asked what gives him hope as May 8 approaches and the state could see some easing of restrictions.

“It’s seeing the grandchild drawing a picture of grandmother and then holding it up at the window of a nursing home, talking to her grandmother through the window, showing that she loves her,” Cooper responded.

“I appreciate that tech worker who is working from home, but says that she’ll do child care for our frontline health care workers,” he continued. “I appreciate that neighbor who is doing shopping for that at-risk senior and putting the groceries on the doorstep every week. Those are the things that give me hope about North Carolina, that we’re going to be even better in the end.”

During the next week, Cooper said he hoped the trends he and his team are tracking will be at a point where the state can start a gradual easing of social distancing restrictions.

Cooper also mentioned the promising news from the federal coronavirus task force about remdesivir, a possible treatment for COVID-19 being researched at UNC-Chapel Hill in the lab of Ralph Baric, an epidemiologist at the Gillings School of Public Health.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said that data from the international clinical trial testing the drug in about 1,090 patients showed “quite good news.”

The trial participants who took the broad-spectrum antiviral drug recovered, on average, in 11 days as opposed to the 15 days for those taking the placebo.

Health care experts agree that no one drug will be a “silver bullet,” and that in the short term, patients will likely receive a “cocktail” of drugs to help them through their infections.  

“Learning about new drugs and vaccine development is encouraging,” Cooper said. “But they will take time. Our job is to do what we know works right now. Keep our physical distance, sanitize, stay at home. I know this is a difficult time for many people, but there is hope and there is a plan, and it is based on data and science and facts. It prioritizes the health and safety of our communities, while focusing on ways to jumpstart our economy safely.” — Anne Blythe

Coronavirus by the numbers

According to NCDHHS data, as of Thursday morning:

  • 378 people total in North Carolina have died of coronavirus.
  • 10,509 have been diagnosed with the disease. Of those, 546 are in the hospital. The hospitalization figure is a snapshot of people with coronavirus on a given day and does not represent all of the North Carolinians who may have been in the hospital throughout the course of the epidemic.
  • More than 128,000 tests have been completed thus far, though not all labs report their negative results to the state, so the actual number of completed coronavirus tests is likely higher.
  • Most of the cases (40 percent) were in people ages 25-49. While 23 percent of the positive diagnoses were in people ages 65 and older, seniors make up 86 percent of coronavirus deaths in the state.
  • 87 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities.
  • There are 3,204 ventilators in hospitals across the state and 745 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital.

Legislative chambers pass their relief packages – reconciliation to come

Lawmakers in Raleigh this week moved quickly to wrap up the appropriation of some of the billions of dollars the federal government has sent to North Carolina to address harms generated by the COVID-19 pandemic. 

Out of about $3.5 billion in undesignated funds sent by Congress, the two chambers of the General Assembly took different tacks to allocating money. The House of Representatives passed a $1.7 billion package that includes a limited expansion of Medicaid to cover all uninsured people earning up to 200 percent of the federal poverty line for coronavirus testing and treatment, $110 million for COVID-related research divided up among the state’s public health and medical universities, and $125 million to help hospitals whose bottom lines have been hammered by the suspension of elective procedures, along with preparations to deal with potential coronavirus patients.

House Speaker Tim Moore (R-Kings Mountain) presided over a sparsely attended session of his chamber Thursday, where members spoke positively of their $1.7 billion bill to distribute federal funding to address needs generated by the COVID-19 pandemic. At the dias with him are legislative staff, who are wearing masks. Photo courtesy: NCGA Youtube screenshot

The Senate bill, amended late Wednesday to come up to a little more than $1.3 billion, includes $20 million to go to Wake Forest University to bolster an antibody study that’s been supported by Senate leader Phil Berger, plus $30 million to other academic centers for COVID-related research. 

The Senate bill does not include the money for the limited Medicaid expansion. However, Berger said he believed the federal government would cover those costs, and to wit, earlier this week the federal Department of Health and Human Services launched a website where health care providers can apply for federal dollars to cover testing and treatment costs for the uninsured. The Senate bill also does not include support for the state’s hospitals, but does provide $61 million that could include grants for “rural and underserved communities especially hard hit by the COVID–19 pandemic.”

The vote board in the House of Representatives usually only has 15 seconds for voting displayed. But during Thursday’s special session to deal with COVID-19 needs, the timer was set to 40 minutes to allow for members to cycle on and off of the floor in order to vote while maintaining social distancing. Photo courtesy: NCGA Youtube screenshot

One unique feature among the many unprecedented aspects of this short session is that the House of Representatives, for the first time, broadcast its floor proceedings via YouTube. This allowed people from around the state to observe how the House floor was essentially empty, save for several dozen lawmakers, many of whom were wearing masks. The House also allowed 40 minutes for votes to be cast, which allows for members to wander on and off of the floor to vote. Revised rules also allowed for members to submit proxy votes to their leaders. All this in far more time than the 15 seconds usually permitted for voting to be completed. 

The Senate as yet does not broadcast on the web. 

Now it’s up to the two chambers to reconcile their competing visions of how to allocate the federal dollars. 

“We are going to try to work out the perfect plan of the House with the not-so-perfect plan of the Senate,” Moore quipped from his podium. – Rose Hoban

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