By North Carolina Health News staff
White House call and a sharper message
North Carolina is seeing such a sharp increase in COVID-19 cases and a troubling increase in the number of people hospitalized with severe illness from the virus that Deborah Birx, coordinator of the White House coronavirus task force, called state health officials on Friday.
“I was very appreciative of that call because she is looking at the data that we are looking at and the trends … in the wrong direction,” Health and Human Services Secretary Mandy Cohen said. “All of us want to make sure we’re staying ahead as much as we possibly can with this virus.”
North Carolina opened up more businesses on May 22, just a little more than two weeks ago, and saw its highest one-day number of laboratory-confirmed COVID-19 cases, 1,370, reported on Saturday.
Of the 15,203 tests reported completed for that day, the 1,370 lab-confirmed positive results were slightly more than 9 percent of the tests run.
Earlier in Phase 2, the positive cases had hovered at 6 to 7 percent.
The state also has had more than 1,000 deaths, a key point that Gov. Roy Cooper noted on Monday.
As bar and gym owners threaten to test the power of Cooper’s executive order keeping them closed while restaurants and other businesses are allowed to open, Cooper and his team shifted the focus to schools.
“We’re concerned that a number of virus metrics are trending upward,” Cooper said at a media briefing Monday afternoon. “Our important mission of opening school buildings on time could be affected by the failure to slow the spread. We do not want that to happen.
The state Department of Health and Human Services issued guidance on Monday for how the public schools could open again for in-classroom learning if key metrics are trending in the right direction.
“If we’re careless now, if we ignore the three Ws, if we violate mass gathering rules, we don’t just risk our own health, we risk the ability to get our students back in the classroom, learning in person with their teachers, socializing safely with their friends, getting back to a routine,” Cooper said.
In short, Cooper was signaling that if metrics don’t improve, parents may be homeschooling their students again in the fall.
In an election year, when Republican lawmakers have pushed laws to weaken Cooper’s power to shape the state’s response to the pandemic, politicians have worked to fracture the “one-team, one-mission” messaging that was prominent while the stay-at-home order was in place for nearly two months.
There has been open defiance of Cooper’s crowd control order and social distancing rules at an Alamance County speedway and other places across North Carolina.
Protesters also have flooded the streets of big cities and small towns as part of a global police brutality protest movement borne from the outrage over the video of George Floyd, a black man born in North Carolina, imploring a white Minnesota police officer to loosen the chokehold on his neck for more than eight minutes. “I can’t breathe,” Floyd repeated over and over until he died facedown in the street, hands cuffed behind his back under the knee of the officer now accused of murder.
Though many of the protesters have worn face coverings as they call for change, public health officials worry about the virus spread that could have occurred at the rallies. — Anne Blythe
Been to a protest or mass gathering? Get tested.
Mandy Cohen, secretary of the state Department of Health and Human Services, urged anyone — even those without COVID-19 symptoms — to get tested for the virus if they attended a protest or other crowded gathering.
Gov. Roy Cooper, who walked around the Executive Mansion with protesters last week, wearing a face covering, but lowering it at one point to speak with a protester, was asked if the state’s message was that anybody in any county could go out and get tested. He also was asked whether he would get tested because he was at the protest.
“That’s a good point,” Cooper said. “Yes. … We want people going and getting tested, particularly if you’ve been out in a crowd. We’ve really broadened the guidelines for being able to go and get tested.”
Cohen said the state had been saying in their guidelines that anyone who had fever, coughs, body aches, a sudden loss of taste or smell and other symptoms related to the virus should get a test.
“Even if you don’t have symptoms, you may have been exposed and could have COVID-19,” Cohen said, urging protesters, people who work at grocery stores or other places with a lot of public exposure to get a test.
“We want folks to think about their own risk factors and to think about testing, but err on the side of getting a test,” Cohen said. “What we are seeing is more viral spread in our communities. So it is now a higher likelihood that you may have been exposed.” — Anne Blythe
If the text is from 45394, it’s a contact tracer
In the middle of a pandemic when contact tracing for COVID-19 plays such a crucial role in trying to limit virus spread, public health officials want people to know what numbers to pay attention to on their phones.
With so many spam callers these days, many people see a number come up on their phone that they don’t recognize and simply decline the call.
In a news release issued last week, the state Department of Health and Human Services announced how contact tracers would try to get in touch with someone to alert them about possible COVID-19 exposure.
The Community Team reaches out with an initial text from the number 45394 or an email from NC-ARIAS-NoReply@dhhs.nc.gov. Follow-up phone calls are from their local health department or NC OUTREACH at 844-628-7223. Any information shared during calls is a private health record, DHHS stressed.
No one from the Community Team will ask for a Social Security number or any financial information such as a bank or credit card number.
DHHS also has added portals to its dashboard where people can check symptoms they might have to see whether they should seek a test for COVID-19. A different portal shows where the testing sites are.
A new password-protected tool also will allow North Carolinians to monitor their symptoms if they test positive for the virus.
On Monday, state epidemiologist Zack Moore, Johnston County Health Director Marilyn Pearson and Scotland County Health Director Kristen Patterson briefed reporters on contact tracing efforts.
The state has ramped up its testing and contact tracing efforts to help identify and isolate virus spread as more people move around throughout the state.
Pearson and Patterson described how contact tracing is done in their counties and the challenges they confront with so many unknowns.
Though public health experts have given a two- to 14-day window for how long it could take for someone to have virus symptoms if they were exposed, some people remain asymptomatic throughout the time they’re infected with COVID-19.
It’s also difficult to put a number on how long someone is contagious with the virus or when they officially have recovered from it.
A test, as public officials continue to point out, only captures a moment in time. Someone might get a negative result, but come down with the virus a day later.
“Whenever we’re conducting contact tracing, we speak with the infected individual, but once they give us the contacts, names and demographics and all that information, we automatically contact that contact and we isolate them because we don’t know the length of exposure,” Patterson said. “With other diseases, you do have a window of exposure, but with this, it’s really difficult.”
“We’re just asking our contacts to go ahead and isolate and there may be some lag time with them getting a test,” Patterson added.
Sometimes, Patterson and her team have to put on personal protective equipment and visit someone at their home to ensure the person contacted is OK and following their guidelines.
Pearson said the number of cases in Johnston County has pushed her team to ask for more tracing help from the state.
“We’ve had a bit of an increase in the past couple of weeks,” Pearson said. “We have about 10 core staff that do case investigation and contact tracing, and there’s staff that I have cross-trained from other parts of the health department so that’s not just my public health nurses. I have public health educators that I have trained in that area. I have public health administrators, lab staff, even some of my providers are helping half days in that area.”
In Johnston County, the interpreter staff has been crucial, Pearson said, due to the number of cases spreading among Latino residents.
“They have been working diligently to do contacts and developing trust in the community that we need,” Pearson said. — Anne Blythe
Bars, gyms, and laws and orders
Rick Gunn, a Republican state senator from Alamance County, told reporters at a briefing on Monday that he would tweak a bill to allow private gyms to open despite an executive order keeping them closed to also include bars.
That bill, Gunn said, now would include a provision that provides some flexibility to the governor to close things down if the state’s metrics for monitoring COVID-19 showed the need to close them again.
Cooper vetoed a bill over the weekend that would have allowed bars to open outdoors with social distancing regulations, similar to those applied to restaurants and other businesses now open.
The governor has stated that bars and gyms pose a higher risk because in those establishments the virus could be more likely to spread. In gyms people are exerting themselves and perhaps spreading the virus through heavier breathing. For bars, Cooper and his team have been less clear on the motives.
Cooper eliminated them from businesses allowed to open in this safer-at-home phase not set to expire until June 26.
Facing lawsuits from bar owners and with gym owners crying foul, Cooper now says he might consider a “Phase 2.5” in which some of those businesses could open again.
On Monday, the governor pushed back against legislation that he could change the course of only with support from the Council of State, a body of elected leaders in which the majority are Republican.
“I would rather open schools than bars,” Cooper said. “We need to keep our focus on doing things to get our numbers in such a position that we can open schools.”
The governor argued that in March, after his order closing schools to in-person instruction took effect, things started “getting better.”
“Things started slowing down and we started doing much better with the virus so that we know when we open schools that people are going to start moving more and being together more and we have a chance to drive our numbers up,” Cooper said.
Gunn said he introduced the bill because he could not figure out why restaurants that serve beer, wine and mixed drinks could have customers but bars could not.
He questioned what data and science-based evidence drove the decisions to exclude bars and gyms from this phase while allowing similar businesses a different path.
“I’m simply tired of wasting time and watching these businesses flounder,” Gunn said. — Anne Blythe
Coronavirus by the numbers
According to NCDHHS data, as of Monday morning:
- 1,006 people total in North Carolina have died of coronavirus.
- 36,484 have been diagnosed with the disease. Of those, 659 are in the hospital. The hospitalization figure is a snapshot of people hospitalized with COVID-19 infections 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.
- 23,653 people who had COVID-19 are presumed to have recovered. This weekly estimate does not denote how many of the diagnosed cases in the state are still infectious.
- More than 520,000 tests have been completed thus far, though not all labs report their negative results to the state, so the actual number of completed COVID-19 tests is likely higher.
- Most of the cases (45 percent) were in people ages 25-49. While 15 percent of the positive diagnoses were in people ages 65 and older, seniors make up 83 percent of coronavirus deaths in the state.
- 171 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities.
- There are 3,092 ventilators in hospitals across the state and 805 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital.
Just starting to see impacts of re-opening the economy on COVID-19 cases
It can take about two weeks to see shifts in COVID-19 cases, said Zack Moore, state epidemiologist during a media briefing Monday morning.
Two main factors cause the delay, he explained. One is that people don’t develop symptoms of the novel coronavirus right away, the virus incubates for roughly a week before symptoms begin. Second, people may wait several days after that before they reach out to their doctor.
For that reason, he said, North Carolina’s current test increases reflect the loosening of restrictions that began over the Memorial Day weekend. Any increases due to exposure from the recent statewide protests would not yet be apparent.
North Carolina first loosened some coronavirus restrictions on May 8 under Phase 1 of reopening the economy. During that phase, which ended late last month, businesses were allowed to operate at half their capacity, but other establishments, such as bars and restaurants remained closed. The implications of easing those restrictions further did not bear out in the data until two weeks later. According to NCDHHS’ data, there had been an increase in cases after Phase 1 began, cases were steadily increasing at about the same rate as right before the restrictions were relaxed.
It’s only now that North Carolina will start to see any reflection in the numbers from restrictions being eased on May 22. The state saw its highest number of hospitalizations over the weekend, with 739 people occupying hospital beds by Monday morning, and the highest one-day tally of positive COVID-19 tests on Saturday with 1,370 newly confirmed cases of the disease. – Liora Engel-Smith