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By North Carolina Health News staff

‘These trends don’t mean that our fate is sealed’

As North Carolinians get out and about more, they’re mingling more with the coronavirus that’s been creating worldwide havoc, raising concern among public health officials and physicians at major health care centers.

They might have been staying at home through most of April and May, but COVID-19 did not go away.

Mandy Cohen, secretary of the state Department of Health and Human Services, pulled out charts and graphs on Friday showing metrics and current trends.

In prior weeks, Cohen’s graphs showed green checks to indicate North Carolina’s progress in combating the virus.

There were no green checks this Friday. Instead, the state got three yellow caution lines and a red X on the metric indicating the trajectory of new cases.

North Carolina had its highest number of new lab-confirmed cases on Friday at 1,768. For most days in the past week, more than 1,000 new lab-confirmed cases were reported.

North Carolina has ramped up testing, bringing an expected increase to the number of people testing positive, still, the overall percentage of positive cases on Friday was at 10 percent.

Before the state started reopening in late May, that rate had hovered at 5 to 6 percent.

Health and Human Services secretary Mandy Cohen showed her trend scoreboard during a press briefing Friday afternoon, June 12. For the first time in weeks, the state had no positive trends in the metrics used to measure how well the state is doing combating COVID-19. Screenshot from UNCTV

“If you look at that 10 percent in the context of our nation, our percent positive is now one of the highest amongst states in the nation,” Cohen said. “We’d like that number to be closer to 5 percent.”

The number of people hospitalized has gone up from a relatively consistent 550 beds filled every day, on average, several weeks ago to the high 700s. This past week, hospitals reported the largest number of beds filled on any one day during the pandemic with 812 on Thursday.

By Friday, the number dropped to 760. – Anne Blythe

Take a role in reversing the troublesome trends

Through the past week, Mandy Cohen, secretary of the state Department of Health and Human Services, and Gov. Roy Cooper have been sounding alarms, encouraging North Carolinians to take it upon themselves to help slow the virus.

“We’re warning everyone that the trends are heading in the wrong direction, but there are things that we can do now to make sure that we can get our kids back to school in August and do other things,” Cohen said.

Cohen declined to describe what the state is seeing as a “second wave”of the virus spreading through North Carolina.

“I think this is our first wave,” Cohen said.

She hearkened back to March and April, when Cooper closed businesses, stopped in-classroom learning in the public schools and ordered people to stay at home except for essential trips to get groceries, prescriptions filled and other necessary outings.

“We took early and aggressive action to flatten the curve and we did that. We did it very successfully. As I said, I think that was an important and critical time that allowed us to build our capacity here in the state to respond to this,” Cohen said.

“We did not see an early spike or a surge,” she added. “I actually think this is our first experience at an increase, at the beginning of that increase.”

Deborah Birx, coordinator of the White House coronavirus task force, called North Carolina public health officials with concerns last week about some of the state’s numbers.

Earlier this week, the state announced plans to surge testing and tracing supplies to eight counties. They are Alamance, Dublin, Durham, Forsyth, Johnston, Lee, Mecklenburg and Wake.

These troubling trends come three weeks after the governor eased restrictions, allowing restaurants to join other retail businesses to open at limited capacity with certain limitations in place.

But there also have been widespread protests over the George Floyd killing which brought many across the state out into the streets. There have also been events held in blatant defiance of the crowd-size restrictions in Cooper’s order.

Cohen was asked whether the surge in positive cases could be tied to targeted testing among more vulnerable communities or whether the increase was more reflective of the overall population.

“We continue to have criteria for testing that is focused on symptoms, but also with exposures,” Cohen responded.

Cohen and her team have encouraged anyone who went to a protest or other mass gathering to get tested even if they were not displaying symptoms. They also want people who work at grocery stores, meat processing plants, congregate care facilities and other high-risk exposure jobs to get tested, symptoms or no.

“I think what we’re seeing in our testing is both a combination of symptoms and exposure that people have and that’s a good thing,” Cohen said. “It means that we are targeting our testing to people who are more likely to be positive.”

Cohen also said they want to get to the point where they’re “casting a wide enough net,” to capture everyone who might have been exposed.

As the public health team casts those nets wider, Cohen and Cooper implored North Carolinians to wear face coverings and watch their distancing with a goal of getting children back to in-person learning in August.

“Nothing is set in stone,” Cohen said. “These trends don’t mean that our fate is sealed. It means that we have the ability to do actions, ourselves, right now, that can change the trajectory of these curves and that’s what we want to make sure that we’re doing.” — Anne Blythe

Are Phase 2.5 or Phase 3 off the timeline now?

Gov. Roy Cooper stressed several times that just because the trends and metrics are going in the wrong direction that he has not yet made any decisions whether or if restrictions could be eased more.

“We are going to rely on our health experts who are reviewing this data, all seven of these trends and indicators, making recommendations to us about whether we move to a 2.5 or a 3,” Cooper said. “No decisions have been made about that yet. These trends that we have been seeing the past week are concerning.”

Instead, Cooper threw it back onto the public for them to act to get the numbers “headed in the right direction.”

“If people are careful, they wear their face covering, they keep their proper distance, they wash their hands. If our leaders across the state, people that others look up to, will do those same things by example, it will help us a lot because I’m going to say right now, the priority is getting our children in school in August.”

Cooper said his team wants that to happen while also continuing to ease restrictions.

In recent weeks, Republicans at the helm of the General Assembly have pushed back against some of the restrictions, going so far as to shepherd legislation through their majority held chambers to weaken Cooper’s executive orders.

Among the latest bills to land on Cooper’s desk is one that would allow bars and gyms to open in the current phase, which is in place until at least June 26.

Initially, Cooper and his team had intended to let bars and gyms open alongside restaurants, but modified the plan when some metrics were not where the public health team wanted them to be.

The General Assembly passed a bill this week that would allow bars and gyms to open at a limited capacity while also giving the governor a way to close them down if the Council of State approved. The Council of State is a body of statewide elected officials in which the majority are Republican.

Lt. Gov. Dan Forest, the Republican challenging Cooper, a Democrat, this election year is one of the members.

Cooper already vetoed a bill sent to him that would have allowed bars to open outdoors at half-capacity with social distancing measures in place.

He objected to codifying that into law in the event there were new increases in cases and hospitalizations that would necessitate restoring restrictions.

The lawmakers added an opt-out for the governor, again requiring a majority of the Republicans on the Council of State to join him.

“We will review that legislation,” Cooper said. “Obviously, we would rather do it through executive order because I think that legislation makes the process much more clumsy and much more difficult to change.”

He said he would let the public know when he makes a decision. — Anne Blythe

Governor’s test results

Gov. Roy Cooper practiced what he has been preaching and got tested for COVID-19 after attending a recent protest.

Cooper walked around the Executive Mansion with protesters nearly two weeks ago, taking off his mask at one point to talk with a group of protesters calling for change in the wake of the killing of George Floyd in Minnesota.

Cooper announced his test results on Thursday, two days after he was tested.

“My COVID-19 test results have come back negative, and I have had no symptoms,” Cooper said in a tweet. “I encourage anyone who has been in a crowd to get tested even if you have no symptoms.”

Cooper pointed his readers to “Find My Testing Place” on the state Department of Health and Human Services dashboard, where testing sites are listed.

Click on the image to go to the NC Find My Testing Place website.

Cooper and Cohen have been urging North Carolinians to get tested if they have been at mass gatherings, such as protests or other events. They’ve also encouraged anyone working in “essential” businesses such as grocery stores and other places with lots of public interaction to get tested.

Some of the testing sites are free.

The state has ramped up testing to more than 15,000 per day, saying identifying people with COVID-19 and isolating them along with anyone they’ve been in contact with is crucial to slowing the virus spread as more activity is allowed.

The state also is adding to its 250-member contact tracing team spread out in county health departments across North Carolina. The Carolina Community Tracing Collaborative has hired 152 tracers so far and is slated to add close to 98 more.

Of the tracers hired, 29 percent are black, 13 percent are Latino, 3 percent are Native American or Alaska Native, another 3 percent are Asian and 39 percent are white.

Communities of color have been hit harder during the pandemic, in large part because of long-standing health care access disparities and higher rates of employment in essential businesses. — Anne Blythe

Judge orders no races at Alamance speedway

An Alamance County speedway that has been blatantly defying crowd-size restrictions and other social-distancing measures in Gov.Roy Cooper’s executive order has now been ordered by a judge to halt racing.

Thomas Lambeth, an Alamance County Superior Court judge, held a hearing on Thursday that was broadcast on YouTube so the proceeding could be open to the public.

Earlier in the week, the state Department of Health and Human Services issued an abatement order after Ace Speedway held events since the Memorial Day weekend in May in defiance of the executive order.

Crowds of several thousand gathered at the stock car track in Altamahaw northwest of Burlington and south of Elon. Few wore face coverings, or sat or stood six feet apart.

The judge issued a temporary restraining order after hearing from attorneys for the state and their concerns about the public health threat. An attorney for Robert and Jason Turner, the organizers of the races, argued that they were exercising their First Amendment rights this past weekend when they billed the event as a protest.

The judge has not ruled on the arguments. His decision halts more races while they await further hearings.

This photo from 2010 shows crowds of people attending a “pit party” at the Ace Speedway, in Alamance County. Photo credit: Mike Kalasnik, Flickr Creative Commons

“I think people are getting quarantine fatigue, as I’ve seen it phrased,” Lambeth said when announcing his ruling. “People, you know, want to get back to normal, but we’re not there yet. I think our leaders should be applauded for trying to do what they can to walk that delicate balancing act between our economy and the public health crisis.”

Cooper appointed Lambeth to the Superior Court bench in Alamance County in 2017 when the position became open upon the retirement of Wayne Abernathy, the Superior Court judge who preceded him. Under state law, North Carolina judges must retire at 72.

Robert and Jason Turner posted a message on Facebook after the judge’s decision, saying there would not be events this weekend or the next.

“To our very loyal Race Fans and Competitors. … We want to thank everyone for their unwavering support. We will resume our season as soon as possible. … Thank you to our local officials who have stood by their beliefs. Thank you to our fans, our employees, our sponsors and our race teams who have expressed their support through the good and the bad. Continue to stick with us, this does not mean 2020 is over, just on hold.” — Anne Blythe

Hospitals might not see impact of reopening, protests for weeks

David Wohl, an infectious disease expert at the UNC-Chapel Hill School of Medicine who co-leads the respiratory diagnostic center at UNC Health, where outpatients are tested for COVID-19, told reporters earlier this week that it could be several weeks before hospitals know the impact of the late May reopening and mass gatherings that have occurred since.

Wohl and Billy Fischer, an associate professor of medicine in the division of pulmonary diseases and critical care medicine at UNC, have studied and treated people with infectious diseases for years. They shared their thoughts in a Q&A session posted to YouTube about the current metrics and trends the state is seeing now.

Wohl said focusing on hospitalizations rather than testing provides a better idea of whether the state has flattened the curve.

“If we’re seeing people sick enough to be admitted to the hospital, that’s telling you that we haven’t flattened the curve,” Wohl said. “That is the best indicator of where we are in the pandemic.”

A patient room in the ICU at UNC Hospital in Chapel Hill. Each room in the “hot zone” containing COVID-19 patients has announcements outside the room reminding staff of the universal pandemic precautions in effect for patients. Photo credit: Rose Hoban

Over the past week, North Carolina has seen the number of people hospitalized hit a pandemic high.

“When someone is admitted to the hospital, what we’re really looking at is the state of the outbreak two weeks before, because they didn’t get infected the day before or the day before that,” Wohl said. “People entering the hospital generally have been infected maybe two to three weeks prior to that and been symptomatic, on average, about 10 days before they get into the hospital.”

Gov. Roy Cooper eased restrictions on May 22. Since then the trends and metrics have deteriorated, leaving the governor and Mandy Cohen, secretary of the state Department of Health and Human Services, sounding alarms.

Fischer said testing and tracing will play a key role in how the state continues to respond to the pandemic.

“As we expand testing, my hope would be that we will identify people who were infected initially so that we can get them into the care that they deserve and need as early as possible,” Fischer said. “If we’re effective in identifying those populations early then we should then see a decrease in the percent of positives because as soon as we get those people into care we can prevent community transmission.”— Anne Blythe

Coronavirus by the numbers

According to NCDHHS data, as of Friday afternoon:

  • 1,092 people total in North Carolina have died of coronavirus.
  • 41,249 have been diagnosed with the disease. Of those, 760 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 595,000 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 82 percent of coronavirus deaths in the state.
  • 181 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities.
  • There are 3,156 ventilators in hospitals across the state and 875 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital.

 

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