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By Anne Blythe
Deja vu all over again on testing supply shortages?
Mandy Cohen, secretary of the state Department of Health and Human Services, has twice this week sounded an alarm on supply shortages that are causing longer waits for COVID-19 test results.
During this phase of the pandemic, North Carolina has increased statewide testing at a variety of sites to about 20,000 per day.
While the state has enough swabs for such a caseload, labs in some health care systems are running short on the reagents, the chemicals that lab workers use to extract any COVID-19 RNA during the process.
“What is happening at our health systems in particular, they could be running more tests if they had more reagents, but they’re needing to actually run less tests per day to … save their reagents as they go forward,” Cohen said.
That paucity leads to a chain of reactions that ultimately results in a longer wait for test results. The health systems in short supply then look to the larger commercial labs and that can create backlogs that have shifted test result turnarounds from the 24- to 48-hour window to sometimes as long as five or six days.
Quest Diagnostics reported last week that testing capacity in the U.S. is “under strain.” By Monday, the company reported that its turnaround time for COVID tests is now one day for “priority” patients, but has crept back up to three to five days for “all other populations.”
North Carolina-based Labcorp said earlier this week that “with the recent increase in demand, results on average may take 1-2 days longer.”
“That’s a real problem,” Cohen said. “We need to really close that gap.”
In March, when North Carolina’s first lab-confirmed case was announced, Gov. Roy Cooper and state public health leaders were among a chorus across the country calling for quicker federal response to their supply requests. Not only were they asking for the necessary chemical reagents to get a window into the genetic footprint of the virus, but there was also an urgent and growing need for personal protective equipment.
As that aid lagged, states took it upon themselves to start securing their own protective equipment. In North Carolina, Mike Sprayberry, director of emergency management, provides updates at media briefings.
Among the more difficult items to find, purchase and have delivered are gowns for health care workers and N95 masks, especially the small size.
“We’re able to meet the current demand,” Cohen said. “If we were to see spikes and surges … that’s going to draw down our resources that we’ve built up again.”
Additionally, it is hurricane season and North Carolina has seen flooding, property damage, as well as people injured and killed in recent years by storms bringing massive amounts of wind and rain.
“We need to be planning for that as well,” Cohen said. “So not only are we trying to respond to current needs, we’re trying to also build up our supplies to be able to respond as we go forward.”
Getting more chemicals to tease out the RNA from testing swabs poses a problem that requires federal aid.
“We can’t solve that problem from the state level,” Cohen said. “We need federal assistance. We need assistance from the supply chain on this. We are raising those concerns today.”
Data day: Two red Xes and two yellow caution lines
For the past several weeks, Gov. Roy Cooper and Mandy Cohen, his top public health official, have warned North Carolinians that current metrics and trends do not warrant further opening of businesses and might force them to close things up again.
On Thursday, with the Fourth of July holiday weekend approaching and the specter of large gatherings, Cohen got out her charts and graphs for an update on where the state stands in its COVID-19 battle plan.
The state continues to see a rise in lab-confirmed cases and not just because more tests are being conducted. The percentage of overall tests returned as positive continues to hover between 8 and 10 percent, double what public health officials would like to see.
Cohen, secretary of the state Department of Health and Human Services, gave a red X for the graph showing an increase in cases, not only because it is evidence of more virus in the state but also because it shows more rapid spread.
Additionally, more people are showing up at emergency departments with COVID-19 symptoms, a troubling sign that could be a harbinger of the need for more hospital beds. For that, Cohen assigned a red X to that trend.
The state’s testing plan drew a yellow cautionary line because of concerns over supply shortages that have slowed turnaround times for results.
Though 912 people were in hospital beds on Thursday sickened with COVID-19 illness, Cohen assigned a yellow cautionary line to that trend because there continues to be room for more patients.
Nonetheless, Cohen pointed to states such as Texas, Arizona and Florida that have had to dial back reopening plans as health care systems in their state saw surges of severely ill patients.
“Across the country, we continue to see dangerous spikes in viral transmission,” Cohen said. “Many states are now moving backwards. They’re closing businesses again and enacting more restrictions. Some have openly recognized that they moved too fast.”
Cohen said North Carolina has used a different approach, describing it as a “dimmer switch” reopening that slowly allows for more activity while also trying to keep close tabs on viral spread.
Despite the efforts and a new statewide mask requirement, North Carolina continues to see a troubling increase in lab-confirmed cases, especially among those 18 to 49 years old.
“We are not in dire straits like some around us,” Cohen said. “We have reason to be concerned though.”
When will we see face mask order impact?
Gov. Roy Cooper’s executive order requiring people to wear face masks in many settings has been in effect for almost a week.
Cooper issued the statewide order several weeks after North Carolina eased restrictions in his stay-at-home order to allow restaurants, retail stores and some other places that had been shuttered to open with social distancing requirements.
That easing of restrictions led to more COVID-19 spread and more people in hospitals that had Cooper and public health officials cautioning a reopening reversal.
On Thursday, during a briefing with reporters, Mandy Cohen, secretary of the state Department of Health and Human Services, was asked how quickly North Carolinians would see the impact of more people wearing face masks.
“As we look at the scientific evidence on the impact of face coverings in other states, I think it can have a very outsized impact,” Cohen said. “I don’t think that is something we will see immediately. It usually can take two to three weeks for us to see new changes in our numbers.”
That has also been the case as restrictions were eased. It can take anywhere from two to 14 days for people to show symptoms of the virus once they are infected, and then another week to 10 days for the health care systems to see the sickest of those infected with the virus.
After loosening restrictions at the end of May, North Carolina’s cases and hospitalizations grew throughout June.
The vexatious issue that complicates COVID-19 control plans is that many people are asymptomatic or have only minor symptoms and do not always realize they are sick. For that reason, Cooper, Cohen and others across the country have been touting the face mask as one known and simple tool that can be used to slow the spread of the virus.
Some people have eschewed such requirements. They complain that government forcing such measures is an impingement on their freedoms.
Yet a recent analysis published by the investment firm Goldman Sachs found that if more people wore masks, it could substitute for continued lockdowns that otherwise erode the nation’s gross domestic product by 5 percent.
President Donald Trump, who has received much criticism for not wearing a face covering in public, gained headlines this week for telling a Fox Business Network reporter that he’s “all for masks.”
In response to the reporter’s question about why he did not make them mandatory, Trump responded:
“Well, I don’t know if you need mandatory because you have many people in the country where they stay very long distances. You talk about social distancing,” Trump said. “But I’m all for masks. I think masks are good. If I were in a group of people and I was close, I would. I have. You know people have seen me wearing one if I’m in a group of people where we’re not 10 feet away. But usually, I’m not in that position.”
In an election year, the mask has become a political symbol, though Republicans at the national level have started bucking the previous trend of not being seen in them.
Cooper and his administration have tried many ways to get people to embrace face masks as an important link to further reopening businesses and school.
Cohen and Mike Sprayberry, the director of Emergency Management, linked their messages on Thursday to the Fourth of July holiday.
“You heard Dr. Cohen talking about our mission as teammates for the 244th celebration of the birth of our nation,” said Sprayberry, a former National Guard member and Marine. “We must all do our part by wearing a face covering, waiting at least six feet apart and washing our hands frequently. It will be easy to be tempted to gather and celebrate this most important holiday and throw caution to the wind. Let’s not do that. We all need to remember that if we don’t follow the three Ws, we run a great risk of more virus spread. This is our chance to pull together.” — Anne Blythe
Coronavirus by the numbers
According to NCDHHS data, as of Thursday afternoon:
- 1,391 people total in North Carolina have died of coronavirus.
- 68,142 have been diagnosed with the disease. Of those, 912 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.
- 45,538 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 971,000 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.
- A plurality of the cases (45 percent) were in people ages 25-49. While 12 percent of the positive diagnoses were in people ages 65 and older, seniors make up 79 percent of coronavirus deaths in the state.
- 220 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities. An outbreak is defined as two or more positive cases in a facility.
- There are 3,410 ventilators in hospitals across the state and 885 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital.