Coronavirus Today – July 7 – Streamlining COVID testing access; Tough being a contact tracer; NC gets F for inmate care - North Carolina Health News
By North Carolina Health News staff
Won’t need a doc’s note to get tested
Elizabeth Cuervo Tilson, the state health director, just issued a statewide order which means you no longer need a doctor’s referral to get tested for COVID-19.
Essentially, she has provided a sweeping referral that has often been the barrier to testing for people in communities of color and some of the state’s more marginalized populations as virus spread grows.
The order, which is slated to remain in place through the duration of the public health emergency, also allows testing sites to collect and submit samples to labs without physician referrals. Now, the labs will be able to report results directly to the sites.
“There’s a standing order to say we want folks to get tested,” Mandy Cohen, secretary of the state Department of Health and Human Services, explained at a briefing with reporters. “It just allows for that testing to happen more quickly as well as for results to go right back to that person in a more streamlined way.
“It’s a mechanism to streamline the work that we were already doing here.”
Across North Carolina, many residents do not have a regular health care provider, which has posed problems as the state tries to attack the virus and contain its spread in some harder hit communities.
Cohen also announced that 300 free temporary testing sites would be set up throughout the month of July in underserved communities.
North Carolina’s Black and Latino populations have felt the disproportionate brunt of COVID-19 because of longstanding systemic health care access disparities.
Black residents in North Carolina make up about 22 percent of the population. While they represent 24 percent of cases, 33 percent of people who’ve died from COVID-19 have been African-American.
Hispanic and Latino residents make up about 10 percent of the population but represent about 45 percent of the lab-confirmed cases for which race and ethnicity are reported. Death rates for Latinos are lower, in part because many of those who have fallen ill are younger, with fewer pre-existing conditions, experts say.
The public health team has pulled together advocates for these communities of color to create a more targeted attack on the coronavirus.
Some of the temporary testing spots will be the more traditional drive-through sites. Because lack of transportation has been a hurdle that keeps some from accessing testing sites, as the Farmworker Advocacy Network pointed out in a June letter to the governor, there also will be walk-in locations.
“The whole idea of this initiative is to get testing into communities that have not had testing access,” Cohen said. “So there will be walk-up sites. … What the idea is for us to work with community partners to say ‘What makes sense for your community?’ It may be a partner with a church or another local non-profit that can host that testing event and then we work with them on the details of how do they want to deploy the logistics for that, including some walk-up opportunities.” — Anne Blythe
Call to HHS Secretary Alex Azar for supply help
Throughout the pandemic, North Carolina has tested nearly one-in-10 North Carolinians, reporting a total of 1.07 million COVID-19 tests.
For much of the past two weeks, North Carolina has conducted more than 20,000 tests per day, though the Fourth of July holiday weekend showed a dip in that number.
With more testing comes the need for more supplies. Mandy Cohen, secretary of the state Department of Health and Human Services, has sounded the alarm several times in recent weeks about a shortage of reagents, the chemicals needed to extract RNA from the testing swabs.
On Monday, Cohen and Gov. Roy Cooper spoke with Alex Azar, secretary of the federal Department of Health and Human Services, seeking federal assistance.
Cohen elaborated on that discussion at a Tuesday briefing with reporters.
“We are seeing supply chain issues, and it is not unique to North Carolina,” Cohen said. “That is happening around the country. When you think about supply chain issues, you do need assistance from others. It’s something we can’t solve by ourselves here in North Carolina.”
Cohen said Azar and others at the federal health and human services department are working through the issues that have arisen as states employ massive amounts of testing and contact tracing to track virus spread during as more places open after shutdowns.
“At the end of the day, though, there is just a limited supply and there’s a lot of folks who need these reagents around the country,” Cohen said. “I think this is going to take a coordinated effort to really think through how to make sure that supplies are being appropriately distributed but I continue to advocate for North Carolina.”
North Carolina’s recent trends and metrics continue to trouble Cohen. The number of lab-confirmed cases continues to rise rapidly as the percentage of positive test results hovers around 10 percent, twice as high as public health leaders like to see.
“We see our numbers are going up,” Cohen said. “We have an opportunity to continue to get our arms around this virus, both by wearing a face covering, but by also doing appropriate testing and isolation that we need to do in order to prevent further spread.”
Because of the supply shortages, labs have not been able to complete COVID-19 tests in a timely way, meaning some people can wait as long as a week now to get their results. Cohen singled out “ballooning turnaround times” for tests at commercial labs.
“The federal government is doing some amount of directing of supplies to places of need,” Cohen said, noting that through conversations her team was able to get reagents to a hospital with a supply shortage. “I think that request is going to be harder and harder for the federal government to fulfill as we watch all of these states that are really surging with cases around us. They are going to understandably be prioritized for supplies.”
That’s why Cohen has been sounding an alarm at the federal level even though the state is not in as dire straits as Florida, Texas, Arizona or parts of California that have had to reverse their reopenings.
“Our numbers are going up, and yes, they’re not going up as much as others and I’m very grateful for all the hard work North Carolinians have done to make that possible, but we still have a need here and we need to make sure we’re getting the supplies we need for North Carolina.”
Cohen stressed that bold action is needed at the federal level, while also pushing for an evolution and more rapid innovation in how testing for COVID-19 is done.
“We need to see other kinds of tests come into (the) market that can actually identify COVID-19 in a way that is faster and cheaper and that we can scale,” Cohen said. “We’re still using a pretty slow method for identifying this virus. While there are some more rapid tests, they’re not as sensitive.” — Anne Blythe
From the percent positive cases to hospitalizations, coronavirus cases and deaths, the pandemic is full of unfamiliar numbers. But what do the numbers mean about the pandemic’s trajectory in the state? To help you make sense of the data, we’ve compiled an explanation of the most important trends in three charts. Got other questions, data-related or otherwise? You can ask them here.
For past questions we’ve answered, visit our COVID-19 Q&A page.
Contact tracers having difficulty getting responses
North Carolina’s team of contact tracers are only reaching about a third to half of the people on their lists, according to Mandy Cohen, secretary of the state Department of Health and Human Services.
The tracers calling people to tell them they have been identified as being in close contact with someone infected with COVID-19 are having difficulty getting people to answer their phone calls. In Dare County, the county health director complained of being cursed at and hung up on when she and her team were reaching out to people who had been at a large party that is the source of at least 27 cases.
“Contact tracing is hard because, one, you have to get in touch with that original case and then go through their history as well as get them to share the names of those contacts as well as contact information,” Cohen said. “We know this is a challenge.”
Testing and tracing have been touted as necessary for slowing the spread of the coronavirus until there is a vaccine.
The state has some 1,500 people doing contact tracing. Forty-seven percent of those hired through the Carolina Community Tracing Collaborative are bilingual.
“We are not close to where I would like to be in the number of folks that we are able to contact,” Cohen said. “It’s not surprising that in our LatinX and Hispanic communities we’re seeing less responsiveness in those communities.
“I think there is certainly more distrust and more fear in addition to language barriers that is a challenge there.” — Anne Blythe
Charlotte-Mecklenburg area and troubling hospitalizations
More people are being hospitalized with severe illnesses related to COVID-19 in North Carolina, and the Charlotte-Mecklenburg region has seen some of the larger numbers of hospital admissions.
That was the report that Mandy Cohen, secretary of the state Department of Health and Human Services, provided on Tuesday.
There were 989 people hospitalized on Tuesday, the highest number yet in the state.
“One of the places we’re watching very closely is the Charlotte area in terms of hospital capacity,” Cohen said. “That is a place where we’ve seen higher rates of hospitalizations.”
Cohen said the health care system has enough capacity to treat people with severe illness, but she also remains concerned about a potential surge of cases that has caused other states to close down bars, gyms and restaurants while their hospitals are overwhelmed with COVID-19 cases.
“Right now I know we have capacity and that is good,” Cohen said. “The other positive news, I would say, while we’re seeing hospitalizations go up, we’re actually seeing ICU, or the intensive care unit utilization, stay the same. So that is a good sign.”
Over the months, health care workers and scientists have adapted their treatment methods as the science evolves and kept more people off ventilators.
“We’re going to still watch it closely because the intensive care unit is the most limited resource here,” Cohen said. — Anne Blythe
Coronavirus by the numbers
According to NCDHHS data, as of Tuesday afternoon:
- 1,420 people total in North Carolina have died of coronavirus.
- 75,875 have been diagnosed with the disease. Of those, 989 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.
- 55,318 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 1 million 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 12 percent of the positive diagnoses were in people ages 65 and older, seniors make up 79 percent of coronavirus deaths in the state.
- 239 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities.
- There are 3,352 ventilators in hospitals across the state and 895 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital.
North Carolina receives failing grade for inmate care during COVID-19 pandemic
North Carolina is failing in its response to COVID-19 in its prisons and jails, according to a new report by the American Civil Liberties Union and Prison Policy Initiative.
But so is almost every other state. The national organizations looked at each state’s actions to protect inmates and staff in correctional facilities. North Carolina received an F+. But according to the analysis, every state is doing a poor job caring for incarcerated people in its custody — the most favorable states, of which there were nine, received a D- grade.
Grading was based on four measurements:
Did the state provide testing and PPE to all prison staff and inmates as of June 10?
- Somewhat: North Carolina’s Department of Public Safety has committed to testing all inmates, but testing for staff is available but not required. Masks are given to all staff, but N.C. lost points due to widespread reports of prisoners not always having access to masks.
Did the state reduce county jail and state prison populations?
- Slightly: N.C. has reduced its jail population by about 22 percent, according to data from 38 jails. The state prison population has dropped by just about 5 percent, according to DPS.
Has the governor issued an executive order accelerating the release of medically vulnerable individuals or those near the end of their sentence from state prisons?
- No: No order from Gov. Roy Cooper, no points.
Has the state published regularly updated, publicly available data on COVID-19 in their prison system?
- Partial credit: North Carolina’s DPS updated prison info daily but lost points on the ACLU measurement for not breaking these numbers down by race of the infected person.
The report suggests what many have deduced from experts likening prisons and jails to Petri dishes and incubators for the virus, and from rising death tolls inside: The United States was wholly unprepared to deal with a highly contagious outbreak within their carceral facilities.
Over 570 incarcerated people and 55 correctional staffers have died of COVID-19 nationwide. Thirty-three of them — 30 prisoners and three staff — perished in North Carolina. In the state prison system, five inmates and one staffer have died, while there have been a total of 26 deaths at the federal prison complex in Butner. – Hannah Critchfield