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By Anne Blythe
Five months into the coronavirus pandemic, the North Carolina governor and his top public health official are expressing deja-vu-all-over-again frustrations about the lack of a strong federal plan for attacking COVID-19.
At a media briefing on Tuesday, Gov. Roy Cooper and Mandy Cohen, secretary of the state Department of Health and Human Services, outlined a series of requests they’ve made to the Trump administration and Congress with the same urgency they used in March and April when the federal response to the states was notoriously lagging.
Cooper sent a letter to the state’s Congressional delegation last week encouraging them to support continued federal aid to help North Carolina “follow best public health guidance and properly resource and implement robust testing, contact tracing and isolation capabilities required for an effective recovery strategy.”
State and local governments have seen a drop in revenue of more than $5 billion, Cooper’s staff said in a news release about that letter.
Cooper noted on Tuesday that the $600 weekly unemployment benefit the federal government had been supplying since the spring to bolster the state’s benefits will stop coming after this week unless Congress extends them.
What happens after $600 federal benefit ends?
North Carolina has paid more than $6.2 billion to 815,000 people who lost their jobs due to the pandemic.
“Many people cannot safely go back to work,” Cooper said.”They can’t go back to their jobs and many don’t have jobs to return to. While this virus continues to spread, we have to support these workers.”
In North Carolina, the Republican-led General Assembly cut unemployment benefits in 2013 to where they are now rated as some of the lowest in the country.
The General Assembly did not address the issue while in session this spring and summer. State lawmakers are set to return to Raleigh in September and Cooper urged them to re-evaluate the state’s compensation program.
“Remember, this federal funding has a multiplier effect, going from families’ pockets back into our local communities, helping small businesses and our economy stay afloat,” Cooper said. “This federal assistance will expire at the end of the week. The clock is ticking and all eyes are on Washington right now. I encourage people to make their voices heard on this issue.”
Another issue where Cohen would like the state’s voices heard is on the paucity of chemicals needed to keep up with the increased COVID-19 testing and contact tracing that play a crucial role in the plan for slowing the virus spread. Without those controls, it will take longer for the economy to pick up again, Cohen and Cooper have said.
Problems getting testing supplies
They have raised concerns with Alex Azar, secretary of the federal Department of Health and Human Services, about the state’s fight to get reagents, the chemicals needed in the labs to tease out the RNA from testing swabs.
The supply chain has been weak for some private labs, causing a slow turnaround for test results, in some cases longer than a week.
“When you go two, three, four, five, even six days, waiting for a test, that person is supposed to isolate and not be around people and not go to work and that’s hard for somebody dealing with that,” Cooper said. “In addition, our contact tracers want to be finding out if this person is positive, who they’ve been in contact with so it reduces the effectiveness of a lot of the things we’re doing when we have a slow turn-around time.
“We’ve continued to push the federal government on this issue. I think a lot of this has to do with a lack of a coordinated federal strategy.”
Cohen and her team have tried to create state workarounds similar to the way they did in the early days of the pandemic when the federal government was not sending necessary personal protective equipment for front-line workers.
At the briefing on Tuesday, Cohen said that her team is matching test collection sites with labs to help alleviate troubling turnaround times.
“There’s a number of ways in which we’re trying to attack this problem,” Cohen said. “There’s no one solution. … We know some of our bigger commercial labs are really swamped but there are smaller labs that do have capacity and we need to make those matches happen.”
The state itself is buying lab reserve capacity, Cohen added, to try to improve the lag between testing and getting results.
‘More federal leadership needed’
Cohen reiterated that this country is at a point in the pandemic when it should be exploring other ways to test for COVID-19 that do not require such expensive lab work.
“Again, this is where more federal leadership is needed,” Cohen said. “We want to explore using other types of testing like antigen testing.”
Antigen testing is different from antibody tests, some of which have proven more effective than others at showing whether someone had been infected with the virus. Effective antigen tests should be able to reveal whether someone has certain molecules known to evoke an immune response to COVID-19.
Few such tests are available on the market, and there has been no federal push to make successful ones available more quickly.
CDC changes isolation guidelines
One thing that has happened that could cut down on the need for as many tests, Cohen said, is the Centers for Disease Control and Prevention guidance change on July 20 for when a non-hospitalized patient with COVID-19 is safe to rejoin the world.
“A test-based strategy is no longer recommended to determine when to discontinue home isolation, except in certain circumstances,” the guidance states.
The criteria to come out of isolation now are:
- No fever for at least 24 hours only if the person has not used medications to reduce it; and
- Improvement in symptoms for those who had them; and
- For those who exhibited no symptoms, they can move freely 10 days after the first positive test.
Despite the updated guidance, state and private labs have been investing in pricey equipment that will make it possible to run more tests and turn results around as quickly as possible. Nonetheless, there are limitations.
“We are certainly making investments for the state public health lab in bringing on new diagnostic platforms to get some additional through-put at our own state labs,” Cohen said. “A number of our commercial lab partners are also doing the same thing in trying to bring on additional capacity.”
“So even if you bring on some of these expensive lab platforms, you still need the reagents to run those platforms,” she added. “I know there are a number of hospitals that are trying to make changes, but they’ve committed to some of these larger platforms, they’ve invested the money and the resources in bringing these platforms online. Now they need the supplies to actually make them run.”
Why not use the defense production act?
What more can the federal government do, Cohen was asked.
“There’s a number of things from the federal side that folks have been talking about,” Cohen said. “Some of that is just transparency. How are supplies being moved around the country and how do we make sure that North Carolina is getting the supplies they need, particularly to some of our hotspots like our hospitals in the Charlotte area.”
For several weeks, Cohen and her team have been watching the Charlotte-Mecklenburg region. There’s lots of back and forth across the South Carolina border, where there is no statewide mask requirement and a less aggressive pandemic attack plan than North Carolina has used.
Cohen also suggested looking into using the Defense Production Act to get private companies to ramp up manufacturing of the supplies.
So far, President Donald Trump has resisted using the act for anything other than to require the country’s meat processing plants, many of which have been virus-spread hotspots, to stay open during the pandemic.
She also suggested discussing potential regulation changes that could bring more coronavirus pandemic-related supplies to the market.
“We are not alone in this,” Cohen stressed. “Every state is sort of going through this at the same time so having that coordination at the federal level is important.”
Deactivating the National Guard
Mike Sprayberry, director of the state Department of Emergency Management, reminded North Carolinians of how much states have had to take on during the coronavirus pandemic as the lack of a unified federal response leaves much to individual governors.
In North Carolina, Sprayberry and others from the Cooper administration picked up the mantle for securing personal protective equipment.
The governor announced that this week, the state would distribute 900,000 face masks and infection control supplies to North Carolina Cooperative Extension county centers to get to farmworkers in 31 counties.
Additionally, Sprayberry and his team are pushing out cloth face coverings to schools across the state as some prepare for in-person learning again. They also are distributing face masks to workers in meat processing plants and sending them to election boards across the state to support poll workers and voters for the elections this fall.
To date, Sprayberry said, the state has spent more than $168 million for procurement of personal protective equipment that was difficult to get in March and April because of a supply shortage at the federal level.
North Carolina used National Guard members to help move the supplies across the state.
“For more than 130 days, National Guard personnel have supported food banks, warehousing and distribution and they delivered meals to support school nutrition programs and many other things,” Sprayberry said. “They’ve helped receive and load and ship PPE from our warehouses and they’ve helped to ensure our state IT infrastructure remained secure during an elevated time of cyber intrusions.”
More recently, they have helped at community testing sites and with widespread testing in the prisons.
“At the end of this week, almost all of those men and women from both the Army and Air National Guard will end their activation and return to their civilian jobs,” Sprayberry said. “We thank them and their families and employers for sharing them with us. For the National Guard team, you have provided vital services to the state. Here’s a hardy hand salute for a mission well done.”
Coronavirus by the numbers
According to NCDHHS data, as of Tuesday afternoon:
- 1,668 people total in North Carolina have died of coronavirus.
- 102,861 have been diagnosed with the disease. Of those, 1,109 are in the hospital. The hospitalization figure is a snapshot of people hospitalized with coronavirus 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.
- 78,707 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.
- To date, 1,458,997 tests have been completed. As of July 7, all labs in the state are required to report both their positive and negative test results to the lab, so that figure includes all of the coronavirus tests performed in the state.
- 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 78 percent of coronavirus deaths in the state.
- 295 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities.
- There are 3,308 ventilators in hospitals across the state and 887 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital.