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By Anne Blythe
As North Carolina’s COVID-19 case counts rise steadily, the tightening grip of the coronavirus is having a disparate impact on the state’s rural counties.
The rate of infections per capita has become alarmingly high in many rural North Carolina counties, Mandy Cohen, secretary of the state Department of Health and Human Services, told reporters on Thursday.
Since September, the rural counties have reported nearly twice as many new cases compared to urban and suburban counties, according to a DHHS report released this week. The majority of the cases are among mostly white people younger than 50.
Deaths related to COVID-19 also have increased markedly in rural counties and now account for the majority of deaths statewide compared to urban and suburban counties.
“It’s particularly worrisome to see high rates of COVID spread in our rural counties because health care can be harder to access in those communities,” Cohen said. “Most rural hospitals are small and some are already feeling stretched to their capacity limits. COVID is adding to the strain that those hospitals already face in colder winter months.”
In North Carolina, 1,279 people were hospitalized with severe illness related to COVID-19, according to the DHHS dashboard.
That dashboard metric will change on Friday, Cohen explained, and going forward will reflect a new hospitalizations definition from the federal government.
“The federal government has changed criteria for reporting COVID-19 hospitalizations,” Cohen explained. “Previously, the [Centers for Disease Control and Prevention] required that people report hospitalizations only when they were under isolation precautions, which is typically about 21 days.”
But some people have suffered longer-term effects of COVID-19, with damaged lungs, tethered to mechanical breathing machines for weeks, sometimes even months. Those patients were not always included in the public reporting that state health departments posted to their public dashboards.
Now they will be, Cohen said.
“As a result, as of tomorrow, we will see a one-time increase in hospitalizations and a continued higher number under this new definition,” she explained.
Dashboard viewers also might notice that the number of daily COVID tests, cases and death count looks lower than usual because of a time shift that DHHS is making for when public data are reported.
To make the adjustment, the department will pull data for just one day that does not represent the full 24-hour window it typically uses.
“That means tomorrow’s numbers should be viewed with caution,” Cohen said. “There will be just a one-time decrease in our testing, cases and death numbers tomorrow. By Saturday, we’ll be back at what we’ve looked at and been used to seeing day over day.”
On Wednesday, North Carolina reported more than 3,000 new COVID-19 cases in a day, a new high that Cohen called “a troubling milestone.”
“That’s not a number I’d hope we would see,” Cohen said. “The percent of tests that are positive and also our hospitalizations are inching up. I’m concerned, particularly as we head into colder months and the holidays, and there is going to be more gathering indoors, where this virus likes to spread.”
More than half of North Carolina adults have underlying health factors that make them at high risk for serious illness from COVID-19.
“This is not a disease to gamble with,” Cohen said.
Cohen said the COVID-19 surge in rural North Carolina comes, in part, because people are letting down their guards in informal, social and religious settings.
Alexander County in western North Carolina has a positivity rate of 17.6 percent, compared to an overall rate of 7.9 percent for the state. Columbus County in the south has a positivity rate of 17.2 percent.
“There’s a couple of reasons why we are seeing more spread in our rural communities,” Cohen said. “First, there are communities that largely were spared earlier in the year. We didn’t see as much spread earlier in the year and now the virus has hit these communities and we’re seeing that the virus is spreading more.”
“That doesn’t mean, I’m not worried about our urban areas,” Cohen cautioned. “Our urban areas continue to be a place that just from the sheer numbers put up the … highest number of cases every day. Our three biggest counties continue to give us our three biggest numbers of cases every single day.”
Guilford County, among the three largest, reported 212 new lab-confirmed cases of COVID-19 with a positivity rate of 7.1 percent. Mecklenburg County reported 380 new cases with a positivity rate of 6.8 percent, and Wake County reported 233 cases with a positivity rate of 5.44 percent.
College students going home
Cohen and her team have been so concerned about the steady increase in COVID-19 cases as Thanksgiving approaches that Gov. Roy Cooper announced on Tuesday he was restricting indoor crowd sizes to no larger than 10 people.
The case surge also comes as many college students across North Carolina are finishing their semesters and making plans for winter breaks that coincide with the coming holidays.
Emily Sickbert-Bennett, director of Infection Prevention at the UNC Medical Center, told reporters during a briefing on Thursday morning, that college students could begin preparing for visits home now by isolating themselves as much as possible for 14 days before any travel.
“If individuals are going to travel and then be in a new area for an extended period of time, one important strategy would be to really be cautious of your activities for the 14 days before you take that trip back home, particularly if you’re entering into a household where you have high-risk individuals,” Sickbert-Bennett said. “The 14-day period before you would travel and return home would be a time period where you would be partaking in far fewer activities, you would be much more limiting in who you would interact with and that would reduce the chance that you could be incubating an infection. …That would give you an entire incubation period.”
Cohen also is recommending that people planning to travel get tested for COVID-19 several days ahead of their departure date.
“To help further prevent the spread of COVID, my department is providing tests to colleges and universities across the state so that students can get tested before they leave campus and go home for holiday break,” Cohen said.
The department plans to distribute 74,470 rapid antigen tests to public and private colleges and universities across North Carolina, a sum determined after Cohen and her team asked leaders of the schools what they would need to get as many students tested as possible.
The department also is helping to stand up testing events in Guilford, Harnett, New Hanover, Mecklenburg and Pitt counties near campuses.
“I strongly encourage anyone who plans to travel or gather with people outside their household for Thanksgiving to get tested,” Cohen said. “If you have a positive test stay home and isolate. But even if you have a negative test result, it’s not a free pass. Tests represent a moment in time and rapid tests miss some cases.”
Mask wearing, social distancing and rigorous hand washing remain important, too, she said.
Will insurance cover COVID test?
Helen Chickering, a reporter at Blue Ridge Public Radio, told Cohen the station was hearing complaints from people who tried to get their insurance companies to pay for tests if they had not been exposed to someone who tested positive for COVID-19 or were asymptomatic.
“This is the first time we are recommending a test when it’s not falling in the buckets of ‘you have symptoms’ or ‘you’ve been exposed,’” Cohen said.
Cohen outlined several ways in which a person could get tested, noting that her department lists community testing events around the state, many of which are free.
“For those who are going to other places, maybe going to their doctor or to places that typically would bill their insurance companies, need to indicate why they might want to be getting a test,” Cohen said.
At CVS or Walgreens, which often have screener questions asking people why they are getting a test, people should indicate that the state public health officials recommended it.
“There’s going to be a category for ‘I have symptoms’ or ‘I have been exposed,’” Cohen said. “But there’s also a category that says our state health officials have said I recommend a test. So you could use that.”
Cohen added that she had spoken with leaders at Blue Cross Blue Shield of North Carolina.
“They are covering a one-time screening test ahead of the holidays,” Cohen said. “I have not spoken to all of the insurance carriers so I do not know that across the board, but a number of insurers are covering that one-time screening test.”
Coronavirus by the numbers
According to NCDHHS data, as of Thursday afternoon:
- 4,706 people total in North Carolina have died of coronavirus.
- 303,454 have been diagnosed with the disease. Of those, 1,279 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.
- 261,719 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. Nor does it reflect the number of so-called “long-haul” survivors of COVID who continue to feel the effects of the disease beyond the defined “recovery” period.
- To date, 4,486,524 tests have been completed in North Carolina. 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 COVID-19 tests performed in the state.
- People ages 25-49 make up the largest group of cases (40 percent). While 15 percent of the positive diagnoses were in people ages 65 and older, seniors make up 81 percent of coronavirus deaths in the state.
- 405 outbreaks are ongoing in group facilities across the state, including nursing homes and correctional and residential care facilities.
- There are 3,478 ventilators in hospitals across the state and 929 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital. As of Thursday, 325 suspected COVID-19 patients were in intensive care units across the state.