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By Anne Blythe

As the battle against COVID-19 heats up in North Carolina, the state’s public health team has set up a war room inside the state’s Emergency Operation Center where they’ve spent much time lately figuring out how to distribute new weapons against the coronavirus.

This week the latest weapon was deployed. It was the vaccine created by Pfizer and BioNTech, a much-anticipated tool that first arrived in North Carolina at 7:20 a.m. Monday at Wake Forest Baptist Medical Center.

Gov. Roy Cooper told reporters at a Tuesday briefing that he spoke with Danny Parson, the UPS delivery driver who dropped off that first allotment of vaccines that public health teams tout as the weapon needed to bring the deadly coronavirus pandemic to an end.

Since early March, North Carolina has had 446,601 lab-confirmed cases of COVID-19, 5,881 which have led to deaths, as of the Tuesday afternoon count.

“There’s real hope that we can stop those painful losses,” Cooper said. “Vaccinations are underway in North Carolina.”

In addition to Wake Forest Baptist Medical Center, 10 other sites have been selected to get the state’s initial allotment of the Pfizer vaccine, an expected 85,800 doses that are to go first to health care workers on COVID-19 wards and in emergency rooms, where the risk of exposure to the virus is high.

Duke Health also received vaccines on Monday, as well as Atrium Health, which began the administration of vaccines on Monday, going first to health care workers in the intensive care units and emergency departments.

“This has been a year that has tested all of us, and after fighting in the trenches 24/7, I am so happy that the cavalry is finally starting to arrive,” Eugene A. Woods, president and CEO of Atrium Health, said in a statement released Monday.

First shot in the arm

First in line at Atrium was Katie Passaretti, medical director of Infection Prevention.

“This is a moment of hope as this vaccine has the potential to change the course of where we are with the pandemic,” Passaretti said in a video that has been shared widely. “I couldn’t be more excited. I feel perfectly fine and I haven’t had any issues or complications with the vaccine. I would highly encourage everyone to talk with your doctor and consider getting vaccinated when it is available for you.”

Mandy Cohen, secretary of the state Department of Health and Human Services, described Monday as “a historic and emotional day for many as we finally have a new tool to protect people from this virus.

Eight hospitals received vaccine shipments on Tuesday, bringing the total number of health care sites with Pfizer shipments to 11 in North Carolina. Forty-two hospitals are expected to receive shipments on Thursday.

Loc Culp, the clinical manager of the medical intensive care unit at UNC Hospital in Chapel Hill, was the first person in the UNC Health system to receive the vaccine. Culp, who was promoted to her job only two months before the pandemic struck, said getting the vaccine was emotional.

“The last 10 months have been really hard,” she told reporters during a Zoom call. “I think of situations like, families getting it, two brothers that got COVID and they passed away. And a husband and wife, they got COVID and passed away within days of each other. And I remember a gentleman that went on a golf trip with his friends, and out of all his friends, he got COVID. I think they all got COVID, but he ended up passing away, and the others did not.”

Hoping to change the federal cadence

The state’s vaccination plan has been in the making for months, and though it could be late spring or as late as early summer before vaccines are widely available to people without predetermined high risk factors, the state is testing the mettle of its preparations.

One issue that already has come to the fore and caused Cooper to put in a special request to Vice President Mike Pence is a tight notification and delivery timeline. Each week, the federal government will inform states on Friday morning how much vaccine they can expect to receive the following Monday. The states must get back to federal officials by 8 p.m. that same Friday with the sites in North Carolina where they want the shipments to go.

This gives the states “just a few hours to direct where those shipments will go,” Cooper said.

He and other governors raised the issue with the vice president during a call on Monday.

“I asked for more time to plan, which is critical as our vaccines roll out across the state,” Cooper said. “They said they will work on it.”

As has been the case more often than state officials would like, the federal government has not always provided concrete answers about the quantity of supplies the states can expect in their war against COVID-19.

In the spring, testing supplies and personal protective equipment for health care workers and others on the frontlines were not coming fast enough, so states had to take it upon themselves to obtain the needed tools to help limit the spread of the disease.

Adding to the complicated logistics, the cadence, as federal leaders call the timing of vaccine rollouts to states, could soon include a second vaccine.

Moderna vaccine in the mix soon?

Moderna, which put in an application to the federal Food and Drug Administration a week behind Pfizer, could find out this week whether the pharmaceutical company will also be given emergency use authorization for distributing its vaccine.

The Vaccines and Related Biological Products Advisory Committee, or VRBPAC, an advisory committee made up of scientists not affiliated to the FDA or the company seeking authorization, is scheduled to meet Thursday to review and discuss safety information and data provided by Moderna.

If the approval is granted, North Carolina could see an additional 175,000 Moderna vaccines next week to complement its Pfizer supplies.

Half of those vaccines would go to nursing homes and long-term care facilities, whose residents and staff also are near the top of the list for inoculation against COVID-19.

“We will have very limited supply of the vaccine at first,” Cohen stressed.

Holiday surge upon Thanksgiving surge?

For weeks, Cohen and Cooper have tried to get North Carolinians to forgo holiday traditions of the past and celebrate Christmas and the end of 2020 and beginning of 2021 with their immediate households only.

Despite their pleas and guidance from the Centers for Disease Control and Prevention recommending against traveling for the holidays for multi-household gatherings, North Carolina expects some residents to ignore the cautions.

Because of that, the state is setting up 300 free community testing events in the coming weeks, urging anyone who travels to get tested several days ahead with full knowledge that a negative result is not a free pass to forgo masks or other social distancing measures.

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Excerpt from an NC Department of Health and Human Services press release: 

The North Carolina Department of Health and Human Services will offer more than 300 no-cost, walk-up or drive-through COVID-19 testing events over the next two weeks to help North Carolinians protect themselves and their loved ones during the holidays. This includes testing in partnership with new retailers in seven counties across the state.

In addition to existing testing events throughout North Carolina, retailers in Buncombe, Durham, Harnett, Iredell, Lee, Mecklenburg and Wake counties are offering testing Dec. 18-20 and Dec. 26-27 in the parking lots of select Agri Supply, Carlie C’s IGA, Home Depot, Piggly Wiggly and Wegman’s stores.

For a full list of all testing event times and locations throughout the state, visit the No-Cost Community Testing Events page on the NCDHHS website. More locations are being added each day, and additional testing sites can be found at Find My Testing Place. [/symple_box]

Thanksgiving, not quite three weeks ago, contributed to record case counts, hospitalizations and intensive care unit admissions in North Carolina.

Now, public health officials worry about a surge atop that surge, and too few nurses and other health care workers to tend to the ill.

“We are experiencing a staggering increase in our pandemic trends, and I am particularly worried about our hospital capacity,” Cohen said. “Just one month ago, we had 1,395 people in the hospital with COVID-19. Today we have 2,735 people in the hospital right now. That’s twice as many people hospitalized than we had on Nov. 15.”

One month ago, Cohen said, 350 people were in intensive care units across North Carolina, battling illness related to COVID-19. On Tuesday, there were 643 people in the ICU, she added.

“I know we’re all getting so numb to these numbers so I’m asking you to take a moment to think about who these people are,” Cohen said. “They’re our neighbors. Our friends. Our family members. They are people we love.”

For many months, Cohen and Cooper have been pleading with North Carolinians to embrace face masks as a necessary weapon in the battle against COVID-19.

Public health advisors continue to stress their importance even as inoculations against the virus begin.

Enforcement help from cities, towns and counties?

On Friday, Cooper, Cohen and Erik Hooks, secretary of the state Department of Public Safety, sent a letter to governing officials of towns, cities and counties across the state, letting them know that Josh Stein, the state attorney general, had issued an advisory concluding that municipalities had legal authority to adopt civil penalties for violators of the governor’s pandemic-related orders.

“Now more than ever we need help with enforcement from our local partners to fight this raging pandemic,” Cooper said at the time. “Taking steps now to protect our communities by enforcing safety precautions will help reduce transmission of the virus and save lives.”

Cooper stressed his support for that on Tuesday, too. He highlighted that penalties for violations in his order can be criminal offenses, although he said civil penalties and fines could be more effective.

“Our aim is not to get people in trouble,” Cooper said. “It’s to get people to do the right things to slow the spread of this virus and to keep it from overwhelming our hospital systems.”

‘Logistically complex’

Juggling the distribution of vaccines and the continued rage of the pandemic with so many unknowns could lead to some unexpected bumps down the road, Cohen and Cooper cautioned.

The state built a database in which they can keep track of where vaccines are distributed, which kind went to which location and when second doses of two-dose vaccines are due.

The Pfizer vaccine spaces the doses 21 days apart. The Moderna doses are administered 28 days apart. For them to be effective people must get both shots from the same pharmaceutical company.

“This is logistically complex,” Cooper said.

The state will have to have good communication with health care providers to make sure the distribution is successful. As the state moves beyond the initial phase of distribution, the plan gets more and more complex.

The Moderna vaccine, which comes in smaller allotments and does not require ultra-cold storage like the Pfizer drug does, is likely to be sent to rural areas.

“As we get more and more vaccine and spread it out further across the state, it will get more complex because there are more people who are going to be involved in it,” Cooper said.

“I know that Dr. Cohen and the team there have been working on this, really on an hourly basis here. They’ve set up a war room, where they are taking questions from health care providers and providing answers, as you can imagine, as the trucks roll in and put the vaccines out, there are some questions by providers,” he added. “We’re trying to communicate and making sure they know exactly what to do and that we don’t waste a single dose.”

Currently, North Carolina is only receiving first doses of the Pfizer vaccine. Two weeks from now, Cohen said, the same places that received the initial allotments will get the second doses so they can administer the second shot to all who received the first one within the 21-day window.

“As the governor said, this is going to get complex because we will be sending out first doses and second doses as soon as a couple of weeks from now,” Cohen added.

Cape Fear Valley Health system restricts visitors 

The Fayetteville-based Cape Fear Valley Health system announced its facilities will be closed to visitors until further notice, with the following exceptions:

  • Labor & Delivery: Laboring mothers may have one support person/coach for the duration of their stay. If that person leaves the premises for any reason, he or she will not be allowed back into the building.
  • Pediatric patients: A legal minor may have one parent or guardian with them.
  • Patients who need a health care decision-maker or require communication assistance may have one assistance person with them.
  • End-of-life patients may have one one-hour visit with up to four people.

“Even in the above situations, visitors with symptoms of a fever or respiratory illness symptoms, including cough or shortness of breath, should remain home. Hospitals will screen visitors for signs and symptoms of illness,” the hospital system said in a news release dated Monday.

— Greg Barnes

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Coronavirus by the numbers

According to NCDHHS data, as of Tuesday afternoon:

  • 5,881 people total in North Carolina have died of coronavirus.
  • 446,601 have been diagnosed with the disease. Of those, 2,735 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.
  • 365,273 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, 6,066,204 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 82 percent of coronavirus deaths in the state.
  • 493 outbreaks are ongoing in group facilities across the state, including nursing homes and correctional and residential care facilities.
  • There are 3,551 ventilators in hospitals across the state and 1,084 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital. As of Tuesday, 580 COVID-19 patients were in intensive care units across the state.[/symple_box]

Anne Blythe

Anne Blythe, a reporter in North Carolina for more than three decades, writes about oral health care, children's health and other topics for North Carolina Health News.