By Anne Blythe

Though COVID-19 vaccines from Pfizer and Moderna being distributed across the state offer rays of light in the fight against the coronavirus that continues to disrupt the world, North Carolina is in a very dark place.

Mandy Cohen, secretary of the state Department of Health and Human Services, has spent the past 10 months stepping before the public in more than 110 online briefings with reporters from across the state, offering an assessment of where North Carolina is in its attack plan and urging residents to dig in with resolve.

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“In the 10 months that we have been fighting this pandemic, this is the most worried that I’ve been for our state,” Cohen told reporters at a Friday briefing aired on UNCTV. “We continue to set new records. We reported over 10,000 new cases yesterday and again today. Our tests that are positive remain in the double digits. And most worrisome, every day we see new record highs of people hospitalized with COVID-19 and record high of those needing intensive care.”

On Friday, North Carolina reported 10,028 new lab-confirmed cases of COVID-19. The day before, that number was 10,398 new cases.

There were 3,980 hospitalized with illness related to the virus on Friday, 446 of which had been admitted over the past 24 hours, according to the DHHS COVID-19 dashboard. Of those hospitalized, 2,098 were in intensive care unit beds and 1,219 were using ventilators.

The state has lost 7,328 residents who have died from illnesses related to COVID-19 so far. Many more are likely to follow.

Though vaccines could lead the state out of the pandemic, it could be late spring or early summer before enough people have been immunized to get back to something resembling life as it was before the pandemic.

Meanwhile, North Carolina has seen case numbers increase sharply since Thanksgiving.

Similar trends are happening across the country. Thursday saw the first time the national daily death toll topped 4,000 and the Centers for Disease Control and Prevention report that hospitalizations are higher nationwide than they’ve been since the pandemic started.

“The situation is so critical that last week the federal government said that if you are with people that you don’t live with, you should assume you’ve become infected with COVID and you’re a danger to others.”

On Wednesday, Cohen issued her first secretarial directive, directing North Carolinians to take many of the same protective measures called for in the statewide stay-at-home order issued last spring, in the early weeks of the pandemic.

“It calls on North Carolinians to stay home,” Cohen said Friday. “You should only leave home for essential activities such as going to work or school, for health care, to care for family members or to buy food.”

She continued to urge residents older than 65 or at high risk for developing serious illnesses to use delivery services for food and other goods they need in their homes.

“Do not gather with people that do not live with you,” Cohen said. “Do not go to another person’s home indoors and do not have others over to your home indoors.”

Masks, social distancing and sanitizing hands will be part of life through 2021, many public health advocates have said, even for those who have been vaccinated.

More contagious COVID variant likely in NC

“The way this virus spreads is called exponential growth, meaning once you start to increase you actually accelerate that increase,” Cohen said in response to a question about why she thinks the case numbers are surging like they are now. “It’s not a linear acceleration it’s exponential, meaning it gets faster and faster as you get more and more. And I think that is what we are seeing, number one.”

Additionally, Cohen said, people traveled over the holidays and gathered indoors with others despite public health pleas to change those traditions during the pandemic.

And now, throughout the United Kingdom and some states across the country, scientists in labs have detected a new COVID-19 variant, one that appears to be more contagious.

Cohen said that she has not heard reports of that variant being detected in North Carolina, but she and her public health team are acting as if it is already.

Coronaviruses often mutate over time and new variants can sometimes be more virulent or weaker than previously. While the COVID-19 variant detected in the U.K. is seemingly more contagious, there has been no evidence that it causes more severe illness or an increased risk of death, according to the CDC.

“It has been identified in a number of states here. It’s why we are operating as if it’s here,” Cohen said. “We need to realize that this virus was contagious before and now is even more contagious as we go forward.”

National Guard vaccine teams to Forsyth, Albemarle

Earlier this week, Gov. Roy Cooper announced that he had turned to the National Guard for more help during the pandemic. After helping with COVID-19 testing, food banks, moving personal protective equipment and other pandemic supplies across the state, guard members now will help with vaccinations.

North Carolina, like many other states across the country, got off to a slower than anticipated start with immunizations.

More than 180,000 doses of the Pfizer and Moderna vaccines have been given, according to Cohen, and some 20,000 shots administered over the past 24 hours.

The state will begin facilitating large vaccination events next week, Cohen said, and have also brought federally qualified health centers into the mix of facilities that will get doses the state gets as part of a federal allotment.

The National Guard will send teams of six members early next week to Forsyth County and to Albemarle Regional Health Services, a public health agency in the northeastern part of the state that serves eight counties.

Cooper said earlier this week that 50 guard members would be activated to help with the vaccine distribution plan. Teams of six will include two with the expertise to administer vaccines, leaving the other four on the team to help with scheduling, data entry and other tasks.

Mike Sprayberry, state director of Emergency Management, told reporters on Friday that emergency supplies of dry ice are in state warehouses in Tarboro and Badin.

“This dry ice can be requested by hospitals, health departments or medical providers if they are at critical risk of losing valuable vaccine due to loss of ultra-cold storage or unable to obtain dry ice through normal purchasing methods,” Sprayberry said.

The Pfizer vaccine has to be stored in ultra-cold freezers or on dry ice, making distribution more complex for smaller health care centers and hospitals without the deep-freeze equipment that exists at many larger and academic medical centers.

The state has a multi-phased vaccination plan that specifies who is eligible for COVID-19 immunization as vaccine supplies remain limited. Health care workers in intensive care units, emergency rooms, on COVID wards or administering vaccines are first in line, as are residents and workers in long-term care facilities and nursing homes.

COVID-19 vaccine flowchart released by the NC Department of Health and Human Services.

This week, the state opened up eligibility to residents 75 and older, even those without any of the risk factors such as diabetes, chronic respiratory conditions, hypertension and autoimmune diseases.

You can get a vaccine outside your home county

The new eligibility has resulted in many questions from an age group that did not grow up with Google alerts, apps and online agility.

County health departments and hospitals in their region are a good place to start. On Friday, Cohen said residents are not restricted to vaccination events in the county where they live.

“Now we always encourage folks to call close to home first and start there,” Cohen said. “You don’t have to stay in your county, particularly depending on where your home is located, it may be quicker to go to another county or to your local hospital that might be closer, but right over the border of the county.”

announcement about where to find COVID vaccine

Cohen said her public health team has worked to make sure there is access to the vaccines in every single county.

Across the state, county health departments have been running at top speed for the past 10 months, helping to test for COVID-19, trace contacts of people who tested positive for the contagious virus, plus tending to other work they do in years without pandemics.

Cohen said the state wants to help those departments with assistance from emergency management.

“If any of our local health departments need any support, any kind of staffing needs, whether that’s back office help to even do data entry, to do the vaccines themselves, they just need to raise their hand and ask,” Cohen said. “We have the ability to mobilize staff to various counties, depending on what they need.”

Additionally, Cohen said, volunteer vaccinators have stepped up to offer their help.

“Our team has been coordinating with those folks to match them up where the need is,” Cohen said. “That’s why you’re seeing the rate of vaccine going into arms has really picked up. Now that we’re out of the holiday time and we’re able to do that support for our local partners, things have really sped up.”

Vaccine hesitancy in long-term care workforce

Some people eligible to receive the vaccine have stepped out of line, hesitant to accept immunization, especially the workforce in long-term care facilities and nursing homes.

Many of the workers come from historically marginalized communities, where there has been festering skepticism because of systemic racism in past medical research projects.

“We have spent a long time thinking about how to partner with folks in our long-term care settings, with those who are in historically marginalized populations, to make sure we are getting good information out to folks so that they feel confident about taking the vaccine when it is their turn,” Cohen said.

Cohen has said it’s important to hear those concerns and then walk through the reasons why she and trusted leaders in their communities believe that no safety shortcuts were taken to create the vaccines. She and Sprayberry both said they plan to get a shot when it is their turn.

“I think we still need to tease through all this, but I think it’s really important for all of us to make sure we’re getting out good information out about the vaccine, that it is safe, that it’s effective, that it’s been tested. You can’t get COVID from it,” Cohen added. “I think those are really key messages that everyone needs to see.”

Because CVS and Walgreens have a federal contract to administer the vaccines in nursing homes and long-term care facilities, Cohen and her team are not yet privy to all the data they want on that program.

As of Friday, CVS and Walgreens reported that 23,965 doses of the Moderna vaccine had been administered at the long-term care facilities and nursing homes, but there could be a lag in reporting, according to Cohen and the DHHS dashboard. As of Jan. 4, the state had allocated 165,900 doses to the federal program since Dec. 21, according to data provided by DHHS earlier this week.

“We are not yet getting the direct data from the CVS and Walgreens program to the state,” Cohen said. “It goes to the federal government first, because again it is a federal program. But we are hoping to see more of that data.”

UNC-CH delays in-person class schedule

As the state ramps up its vaccine distribution and COVID-19 cases continue to rise, college students are gearing up to start the spring semester in the coming weeks.

On Thursday, UNC-Chapel Hill adjusted its plans for the spring semester, delaying any undergraduate classes that had been planned for in-person instruction until at least Feb. 8.

Chancellor Kevin Guskiewicz issued an update for students, faculty and staff, saying adjustments were being made because of “record COVID-19 cases and hospitalizations in North Carolina and around the country.”

Classes will begin on Jan. 19, as planned. Students who signed up to live in single-occupancy dorm rooms have the option to move in on Jan. 13 or they can delay their return until Feb. 7.

Last semester, UNC-CH welcomed students back on campus in August, with in-person classes planned for undergraduates and residence halls filled with more students than will be allowed in the spring semester.

At a time when the number of COVID-19 cases had leveled off across the state, the Chapel Hill campus and soon other universities reported many clusters of cases in residence halls, fraternity houses and from off-campus parties.

The school quickly reversed course, the first in the country to do so, pushing undergraduate classes to online instruction only and causing many students to move out of residence halls shortly after moving in.

This semester, the campus is launching the Carolina Together Testing Program that applies to students off-campus, too.

Students who have in-person classes, or live in campus housing or in homes with more than 10 people will be subject to mandatory testing two times per week.

Undergraduate students who live off campus in homes with fewer than 10 people who do not have in-person classes must be tested once a week.

Faculty and staff are not required to get regular testing, but if they work on campus they can get tested voluntarily once a week.

Testing will occur at three campus sites seven days a week. All involved in the program can register for appointments and get test results through an app built for that purpose.

Coronavirus by the numbers

According to NCDHHS data, as of Friday afternoon:

  • 7,328 people total in North Carolina have died of coronavirus.
  • 602,774 have been diagnosed with the disease. Of those, 3,960 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.
  • 487,090 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, 7,351,909 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 83 percent of coronavirus deaths in the state.
  • 689 outbreaks are ongoing in group facilities across the state, including nursing homes and correctional and residential care facilities.
  • There are 3,568 ventilators in hospitals across the state and 1,219 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital. As of Wednesday, 736 COVID-19 patients were in intensive care units across the state.

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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.