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By Anne Blythe

On Jan. 21, one year ago, the United States reported its first case of COVID-19.

Since then, the novel coronavirus has lost its sense of novelty within a state, country and world where employment, everyday life and typical rites of passage have been obliterated by the contagion.

“As I reflect on one year of being involved in responding to this crisis, it’s been a hard year on every single person, family and community here in North Carolina,” Mandy Cohen, secretary of the state Department of Health and Human Services, said Thursday during a briefing with reporters. “It’s been particularly challenging of course for our team that’s been in a state of emergency for nearly a year at this point.”

North Carolina’s first lab-confirmed case of COVID-19 was reported on March 3 after a Wake County man returned from Washington State where he had been exposed to the virus while visiting a long-term care facility with one of the earliest outbreaks in this country.

Since then, Cohen, her public health team and Gov. Roy Cooper have tried to tamp down the spread of the virus through stay-at-home orders, mask mandates, social distancing recommendations and now with a fledgling statewide vaccination program with limited supplies.

“We recognize the hard work that’s gone on over a year, but it’s not letting up now,” Cohen added. “We want to make sure we are getting vaccines to folks as quickly as possible. We’ll continue to work through that effort until everyone who wants a vaccine can have it, but I encourage caution, everyone, that those vaccine supplies are very limited, so it’s going to take a number of months before vaccines are widely available to everyone.”

As of Thursday, Cohen said, 569,334 total doses of COVID-19 vaccines had been administered, a rollout that put North Carolina 10th in the country in the number of inoculations given, even as the state lags behind some other states in the percentage of doses administered, according to some measures.

Over the past week, the state has seen a rapid increase in the number of doses administered, in part because of large-scale events such as the one set up at the Friday Center on the UNC-Chapel Hill campus by UNC Health.

The first weeks of distribution got off to a bumpy start with some county health departments unable to get all their allotments into arms, raising questions about the timing. Those early weeks also exposed problems with a system that called on county health departments and individual health care systems to establish their own scheduling systems, either through online portals or phone banks that often leave callers waiting and waiting for answers.

On a phone call with all the county health directors Thursday morning, Cohen said she encouraged them to reach out to her department for staffing help, even if all they needed was someone to answer the phones.

Cooperation, vaccine transfers

“Our people resources have always been our most precious commodity through this entire response, whether that was to be able to surge our staffing in our hospitals and respond to COVID or now as we try to make sure we have the staff and capacity to get vaccines out,” Cohen said. “That continues to be a challenge.”

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Cohen’s team has been coordinating with the state Emergency Management team to send extra support to health departments that need help. In addition to calling in National Guard teams to assist, Mike Sprayberry, director of emergency management, said last week that his team was developing a roster of volunteers who have offered their services.

Another improvement to the distribution system, Cohen said, has been the willingness of health departments or systems to shift vaccines they are unable to administer that week to places that can.

“While vaccine might get allocated to one provider, there is a lot of partnership going on at the local level,” Cohen said. “Just yesterday, as one day only, we had 40,000 transfers of vaccine alone from one provider to another.”

Weekly goal is to ‘run out of vaccines’

Each week, the state gets new shipments of vaccines from the federal government on Wednesday, four days after local health departments and hospitals have learned from DHHS what their weekly allocation will be.

“The allocation is one mechanism for us to get the vaccine out,” Cohen said. “But it’s really becoming a very nice partnership in the local areas, where we see the hospitals and local health departments and other providers work together to get that vaccine out.

“We all share that same sense of urgency to get vaccine out to our communities as quickly as possible so I’m really appreciative of those who are willing to transfer and partner to make sure this vaccine is getting out.”

Cohen recommends that anyone eligible for a vaccine, all health care workers along with people 65 and older, call their county health departments or hospitals in their communities as a starting point to find available sites.

While some county health departments complained initially that they were not able to administer all their vaccine allotment as quickly as recommended, some now complain of running low on supplies.

“That is our goal, to run out of vaccines every week before the next shipments come,” Cohen said. “I’m not surprised that they don’t know what they’re getting next week. That’s because they haven’t gotten their allocation yet. We are on a week over week schedule.”

Cohen said her team has tried to forecast coming supplies for local health departments and hospitals so they know how to plan.

“We’ve said what you’re getting now is about what you’re going to get in the future, assuming that you are able to continue getting out that vaccine in a timely manner,” Cohen added. “So we are asking our partners to quote, unquote, ‘run out of first dose vaccines’ and I want to clarify that, first dose vaccines, before their next shipments come.”

Because of how the federal government alerts states about what their allotments will be, the state typically lets local health departments and hospitals know on Friday what to expect in their shipment for the coming Wednesday.

In some counties, people have signed up to receive vaccines at clinics only to find that supplies were exhausted before they got a shot. Cohen and her team have encouraged facilities to move to a system in which they create waitlists for the vaccine instead of having to cancel appointments.

“I would say that when folks report to us that they are running out and they have something that is scheduled already and have appointments we work very hard to see if we can figure out a transfer, meaning that there is vaccine available somewhere else in the state that we might be able to get them,” Cohen said. “That happened two or three times yesterday that I just happened to hear anecdotal stories of. We’re trying very hard to make sure that we are moving vaccine to the places where folks have appointments, but it’s not going to be perfect. We are just figuring out: ‘What is our operational tempo.’”

New president, new plan

On the anniversary of the first COVID-19 case reported in this country, President Joe Biden started his first full day in charge of a federal administration that plans to take a very different approach to fighting the pandemic. This is the week the death toll from the pandemic topped 400,000.

Anthony Fauci, head of infectious diseases at the National Institutes of Health, informed the World Health Organization on Thursday that the United States would remain a member, reversing former President Donald Trump’s decision last year to withdraw from the United Nations’ global health agency.

The United States also will join COVAX, a WHO initiative to make COVID-19 vaccines accessible to all countries around the world, trying to ensure equitable access as wealthier countries continue to take hold of the bulk of the limited supplies available.

Biden posted his 200-page National Strategy for the COVID-19 Response and Pandemic Preparedness on Thursday afternoon to the White House website.

“It is a comprehensive plan that starts with restoring public trust and mounting an aggressive, safe, and effective vaccination campaign,” Biden said in a letter accompanying the new document. “It continues with the steps we know that stop the spread like expanded masking, testing, and social distancing. It’s a plan where the federal government works with states, cities, Tribal communities, and private industry to increase supply and administer testing and the vaccines that will help reopen schools and businesses safely. Equity will also be central to our strategy so that the communities and people being disproportionately infected and killed by the pandemic receive the care they need and deserve.”

Biden plans to ramp up production of vaccines, testing supplies, personal protective equipment and has instructed relevant agencies to use the Defense Production Act if necessary to force manufacturing.

More open lines of communication?

Cohen was asked on Thursday before the release of the Biden plan what she expected from the new administration.

“I want to commend the mask mandate,” Cohen responded. “I know that is limited to federal property, but it very much fits hand in hand to what we’ve been doing here in North Carolina for more than half a year. I think masks are the number one thing we need to continue to do to slow the spread of this virus. We know how this virus spreads. We know that masks work. I applaud the federal leadership. I think that consistent message about masks is going to be really, really critical.”

Cohen added that she “appreciates the broad strokes of where the vaccine planning is going.”

Both Cohen and Cooper have voiced their frustrations with how the Trump administration let them know on short notice each week what their allotments would be for the coming week, and how that created a weekly scramble to decide where they wanted the doses shipped across the state.

 

Other governors across the Southeast also have weighed in, Cohen said, with feedback on how to create a better flow of information between the states, the Centers for Disease Control and Prevention and the federal Department of Health and Human Services.

“Some of the things include just better communication and coordination so we know what allocations are coming to us,” Cohen said. “I’ve already shared feedback on the fact that the CDC data for North Carolina does not reflect the data we are seeing here in the state. You see our own vaccine dashboard shows over half a million vaccinations. CDC does not reflect that. So we just need better coordination and communication of the same information so that we can plan going forward.”

Ninety-nine counties are red or orange

North Carolina’s updated COVID-19 County Alert System map shows the prevalence of the virus across the state. Greene County in the eastern part of the state is the only county of the state’s 100 that does not have “critical” or “substantial” community spread of the virus.

Eighty-six counties are designated as “critical” and 13 counties have substantial spread, even though some of the metrics and trends have leveled out some since two weeks ago, when hospitalizations, daily case counts and the percentage of COVID-19 tests coming back positive were at pandemic highs.

On Thursday, the state reported 7,187 new lab-confirmed cases, 3,666 hospitalizations and 8,339 deaths over the course of the pandemic. Cohen issued a secretarial directive several weeks ago, urging all in North Carolina to stay home except for work, school or essential trips to get food or health care.

Although vaccines are being administered, Cohen stressed the importance of continuing to wear masks and follow social distancing guidelines in the months ahead.

Free rides to vaccine appointments

As more people who are 65 and older in North Carolina have been able to do what it takes to get vaccine appointments and get shots in their arms, Cohen and her public health team remain committed to ensuring equitable access across the state.

They don’t want a lack of transportation to keep someone from receiving a jab.

On Thursday, Cohen and the state Department of Transportation announced that nearly $2.5 million in federal funds for coronavirus relief would go to local transit agencies across the state to help pay for public transit rides for people who need help getting to a vaccine site.

Each agency will receive a sum that can be used until depleted.

Eric Boyette, the state DOT secretary, said on Thursday that his department had estimated that the funds could cover expenses for some 30,000 people at $22 per trip.

“Fighting the COVID-19 pandemic is everybody’s business and every organization has something they can do to help,” Boyette said in a prepared statement.

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Coronavirus by the numbers

According to NCDHHS data, as of Thursday afternoon:

  • 8,339 people total in North Carolina have died of coronavirus.
  • 690,912 have been diagnosed with the disease. Of those, 3,666 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.
  • 521,475 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, 8,171,658 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 (39 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.
  • 751 outbreaks are ongoing in group facilities across the state, including nursing homes and correctional and residential care facilities.
  • As of Thursday, 803 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.