By Anne Blythe

As North Carolina’s COVID-19 vaccination numbers go up, the number of people getting tested for the virus has gone down.

While that could be a sign of hope that virus spread has slowed because of the millions of people who are fully or partially vaccinated in this state, it also troubles public health experts.

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Mark McClellan, founding director of the Margolis Center for Health Policy at Duke University and a former head of the Food and Drug Administration, spoke recently about the COVID-19 variants in this country and the need to identify them quickly to keep ahead of potential case surges.

If fewer people are getting tested, McClellan said, that could lead to a decline in genomic sequencing in labs. That could make it more difficult to identify troubling variants as the virus continually mutates.

“It does make it harder and I am concerned about what’s been a leveling off, or even a downturn in testing,” McClellan said during a recent briefing with reporters. “Some of that we should expect. Fortunately, we’re having a lot fewer cases of COVID.

“But if you look around the country, there are some parts of it where we’re still having pretty high positivity rates, meaning there is a significant amount of COVID out there that we probably aren’t detecting as early and comprehensively as we should.”

Ramping up genomic testing

Mandy Cohen, secretary of the state Department of Health and Human Services, said nearly a week ago that North Carolina sends samples to the Centers for Disease Control and Prevention and is in the process of scaling up genomic testing in the state.

Right now, North Carolina sits in the bottom tier for the amount of testing for variants in the country. The state tests only about four of every thousand tests for COVID variants, such as the U.K. variant which has been found to be more transmissible. In contrast, states such as Maine, Wyoming and Hawaii test more than four of every hundred tests.

“The federal government just put forward a new swath of resources to be able to do that,” Cohen said during a briefing with reporters on March 23. “We do send a large number of our samples to the CDC right now to get sequenced. We know that there’s also sequencing going on among some of our academic research partners so we are working to make sure we can share all that information.”

According to the CDC, North Carolina has sent in 3,736 tests for genetic sequencing.

In The Atlantic this week, UNC-Chapel Hill sociologist Zeynep Tufekci  noted that the most common COVID variant circulating is both more transmissible and more deadly for people who remain unvaccinated.

Rapid COVID tests en route

To stay ahead of the virus, public health officials have been creating new testing programs.

This week, the CDC announced that Pitt County has been chosen as one of the places it plans to launch a community health initiative called “Say Yes! COVID Test.”

The program, which also will be set up in Chattanooga, as well as Hamilton County, Tennessee, will give some 160,000 residents access to free, rapid, antigen tests that they can self-administer, three times per week for a month.

“Reliable and widely available testing is a critical part of our efforts to stop the spread of COVID-19. Regular screening with at-home COVID-19 tests can strengthen our prevention efforts,” Rochelle P. Walensky, the CDC director, said in a statement released March 31. “Combined with efforts to increase vaccinations, this important initiative will help us understand how best to utilize these new at-home tests to reduce viral transmission rates in communities.”

Trying to stave off a fourth surge

Walensky went off script during a White House COVID-19 Response Team press briefing on March 29 and raised her growing concerns about the country passing the 30-million mark for COVID cases.

The number of cases reported across the country had gone up 10 percent over the past week and hospitalizations were up to 4,800 admissions per day from 4,600 per day the prior week.

The country’s death rate has been rising again, too, after trending downward.

“When I first started at CDC about two months ago, I made a promise to you: I would tell you the truth, even if it was not the news we wanted to hear.  Now is one of those times when I have to share the truth and I have to hope and trust you all listen,” Walensky said during the briefing. “I’m going to pause here.  I’m going to lose the script.  And I’m going to reflect on the recurring feeling I have of impending doom.  We have so much to look forward to, so much promise and potential of where we are, and so much reason for hope, but right now I’m scared.”

As states open for more activity, and some drop mask mandates, Walensky called for a renewed commitment to continue social distancing measures as health care providers work to get a larger percentage of the population vaccinated.

The good news is that so many older citizens, who were most likely to die from COVID-19 infections, have been vaccinated. The bad news is that new infections from variants could infect young people. They might not die, but will become susceptible to long-term effects of COVID infections, so-called “long-COVID,” Tufekci noted.

“I’m calling on our elected officials, our faith-based communities, our civic leaders, and our other influencers in communities across the nation, and I’m calling on every single one of you to sound the alarm to carry these messages into your community and your spheres of influence,” Walensky told reporters. “We do not have the luxury of inaction. For the health of our country, we must work together now to prevent a fourth surge.”

Sending out rapid tests

North Carolina has seen an increase in cases over the past week, as well as a rise in hospitalizations. The upward ticks come after Gov. Roy Cooper eased capacity restrictions on restaurants, bars, museums, sporting events and more.

McClellan and others maintain that keeping a focus on testing in the months ahead will be important as public schools open and people start moving about and mingling more than they have for the past year.

North Carolina announced recently that it was partnering with Labcorp to launch a pilot program in which 35,000 free home test collection kits will be distributed to residents who receive food and nutrition services or who are disabled and might have trouble accessing community testing sites.

Through the programs, residents will be able to access a Pixel test.

“What was so hard to do in the past year, we had such a large spread of COVID, we really couldn’t really get ahead of the virus,” McClellan said. “We really couldn’t do containment. Things like contact tracing and the like. What we have much more of now are these tests that can be done rapidly, other types of screening tests like something called pooled lab testing. … That kind of capability more widely is also a very important part of testing going forward.”

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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.