By Thomas Goldsmith

From New Year’s Day until late June, when the happy summer of a tamer COVID-19 was supposed to be underway, cases of the novel coronavirus among North Carolinians older than 65 fell by about 98 percent.

Then came the Delta variant, with its increased ability to spread infection and cause more serious cases. Now, the trend has reversed.

In full swing by July, the Delta variant created uncertainty and fear among people who had been among the first to receive vaccinations – many of the state’s older residents.

“I’ve started wearing a mask everywhere and many of my friends have as well,” said Sara Quandt, a Winston-Salem resident and a professor at Wake Forest University.

“It’s just a feeling that the atmosphere isn’t as safe as it was. I think those of us who have been vaccinated feel like we are quite safe, but you have no way of knowing who out there has been vaccinated or not.”

Recent state records show an increase in COVID-19 cases among people 65 and older of about 92 percent since July, a faster rate than the 88 percent increase seen among the closely watched 18-24 group. The number of hospitalizations in the older population has gone from 10 or 20 admissions a day in early July to about a hundred every day now. 

Causes for the increases range from the power of the new strain to complacency following vaccine-driven progress against the disease. 

And now, like a recurring nightmare, infections are being brought into long-term care facilities by staff who still haven’t been vaccinated and are not being required to by their employers. 

‘It’s really hard right now’

“It’s a nightmare with staffing,” said Barbara Matchar, director of the Duke Dementia Family Support Program. “Right now not all staff are vaccinated in facilities.” 

She noted that some facilities have made vaccination mandatory. 

“Others have been reluctant to do so because they may lose staff. It’s really hard right now to get direct care when there’s a staffing shortage.” 

State officials say 87 percent of North Carolinians older than 65 are fully vaccinated, compared to 58 percent of the overall population. And Gov. Roy Cooper continues to urge the shots for everyone except young children, for whom the vaccine has yet to be approved. 

“Don’t wait until you and your loved ones are sick, in the hospital or dying to get this vaccine, because then it’s too late,” Cooper told a recent Fayetteville gathering. 

Got a question about Delta? Join us on Thursday morning for Health Care Half Hour, with UNC Health Care infectious disease physician David Wohl when he will answer reader questions. Send your question to

Some people are apparently listening. As July turned into August, the state saw an increase of more than 40 percent in first shots after weeks of declining rates, according to the state COVID-19 dashboard. But still, only 55 percent of eligible people in North Carolina are vaccinated.

Even outside long-term care facilities and the halls of government, COVID-19 remains a looming, unpredictable presence, affecting conversations and routines in homes, businesses, schools and houses of worship. Questions are being asked such as:

  • Should I still wear my mask to the grocery store? 
  • May I ask people their vaccination status?
  • Should the congregation meet in person again, or given our older parishioners, should we keep our worship on Zoom?

Loss of visitors and lives

“I’m a 70-year-old person, and it may be that my immune system is not as good as it was when I was 50,” Quandt said “So, I worry about myself, but also for other people out there who aren’t vaccinated.” 

Nearly 5,600 people have died in North Carolina long-term care centers in the pandemic. The most recent data from the Department of Health and Human Services also showed that 160 COVID outbreaks (that have produced 56 deaths) are ongoing in long-term care as of late this week, one of the continuing pieces of news that contributes to a fearful environment in and outside institutional care.

The change in the nature of the disease meant that residents of nursing homes in some cases could not receive visitors, mirroring the conditions that held sway throughout 2020 and into the early part of this year.

“Their families are pretty horrified, because not only are they worried about their person getting sick, but it also reduces visitation,” Matchar said. “And that’s been really painful.”

Do COVID-19, dementia interact?

The ultimate effects of COVID-19 on people with dementia remain another mystery, but a recent scientific presentation at the Alzheimer’s Association International Conference linked COVID-19 with “persistent cognitive deficits, including the acceleration of Alzheimer’s disease pathology and symptoms.”

In addition to the respiratory and gastrointestinal symptoms that accompany COVID-19, many people with the virus experience short- and/or long-term neuropsychiatric symptoms, including loss of smell and taste, and cognitive and attention deficits, known as “brain fog.” 

Researchers said that neurological problems such as loss of taste and smell and the “brain fog” experienced by many COVID-19 patients should be studied as well as the more common lung and GI symptoms.

“It’s kind of like adding insult to injury, if you already have dementia,” Matchar said. “And then you get COVID and it makes it worse.”

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Thomas Goldsmith worked in daily newspapers for 33 years before joining North Carolina Health News. Goldsmith is a native Tar Heel who attended the UNC-Chapel Hill, and worked at newspapers in Tennessee...