By Anne Blythe

As North Carolina public health officials continue to urge those not yet vaccinated against COVID-19 to get a shot, plans are in the works to start administering Moderna and Pfizer booster shots this fall.

The highly contagious Delta variant latching onto and clinging tightly to the unvaccinated across North Carolina has pushed the state into one of its most precarious positions since the start of the pandemic 18 months ago.

North Carolina has had more than 1.131 million lab-confirmed cases of COVID-19 since March 2020, and 5,256 of those cases were reported on Wednesday. The rate of COVID tests coming back positive on Wednesday was 13.2 percent, more than double the 5-percent mark that public health officials set as a goal to be at or below.

In late June, the rate of positive tests was as low as 2 percent.

The number of people showing up at emergency departments with COVID symptoms is much higher than it was last year at this time in North Carolina, Mandy Cohen, secretary of the state Department of Health and Human Services, said during a briefing with reporters.

The case numbers and hospitalizations are climbing near to what they were at the peak of the pandemic in January, when vaccines were not widely available to most North Carolinians. Now more than half of those people who are eligible are vaccinated. 

Nonetheless, on Wednesday, 2,930 people were hospitalized with severe illness related to COVID-19, 728 of them in intensive care units, more than 400 of whom were on ventilators.

“Our hospitals are strained and many have limited capacity already,” Cohen said. “Hospitals are managing now by proactively scaling back non-urgent procedures and working with one another to transfer patients so that people get the care they need.

“But this is exactly the situation we’ve been working to avoid. It is imperative that everyone get vaccinated and wear a mask so hospital beds are there for anyone who needs one — whether it’s someone experiencing a heart attack or a car accident victim or someone with COVID-19.”

Now that pharmacies, doctor’s offices, public health centers and more offer vaccines, Cohen and Gov. Roy Cooper tout the shots as the most effective tool to fight the Delta variant and move the state beyond the pandemic.

Although 10 million doses of COVID vaccines have been administered in North Carolina, only 59 percent of the adult population is fully vaccinated.

400 percent risk factor

Unvaccinated people are four times, or 400 percent, more likely to get COVID-19 than fully vaccinated people, Cohen said.

“We are experiencing the fastest acceleration in cases since the pandemic started,” Cohen said. “If cases keep increasing at the current rate, we will pass that January peak in a matter of weeks.”

The state is averaging about 5,000 new COVID cases per day, according to Cohen. The case rates are highest among people 18 to 24, an age group of which only 37 percent are fully vaccinated. The next highest infection rate is for people 24 to 49, another group with lower vaccination rates than public health officials would like to see.

All 100 counties in this state have a high level of community transmission of COVID, according to the most recent Centers for Disease Control and Prevention data tracker map.

“That means everyone in North Carolina should be following the CDC guidance and wearing a mask in indoor public spaces until more people are vaccinated and viral transmission has decreased to at least moderate or low levels,” Cohen said. “All schools should require masks to keep everyone in school for in-person learning.”

Masking in K-12 schools

Cohen and Cooper have been trying to persuade school boards across the state to employ guidelines laid out by public health officials at the state and federal level as children return to elementary, middle and high schools across the state.

Only 30 percent of children ages 12 to 17 are vaccinated, according to Cohen. Those younger than 12 are not eligible for a vaccine, putting them and their families in a position of relying on others to get vaccinated and mask up to protect them.

Last week, in anticipation of all the students congregating again, Cooper, Cohen and Elizabeth Tilson, the DHHS State Health Director and Chief Medical Officer, sent a letter to school boards across North Carolina that had not adopted recommendations in the StrongSchools/NC Public Health Toolkit.

After giving North Carolinians a brief taste of what it was like to put their masks away in the late spring and early summer, public health officials changed their recommendations and urged even the vaccinated to wear masks in indoor public spaces as the Delta variant spread swiftly through the counties.

Though masks became political symbols early in the pandemic, public health officials are urging school boards to take the politics out of their decision-making and encourage the use of face masks, one of the only protections available to children under 12 since vaccines remain out of reach for them.

The toolkit recommends that teachers, students and staff wear face coverings in school even if they are vaccinated.

Since sending the letter out to about half of the state’s 115 public school districts, Cooper and Cohen said some that had previously decided to make masks optional had reversed course and now were requiring them.

“We believe 75 percent of the students are covered by a mask mandate,” Cohen said. “Since sending that letter we believe that 12 or 13 school districts have relooked at this, taken a different vote and decided to go with a mask mandate. I’m grateful for them working with us.”

Cohen said her public health team is working with other school districts and hopes to persuade even more to move toward mask mandates.

In their Aug. 12 letter, Cooper, Cohen and Tilson stated the Delta variant had created an urgent situation.

COVID hospitalizations had more than doubled over a two-week period, cases had increased by 50 percent in just one week and hospitalizations were as high or higher than at the peak of the pandemic this past winter.

“In addition, we are seeing increasing rates of infection in children,” the letter states. “While it is still unclear if the Delta variant causes more severe illness in children than prior variants, we are seeing increasing hospitalizations for pediatric patients. In addition, we are still learning more about the risk of long-term complications in children.”

Though Cooper said he thought such mandates worked better if they were decided at the local level, he did not rule out instituting a statewide mandate if needed.

“You get more effective buy-in when it is done at the local level, and decisions are being made at the local level, particularly now with all of the knowledge that we have,” Cooper said. “I know that Dr. Cohen, Dr. Tilson, a lot of our medical providers have been on the phone with local …boards. They’re educating them on this. They’re becoming more receptive about the need to do this. I think it’s a better way to do it right now.”

Boosters in September

The push to get children safely back in school, with in-person learning, comes as federal public health and medical officials noted that booster shots for the Moderna and Pfizer vaccines will be needed for some not too far into the school year.

Rochelle Walensky, director of the Centers for Disease Control and Prevention,  Janet Woodcock, acting FDA commissioner, Vivek Murthy, the U.S. Surgeon General, Francis Collins, the National Institutes of Health director, Anthony Fauci, chief medical advisor to President Joe Biden and National Institute of Allergy and Infectious Diseases director, Rachel Levine, assistant U.S. Secretary for Health, David Kessler, chief science officer for the COVID-19 Response, and Marcella Nunez-Smith, chair of the COVID-19 Health Equity Task Force, issued the statement.

Their recommendation is based on data gathered over the past nine months for which the shots were available and being administered in this country. 

Nonetheless, the FDA and the CDC’s Advisory Committee on Immunization Practices plan to conduct an independent evaluation on the safety and effectiveness of a third dose.

The Biden administration is prepared to offer booster shots for all Americans beginning the week of Sept. 20 and starting eight months after an individual’s second dose, according to the statement.

“At that time, the individuals who were fully vaccinated earliest in the vaccination rollout, including many health care providers, nursing home residents, and other seniors, will likely be eligible for a booster,” the medical and public health advisers stated. “We would also begin efforts to deliver booster shots directly to residents of long-term care facilities at that time, given the distribution of vaccines to this population early in the vaccine rollout and the continued increased risk that COVID-19 poses to them.”

Because there is not as much data available yet from the Johnson & Johnson vaccine, which was not widely available until March, the physicians and public health officials have stopped short of recommending a booster at this time, but say they expect an additional jab will be needed as well.

“[W]e expect more data on J&J in the next few weeks,” they said in their statement. “With those data in hand, we will keep the public informed with a timely plan for J&J booster shots as well.”

The physicians and scientists stressed that vaccines remain the most effective tool to prevent severe illness and death.

“We also want to emphasize the ongoing urgency of vaccinating the unvaccinated in the U.S. and around the world,” they stated. “Nearly all the cases of severe disease, hospitalization, and death continue to occur among those not yet vaccinated at all. We will continue to ramp up efforts to increase vaccinations here at home and to ensure people have accurate information about vaccines from trusted sources.”

Big rewards for vaccinated

Two vaccinated North Carolinians reaped extra reward for protecting themselves and others from COVID-19 by getting a shot.

Cooper announced on Wednesday that Lilly Fowler, an East Bend resident and senior at N.C. State University, received a $1 million prize as the state’s final Your Shot at A Million Summer Cash Drawing winner.

Breelyn Dean, a 15-year-old and soon-to-be high school sophomore from Garner, won a $125,000 scholarship toward a college education.

“I chose to get vaccinated because I was transferring from an early college, and last year, junior year of college, I wasn’t able to live in Raleigh, but now I’m in my senior year at State, I’m in Raleigh, it’s a bigger city, more risks and I decided it was time for me to get vaccinated,” Fowler told Cooper when asked why she got a vaccine. 

Fowler said she’s “pretty frugal” and probably will invest her prize money and wait to use it when she’s ready to buy a house. She might use some of the money, she said, to take her young cousin, a fan of Elsa and Mickey Mouse, to Disney World.

Dean said she has her eye set on UNC-Chapel Hill, where she hopes to spend her scholarship money.

“I chose to get vaccinated because it will protect me, my family and others around me to prevent any other spread of the virus,” Dean said.

Shots available for immunocompromised

The announcements on Wednesday come several days after state DHHS officials reported that North Carolinians with severely or moderately compromised immune systems are eligible for an extra dose of the Moderna or Pfizer vaccines.

The federal Food and Drug Administration amended the authorizations for emergency use of both vaccines on Aug. 12 to allow for an additional dose in certain immunocompromised populations. The agency cited organ transplant recipients as people in that category and others in similar situations.

Additionally, the FDA recommended that organ transplant recipients who contract COVID should discuss monoclonal antibodies as a treatment possibility with their physicians.

People should use the same vaccine brand for which they received their first two doses if possible, health care providers say, and wait at least 28 days after receiving a second dose to receive the third.

On Monday, the state issued similar guidance.

“This additional dose will offer valuable protection to those who need it, especially as we face a surge in COVID-19 cases due to the Delta variant,” Tilson, NCDHHS State Health Director and Chief Medical Officer, said in a statement released Monday. “I encourage those who are eligible to get this additional dose. In addition, if you are not fully vaccinated, please do so now to protect yourself and others – like those who are immunocompromised – from severe illness, hospitalization and death from COVID-19.”

Precaution in freshwater ponds

As COVID surges across the state, public health officials cautioned North Carolinians to remain vigilant against another fatal threat.

A child became ill and died last week from a rare brain infection caused by an amoeba that is present naturally in freshwater ponds.

The amoeba, Naegleria fowleri, can cause illness if forced up the nose, for example, when someone is diving or jumping into the water or taking it in while water-skiing or other activity.

Swallowing the amoeba does not cause illness, according to health care providers.

The child who died had been swimming in a pond in central North Carolina. No other details of the specific incident were provided. The last incident in North Carolina was in 2016 after a visitor to the U.S. Whitewater Center in Charlotte contracted the amoeba. 

Symptoms associated with the rare brain infection, primary amebic meningoencephalitis, or PAM, include a severe headache, fever, nausea, vomiting with progression toward a stiff neck, seizures and comas.

The amoeba grows best in high water temperatures after prolonged periods of high heat, as well as in ponds and other bodies of freshwater likely at low water levels.

“Our heart-felt condolences and sympathies are with the family and friends of this child,” Zack Moore, the state epidemiologist, said in a statement announcing the death. “Although these infections are very rare, this is an important reminder that this amoeba is present in North Carolina and that there are actions people can take to reduce their risk of infection when swimming in the summer.”

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