we see hands under a laboratory hood using scientific instruments such as those used for studying coronavirus
A researcher uses a pipette to feed cells with growth medium for immunological studies at a lab in Chapel Hill. Photo credit: Rose Hoban

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We’ve been getting a lot of questions from readers about the novel coronavirus, called COVID-19 and so, we’ve been doing  the research and asking the experts to answer them. We’ll continue updating these questions as more come up and we get  more answers.

Got a question about coronavirus? Click on the CONTACT box in the blue menu above, or leave a message in the comments. We’ll do our best to find an answer.

Q: How does North Carolina’s Coronavirus pandemic compare to other states?

Q: How many North Carolinians have been tested?

Q: How is my county doing compared to other counties?

Q: How many people died of coronavirus in North Carolina?

Q: How many cases are there? 

Q: I’ve been vaccinated. Can I see people indoors, without masks?

Like so many things, the answer among experts was “it depends.” 

“My fear is that after folks get vaccinated, that they’re gonna see it as a ticket to just remove your mask, do whatever you want, and hold mass gatherings,” said Kullar. “But we don’t know [definitively] whether these vaccines prevent transmission.”

Epidemiologists said North Carolinians should continue to practice “the 3Ws” – wearing a mask, washing hands, and watching distance between others – while out in public until most people have been vaccinated.

But what about the grandparent you haven’t seen in a year? 

Robinson said if her parents who have been vaccinated wanted to plan a visit, she’d welcome that.

“But probably what I’ll do is try to still see them outdoors,” she said. “I’ll probably still mask with them indoors. Just to be extra cautious, especially since my kids are at school, and I want to make sure not to pass anything into the school setting.”

There’s some nuance, she said.

“If I have a group of friends who are vaccinated, we might get together in a way that we wouldn’t before,” said Robinson. “I think people can modify behavior, but I think we still need to be cognizant of creating a social norm of masking because of what we don’t know. Because ultimately, a partially vaccinated population can be really dangerous as far as selecting for more infectious variants. The more we can step down transmission while also vaccinating people, the better.”

Smith said for now, it’s better to “hang on” when it comes to wearing masks around others outside your household, even if you’ve been vaccinated.

“At any moment, with the normal way viruses evolve, there could become a variant that is going to have what they call an “escape mutant” – where your own immune response won’t help,” she said. “If that happens and you’re now around other people, you could get sick or they’ll still get sick or vice versa. I think we need to carry on and continue doing all these things until everyone who wants to be vaccinated can.”

In the coming months, she anticipates a gradual rolling back of restrictions as people begin to “test the waters” of larger social gatherings. But right now, it’s still too early for that. 

And even then, she said, “masks will be the last thing to go.”

Q: How long does it take to see the impacts of re-opening the economy on COVID-19 cases in the state?

It can take about two weeks to see shifts in COVID-19 cases, said Zack Moore, state epidemiologist. Two main factors cause the delay, he added. People don’t develop symptoms right away. The virus incubates for roughly a week before symptoms begin. And people may wait several days before they reach out to their doctor.

For that reason, he said, North Carolina’s current test increases reflect the loosening of restrictions that began over the Memorial Day weekend and any increases due to exposure from mass gatherings such as protests will not become apparent right away.

North Carolina first loosened some coronavirus restrictions on May 8 under Phase I of reopening the economy. During that phase, which ended late last month, businesses were allowed to operate at half their capacity, but other establishments, such as bars and restaurants remained closed. The implications of easing of those restrictions further did not bear out in the data until two weeks after. According to NCDHHS’ data, there had been an increase in cases after Phase I began, cases were steadily increasing at about the same rate as right before the restrictions were relaxed.

Q: How does NCDHHS calculate percent positive COVID-19 tests? 

Not all labs who test for COVID-19 report their negative results, Moore said, so when the department calculates the percent of positive, it only uses the results from labs that reported both positive and negative tests.

Moore said that the department is working to make reporting of both positive and negative results mandatory. But in the meantime, including positive results from labs that don’t report their negatives would have the effect of artificially skewing the percent of positive cases upwards.

By only including the labs that report both percent positive and negative results, he said, the department has a better sense of the proportion of positive tests in the state.

Q: I work in environmental services in a large hospital. My job is cleaning patients rooms and discharges. Would it be a good thing for me to take hydroxychloroquine?

There have been several studies underway to look at HCQ effectiveness, we wrote about one being done in health care workers.
We’re looking to update that story to see if the study leaders have been able to recruit health care workers into the study. Even if they were, it would take a very large number of people, more than 20,000, to study it effectively and we don’t know what the study will show. There is a lot of uncertainty.
Recently, there’s been more data coming out showing that HCQ is a problem, leading to more deaths of people who were taking the drug. Also, in recent days, one of the largest studies of the drug was called off because so many of the people in the study had negative effects.
We hope your hospital is providing you with protective equipment and that you wash your hands a lot, and learn proper methods of putting on and taking off protective equipment.

Q: Why not test every nursing home worker? Or every child care worker?

Now, in the end of May, its easier for asymptomatic people to get tested, but still, that needs to happen frequently in order to be completely safe and sure that workers are not bringing COVID into their elder care or child care workplaces, or bringing it home with them.
There are thousands and thousands of these workers around the state and it would be a logistical challenge to test them frequently enough, because this type of testing would need to happen repeatedly. The state is now testing more than 10,000 people on average daily, but it’s still not enough.
There’s also a cost. One national organization that supports nursing homes calculated what it would take to test every long term care worker in North Carolina. That estimate came out at more than $12 million just to test people once.  It takes 3 to 10 days for any symptoms to manifest themselves and during that time, people can pass along the disease. So, the reality is that in order to be completely safe, the state would need to test workers every 3 to 5 days.
This is going to be a long year, with people being forced to choose between their livelihoods and their health. There are ways to reduce risk, like washing hands almost obsessively, covering up faces with masks, etc. It’s going to be really challenging for senior care, or child care, workers to be completely sure they’re not an asymptomatic carrier.

Q: When should I get care for COVID-19?

The USC Gehr Family Center for Health Systems Science and Innovation developed a tool to help you know when you should get care for COVID-19.

Source: USC Gehr Family Center for Health Systems Science and Innovation

Q: I don’t have internet at home, what can I do?

To help those whose internet connection is either unreliable or nonexistent, the North Carolina Department of Information Technology compiled a statewide list of free hotspots.

The map includes library parking lots and businesses who set up hotspots to help people access the internet for free, among other locations.

Q: I have a dental emergency and my dentist’s office is closed, where can I go?

To find dental providers that are open in your area, contact the North Carolina Oral Health Collaboration’s hotline (919) 537-3088 or click on locations in the map below. For more information, visit the collaboration’s website.

Map credit: NC Oral Health Collaboration

Q: Where can I find meals for my kids while school is out?

Various organizations are operating meal feeding sites for children while schools are closed. Parents who are looking for food for their children can  text FOODNC to 877-877 to find free meal sites. The texting service is also available in Spanish by texting COMIDA to 877-877. The locations of all the sites are also listed in the map below. More information is available at No Kid Hungry.

Map Credit:No Kid Hungry NC

Q: What’s the difference between being self-quarantined and being in isolation?

State health director Elizabeth Cuervo Tilson explained the difference between isolation and self-quarantine at a news conference last week.

Isolation is when a person who has been diagnosed with the novel coronavirus, COVID-19, isolates themselves from the rest of society for at least 14 days.

People need to observe quarantine when they’ve been exposed to coronavirus (or another communicable disease) and they need to wait 14 days to see that they do not develop the symptoms of the disease. Both involve people removing themselves from society, but isolation is more stringent. An isolated person should remove themselves from other people in their family by limiting their interactions and staying in a separate room.

Q: My job is slowing down and with it my income. How am I going to pay my bills?

Water utilities for Raleigh, Charlotte, Chapel Hill, Carrboro, Greensboro and New Hanover County have suspended water disconnections for nonpayment of utility bills because of the threat to employment posed by the coronavirus outbreak. Utility officials also likely made the move in an attempt to manage an outbreak which will be largely contained by handwashing and keeping surfaces cleaned that people had access to water.

In addition, Duke Energy and Piedmont Natural Gas announced that they will not disconnect electric and gas customers for nonpayment while the virus continues its spread across the country.

“One of the most important safeguards for our community to prevent the spread of COVID-19 is hand-washing,” Jim Flechtner, executive director of the Cape Fear Public Utility Authority, said in a statement issued March 13. “This small step ensures all of our customers have access to water during this time to keep themselves and their families safe and healthy.” The authority serves New Hanover County.

A spokeswoman for Fayetteville’s Public Works Commission said the commission has not suspended disconnections for nonpayment but is monitoring the situation and “will provide our customer service the flexibility to work with customers as needed.”

[symple_box color=”green” fade_in=”false” float=”center” text_align=”left” width=”85%”]The Raleigh water utility is encouraging customers to avoid paying bills in person and to use alternate payment methods, including by mail, the city’s online portal or by calling 919-996-3245. It is reconnecting water service for customers who were previously disconnected. If service is not reconnected within 24 hours, call 919-996-3245. 

Cape Fear Public Utility Authority customers who have already been disconnected and want to reconnect can call 910-332-6550.[/symple_box]

Duke Energy took to Twitter to make its announcement: “Since many of our customers may be facing unusual financial hardship, we are suspending disconnection for nonpayment effective immediately. This applies to all home and business accounts in Florida, Indiana, Kentucky, North Carolina, Ohio, South Carolina and Tennessee.”

According to the U.S. Environmental Protection Agency, Coronavirus poses little threat to public drinking water.

“The COVID-19 virus has not been detected in drinking-water supplies,” the EPA said in a statement. “Based on current evidence, the risk to water supplies is low. Americans can continue to use and drink water from their tap as usual.”

Q: When are you contagious?

There’s still some uncertainty about when a patient is still contagious, but recent research is providing some insight.

It’s becoming clearer that people tend to be contagious, even before they display symptoms, as one Seattle woman we interviewed recounted.

A study released this past week by German researchers indicates that the virus reproduces rapidly in the upper respiratory tract – nose, throat and pharynx – of infected people early in the course of the disease. In the small group of patients who were tested, the researchers found peak concentrations of the virus present before the fifth day of infection, including days before those patients were actually experiencing symptoms.

The researchers also found that the patients continued to “shed” infectious virus in their sputum during the first week of infection. For patients who went on to have a more serious course of illness, they also had viruses replicating deeper in their lungs.

As people got better in the second week of the disease, there were decreasing, but detectable, amounts of virus in their sputum. By about 14 days after symptoms appeared, patients were no longer producing enough virus to be contagious.

In another study, published on March 10, Chinese researchers looked at news reports and press releases that mentioned the onset of symptoms and found the average time between exposure and illness was five days.

We spoke to a patient from Seattle who believes she was exposed to COVID-19 on Feb. 25 and who developed symptoms on Feb. 28. She was tested the following day, when she was home and feeling achy and feverish. But the day before she felt sick and isolated herself, she had lunch with three other people, now two of them are sick.

Q: Will North Carolina make it easier to virtually see patients?

The N.C. Department of Health and Human Services announced several Medicaid policy changes that, starting Friday, encourage providers to perform home visits, especially for high-risk individuals and those living in group home settings.

The state agency also will reimburse providers for virtual, or telehealth, consultations made via telephone. That includes those who are experiencing mild symptoms of what could be COVID-19 (fever, cough, shortness of breath), along with routine, uncomplicated care where follow-ups are not needed.

Behavioral and mental health visits can also be conducted virtually. State officials are working through details of policy and reimbursement.

Medicaid is a significant provider of health care in the state, nearly 2.2. million North Carolinians, or one in five people in the state, receive benefits through the safety net program designed to provide health care to low-income, seniors, disabled people, children and their families.

Those on Medicaid can also get longer supplies of prescribed medicine. The state did away with a 30-day waiting requirement on prescriptions and allowed prescriptions of up to 90-day supplies of both generic and name-brand medications. Providers are asked to write 90-day prescriptions to limit the number of times a person needs to go to a pharmacy.

[symple_box color=”green” fade_in=”false” float=”center” text_align=”left” width=”85%”]These policies go into effect Friday, click here for more information.[/symple_box]

Medicare, which provides health care for those over 65, covers many telehealth appointments and will cover any expenses related to COVID-19 testing or treatment.

Blue Cross Blue Shield, the largest health care insurance company in North Carolina, announced last week it would cover members’ costs for COVID-19 testing and expand virtual access to doctors.

Q: I keep seeing scary high rates of death with coronavirus. What’s the real risk of dying? 

That’s a good question.

The vast majority of people will have a mild to moderate illness. People who have been diagnosed report feeling “walloped,” others say it’s not much of anything, so there’s obviously a range of reactions to contracting COVID-19.

Scientists in China have done the math on the number of cases where the patient ended up dying and it came out to a terrifying 3.8 percent. But – and there’s a very big BUT in there – that’s because the Chinese were measuring laboratory-confirmed cases.

As of this writing, the World Health Organization says that about just under 4,000 people worldwide died out of more than 113,000 laboratory-confirmed cases, which seems to confirm the Chinese rate.

There’s the reality that there are likely a lot of people who contracted coronavirus and stayed home, felt lousy, and didn’t get their noses or their throats swabbed, thus they weren’t counted in the total number of laboratory-confirmed cases.

According to epidemiologist Jean-Maria Maillard, from the N.C. Department of Health and Human Services, there’s likely a spectrum of illness for people who contract COVID-19. Some have severe infections requiring hospitalizations, but there are many, many folks who never see a doctor.

“All the people who have milder symptoms and either do not consult or does not result in something that leads to testing, they do not get recorded,” he said.

Maillard referred back to elementary school math, where we all learned fractions. If the total number of people with the disease (the denominator, or the bottom number in a fraction) is very large because there are a lot of undiagnosed mild cases of the disease, then the fatality rate could be lower.

Doing the math on what we know about Chinese cases now:

3136 deaths / 80735 total confirmed cases = 3.8% mortality rate

Keep in mind the death rate for seasonal flu is around 0.1 percent.

But in South Korea where they did hundreds of thousands of tests, they have a better count of those mild cases. because they went hunting for them. That country is appearing to have a lower mortality rate, likely because they have a better handle on the denominator:

53 deaths / 7478 total confirmed cases = 0.7% mortality rate

That’s still a death rate that’s seven times the rate for seasonal flu, which remains daunting. But it’s not a rate that’s almost 40 times the seasonal flu.

What we don’t know is how many people had mild forms of the disease (the denominator) in China and we likely will never know. We may just have an estimate when it’s all said and done.

Even Chinese scientists admit that this is the case in a paper published in the Journal of the American Medical Association in late February, where the authors wrote: “The total number of COVID-19 cases is likely higher due to inherent difficulties in identifying and counting mild and asymptomatic cases. Furthermore, the still-insufficient testing capacity for COVID-19 in China means that many suspected and clinically diagnosed cases are not yet counted in the denominator.”

In Seattle, a program created by the Gates Foundation is sending out in-home test kits to people there who think they may have contracted the virus, in an attempt to get a better handle on that elusive denominator. This may give us some important data. – Rose Hoban

Q: So, who’s most at risk from coronavirus? 

The Chinese Center for Disease Control and Prevention has some important information for the rest of us, about who dies from this novel coronavirus, or COVID-19.  They’ve kept track of the identified cases and the people who’ve died and here’s what they found:

Graph courtesy: Michael Mina, M.D., Ph.D./ Harvard T. H. Chan School of Public Health

 

It shows that kids with lab-confirmed cases did well, with a death rate of about twice the rate we see in the annual flu. Any death is too many, but this is a pretty low rate, all things considered.

As patients got into their 30s and 40s and especially their 70s and 80s, the risk of death became much higher. It also notes that people with pre-existing conditions such as diabetes, heart and lung diseases, and cancer were more likely to die.

This puts into context what happened in Seattle, where there have been a lot of deaths, mostly of older people who likely had pre-existing conditions. In other words, older people living in a long-term care facility were sitting ducks for COVID-19.

What that means is that facilities such as these need to be super-duper careful about infection control. The U.S. Centers for Disease Control and Prevention has also that in addition to those over 65 and people living in long-term care facilities, the following groups are at high risk for complications from a COVID-19 infection:

  • People with severe obesity, particularly if they have underlying conditions such as diabetes that are not well controlled.
  • People with chronic lung disease, including moderate to severe asthma
  • People who have heart disease with complications
  • Immune compromised people
  • Pregnant women should be monitored since they are at higher risk for severe viral illness

Q: There are now multiple cases in North Carolina, how much at risk am I?

 Level of risk
 CDC guidelines for assessment
High Living in the same household as, being an intimate partner of, or providing care in a non-healthcare setting (such as a home) for a person with symptomatic laboratory-confirmed COVID-19 infection without using recommended precautions for home care and home isolation.
Medium (assumes no exposures in the high-risk category) • Close contact with a person with symptomatic laboratory-confirmed COVID-19

• On an aircraft, being seated within 6 feet (two meters) of a traveler with symptomatic laboratory-confirmed COVID-19 infection; this distance correlates approximately with 2 seats in each direction

• Living in the same household as, an intimate partner of, or caring for a person in a non-healthcare setting (such as a home) to a person with symptomatic laboratory-confirmed COVID-19 infection while consistently using recommended precautions for home care and home isolation.

Low (assumes no exposures in the high-risk category) Being in the same indoor environment (e.g., a classroom, a hospital waiting room) as a person with symptomatic laboratory-confirmed COVID-19 for a prolonged period of time but not meeting the definition of close contact.
No identifiable risk Interactions with a person with symptomatic laboratory-confirmed COVID-19 infection that do not meet any of the high-, medium- or low-risk conditions above, such as walking by the person or being briefly in the same room.