Coronavirus Today – Oct. 21 – Paused in Phase 3; Counties asked to toughen COVID restrictions; Promising treatment underperforms; Veterans’ home outbreaks - North Carolina Health News
By Anne Blythe, Hannah Critchfield and Thomas Goldsmith
On a day that North Carolina’s COVID-19 death toll topped the 4,000 mark and the number of people hospitalized with illness related to the novel coronavirus is the second highest in the pandemic, Gov. Roy Cooper hit the pause on any further reopening.
North Carolina public health officials reported that 4,032 people have died from illness related to COVID-19 and that 1,219 people are in the hospital because of the virus.
The number of cases in this state also passed the quarter-million mark with 250,592 lab-confirmed cases of the virus leading to even more cases of pandemic fatigue.
“As this pandemic continues, I know that it’s tiring and difficult to keep up our guard, especially when we’re gathered with people we love,” Cooper said Wednesday during a briefing with reporters. “But it’s necessary. No one wants to spread COVID-19 accidentally to friends or family. So we must keep prevention at the forefront. Wearing a mask shows that you care about people. It’s more for them than for you. Wearing a mask is an easy way to protect our communities and to look out for each other. Confronting the virus head on and doing our part as individuals is good for our health and it’s good for our economy.”
Despite the pleas throughout the pandemic for mask use, some in North Carolina continue to ignore them, frustrating those who embrace the idea as a necessary measure to slow the spread of COVID-19 and live with the virus more safely as the pandemic continues.
Seeking help from high-transmission counties
On Tuesday, in an effort to reverse disease trends that have been getting worse, the state Department of Health and Human Services and the state Department of Public Safety sent a letter to county managers and chairs of their elected boards asking for help in counties that have:
- Had 300 or more new cases over the past 14 days;
- Been identified by the White House COVID-19 Task Force as a county of concern;
- A rate of cases that is greater than 50 per 10,000 people; or
- One of the three most populous in the state.
Letters went to Alamance, Avery, Burke, Caldwell, Caswell, Catawba, Chowan, Cleveland, Craven, Cumberland, Davidson, Duplin, Edgecombe, Gaston, Graham, Greene, Guilford, Hoke, Hyde, Johnston, Lincoln, Mecklenburg, Moore, Nash, New Hanover, Onslow, Pitt, Randolph, Robeson, Rockingham, Rowan, Scotland, Union, Wake, Watauga and Wayne counties.
Mandy Cohen, the DHHS secretary, discussed this possible approach a week ago during a briefing with reporters in which she was asked about New York Gov. Andrew Cuomo’s decision to close down schools, restaurants, synagogues and churches in some New York City neighborhoods where COVID-19 cases were on a rapid rise.
The letter suggests that some counties might want to adopt ordinances of their own that are stricter than the statewide thresholds set in Cooper’s executive orders.
Under those orders, criminal citations may be issued to people not following the rules. County ordinances can impose civil penalties, such as fines that won’t result in criminal records, for people who blatantly violate measures intended to protect the public’s health.
Early in the pandemic, some counties and cities set curfews and ordered face coverings in public before statewide measures were in place.
Cooper and Cohen have suggested such actions to help tamp down hotspots where health care systems are beginning to feel strained.
Dan Forest, the Republican lieutenant governor running against Cooper, a Democrat seeking re-election, quickly criticized the request to the 36 counties in a post to Twitter.
The memo in the tweet begins: “Is Gov. Cooper Trying to Continue His Shutdown of NC by Passing the Buck on His Responsibility?”
“To put it bluntly: Governor Cooper is attempting to use local governments to punish individuals doing what they can to survive,” the memo states. “He has repeatedly said he has full authority over his COVID shutdown, which means he also gets 100 percent of the responsibility. Passing the buck to local businesses and municipalities is the antithesis of leadership.”
Forest, who has held rallies indoors and outdoors with attendees not wearing masks or social distancing, has said he would rescind the mask order if elected.
Cooper was asked about Forest’s response during the briefing with reporters.
“What we’re doing now in working with local governments to slow the spread of the virus is no different from how we started this thing back in March and April and June,” Cooper said. “We set a floor with statewide restrictions, but at that time we also encouraged local governments, that if they were seeing more viral spread in their community, and it worked better in their community, they could use restrictions that were greater than the state floor. And a number of our cities across the state did that and it helped us to slow the spread of the virus.”
Who will enforce the orders?
There have been times during the pandemic that local law enforcement officers in some counties have refused to or been reluctant to enforce the restrictions in Cooper’s statewide executive orders.
In June, the sheriff in Alamance County, one of the counties that received this week’s letter, refused to enforce Phase 2 restrictions when ACE Speedway held events with crowds larger than what was allowed under the statewide order.
The Halifax County sheriff said in June that his deputies would not enforce the face mask order, but reversed course this month, WRAL’s Lena Tillett recently reported, after six deputies in the department fell ill with COVID.
“A lot has happened since June,” Halifax Sheriff Wes Tripp told WRAL. “It is not a hoax.”
“More and more law enforcement across the state are beginning to recognize that it is important for them to play a role in enforcement, even if it is an informal one going and talking to people and being leaders in the community,” Cooper said, citing Tripp’s change of direction.
Health departments have enforcement power, too
Additionally, local health departments and DHHS have authority under public health laws to enforce safety precautions and make sure the state is “sending the signal that is serious and that we have to slow the spread of the virus,” Cooper said.
“I’m feeling more confident that we can enforce what we have to be able to drive down our numbers,” Cooper said. “It really takes people working together, but I think more people are recognizing that it’s important for us to do that.”
Cooper’s order puts much of the onus on retail establishments to make sure people in the restaurants, grocery stores or other shops are following the mask requirements and other social distancing measures put forth.
“Our health departments and our department of Health and Human Services also have the authority under the abatement provisions. … That already has been used in some circumstances and we anticipate that is going to be used more in the coming days, particularly working with local health department,” Cooper said.
The state health department used that process in June to halt ACE Speedway gathering held in defiance of statewide orders.
In her metrics and trends presentation on Wednesday, Cohen noted a bit of good news in that the number of people showing up in emergency departments over the past week with COVID-19 symptoms had started to decline.
But the number of cases is much higher than she or the governor would like to see and the rate of people showing up for COVID-19 tests and testing positive has crept up beyond the 5-percent mark.
Contact tracing is not working as well as Cohen would like to see either. Some people do not pick up their phones. Others are not forthcoming with information about who they have been around when reached by a tracer.
With a united front, this, too, shall pass
“This has been a really hard year. I understand how much everyone wants to be with family and friends without having to worry about a virus,” Cohen said. “We miss the people we love and the places that bring us joy or provide comfort. I haven’t seen my parents in person and I miss seeing them play with my girls. And I’m sad that I’ve never met my new baby niece.”
Over the past two weeks, public health officials have seen an increase in COVID-19 clusters in social gatherings, events such as informal get-togethers, family gatherings and parties.
Additionally there have been more cases in clusters from religious gatherings. The state recently posted new guidance for private social gatherings that includes mask wearing when with anybody not from your own household and setting up tables and chairs outside well distanced.
“Look, we’re doing everything we can to slow the spread of this virus,” Cohen continued. “The simple fact is we can’t do it on our own. Ignoring the virus does not make it go away, just the opposite.”
Cohen assured people that there will be a day when the virus is not at the forefront, but there is much work to be done in the months ahead.
“As hard as this is, it will end,” Cohen said. “We will get through this. Let’s do it by looking out for one another.”
Studies cast doubts over once-hailed COVID-19 treatment
Three new studies of a previously promising therapy for patients with COVID-19 have once again complicated the coronavirus treatment narrative.
Tocilizumab, an antibody drug commonly used to treat inflammatory arthritis, was hailed as a possible treatment for COVID-19 pneumonia early on in the pandemic. Observational studies, first in China and then elsewhere, initially suggested the immunosuppressive drug could alleviate the hyperinflammation that often accompanies severe illness from the virus, leading to a “mortality benefit” — a difference in death between treated and untreated patients.
“As a result of those studies, tocilizumab use became fairly widespread in the United States and other sites,” said Jonathan Parr, a professor of infectious diseases at the University of North Carolina School of Medicine and author of a JAMA article on the impact of the new studies. “We at UNC initially used tocilizumab for a small number of patients, but then significantly scaled back our use when we realized that we weren’t seeing the same types of clinical courses that had been described in the original study.”
Those early observations were limited to a small number of patients; guidelines from organizations such as the National Institutes of Health now recommend against prescribing tocilizumab except in clinical trials.
Three articles on more comprehensive studies, all released yesterday, present mixed results about the drug.
One, a large observational study of tocilizumab in COVID-19 involving about 4,000 people, found that individuals treated with the drug were less likely to die than those who were not (a mortality rate of 28 percent vs. 37 percent).
But the other two, which were randomized studies — considered the gold standard for trials assessing the efficacy of a treatment — found no difference in mortality between COVID-19 patients treated with the drug and those that were not.
“Whenever we are forced to make hard decisions about whether to use an off-label treatment, or an unproven treatment, we always need to give priority to the randomized trial results,” said Parr.
Based on the available evidence, Parr said he doesn’t plan to use tocilizumab for COVID-19 pneumonia in his clinical practice.
“Unless new results come out from randomized trials that tell a different story,” he said. “Which is possible.”
More studies of the impact of the drug in treating COVID-19 infection are slated to be released in the coming weeks and months.
“But until we have those results, it’s difficult to say,” Parr added. “For me personally, it’s hard to justify the use of an expensive, unproven treatment option when the randomized trial data that we have now doesn’t support its use.” – Hannah Critchfield
Two new COVID outbreaks in privately managed state veterans nursing homes
The N.C. State Veterans Home in Salisbury, where 15 residents died of the disease earlier this year, has five new cases, according to DHHS. The State Veterans Home in Kinston, with one previous veteran’s COVID-related death in 2020, has four new cases. Both are classified under a definition that defines an outbreak as being two or more cases.
As previously reported in NC Health News, in the four Pruitt-run veterans nursing homes in the state, 36 residents have died during the pandemic. Attempts to reach Pruitt officials for comment Wednesday were unsuccessful.
PruittHealth officials have said they will request an annual renewal this year of their long-term contract to manage the four NC state veterans nursing homes for a 9.25 percent commission. A renewed contract would also put the company in charge of two additional veterans nursing homes in the planning stages.
Gov. Roy Cooper’s administration has said it will reexamine the contract before a planned Dec. 1 contract renewal. – Thomas Goldsmith
Coronavirus by the numbers
According to NCDHHS data, as of Wednesday afternoon:
- 4,032 people total in North Carolina have died of coronavirus.
- 250,592 have been diagnosed with the disease. Of those, 1,219 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.
- 218,541 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, 3,668,243 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 (40 percent). While 13 percent of the positive diagnoses were in people ages 65 and older, seniors make up 81 percent of coronavirus deaths in the state.
- 352 outbreaks are ongoing in group facilities across the state, including nursing homes and correctional and residential care facilities.
- There are 3,442 ventilators in hospitals across the state and 927 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital. As of Tuesday, 308 suspected COVID-19 cases were in intensive care units across the state.