Coronavirus Today – July 16: Hospitalization and incidental COVID-19 cases; Latinos complain of being turned away; Federal change-up and NC impact - North Carolina Health News
Hospitalizations, incidental COVID-19 cases and Data Day
As school districts across the state roll out a variety of plans for how they will greet their students next month, bars, gyms, bowling alleys, large entertainment venues and other businesses that remain closed must wait at least three more weeks to find out when they might be able to reopen.
Gov. Roy Cooper announced earlier this week that his Phase 2 “Safer-At-Home” order, set to expire on Friday, will be extended for three more weeks.
Mandy Cohen, secretary of the state Department of Health and Human Services, pulled out her charts and graphs on Thursday to give a sense of the data behind this decision.
Throughout the pandemic, Cohen culls data collected by the state to update the public on trends and metrics that guide her counsel to the governor.
As she did last week, she issued two red Xes for trends going the wrong way and two yellow cautionary lines.
Emergency departments across the state continue to see a rise in the number of people coming in with symptoms of COVID-19, an indicator that more hospital beds could be needed in the weeks ahead.
The number of lab-confirmed cases also continues to rise. Through the pandemic, there have been 93,426 lab-confirmed cases in North Carolina. On Thursday, the state reported 2,160 new cases from test results sent to their portal in the past 24 hours.
Some labs report results many days after tests were completed so day-over-day results are not always representative of what happened the day before.
North Carolina has increased its testing for COVID-19 and is up to conducting about 25,000 tests per day, Cohen said.
The percentage of tests with positive results has been hovering between 8 and 10 percent, Cohen said, double where public health leaders want it to be to open more businesses.
Because that percentage has remained relatively level and not spiked higher, Cohen assigned a yellow cautionary line to that trend. She noted that states such as Arizona, Florida and Texas where health care systems have become overwhelmed have higher rates of positivity. Earlier this week, Arizona had a positivity rate of 19 percent, Florida had a rate of 18.8 percent, and Texas had a rate of 16.9 percent, with individual cities in those states experiencing even higher rates of positive tests.
Because labs performing testing may take as many as ten days to return information to the state, complete information about lab-confirmed cases information lags behind real time.
Cohen batted back assertions by some that the number of hospitalizations in North Carolina has been artificially inflated by systems reporting every person who tests positive for the virus while in their care even if they are there for some other treatment.
“I keep hearing there are hospitalizations to unrelated surgeries,” Cohen said. “That prevalence is extremely low.”
She encouraged reporters to get in touch with some of the hospitals.
“Particularly in the Charlotte area who I know are seeing a lot of cases of COVID-19 and some folks who are quite sick,” Cohen said. “I’d engage with them in some conversations about what they are seeing within their hospitals because we are seeing a higher burden of COVID-19 patients in our hospitals.”
Cohen stressed that North Carolina is not in the same place as Arizona, Florida, Texas and other states that have had to dial back reopening plans and close bars, gyms and other places that contributed to virus spread, particularly among 18- to 49-year-olds.
“This is not just incidental findings in our hospital,” Cohen said. “These are sick folks who unfortunately are coming into our hospitals that are getting taken care of by some of our doctor, nurse, some other clinician heroes.”
Because North Carolina has not seen the surge that overwhelmed other states and continues to have the capacity to treat more people sick with severe COVID-19 illness, the hospitalization trend drew a yellow cautionary line.
“I think what you are seeing in other states, whether it’s Florida or Texas or Arizona is that hospitals are running out of capacity,” Cohen said. “There are many hospitals who are now on divert, which means they are not taking any new patients. We don’t want to get into that situation.”
Cohen repeated a refrain she often uses on “Data Day.”
“Don’t forget, we have the ability to impact these trends right now, today,” Cohen said. “What happens next largely depends on how each North Carolinians answers three simple questions. Will you wear a face covering? Are you waiting six feet apart? And are you washing your hands frequently? I hope you know the answer should be yes to all those.”— Anne Blythe
Concern over new hospital data reporting system changes
Public health experts and political analysts are scrambling to figure out what drove the abrupt decision this week to halt hospitals from reporting COVID-19 data to the Centers for Disease Control and Prevention.
Now, five months into the pandemic, they have been told to use a new data collection system to send information only to the federal Department of Health and Human Services.
The change came with little to no roll-out warning, prompting multiple concerns and political conspiracy theories, as well as worries that some health care systems are already stretched thin and now have the monumental work required to move from one data entry system to another.
Mandy Cohen, secretary of the state Department of Health and Human Services, said her team will continue to get data from North Carolina hospitals.
However, she raised concerns during a media briefing on Thursday that if the national information her team had been tracking on CDC websites no longer is easily accessible, it will be more difficult to compare what’s happening here to other states.
“This was a very abrupt change,” Cohen said. “I don’t think we got any warning that it was coming.”
The state public health team has checked in with hospital partners, Cohen added, and decided that it would be more reasonable for them to do the direct reporting to the federal government on their own instead of letting the state do it as it had been.
Still the hospitals will report data about how many hospital beds are available as well as intensive care unit capacity to the state. They also automatically report how many people are showing up with COVID-19 symptoms to emergency departments via the NC DETECT system. That number continues to rise as the virus spreads in North Carolina.
Cohen told reporters at the briefing on Thursday afternoon that later this week the DHHS dashboard would start including more hospitalization data that show how different regions of the state are faring in the attack against COVID-19.
Multiple entities have been requesting such data. A consortium of news organizations, including North Carolina Health News, has sued Gov. Roy Cooper and Cohen for the information to better understand how the pandemic is playing out in different regions.
The Charlotte-Mecklenburg County area has had such high hospitalization numbers that Cohen and her team helped the hospitals there coordinate a team response so that if one health care system is starting to become too burdened with patients, another can help with care.
Federal officials have used hospital data to determine how to distribute supplies such as remdesivir, a drug that has proven to be beneficial in treating patients with severe COVID-19 illness.
In a presidential election year, when face masks, data dissection and federal and local response to the pandemic have fueled political rhetoric, some want more data to bolster their arguments. The information that hospitals must now submit to the federal health department could provide an even more granular portrait of the public health crisis.
“Critical decisions that impact the health and safety of the American people are made based on this data, and the physicians, public health officials, and elected leaders making these decisions must be able to trust the data they are seeing is timely, reliable and actionable,” read a statement issued Thursday afternoon by Susan Bailey, president of the American Medical Association. “We urge HHS to be transparent and forthcoming about these changes to hospital reporting for COVID19 infections, so they are understood by all.”
Meanwhile, business and school leaders say that more information would be useful in making their determinations on how to proceed with openings and future planning.
“We went from needing to report 30 data elements to something like 96 data elements overnight,” Cohen said. “That is not something that happens overnight so we are working hard on that.
“I’m disappointed in the way that got rolled out in such an abrupt way. I’m all for data efficiency, but I think we needed a bit more lead time to understand what was needed. I think we all have questions about when that data is now going to the federal government, what visibility will come back. Will they be using that data to be giving all of us the visibility that I know folks want?”
Eventually, the state could assume the role of reporting the information to the federal government.
“We’re hoping that as we can ingest the new requirements from the federal government, we can go back to streamlining that so we can again go back to reporting on behalf of the hospitals and make it more efficient,” Cohen said.
“We will continue to be transparent at the state level, but I think it always helps for us to be able to compare what’s going on in other states and understand where we fit into the national landscape.” — Anne Blythe
Testing, tracing and new information in Spanish
North Carolina has been developing new programs and adopting different strategies in recent weeks to get more help to communities of color that have suffered disproportionately from COVID-19 infections.
The pandemic has exposed disparities in health care access around the globe and highlighted how difficult it can be for marginalized communities to have ready access to testing, contact tracing and information that could make them less vulnerable.
Cardra Burns, senior deputy director for the state Division of Public Health, has been leading a testing effort in North Carolina to ensure that Black and Latino communities, which have been hit harder in this state, are not deprived of an important component of slowing COVID-19 spread because of access barriers.
“When we talk with our communities about barriers around testing, it’s clear we have to put an emphasis on breaking down cost barriers to make sure no one skips a needed test because of financial concerns,” Burns said during a briefing with reporters on Thursday. “All of the community testing events that are a part of our initiative are free.
“I will say that again. Free.”
Through the initiative that Burns leads, there have been 60 pop-up testing events set up for the marginalized communities with some 2,000 tests collected in one week.
Looking for a site near you? Search here by ZIP code.
More are planned for the weeks ahead, with the team trying to set them up not only in places that are easy to access, but trusted places such as churches, recreation centers and even at some farms where migrant workers live in close quarters.
For Latino and Hispanic communities, the state Department of Health and Human Services offers a Spanish version of Check My Symptoms, or Comprobar mis síntomas, that will lead to Find Your Testing Site on the public dashboard.
But Cohen and Viviana Martinez-Bianchi, a Duke physician who has been working with the state public health team to help break down access barriers for Latino residents, acknowledged that there is more to do.
Some immigrant advocates have heard stories about people being turned away from care because they don’t have health insurance or they are worried that they will be asked about their residency status.
“We want to make sure that we have accessible care for everyone who is here in North Carolina,” Cohen said.
“Our hospital systems are already required by law to treat anyone who walks through the doors,” she said, citing EMTALA, the federal law passed in 1986, which requires emergency departments to provide stabilization and treatment.
“They cannot be asking about either insurance status or immigration status in order to treat someone who is right in front of them,” Cohen added. “That should not be happening in any hospitals.”
Cohen added that her team is aware that testing can sometimes be problematic for the uninsured.
“We do know that there are access issues for folks who do not have insurance,” Cohen said. “We know that without insurance that testing can be quite expensive for someone. But we want to make sure that tests are accessible to folks, which is why we are putting those free sites up in ZIP codes that have been impacted by COVID-19, but also we see are historically marginalized communities.”
Martinez-Bianchi said she and others at Latin-19, a discussion group that she and a Duke colleague launched, have been hearing Hispanic and Latino residents complain about being turned away from care.
“We have identified it as an issue of self-advocacy in one way, but also the importance of really figuring out where these cases are happening and how can we inform our hospital organizations, our people working in triage to really not turn people back,” Martinez-Bianchi said in a separate interview with NC Health News.
Martinez-Bianchi often finds herself helping others in health care being cultural interpreters and trying to get across messages that sometimes might be lost in translation.
“We really are trying to understand the magnitude of this situation,” Martinez-Bianchi said. “It is extremely important that we talk together and understand where are these situations happening.”
If it’s an issue of residents from communities of color not knowing how to advocate for themselves in health care systems that push lots of forms at patients seeking care for illness, there needs to be more help, Martinez-Bianchi said.
“That shouldn’t have to be so hard to do,” Martinez-Bianchi said. “Organizations should not put already struggling families, fearful of what is happening with their health, having to explain that they’re really sick enough to be in the hospital. Those are the majority of cases that we’ve heard.” — Anne Blythe
Coronavirus by the numbers
According to NCDHHS data, as of Thursday afternoon:
- 1,588 people total in North Carolina have died of coronavirus.
- 93,426 have been diagnosed with the disease. Of those, 1,134 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.
- 67,124 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.
- To date, 1,284,637 tests have been completed. 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.
- Most of the cases (45 percent) were in people ages 25-49. While 12 percent of the positive diagnoses were in people ages 65 and older, seniors make up 78 percent of coronavirus deaths in the state.
- 283 outbreaks are ongoing in group facilities across the state, including nursing homes, correctional and residential care facilities.
- There are 3,327 ventilators in hospitals across the state and 882 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital.
CMS announces fall school plan
As the number of infections continues to spike in Mecklenburg County, Charlotte-Mecklenburg Schools came up with a fall school plan no one expected. For two weeks, students will rotate through schools for socially distant in-person orientation and teacher interaction. By August 31, all students will move to remote learning. Parents who don’t feel comfortable with an in-person orientation will be able to choose a fully remote option.
CMS is basically implementing Gov. Roy Cooper’s “Plan C” but with a short period of time for students to meet in very small groups to connect with classmates and teachers. An alternate plan to have students rotate through one week of in-person class and two weeks of remote learning failed in a 7-2 vote of the CMS board.
“We’ll be in remote learning mode until the COVID numbers can come down and we can all feel really safe for students and staff to get back into the building,” said CMS board chair Elyse Dashew. “We do not feel confident that for the long term we’re quite there yet.
“It’s a matter of managing the risk.”
Dashew says that while in-person schooling might ultimately prove to be safe, staff and teachers simply aren’t comfortable with that at the moment.
County health director Gibbie Harris told the board that Mecklenburg county doesn’t look like the rest of the state.
“We have higher numbers than anyone else,” Harris said. “That impacts how we take [Gov. Cooper’s] guidance and translate that on the ground. We’ve got to customize it to make sure it works for Mecklenburg County.”
Dashew said the board is working with county health partners to determine a metric to figure out when it will be safe for students to return to school full time. — Melba Newsome
Mecklenburg County will restrict late night alcohol sales
Current state restrictions have closed bars but allow restaurants to remain open, provided their occupancy is at or below 50 percent capacity and customers can stay six feet apart.
Over the weekend, photos and videos circulated showing two popular Charlotte businesses, Explicit Bistro and Ink & Ivy, clearly not abiding by those rules. Both locales were packed to the gills with maskless customers seemingly ignoring social distancing guidelines.
George Dunlap, chairman of the Mecklenburg County commissioners, had seen enough to know he’d seen too much.
“I’ve seen enough videos of businesses that show no concern about the general public and the general welfare,” Dunlap told the Charlotte Observer.
Mecklenburg County will enact a prohibition on alcohol sales after 10 p.m. in unincorporated parts of the county, the city of Charlotte, and in the towns of Davidson, Matthews and Mint Hill. Cornelius, Huntersville and Pineville have not signed on to the measure.
A similar prohibition is already in effect in Orange County.
Proponents of alcohol restrictions say the move will deter overcrowding around bars inside businesses and reduce instances of potential COVID-19 exposure, as drinking alcohol may lower a person’s inhibitions.
The start date hasn’t been confirmed but the restrictions will be in effect as long as North Carolina remains in Phase 2 of reopening which, according to Gov. Roy Cooper, will be until at least August 7. — Melba Newsome
