North Carolina COVID-19 cases surpass 100,000. Experts say it’s just the beginning.
North Carolina surpassed 100,000 COVID-19 cases Monday, a somber milestone that comes roughly 140 days after the pandemic first struck.
The state Department of Health and Human Services reported 101,046 confirmed cases of COVID-19 Monday, along with an updated death toll of 1,642 people.
North Carolina identified its first case of COVID-19 on March 3. Cases crossed 50,000 a month ago on June 20. As of Monday, more than 78,700 people had recovered, according to DHHS.
“One thing that is really important to know is that North Carolina is still really at the beginning of the pandemic,” said Julie Swann, N.C. State University professor and researcher who has worked with the federal Centers for Disease Control and Prevention.
Fewer than 10% of the population has been infected, meaning the other 90% is still susceptible, she said.
How many of those people get COVID-19 between now and a vaccine, which likely won’t be available for mass distribution until at least 2021, directly depends on whether people wear masks and socially distance.
“Everything for the future will depend on what people do,” she said.
If people wear masks and socially distance at a high rate the state could stay pretty close to the same level of cases spread out over a long period of time until the vaccine is ready.
If people don’t wear masks and don’t distance, then North Carolina would end up like other states that have run out of hospital beds, she said.
Lisa Gralinski, an assistant professor at the UNC-Chapel Hill who has studied coronaviruses since 2008, agrees this is just the beginning.
The United States was unprepared, and the virus started spreading before the country had the ability to test and identify patients, she wrote in an email. Now, a record number of new patients is diagnosed multiple days a week.
“We’re struggling to play catch up with our response at a time when school is out and people are able to spend a lot of time outside to help with social distancing,” she wrote. “This makes me really worried about what the coming winter will be like.”
The News & Observer also submitted questions to DHHS, which hadn’t responded by Monday morning.
How has North Carolina done?
Experts said while other countries who implemented robust testing and tracing very early in the spread of disease have been more successful in addressing COVID-19, North Carolina is in a much better position than states like Georgia, Florida and Texas that reopened sooner and resisted restrictions.
“A lot of European countries, New York and the New England states have been really successful in bringing down their case numbers so that they can more easily identify and contain any small new outbreaks,” Gralinski said. “I think the earlier mask mandates made a difference, along with the very slow reopening process. “
Dr. Cameron Wolfe, an infectious disease specialist at Duke University, gave the state’s response a B or a B-minus on an A through F grade scale.
“I would give us a mixed bag,” he said.
North Carolina had some natural advantages in terms of its response to the pandemic, such as it’s a relatively rural state not dependent on mass transit systems.
Cooper very quickly formed committees that involved medical and other experts, Wolfe said.
Triangle counties and cities and the state restricted social activities quickly, he said, slowing the initial spread and giving hospitals time to adjust and prepare.
“Those benefits are still playing out,” he said.
Overall, Gralinski has been impressed by the regular briefings from Gov. Roy Cooper and Dr. Mandy Cohen, the state’s Secretary of the Department Health and Human Services, their transparency with the data and North Carolina’s situation, and the overall respect for the science involved.
“I check the COVID-19 dashboard on the DHHS website daily, and it has a lot of information that is very clearly presented, it’s a great resource,” she said.
Still, Gralinski said, she wishes the state had spent more time in the first phase of the stay-at-home order.
Data driven?
On March 30, Cooper’s stay-at-home order went into effect.
On May 8, North Carolina moved to Phase 1 of its reopening, which allowed most retail businesses to open at limited capacity.
Phase 2 opened on May 22 — the Friday before the Memorial Day holiday weekend — allowing larger gatherings, indoor dining at limited capacity and personal care facilities to open.
Cooper said the phase was more modest than initially expected.
“I think where we have struggled is that we haven’t always followed our own guidelines about data,” Wolfe said.
National guidelines suggested that restrictions should be eased when testing is robust enough to minimize the spread among minimally symptomatic or asymptomatic cases, as well as when communities experienced sustained declines in numbers, Wolfe said.
Testing has ramped up steadily across the state as the pandemic has spread. On Monday, DHHS reported 1,423,888 COVID-19 tests had been performed, up more than 29,000 from Sunday. The rate of positive tests also declined Monday, falling to 7 percent.
But opening too soon, without the right messaging, may have led to the current increases, Wolfe said.
“I think if you go back to May and June, really when we, I think, took the missteps that perhaps led us (and other states) into the current position,” he said.
A position in which the state surpasses 100,000 cases and hospitalization rates are higher than ever, he said.
“You can’t on one hand say we are going to be really data- and analytically driven, and on the other hand just ignore all the data you pull out anyway because it is not the data you want to see,” he said.
Hospitalizations
While cases are expected to increase with more testing, hospitalizations have also been increasing steadily with multiple new records each week.
The number of those in the state hospitalized decreased by 29 people Monday to 1,086. On Friday, the last time the hospitalizations peaked at 1,180, was up 12% from seven days before and 30% since July 1.
On June 24, Cooper extended Phase Two and issued a mask mandate. Last week, Cooper announced Phase Two would stay in place through at least Aug. 7.
Gralinski said she was relieved when the mask mandate went into effect.
“Somehow we’re in a situation where we have a slow but steady rise in cases each week but aren’t seeing the explosive growth of states like Florida, Texas, etc.,” she wrote. “But with (about) 2,000 new cases being diagnosed each day it’s clear that there is a lot of virus spreading around our communities, and there is a real risk that a superspreading event happens and our cases start to go up dramatically.”
Wolfe hopes the current surges across the country give people a wake-up call.
“I am hopeful that people are seeing the cold, hard reality that summer is not going to make this melt away,” he said.
Experts said they don’t believe the data yet reflects the spread of the virus during the July Fourth holiday. It may take a virus weeks to reach someone who is tested or hospitalized, they said.
Gralinski and other experts said testing capabilities as a state are generally good, but it’s generally taking longer for results to come back, which can result in individuals spreading the disease while they wait.
Nursing homes, jails
Swann, who agreed North Carolina had done well with social distancing and face coverings, said state officials need to continue to look at the systems such as the prisons and the nursing homes in making sure they are focusing on testing and isolating in those environments, she said.
In North Carolina, nursing home residents make up almost half of all coronavirus deaths in the state, the latest data show. In late June, the state expanded testing to all nursing homes, even if there aren’t any detected cases, The News & Observer reported. But experts say the universal testing came too late, The N&O reported in July.
There have been 1,966 cases in North Carolina jails and prisons and 31 deaths, as of Thursday.
On July 10, a judge ruled that state prisons were out of compliance with a court order by not providing certain information to the court, while, The Charlotte Observer reported.
A month ago, Wake County Superior Court Judge Vinston Rozier Jr. ruled that conditions in state prisons were likely unconstitutional in light of the COVID-19 pandemic.
The Latino community
As the cases have risen, the virus has hit the Hispanic community disproportionately.
Hispanic residents are less than 10% of the state’s population, but account for 43% of the lab-confirmed COVID-19 cases, according to DHHS.
Ivan Parra, lead organizer with the North Carolina Congress of Latino Organizations, said the state could make improvements by increasing access to testing and better align with community groups, such as Latino churches.
“We are hoping that the state will pay attention to and work with religious leaders,” to do testing and contract tracing, Parra said.
North Carolina announced a new Spanish website focused on coronavirus testing, and the state is opening 300 temporary sites this month for free testing in Black, Latinx and Native American communities.
Parra said there should also be more testing and sharing of information related to meat processing plant employees and for agricultural workers.
“We know the state is trying to do a lot,” Parra said. “We hope there would be a plan that could be public about what they are doing in our community.”
While testing has increased, hitting a record high in the state of more than 35,000 new tests on Saturday, North Carolina is still struggling with ramping up testing and having sufficient supplies, the experts said, as are most states across the nation.
What did you expect?
Wolfe knew it was a possible outcome to end up in the position the state is in now, but said he had hoped they would have more control on the spread of the virus at this point.
“I would not have thought this was likely, nor would I have hoped for anything like this,” he said.
Since March, Swann said, she has known the pandemic would last for months and she has been surprised about the requirements that have gone in place.
“I did not anticipate the U.S. would be willing to do those things,” she said.
The next challenge, experts said, will be convincing younger generations to stay home.
Across the country, the average age for new cases has been dropping, Swann said, which suggests young adults are spreading the disease probably through social interactions.
In North Carolina, people 25 to 49 now account for the highest number of coronavirus cases. Places like Raleigh and Orange County have started enacting rules to cut off when alcohol is served at restaurants to address this.
“And that is so hard to control, because at the end of the day, these are just behaviors and choices made by individuals,” Swann said.
This story was originally published July 20, 2020 at 12:10 PM.