As NC preps for move to Phase 3, where does state stand on its coronavirus metrics?
North Carolina will move to Phase 3 of its coronavirus reopening Friday evening, the latest move toward a return to normal since the pandemic shut down much of the state in March.
Bars, movie theaters and other entertainment venues are impacted by the easing of restrictions announced by Gov. Roy Cooper on Wednesday. State officials have also loosened restrictions on long-term care facilities, such as nursing homes, and allowed local school districts to bring more students back in recent weeks.
State government and health officials have pointed to specific metrics throughout the pandemic as they’ve made their re-opening decisions. They include trends in new cases, trips to clinics or hospital emergency departments for COVID-like symptoms, hospitalizations and the percentage of tests that are positive.
“Together these four metrics give us a complete picture of where we are,” said Mandy Cohen, secretary of the state’s Department of Health and Human Services.
The state’s first restrictions went into place March 30 with a 30-day stay-at-home order. Phase 2 was originally scheduled to end Aug. 7, but Cooper extended it several times and moved the state to a Phase 2.5, which ends Friday night.
As of Thursday, more than 212,000 people in North Carolina have tested positive for the virus, and more than 3,570 people have died. President Donald Trump and first lady Melania Trump announced early Friday morning that they had tested positive for coronavirus.
“We’re cautiously encouraged about where we are in this pandemic. The key indicators we watch in North Carolina remain mostly stable,” Cooper said Wednesday. “But I have to tell you that we see warning signs that the disease could spike again — here and across the country.”
How did we get here?
Here’s are the state’s COVID-19 numbers at the beginning of each month. Cases, deaths and tests are cumulative since the coronavirus began spreading in North Carolina in early March. Hospitalizations are the number of people hospitalized on a particular day.
April 1: 1,584 cases; 10 deaths; 204 hospitalizations; 26,243 tests
May 1: 10,923 cases; 399 deaths, 547 hospitalizations; 133,832 tests
June 1: 29,263 cases; 898 deaths; 650 hospitalizations; 421,908 tests
July 1: 66,513 cases; 1,373 deaths; 888 hospitalizations; 942,238 tests
Aug. 1: 123,878 cases; 1,964 deaths; 1,133 hospitalizations; 1,786,412 tests
Sept. 1: 169,424 cases; 2,683 deaths; 946 hospitalizations; 2,295,698 tests
Oct: 1: 212,909 cases; 3,579 deaths; 939 hospitalizations; 3,058,541 tests
Here are the benchmarks the state is monitoring as it makes reopening decisions.
Trajectory of COVID-like syndromic cases over 14 days
What it means: North Carolina has a surveillance network that tracks visits to emergency rooms or clinics with COVID-19 symptoms, such as fever, cough, shortness of breath or need for oxygen therapy. It’s not a perfect measure of who has the virus, but it provides an early indication of what might be happening.
“This is our earliest detection mechanism,” Cohen said.
Limitations: It can only measure people who are seeking care. Everyone with symptoms does not seek care, and other measures indicate that fewer people than normal are seeking care during the COVID-19 outbreak. The state releases this information weekly on its COVID-19 dashboard.
Trend: The share of visits with those symptoms initially peaked at above 4% during the week of March 21 and then spiked to above 6% in late July. It has been steadily heading down since and was at its lowest level (less than 4%) since late May before a slight uptick in the last week. This year’s chart looks much different from the previous two flu seasons, when visits spiked in February and then steadily declined.
“The slight increase shows that we are at this fragile time, and we have work to do to keep us on track and keep that viral spread low,” Cohen said.
Trajectory of lab-confirmed cases over 14 days
What it means: The number of people who have tested positive for the coronavirus over the last two weeks. Laboratories must report positive cases to the state.
Limitations: It can take a few days to get lab reports back. Not everyone with COVID-19 symptoms was getting tested early in the pandemic, though the state changed its guidance on that in late April, loosened the criteria further on May 15 — pushing for more people to get tested — and in June dramatically expanded testing. As the number of tests administered per day increases, we would expect this number to also increase.
Trend: Officials want new cases to decline or level out. Cases hit their peak in July and then showed another spike in August, when colleges and university students returned to campuses. Daily cases have dipped since then. In Wednesday’s briefing, Cohen called them “level.” On Thursday, however, the state saw its biggest daily increase since the end of July with more than 2,200 cases.
Positive tests as a percentage of total tests over 14 days
What it means: The total of positive tests each day divided by the number of completed tests. This figure adds context to the raw number of positive tests as testing increases.
North Carolina is calculating this number with information entered into its Electronic Disease Surveillance System to ensure a more accurate daily number. That is slightly different from publicly available data.
Limitations: Again, not everyone is getting tested. Labs are required to report their positive tests to the state, but not their negative results. So we don’t know exactly how many tests have been completed. Cohen has said the state is getting the “vast, vast majority” of completed tests — positive and negative.
Trend: Officials want the percentage to decline or level out at below 5%. The state finally reached that point near the end of September, Cohen said. But the last few days it has crept back up over 6%.
Trajectory of hospitalizations due to COVID-19
What it means: How many people are in the hospital due to the coronavirus at a given time. Hospitals self-report those numbers to the state.
Limitations: The percentage of hospitals reporting to the state each day varies, reaching highs above 90%, but lows in the 70s. The number has gotten more consistent in recent weeks, holding above 90% for three weeks. The figure is a total number, so it’s unclear how many new patients are entering the hospital and how many patients have left. It is also a lagging indicator, trailing infections by a few days or weeks.
Trend: Officials want the numbers to decline or level out. Hospitalizations have leveled off, settling just below 1,000 for the last six weeks. “This trend is level, and we maintain sufficient hospital capacity,” Cohen said.
Tests
When the benchmarks were set, North Carolina had been administering about 2,500 to 3,000 tests per day with the goal of pushing that number to 5,000 to 7,000 per day. The state is now far beyond that and has expanded the criteria for who should get tested.
Status: The state’s overall testing numbers vary greatly from day to day, hitting highs of over 40,000 and lows around 15,000. “We still want to see more testing being done,” Cohen said.
Contact tracing
When someone tests positive for coronavirus — or other diseases that the state wants to track — county health departments follow up with the patients to get more information, including who they have been in contact with.
On April 27, the state announced the Carolina Community Tracing Collaborative, an effort “to hire and train staff to support existing efforts of local health departments to track the transmission of COVID-19.”
Status: The state said more than 1,500 people are working as contact tracers through local health departments. It has hired another 900 contact tracers with an emphasis on serving the Black and Latino populations. More than half of the 900 added tracers are bilingual.
North Carolina also launched a mobile app (SlowCOVIDNC Exposure Notification app) that can let you know if you’ve been in close contact with someone who shared a positive COVID-19 test result in the app, according to DHHS. People who test positive can anonymously share their positive result. Cohen said the app has been downloaded more than 80,000 times.
PPE
North Carolina wants to have a 30-day supply of personal protective equipment or PPE on hand to supply local hospitals in the event of a potential outbreak.
It measures its supply based on the average of requests received during the month.
The state began releasing information about its stockpile of PPE on April 23. It updates that information each Monday.
Status: The state is well stocked with face shields, gloves, gowns, N95 respirators and procedural masks. Cohen said the federal government is now paying for PPE only for health care workers and not for places such as schools.
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This story was originally published October 2, 2020 at 11:12 AM.
