NEW HANOVER COUNTY — As testing increases and social distancing rules relax, Covid-19 cases are on the rise in New Hanover County and North Carolina. The curve is getting steeper — not flatter.
Hospitalizations peaked statewide Monday, with 739 patients hospitalized for the virus and 77% of hospitals reporting data to the state.
New Hanover County Regional Medical Center (NHRMC) has seen a recent increase in Covid-19 hospitalizations, its spokesperson confirmed Monday. The hospital is below 90% capacity as of Monday, with the temporary ability to exceed its licensed occupancy if necessary, per a new state order. It is not clear exactly how many Covid-19 patients are currently hospitalized in New Hanover County.
“We are concerned by any uptick in cases, and with increased testing and easing restrictions we expect the numbers will increase. We continue to closely monitor the situation and remain prepared to respond in the event of a sudden outbreak in our region,” NHRMC spokesperson Julian March wrote in an email Monday.
Week-over-week, cases are creeping up. In just two weeks, New Hanover County logged 110 new Covid-19 positive cases, bringing its total case count to 278 as of Monday. In all, five people have died and 123 have recovered.
The rate of increase has sharply taken a turn upward; after weeks of sitting steady, adding an average of about 2.5 new cases each day, the county has tacked on an average of nine new cases daily since May 28, one week after Governor Roy Cooper’s phase two order took effect.
This represents a nearly threefold increase in the rate of new cases daily when using a consecutive five-day rolling average.
“The data does show that we’re seeing increases in cases,” Lisa Brown, New Hanover County Public Health preparedness coordinator said in an interview Friday.
“There’s a clear trend that’s heading up. And it’s gotten steeper. So I would love to eat those words next week and it’d be leveled off. But I’m afraid that this is a trend that’s going in a direction that we don’t want it to go,” Brown said.
Click to enlarge: The rate of positive Covid-19 cases is on the rise.
At least two things have recently changed: 1) state testing protocol has expanded the eligible pool of close contacts to now include asymptomatic individuals and 2) people are mingling, moving, and generally more relaxed about the virus.
When health officials test more people, they’re bound to find more cases. And when more people resume life as normal, relaxing safety measures previously taken under stay-at-home orders, the risk of spreading the virus rises.
The upward trend makes it more difficult for local health officials to keep track of who is most likely to contract the virus. “Obviously the higher volume of cases that you see — especially in a short amount of time — the more difficult that is to try to maintain and to do quickly,” New Hanover County Personal Health Services Assistant Director Carla Turner said, explaining recent difficulties faced by the county’s contact tracing team.
New Hanover County expanded its testing efforts with a drive-thru station April 29. The county anticipated seeing an increase in positive cases with the expanded testing. County data shows the rate of increase after this site became available did slightly tick up compared to the weeks prior. “Testing doesn’t make cases. Testing just finds cases that are already there,” Brown said.
“We expected to see an increase in cases because we would be testing more. The issue is that that increase has maintained many weeks later and has gotten steeper,” Brown explained.
An earlier campaign to “flatten the curve” really did work, Brown said. But now, with life moving closer to normal and further from previous stay-at-home orders, she said it’s not surprising the virus is spreading.
“As we’re interacting more and people are in contact with other people more, especially if they’re not adopting those three Ws, wearing that mask, It’s not surprising that we would see cases also increase just understanding that is how the virus spreads.”
The wrong direction
Friday, White House Coronavirus Task Force coordinator Dr. Deborah Birx called the state’s Department of Health and Human Services to share concerns about how North Carolina’s key metrics are accelerating in the wrong direction.
Saturday, the state reported its highest number of new positive cases in a single day to date, with 1,370 new cases, bringing the total number of cases to 36,484 as of Monday.
Brunswick County added 27 new positive cases over five days last week, with its total positive case count at 144. The county partially contributed the increase to new state testing guidance that expanded the eligible pool of individuals that should be tested, including asymptomatic close contacts of positive cases. Last week, the county said the increase was “not considered a spike.” Asked whether this assessment is still relevant, county spokesperson Meagan Kascsak explained the county is seeing an increase along with the rest of the state’s counties.
“Brunswick and most surrounding counties have experienced triple-digit percentage increases in positive cases over the past month,” Kascsak said Tuesday morning.
Per capita, Brunswick (12) and New Hanover County’s (11) positive cases are still below the state average (23 per 10,000 residents). Pender County (18) and Columbus County (67) have the highest concentration of cases per capital in southeastern North Carolina.
“It remains hard to quantify to what extent relaxed mitigation efforts have contributed to the increases we are seeing statewide, but single-day case counts, hospitalizations, and the percentage of positive COVID-19 cases have all increased since the state moved into a phased reopening,” Kascsak said.
More than half of all Covid-19 deaths statewide — 1,006 as of Monday — come from nursing homes. Nursing home residents fall in the highest Covid-19 risk category for having adverse outcomes from the virus. Last week, Brunswick County identified its first outbreak in a nursing home in Shallotte and New Hanover County identified its first outbreak in a Murrayville nursing home the week prior. Each has three positive cases and no deaths.
One individual is hospitalized in Brunswick County due to Covid-19 as of Monday. Earlier models predicted a one-in-four chance of the state’s hospital system becoming overwhelmed if stay-at-home orders remained in place and a 50% chance if the orders were lifted. Fortunately, reality turned out to be more positive than the models, with hospitals in North Carolina not nearing their capacity. Novant Health Brunswick Medical Center spokesperson said the downtime was well spent to better equip hospital systems.
“When the coronavirus first hit our communities, the models showed concerning surges in patients and strains on our hospitals. Without stay-at home policies, we were looking to run out of beds, staffing and critical resources like PPE and equipment, costing more lives,” Novant Health spokesperson Kristen Barnhardt wrote in an email Tuesday.
“Novant Health, along with many others, called for stay-at-home policies in order to give our healthcare systems critical time and space necessary to increase our capacity and conserve our PPE while the community helped flatten the curve. With time, investments, and tireless efforts, we feel prepared today to care for both the number of patients with COVID-19 in our communities and patients seeking care for everything else. Understand, today’s models are based on sustained physical distancing and people staying-at-home as much as they can,” according to Barnhardt.
Testing reflects only a small snapshot of how many people in the community are actually Covid-19 positive. When outbreaks arrive in confined spaces, including a Navy ship or jails, the proportion of Covid-19 positive cases in which individuals show no symptoms ranges from 60% to 96%.
Of course, typical life doesn’t resemble a Navy ship, so the risk of infection will not be as high in say, a grocery store. Indoors, close-quarter settings that are conducive to the virus spreading present the greatest risk of contagion. Still, the predominance of documented asymptomatic cases gives rise to the concern surrounding just how many undocumented cases roam freely.
In the general population, the Centers for Disease Control places the percentage of infections that are asymptomatic at 35%. The CDC’s current “best estimate” describes asymptomatic individuals as equally contagious compared to symptomatic cases and its lower-bound estimate at half as contagious. Monday, the World Health Organization claimed asymptomatic individuals with Covid-19 rarely spread the virus, but later walked back its statements, later clarifying that modeling suggests 41% of transmission may be due to asymptomatic individuals.
The confusion arose from the distinction between asymptomatic individuals (those who have the virus and never develop symptoms) and so-called “pre-symptomatic” individuals (those who have contracted the virus and will show symptoms but haven’t yet). Though research is still ongoing, in general, pre-symptomatic individuals are believed to be more contagious than asymptomatic individuals.
Criteria for who can be tested has fluctuated since the pandemic hit as resources become available and experts’ understanding of how the virus spreads evolve. Monday, Secretary of the North Carolina Department of Health and Human Services Dr. Many Cohen urged asymptomatic people who work in high-risk settings without a direct link to Covid-19 positive individuals to get tested — a shift in messaging from months back when testing was reserved for only symptomatic individuals.
But even if all 234,400 New Hanover County residents could feasibly get tested this week, Brown said there would still be blind spots.
“As a practical matter, even if tomorrow, we could go out and test every single person in the county, that only gives us a snapshot of what was going on with those folks at that exact moment. If we tested too early and the virus was still incubating, we might tell them they were negative and two days later they became ill,” she said. “Testing alone is never going to be the solution.”
So what is the solution? The same protocols health experts have been pushing all along, the very ones that a large portion of the public seems to be getting tired of: wear a mask in public, even if you don’t have symptoms; maintain a 6-foot social distance from others; frequently wash your hands.
Author’s note: Stay tuned for part two, which will dive into how and why it’s important to fight ‘covid fatigue’.
Send tips and comments to Johanna Ferebee Still at firstname.lastname@example.org