Thursday, June 20, 2024

Q&A: New Hanover health official talks leveling the Covid curve, accelerating vaccinations, possible spring-break spikes

Public health nurses stand outside a tent set up last summer by the county to test residents for Covid-19. (Port City Daily/Mark Darrough)

NEW HANOVER COUNTY — It’s been over a year since Governor Roy Cooper’s first major Covid-19 restrictions went into effect. Back then, New Hanover County tracked 34 cases by the end of March 2020. Fast forward to March 2021, and over 17,000 have been confirmed in the county over the last 12 months.

According to New Hanover Interim Health Director David Howard, the amount of positive cases recorded over the past month-and-a-half is slowing. The county is now averaging around 50 Covid-19 cases per day over the last 15 days. If it continues on this pace throughout March – along with increased vaccinations of people in groups 1 through 4 – it could result in a continued leveling of the curve.

On Friday, Port City Daily interviewed Howard and county spokesperson Jessica Loeper to get a better understanding of what this trend could mean for the county’s response to the pandemic.

Howard said demand and a “sense of urgency around the vaccine” is on the rise. Particularly, there has been significant public interest to get the one-shot Johnson and Johnson vaccine. 

“We’ve seen strong demand [for vaccines] while some of the other counties have seen softer demand,” Howard said.

To date, 37,903 residents (16.2% of the county’s population) have been fully vaccinated, while 53,712 residents (22.9%) have been partially vaccinated.

Though the vaccination rollout is gaining speed and efficiency in New Hanover, Howard said he is still concerned about another potential spike. Specifically, many college students have travelled or plan to travel for spring break, although many colleges have canceled the break.

“[U]ltimately, I think in the public’s mind, a lot of those young folks don’t see it as a great risk,” Howard said, “because they have not heard that a lot of their friends are in the hospital or are passing away.”

He points to the reality that the threat comes two, three, or more transmissions later when Covid-19 spreads to an elderly person or someone with a compromised immune system.

As the county continues to ramp up vaccination efforts, Loeper said that she hopes by sometime next week, it will also begin facilitating further testing that will be carried out by the state’s contracted provider, Optum Health, to host more Covid-19 testing operations.

Howard and Loeper run down these and other issues in more detail in the following interview, which has been slightly edited and condensed.

The total number of cases reported by the county at the end of each month, dating back to the first 34 reported cases in March. (Port City Daily/Created with data provided by New Hanover County)

Leveling the curve, but not close to herd immunity

Port City Daily (PCD): We noticed if the current pace plays out – 50 cases per day from March 1-15 – it would show a slight leveling of the curve at the end of the month. Is that what you guys are seeing too?

David Howard (DH): Yeah, if you graph this out, you’ll see in the past month-and-a-half that the line is leveling, in terms of cases per day and cases per week. We’re seeing that across the state and in most of the country, which is encouraging. We can’t predict that that’s going to continue, though.

We have several variables and factors affecting what’s going on in terms of the vaccination campaign, including mitigation measures at various levels and the activity of individuals. As people travel across states, whether it be for business or pleasure, we’re going to return to some of that same environment we saw way back last spring before these mitigation measures were put in place, in terms of travel restrictions, stay-at-home orders, schools going fully virtual, and all of those measures. So it’s very hard to protect.

I think we are encouraged by some of the factors — mitigation in combination with vaccines — have absolutely contributed to decrease cases. In reality, the first three groups have been protective of our population. So healthcare and long-term care of staff and residents, initially, then we moved into the elderly population who are most at risk for serious illness, hospitalization and passing away. Very protective measures there: 75 and older, then 65 and older.

And we hit really strong numbers locally and across the state of North Carolina, which is highly ranked across the country in terms of those efforts. And then as we moved into the central workforce, we were protecting very important societal functions: our educational system, our very important workers. You have to keep things running that everybody depends on — utilities and all those kinds of things. 

So it’s been very protective to this date. The one concern we do have is: The vast majority of the population is still not vaccinated [about 77%]. So all those people who were typically very active — at work, socially, etc. — most of those are still not vaccinated. That’s why the governor and most experts are saying we still need to continue mitigation measures: face coverings, keeping our distance, staying away from large crowds if we can. 

So what we’re seeing is a good effect from vaccinations and measures to date, but we’re still only about 16% fully vaccinated for the county.

[Author’s note: The state’s numbers for New Hanover as of Saturday, March 20 were 16.2% fully vaccinated and 22.9% partially vaccinated.]

So, although we’ve had good effects, we’re still not to the point where we have anything close to community-wide herd immunity.

PCD: And when do you expect to reach that level?

DH: So on the calendar it’s tough to say. What’s happening nationally and across the state is: Things are changing, in terms of demand and a sense of urgency around the vaccine, and the disease itself. Now we have three vaccines, and the most recent — the Johnson and Johnson vaccine — is a one-dose. We’ve heard from other counties in the state, and we’ve seen a little bit of it here, significant interest from the public to get that vaccine. 

We call it “brand shopping.” So, as we go through this year, we’ll be looking to educate and motivate as much as meet demand. So it’s going to be a parallel workflow for us going forward. As we move through the groups, we see high demand from those early adopters — those folks who are eager to get vaccinated. Then some of the groups are not so eager; they’re willing to wait and see. 

So we’ve seen strong demand while some of the counties have seen softer demand. The state is working very hard to balance the system, and it’s a challenge for us. It’s clearly a challenge for all providers to plan every single week — we make a plan for everything we’re getting, and we put that plan out.

We’ve experienced a few no-shows and some cancellations, partially, because there are more providers in the area, which is great. But it’s a challenge for all of us to reconfigure plans every single week, sometimes more than once, simply to run this operation.

The total number of Covid-19 deaths reported by the county at the end of each month, dating back to the first 2 reported deaths in March. (Port City Daily/Created with data provided by New Hanover County)

November-January spike

PCD: From our graph, it looks like the number of cases and deaths really spiked between November and January. Can you explain that? Did it follow state and national trends? Was there anything specific to what happened in our county?

DH: So, in a general sense, what we are attributing that to is the for-pleasure, business, and family-related travel and gatherings, beginning with Thanksgiving. And to whatever extent it was happening, shopping activity leading into the Thanksgiving holiday and through Christmas, and other holidays. All that activity, plus students returning and coming back at institutions of higher learning, all of that mobility creates an opportunity for transmission. 

And so that’s where we saw a spike in cases and in deaths. Looking at the graphs, they’re almost mirror images of the cases going up and the deaths going up.

Unfortunately, at least here locally, 90% of people who passed away have been 65 and older, and with at least one or two chronic conditions, which put them at a high risk for complications from the virus illness.

Concerns of another spike

PCD: Are you concerned at all with spring break, and people coming to Wrightsville Beach and Carolina Beach, and things of that nature?

DH: Yeah, to some degree. I think a lot of institutions of higher learning have tried to bypass spring break — in other words, schedule it out of their calendars. Students are taking breaks anyway. We are concerned about that, but most of the vaccination efforts and a lot of our mitigation efforts are around protecting those who are most vulnerable. 

So, as we open back up to some degree, we are concerned that 65-and-over and those with chronic conditions are going to attempt to re-enter normal activities and encounter some of those students, some of those young people, some of those workforce employees who are not taking many precautions anymore, and possibly passing the virus to them. 

It’s not simply the fact that people are taking a break. If someone goes somewhere where they don’t see anybody else, and they’re just taking a break for their own mental health, that’s one thing. But the the issue of many people from many different states and schools gathering together in one place, and then going back home, that is very concerning. That could cause a spike. And, ultimately, I think in the public’s mind, a lot of those young folks don’t see it as a great risk because they have not heard that a lot of their friends are in the hospital or are passing away.

The threat is down the road. Those two-three-six transmissions down the road that reaches an elderly person with chronic conditions — that they never know. And we’re trying to educate around that. But it can be tough.

Carolina Beach was packed with thousands of visitors on March 20 as town councilmembers voted to close all beach accesses. (Port City Daily photo/Mark Darrough)

Transition from testing to vaccination rollout

PCD: Communications Coordinator Kate Oelslager noted in an email to Port City Daily at the beginning of January that the county was not focusing on testing and all resources were going toward vaccines. How has the focus on vaccinations versus getting tested impacted your department?

Jessica Loeper (JL): Let me clarify that a touch: Back in 2020, we ran multiple testing sites; we ran a testing site every single week. We did mass testing sites through public health. Starting December 22, we had to really pivot, and the logistics, the staffing of those mass-testing sites transitioned to mass vaccination with our public health team. So our emphasis on testing didn’t change; we still encourage people to be tested. I think at that point, though, just as we hope will happen with the vaccination effort, there are other providers in the community offering free and easy testing. 

After testing started in the summer, we began ramping up our testing efforts, specifically, because there really weren’t any resources in the community to go and get tested; that was really limited. We’re seeing a lot of providers now able to provide that testing. Almost every medic has it; a lot of doctors’ offices have it. They even have prescriptions that doctors can write for in-home Covid testing. So that frontier has really changed, and it wasn’t necessary for public health to remain in that — for lack of a better word — testing business, where we set up mass-testing sites. 

We have worked with the state and with UNCW to help facilitate testing sites. We did that a lot toward the end of last year. We had an open community testing site where anybody, regardless of symptoms, could come and get tested. That was shut down once we saw the need wasn’t quite as high in our community. And we were getting vaccinations, and so public health had to kind of step back from that effort. 

But that effort is actually going to pick up again. Public health has worked with the state, UNCW, and Optum Health to be doing some testing starting, we think, next week. It’s still tentative. We don’t have a date or additional details for the community at this point. It’s not a public health effort, but we are partnering to make sure that resource comes to our community.

I think it’s going to be really beneficial, specifically for UNCW. Students who are maybe going to other places will have a resource right on their campus that can handle drive-through mass testing. And so that’ll be an important resource for that demographic and that community.

DH: Optum is contracted with the state. They’re one of several entities with resources large enough to contract with states to provide testing sites. They’ve been setting up testing sites throughout North Carolina for the past year. So we’ve basically facilitated a connection with them to set up another site. 

And to Jessica’s point, some of the at-home technologies are rolling out and becoming more and more feasible, cost-effective and reliable. And for the healthcare community, they just need to see what the test really tells them and what it doesn’t, so they can use it properly in terms of diagnosing a treatment.

PCD: How has the vaccine rollout from the state level impacted the county?

DH: From a 60,000-foot perspective, you have — especially since January 20, I think, more so since then — the Biden administration has made a commitment to ink more deals to broaden and enhance the distribution network. So you’ve seen this national pharmacy chain contract be signed.

Walgreens is the first of several in North Carolina, but many national pharmacy chains have contracted to receive and administer vaccines across the country. So more vaccines will be shipped directly from the manufacturers, under those contracts, directly to those chains that we don’t have eyes on yet. 

Then the other flow channel is going to allocate it to state public health departments across the country — and that’s what’s coming to us. That’s what’s coming to New Hanover Regional Medical Center, Wilmington Health, and MedNorth.  Another example of some federal allocations are to the VA [Veterans Affairs] clinics. 

Operation Warp Speed is still Operational Warp Speed [the public-private partnership initiated by the Trump administration to accelerate the development, manufacturing, and distribution of vaccines]. The emphasis is to get this pandemic behind us. So sometimes the action and the activity is a little ahead of the complete picture of all the numbers. And that’s OK — it’s absolutely OK.

Eventually, the state will have eyes on all of those doses coming into the state through different channels. We’re not now able to report that, but they’re working with the federal government to get eyes on that and get some kind of report every week across the state.

The provider pool was always going to widen. One of the realities of the way Pfizer ships in these large batches, for instance, makes it tough to ship to small providers. The state and local counties are working with more providers and working through those issues. The Johnson and Johnson vaccine will start flowing to a greater volume in the future. So we’ll see how that works out. 

We’re constantly shifting and adjusting and pivoting and replanning — and replanning again — around a new vaccine or a new volume or a new target group, a new partner to work with. We do this to try to deliver vaccines into the community, especially those hard-to-reach pockets — historically marginalized populations, people typically left out or left to the end, or people heavily impacted by either transmission and-or disease, and-or loss of life. That is a big concern for us. 

The total number of vaccines distributed by public health officials of New Hanover County, as recorded at the end of each week beginning December 22. (Port City Daily/Created with data provided by New Hanover County)

Vaccination rollout

The following part of the interview was based on the number of vaccinations administered by county public health officials, shown above.

PCD: You’re definitely scaling up vaccinations quite significantly every week. Are you starting to see positive effects from that operation?

JL: The amount we’re administering is really based on the supply we receive. We’re able to plan these clinics and get the vaccination out, but, especially in the beginning, we were limited by the supply we received. So it was frustrating for the community and for us. We wanted to be able to do more, we wanted to be able to get more shots in arms, but we could only give as many doses as we had. 

We are starting to see that allocation. Over the past couple months, we’ve gotten into a good cadence. And we have, especially over the past month, been able to know how much we’re receiving each week, so that’s helped us plan a little bit more.

But we have consistently advocated to the state that we are able to get more than 3,000 doses out of the door at public health if we have that many in supply. And so we’re working really hard.

And you have to remember, we’re not only doing first doses, we’re doing second doses too. Managing that and balancing it — because you can’t have a day where you’ve got 1,000 second doses and then add first doses onto them — you have to really manage it. 

So it has been a logistics-planning-operations conundrum at times making sure that we can get the supply that we have out the door, in balance with the second doses that we’re making. And we’ve gotten into a better rhythm to be able to do that. But we have a solid operation; we’ve got a lot of people who are able to commit their time and energy on this. And so you do worry about those smaller providers coming on board, and their ability and capacity to be able to do that, given the logistics involved. 

If we can get more doctors’ offices that are even getting a small amount of doses out to their patients, that’s going to help us. So all of those little things that can combine to really create what is similar to a flu vaccine, where you go to the doctor, you get your vaccine, you walk out the door; it’s just a little bit more normalized. Right now we’re still in the mass-vaccination stage of this, where we’re trying to get as many out the door as we can. But, again, we can only do it as much as the supply will allow us.

A sign outside the county’s public health headquarters on December 30 details the prerequisites for receiving a vaccination shot, based on Phase 1A in North Carolina’s vaccination plan. (Port City Daily/Shea Carver)

Are the vaccinations working?

PCD: So have you seen enough vaccination to start slowing the spread

DH: In a word, yes. Those numbers you got earlier are certainly nowhere close to herd immunity, but they are having an effect. We can’t put a number on that, but those vaccinations, in combination with continued mitigation and prevention measures — and with the reality that at least some portion of population has contracted, recovered, and has some natural immunity — all those factors combined together have worked to depress the transmission and the case count, and the number of people in the hospital at risk of losing their lives. 

Our goal now is to maintain a sense of awareness and urgency around the virus as we move through the vaccination campaign. We have done a great job.

Earlier this week, I realized we’ve been at this vaccination effort since a few days before Christmas, for nearly months now. In the beginning, we said it might be six to nine months before we really get through all of this, throughout the whole country. So we’re on a good pace. And the priorities are just going to evolve throughout the campaign, in terms of how we approach getting people vaccinated and how they’re getting vaccinated.

To Jessica’s point, the smaller providers need to find a way to pull that into their normal operations to some degree in the future. It’s hard for a smaller operation to break away from the stuff they normally do day-to-day. So we’re all working on that with them. 

But it’s definitely having an effect; it’s definitely improving things. I think once we get to that herd immunity of 70% — well, of course, we’re learning more and more from CDC around the immunity duration, and all of those questions people have. How long does this last? We’ll learn that in the future. The manufacturers and CDC don’t even know that yet. So we’re just gonna keep on plugging along, and when we learn that, we’ll share that and make our plans according to that.

PCD: What specifically has Novant Health brought to the table operationally?

DH: Public health continues working in partnership with all the same great people at NHRMC we’ve been working alongside since the beginning of the pandemic. In fact, we have a long-standing working partnership with NHRMC and this is simply a continuation and scaling up of our shared missions. We have partnered with them to vaccinate our community’s childcare and education staff, worked on outreach together, communicated weekly — and sometimes daily — on our metrics and any actions that need to be taken to ensure our hospital does not become overburdened, and so much more.

PCD: What percentage of 65-plus residents has been vaccinated?

DH: Below are the percentages of partially and fully vaccinated older adults in NHC, according to the NCDHHS dashboard, as of March 19:

  • 75+ = 71.8% are partially vaccinated
  • 5-74 = 67.6% are partially vaccinated
  • 75+ = 65.5% fully vaccinated
  • 65-74 = 57.4% fully vaccinated

PCD: Are you concerned about increased eligibility causing a balloon of vaccinations administered?

DH: No, as we’ve gone through the past three months our amazing staff have successfully pivoted to equitably provide vaccination to eligible groups. As the eligibility widens, we will simply continue our weekly operations alongside our vaccine providers to bring our community out of this pandemic.

PCD: How many vaccinations does the county currently have on hand

DH: The vaccine we have on hand on any given day is obligated. In other words, we receive news of our shipments for each week in the middle of the prior week, and we make our plans for administrations, and then implement that plan the following week when the vaccine arrives.

We have seen some no-shows and cancellations of appointments, but our planning team has quickly re-allocated doses in such situations. So we have zero doses on-hand that are not already obligated in our plans.

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