Test, trace, trend: Gov. Cooper lays out road map for when NC will reopen

North Carolina will need more widespread COVID-19 testing, extensive efforts to track down people in contact with the sick and slowed case and hospital rates before movement and commerce restrictions can ease, Cooper said on Wednesday.

“This virus is going to be with us until there is a vaccine, which may be a year or more away,” said Cooper. “That means that as we ease restrictions, we are going to enter a new normal. We want to get back to work while at the same time preventing a spike that will overwhelm our hospitals with COVID-19 cases.”

[ Loosening of stay-at-home restrictions will likely happen gradually, experts say ]

Cooper, who must decide soon what to do with a stay-at-home order that expires April 29, also warned that any improvements for businesses and the public will be incremental, and could be turned on and off like a dimmer switch, depending on the data.

Expert modeling has shown it would be dangerous to lift the restrictions all at once because it would increase the chances that hospitals become overwhelmed and unable to care for severely ill patients. Cooper emphasized that changes in restrictions must protect public health, especially those who are most vulnerable to severe illness, including people over age 65, those with underlying health conditions and people living in congregate settings.

“Experts tell us it would be dangerous to lift our restrictions all at once. Rather than an on/off light switch, we are viewing this as a dimmer switch that can be adjusted incrementally,” said Cooper. “I know the changes that we’ve all made in our lives seem to have happened very quickly, but undoing those changes won’t happen as fast. To protect our health and long-term economic prosperity, we have to act with care, rather than haste.”

The governor said any “new normal” could include partially-full restaurants and concerts and sporting events without audiences in the name of social distancing and safety. And residents most vulnerable to the new coronavirus still must be protected until a vaccine or effective treatment is available.

In order to ease restrictions, the state needs to make more progress in three areas: testing, tracing and trends.

Testing

“First – testing. Our new normal relies on an increase in testing capabilities to isolate and track new cases of COVID-19,” said Cooper.

According to Cooper, that means adding supplies and lab capacity and antibody testing to show who’s had the virus, but he didn’t say a number.

State planning relies on an increase in testing capabilities to identify, isolate and track new cases of COVID-19. This means having the supplies and lab capacity to do more testing across the state. Dr. Mandy Cohen, Secretary of the Department of Health and Human Services, has brought together laboratory partners from the public and private sector to coordinate efforts to ensure testing -- diagnostic and antibody -- is widely available across the state while also conserving protective equipment.

As of Wednesday night, North Carolina has completed nearly 68,000 tests, but there are 10.5 million people in the state.

There’s no benchmark yet on what enough testing would look like.

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Tracing

“Second – tracing. We have to boost our public health workforce to trace and track new cases,” said Cooper.

This is time-intensive work, tracking down all of the people who patients have come in contact with. Currently, just 150 people in local health departments are doing that work.

Tracing requires the state to boost the public health workforce and the ability to trace contacts of new cases of COVID-19. Contact tracing can be effective at containing new outbreaks, but it requires more personnel. When a person tests positive, the tracing efforts will help identify who that individual may have been in contact with so those people can get tested and take the right precautions. NC DHHS is working with its partners to increase this critical piece of our public health workforce. New digital tools can also help scale this effort.

Cooper said the state will partner with hospitals and universities to get enough people to do that, tracing work on a larger scale.

Trends

“That includes trends in the number of new positive cases, hospitalizations, deaths, as well as available supply of personal protective equipment, hospital capacity and more,” said Cooper.

In order to ease restrictions, the state needs to understand how COVID-19 is impacting the state and impacting specific populations and regions of the state to determine when to strengthen or ease social distancing policies. Trends that will influence policy decisions will be based on data like the new positive cases, hospitalizations, deaths, as well as the available supply of personal protective equipment, hospital capacity.

“Because we acted early and because we acted together, we have averted the devastating scenarios we have seen playing out in other parts of our country and across the globe. We now need to look ahead at how we stay ahead of the curve. Widespread testing, aggressive contact tracing, and data-informed policy decisions are our best tools to keep our communities safe and protect our frontline workers,” said NC Department of Health and Human Services Secretary Mandy Cohen, MD.

Cooper and Department of Health and Human Services Secretary Mandy Cohen didn't give many specifics on what would equate to meeting testing, tracing and statistical goals. But Cohen said there were good developments on testing access, and the case count shows the stay-at-home order is working.

State DHHS data shows there were over 5,100 positive COVID-19 cases as of Wednesday morning, which was only a 1% increase compared to Tuesday. The number of COVID-19-related deaths grew by nine to 117, while current hospitalizations increased slightly to about 430.

Cohen said efforts were underway to expand the workforce to join local health workers who already track down people in contact with those testing positive in order to control the virus' spread. For most people, the coronavirus causes mild or moderate symptoms, and the vast majority survive. But for others, especially older adults and people with existing health problems, it can cause pneumonia or death.

Cooper released his parameters on reopening the day after dozens of protesters unhappy with the stay-at-home order stood together near their cars in a parking lot within sight of the Executive Mansion. One person was arrested who refused to leave after Raleigh police told the crowd repeatedly that they were violating Cooper's executive order requiring social distancing.

The order and an earlier ban on dine-in service at restaurants and bars, like those in other states, have contributed to a massive economic setback. Nearly 600,000 initial unemployment benefit claims have been filed with the state in the last four weeks.

Several Republican lawmakers, in particular Senate leader Phil Berger, have urged more widespread testing to better determine the extent of the virus within the population.

The General Assembly's decision to spend $100,000 to help jump-start an effort by Wake Forest University to collect data on people who have developed immunity to the virus is part of that effort. The money will be used to purchase and send 1,000 at-home antibody kits to a sample of state residents.

"Without hard data to back up the opinions that are being expressed, people are increasingly going to be reluctant to comply with government-mandated shutdowns," Berger told reporters on Wednesday. The data also may show that the spread of COVID-19 is not as great as leaders have feared, he said.

Cohen said she wasn't aware of the Wake Forest activity until it was announced earlier this week. She emphasized collaboration with the state and researchers to share data on various components of the virus for maximum benefit to the public.

Deaths continue to accumulate in North Carolina nursing homes. Franklin County health officials said Wednesday that three more residents at the Louisburg Nursing Center have died, bringing the total of resident deaths to five. Six residents at the Springbrook Rehabilitation & Nursing Center in Johnston County have also died, officials said.

Four prisoners who tested positive for COVID-19 at the medium-security federal correctional institution in Butner have died, the U.S. Bureau of Prisons said. Forty-six inmates and 27 staff members there have tested positive there so far.