Is N.C. on track to move into phase three? It’s complicated

Is N.C. on track to move into phase three? It’s complicated
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Since Memorial Day weekend, lakes and parks have been packed, Saturday night lines outside of popular South End breweries and restaurants are back, and thousands of protesters have filled Charlotte’s streets to demand justice for Black Americans. All while the coronavirus is still, as NCDHHS secretary Dr. Mandy Cohen says, “a very real threat.”

The dangers of meeting in large groups during a pandemic led to gathering sizes being restricted to 10 people during phase one of reopening. Now that those initial restrictions have been relaxed, North Carolina — and specifically Mecklenburg County — have regressed. Last week, the White House’s Coronavirus Task Force mentioned Mecklenburg as a county of concern in North Carolina.

The beginning of phase three is scheduled for June 26. As that date approaches, many of the key indicators — total cases, percent positive cases, hospitalizations, and deaths — are on the rise.

“Our numbers aren’t where we want them to be, but they don’t have to stay that way,” Governor Roy Cooper said during a June 12 press briefing.

What the numbers say: Last week North Carolina had five separate days with more than 1,000 new coronavirus cases. The percent of positive cases is increasing, too. Right now it’s 10 percent in Mecklenburg County. So we know these numbers aren’t just a reflection of increased testing.

Percentage of positive COVID-19 tests in Mecklenburg County. (Courtesy Mecklenburg County)

Are you still social distancing? In its most recent bi-weekly report, the county says social distancing is decreasing — almost to the point of nearing pre-Covid restrictions distancing.

“We’re probably a couple of weeks from baseline if we continue with the rate we are right now with the decrease,” county health director Gibbie Harris said last week.

UNC Charlotte public health sciences professor Dr. Melinda Forthofer compared social distancing to sexual partners. When someone has sex with a new partner, they’re essentially having sex with that person’s previous partners as well, at least in terms of risk.

“The same thing is true of COVID-19,” she says. “If I go to a gathering, the question I think we all should be considering is who’s going to be there and what do I know already about the extent to which they’re taking the same precautions that I think are important to take.”

A full phase three unlikely: When Governor Cooper announced his three-phase reopening plan in April he said the decisions to move forward would be based on improvements in key metrics. He also said if those metrics turned in the wrong direction, the state may go back to a previous phase.

That hasn’t happened yet. When Cooper concluded the state wasn’t ready to move to a full phase two in May, he created modifications that allowed restaurants and salons to reopen but not bars and gyms. Health experts agreed with the move, but it brought on significant backlash from people who own those types of businesses.

[Related Agenda story: Who is suing North Carolina Governor Roy Cooper now?]

Now, experts say they’d be surprised if state officials moved to a full phase three at the end of the month.

“What we anticipate and had hoped for was to see those trending in a downward direction. We’re not seeing that right now with anything except for social distancing,” Harris said. “So I think it’s going to be challenging for us to do a lot of reopening until we see at least some leveling off, if not some decrease in those trends.”

Instead, it’s more likely the governor extends phase two or opts for a modified plan, similar to phase 2.5, which would allow bars and gyms to reopen but keep other phase two restrictions in place.

During phase three, the final phase of reopening, restaurants and bars could increase capacity and gathering size would increase as well. The main group still under restrictions would include nursing home residents and people who are immunocompromised.

Atrium Carolinas aerial

Atrium Health’s Carolinas Medical Center (courtesy Atrium Health)

The hospitalization ‘balancing act’: Case numbers will likely increase as we move to new phases. The goal, though, is to make sure they stay at a level that the hospital system can handle.

“The challenge that we’re faced with is managing the rate of cases so that our healthcare system can manage the demand,” Forthofer said. “It’s a balancing act. We have to constantly be trying to find the sweet spot.”

As of June 15, 797 people across the state were hospitalized for COVID-19. A month ago on May 16, the number of people hospitalized with coronavirus was 481.

NCDHHS shows of the reporting hospitals across the state, 73 percent of inpatient hospital beds are in use. Of the ICU beds across the state, 78 percent are occupied. Just less than a third of the state’s ventilators, 29 percent, are in use right now.

Though these trends are concerning as well, Dr. Katie Passaretti, Atrium Health’s Medical Director for Infection Prevention, says there is time to turn them around. The next two weeks will be important, she says.

“I’d say right now we’re treading water. We peaked in the 800 plus hospitalizations across the state late last week,” said Passaretti. “I think this week is going to be really telling.”

During a press briefing on June 15, Governor Roy Cooper said officials are concerned about current trends in North Carolina. He said a decision about phase three would come early next week.

“At the first of next week, we will be announcing our decision based on science, based on advice from health experts, as to if we’re going to go into the next phase that would start on Friday of next week — and if we are, what it will look like,” Cooper said.

The protest spike?: Despite the severity of the COVID-19 pandemic, Forthofer says the U.S. is facing a separate health crisis: racism.

Protests with thousands of people could certainly increase the spread of the virus. On the other hand, they’re also helping raise the voice of Black Americans who have been marginalized and unjustly discriminated against for centuries.

“We know that systemic racism is also a public health crisis that we would define on the level of a pandemic,” Forthofer said.

Community conversation protest night 6

Protesters hold signs during a community conversation outside the Government Center.

Critics argue that protests are just as dangerous as other, still-restricted activities. Forthofer, though, says protests are important, despite the risk. Still she advises those who’ve attended demonstrations to limit time with vulnerable friends and family members to keep them safe from exposure.

State public health officials also advise protesters get tested for COVID-19.

“We really are looking at the dynamics surrounding two pandemics,” Forthofer said. “We’re looking at the dynamic surrounding people’s response to racism and its impact on the health of our populations and the pandemic that is COVID-19 and it’s a delicate, delicate balancing act.”

Featured photo courtesy of Atrium Health.

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