North Carolina's high COVID-19 metrics from July could be affecting the state's death rate now, Dr. Cohen says

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Friday, August 14, 2020
Health leaders say rise in COVID-19 deaths related to increase in July cases
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Dr. Mandy Cohen said deaths are a lagging indicator, showing what was happening in the states several weeks prior.

As North Carolina makes progress in several key COVID-19 metrics, most notably a decreasing positivity rate, both Governor Roy Cooper and North Carolina Department of Health and Human Services Dr. Mandy Cohen on Thursday addressed the state's rising death rate.

"First, we're going to lower the number of deaths by slowing the spread of the virus, but also (by) improving treatment, making sure our hospital system is not overwhelmed," Cooper said. "In some of these other states, some of their deaths can be attributable to the fact that they were having a hard time getting an ICU bed or a ventilator to a patient. We do not want that to happen in North Carolina. So slowing the spread is important, but also getting people the best medical treatment that they can is important."

"Death is very much of a lagging indicator, and it really tells us more about what was happening in North Carolina back in July," Dr. Cohen added. "And we know in July as we saw from the metrics earlier that I shared is that was when our cases were at our highest. So it's not surprising now that our deaths have gone up a bit. I think that reflects that's what was happening in July. I expect those to be leveling off and then decline. When you look at us compared to our other Southern states, it's not going to be surprising. They had a surge of cases, they're going to see a surge of hospitalizations as the Governor mentioned. And they're going to see a surge of deaths. We won't see that here. We'll see that increase to reflect the increase in cases. We'll also likely see that stabilize and see the trend decline in the next couple of weeks as well."

NCGOP spokesman Tim Wigginton rebutted Cooper's connection between death totals and ICU capacity.

"The truth is because of President Trump's strong leadership that nobody in America has been denied a ventilator, and the majority of deaths from COVID-19 have occurred in states where Democrat Governors have refused to fully implement the CDC guidelines for nursing homes," said NCGOP spokesperson Tim Wigginton. "Cooper fails to acknowledge that the main source of death from COVID-19 is nursing homes and long term care facilities according to his own administration."

NCDHHS has recommended for months that congregate care facilities follow recommendations from the CDC regarding repeat testing.

In addition, in late June, NCDHHS announced a testing initiative for nursing homes; last week the department announced they would pay for ongoing testing for nursing home staff. Guidance released by NCDHHS in May recommended clinicians ensure people who live in nursing homes have access to testing, regardless of symptoms.

In April, Cooper issued an executive order requiring staff to wear medical face masks and be screened daily for the virus, among other restrictions. This came shortly after state health officials learned of an outbreak at an Orange County nursing home.

There have been 2,287 deaths from COVID-19 in North Carolina. Wigginton points to data from the NCDHHS, which reports there have been 938 COVID-19 deaths of people who lived nursing homes, and another 197 deaths of people who lived in residential care facilities.

According to a recent Washington Post report, residents of nursing homes account for about 35 percent to 40 percent of all COVID-19 deaths in the United States.

The CDC reports North Carolina has a death rate of 22 per 100,000 people. Comparatively, three states that border North Carolina have higher death rates (Georgia - 42/100,000 people, South Carolina - 42/100,000 people, Virginia - 28/100,000 people), while North Carolina has a higher death rate than Tennessee (19/100,000 people).

North Carolina state health officials have repeatedly reported that ICU space and hospital capacity have not been a major issue during the pandemic, noting the state has avoided major spikes that have occurred elsewhere.

However, ICU capacity has been a concern in other states that have experienced surges in cases.

There is also heightened emphasis on maintaining hospital space and ICU capacity as flu season nears.

"Progress is fragile. It's going to take continued work to make sure our trends continue in the right direction," Dr. Cohen said. "I see a challenge in front of us. As schools go back into session, more and more people will be moving around, and we know virus will be moving around. If we can do the three Ws, we know science tells us that will keep viral spread low. What I see though when we go into the fall also is the start of flu season. Then we start to have two viral illnesses out there that can have severe impacts on our population."

Thursday, Dr. Cohen stressed the importance of COVID-19 testing, noting that turnaround times - which have been an issue in several states - have greatly improved. To find a free testing site near you, click here.

Flu season begins in October and runs thru mid-May. This past flu season, the peak was late December thru mid-March.

Each flu season varies in severity and spread. The CDC estimated that there were between 410,000 and 740,000 hospitalizations during the most recent flu season, and there were 18 million to 26 million flu medical visits.

Doctor explains why this year's flu vaccine is more important than ever

Last year, 186 North Carolinians died of the flu, with more than half (105) of all deaths reported in people 65 years or older.