North Carolina health officials signaled a change in how they will track the new coronavirus this week, as wait times for results from testing grew along with the number of positive cases across the state.
On Monday, N.C. Department of Health and Human Services Secretary Dr. Mandy Cohen said her agency would move to a model to track the virus that relies less on testing and more on other surveillance techniques.
“As we move into this next phase of work, we will start to do tracking of the virus very much in the way that we track the flu every season,” Cohen said. “It is not about positive lab tests. Instead, our epidemiologist will create a new surveillance system going forward.”
The changes came days after state health officials announced that testing had confirmed North Carolina’s first case of community spread — a patient who had not been in contact with a known positive case or traveled to areas at high risk for the virus.
What testing public health departments do conduct will be largely limited to patients 65 and older, people with underlying health conditions, first responders and health care workers.
At a news conference Wednesday, Gov. Roy Cooper told reporters that more testing would provide “a better snapshot of where we’re going and what we need to do.”
“But until this country can build up the supply chain for both personal protection equipment and testing that we need, we’ve got to concentrate it on the greatest need right now,” Cooper said.
The changes are consistent with new guidelines from the Centers for Disease Control and Prevention announced Tuesday.
“We don’t want to send people unnecessarily to providers or the hospital, which burdens the resources and makes it difficult for the hospitals to provide care to those coming in with severe illness related to the virus,” Dr. Kim McDonald, Wake County medical director, said in a news conference Tuesday.
People in low-risk groups with mild COVID-19 symptoms — fever, cough and difficulty breathing — are no longer advised to seek testing. Instead, they should isolate at home for seven days and remain there three days after their symptoms clear up, according to the revised guidance.
“A test will not change what someone with mild symptoms will do,” Dr. Betsey Tilson, state health director, said in a news conference Tuesday. “The vast majority will recover at home.”
But the changes announced this week do not address the backlog of samples currently waiting to be tested across the state. Nor do the changes help the public better comprehend the full scope of the pandemic at a time when the number of new cases announced each day continues to grow.
In an effort to put those numbers in better context and to get additional answers to outstanding questions, reporters from WBTV, WRAL, Carolina Public Press, WECT, the Charlotte Observer and the Raleigh News and Observer have continued a collaborative project to track issues related to COVID-19 testing and other questions across the state.
As part of that effort, reporters from the six media outlets late last week sought data and records from DHHS detailing the extent of testing in both public and private labs reporting to the state.
Those records are public under the N.C. Public Records Act and the emergency order related specifically to the COVID-19 pandemic signed by Tilson.
A spokesman for NCDHHS acknowledged on Friday that the agency had received the request but had not produced any records as of Wednesday afternoon.
Similarly, letters regarding the outlets’ request sent directly to Tilson, a top lawyer in the N.C. Department of Justice and to senior staff in Cooper’s office all went unanswered.
A DHHS spokeswoman addressed the outstanding records request late Wednesday in response to questions posted for this story.
“DHHS continues to receive routine public record requests as well as multiple requests related to the COVID-19 pandemic,” spokeswoman Kelly Haight Connor said. “Staff are working diligently to review and process requests within a reasonable time.”
Haight Connor did not specify what a “reasonable time” is.
Patients waiting a week for COVID-19 test results
Data provided by the state shows testing ramped up considerably since the first cases emerged in North Carolina in early March. In the past week, public and private labs reported testing an average of 1,200 patients a day.
At the state lab, health officials say they’re returning those results to patients the same day. LabCorp, as of March 13, said its results take three to four days.
But patients across the state who have been tested for the virus say they’re often waiting much longer.
Shannon Ritchie, a 35-year-old Durham resident, initially came down with a dry cough, a low-grade fever and tightness in her chest on March 11. After multiple calls to her doctor and the state coronavirus hotline, she got tested at her doctor’s office on March 17 after her symptoms began to worsen. She was told to expect results in two days.
Five days later, her test from LabCorp came back negative for the virus. She spent that time isolated from her family as a precaution, making plans with them about what to do if her illness got more serious.
“It certainly added additional stress and fear,” Ritchie said. “We were making those decisions without any conclusive diagnosis or connection to a health care provider.”
She’s worried that the time she had to wait for testing increased the chances of a false negative and said she’s continuing to isolate until her symptoms subside. Until then, she and her husband will continue to rely on help from the community for things like grocery delivery and virtual instruction for their children — a privilege she said not everybody who gets sick will have.
“I’m keenly aware at every single step of this process how much more difficult it would be for other people,” Ritchie said.
In response to questions from a reporter, LabCorp spokesman Mike Gellar said Wednesday that from specimen pickup to issuing a result, the testing process takes about four to five calendar days.
“Test results are more typically reported electronically, which generally allows for faster delivery,” Gellar wrote in an email.
That time can also shift depending on how long it takes for the sample to get to the lab, and how patient samples are prioritized. He said the company cannot provide specifics about LabCorp’s testing efforts in North Carolina.
In Avery County, Meredith Dolhare was on day seven of waiting for her test result as of Wednesday afternoon.
Dolhare, a former professional long-distance runner who lives in Charlotte but went to the mountains to self-quarantine, said she got tested for the virus on March 19 after a telehealth appointment following three days of a high fever, aches and pains.
On Wednesday, she still had a fever above 102 degrees, was still lacking energy and was still in pain. After a call with health officials, she wasn’t any closer to knowing her test results.
“They’ve just called to check on me but they’ve had no results,” Dolhare said. “They can’t seem to find my test.”
The delays in test results come as labs across the state increase capacity. Last week, UNC Health launched its own COVID-19 testing facility. This week, Charlotte-based Atrium Health announced it had set up its own lab at ZMax Dragway. Atrium said its test facility was able to provide results within 24 hours.
“Because we’re able to do the tests ourselves, it simplifies the process,” an Atrium spokesman said. “The samples don’t have to be transported to another city, and there’s no queue line with others ahead of us since it is our teammates doing the testing.”
Delayed testing results mean less understanding of virus spread
DHHS spokeswoman Haight Connor said the number off cases being report reflect a delayed picture of people being exposed to the virus.
As a result, she said, the pike in numbers being reported now do not reflect changes as a result of additional social distancing measures being implemented across the state.
“The effectiveness of measures put in place to stop the spread of COVID-19 will become more clear in the coming weeks,” she said. “It’s also important to recognize that the number of laboratory confirmed cases does not provide (an) accurate picture of the virus in the community.”
Dr. Paul Kamitsuka, a Wilmington epidemiologist and infectious disease expert, said testing timelines are improving with the passage of time, down from five to six days to just one or two, but the delay in beginning testing in the first place has stunted the understanding of how much the virus has spread.
“If we did test widely, if we had that capability let’s say a month ago, then we would have a much clearer picture of just how widespread things are, but I think at this point the epidemic curve is almost straight up,” he said.
Kamitsuka said that, with documented community spread, testing efforts clearly are not accurately capturing the scope of COVID-19.
“We have to assume that it is already widespread,” he said. “But we are only seeing the tip of the iceberg with tests that are turning positive and we need to dramatically change your behavior now if we have any chance of controlling this ongoing pandemic.”
He said the state’s move to begin assuming patients with mild symptoms are positive rather than waiting for test results is the best move forward because it refocuses what limited testing resources are available toward those who need them most: patients in the hospital and health care providers.
Local agencies sharing more information as testing continues
Since the outbreak of the coronavirus, some counties have begun to share more information on tests and their results.
Often, this information comes as emails to the media, tweets or posts on government webpages.
Lincoln County officials, for example, send regular emails on the number of tests completed (102 as of Tuesday), the number of tests pending (35) and the number of positive tests (1).
In a release to reporters, Caldwell County officials confirmed their first positive case of the coronavirus Tuesday. The release also said 324 tests were completed and 32 came back negative.
Mecklenburg officials have gone even further.
Last week, following the media’s push for additional information, Mecklenburg leaders released data on the number of positive tests by sex, age and race — by far the most detailed information the county has released so far.
A county bar chart shows cases by day, and a map shows cases by ZIP code.
The health departments in New Hanover and Brunswick counties have similarly started reporting more detailed information, including the number of tests conducted to date.
Some counties in Western North Carolina have also begun providing additional information. Henderson and Buncombe counties, among others, are now posting regular updates on their confirmed cases.
However, some testing information, such as which screening sites are operational at any given time, has been so fluid that even county websites have gone to asking residents to call for current information.
Confirmed cases of the virus spread more slowly into the mountain counties than many other parts of the state, but with several counties in the region now reporting cases, others are beginning to gear up their information efforts in earnest.
Health Director Diane Creek, who oversees the Toe River Health District that encompasses the Yancey, Mitchell and Avery county health departments, said earlier this week that her agency is using Facebook to keep area residents regularly informed and reassured as test results trickle in.
Other counties, however, are less forthcoming. Durham County Public Health spokesperson Dr. Alecia Smith wrote in an email Tuesday, “The Durham County Department of Public Health practice of not releasing further demographic information for COVID-19 cases is in accordance with state law and HIPAA regulations.”
Wake County communications staff asked that a public records request be filed for the information.
More statewide detail may be coming soon.
Tilson, the state health director, told reporters at a news conference Tuesday that DHHS was working to put together an online dashboard on more detailed demographics. She did not provide a timeline for the dashboard’s release.
This story was jointly reported and edited by Kate Martin, Melissa Reardon and Frank Taylor, of Carolina Public Press; Gavin Off, Ames Alexander and Doug Miller, of The Charlotte Observer; Nick Ochsner, of WBTV; Emily Featherston, Brandon Wissbaum and Brad Myers, of WECT; and Tyler Dukes and Ashley Talley, of WRAL.
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