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State officials have cited “sustained leveling” of positive COVID-19 tests and hospitalizations as a rationale for easing restrictions on travel and commerce in North Carolina.
As hospitalizations reached an all-time high twice last week and positive tests continued their rapid ascent, what exactly does “sustained leveling” mean?
Dr. Lisa Gralinski, an assistant professor at the UNC Gillings School of Global Public Health, said that, to her, “sustained leveling” has a specific meaning. It means “things are roughly under control, that nothing is getting worse,” she said.
“I wouldn’t say it’s what we are observing in terms of cases in North Carolina right now.”
State officials started using the term “sustained leveling” at the end of April as a means to quantify success and justify reopening the state’s economy.
On April 23, Dr. Mandy Cohen, who leads the N.C. Department of Health and Human Services, said, “We want to see a decrease or sustained leveling” for several metrics: of people hospitalized with COVID-19, the disease caused by the new coronavirus; of people arriving at emergency rooms with COVID-like symptoms; the number of positive tests; and the number of positive tests in relation to total tests.
At the time, North Carolina had just seen its 253rd confirmed coronavirus-related death. As of Sunday, the state had 886 deaths.
Gralinski has studied coronaviruses for more than a decade and said North Carolina’s trends in coronavirus metrics are cause for concern.
The interview with Gralinski occurred Thursday morning, before the state released figures that added another 784 positive COVID-19 tests to the state total and an all-time high of 708 people statewide hospitalized due to the virus. Then the state added more than a thousand cases each on Friday and Saturday, with another 900 on Sunday. Saturday’s 1,185 total of new cases was the biggest single-day increase so far.
When asked what “sustained leveling” meant at the beginning of the month, Kelly Haight Connor with DHHS said: “Sustained leveling means that over a 14-day period there were not significant variations in the seven-day rolling average trend line.”
In layman’s terms, “sustained leveling” means the number of cases and hospitalizations can be climbing steadily upward as long as there is not a spike, or “significant variation” in a seven-day average. When asked what “significant variation” meant via an email on May 11, Haight Connor did not respond.
Gralinski said she’s “actually pretty OK with that definition, but I still don’t think we are seeing it in the North Carolina data.”
“I am seeing that our numbers continue to go up, and even if you consider the nasty Tyson meat plant outbreak that a lot of cases came in there recently in the Winston-Salem area, even if you take away those cases, that doesn’t account for the continued increase,” Gralinski said.
“Also, we shouldn’t take away those cases because they are real people who exist in our community.”
Hospitalizations had been steadily moving downward, which meets the definition of sustained leveling provided by DHHS. But Gralinski noted they were “creeping up” last week. Several days of hospitalizations above 700 were the highest levels reported.
“I hope we do really get to that sustained leveling point, absolutely. But we are not there now,” Gralinski said.
However, she is buoyed by the state’s increase in testing capacity for COVID-19.
“That indicates we would be more able to identify any new outbreak or new cases pretty quickly,” she said. “That’s a good thing, and we are meeting the metric we want to there, it seems.”
Though numbers for the nation as a whole are trending down, which Gralinski said is encouraging, she said it’s not the case in the South. The positive cases we see now were contracted two weeks ago, and today’s hospitalizations may represent COVID-19 spread from three or more weeks ago.
“It takes a while for changes in activity to be reflected in overall state numbers. If we move too quickly to open up and whatnot, then we can’t properly assess the effects of the actions that we’ve already taken,” she said.
People need to take the virus seriously since researchers have been studying COVID-19 for only about five months, she said.
“These are nasty diseases that mess with your immune system,” she said. “While a lot of people have a mild disease, a significant percentage have severe diseases, and it takes a long time sometimes for that to develop.”
When asked what she tells her friends and family to do, Gralinski said she asks them to be cautious about relaxing social distancing if they are not comfortable and continue to stay home.
“It’s OK to continue to be at a distance,” she said. “Connect with people by phone or by Zoom. And if you are going to get together with people — outdoors. Groups of people in enclosed spaces are definitely what we have learned are the riskiest environments for spread of the disease.”