Kim Hines shops at Citi Trends in Goldsboro on May 15. Melissa Sue Gerrits / Carolina Public Press

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Monday ended North Carolina’s deadliest seven-day period for COVID-19, with another 223 people dead from the disease caused by the new coronavirus. To date 4,245 have died — well beyond even a bad flu year in just 10 months.

Each week seems to set a new milestone for North Carolina’s coronavirus metrics. More than 1-in-10 of the state’s 266,136 cases recorded since the start of the pandemic have been reported in the past two weeks. 

While the virus was largely in urban areas in September, the latest numbers show the virus has now gripped rural areas, both in North Carolina and nationwide.

That’s not surprising to Dr. William Hathaway, chief medical officer for Mission Health/HCA Healthcare North Carolina Division in Asheville, who keeps a close eye on the numbers and hospitals around the region.

“It hasn’t by any means overwhelmed us. But the trends — you never know which day is going to be the exponential explosion versus just a few more cases, so yes, it has us very concerned,” Hathaway said.

An explosion in positive cases is typically followed by people seeking treatment at the hospital a week or two later, which, after another week, is then followed by more deaths due to the virus. Doctors around the globe have since lowered those case fatality rates, and hospitals in North Carolina, including Mission, are poised to rapidly increase the number of intensive care unit beds if needed.

“We’re in a much, much better place than we ever were, but we need people to do what they can do to limit the spread,” he said.

Letters to troubled counties

The precipitous climb in North Carolina’s positive cases and hospitalizations prompted the N.C. Department of Health and Human Services to send letters to leaders in more than a third of North Carolina’s 100 counties sounding the alarm of the accelerated spread of the contagious and deadly virus.

Along with others on his team at nc-covid.org, Paul Delamater, a health geographer and assistant geography professor at UNC Chapel Hill, examines DHHS data to spot trends in COVID-19’s spread. In the past two weeks, rural areas — from the mountains to the sea — have seen a higher spike in COVID-19 than the urban areas.

“My biggest concern, especially in some of these regions with high case rates right now and really intense transmission, I worry about what’s going to happen in the upcoming weeks in those regions,” Delamater said.

In Alamance County, 5,181 people have tested positive for COVID-19 since the start of the pandemic, of which 76 have died. In the last 14 days, Alamance County has reported 626 people testing positive for COVID-19.

“Approximately 65%-70% of new COVID-19 cases in the last seven days have been in the general population (not congregate living facilities),” Arlinda Ellison, health education supervisor for the Alamance County Health Department, said in comments last week. 

“We don’t know the specific reason for the increase, but we have identified social gatherings as an emerging trend.”

By contrast, Hyde County has seen four cases outside of congregate living arrangements in the last 14 days. The county so far has been contacted everyone who tested positive, all of whom health officials have been able to contact-trace.

However, Luana Gibbs, health director for the Hyde County Health Department, said that, while Hyde County is currently in a good position to weather the next few months, it can only happen if people take the pandemic seriously. 

In the coming months, she said, she is worried about whether people will follow the 3 Ws — wearing a face covering, washing their hands and waiting 6 feet apart from those not in their households

“People are more apt to stay inside, social gatherings for the holidays will likely continue,” Gibbs said. “I personally do not believe Hyde County is in a bad position, but I do not want to see us get there.”

Viruses thrive as people go indoors

More distancing and other measures to limit the spread are a tough ask this time of year. The changing leaves normally herald a season of togetherness, sharing treasured family meals and traditions.

Social distancing and these traditions don’t necessarily mix well.

Fall is also the start of flu season, and medical professionals are uneasy. Both viruses spread to new hosts best in dry, poorly ventilated indoor spaces.

“I do believe that because of our habits, we’re likely to see an increase in the number of cases,” Hathaway said. “And on top of that, we’re in a sort of a limbo-land not knowing what will happen with influenza.”

Flu season strikes hard in November and December. For the past several years, influenza and pneumonia together have been among the top 10 causes of deaths for North Carolinians, according to the U.S. Centers for Disease Control and Prevention. From 2014-17, flu and pneumonia have killed between 1,874 and 2,115 people each year.

Like the flu, the coronavirus frequently kills the aged and infirm. More than half of North Carolinians are either over age 65 or have at least one medical condition that makes it more likely they will have a serious illness or could die from COVID-19, DHHS data shows.

“I’m scared that when we do start going inside and start spending time indoors, we’re going to be at a very high level of (COVID) infection in the state,” said Delamater.

We gather together?

Many people can be infected with the coronavirus and not know it, becoming unwitting carriers of a disease that has so far killed nearly 1-in-7 North Carolinians over age 75 who contracted it, according to DHHS data.

Hathaway, the doctor at Mission Hospital, said his family has “made the decision to be exceptionally cautious” this Thanksgiving. His wife is a physician, he explained, and her mother is nearly 89 years old and lives in congregate care. 

Fewer will travel from afar to celebrate the holiday. Guests who do plan to travel will quarantine for a few weeks before the holiday. And rather than gather inside, Hathaway said their plans include spending time outside and wearing masks.

“While it’s painful to think about that, for such an important family holiday that means so much to so many people, it’s even more painful to think that we hurt a family member, especially someone who’s very vulnerable like my soon-to-be 89-year-old mother-in-law — that would be a tragedy beyond words,” Hathaway said.

Similarly, Gov. Roy Cooper’s family tradition typically includes broader extended family, he said Wednesday. 

“This year my family’s just going to have our children and Kristen, and me, and the animals,” Cooper said. 

“I would recommend that people look at this — look at the people who are vulnerable in your family. Realize that, hopefully, next holiday season, we’ll be out on the other end of this. And this is not going to be forever, we’re not going to be forever in this valley.”

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Kate Martin

Kate Martin is lead investigative reporter for Carolina Public Press. Email her at kmartin@carolinapublicpress.org.

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