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Charlotte hits promising COVID-19 milestone but neighboring counties are faring worse

Charlotte Observer - 10/15/2020

Oct. 15--Mecklenburg County, once the epicenter of the COVID-19 pandemic in North Carolina, has managed to record stable metrics in recent weeks -- even as surrounding counties reel from soaring case tallies and an increase in people who need critical care treatment for the disease.

In Gaston County, for example, hospitalizations have sharply increased over the last 30 days. At CaroMont Health the number of people hospitalized per day for confirmed or suspected COVID-19 illness rose from about 15 patients to more than 65 last month, spokeswoman Meghan Berney told the Observer on Thursday.

"It would be safe to assume there is a correlation between an increase in community spread and an increase in hospitalizations," Berney said.

In Lincoln and Cleveland counties, the caseload increased by over 200% in the past month, according to Mecklenburg Public Health Director Gibbie Harris, whose department is monitoring regional impacts of the pandemic. Officials in those counties did not respond to requests for information from the Observer.

And in Stanly County, school leaders abruptly shut down in-person learning for two weeks after outbreaks affecting students and teachers. Julie Davis, a 49-year-old third grade teacher in Stanly County Schools, died less than one week before the shift to virtual only class. Her family says she contracted the coronavirus at school but district leaders have said they believe Davis was infected outside work.

Data this week from N.C. DHHS show the greater Charlotte region has the highest number of hospitalizations anywhere in the state but facilities have remaining capacity.

By contrast, publicly-available public health data show Mecklenburg is months past its peak of COVID-19 patients. The number of hospitalizations in the county has been falling since late July and the positivity rate has generally declined and is now stable.

"We have talked about the need to continue to be vigilant and to do the things that we know will help us here," Harris told county commissioners. "But recognizing the fact that we are seeing these increases all around, we need to anticipate what may happen in Mecklenburg County."

Mecklenburg has recorded nearly 31,000 coronavirus cases since March, the North Carolina Department of Health and Human Services reports. That's a cumulative rate of 282 infections for every 10,000 residents. Gaston and Cleveland counties have similar infection rates based on population, but the trajectory of the virus' spread there, as well as in Lincoln County, began to diverge from the Charlotte area's trends in mid-to-late September.

Already, Mecklenburg is grappling with the rippling impact of viral spread elsewhere.

Overwhelmed hospitals in the western part of the state have begun diverting patients to the Charlotte and Winston-Salem regions, Harris said. It's unclear how many non-county residents are currently being treated at Atrium Health and Novant Health facilities locally. The increase also likely affects the demand for resources like ventilators and intensive care unit beds.

"We are a regional healthcare provider. I think a lot of times people forget that ... As a regional healthcare provider, the beds will fill up quickly," Elaine Powell, vice chair of the county commissioners, said during Tuesday's meeting.

Stabilizing in Mecklenburg, rising elsewhere

Improved data reporting from the state recently has allowed Mecklenburg health officials, for the first time in the pandemic, to detail publicly the positivity rate among county residents versus others who get tested for COVID-19 here but live somewhere else

N.C. DHHS has also required medical providers to report negative COVID-19 test results, forging a departure for public health practice that usually calls for only confirmed cases, said Raynard Washington, Mecklenburg's deputy health director. The latest changes, he said, offer "a more narrow, targeted and focused view" on Mecklenburg's local coronavirus conditions.

About one-third of tests in August and September were for residents of another county. That can be linked to the availability and convenience of healthcare around Charlotte, Washington said.

That new nuanced data shows the test positivity rate -- a key indicator of how well the virus spread is under control -- is lower when non-residents are removed from Mecklenburg's tallies. The trend emerged in early September, as Mecklenburg's positivity rate stabilized while other counties' rates climbed. Before then, the greater Charlotte region followed a similar trajectory.

On Sept. 30, for example, Mecklenburg's weekly average positivity rate was 5%, based on health data from only county residents. When non-county residents were factored into the analysis, the weekly average positivity rate jumped to 6.5%, according to an Observer analysis.

"It's still just as important and just as valuable for us to understand the region around us, and we always think about our neighboring counties," Washington said. "Those same folks who come to Mecklenburg County for healthcare come to Mecklenburg County for groceries ... and they come to Mecklenburg County to work."

Tests from only Mecklenburg residents show the positivity rate has hovered around 5% for nearly a month.

That is the recommended threshold -- in addition to other metrics like hospitalizations and caseload -- recognized by state, local and world health leaders when considering easing COVID-19 restrictions on businesses and travel.

"Things look positive in Mecklenburg County for us right now, but as this pandemic has evolved over time, things rapidly change," Washington said. "This is not necessarily a green light of any kind."

Charlotte-Mecklenburg Schools, for instance, uses the 5% positivity rate as one metric to guide a gradual and phased return to in-person learning. Similarly, local court administrators are carefully monitoring COVID-19 trend data to determine how and when jury trials will restart.

'The fire's not out'

While the more specific reporting strategy can better show how prevalent the virus is among Mecklenburg residents, the data alone can't gauge potential risks of transmission.

For example, weeding out the positive test results from non-county residents in Mecklenburg's metrics doesn't mean those cases aren't impacting public health locally.

Some non-residents are active in daily life in Charlotte and its surrounding towns, said Michael Thompson, associate chair of the Public Health Sciences department at UNC Charlotte.

"What we really don't know, for those people who aren't residents, how much time they are actually spending here," he said. "Are they people who are working here, interacting here more or did they just come over for a test? That changes the nature of whether their risk means something for our community."

Thompson said it's to be expected that non-residents are seeking healthcare in Mecklenburg, given the county's "resource rich environment" for medical facilities and testing availability. And, he said, it's not surprising a greater share of those tested turn out to be positive, because they took extra effort to travel for a test.

Even though the new data reporting process shows a lower positivity rate for Mecklenburg residents, it's not time to slow down mitigation efforts like social distancing and mask wearing, Thompson said.

He likened the pandemic to a fire, and the 5% rate is "a benchmark that we're doing a good job of containing the fire.

"But the fire's not out," he said. "We cannot go back to what we were doing before."

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