An increasing number of counties and towns across North Carolina are issuing stay-at-home orders in response to State health officials’ shift this week away from tracking only lab-confirmed cases to assess the spread of COVID-19 into implementing a community mitigation strategy to slow the outbreak—a strategy that has resulted in a major change in testing criteria.

“The case counts that we get are not a great marker for how fast this is accelerating or what the true burden of COVID-19 is out there in the community,” State Epidemiologist Zack Moore said, according to a report yesterday by The News & Observer.

Both the N.C. Healthcare Assn., which has 130 hospital members, and the N.C. Nurses Assn. have asked N.C. Governor Roy Cooper to issue a statewide shelter-in-place order so that hospitals can keep up with the growing number of COVID-19 patients and not be depleted of necessary supplies and beds.

Although Governor Cooper has indicated in recent remarks that he soon will be issuing more restrictions, he has not announced a statewide shelter-in-place order yet.

Directed by Dr. Moore, the N.C. Dept. of Health and Human Services (NCDHHS) has significantly changed its COVID-19 testing recommendations, in accordance with guidance from the U.S. Centers for Disease Control and Prevention.

Whereas previously the NCDHHS had advised clinicians to test patients for the respiratory illness caused by the new coronavirus, SARS-CoV-2, if they had a fever, a negative flu test, and a cough OR shortness of breath, it is now advising them to test only those patients who have a fever, a negative flu test, a cough, AND shortness of breath or another severe symptom such as chest discomfort, difficulty breathing, altered thinking, or cyanosis.

The change in testing criteria is intended to reduce the community spread of the illness—which is furthered when infected people go out to be tested—and to protect people from being exposed to the coronavirus when seeking testing, especially in healthcare settings.

It is also designed to preserve Personal Protective Equipment and supplies needed for outbreaks in high-risk settings, to protect frontline healthcare and emergency personnel, and to care for people with the more severe symptoms.

North Carolina has the same critical shortage as the rest of the nation in test kits, necessary components for testing such as swabs, and the masks, gowns, and gloves that healthcare workers must wear when they perform the tests.

With the demand for testing outpacing its supply, the CDC has altered the criteria for testing to reduce the demand and conserve medical supplies and capacity so that healthcare workers can care for people who most need medical attention.

State Senator Jeff Jackson of Mecklenburg County, which accounts for 25 percent of all of the confirmed COVID-19 cases in North Carolina, has been issuing regular updates during the pandemic crisis. In an afternoon email today, he gave context to the testing change, saying:

“[It] means if you’re a middle-aged, reasonably healthy person and you develop mild, flu-like symptoms and think you may be infected, the new guidance is to call your doctor, at which point your doctor will likely tell you to assume you’re infected and self-quarantine until you’ve been fever-free for three days (unless your condition worsens, in which case call your doctor again).”

The NCDHHS is also urging clinicians to use telehealth/televideo and telephone triage to assess patients with respiratory illness.

Both NCDHHS and the CDC have posted online “what to do if you feel sick” fact sheets:

From the CDC: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html

From the NCDHHS: https://files.nc.gov/ncdhhs/documents/files/covid-19/C19-PatientGuidance-3.23.20-FINAL–003-.pdf

The shift in testing places even more importance on social or physical distancing, which is why counties (Mecklenburg, Wake, Orange, Pitt, Buncombe) and towns (Winston-Salem, Clemmons, Beaufort) are ordering people to stay home.

Such orders generally require people to leave their own property only to perform essential tasks, keep essential appointments, and pick up essential supplies. Some of the businesses that are considered essential service providers include grocery stores, pharmacies, auto-repair shops, banks, legal advisers, and laundromats. (Last we checked, the ABC Stores were still open.)

Stay-at-home orders give law enforcement officers authority they currently lack now in counties, cities, and towns where residents have been asked to comply voluntarily with physical distancing. In Mecklenburg County, for example, police may arrest people who violate the order and charge them with a misdemeanor. (The Beacon does not know if imposing criminal consequences for violation of these orders is standard or not. We would speculate that it is.)

For an update on the N.C. counties and towns where stay-at-home orders have been issued, see: https://www.newsobserver.com/news/coronavirus/article241524906.html

IN OTHER NEWS: The White House has granted Governor Cooper’s request for a federal disaster declaration for the COVID-19 pandemic in North Carolina. This declaration enables local governments, state agencies, and eligible non-profits to be reimbursed by the Federal Emergency Management Agency for costs related to their response to the outbreak.

See https://www.ncdhhs.gov/news/press-releases/north-carolina-receives-federal-disaster-declaration-covid-19

Ann G. Sjoerdsma, 3/26/20

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