11/30/20: FIFTH DARE COUNTY RESIDENT DIES OF COVID-19; NINE LOCALS ARE NOW IN THE HOSPITAL.

A fifth Dare County resident has died of COVID-19, according to the Dare County Dept. of Health and Human Services, which also reported today that a Dare County woman, age 65-or-older, has been hospitalized for treatment of the disease.

The DCDHHS gave no personal details about the deceased person, but its dashboard accounting indicates that he or she was not in the hospital when death occurred.

Nine local residents with COVID-19 are currently hospitalized, according to today’s dashboard report.

Eighteen new COVID-19 cases were reported in Dare County over the weekend, 15 of them on Sunday. Of those 15, five were age 17 or younger, including four local children. Eight of the others were between the ages of 18 and 49, and the remaining two were non-resident men, age 65 or older, one of whom was hospitalized.

COVID-19 metrics statewide continue to “move in the wrong direction,” as both Governor Roy Cooper and NCDHHS Secretary Dr. Mandy Cohen have said. Today’s positivity rate was 9.5 percent, the highest it has been since July.

We will provide a more detailed COVID-19 update later in the week.

THE BEACON, 11/30/20

11/30/20: NUMBER-CRUNCHING, NOT NEED, DEFINES TOWN’S PROPOSED MUNICIPAL SERVICE DISTRICTS: AN ANALYSIS OF MSDs AND THEIR CREATION, AND HOW WE BELIEVE SOUTHERN SHORES HAS ERRED.

Homeowners on Seventh Avenue were very vocal in public meetings about needing beach nourishment. If nourishment would benefit Seventh Avenue “to a demonstrably greater extent” than other other areas in town, then Seventh Avenue, arguably, should be an MSD.

Before establishing a municipal service district for a beach erosion-control project, a town’s governing board must determine that the proposed district is in need of the project “to a demonstrably greater extent” than other areas in the municipality.

North Carolina law permits MSDs to be created—and towns to levy an additional tax on properties within them that would otherwise be unconstitutional—because it assumes that the property owners in the MSDs benefit more from the projects (e.g., beach nourishment) or extra services provided by the municipality than other town property owners do.

The most common MSDs, according to the University of North Carolina School of Government, are established for downtown or urban area revitalization and are often referred to as business improvement districts or BIDs.    

You can see easily how the overhaul of a blighted section of a downtown area would directly benefit businesses located there.

But who benefits to a “demonstrably greater extent” from beach nourishment in a resort town where every property owner benefits from maintaining the beaches so that they continue to attract vacationers, who bring revenue to the town; enhance the value and desirability of all homes and properties; and offer exceptional recreational opportunities?

Who benefits to a “demonstrably greater extent” when everyone in town benefits and the beaches, themselves, are not privately owned?

The “demonstrably greater extent” standard for defining municipal service districts was established by North Carolina state law and is fundamental to the designation of such districts. You will find it presented in plain English in N.C. General Statutes sec. 160A-537(a).

We can say unequivocally that at no time during the Town Council meetings held in the six months before the June 16 beach nourishment public hearing was NCGS sec. 160A-537(a) referenced or the “demonstrably greater extent” standard mentioned.

At no time did Town Attorney Ben Gallop or any other attorney explain the standard and the process of creating MSDs to the Council or the general public.

Instead, the Town Council approved hiring DEC Associates, Inc., of Charlotte to work with Town staff to prepare “beach nourishment funding [financial] models,” based on the Town securing special obligation bonds, which would be financed in part by increased special taxes on property owners in newly designated MSDs.

In other words, the Town created proposed municipal service districts in order to start crunching numbers to figure out how much property owners’ real estate taxes would have to increase—and how many properties would have to be included in an MSD—if it approved a 2022 beach nourishment project.

The Town Council expressly authorized Interim Town Manager Wes Haskett to obtain the real-estate value assessments for all properties within Southern Shores in order to work with DEC Associates to calculate how much more tax MSD property owners would have to pay to meet expenses estimated for three possible beach nourishment projects.

Surely you remember the preliminary MSD maps and number-crunching prepared and circulated by the Town that showed three districts, defined solely by proximity to the oceanfront, and suggested tax rates, don’t you? If not, you can refresh your memories by looking at the meeting packet to the Council’s May 19 workshop meeting.

See “Beach Nourishment Funding Models”: Meeting-Packet_2020-05-19.pdf (southernshores-nc.gov)

Unfortunately, it is not possible to search Municipal Service Districts on the Town’s inadequate website and be directed to any useful information. You have to search Council meeting minutes and packets, or go through the archives of The Beacon, to glean the facts.

On April 15, we wrote in The Beacon that:

“The Town has preliminarily proposed three ‘municipal service districts’ to fund the [beach nourishment special-obligation bond] debt through varied tax increases—oceanfront property owners would pay the highest tax rate increase—but it has yet to prepare a report that demonstrates and justifies the proposed district boundaries. All it has done is provide financial data, not a coherent report.”

Town Councilman Matt Neal, who is a wiz with numbers and mathematical calculations, spearheaded this effort. Mr. Neal could, and did, tell property owners at the June public hearing how much additional tax they could expect to pay, based on the location of their property and the tax rate that had been preliminarily calculated.

We have a lot of respect for Mr. Neal’s intellectual abilities and his character. Indeed, we consider him a friend. But we disagreed with his—and the Council’s—modus operandi in this instance. We considered it slipshod and arbitary, if not invalid.

On May 19, we wrote to Councilman Neal that we seriously questioned “the legal justification of the districts that the Town has carved out from the ‘townwide’ tax base, as well as those it has omitted (i.e., the commercial area). They are based solely on proximity to the oceanfront, not on the ‘demonstrably greater extent’ standard.”

We concluded in our letter that: “[A]n analysis based on the statutory standard—not just on simple real-property tax-value number-crunching—is required before MSDs can be created.”

When the Town Council convenes tomorrow at 5:30 p.m. in the Pitts Center, it will have before it two proposed MSDs. They are MSD1, consisting of oceanfront and oceanside properties; and MSD2, which generally consists of properties on the west side of Ocean Boulevard.

As illustrations in the Dec. 1 meeting packet show, MSD2 may or may not include properties between Ocean Boulevard and Duck Road and those on the side streets in Seacrest Village east of Duck Road.

See the meeting packet: https://www.southernshores-nc.gov/wp-content/uploads/minutes-agendas-newsletters/Meeting-Packet_2020-12-01.pdf.

According to a report by Town Manager Cliff Ogburn in the packet, all that the Town Council has to do tomorrow  is consider the “size and makeup” of these two MSDs. The legal question of benefit is still not considered germane. It will be worked into a report after the Council decides which property owners it wants to tax.

BACKTRACKING TO CONFORM WITH N.C. LAW

The Town needs to generate $1,224,775 per year for the next five years to pay for what is estimated to be its portion of the estimated $16 million beach-nourishment project, according to Mr. Ogburn.

That assumes, he says, that Dare County will pay for 50 percent of the project’s costs from its beach nourishment fund, which is made up of monies from the county’s occupancy taxes; but that funding is “uncertain.”  Still.

It is still uncertain more than a year after County Manager/Attorney Bobby Outten spoke to the Town Council at length about the County’s funding capability, and The Beacon extensively covered what he said.   

“Current planning,” Mr. Ogburn writes, calls for a property tax to be levied through a town-wide tax, so that all property owners contribute to the project, with owners of properties in “one or more municipal service districts” paying a higher tax rate.

The increased taxes will be levied July 1, 2021.

The N.C. law on MSDs requires a town council to hold a public hearing on proposed new MSDs before it votes to adopt an ordinance defining them. (NCGS sec. 160A-537(b))

Before a public hearing can be held, the town council must prepare a report containing:

  1. A map of the proposed district, showing its proposed boundaries;
  2. A statement showing that the proposed district meets the “demonstrably greater extent” standard; and
  3. A plan for providing in the district one or more of the services listed in G.S. sec. 160A-536, among which is “beach erosion control and flood and hurricane protection works.”

We argued to Mr. Neal in our letter that this report should have preceded the June 19 public hearing, when a number of speakers addressed the preliminary MSDs and their possible tax rates, but to no avail. Again, we consider the statutory process to have been abused and the analysis done to have been arbitrary and results-oriented.

According to a hypothetical “Beach Nourishment MSD Creation” timeline drafted by Mr. Oburn, MSD property owners will be notified of proposed districts by the end of January, and a public hearing will be held on their designation in March.

State law requires this notice to be sent at least four weeks before the hearing date.

State law also permits property owners to request exclusion from the MSD at the hearing or to submit a written request of exclusion to the Town Council no later than five days after the hearing.

To be excluded, an owner must “state with particularity the reasons why the tract or parcel is not in need of the services . . . of the proposed [MSD] to a demonstrably greater extent than the remainder of the [town], and provide any other additional information the owner deems relevant.” NCGS sec. 160A-537(c1).

We know that an exclusion request is not likely to be granted by a town council that has already made up its collective mind, but this is the redress provided by the statute. There is no statutory right to appeal the Council’s denial of exclusion, but we are not prepared to say that legal action may not be possible subsequent to a denial. 

For the MSD ordinance to be adopted, a majority of the Town Council must approve it at two separate meetings.

Final adoption of the MSDs must be made in April, during the FY 2021-22 budget process, according to Mr. Ogburn’s timeline. The Town Manager notes that the “Dare County Tax Collector” has requested that the MSDs be established no later than May 4, the date of the Council’s May 2020 meeting.

Inasmuch as the timeline shows the Town proceeding “full steam ahead” with presumed votes of approval, and in accordance with the Tax Collector’s deadline, we view the whole process as a farce. If the Town Council truly cared about the application of the statutory standard and about what property owners think, it would have proceeded with a report and a hearing about MSDs immediately after the June 19 hearing. It is clearly just going through the motions here. 

We also wonder, will the notification to MSD property owners come at the same time as those on the oceanfront are being asked to grant perpetual and irrevocable easements to the Town for erosion control activities, which when described in draft form Oct. 6 were grossly overbroad and poorly defined?

A revision of the easement draft has not yet surfaced. Property owners should not have to make multiple trips to their lawyers to sort out what the Town of Southern Shores is doing to them.

FULL DISCLOSURE OF FINANCIAL INTEREST

Many of you know that I am a co-owner of oceanfront property. My siblings and I co-own two of the few remaining undeveloped oceanfront lots in Southern Shores, as well as an oceanfront beach box that we rent out each summer.

My parents arrived in Southern Shores in the 1960s and purchased property when it was plentiful and housing tastes were still very modest. Southern Shores became my family’s home away from home before it became my home now decades ago.

As I said above, North Carolina beaches are public beaches. More precisely, the dry-sand portion of the beaches is held in trust by the State of North Carolina for the public’s use and benefit. I cannot walk out to the beach in front of my family’s oceanfront cottage and tell members of a yoga class that has assembled there to get lost because they are trespassing. They are not. They have a right to use that beach.

And yet, Southern Shores proposes to tax me more for nourishing beaches that I do not own simply because I own land next to them. And the Town Council does not care what use I make, or do not make, of that land.

I will not make an argument today about why I do not think my family and I benefit “to a demonstrably greater extent” from beach nourishment than a property owner elsewhere in town, far removed from the oceanfront. I conclude not with a summation, but with a word about history.

Dare County first started talking about putting sand on its beaches in 1965, as I recall from press reports in the 1990s, but the real push began in 1991 when the county and the U.S. Army Corps of Engineers launched a study. Subsequently, however, federal money dropped out of the equation, and the N.C. General Assembly did not obligate the State to finance nourishment along its coastline of public beaches. Such projects became the responsibility of local governments, of town-county commitments.

I’m glossing over a lot of history here, most of it featuring the Town of Nags Head, which was the town in most need of beach nourishment.

Some of you may recall that, after gaining the General Assembly’s approval, the Dare County Board of Commissioners imposed in 2005 a 1 percent increase in the general sales tax to bolster funds for beach nourishment.

At the time, people still thought that the federal government would pay for 70 percent of a large-scale nourishment project from southern Kitty Hawk to South Nags Head, and that the state and county would kick in the remaining 30 percent. They opposed the so-called “sand tax.”

A local group known informally as the Beach Huggers gathered enough signatures on petitions to force a referendum on repealing the sand tax, which was to remain in place for eight years. Seventy percent of Dare County voters voted to repeal the tax in 2006.

Big mistake. Had the tax remained in force for its projected eight-year life and then been renewed for another eight years, it, in combination with the occupancy taxes dedicated to beach nourishment, might have paid for all of the projects on the Outer Banks’ public beaches.   

Instead, federal and state money (except grants) for beach nourishment disappeared, and now we have municipal service districts, a mechanism that enables towns to stick it to property owners who already pay increased taxes because of their properties’ location and arguably would derive no more benefit than a property owner elsewhere in town.

Ann G. Sjoerdsma, 11/30/20

11/29/20: MSDs CAN WAIT; TOWN COUNCIL TO REDUCE PUBLIC MEETINGS IN 2021.

We love the cleverness of this sign on South Dogwood Trail. We wonder: Will beach nourishment encourage more yard-sign opinions?

Dear Beacon Readers:

We have decided not to diminish our Sunday pleasure by writing extensively about the Town Council’s understanding and handling—past, present, and future—of municipal service districts (MSDs) for the purpose of unequally taxing town property owners to finance the nourishment of Southern Shores’ public beaches. Nor do we intend to write about COVID-19. 

Such work is what Mondays are for, and tomorrow will come soon enough.

We will say that the Southern Shores Town Council is scheduled to consider at its Tuesday meeting its previous handiwork in creating possible MSDs—the district maps are in the meeting packet—which it did without reference to (or concern for) the N.C. statutory standard that governs their creation and, no doubt, with a majority of the Council members not having bothered to read the relevant statute .

You may recall seeing these district maps in the springtime before the last public hearing on beach nourishment, and you may have wondered what became of them. Well, they’re back for the Council’s predictably perfunctory input—which will be predictably approved unanimously—on Tuesday when it meets at 5:30 p.m. in the Pitts Center.

You may access the Council’s agenda here: https://www.southernshores-nc.gov/wp-content/uploads/minutes-agendas-newsletters/Agendas_2020-12-01.pdf.

The meeting packet is available here: https://www.southernshores-nc.gov/wp-content/uploads/minutes-agendas-newsletters/Meeting-Packet_2020-12-01.pdf.

The meeting is open to the public, with COVID-19 safety protocol in place. Everyone must wear a mask and observe six-foot physical distancing.

The meeting also will be available to view by live stream on the Town’s You Tube website: https://www.youtube.com/user/TownofSouthernShores.

There will be two public-comment periods during the meeting. If you will not be attending the meeting and would like to submit a comment, you are directed in new instructions posted on the Town website to email “public comment” to info@southernshores-nc.gov, not to send comments to Town Clerk Sheila Kane. 

COUNCIL TO REDUCE ITS PUBLIC MEETINGS IN HALF

We note that, pursuant to a resolution included in the meeting packet, the Town Council has decided to eliminate its second workshop meeting of the month in 2021, reverting to the 2018-2019 calendar schemes of holding a meeting on the third Tuesday of the month “as needed.”

The Town Council has been inconsistent in its scheduling of third-Tuesday meetings during Mayor Tom Bennett’s two terms in office.

We see this move as an opportunity lost for the public to know what the Council is doing and thinking, in more detail—if it would cooperate in enlightening us—and for the public to bring up problems and concerns, as well as to voice opinions, to elected officials.

That the curtailment has occurred just as the Town Council is moving into the potentially contentious financial phase of the 2022 beach nourishment project is disappointing, and, we hope, coincidental.

The cost of the 2022 project, the details of which the Town Council has never specifically approved, is estimated to be about $16 million, of which Dare County presumably will pay a sizeable portion. According to a statement by Town Manager Cliff Ogburn in the meeting packet, the Town has not yet secured a commitment from the County for a sum certain.

The reduction in the number of meetings also suggests to us a refusal by the Town Council to engage in long-range planning, which requires workshop-type meetings, over time, to discuss.

The regular first-Tuesday meetings are chock-full of staff reports and other housekeeping matters and leave little time for the thoughtful and unrushed discussion of other issues facing the Town that require analysis and planning.

Indeed, we note further that the proposed 2021 calendar contains no designated dates for budget or planning workshop sessions. This is highly unusual. The Town Council has not held a strategic planning retreat since Feb. 16, 2016, but it has held planning sessions. With a brand-new fire station, it has an ideal location to hold a retreat.

Perhaps the next mayor will be inclined to engage in this highly valuable planning tool, which allows for the expression and consideration of public opinion in an informal setting.

(Revision of the Town Land-Use Plan, which is to be budgeted for fiscal year 2021-22, should involve a community meeting/retreat, if history is any guide. Although the current Land-Use Plan is dated 2012, it is based on community opinion data collected in 2005. The plan was so lacking when it was submitted in 2008 that the N.C. Division of Coastal Management sent it back to the Town for corrections and revisions, thus delaying its finalization for years.)    

We remind you that next year is a municipal election year. The four-year terms of Mayor Bennett and Town Councilman Jim Conners will be expiring in 2021, and their successors will be elected in November.

The other three Council members mark their first anniversary of Town elected service this week.

Ann G. Sjoerdsma, 11/29/20 

11/28/20: COVID-19 PATIENTS WHO INITIALLY HAD MILD SYMPTOMS ARE SEEKING MEDICAL HELP LATER FOR ‘RESURGENCE’ OF SYMPTOMS, DCDHHS REPORTS.

Eleven people who initially experienced only mild symptoms of COVID-19 sought treatment the week of Nov. 15-21 at the Outer Banks Hospital Emergency Department for a “resurgence of symptoms,” the Dare County Dept. of Health and Human Services reported yesterday in its first-ever followup of any of the 1,035 people who have tested positive locally for the disease.

These 11 people are among what Dr. Sheila Davies, Director of the DCDHHS, characterized in her Friday COVID-19 update, as a “concerning increase” in the number of people who are experiencing such a resurgence.

Dr. Davies, who is the county’s Public-Health Director, also reported that nearly one-third of the 1,035 COVID-19 cases that have been diagnosed in Dare County since March—332 of them—were diagnosed in November, as people “let down their guard” in observing safety protocols.

“Concerning” is a newly fabricated, and seemingly ubiquitous, adjective that we strongly dislike. It says nothing in this instance except that Dr. Davies is concerned.

Unfortunately, physicians and scientists, such as Dr. Mandy Cohen, Secretary of the N.C. Dept. of Health and Human Services, who describes COVID-19 metrics in North Carolina as “concerning,” have embraced this new word and its meaninglessness.

We would like to know from Dr. Davies: How many people infected with COVID-19 are seeking treatment in the ED for resurgent or lingering symptoms that are more severe? What symptoms are they experiencing? Are they people who were considered to have recovered because they tested negative twice for COVID-19? What is the average time gap between their initial symptoms and the current symptoms about which they are complaining? What do you make of this?

The next time Dr. Davies speaks to the symptomatic history of people infected with COVID-19, we trust the scientist who is entrusted with mitigating the damage caused to Dare Countians by the SARS CoV-2, will be more specific—starting with a profile of who these people are, vis-à-vis the disease.

We do not need their names or their places of residence, but we do need to be informed about the course of their illness.

As Beacon readers know, we have been writing lately about post-COVID-19 syndrome, which occurs after the acute phase of the illness has passed, and patients are considered to have recovered. It is also known as long COVID, and those who suffer from it are called long-haulers. (See The Beacon, 11/22/20, 11/24/20.)

There is no definitive set of symptoms to define post-COVID-19 syndrome, nor is there yet a defined duration, although symptoms are generally not considered lingering until three months after a patient’s diagnosis.

Post-viral syndromes, such as those that occur in patients who formerly had the Epstein-Barr or Ebola virus, are a well-known phenomenon. One condition manifested by these patients is myalgic encephalomyelitis, sometimes called chronic fatigue syndrome, ME or ME/CFS. As one sufferer described it, it is a I-can’t-get-off-the-couch fatigue because any exertion is exhausting.

The most common symptoms suffered by COVID-19 long haulers are profound fatigue, body aches, shortness of breath, and difficulty concentrating (“brain fog”), according to our medical-research sources. Other symptoms include chills, sweats, pain, fever, and difficulty regulating blood pressure and heart rate.

Post-COVID syndrome is a morbidity of COVID-19. A morbidity is simply a diseased state. It cannot be known yet if this morbidity is permanent.

Since the coronavirus pandemic began, the focus by public-health officials, governments, and the media has been on the mortality caused by the virus, not on possible morbidities. This was as it should be, with so many people stricken, tethered to ventilators, and dying, and with hospitals’ capacity to treat them all strained and exceeded. But we believe it is time now to enlighten the public about other potential harms that the virus may cause.

As we have said previously, this is a new virus that is causing what scientists call an emerging infectious disease. With emergence come uncertainty and a certain amount of scientific guesswork based on analogy to other respiratory viruses. But all analogies are, by their nature, flawed. (Hence, the early belief that wearing a mask would not be beneficial to the wearer.)

SARS-CoV-2, which causes the disease dubbed COVID-19, is unique. It is not the same as a strain of the influenza virus, SARS-CoV-1, which causes what is referred to as severe acute respiratory syndrome, or any other virus that has a known clinical history. It is not possible yet to know how this virus, which invades so many organ systems, may affect people who contract it and then recover. That scientific truth alone should make everyone cautious.

We look forward to receiving more information from Dr. Davies about patient followup.

BACK TO THE NUMBERS: 20 NEW CASES REPORTED LOCALLY ON THANKSGIVING

We were wrong in anticipating that the DCDHHS would take a break on Thanksgiving. Instead, it reported 20 new COVID-19 cases on its dashboard that day and seven more yesterday.

Eleven of the 20 people whose positive COVID-19 test results were in the Thanksgiving count are Dare County residents, and nine are nonresidents, according to the DCDHHS dashboard.

Five of the 11 new Dare County cases are in the 25-to-49 age group; three are in the 50-to-64 age group; two are age 65 or older; and one is a juvenile, age 17 or younger.

Five of the nine non-resident cases are also in the 25-to-49 age group, along with two in the 18-to-24 age group; one, age 50 to 64; and one age 65 or older.

Yesterday’s seven cases were concentrated in the 50-to-64 age group: Five people in that age group, of whom four were Dare County residents, tested positive for COVID-9. The remaining two cases were a local man, age 18 to 24, and a non-resident man, age 65 or older.

All 27 of the newly diagnosed people are in isolation.

Dr. Davies’s analysis yesterday of the means of contagion of the most recent COVID-19 cases continued to show that direct contact with an infected person predominates.

ON THE STATE LEVEL: The NCDHHS has reported 7,278 new COVID-19 cases during the past two days after taking a break for Thanksgiving. Yesterday’s total was 3,834, and today’s total is 3,444.

After COVID-19-related hospitalizations statewide dipped slightly yesterday, they climbed back up today and now number 1,840–a record high–according to the NCDHHS dashboard.

Eighty-one more North Carolinians have died of COVID-19 in the past two days, bringing the total number of COVID-19 deaths in the state since tracking began in mid-March to 5,219.

The NCDHHS reported a positivity rate of 7.3 percent yesterday and a positivity rate of 7.8 percent today.

New COVID-19 infections acquired over the Thanksgiving weekend will not be reported until the middle of next week, at the earliest.

Ann G. Sjoerdsma, 11/28/20

11/25/20: N.C. AND DARE COUNTY POST MORE GRIM COVID-19 STATISTICS ON THANKSGIVING EVE; 8TH LOCAL RESIDENT IS HOSPITALIZED. Plus Town Council To Tackle MSDs At Meeting Next Tuesday.

A Thanksgiving celebrant on South Dogwood Trail.

The COVID-19-positive test results of 16 more people were reported today by Dare County, including a local man age 65 or older who has been hospitalized.

There are now eight Dare County residents in hospitals outside of the area being treated for COVID-19, according to the Dare County Dept. of Health and Human Services dashboard. Most of them have been under hospital care for weeks.

The COVID-19 statistics statewide were just as grim today as the N.C. Dept. of Health and Human Services reported 4,212 new cases and a record-high 1,811 hospitalizations.

On Monday, when 200 fewer people with COVID-19 were in the hospital, NCDHHS Secretary Mandy Cohen said that the state’s hospitals were “starting to feel the strain” of patient capacity.

The hospitalized Dare County man was one of four men in the oldest age group reported today by the DCDHHS to have tested COVID-19-positive. Three of the four are locals.

Overall, nine of the 16 new cases are Dare County residents. Two of them are girls age 17 or younger; three are in the 25-49 age group; and one is in the 50-to-64 age group.

The Beacon will be taking a break tomorrow from COVID-19, as will the N.C. Dept. of Health and Human Services. The DCDHHS gave no indication today as to whether it will be observing a holiday tomorrow from COVID-19 metrics, but we anticipate it will.

TOWN COUNCIL MEETING, TUES., DEC. 1, 5:30 p.m.

When The Beacon resumes publication over the weekend, we will be considering another grim topic: the designation of “municipal service districts” for the purpose of assessing higher taxes on some Southern Shores property owners to pay for the 2022 beach nourishment project.

In a display of holiday spirit, the Southern Shores Town Council will conclude this tumultuous year, which is heading toward a crisis ending, at its meeting next Tuesday by suggesting boundary lines for MSDs near and on the oceanfront.

The Council will meet Dec. 1 at 5:30 p.m. in the Pitts Center. Its meeting is open to the public, with COVID-19 safety protocol in place. Everyone must wear a mask. The meeting also will be available to view by live stream.

We believe the timing of the Town Council’s boundary/tax-rate exercise calls for sarcasm. The Council has delayed consideration of MSDs for months, most recently canceling its Nov. 17 workshop, which had been informally noticed as a forum for their discussion.

The Town Council spent a total of 47 minutes meeting in public in November.

The cost of the beach nourishment project, the details of which the Town Council has never specifically approved, is estimated to be about $16 million, of which Dare County presumably will pay a sizeable portion—although the Town has not yet secured a commitment from the county for a sum certain.

We also wonder what happened to the wording of the draft perpetual and irrevocable easement, last discussed at the Council’s Oct. 6 meeting, that the Town would like oceanfront property owners to grant without compensation.

We will discuss MSDs and the process of creating them, as well as highlight other business on the Council’s agenda, in a blog before the meeting.

You may access the Council’s agenda here: https://www.southernshores-nc.gov/wp-content/uploads/minutes-agendas-newsletters/Agendas_2020-12-01.pdf.

The meeting packet is available here: https://www.southernshores-nc.gov/wp-content/uploads/minutes-agendas-newsletters/Meeting-Packet_2020-12-01.pdf.

Happy Thanksgiving, everyone.

Ann G. Sjoerdsma, 11/25/20

11/24/20: DARE REPORTS 21 NEW COVID-19 CASES; EMERGENCY MEDICINE PHYSICIAN AT EMORY DESCRIBES HIS ‘LONG COVID.’

After three days of relatively modest case numbers, Dare County reported a surge today of 21 new COVID-19 cases, including a local man age 65 or older who was hospitalized.

There are now seven Dare County residents hospitalized outside of the area.

Fifteen of the 21 new cases are Dare County residents, according to the Dare County Dept. of Health and Human Services dashboard, and of those, an astonishing nine are in the 50-to-64 age group; four are in the 25-to-49 age group; and two are age 65 or older.

The five nonresidents who tested positive for COVID-19 are generally younger: Three are ages 18 to 24; one is age 17 or younger; and one is in the 25-to-49 age group.

In her Tuesday update today, Dr. Sheila Davies, director of the DCDHHS, looked at 27 new cases since Friday. The dashboard, however, only recorded 26 cases during this time.

Dr. Davies said the county had a COVID-19 positivity rate of 5.4 percent during the week of Nov. 16-Nov. 22.  

The DCDHHS Director’s rundown of the 27 cases shows that they generally adhere to the pattern that has emerged locally of the disease’s transmission being caused by close contact with a known infected person.

Dr. Davies again asks that people observe the three Ws, in order to prevent the spread of COVID-19. She does not mention the Governor’s stricter face-covering mandate, which takes effect tomorrow at 5 p.m. (See The Beacon’s post earlier today.)

LONG COVID IN A YOUNG DOCTOR WITH NO PREEXISTING CONDITIONS

In our continuing effort to inform people about post-[acute] COVID syndrome or chronic COVID-19 symptoms, we refer you to a compelling column in “The Journal of the American Medical Assn.” written by a young physician who is a COVID-19 “long-hauler.”

Dr. Jeffrey N. Siegelman, an assistant professor of emergency medicine at the Emory University School of Medicine in Atlanta, writes in “Reflections of a COVID-19 Long Hauler,” that he awoke on a Monday morning with a headache, “and I am not a headache person.

“Fever followed,” he continues, “and the next morning my blueberry yogurt tasted of nothing. Thick emptiness. I knew I had it. Now, after more than three months of living with coronavirus disease 2019 and the fatigue that has kept me couch-bound, I have had ample time to reflect on what it means to be a patient . . .”

See Dr. Siegelman’s JAMA article at https://jamanetwork.com/journals//jama/fullarticle/2773056.

Dr. Siegelman graduated in 2007 from the Albert Einstein College of Medicine at Yeshiva University in New York and did his post-graduate training at Harvard. He is probably about 40 years old, although he does not give his age.   

One important point the young emergency physician makes is that a “mild” case of COVID-19 can have “dramatic effects,” of long duration.

According to Dr. Siegelman, he had “no preexisting conditions, was never hospitalized, had minimal respiratory symptoms, and even managed to do limited office work throughout the acute illness.

“. . . And yet, living with this has been anything but mild. I quarantined in the basement for 40 days, staying isolated from my family because low-grade fevers continued, and the Centers for Disease Control and Prevention guidance was unclear for people like me.”

Another important point he makes is that “The lack of objective data does not preclude illness.”

Based on the known objective data, Dr. Siegelman recovered from his bout with COVID-19. His body was clear of the virus, as he writes:

“My test results were normal: nasopharyngeal swabs for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), imaging, laboratory results, oxygen saturation were all fine. But I did not feel fine, and still do not.

“I have had a rotating constellation of symptoms, different each day and worse each evening: fever, headache, dizziness, palpitations, tachycardia, and others.”

Dr. Siegelman is fortunate that he can isolate safely from his family in a well-equipped basement and can afford to miss days from work. His supportive colleagues have covered his shifts. He also has long-term disability insurance that will give him financial security if his three-month-long illness extends beyond six months.

“With each negative test,” he writes, “my worry increased that my employer would ask me to go back to work too soon or my primary care physician would rule out COVID-19 despite strong clinical evidence.”

How many PCPs would simply dismiss a long COVID patient as having symptoms that are only “in his head” or attribute them to severe anxiety?

“[M]any physicians are not aware of long COVID,” writes retired scientist Debra Krummel, Ph.D., in a comment at the end of Dr. Siegelman’s article, who says she has been in the same “boat” for more than four months.

Finally, Dr. Krummel says, “research into this chronic condition is now happening.” COVID-19 morbidity, as well as mortality, is being discussed.

Dr. Siegelman says that he “doubted myself multiple times—thinking if I just pushed myself harder maybe I could go back to work and to my regular life, to move on.

“Then,” he explains, “I would eat something without taste, would feel my heart pounding uncontrollably for hours, or would get so dizzy that I could not even write a simple letter.

“Each evening as my symptoms peaked, I was reminded that my diagnosis was not in question.”

Ann G. Sjoerdsma, 11/24/20

11/24/20: N.C. IN ‘DANGER’: GOVERNOR ‘RATCHETS UP’ MASK MANDATE, AUTHORIZING CRIMINAL CHARGES FOR NONCOMPLIANCE; Face Coverings Now Required Indoors in Public Places Outside Home.

Dr. Mandy Cohen asked people yesterday to “consider celebrating Thanksgiving differently this year.” She advised them to “avoid traveling and getting together in person, especially indoors.”

All people in North Carolina will be required to wear a face covering when they are indoors in any public place outside of their homes that is also occupied by a non-member of their household and outdoors when they cannot maintain six feet of distance from non-household members, starting tomorrow at 5 p.m., according to a new executive order announced at a 2 p.m. briefing yesterday by Governor Roy Cooper.

The order also requires businesses to take more responsibility for ensuring that “masks are worn by everyone” in their indoor space, at the risk of criminal sanctions, and extends Phase Three until 5 p.m. on Dec. 11. The last executive order had extended the phase until Dec. 4.

“I have a stark warning for North Carolinians today,” the Governor said before introducing new Executive Order 180 and after citing the State’s “record-high” number of new COVID-19 cases and hospitalizations and its reach of the “grim benchmark of 5,000 deaths.” (See The Beacon, 11/22/20.)

 “We are in danger,” the Governor said. “This is a pivotal moment in our fight against the coronavirus. Our actions now will determine the fate of many.”

(Today’s statewide numbers are even worse than yesterday’s: 3,100 new COVID-19 cases and 1724 hospitalizations, according to the N.C. Dept. of Health and Human Services’ dashboard.)

Although not mentioned directly by Governor Cooper, Executive Order 180 specifically authorizes state and local law enforcement to enforce what he called a “strengthened” Face Covering Mandate against individuals who fail to wear a covering. A violation of the mandate is a Class 2 misdemeanor, which carries a maximum penalty of 60 days in jail and a $1,000 fine.

Law enforcement also may cite a business or organization that fails to enforce the face-covering requirements, as they are ordered to do.

The offense charged would be a violation of N.C. General Statutes section 14-288.20A, which pertains to emergency prohibitions and restrictions.

See Executive Order 180 at EO180-Face-Coverings-Requirements.pdf (nc.gov).

That Governor Cooper, who has long sought to persuade, not force people to wear protective face coverings, is finally calling for criminal sanctions against those who do not wear them outside of their homes, and, therefore, violate his new executive order, is a testament to how “dire” and “deadly serious”—in his words—the situation is statewide.

Ten more N.C. counties are now in the “critical” red tier on the COVID-19 County Alert System map, according to the Governor, thus, bringing the total red counties to 20. This escalation is based on COVID-19 metrics received from county health departments for the period from Nov. 6 to No. 19.

(See The Beacon, 11/18/20 for an explanation of this system, which was introduced just last week. Dare County remains in the “substantial” orange tier; we will discuss its status below.)

The Governor said that the State’s plan had been to update the county alert map every four weeks, but with the next seven to 14 days in the fight to stop the spread of COVID-19 being so “critical,” he decided to give North Carolinians a “snapshot” of where the state is now.  

See COVID-19-County-Alert-System-Report.pdf (nc.gov)

“We are on very shaky ground,” said Dr. Mandy Cohen, Secretary of the NCDHHS, concurring with the Governor and elaborating upon the State’s “worsening” COVID-19 metrics.

“I do not want to see the bottom fall out,” she said grimly. “I’m particularly concerned about our record number of people in the hospital.”

The number of hospitalizations statewide topped 1,600 yesterday, according to the NCDHHS dashboard. Today, it is over 1,700. On Saturday, a record-high 4,514 new COVID-19 cases were reported, for a positivity rate of 8.5 percent.   

Although hospitals still have capacity for COVID-19 patients, Dr. Cohen said that some of them “are starting to feel the strain.”

The NCDHHS Secretary put the situation in easy-to-understand terms when she said, “The coming weeks will be a true test of our resolve—to do what it takes to keep people from getting sick, to save lives, and to make sure you have hospital care for whether it’s a heart attack, a car accident, or COVID-19, when you need it.”

“This virus is deadly,” Governor Cooper emphasized. “It’s spreading too fast, and it’s up to each one of us to slow it down.”

RESTAURANT GUESTS MUST WEAR MASKS WHEN TALKING TO EACH OTHER

Executive Order 180 requires face coverings to be worn in all “public indoor settings” and specifically elaborates upon these settings: for example, child care facilities; fitness and physical activity facilities; government operations; museums and aquariums; restaurants, breweries, distilleries, and wineries; retail businesses, etc.

A new restriction not singled out at yesterday’s briefing requires all guests at restaurants to wear face coverings—including at their tables—when they are “not actively drinking or eating.”

There is no exception in the Executive Order for “actively conversing.” The letter of the EO clearly requires guests to mask up when they are simply talking among themselves.

Restaurant employees must wear face coverings at all times.

The new order also requires retail businesses to ensure that all “guests” wear face coverings when they are inside their establishments. Further, any retail business that has more than 15,000 square feet of interior space must post at each public entrance a worker who “is responsible for [enforcing] the Face Covering and Emergency Maximum Occupancy requirements established by Executive Orders.”

While both the Governor and Secretary Cohen referred to “partnering” with businesses to “stem the tide” of COVID-19, the new order clearly puts a burden on businesses to ensure compliance person-by-person, at the risk of sanctions. You might analogize the employee at the entrance to a large retail store to a bouncer at a bar or nightclub. 

Executive Order 180 also makes a noteworthy exception for professional or collegiate athletes who are operating “under a COVID-19 health and safety protocol.”

Such athletes are to be “encouraged,” but not required, to wear face coverings when they are “strenuously exercising or recovering from exercise,” the order states, and when they are training for, or participating in, a sport that is under the oversight of a league or other organizer that has a COVID-19 protocol in place.

When such athletes are on the sidelines and in practice, or at any other time that “they are not strenuously exercising or recovering from recent exercise,” the Executive Order requires them to wear face coverings.

We will soon see how college football teams playing in North Carolina, as well as the Carolina Panthers, respond to these demands. 

The face covering mandate applies to all people at least 5 years old and is recommended for those everyone over age 2.

MASKS WORK: WHAT WILL IT TAKE?

“The [Three Ws] actions are simple and the effects are profound,” Dr. Cohen stressed yesterday yet again. “Masks work.”

And yet, people refuse to wear them. What will it take to change this behavior? Throwing people in jail?

And if people are arrested for not wearing masks, what will the public/community ramifications of such arrests be?

The preamble to the new Executive Order—the “whereas” portion—cites five studies that purportedly show the effectiveness of face coverings.

The evidence is there, the order virtually screams, if people care to read it and to give it due weight–much in the same objective manner that scientists apply in arriving at their decisions.

Dr. Cohen repeated yet again yesterday that the virus is transmitted through respiratory droplets in the air emitted by an infected person when he/she sneezes, coughs, talks, sings, or just breathes.

The mask “is a barrier,” she stressed. “Studies show masks reduce the spray of respiratory droplets. . . . The more people who wear a mask, the more the community is protected, and, therefore, the more you individually benefit.”

While we appreciate that Governor Cooper and Secretary Cohen are at their wits’ end, frustrated that millions of North Carolinians refuse to do something as simple—and as effective—as wear a face covering, we believe that the Secretary’s “get behind the mask” reiterations are ineffective, and the Governor’s soft-pedaling of the criminal sanctions he has authorized is a mistake.

The Governor should have said directly and honestly that people who refuse to wear a face covering as ordered are now subject to criminal charge and conviction. Local police may refuse or be reluctant to take action, but that is beside the point. Leaders who are not bold face criticism from their detractors.

Instead, in response to a question from a reporter about enforcement, North Carolina’s Chief Executive said: “The enforcement of the Executive Order can be done by local and state law enforcement, local health departments, the state Department of Health and Human Services—all of those enforcement tools are available.” 

That does not cut it, as far as we are concerned. He should be up-front about the possibility of an arrest and explain why such enforcement would be constitutional. We can already hear the grumbling among the maskless about the United States being a “free country.”

Instead of repeatedly urging people to wear a face covering for the sake of the public’s health, he should explain to those who refuse to do so—especially because of a “civil liberty” claim—why their thinking is wrong-headed. Engage them. Don’t just issue a “call to arms.” They are hearing a different call.

We also believe that Secretary Cohen should have said more about the option of filing a complaint with a local health department about a violation of the new Executive Order. Dr. Sheila Davies, the director of the Dare County Dept. of Health and Human Services, should step up and do the same.

In our reporting 11/22/20 about post-COVID syndrome in “long-haulers,” also known as long COVID, we sought to discuss the risks presented by this virus in a way that no one in the public eye is discussing.

It is well known in informed medical circles that some people–including young people–who have “recovered” from COVID-19, both mild and severe cases, still suffer from lingering or “chronic” symptoms. If someone thought he or she would experience cognitive impairment for months, if not longer, after acquiring COVID-19, would he/she reevaluate a decision not to wear a mask?

This is a new virus, a pathogen that has no long-term clinical history. It is not the same as influenza or the coronavirus 1 that causes severe acute respiratory syndrome (SARS). It is not possible to know yet how this virus, which invades so many organ systems, may affect people who contract it and then recover. Cases vary by the individual. There is a big risk of the unknown here.

People should understand that, or at least be told that.

We believe that if both Secretary Cohen and Dr. Davies put on their scientist caps and communicated with the public about what is known about COVID-19 and its risks to the health of all people, they might connect with some noncompliant North Carolinians. While they both stand behind the “science,” they never discuss it apart from the COVID-19 metrics, and the metrics don’t involve much informative scientific data. They are quantifications that people can find ways to minimize and deny.

The Governor said yesterday that “We don’t want to go backward, but we will if it’s necessary.” He will “rachet up” restrictions even more, he said, in order to protect the health and safety of North Carolinians.

He also concluded that he and Dr. Cohen believe “that with these [new] rules in place, that if we get more compliance and better enforcement, that we can stem the tide without having to go backward with more restrictions.”

More compliance, better enforcement . . . Why would they get either? So far, what the Governor and the Secretary are doing has not worked.

Maybe they will get the cooperation of some local officials in stopping the spread and make inroads on the grass-roots level. The Mayor of Greensboro spoke eloquently yesterday about the safeguards she is requiring in her city, but Greensboro ain’t Mayberry, or Dare County, for that matter.

We think the State officials should consider taking a different approach with the public and speak to the noncompliant in a manner that would be meaningful to them.

DARE COUNTY’S ORANGENESS 

As stated above, Dare County remains in the orange tier in the State’s COVID-19 alert system, with a “substantial” risk of transmission of the disease. Currituck County is in the yellow tier, with a “significant” risk.

Interestingly, the data accompanying the map now show the number of COVID-19 cases all 100 N.C. counties had in a 14-day period per 100,000 people. Dare’s is a whopping 413.4 cases during the Nov. 6-19 period.

Last week, in response to a reader’s inquiry, we did calculations of Dare’s recent cases over a 14-day period and determined that it should be in the red tier, with far more than 200 new cases per 100,000 people. (See The Beacon, 11/19/20.) As this new data show, we were correct.

Dare County does not qualify for the critical red tier, however, as we surmised, because its positivity rate was less than 10 percent, and the impact of COVID-19 on its hospital is only “moderate,” not “high.”

To be classified as “red,” a county either has to have a positivity rate of at least 10 percent or a “high” COVID-19 impact on its hospital(s).

If Dare County COVID-19 patients were actually hospitalized locally, the impact on the Outer Banks Hospital might be considered high. Instead, they are transported outside of the area, a fact that diminishes the usefulness of the new mapping tool.

Dare County’s new single-day case numbers have been five or fewer since last Friday, according to the DCDHHS dashboard. We do not know yet, however, how many tests were performed locally the weekend before Thanksgiving.

Ann G. Sjoerdsma, 11/24/20

11/22/20: COVID-19 CASES STATEWIDE TOP 4,500 IN ONE DAY; A Dare County Woman Is Hospitalized; And a Word About Post-Covid Syndrome.

For a news report on post-COVID syndrome, tune into ’60 Minutes’ tonight at 7 on CBS.

Single-day COVID-19 cases statewide hit a record-high 4,514 today, according to the N.C. Dept. of Health and Human Services’ dashboard, while current hospitalizations declined in number, but remained high at 1,571.

The NCDHHS also reported a positivity rate of 8.5 percent.

Thus far this weekend, the Dare County Dept. of Health and Human Services has reported only five new COVID-19 cases—three among locals—but one of them is a Dare County woman age 65 or older who has been hospitalized.

The number of hospitalizations of Dare County residents jumped from four to six on the DCDHHS dashboard yesterday, with no explanation for the other case. Either an error was made, or someone in isolation has regressed and needs hospitalization—a “status change” that went unreported by the DCDHHS.

Dare County’s new-case count for today will likely be posted after 5 p.m., if the DCDHHS conforms to its recent timing for updating the dashboard. (UPDATE: The DCDHSS reported four new cases at 5:30 p.m., two residents and two nonresidents. One resident is a man age 65 or older. The other three cases are people in the 18-to-24 age group. All are in isolation.)

Even though the U.S. Centers for Disease Control and Prevention recommended last Thursday that people stay home and not travel for Thanksgiving, The Washington Post and other news organizations reported yesterday that more than 1 million people passed through the nation’s airports on Friday, as counted by the Transportation Security Admin. (TSA).

CNN reported today that the number of TSA screenings yesterday brought the total number of people traveling by air Friday and Saturday to more than 2 million.

These numbers are 42 percent of the total screenings performed on the Friday and Saturday before Thanksgiving last year, CNN said, but they are also the second and third-busiest U.S. air travel days since mid-March. (For some reason, 1.03 million passengers were screened on Oct. 18, the news network reported.)

The CDC reached its recommendation after being alarmed to see 1 million new COVID-19 cases reported across the county during the immediately preceding week.

Earlier, the CDC had reported that more than 50 percent of COVID-19 transmission is caused by infected people who are asymptomatic or presymptomatic and do not feel ill.

See Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2 | CDC

We appreciate that, whether people travel or stay home, dine alone or with a large party, they are doing their own risk-benefit assessments, and we do not intend to second-guess them—provided they take precautions to protect other people from possible contagion.

But we do wonder how many people have given any thought to contracting the virus and never recovering from some of its vexing effects or spreading it to someone else who becomes a “long hauler”?

WHAT IS LONG-HAUL COVID-19 SYNDROME?

We have been reading for months about post-COVID syndrome, aka long-haul COVID-19, long-hauler syndrome, or, as it is known in the United Kingdom, long COVID, and wondering when the nation’s and the state’s public-health experts would start talking about it.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, first brought it to our attention in June or July when he spoke about a post-COVID 19 syndrome characterized by “profound fatigue” and “brain fog.”

We previously had read about severe long-term damage to the lungs, hearts, and brains of COVID-19 patients, but this was not what Dr. Fauci called post-COVID.  

COVID-19 long haulers are patients who have recovered from the disease, but continue to have lingering symptoms at least three months after onset of the disease, according to the Harvard Medical School, which provides a nice summary here: https://www.health.harvard.edu/blog/the-tragedy-of-the-post-covid-long-haulers-2020101521173

People are post-COVID—they have “recovered”—when tests no longer detect the virus in their bodies. According to published studies and surveys conducted by patient groups, Dr. Anthony Komaroff of Harvard writes, 50 to 80 percent of patients continue to suffer from symptoms.

Post-COVID syndrome is somewhat analogous to surviving the horrors of war only to experience a lifetime of post-traumatic stress. With COVID-19, however, there is insufficient clinical history to know how long symptoms might last or even to predict their duration.

But post-viral symptoms, such as those that occur in patients who formerly had Epstein-Barr, Ebola, or severe acute respiratory syndrome (SARS), are a well-known phenomenon. One condition manifested by these patients is myalgic encephalomyelitis, sometimes called chronic fatigue syndrome, ME or ME/CFS.

(I knew someone who had post-polio syndrome. She recovered from polio as a child, only to be stricken decades later by debilitating symptoms that affected her leg muscles, causing them to atrophy and disabling her mobility.)

Coincidentally, CBS’s “60 Minutes” will be featuring a segment on post-COVID syndrome tonight at 7 on channel 10. We only found out about this report during the Washington Football Team’s game this afternoon, after we started writing this post.

A distressed young woman, in the 25-to-49 age group, appeared on one “60 Minutes” promotion talking about a “viral tornado.”

It is long past time to bring this syndrome to the public’s attention. 

LINGERING SYMPTOMS

The CDC alerted physicians in May to a life-threatening COVID-19 “multisystem inflammatory syndrome” in children—remember the Kawasaki-like syndrome?—but it has been slow to respond to the gathering clinical evidence about post-COVID in adults.

The most common symptoms suffered by post-COVID long haulers are fatigue, body aches, shortness of breath, difficult concentrating (“brain fog”), headaches, inability to exercise, and trouble sleeping, according to our research sources.

The full constellation of symptoms also includes chills, sweats, pain, fever, difficulty regulating blood pressure and heart rate, and a variety of others, depending on which organ systems the virus attacked.

There is no definitive set of symptoms to define long-haul COVID-19, nor is there yet a defined duration.

Harvard’s Dr. Komaroff divides long-haulers into two groups:

  1. Those who experience some permanent damage to their lungs, heart, kidneys, or brains that may affect their ability to function; and
  2. Those who continue to experience debilitating symptoms like those described above despite there being no detectable damage to organs.

Myalgic encephalomyelitis, aka chronic fatigue, is associated with the second group.

Three people with post-viral ME write movingly about their chronic condition and reach out to COVID-19 long-haulers in The Washington Post article, “With Long-Haul COVID-19, Important Advice for Patients, Doctors, and Researchers,” at https://www.washingtonpost.com/health/long-haul-covid-patients/2020/10/23/ab7c5324-0712-11eb-9be6-cf25fb429f1a_story.html

Clinical research that we read online shows that both people only mildly affected by COVID-19 as well as those who were severely ill can have post-COVID syndrome.

Typically, it takes less than two weeks to recover from a mild case, and about four to six weeks to recover from a severe case.

Dr. Komaroff says that lingering symptoms are “more likely to occur in people over age 50, people with two or three chronic illnesses, and people who became very ill with COVID-19,” but we view this as a tentative assessment.

He also does not define the “chronic illnesses.” Obvious illnesses are hypertension and diabetes, but a vitamin D deficiency, according to one report we read, also could be a chronic illness.

One COVID-19 news website cites asthma as the most common co-morbidity in long-haulers, even though people with asthma are less likely to contract COVID-19 than non-asthmatics.

Various hypotheses about the cause of post-COVID have been proposed: They include a severe inflammatory response, venous blood clotting, and oxygen deprivation.

Dr. William Petri, a medical professor at the University of Virginia, reportedly hypothesized that the virus remains in “immune privileged cells” of post-COVID sufferers and cannot be cleared or detected. Some of these so-called IPCs are in hair follicles, which could explain why long-haulers are reporting hair loss!  

We will not cite any firm conclusions here. Science is often uncertain. Clearly, further clinical studies and information about long-term recoveries are needed.

Here are some other articles for your edification:

Commentary: What We Know So Far About Post-COVID Syndrome – Merck Manuals Consumer Version

Post-Covid Syndrome: What It Is, Causes, Similarities to Chronic Fatigue Syndrome (ME/CFS) | Berkeley Wellness

Post-COVID syndrome: Mayo Clinic studying symptoms affecting some long after infection – Twin Cities

Wikipedia even has an entry under “Long Covid,” in which more symptoms are reported.

We plan to watch “60 Minutes” tonight. Stay tuned.

UPDATE: The “60 Minutes” segment featured patients and their treatment at the Center for Post-Covid Care at Mount Sinai Hospital in New York. It was very sketchy. Long-haulers at Mount Sinai were characterized as young people in their 20s to their 40s who had mild cases of COVID-19 and were never hospitalized, but months later have debilitating symptoms.

The lingering symptoms described by the profiled patients included profound fatigue, severe headaches, hand tremors, tachycardia (rapid heat beat), heavy limbs, ataxia (a lack of muscular movement coordination), and peripheral pins-and-needles pain. They were all women.

One cause offered by a physician for the post-COVID syndrome was the severe inflammatory response that we mentioned. For some reason, the immune system goes into overdrive and continues to fight the virus even after the virus has been vanquished, killing healthy cells.  

This same physician called the syndrome a mystery.   

Ann G. Sjoerdsma, 11/22/20

11/19/20: N.C. TOPS 4,000 NEW COVID-19 CASES IN ONE DAY; Plus A Clarification on Dare County Risk Calculations.

A change of visuals can’t hurt.

Two days after the Governor introduced a COVID-19 county risk mapping tool to try to persuade North Carolinians resistant to masks and social distancing to take precautions against viral transmission, the State topped 4,000 new COVID-19 cases in one day and  set a new record-high number of hospitalizations.

Today’s N.C. Dept. of Health and Human Services dashboard reports 4,296 new COVID-19 cases in the past 24 hours and 1,538 COVID-19-related hospitalizations.

According to the NCDHHS, 38 more North Carolinians have died because of COVID-19, a number that brings the total number of deaths in the state to 4,936.

The 4,296 new COVID-19 cases are 1,000 more than were reported by the NCDHHS on Tuesday, when Governor Roy Cooper said at a briefing that, although the State’s daily case numbers are “too high,” they are only “increasing, not surging.” 

The Governor has sought to distinguish North Carolina from other states currently experiencing COVID-19 outbreaks, such as the Dakotas, Iowa, Nebraska, and other heartland states, as not having a “surge” in cases. He also said that North Carolina never experienced a “spike” in cases, but rather a steady increase.

We wonder what would have to occur statewide for the Governor to consider the fast-rising number of new COVID-19 cases each day in North Carolina a surge and whether that characterization would compel him to change his strategy. 

CALCULATING THE RISK OF COVID-19 IN DARE

Thanks to an astute reader’s inquiry, we went back over our recent posts regarding the Harvard Global Health Institute’s mapping of COVID-19 risk by state and county and discovered that we omitted two key words in describing the measure: per day.

The Harvard risk system calculates the number of new COVID-19 cases in a county PER DAY per 100,000 people. In contrast, the new N.C. COVID-19 County Alert System calculates the number of new COVID-19 cases in a given 14-day period per 100,000 people.

In explaining the new mapping tool Tuesday, Dr. Mandy Cohen, the Secretary of NCDHHS, cited the White House Coronavirus Task Force as the source for the metrics methodology that her department used.

You may access the COVID-19 County Alert System here: https://files.nc.gov/covid/documents/dashboard/COVID-19-County-Alert-System-Report.pdf

Is it possible for Dare County to be in Harvard’s critical red zone for reporting 30.5 new COVID-19 cases per day per 100,000 people and also in the State’s orange zone for reporting 100 to 200 new cases per 100,000 people from Nov. 1-Nov. 14, 2020?

You do the math.

Between Nov. 1-14, 2020, according to the Dare County Dept. of Health and Human Services’ dashboard, the county reported 181 new COVID-19 cases, of which 141 were local residents. 

The Harvard researchers use a moving seven-day average to calculate their per-day case increase. Thus, you need to know that between  Nov. 1-7, the DCDHHS dashboard reported 77 new COVID-19 cases, of which 53 were locals, and between Nov. 8-14, the numbers were 104 new COVID-19 cases, of which 88 were locals. 

(Of course, the Harvard team could have used another recent seven-day period, as well.)

You also need to know that, unless there has been a radical population explosion this year, Dare County has about 40,000 year-round residents. Roughly speaking, you would have to adjust any average number of cases by multiplying by 2.5, to arrive at a per-100,000 people figure.

In the first week of November, the daily case average for the Harvard researchers is either 11, if you take into account all of the cases, or eight, if you only use the Dare County resident cases. In the next week, the numbers are 15 and 13, respectively.

Regardless of which figure you use between eight and 15 for an average, you can easily see how Harvard derived its quantification of risk of 30.5 cases per day per 100,000. 

But how did the State of North Carolina calculate that Dare County had 100 to 200 new cases per 100,000 people from Nov. 1-Nov. 14, 2020?

Between those dates, as stated above, the DCDHHS reported 181 new COVID-19 cases, of which 141 were local residents. If you multiply either of those figures by 2.5, to adjust for population, you get numbers that clearly put Dare County in the red tier, which is defined as more than 200 COVID-19 cases per 100,000 people.

But here’s the rub: In order for a county to be assigned to the red tier, it also must meet one of two other thresholds, according to the NCDHHS explanation that accompanies the map. Either the county has a positivity rate of 10 percent, which Dare does not, or the impact that COVID-19 has had on the county’s hospital is “high,” which it is not.

Dare would appear to be over-qualified for the orange tier, and under-qualified for the red tier.

Obvious questions include: What population figure did the NCDHHS use for Dare County? And did it adjust for a seasonal increase of nonresidents?

This is the best we can do in deciphering the State’s determination that Dare County is in the orange tier for COVID-19 risk.  

We regret any confusion that we caused by omitting the critical words “per day” in our earlier post and any confusion we may cause today with our rough figuring.

Whatever methods the NCDHHS used, we agree with Governor Cooper who said on Tuesday about the state’s COVID-19 cases: “These are numbers we cannot ignore.”

Ann G. Sjoerdsma, 11/19/20

11/18/20: 15 MORE COVID-19 CASES REPORTED IN DARE COUNTY, 14 OF THEM LOCALS.

Dare County reported 15 new COVID-19-positive tests today on its Dept. of Health and Human Services dashboard, 14 of them of local residents.

Of the COVID-19-positive residents, seven–or one-half of them–are between the ages of 25 and 49, the demographic that is driving the pandemic nationwide, and four are children age 17 or younger. Only one is age 65 or older, and all are in isolation.

As has been the case since the pandemic began, females continue to be diagnosed with COVID-19 more often than males.

The total number of COVID-19 cases reported in Dare County since March is 929: 584 Dare County residents and 345 nonresidents.

THE BEACON, 11/18/20