Amid calls to reopen NC, top COVID forecaster says state 'definitely opening too soon'
Posted May 12, 2020 6:25 p.m. EDT
Updated May 14, 2020 5:46 p.m. EDT
Raleigh, N.C. — One of the lead University of Washington researchers whose team is now predicting more than 4,400 deaths in North Carolina from COVID-19 through early August says state leaders are moving too quickly to reopen.
Revised modeling from UW's Institute for Health Metrics and Evaluation published Tuesday sharply increased the statewide number of expected coronavirus deaths, a fourfold rise over past projections. Just two days before, the model from the university-based independent research center put the forecast number of cumulative deaths in North Carolina at about 1,200 through Aug. 4.
The changes to North Carolina's death forecast were among the most significant of any state.
In an interview with WRAL News, Ali Mokdad, professor of health metrics sciences at IHME, said the increases were squarely the result of people traveling and interacting more as talk of easing restrictions began to build. And he was unequivocal that Democratic Gov. Roy Cooper's decision to roll back parts of his stay-at-home order were premature.
"North Carolina is definitely opening too soon," Mokdad said.
Mokdad's comments come on the heels of calls from protestors and some Republican lawmakers for Cooper to move faster to restart the state economy – and as unemployment claims in the state filed since the pandemic hit topped 1.1 million. State Senate Leader Phil Berger this week called on the governor to grant counties the discretion to open restaurants and hair salons, pointing to other states in the southeast that have already made similar moves.
"We see that we flattened the curve, and not only are hospitals not overwhelmed – they’re laying people off. We see that half of North Carolina counties comprise less than 10 percent of confirmed cases, which would suggest a county-by-county approach is best," Berger spokesperson Pat Ryan said in an email Thursday. "And we see that hourly workers – those who work in hair salons and restaurants, for example – can’t earn a living and can’t collect the unemployment assistance they’re due."
A recent WRAL News poll, meanwhile, found that a majority of North Carolinians would support reopening around June 1 or later.
Before the state had even entered phase one of reopening, which allowed some non-essential retail stores and state parks to reopen after 5 p.m. Friday, IHME's data showed a significant increase in mobility among state residents. That rise in mobility – and decreased social distancing – is projected to continue through mid-May, where the forecast predicts we'll move around twice as much as we did compared to a low point in early April.
"Talking about the relaxation of measures – that is a psychological effect for people. 'Oh, it's getting better now. I can get out,'" Mokdad said. "And people started getting out."
Mokdad said his team's modeling doesn't support the arguments for relaxing social distancing in the state yet, especially as the rate of new infections continues to grow.
"We will have epidemics when we relax. Every state will have an epidemic here and there," Mokdad said. "But the magnitude of that epidemic will be smaller if your cases right now are much less – one, two – and then if your mobility is not [high] at the time when the virus is still going up."
In a press briefing Thursday, Cohen said cast a degree of skepticism at the IHME model, which she described as largely based on the outcome of restrictions put in place and later removed in Wuhan, China. The forecasts have been criticized by other national experts as well.
"What is hard for them in their model, I believe, is understanding as we ease back, what does that really do in terms of changing?" Cohen said. "They have a bit more of an on/off switch for things that would impact viral spread, where we are trying to take a measured approach to easing the restrictions."
In response to follow-up questions Thursday evening, Mokdad disputed Cohen's characterization of the IHME modeling, saying the Wuhan experience "is irrelevant now and not used."
"Early on it was based on restrictions in Wuhan, South Korea, Spain, and Italy," he said in an email. "Now it is based on US experience and mobility data for the US."
The IHME model shows North Carolina is no longer projected to be past its peak of new "estimated infections" – a figure that includes both lab-confirmed cases and other, untested cases.
Two days ago, the model projected that the end of May would see about 1,100 new estimated infections per day and dropping. Now, that projection forecasts we'll see about 7,500 new estimated infections daily by May 31, up from 4,400 estimated new infections today.
The peak now isn't expected until early June, when IHME forecasts the state will hit almost 8,000 new estimated infections a day.
Even with number of infections and deaths revised upward, the model predicts the spread of the virus isn't likely to overwhelm the state's hospitals – one of the early concerns nationwide that prompted health experts to encourage social distancing.
Although IHME researchers are projecting a continued increase in testing capacity through early August, Mokdad said it won't be enough to keep up with the estimated number of infections on the horizon – and all the contact tracing that comes with it.
"You want more tests because you want to test those who are asymptomatic," he said. "You want to do a random sample in North Carolina, find out how the virus is behaving and you do it on a regular basis, basically taking the pulse and the blood pressure of the state and to see the virus is not going up, it's coming down."
State health officials have previously resisted calls – particularly from Berger – to conduct random testing amid shortages of diagnostic supplies and personal protective equipment. And for most of the pandemic's early spread, state guidance restricted tests to patients who met certain criteria.
But with testing capacity increased in recent weeks, state officials in both the administration and the legislature have now backed wider studies to detect asymptomatic spread. And on April 20, DHHS expanded guidelines to providers to "consider testing for any patient in whom COVID-19 is suspected."
Still, Mokdad's concerns North Carolina isn't testing enough conflicts with goals from Cooper and DHHS Secretary Dr. Mandy Cohen to test an average of 5,000 to 7,000 people daily – goals the state began meeting in early May.
Cohen said although state leaders are looking "at all types of models to help us inform our thinking," they're focusing more closely on their own numbers – and what they know about the state's own nuances – to make decisions.
"The hard part about this is we don't have data to know precisely, if we ease up on these kinds of things that are higher risk ,what will it mean in terms of viral spread, which is why we have to go slow," she said. "We have to keep looking at these trends as we make these changes to understand how is the virus spreading."
Mokdad acknowledges there are still plenty of unknowns. Among them, how North Carolinians interact when they do begin to travel more. It's still possible, he said, to bring projected death numbers down with changes in behavior.
"The question mark for North Carolina is, when people go out, will they be wearing a mask? Will they keep a safe distance from each other? That's a big determining factor," he said. "Mobility right now could be different than the mobility in the past."
WRAL statehouse reporter Travis Fain contributed reporting.
Editor's Note: A version of this story originally published Tuesday evening was significantly updated Thursday with comment from one of the researchers at IHME.