DHHS expands coronavirus testing through statewide order, temporary test sites
Dr. Mandy Cohen, secretary of the state Department of Health and Human Services, provides a July 7, 2020, update on the coronavirus outbreak in North Carolina and the state's response to it.
and I am joined by Brian Tipton and Karen Magoon, who are today's American sign language Interpreters and working behind the scenes are are Spanish translators Jackie and Jasmine. Motive. Here, As usual, I'll start with a rundown of our numbers. So as of this morning, there are 75,875 lab confirmed cases, 989 people currently hospitalized, and sadly, there have been 1420 deaths. I continue to be concerned that North Carolina's Key Cove in 19 metrics moving in the wrong direction. Daily case counts are up, and the percent of tests returning positive has stayed high. And today is another new high for the number of people with Cove in 19 who are hospitalized. Our state needs to stabilize thes trends in orderto avoid a dangerous spike in the virus that could overwhelm our medical system and race. Risk us going backwards like so many states are doing right now, everyone should be wearing a face covering when they're in public. This is a statewide requirement because we now have growing evidence that cloth face coverings, when worn consistently, can decrease the spread of covert 19 especially among people who are not yet showing symptoms of the virus. Face coverings are key to moving forward with getting our kids back to school and further easing of restrictions. Wearing a cloth face covering in public settings is a simple but powerful action to help us protect people's health and reignite the economy. In addition to critical prevention actions to slow the spread of the virus. Today we have two announcements on how we are accelerating the work to ramp up testing across the state. Both the announcements are focused on improving access to testing for historically marginalized populations that are being hit hardest by Cove In 19 first, we have issued a statewide standing order for COVE in 19 testing, which eliminates the need for cove in 19 testing sites to require a doctor or other provider referral in order to be tested. This new policy will reduce barriers to testing, especially for members again of our historically marginalized populations. Second, we will also be deploying up to 300 free temporary testing sites to underserved North Carolina communities throughout the month of July. This new initiative is designed to increase access to Free Cove in 19 testing in African American, Latin, X, Hispanic and American Indian communities in 100 ZIP codes that currently have limited testing access. North Carolina is partnering with East Carolina University and with origin to deploy these free testing sites in underserved communities, which have been identified by the Department of Health and Human Services on will also bring additional lab capacity to our state, which is a good thing. These partners are also required to connect individuals who get testing with medical homes and provide services with culturally and linguistically appropriate standards. The initiatives unique contracts were developed with input from a group of internal and external advisers who are working with us to address health and equities during the Cove in 19 Pandemic and North Carolina's response Combined. Today's two actions make it easier for North Carolinians to get tested and for trusted organizations in the community, such as churches and other civic engagement nonprofits to provide testing. And that's important because we know community engagement is one of our most effective strategies to help historically marginalized populations, trust and access, needed testing and care, increasing access to testing his key to our ability to respond to and contain Cove in 19. Which is why we still urge members of the public to get tested if they believe that they've been exposed to Cove in 19 whether or not you have symptoms. Additionally, people should seek testing if they're in a member of any one of the following groups. First, a historically marginalized group who may have been at higher risk for exposure. People who spend time and hire a settings, including long term care facilities, homeless shelters, correctional facilities, migrant farm worker camps, people who work in essential settings where social distancing might be difficult to maintain, such as grocery store clerks, gas station attendants, childcare workers, construction workers and meatpacking workers. Front line health care workers and first responders should also be getting tested and people who are at higher risk of severe illness, including senior citizens and people of any age with underlying health conditions. When we test and identify infections promptly, we get the information we need to slow the spread of the disease, protect public health and save lives. Today's actions accelerate our ability to do just that. I do want to note my continued concern about laboratory re agents for our health system, labs and the ballooning turnaround times for tests at our commercial labs as cove, it has spread and worsened in many parts of our country. Testing re agents are in short supply again, and the wait times for testing results is now approaching 6 to 7 days, which is far from ideal. Today's new testing partners that I just announced will bring new capacity to our state, which is helpful, but we continue to be concerned about testing capacity and lab processing times. We've shared these concerns with our federal partners on several occasions and continue to need their assistance. Going forward Testing is important, however, Our best strategy remains prevention. Remember practicing the three W's wearing a face covering over your nose and your mouth waiting six feet apart and washing your hands often is the key to us fighting Kobe 19 Together where weight and wash. And with that it's again, it's just me. So Allah, open now for your questions. Our first question today will come from Lynn Bonner with the News and Observer. Thank you very much for taking my question is Lynn Bonner from the News and Observer. Um, I noticed that the daily counter completed test has been somewhat up and down to the past week or so. Is this the result of the region shortage? And do you see any sign to that easing? You said you'd ask the federal government for some help. What are you requesting specifically? And, um, have they said anything about coming through with that help? Well, thanks, Lynn, for that question in terms of our testing number. Yes, you've noticed there been up or down. I think there's a combination of factors. Some of it is that there is less tests being processed per day because there are now longer queues or wait times at some of those labs that are being done. There are less re agents or hospital systems are processing less tests. But we also have to remember the last week. We also did have a three day holiday weekend, and we know that testing is lower over holiday weekends. We've seen that in the past, so I think it's a combination of factors. I'll certainly be looking at our testing numbers as we move through this week to make sure that we're going to be continuing toe, have access to testing for our whole state as we move forward, and I think the announcement we're making today with those 300 additional temporary sites were putting up in 100 different ZIP codes. I think that's really going to accelerate access to testing in some of our most needed communities that haven't had access to testing, which is why we wanted to remind folks in terms of who we want to to make sure goes, get tapped to get tested first. Anyone with a symptom should go get tested. Of course, anyone who has been in close contact or been exposed to someone who has Cove in 19 should get tested. And then there are a number of other folks who we want to be sure to have a very heightened sense of getting tested. Those people, like I said, historically marginalized communities who are being harder hit, particularly our Latin X, Hispanic communities, folks who are working in high risk work settings where social distancing is hard. We want them to also think about going to get testing. So we have a lot of work to make sure that we're doing the testing that that is needed to identify, particularly the spread of the virus before people have symptoms. So don't wait until you have symptoms to get tested if you have an exposure to someone Cove in 19 to get tested as far as the assistance that we need from the federal government. So yes, we are seeing supply chain issues, and it's not unique to North Carolina that is happening around the country. And when you think about supply chain issues, you do need assistance from others at something we can't solve by ourselves here in North Carolina. So we have shared with our partners at HHS in various ways, as well as with, um, uh directly with Secretary Cesar. The governor and I had the opportunity to speak with him last evening and shared those concerns again. You know, they are working through those. I think at the end of the day, though, there is just there's a limited supply, Um, and there is a lot of folks who need these re agents around the country, so I think this is going to take a coordinated effort to really think through how to make sure that supplies are being appropriately distributed. But I'll I continue to advocate for North Carolina. We see our numbers are going up. We have an opportunity to continue to get our arms around this virus both by wearing a face covering, but by also doing the appropriate testing and isolation that we need to dio in order to prevent further spread. So we'll continue to articulate those concerns to our federal partners to work with them. We that they have been successful before. We've continued to have those conversations, and they've been able to get us some more re agents to certain ones of our hospitals. But the issue has continued, and we need continued support from them on that front. Thanks, Lynn. Follow up from Lynn Bonner with the News and Observer. Thank you, Dr Clone with me. Um, new sites. I'm wondering if any of those are going to be sites where people can actually walk into a facility and and get a test. A lot of the site new sites we've seen have been You need a car. Um, and I'm wondering about people who don't have access two cars and how they can be tested. Lin, Great question. And thank you for the follow up. So yes, a number of these sites will be drive drive through because that that those some of the sites will be, ah, that that kind. But we know to your point that not everyone has a car and that would limit access in the. The whole idea of this initiative is to get testing into communities that have not had testing access, so there will be walk up sites. It won't be. All 300 of them will not be walk up, so they'll be a combination. Some will be drive through. Some will be walk up. Um, and what the idea is, it's for us to work with community partners to say what makes sense for your community. It may be a partner with a church or another local nonprofit that can host that that testing event, and then we work with them on the details of how do they want to deploy the logistics for that, including some walk up opportunities. In addition to drive through thanks. Our next question comes from Claire Donnelly with wf a radio. My secretary Cohen clear Donnelly was still u F A e. I'm wondering if you know the average response ring's to contact tracers statewide And then, if you are disappointed in the effectiveness of contact tracing Claire, thanks for that question. For folks just back up in terms of contact tracing. This is what happens when someone is found to be positive. We work with that, that person to find out where they may have been. And if there has been any exposure to close contacts and then we get in touch with those contacts to say, Hey, you've been, ah, in contact with someone. You should both quarantine at home for 14 days and you should go get tested, I think. Claire, you're rightly pointing out that the contact tracing is hard because one you have toe get in touch with that original case to say, Hey, where have you been? And go through their history? Um, as well as get them to share. They're the names of those contacts as well as contact information. Um, so we know that this is it is a challenge. And so we have been trying to share messages, for example of saying, Pick up the phone. You may see something on your phone that says NC outreach that maybe some of our contact tracers trying to get in touch with you because you've been potentially exposed to Cove in 19. But we look, we know that in this time having having a someone who may be a stranger to you call you and say, Hey, can I have the names of your friends? And their phone numbers is not always the most comfortable. So we're trying to share with folks the intent behind this right, which is to make sure that we are getting in touch with folks who might be exposed because they could be spreading the virus, toe other people, and the way that we can kind of get ahead of it is that we can help help people know that they've been exposed and so that they don't expose other people. So that's why contact tracing so important. So we're not close to where I would want to be in terms of the number of folks that we are, um, uh are able took to contact. And it's not surprising that in our our Latin acts and Hispanic communities were seeing less responsiveness in those communities, I think there is certainly more distrust and more fear. In addition to a language barrier that is a challenge there. So I think we're seeing similar results to a few of the states that have put out some some data. Ah, around contact tracing where we're only about able to reach about 1/3 to 1/2 of of folks that at any given time and again that that changes depending on, um, again, sometimes your race and ethnicity, your age and etcetera. So we're still trying to work on improving our ability to do contact tracing. But it starts with everyone understanding why contact tracing is so important and an important tool in this. And we're working actually with a number of partners to try to improve and look for best practices. I think we're all working to try to improve and find best practices around. We're working with a number of, um, organizations that that are are doing that work to try to improve contact, tracing and thinking about how do we use different and innovative ways for reaching people so that we can continue improve our act actions? They? Our next question comes from Nikki Hauser with W i t N Yes. Hi, Nandi. Thanks for doing this. I wanted to ask about the new scientific data that's out showing that the virus can spread through aerosol transmission, so those smaller particles people get get it at longer distances and backing spread quickly that way. With all this new information in mind, is the state planning to implement any extra measures or address, uh, the virus any other way? With this new scientific information? Nikki, thanks for that question about heiress allies. And what that means is, can the virus be transmitted in the air versus through what through through a droplet? And so it's a little bit confusing because we have been talking about respiratory spread of the virus, and it obviously comes from your nose in your mouth and then goes out into the air and it is in the air, which on and then can potentially infect someone else. And it goes in through their nose, their mouth, their eyes. Ah, and that's the way the virus is transmitted. What we're seeing is that in certain circumstances, with the virus can stay in the air for a longer period of time. But we were still learning Maura about where and what makes this virus aerosolized. We know when you're having certain medical procedures like you're getting a nebulizer treatment if you are an asthmatic or you're doing something like an intubation, which is when you're putting a breathing tube down for someone that has times where you can kick up more virus into the air. And that is why we have our folks in health care settings who are doing those kinds of procedures wearing a kind of face covering called an N 95 that does even more filtration. Um, the the majority of the data that is out there continues to say that this virus is transmitted by droplets again. That's different than aerosolized. Now the drop let's move through the air. But it is through those droplets that the virus is transmitted. I think we are still trying to understand more and more data to understand what circumstances would cause that virus to stay in the air or be aerosolized and transmit to others. Because obviously, when it's staying in the air, that could make it more contagious for a longer period of time and again, we're trying to isolate when of the times that the virus could become, as you said heiress allies, what we're seeing is, most of the transmission of this virus continues to be droplet. Um, not through the air, right? It's through through it does come out through your nose in your mouth, but it's on your hands and other, uh, other ways of transmitting to someone else that is close contact to you, so we'll continue to review that evidence. But what I would say for folks overall, the whole take. What does this mean for me at home? It's where face covering it goes back to that, Um, we're still going to be able to use face coverings right when it covers your nose and mouth to be able to prevent those droplets from coming out of your nose and mouth and infecting other people. So while we continue to study this and there may be things that will need to do differently as we learn more about this virus, we've always said that. But for right now, the recommendation continues to be a cloth face covering in public settings, and we know that is what is going to help us cut down on the amount of virus transmission out there. Thanks. Our next question comes from roof ruling. Jones with spectrum news have been Jones from Spectrum News and Charlotte, I want to ask you about the hospitalizations, Obviously with the new high that elaborate on where we are in terms of capacity levels and you're concerned levels there, Can you provide any numbers in the sense of Okay, we're at 989 Hospitalizations. But at what point do you get worried about capacity? And is there a stage where you would need to bring in any sort of outside resource is or go back to the conversations we saw here in Charlotte a few months ago about setting up some sort of field hospital? Well, thanks for that question on hospitalizations. And when I look at our overall statewide capacity, we have hospital capacity. But I think we need to also look at that regionally because we know folks get hospital care near where they live. So one of the places we're watching very closely is the Charlotte area in terms of hospital capacity. Um, that is a place where we've seen higher rates of hospitalizations in that area. Again, I'm I'm not needing to do anything different right now, but we are having conversations with the with them every single day, as we always do, to make sure we know how they are managing their patient loads and and what is going on within their hospital. So we're in close coordination right now. I know we have capacity, and that is good. The other positive news. I would say. While we're seeing hospitalizations go up, we're actually seeing I see you or the intensive care unit utilization stayed the same, so that is a good sign. So we're seeing more patients in the hospital, but less of them needing that highest level of severe kind of care that we would see in the hospital. That's a good thing. I think that's a combination of both the great work of our scientific and and Dr community both getting better at at treating Cove in 19 having new techniques like prone ing people, um, using decks, a method zone, a new medication that improves mortality or and make sure that that more people are are living with after getting severe coveted illness. Um, using rum, desert beer. So I think there are number things that we have learned about this virus, and it's keeping people out of the intensive care unit. I think that's a good thing. But we're going to still watch it closely because the intensive care unit is the resource that is the most limited here in the state, as in every state. But that is a good news that we have been relatively stable for intensive care unit usage. Are hospitalizations overall going up again Statewide capacity feel very good about There are certain regions that we're looking at more intensely the Charlotte area, the Mecklenburg area being one of those places where we're seeing the hospitalizations tick up a little bit faster than the rest of the state. And so we're gonna work closely with them as we go. But no, um, as of right now, don't need to take any other additional actions. But I just go back and remind folks that it is the actions and the simple things we do every day. The wear weight wash that is going toe prevent us from overwhelming our hospital systems because we don't want to go to a field hospital situation that is a nine ideal in every way. For us to be able to have to do care outside of the hospital walls. I'll say as a physician, that is. That is not how we want to be caring for folks, whether they have cove it or not. And so we all need to do the hard work to make sure we don't get to that place. Thanks. Do it. Do we have another? Do we have another question? Yeah, I know. Question will be What? From Brian Anderson. What? The a p by Dr Cohen. Ah, Brian Anderson here with the Associated Press. Thanks for taking the time. I have two questions for you. Can you just sort of explain the doctors order on how long that that's good for meeting Like North Carolinians, It sounds like they won't get a doctor's orders. That in perpetuity is that just for the next couple of weeks at least, if you could just sort of explain what that means for the average NC resident here, that would be helpful. Secondly, you echoed similar concerns about a limited supply of regions last Thursday, and you mentioned just today that you had a conversation with the governor and secretary. A czar. What if any federal support has the state secured since last Thursday? Thank you. Thanks, Brian. So, first on the standing order, I want to make sure we go back and confirm with our team, but I believe it's for the duration of the the public health emergency that we are in. But I will confirm that with our team and what it means for a lay person, is that it now, for number of our testing sites, it was requiring a referral from a doctor or another provider in order Get that test. Now we have ah, Dr Betsy Tilson, our state health director who has issued that order for the state of North Carolina. So there is a standing order to say we want folks to get tested, and again, it's it's just allows for that testing to happen more quickly as well as for results, to go right back to that person and, um or, ah, streamlined way. So again, it's a, I think, a mechanism to streamline the work that we were already doing here. I believe it goes through the end of the public health emergency, but will make sure our team clarifies that for you and his terms of re agent supply, I will say that that is something we've been sharing with the federal government for a number of weeks. We work specifically with with, um, them to facilitate a conversation with one particular supplier, and the federal government is doing some amount of directing of supplies to, ah to places of need. And so when we did identify that the that particular hospital was able to get some additional re agents, I don't have off the top of my head exactly what was secured. But we did make some progress and I'll say some because it's time limited. They use up the re agents that came. And now we're kind of back where where we are because he burned through those re agents pretty quickly. Um, and I think that that request is going to be harder and harder for the federal government to fulfill. As we watch all of the's states that are really surging with cases around us, they are going to understandably be prioritized for supplies. And so I'm concerned, and I'm sort of raising the alarm that we in North Carolina, our numbers are going up and, yes, they're not going up as much as others. And I'm very grateful for all the hard work North Carolinians have done to make that possible. But we still have a need here, and we need to make sure that we're getting the supplies we need for North Carolina. I think at the end of the day, this is about the fact that the supply chains are just tight everywhere, Um, and so I think we will raise these issues to the federal level. Um, and I think it's going to take some additional kinds of bold action. But I also think it's going to take some some more rapid innovation in the diagnostic testing space. We need to see other kinds of tests come to market that can actually identify Cove in 19 in a way that is faster and cheaper and that we can scale. We're still using a pretty, ah, slow method for identifying this virus on, and while there are some or rapid tests there, they're not as sensitive, and so we're trying to figure out how to best move forward. So I think there's a supply chain issue the federal government needs to help with, but also working with, um, the scientific community in the private sector on really getting to the market. Some of these additional new ways of testing, whether it's using anti gin testing and making sure that we are getting an antigen test that has the sensitivity and specificity that is needed for us to be able to use it a wide scale. So there's two different things that I think the federal government can assist with as we're thinking about its supply chain is just what it is and how do we ramp up that production? But then it's also that innovation and the bringing to market some of those scientific innovations that I think are badly needed in the testing space. But they're also needed in the therapeutic space, the vaccine space. So I know a lot of work is going on, but but I think we are certainly raising the alarm bell. Um, as we're seeing what is happening within our state that this the time is now and it is very urgent. And yet, uh, and for giving Dr Cohen, you also said that it takes 6 to 7 days just for people to get, um, open test results back in certain cases. Where is that occurring? And is there an average response time that you're seeing statewide for people just to be informed whether they have the virus or not, Yes, so what? What I'd say is that for patients who are hospitalized, those are our most urgent to get those tests back very quickly. Those air still happening within 24 hours, and most of that testing is still being handled by the hospital system themselves. Or if they need Teoh, uh, use some of our lab, a commercial lab capacity, those air kind of being put to the front of the line. So that is good. But then, when you look at some of our other testing, whether it's in some of our pharmacy sites or just, you know, a number of our sites that are using some of our big commercial lab partners like Lab Core or Quest or others, that is where we're seeing those 76 to 7 day turnarounds. And again, that is just a volume issue. There is a lot of testing samples coming to those commercial labs, not just from North Carolina, but really but across the country on. And so we're just seeing high volumes, and it has really pushed out the number of days in which people would get there were test results. So I want to share with folks, right. If you've been exposed to Cove in 19 you need to be quarantining or isolating, staying in your home for 14 days. And I know that can feel hard particular if you feel well. But if you've been exposed and you've gotten your tests and you're still waiting for your test results, you need to be staying home until we, uh you know, you make it through that 14 day period. Um and you know, so not having those test results back sooner is is not ideal. And obviously we want to work on getting back to closer toe, you know, 2 to 3 day turnaround, which is what we were seeing for most of June. And so we'd like to get back there. We're going to try to do what we can from the state. As I said, as we've been doing these procurement were trying to buy lab capacity in other ways. Teoh increase the pie and not put more strain on those same same labs. But But that that is that it is hard to do with the fact what's going on around the whole country? But we're gonna keep working at it. Um, as well as keep talking about the concerns with with those who can assist us in the federal federal government. All right, with that, I'm going toe leave you. Thanks for the opportunity to share some information about some new announcements around testing, But again want to leave you with our important message of prevention, right? That's what we want to focus on. We don't want even get to the stage of testing the aunt. You know, wear a face covering wait six feet apart and wash your hands. Um, and stay well, all right. Thank you.