NC doctor after 10-hour shift in the ER: ‘We are not out of the woods yet’

NC doctor after 10-hour shift in the ER: ‘We are not out of the woods yet’
NC doctor after 10-hour shift in the ER: ‘We are not out of the woods yet’ (Source: Charlotte Observer)

CHARLOTTE, N.C. (The Charlotte Observer) - The Charlotte area has yet to win the battle against COVID-19, despite hard-fought progress to flatten the curve this summer, warns Atrium Health emergency medicine physician Dr. David Callaway.

Callaway on Friday morning had just finished a 10-hour shift at the ER before joining Mecklenburg County officials at a news conference, where he pleaded with Charlotteans to make smart decisions this Labor Day weekend.

“I will tell you we are not out of the woods yet,” Callaway said. “This is not a joke. It is important that we do the simple things, and we do it right.”

Callaway first held up the bulky hospital-grade face mask he and nurses wear for hours to protect themselves: “Putting this thing on, every single night, and breathing through it for eight hours ... Having their skin breakdown in their noses and around their ears (from the respirator mask) that’s inconvenient, as well. It’s painful but it’s what we do to take care of patients.”

Then he held up a simple, light blue face covering like what many people wear in public: “What we’re asking is that you do something simple — just wear a mask like this.”

Callaway said he had just treated young patients at the hospital who were struggling to breathe, their lungs scarred by the virus despite recovering weeks earlier.

His urgent message came hours before the beginning of “Phase 2.5” — North Carolina health officials’ plan for easing some COVID-19 restrictions to allow gyms and museums to reopen at limited capacity.

Callaway on Friday recounted how the Charlotte area was once a “hotspot” in the United States. For much of the spring and summer, the region saw growing spread of the coronavirus.

But a requirement that people wear masks in public, Callaway said, has effectively reduced transmission.

Two crucial coronavirus metrics — the positivity rate and number of hospitalizations — have stabilized or declined locally in recent weeks, Mecklenburg County public health data show.

The average weekly positivity rate is 6.7% as of Wednesday, Public Health Director Gibbie Harris said.

Harris and other county officials have not set a goal for the percent of positive tests locally but the World Health Organization has specified 5% as a benchmark to meet before governments should consider reopening.

The positivity rate or percent positive helps gauge how widespread infections are in a given community and is one indication of whether enough of the population is being tested, according to the Johns Hopkins Bloomberg School of Public Health.

A low percent positive means “coronavirus transmission, relative to testing, is low,” professors David Dowdy and Gypsyamber D’Souza write on the school’s website.

There is still community spread of COVID-19 across Mecklenburg and residents have repeatedly experienced the consequences of letting their guards down, County Manager Dena Diorio said on Friday.

“Earlier this summer after both the Memorial Day and July 4th holidays, we saw significant spikes in the number of positive cases, which took weeks to recover from,” Diorio told reporters.

MORE CASES, LESS MASK WEARING

One closely-watched trend — the daily caseload — is already starting to slowly climb again after a few weeks of improvement in late summer in the Charlotte area.

Across North Carolina, a similar trend is seen.

There was a peak in mid-July, when the state was adding around 2,000 new cases per day, according to data compiled by the New York Times. By mid-August, the average reached around 1,277 cases per day.

In the past two weeks the average has climbed again, to around 1,600 new cases every day.

The local trend mirrors the state’s trend, a Charlotte Observer analysis of public health data shows.

In mid-July in Mecklenburg County, the 7-day average of new cases hit a high of 372. By Aug. 20, the figure fell to as low as 113. In the last week, that average was 168.

The increase in cases is likely due to both less social distancing and more people gathering while not wearing masks, Harris told reporters on Friday.

“Our ability to keep these numbers moving in the right direction depends on people changing that behavior ... We do not have other options available to us right now,” she said.

The rise in new cases in late August, she said, may also be due to a delayed reporting by LabCorp for people who had tested positive earlier in the month. The Observer’s analysis shows that the caseload locally has been rising in August prior to the addition of delayed test results.

‘WATCH THAT TREND’

Some of Mecklenburg’s improved metrics — and cautious optimism so far from county officials — directly followed lapsed precautions during Fourth of July festivities. That, in turn, fueled a surge of infections and a record number of people seeking hospital-level care.

Dr. Mandy Cohen, secretary of the state Department of Health and Human Services, said people should plan ahead for Labor Day and avoid large gatherings. Otherwise, Cohen said, North Carolina will likely experience more viral spread.

“This can get away from us really quickly,” Cohen said during a news conference Thursday, while reinforcing the three Ws of wearing a mask, waiting 6 feet apart and washing one’s hands.

“It’s important to practice these preventative steps whenever you’re around people who are not in your immediate household. That includes gathering with extended family and close friends.”

The Charlotte area reached a peak of around 200 coronavirus hospitalizations in late July. The number then steadily declined and reached a low of 125 on Aug. 29. About 5% of all cases have required hospital-level care, Harris said.

In the last several days, though, hospitalizations in Mecklenburg’s acute care facilities have crept upward. About 160 people were hospitalized on Tuesday, the last day included in the county’s most recent update.

Last month, an average of two to three county residents died each day from coronavirus-related complication. Experts have cautioned that deaths are a “lagging” indicator, meaning deaths only increase a few weeks behind an increase in cases.

Adults 60 and older with underlying chronic illnesses account for the vast majority of coronavirus deaths.

But young adults ages 20 to 39 account for almost 45% of Mecklenburg’s total infections.

“We need to watch that trend,” Harris said.