North Carolina experiencing “first wave” of COVID-19 cases, more likely to come

The peak of flu season occurred in early February. After reports of flu-like illness fell, by early March, they began increasing again, because of COVID-19. (Graph: NC DHHS)

North Carolina is in the “acceleration phase” of the COVID-19 pandemic, state epidemiologist Dr. Zach Moore said today, with the number of cases expected to rise over the next two weeks.

“There’s every indication that it’s really ramping up now,” Moore told the media during a call-in press conference. “We have not peaked.”

As of March 30, more than 1,300 people have been diagnosed with COVID-19; six people have died. Ninety-one have been hospitalized, according to the NC Department of Health and Human Services. However, Moore reiterated that the number of reported cases is an undercount. For example, it doesn’t include people who have not gone to the doctor and who have mild or no symptoms.

Gov. Roy Cooper has issued a statewide stay-at-home order, effective at 5 p.m. today, through April 30. Only businesses deemed essential, such as groceries, can remain open. Restaurants are limited to take-out or delivery services. Gatherings of more than 10 people are prohibited. People should also stay at least 6 feet apart from one another.

The state’s flu surveillance regions are also reporting data about confirmed and suspected COVID-19 cases, which helps epidemiologists better understand the outbreak. (Map: NC DHHS)

To better estimate the number of cases, the state has directed doctors and medical facilities to conduct “syndromic surveillance,” which means they are reporting incidents of fever and cough, even lacking a formal diagnosis of COVID-19. “This allows us to get to people who present for medical care but who can’t be tested,” Moore said.

“Lab-confirmed counts are never the whole picture. We need to rely on other evidence-based tools. This is a rapidly evolving situation, and we need to use data from different strategies to understand the spread.”

State, commercial and hospital labs have conducted 18,945 tests, as of March 30. The state lab is caught up with its tests, Moore said, but some commercial and outside labs are experiencing backlogs.

The effects of the statewide stay-at-home order won’t be realized for about two weeks, equivalent to the extent of the 14-day incubation period for the new virus. The average incubation period — the time of exposure until the appearance of symptoms — for COVID-19 is five to seven days.

There are seven influenza surveillance regions in North Carolina; health officials from these areas are also reporting data related to COVID-19 symptoms. After influenza-like illnesses peaked in early February — the result of the incidences of the common flu — the numbers began to fall. But since early March, all seven regions have reported an increase in influenza-like illnesses. Emergency room visits for fever and cough have also increased over the same period.

“That tells us that what we’re seeing now is likely being driven by COVID-19,” Moore said.

No antibody tests are yet available to detect those who have been infected but who had no symptoms. This information would help researchers and epidemiologists better understand the full reach of the virus — and to control future outbreaks, which are likely.

“We are very much in the first wave — worldwide, the nation and the state,” Moore said. “Nobody has immunity to this and everyone is susceptible. It’s possible that we’ll have additional waves.”

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