COVID-19 cases are expected to increase in NC. Will wastewater help us know when?

COVID-19 (Image:CDC)

Another increase in COVID-19 cases is expected in North Carolina, but it’s predicted to be not as big as the wave of infections that filled hospitals last winter, state health officials told legislators Tuesday.

Susan Gale Perry, state Department of Health and Human Services chief deputy secretary, detailed COVID-19 monitoring and responses for legislator Tuesday, as cases in the northeast United States and Washington DC are rising and the day after Philadelphia announced it is reinstating its mandate for indoor masking.

Last month, DHHS started updating its COVID-19 data dashboard weekly rather than daily, and redesigned it to deemphasize testing. With so much home-testing, the state no longer has complete information on testing and new cases.

North Carolina saw a slight uptick in cases between March 26 and April 2. From March 13-26, about one-third of the COVID-19 variants detected in the state were omicron BA.2, the subvariant behind the rise in cases in the United Kingdom and parts of Asia.

Trends in the United States mirror the United Kingdom, said Dr. Susan Kansagra, chief of the chronic disease and injury section in the state Division of Public Health.

“We can expect to see cases start to increase again,” she said.

In a webinar with reporters last month sponsored by Ethnic Media Services, Dr. John T. Brooks said more than 95% of people in the U.S. have COVID-19 antibodies from vaccinations or infections, possibly placing the country in “a slightly better position” than others. Brooks is senior science advisor for the CDC emergency COVID-19 response.

“We will see increases,” he said. “I hope it is not as high or severe as it has been in other places. We would not be surprised if there are regional variations. Some parts of the country may see increases where others do not.”

Perry told legislators that the state has an adequate supply of COVID-19 treatments, although Rep. Hugh Blackwell, a Burke County Republican, said he knew of people who were having trouble getting monoclonal antibody therapy.

North Carolina researchers started monitoring wastewater for COVID-19 in the first year of the pandemic. People who are infected shed the virus in their feces.

Checking COVID-19 levels in municipal wastewater has been elevated to be an early warning indicator in North Carolina, and has been endorsed by the CDC as a community-level COVID tracker.

“Sustained trends over time can give us an early indication of COVID-19 infections in communities,” Brooks said last month.

But wastewater monitoring can’t serve as an early warning sign in communities that use septic systems.

“We don’t have a direct answer to that question,” Brooks said. Cases that start in communities on septic systems would be picked up when infections spread to neighborhoods on municipal wastewater systems, he said.

North Carolina is checking wastewater at about two dozen sites, but there are wide swaths of the state where no such monitoring exists.

Perry said Tuesday that North Carolina considers wastewater monitoring a statewide early detection system, and has other indicators that can fill in the COVID picture.

DHHS counts the percentage of emergency room visits by people with COVID-19 symptoms as the other early indicator. That remained steady at 2% from March 26 to April 2.

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