But without careful planning, they say, the state may be only a few weeks away from becoming a severe COVID-19 hot spot.
States across the South are experiencing surges of the novel coronavirus as reopening efforts continue. Texas, Arizona, Florida and Georgia have all seen a spike in their case counts, and North Carolina reached 100,000 COVID-19 cases earlier this week.
So far, North Carolina is fairing better than those four states in key metrics like hospitalizations, number of cases per 100,000 residents and the percent of tests that come back positive.
But as North Carolina’s cases continue to climb, public health experts and local officials fear things will only get worse. In many states in the South, that fear has already come true.
Reopening too early?
Both Arizona and Texas have emerged as two of the country’s COVID-19 epicenters. Cases and deaths are rising rapidly, and experts say that premature reopening has contributed significantly to the surge. Decreased social distancing and inconsistent mask wearing have also worsened outbreaks, experts say.
Erika Austhof, an epidemiologist at the University of Arizona, said that Arizona’s stay-at-home order was lifted far too early on May 15. “We definitely opened too soon,” Austhof said, “A lot of what we’re seeing now is a result of that order being lifted. It’s really just been exponentially increasing since then.”
Arizona had a plan to reopen in phases, but on May 15 the state had not met the requirements to continue the process, Austhof said. Although certain coronavirus metrics were not where they needed to be, Gov. Ducey lifted the stay-at-home order anyway, she said.
“Now it feels like we’re just playing catch up,” Austhof said.
Gov. Cooper has extended North Carolina’s second phase of reopening twice, once in late June and again last week. Phase two will remain in effect until at least August 7, Cooper said in a news conference last week.
Cooper’s decision to delay phase three of reopening has likely been a key factor in keeping the pandemic under control in Charlotte and the rest of the state.
Dr. Catherine Troisi, an infectious disease epidemiologist at the UTHealth School of Public Health in Houston, says that reopening quickly and early is a commonality she sees in many of the states that are now reporting record amounts of new coronavirus cases.
“As soon as you get people together again, particularly when they’re not socially distancing or wearing a mask, the virus is going to take advantage of that and spread,” Troisi said. Texas’ spike in cases was no surprise, she said.
“A few weeks back, this was totally predictable,” Troisi said, “It was wishful thinking. ‘We’re tired of the pandemic, our economy is hurting, so let’s pretend that everything is ok.’”
Anthony Alberg, chair of the epidemiology and biostatistics department at the University of South Carolina Arnold School of Public Health, says that Gov. Cooper’s decisions are paying off.
“North Carolina seems more concerned about following the actual evidence-based guidelines,” he said, “As bad as the trends are looking there, the steps that have been taken appear to have helped control COVID-19 compared to neighboring states.”
Experts within North Carolina are paying attention to the dire circumstances in other states. They want to make sure that NC doesn’t make the same mistakes.
“In some of these places where they decided to just open up without giving any consideration to the data, now they’re seeing a spike in cases and they’re trying to avoid another shutdown,” said Dr. Ahmed Arif, a professor of epidemiology at the University of North Carolina at Charlotte. “There’s a lesson to be learned here.”
Moving backwards
North Carolinians are eager to return to their normal lives, and many are frustrated with the delays in reopening. But experts warn that residents should be prepared not only for pauses in the reopening process, but also for taking steps backwards when necessary.
Epidemiologists in Arizona and Texas agree that backtracking during reopening would have helped prevent the crises in their states. And Arif hopes that North Carolina will be open to that possibility.
North Carolina’s phase two has been extended twice, but coronavirus metrics are still moving in the wrong direction. “The cases are going up,” Arif said, “At some point we may have to think about whether we need to take a step back, if this doesn’t improve soon.”
Austhof, from Arizona, says that every state should be more willing to move backwards in their reopening processes. If things are not improving, it makes more sense to back up than it does to keep things the same, she said.
““That’s how the system is set up, that’s how it should be working. That’s just not what we’ve done,” Austhof said.
Texas’ Dr. Troisi echoed her sentiment. “You are having spread during this phase, so if you keep pausing the phase, presumably you’re still going to have spread. It would make more sense to me to back up a little bit,” she said, after reviewing North Carolina’s coronavirus data.
But Troisi knows that backing up is much easier said than done. It’s harder for residents to accept a second shutdown or stay-at-home order, she said. There’s also pressure on local officials to reopen businesses for the sake of the economy.
“We all scientists recognize that the economy is critical, and we do have to open up,” said Dr. Jose Szapocznik, Chair Emeritus of the Department of Public Health Sciences at the University of Miami. Szapocznik says that proper contact tracing is one of the most important measures to take while reopening.
“The lesson for North Carolina is simple,” Szapocznik said. “As we open up, are we mounting the level of testing, contact tracing, and serious isolation that is needed? If not, maybe you need to lock down,” he said.
Troisi understands that Texas’ Gov. Abbott and other local politicians are in a tough position, caught between a public health crisis and a struggling economy, she said. But she thinks there’s a way to support the economy without compromising peoples’ safety.
“I think this ‘economy or public health’ debate is a false dichotomy,” she said, “Of course the economy is important. People need to put food on the table and have a roof over their head. But we could open up smarter than we have been.”
Taking responsibility
While a state’s reopening timeline may be in the hands of politicians, much of the responsibility still falls to individual residents. The attitudes that communities hold towards the pandemic can greatly impact its severity, public health experts say.
Arif emphasized the importance of social distancing, wearing face masks, washing hands and staying away from crowds. These actions are essentially the only defense people have against the coronavirus.
“We don’t have any other measures, we don’t have vaccines, so what we are left with are these important steps that are very much dependent on individuals’ behavior,” Arif said. A face mask mandate also helps, he said, but is difficult to enforce.
Arizona, Georgia, South Carolina and Florida all lack a statewide face mask requirement. North Carolina has had one since June 24, when Gov. Cooper announced an executive order mandating the use of face masks in all public areas.
“We know that social distancing and masks work, when they’re done consistently and well,” said Austhof, “We have that data from other countries around the world.”
In Georgia, a growing coronavirus hot spot, one expert says that irresponsible behavior on the part of both residents and local officials have made things worse. Dr. Handel Andreas, an epidemiologist at the University of Georgia, noticed “general underestimation by leaders and individuals of the severity of the situation,” he wrote in an email to the Observer.
He thinks Georgia would be in much better shape if there was “stronger and clearer messaging regarding the importance of continuing to practice social distancing, and the importance of wearing face masks,” he wrote.
North Carolina’s leadership needs to be clear, consistent and evidence-based, Andreas said. “There is no return to normal or economic recovery until cases are driven to a very low level, and that to accomplish that, people will have to behave in a responsible manner,” he wrote.
One metric experts say must be carefully monitored is the rate of patients hospitalized with COVID-19. North Carolina coronavirus hospitalizations hit a new record on Tuesday.
“The increase in hospitalizations is very concerning,” said Troisi, “The whole reason for flattening the curve back in March and April was to prevent our health care facilities from becoming overwhelmed.”
Cases need to be kept low enough for health care workers to manage patients, and to avoid putting a strain on hospital resources like ventilators and personal protective equipment.
“We may reach the point where we need to ration care, and that’s a terrifying thought,” Troisi said.
Professor Alberg from the University of South Carolina said that rationing care has already become a reality in some hospitals.
“I know we’re balancing the economy and public health here, but we need to prevent the worst case scenario which is when the health care infrastructure starts to break down,” Alberg said. “That’s part of what’s happening now in the United States. We don’t need to turn to Italy for examples,” he said.
Some experts have described North Carolina as “the best of the worst” among the southern states hit hardest by COVID-19. This means that the state is likely approaching a tipping point, and if things get much worse, cases and deaths will soar.
“There’s too much at stake,” Dr. Szapocznik said, “Our economy is at stake, peoples’ well being is at stake. I just hope you don’t end up like us.”
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