Friend,

There has been a major change in who qualifies to get a coronavirus test in North Carolina and it means a broad strategic shift in how we're waging this public health battle.

NEW TESTING RULES

When it comes to testing, our state - along with the rest of the country - has three critical shortages:

1. the test kits

2. necessary components, like extraction kits and swabs (believe it or not, the main manufacturer for the swabs is in Lombardy, Italy...), and

3. the masks/gowns/gloves necessary to perform the tests.

The good news is we've made real strides in the last ten days with private labs coming online. 90% of the testing in our state is now being done by private labs and we're doing more testing per capita than most states.

Here's the bad news. Even with this added capacity, the CDC anticipates that the demand for testing will continue to outpace supply. So the CDC has put out new guidance on criteria for testing, and NC has adopted that new criteria.

And the short version is this, direct from DHHS: "In general, patients with mild illness (defined as fever and cough without shortness of breath or difficulty breathing) do not need testing."

So the old qualification was: fever + negative flu test + cough OR shortness of breath.

The new qualification is: fever + negative flu test + cough AND shortness of breath (or other serious symptom).

That means if you're a middle-aged, reasonably healthy person and you develop mild, flu-like symptoms and think you may be infected, the new guidance is to call your doctor, at which point your doctor will likely tell you to assume you're infected and self-quarantine until you've been fever-free for three days (unless your condition worsens, in which case call your doctor again).

That's a major shift in combating this virus, and it dramatically increases the importance of social distancing. As DHHS says, "We are moving to a different phase of our response efforts [and are now focused on] mitigation strategies" in which a big part of the goal is "to conserve supplies and capacity so our health care workers can care for people who need medical attention even during the peak of the outbreak."

Let's be honest about what that means: It means we are not going to have the type of widespread testing we would ideally have because we just don't have the supplies, nor - at this point - the time. It's not good news, but it is a realistic assessment of where things stand.

If we're not going to beat this the way South Korea did (test -> trace -> isolate) then we have no choice but to beat this by not getting sick in the first place - or at least not all at once - which means social distancing is our only real, scalable strategy at this point. It's the only lever big enough that - if we pull it really hard - will actually flatten the curve and keep our hospitals from being overwhelmed, as we're starting to see in NYC. We're on to Plan B, and there is no Plan C. So we have to make this work.

STAY AT HOME ORDERS

That's why you're starting to see stay at home orders on the county and city level (Mecklenburg + Wake + Orange + Durham + Pitt + Madison + Buncombe + Winston-Salem + Clemmons + Beaufort), and why you're going to see more, and why we may see similar statewide action soon. In response to whether there would be a statewide shelter in place, the Governor recently said, "We will be issuing additional restrictions soon."

GEARING UP - HOSPITAL BEDS

• Hospitals are looking at sites for possible rapid expansion, if necessary.

• They are stressing telehealth as much as possible to free up space.

• They are canceling elective surgeries - some more quickly than others. Our hospitals are typically 85% full, so getting that number down really matters. Progress on that front has been mixed. We're not where we need to be yet, but that's because we have many hospitals - especially in rural areas - that are barely getting by. They are essentially waiting until the last minute to cancel procedures that help them bring in revenue and keep the doors open. However understandable that may be, we're reaching the point where we really need to make sure we have maximum bed availability, so more formal (i.e., mandatory) guidance may be coming to instruct a more rapid transition.

GEARING UP - PPE

The bottom-line here is we're doing everything we can to get our hands on more PPE (personal protective equipment = masks/gloves/gowns).

1. We're getting it from the federal government. We've received two shipments already, with more coming.

2. We're buying it ($66m worth of orders, but much is back-ordered due to demand).

3. We're working with North Carolina manufacturers to start making what we need.

4. We're asking citizens to donate any PPE they may have (email BEOC@ncdps.gov if you've got some, or if you're near a Novant hospital you can also email donatesupplies@NovantHealth.org).

5. UNC Health is accepting homemade masks made of tightly woven cotton. 

UNEMPLOYMENT INSURANCE

The economic piece of this crisis is starting to come into view, and it's incredibly serious. Over the last ten days, North Carolina has received over 150,000 unemployment claims. We're used to seeing about 3k per week.

And check out the historical comparison (and that last bar is actually 50% higher now due to new data...):

That means there are three things about our state's unemployment insurance we need to fix immediately:

1) The website/call center

We are adding capacity quickly but I'm still getting reports (as recently as while I was writing this) that folks can't get through. This is a known problem and we're working on it. If you need to file a claim, it's des.nc.gov or (888) 737-0259. They encourage you to apply online if possible, and the process usually takes about 20 minutes. The earliest you will receive benefits is two weeks.

2) The size/duration of the benefits

Most states offer up to 26 weeks of unemployment insurance. North Carolina caps it at 12 weeks - 49th in the nation.

Nationally, the average weekly benefit is $378/week. North Carolina's average payment is $277/week - 41st in the nation.

That means right now the average North Carolinian on unemployment gets just under $2,300, spread out over two months. Looking at the chart above, you can tell that's not going to be enough.

3) Who qualifies for benefits

In North Carolina, only 10% of unemployed people qualify for unemployment insurance - again, 49th in the nation.

That's going to have to change. For starters, we are certainly going to have to include independent contractors, the self-employed, and nonprofit workers, which we currently don't.

The good news is that the federal stimulus that looks like it's about to pass in D.C. has a major UI component that does a lot of what we need to do. But it's still up to the state legislature to do some real work to make sure we maximize our eligibility for new federal funds for those who are now out of work. Fortunately, at this point, there appears to be a strong bipartisan interest in doing that, so I'm optimistic on this front.

NATIONAL GUARD

They've been activated, but only to supply logistical and transportation support. I happen to be in the National Guard, and I was given a heads up that I might be called in. If I am, I'll let you know.

NEAR-TERM GOALS

This is all about buying time for our hospitals to gear up. Every day we stay healthy is another day we give them to prepare to take care of those of us who will become seriously ill. It's rare that our country so rapidly shifts to a single point of focus, but we're there. Flattening the curve is what we do now, it's who we are for this moment in time. We still have time to get this right in North Carolina.