Analysis: Columbia Epidemiologist on NC’s Data: 'I Can Only Share Your Befuddlement'
The governor of a Southern state said he’s “hopeful” that reopening can start in a week – even as COVID-19 hospitalizations and the number of new cases are near all-time highs.
Sounds reckless. Is this Georgia? Tennessee? South Carolina?
It’s actually North Carolina.
On April 23, N.C. Gov. Roy Cooper said it wasn’t safe to end the stay-at-home order, which he extended by 10 days to May 8. The state said it would be using data-driven benchmarks to see if it was ready to re-open.
But as Cooper said on Thursday he’s “hopeful” the state can move to Phase 1 next week, the state is arguably doing worse on three of the four metrics.
The state, however, says it’s meeting its goals in two of the four metrics. But in one critical metric – hospitalizations – the Department of Health and Human Services changed how it presents the data, making N.C. appear to be doing better than it is.
Jeffrey Shaman, a Columbia University epidemiologist, reviewed for WFAE how DHHS has presented COVID-19 data over the last several days. He said he has “befuddlement” as to why the state changed its charts on hospitalization.
"I can only share your befuddlement," Shaman said. “Either it is an honest mistake or an attempt at spin to help justify reopening.”
In a news conference Friday, DHHS Secretary Mandy Cohen said she wasn’t aware that her department was using a different scale when presenting data on hospitalizations.
While a new scale may make it appear that hospitalizations are flat, Cohen said the important factor is that the state has enough hospital beds to treat COVID-19 patients.
Here are the four metrics:
This is arguably the most important statistic because the main goal of social distancing is to flatten the curve so hospitals aren’t overwhelmed. When Cooper said the state wasn’t ready to reopen, there were 486 COVID-19 patients in N.C. hospitals. When he said he was optimistic the state could move into Phase 1 on Thursday, there were 546 COVID-19 patients. The day before, there was an all-time high of 551 patients.
Health and Human Services' Cohen says she wants to see a “decreasing or sustained leveling” of hospitalizations.
Here is how the state charted hospitalizations on the DHHS website on Thursday.
That is certainly not decreasing. And it does not look like “sustained leveling.” In fact, it shows that the number of COVID-19 patients in hospitals has increased by more than 60% since mid-April.
And on April 23, when the state announced it was extending stay-at-home, DHHS charted hospitalizations with a chart with a Y-axis ranging from 0 to 500. Charting hospitalizations that way showed a steady increase, and the state said “there has not been a downward trajectory over the past 14 days.”
But during a news conference on Thursday – and with a formal decision on reopening looming -- the state used a different graphic, with a Y-axis that goes from 0 to 1,000.
Cohen said this slide shows that hospitalizations are leveling – even though there are more COVID-19 patients in hospitals than there were when stay-at-home was extended on April 23.
2. A Decline In The Percentage Of ER Visits For COVID-19-like Symptoms.
This is seen as an early indicator of a problem, even before testing. It’s been trending downward, but ticked up this week.
3. Laboratory-Confirmed New Cases
In North Carolina, the number of new cases is increasing steadily. The state had an all-time high of 551 new cases on Wednesday, and there were 546 new cases on Thursday.
Cohen said the state doesn’t need to see the number of new cases going down, but it wants to see them level.
That’s not happening.
It should be noted that the state kept the same 0-600 Y-axis on this graphic for its news conference.
4. Percent Positive Of Tests
As testing increases, the number of positive cases is also likely to go up. In the past, people with mild symptoms would not get a test.
Now they are more likely to be tested, so the percentage of positive tests going down would be an indicator that the spread of the virus is declining.
The state wants to see the average percent of positive tests go down over two weeks. And that’s happening.
Here is the chart:
So that’s clearly one trend moving in the right direction. There are two trends going the wrong way.
And the fourth trend – hospitalization – gets close to leveling, so long as the Y-axis is changed to hide larger changes over time.
The state is also charting three other areas.
Can it increase testing? Can it hire more contact tracers? And does it have enough PPE to withstand a second surge of cases?
Cohen said the state is making progress on testing and hiring contact tracers, but still doesn’t have enough PPE.
At the top of the newsletter, I compared North Carolina to Southern states with Republican governors who have been criticized for opening too soon.
It should be said that North Carolina has a much slower reopen plan than Georgia, Tennessee and South Carolina.
North Carolinians want to reopen. It appears the governor does too. Mecklenburg County – perhaps taking a cue from the state – has changed its tone, saying the county is “ready” for Phase 1 while just a week ago saying a longer stay-at-home was essential.
N.C. has said it’s going to rely on the data to guide its reopening. What will the state do if the data doesn’t break the state’s way?
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