RALEIGH, N.C. _ The number of people hospitalized with COVID-19 in North Carolina each day has crept up in the last two weeks, and some doctors worry it may be a sign of things to come.
The hospitalization numbers reported by the state Department of Health and Human Services fluctuate from day to day, but from mid-April to mid-May they mostly remained between 400 and 550.
But since May 25, Memorial Day, an average of 671 people a day have been hospitalized with COVID-19 statewide, with the number exceeding 700 four times and hitting a new high of 717 on Friday.
Dr. David Wohl, an infectious disease physician at the UNC School of Medicine in Chapel Hill, says new coronavirus cases can vary with the number of people tested and that counting people who end up in the hospital is a more straightforward measure of the outbreak.
"I think that's really the truest canary in the coal mine for us," Wohl said this week. "If we're seeing people get sick enough to be admitted to the hospital, that's telling you we have not flattened the curve. So this is the best indicator, I think, that we have of where we are with the pandemic. So it is concerning to me."
Wohl, who helps run a coronavirus diagnostic center at UNC Medical Center, said hospitalization numbers show the extent of the virus two to three weeks earlier, because it generally takes that long for an infected person to get sick enough to need hospital care. He worries the trend will continue upward because of what's happened since Memorial Day weekend.
"I think if we're going to see an uptick due to reopening, due to the protests that we're seeing, it's not going to be tomorrow, it's going to be another two to three weeks from now," he said.
Tracking the outbreak
The number of people hospitalized is one of four metrics that state public health officials use to track the course of the coronavirus outbreak over time.
Dr. Mandy Cohen, the DHHS secretary, says the most encouraging metric has been the percentage of people who visit emergency rooms with COVID-19 symptoms. That percentage has been declining, though state officials acknowledge that overall traffic to emergency rooms has increased, perhaps as people's fears about seeking treatment for non-COVID illnesses subsides.
The other two metrics _ the number of new cases and the percentage of people tested who are positive _ paint a mixed picture. Nearly 9,300 people have tested positive since Memorial Day, an increase of 39%. But the percentage of tests that are positive remains steady, suggesting much of the increase is due to more extensive testing.
"We cannot look at any one of these metrics in isolation," Cohen said during a press conference this week. "We look at them as a whole package when doing decision-making."
Three months ago, hospitals in North Carolina feared they could be overrun with coronavirus patients, as health care systems had been in places such as Italy and New York. Hospitals postponed non-urgent surgeries and procedures to preserve supplies and free up staff and beds for an expected surge in COVID-19 patients.
That surge never materialized, and state and hospital officials credit the public response to executive orders that closed schools and businesses and kept people at home.
Cohen notes that North Carolina hospitals still have plenty of capacity to treat coronavirus and other patients, even with the resumption of non-urgent procedures. As of Friday, there were about 3,700 hospital beds and 521 intensive care unit beds available in the state, according to DHHS.
Still, the increase in hospitalizations bears watching, Cohen said.
"We continue to have capacity in our health care system to take care of people if they become seriously ill, so that is good," she said. "But we would like to see this number declining, not increasing."
Will reopening, protests make it worse?
It's been two weeks since North Carolina entered Phase Two of the governor's lifting of restrictions on businesses, allowing restaurants, salons and barbershops to reopen with limits. The easing of stay-at-home rules, coupled with the relatively low number of coronavirus cases in the state (33,255 as of Friday), has encouraged many people to try to resume their normal routines.
Dr. Cameron Wolfe, an infectious disease specialist at Duke University School of Medicine, said the people taking part in the protests over George Floyd's death and crowding parks, beaches and racetracks around the state may be younger and healthier overall and less at risk of becoming seriously ill with COVID-19.
But they could become carriers of the contagious disease and infect others who will need hospitalization later, Wolfe said.
"So you have to add another incubation period between when they get sick and when they then accidentally infect their parents or grandparents who are ultimately the ones who crash into the hospital," Wolfe wrote in an email. "So the entire impact of this very slow, protracted illness isn't seen instantly."
Wolfe said he's particularly concerned about the protests and the use of tear gas by police to disperse people, as happened over two nights in Raleigh last weekend.
"Strikes me as no possibly better way to spread a respiratory virus than to tear gas a crowd, leaving them tearing, running nose, and coughing everywhere," he wrote.
