By Natalie Anderson
natalie.anderson@salisburypost.com

SALISBURY — Rowan County ended the week with five reported deaths and nearly 13% of its cases currently active as cases and hospitalizations continue to rise across the state.

Those statistics are one reason why state health officials sent a letter to 36 counties, including Rowan, on Tuesday urging officials to implement ordinances and penalties to enforce the governor’s executive order. But local leaders are unsure how they could do that with limited resources and financially impacted budgets.

In the letter, state health officials said Rowan County has had 300 or more new cases in the last 14 days and has been identified by the White House Coronavirus Task Force as a county of concern. Additionally, the letter states Rowan County’s case rate amounts to more than 50 per 10,000 residents.

The letter calls for local leaders to “win the hearts and minds of North Carolinians” by promoting mask wearing and practicing the three Ws — wear a face covering, wash hands and wait 6 feet apart.

The letter also called for local leaders to implement and enforce ordinances for violating COVID-19 executive orders. Examples the letter cites include imposing civil penalties for violating the state’s executive order related to wearing masks and limiting gatherings, issuing a local emergency proclamation with higher standards and supporting the local health director to issue and enforce an imminent hazard abatement order against entities whose actions present an imminent hazard to the community.

The county reported five deaths this week, with four among residents not associated with a congregate care facility. One of the two deaths reported on Friday is from Liberty Commons, which has now seen 14 deaths throughout both its current and previous outbreak. That amounts to 116 deaths, which puts the county fourth in the state for reported deaths.

And after reporting 4,008 cases since March, that puts Rowan County 17^th in the state for most cases per 10,000 residents. Currently, 489, or nearly 12%, of those cases are currently active. The current rate of tests returning positive is 7.7%.

Additionally, the county reported an average of 22.86 single-day increases in COVID-19 cases this week.

Meredith Littell, the county’s nursing director, said though the county has seen large one-day increases recently, the outbreak outside of congregate care facilities seems to be fairly steady. Nonetheless, it’s likely many locals have let their guard down and stepped back from following the three Ws to prevent the spread.

She added that, as flu season approaches, local health officials and leaders will need to amplify that message and put it back at the forefront of locals’ minds because the three Ws are still the best known defenses for preventing the spread.

As of Friday, state data counted 247 cases at facilities with outbreaks still declared active, including Elmcroft of Salisbury, Trinity Oaks Health and Rehab, Liberty Commons, Accordius Health and the N.C. State Veterans Home, which has now seen its second outbreak.

Additionally, the North Carolina Department of Public Safety reports 10 cases are active at the Piedmont Correctional Institute.

Both Compass Health and Autumn Care saw their outbreaks declared over this week.

Salisbury Mayor Karen Alexander said she and Greg Edds, chairman of the county commissioners, are not sure how the county and city could enforce mask wearing, social distancing and limiting gatherings due to limited resources and the financial impact to budgets.

She added that, unlike the federal government, local officials are required to balance their budgets each year. A lot of COVID-19 funds have been used to help the most vulnerable in the community, as well as assisting locals with general living expenses like utilities payments, she said.

“Firefighters stay busy all the time,” Alexander said. “And our police officers are stretched to the limit.”

She said if the governor isn’t able enforce precautions on a statewide basis, it’s not particularly helpful to put the extra burden on local leaders.

Additionally, she said enforcing one aspect of the safety precautions, such as wearing masks, may result in less focus on the other two precautions — washing hands and social distancing.

“It’s working all of those together that’s going to net us the best results,” Alexander said.

Alexander said it’s possible the letter will be put on a future city council agenda for public discussion. So far, she said, one local citizen has sent a letter to local leaders calling on them to do more with implementing ordinances or enforcing penalties.

Angela Worley, one of the county’s nursing supervisors, works with the county’s investigations team, which follows up with positive patients as well as COVID-19 hospitalizations and deaths. She suggests reminding people, especially young people who aren’t at a high-risk of COVID-19 complications, that older people and those with underlying health conditions can be hospitalized for weeks. That sometimes leads to patients’ loved ones having to make tough decisions like deciding if they should “pull the plug” on a ventilator.

“Talk to that family that’s lost their loved one,” Worley said. “Because that’s very real. If we all had a dose of that, we’d take this more seriously.”

Across the state, 258,292 people have tested positive after 3.79 million completed tests, for a percent positive rate of 6.8%. A total of 1,182 people are being hospitalized and 4,144 people have died.

State hospitalization demographic data, first reported this week, show the pandemic disproportionately impact Black and American Indian/Alaska Native North Carolinians. As of Friday, 28% of the 150 newly admitted patients are Black, though Black North Carolinians only comprise 22% of the state’s overall population. And 3% of those hospitalizations are among American Indian/Alaska Natives, though they make up less than 2% of the state’s population.

More than half, at 54%, of the newly admitted patients are among white North Carolinians, while 7% are among Hispanic North Carolinians.

Those older than 49 years old make up the plurality of those hospitalizations. A quarter of those hospitalizations are among those between 70 and 79 years old, while less than a quarter are among people aged 49 or younger collectively.

More than half of recently admitted hospitalizations are among males.

COVID-19 deaths also disproportionately impact Black North Carolinians as they make up 30% of the 4,144 reported deaths across the state. Additionally, 9% of the total deaths have been among Hispanic North Carolinians.

More than half, at 58%, of the deaths have been among North Carolinians aged 75 and older.

State health officials also report that North Carolina has seen an increase in COVID-19 clusters that stem from social events and gatherings, such as parties, weddings and funerals.

Clusters are defined as at least five cases with illness onsets or initial positive test results as well as a plausible epidemiologic linkage between cases, meaning cases are present in the same general setting during the same time period.

In September, the number of cases associated with clusters in religious gatherings increased. A total of 76 clusters have been reported from religious gatherings, totaling 1,040 cases and 13 deaths.

State health officials recommend the following for faith leaders to prevent further spread of the virus:

• Follow N.C. Department of Health and Human Services guidance on social distancing, wearing masks, sanitizing high-touch surfaces and limiting gatherings.
• Keep congregations and faith communities informed about prevention, testing, contact tracing and community supports.
• Urge community members to “get behind the mask.”
• Encourage congregations to download and use the mobile app SlowCOVIDNC.
• Urge congregations to get tested for COVID-19 if they have symptoms or think they’ve been exposed.
• Host a testing event in the community.
• Help connect people to resources and supports.
• Distribute masks and other personal protective equipment.
• Encourage people to participate in contact tracing.
• Amplify messages on social media.

Clusters in colleges and universities peaked in late August. To date, there have been 168 reported clusters and 1,902 cases.

And while 39 clusters and 3,841 cases have been linked to meat and poultry processing plants, the number of cases in those settings has decreased since May, state health officials report.

Data also show a total of 19 clusters and 115 cases linked to restaurants, two clusters and 115 linked to bars and breweries, 49 clusters and 401 cases linked to child care facilities and 168 clusters and 1,902 cases linked to health care settings.

On Monday, the state updated its guidance for private social gatherings. In addition to limiting inside gatherings to no more than 25 people and outdoor gatherings to no more than 50 people, state health officials recommend considering the amount of space available to social distance when planning events. It’s also advised for those older than 65 and anyone at high-risk for COVID-19 related complications should avoid social gatherings as much as possible.

If anyone develops COVID-19 symptoms within 48 hours after the event, they should notify others who attended. Additionally, guests should stay home if they’ve been exposed to COVID-19 within the last 14 days or are showing symptoms of the virus.

State health officials also recommend hosts of in-person holiday gatherings ask all guests to strictly avoid contact with people outside of their households for 14 days prior to the gathering.

As flu season and the holidays approach, Littell suggests people take a step back and think about who they’re gathering with and what risks they could pose by gathering with family members. And if anyone isn’t feeling well, they definitely shouldn’t be out or around other people.

Alexander said she continues to push out new information from local and state health officials regarding the pandemic on social media platforms. She also said it’s a good idea to keep extra masks handy in case anyone doesn’t have one.

“The city of Salisbury as an entity is encouraging these precautions all of the time,” she said.

Contact reporter Natalie Anderson at 704-797-4246.