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1.
MMWR Morb Mortal Wkly Rep ; 70(46): 1603-1607, 2021 Nov 19.
Article in English | MEDLINE | ID: covidwho-1524679

ABSTRACT

During October 3, 2020-January 9, 2021, North Carolina experienced a 400% increase in daily reported COVID-19 cases (1). To handle the increased number of cases and rapidly notify persons receiving a positive SARS-CoV-2 test result (patients), North Carolina state and local health departments moved from telephone call notification only to telephone call plus automated text and email notification (digital notification) beginning on December 24, 2020. Overall, among 200,258 patients, 142,975 (71%) were notified by telephone call or digital notification within the actionable period (10 days from their diagnosis date)* during January 2021, including at least 112,543 (56%) notified within 24 hours of report to North Carolina state and local health departments, a significantly higher proportion than the 25,905 of 175,979 (15%) notified within 24 hours during the preceding month (p<0.001). Differences in text notification by age, race, and ethnicity were observed. Automated digital notification is a feasible, rapid and efficient method to support timely outreach to patients, provide guidance on how to isolate, access resources, inform close contacts, and increase the efficiency of case investigation staff members.


Subject(s)
Automation , COVID-19/diagnosis , Electronic Mail , Text Messaging , Adolescent , Adult , Aged , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Testing , Child , Child, Preschool , Disease Notification/methods , Disease Notification/statistics & numerical data , Humans , Infant , Infant, Newborn , Middle Aged , North Carolina/epidemiology , Time Factors , Young Adult
2.
PLoS One ; 16(11): e0260310, 2021.
Article in English | MEDLINE | ID: covidwho-1523457

ABSTRACT

The first case of COVID-19 was detected in North Carolina (NC) on March 3, 2020. By the end of April, the number of confirmed cases had soared to over 10,000. NC health systems faced intense strain to support surging intensive care unit admissions and avert hospital capacity and resource saturation. Forecasting techniques can be used to provide public health decision makers with reliable data needed to better prepare for and respond to public health crises. Hospitalization forecasts in particular play an important role in informing pandemic planning and resource allocation. These forecasts are only relevant, however, when they are accurate, made available quickly, and updated frequently. To support the pressing need for reliable COVID-19 data, RTI adapted a previously developed geospatially explicit healthcare facility network model to predict COVID-19's impact on healthcare resources and capacity in NC. The model adaptation was an iterative process requiring constant evolution to meet stakeholder needs and inform epidemic progression in NC. Here we describe key steps taken, challenges faced, and lessons learned from adapting and implementing our COVID-19 model and coordinating with university, state, and federal partners to combat the COVID-19 epidemic in NC.


Subject(s)
COVID-19/epidemiology , Hospital Bed Capacity/statistics & numerical data , Hospitalization/trends , Intensive Care Units/trends , Pandemics/statistics & numerical data , Delivery of Health Care , Forecasting , Humans , North Carolina/epidemiology
5.
JMIR Public Health Surveill ; 7(8): e28195, 2021 08 04.
Article in English | MEDLINE | ID: covidwho-1341584

ABSTRACT

BACKGROUND: COVID-19 has been one of the most serious global health crises in world history. During the pandemic, health care systems require accurate forecasts for key resources to guide preparation for patient surges. Forecasting the COVID-19 hospital census is among the most important planning decisions to ensure adequate staffing, number of beds, intensive care units, and vital equipment. OBJECTIVE: The goal of this study was to explore the potential utility of local COVID-19 infection incidence data in developing a forecasting model for the COVID-19 hospital census. METHODS: The study data comprised aggregated daily COVID-19 hospital census data across 11 Atrium Health hospitals plus a virtual hospital in the greater Charlotte metropolitan area of North Carolina, as well as the total daily infection incidence across the same region during the May 15 to December 5, 2020, period. Cross-correlations between hospital census and local infection incidence lagging up to 21 days were computed. A multivariate time-series framework, called the vector error correction model (VECM), was used to simultaneously incorporate both time series and account for their possible long-run relationship. Hypothesis tests and model diagnostics were performed to test for the long-run relationship and examine model goodness of fit. The 7-days-ahead forecast performance was measured by mean absolute percentage error (MAPE), with time-series cross-validation. The forecast performance was also compared with an autoregressive integrated moving average (ARIMA) model in the same cross-validation time frame. Based on different scenarios of the pandemic, the fitted model was leveraged to produce 60-days-ahead forecasts. RESULTS: The cross-correlations were uniformly high, falling between 0.7 and 0.8. There was sufficient evidence that the two time series have a stable long-run relationship at the .01 significance level. The model had very good fit to the data. The out-of-sample MAPE had a median of 5.9% and a 95th percentile of 13.4%. In comparison, the MAPE of the ARIMA had a median of 6.6% and a 95th percentile of 14.3%. Scenario-based 60-days-ahead forecasts exhibited concave trajectories with peaks lagging 2 to 3 weeks later than the peak infection incidence. In the worst-case scenario, the COVID-19 hospital census can reach a peak over 3 times greater than the peak observed during the second wave. CONCLUSIONS: When used in the VECM framework, the local COVID-19 infection incidence can be an effective leading indicator to predict the COVID-19 hospital census. The VECM model had a very good 7-days-ahead forecast performance and outperformed the traditional ARIMA model. Leveraging the relationship between the two time series, the model can produce realistic 60-days-ahead scenario-based projections, which can inform health care systems about the peak timing and volume of the hospital census for long-term planning purposes.


Subject(s)
COVID-19/therapy , Censuses , Forecasting/methods , Hospitals , Models, Theoretical , COVID-19/epidemiology , Humans , Incidence , Multivariate Analysis , North Carolina/epidemiology
6.
Pediatrics ; 148(4)2021 10.
Article in English | MEDLINE | ID: covidwho-1332046

ABSTRACT

OBJECTIVES: When the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic began, experts raised concerns about in-person instruction in the setting of high levels of community transmission. We describe secondary transmission of SARS-CoV-2 within North Carolina kindergarten through 12th-grade school districts during a winter surge to determine if mitigation strategies can hinder within-school transmission. METHODS: From October 26, 2020, to February 28, 2021, 13 North Carolina school districts participating in The ABC Science Collaborative were open for in-person instruction, adhered to basic mitigation strategies, and tracked community- and school-acquired SARS-CoV-2 cases. Public health officials adjudicated each case. We combined these data with that from August 2020 to evaluate the effect of the SARS-CoV-2 winter surge on infection rates as well as weekly community- and school-acquired cases. We evaluated the number of secondary cases generated by each primary case as well as the role of athletic activities in school-acquired cases. RESULTS: More than 100 000 students and staff from 13 school districts attended school in person; of these, 4969 community-acquired SARS-CoV-2 infections were documented by molecular testing. Through contact tracing, North Carolina local health department staff identified an additional 209 infections among >26 000 school close contacts (secondary attack rate <1%). Most within-school transmissions in high schools (75%) were linked to school-sponsored sports. School-acquired cases slightly increased during the surge; however, within-school transmission rates remained constant, from presurge to surge, with ∼1 school-acquired case for every 20 primary cases. CONCLUSIONS: With adherence to basic mitigation strategies, within-school transmission of SARS-CoV-2 can be interrupted, even during a surge of community infections.


Subject(s)
COVID-19/transmission , Schools , Adolescent , COVID-19/ethnology , COVID-19/prevention & control , Child , Child, Preschool , Community-Acquired Infections/ethnology , Community-Acquired Infections/prevention & control , Community-Acquired Infections/transmission , Contact Tracing , Humans , Masks , North Carolina/epidemiology , Pandemics , Physical Distancing , Race Factors , SARS-CoV-2
7.
JMIR Public Health Surveill ; 7(9): e29310, 2021 09 02.
Article in English | MEDLINE | ID: covidwho-1323049

ABSTRACT

BACKGROUND: As the world faced the pandemic caused by the novel coronavirus disease 2019 (COVID-19), medical professionals, technologists, community leaders, and policy makers sought to understand how best to leverage data for public health surveillance and community education. With this complex public health problem, North Carolinians relied on data from state, federal, and global health organizations to increase their understanding of the pandemic and guide decision-making. OBJECTIVE: We aimed to describe the role that stakeholders involved in COVID-19-related data played in managing the pandemic in North Carolina. The study investigated the processes used by organizations throughout the state in using, collecting, and reporting COVID-19 data. METHODS: We used an exploratory qualitative study design to investigate North Carolina's COVID-19 data collection efforts. To better understand these processes, key informant interviews were conducted with employees from organizations that collected COVID-19 data across the state. We developed an interview guide, and open-ended semistructured interviews were conducted during the period from June through November 2020. Interviews lasted between 30 and 45 minutes and were conducted by data scientists by videoconference. Data were subsequently analyzed using qualitative data analysis software. RESULTS: Results indicated that electronic health records were primary sources of COVID-19 data. Often, data were also used to create dashboards to inform the public or other health professionals, to aid in decision-making, or for reporting purposes. Cross-sector collaboration was cited as a major success. Consistency among metrics and data definitions, data collection processes, and contact tracing were cited as challenges. CONCLUSIONS: Findings suggest that, during future outbreaks, organizations across regions could benefit from data centralization and data governance. Data should be publicly accessible and in a user-friendly format. Additionally, established cross-sector collaboration networks are demonstrably beneficial for public health professionals across the state as these established relationships facilitate a rapid response to evolving public health challenges.


Subject(s)
COVID-19/epidemiology , Data Analysis , Data Collection , Pandemics/prevention & control , Stakeholder Participation/psychology , Female , Health Education , Humans , Male , North Carolina/epidemiology , Public Health Surveillance , Qualitative Research
8.
MMWR Morb Mortal Wkly Rep ; 70(28): 991-996, 2021 Jul 16.
Article in English | MEDLINE | ID: covidwho-1311471

ABSTRACT

COVID-19 has disproportionately affected non-Hispanic Black or African American (Black) and Hispanic persons in the United States (1,2). In North Carolina during January-September 2020, deaths from COVID-19 were 1.6 times higher among Black persons than among non-Hispanic White persons (3), and the rate of COVID-19 cases among Hispanic persons was 2.3 times higher than that among non-Hispanic persons (4). During December 14, 2020-April 6, 2021, the North Carolina Department of Health and Human Services (NCDHHS) monitored the proportion of Black and Hispanic persons* aged ≥16 years who received COVID-19 vaccinations, relative to the population proportions of these groups. On January 14, 2021, NCDHHS implemented a multipronged strategy to prioritize COVID-19 vaccinations among Black and Hispanic persons. This included mapping communities with larger population proportions of persons aged ≥65 years among these groups, increasing vaccine allocations to providers serving these communities, setting expectations that the share of vaccines administered to Black and Hispanic persons matched or exceeded population proportions, and facilitating community partnerships. From December 14, 2020-January 3, 2021 to March 29-April 6, 2021, the proportion of vaccines administered to Black persons increased from 9.2% to 18.7%, and the proportion administered to Hispanic persons increased from 3.9% to 9.9%, approaching the population proportion aged ≥16 years of these groups (22.3% and 8.0%, respectively). Vaccinating communities most affected by COVID-19 is a national priority (5). Public health officials could use U.S. Census tract-level mapping to guide vaccine allocation, promote shared accountability for equitable distribution of COVID-19 vaccines with vaccine providers through data sharing, and facilitate community partnerships to support vaccine access and promote equity in vaccine uptake.


Subject(s)
COVID-19 Vaccines/administration & dosage , /statistics & numerical data , Adolescent , Adult , Aged , COVID-19/epidemiology , COVID-19/ethnology , COVID-19/prevention & control , Health Care Rationing/methods , Health Status Disparities , Humans , Middle Aged , North Carolina/epidemiology , Vaccination Coverage/statistics & numerical data , Young Adult
9.
JAMA Netw Open ; 4(6): e2110782, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1248672

ABSTRACT

Importance: Vaccination against SARS-CoV-2 has the potential to significantly reduce transmission and COVID-19 morbidity and mortality. The relative importance of vaccination strategies and nonpharmaceutical interventions (NPIs) is not well understood. Objective: To assess the association of simulated COVID-19 vaccine efficacy and coverage scenarios with and without NPIs with infections, hospitalizations, and deaths. Design, Setting, and Participants: An established agent-based decision analytical model was used to simulate COVID-19 transmission and progression from March 24, 2020, to September 23, 2021. The model simulated COVID-19 spread in North Carolina, a US state of 10.5 million people. A network of 1 017 720 agents was constructed from US Census data to represent the statewide population. Exposures: Scenarios of vaccine efficacy (50% and 90%), vaccine coverage (25%, 50%, and 75% at the end of a 6-month distribution period), and NPIs (reduced mobility, school closings, and use of face masks) maintained and removed during vaccine distribution. Main Outcomes and Measures: Risks of infection from the start of vaccine distribution and risk differences comparing scenarios. Outcome means and SDs were calculated across replications. Results: In the worst-case vaccination scenario (50% efficacy, 25% coverage), a mean (SD) of 2 231 134 (117 867) new infections occurred after vaccination began with NPIs removed, and a mean (SD) of 799 949 (60 279) new infections occurred with NPIs maintained during 11 months. In contrast, in the best-case scenario (90% efficacy, 75% coverage), a mean (SD) of 527 409 (40 637) new infections occurred with NPIs removed and a mean (SD) of 450 575 (32 716) new infections occurred with NPIs maintained. With NPIs removed, lower efficacy (50%) and higher coverage (75%) reduced infection risk by a greater magnitude than higher efficacy (90%) and lower coverage (25%) compared with the worst-case scenario (mean [SD] absolute risk reduction, 13% [1%] and 8% [1%], respectively). Conclusions and Relevance: Simulation outcomes suggest that removing NPIs while vaccines are distributed may result in substantial increases in infections, hospitalizations, and deaths. Furthermore, as NPIs are removed, higher vaccination coverage with less efficacious vaccines can contribute to a larger reduction in risk of SARS-CoV-2 infection compared with more efficacious vaccines at lower coverage. These findings highlight the need for well-resourced and coordinated efforts to achieve high vaccine coverage and continued adherence to NPIs before many prepandemic activities can be resumed.


Subject(s)
COVID-19 Vaccines/pharmacology , COVID-19 , Communicable Disease Control , Mass Vaccination , Vaccination Coverage , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Communicable Disease Control/statistics & numerical data , Computer Simulation , Disease Transmission, Infectious/prevention & control , Female , Hospitalization/statistics & numerical data , Humans , Male , Mass Vaccination/organization & administration , Mass Vaccination/statistics & numerical data , Mortality , North Carolina/epidemiology , Risk Assessment/methods , Risk Assessment/statistics & numerical data , SARS-CoV-2 , Treatment Outcome , Vaccination Coverage/organization & administration , Vaccination Coverage/statistics & numerical data
10.
JMIR Public Health Surveill ; 7(5): e29298, 2021 05 27.
Article in English | MEDLINE | ID: covidwho-1231310

ABSTRACT

BACKGROUND: The opioid crisis in the United States may be exacerbated by the COVID-19 pandemic. Increases in opioid use, emergency medical services (EMS) runs for opioid-related overdoses, and opioid overdose deaths have been reported. No study has examined changes in multiple naloxone administrations, an indicator of overdose severity, during the COVID-19 pandemic. OBJECTIVE: This study examines changes in the occurrence of naloxone administrations and multiple naloxone administrations during EMS runs for opioid-related overdoses during the COVID-19 pandemic in Guilford County, North Carolina (NC). METHODS: Using a period-over-period approach, we compared the occurrence of opioid-related EMS runs, naloxone administrations, and multiple naloxone administrations during the 29-week period before (September 1, 2019, to March 9, 2020) and after NC's COVID-19 state of emergency declaration (ie, the COVID-19 period of March 10 to September 30, 2020). Furthermore, historical data were used to generate a quasi-control distribution of period-over-period changes to compare the occurrence of each outcome during the COVID-19 period to each 29-week period back to January 1, 2014. RESULTS: All outcomes increased during the COVID-19 period. Compared to the previous 29 weeks, the COVID-19 period experienced increases in the weekly mean number of opioid-related EMS runs (25.6, SD 5.6 vs 18.6, SD 6.6; P<.001), naloxone administrations (22.3, SD 6.2 vs 14.1, SD 6.0; P<.001), and multiple naloxone administrations (5.0, SD 1.9 vs 2.7, SD 1.9; P<.001), corresponding to proportional increases of 37.4%, 57.8%, and 84.8%, respectively. Additionally, the increases during the COVID-19 period were greater than 91% of all historical 29-week periods analyzed. CONCLUSIONS: The occurrence of EMS runs for opioid-related overdoses, naloxone administrations, and multiple naloxone administrations during EMS runs increased during the COVID-19 pandemic in Guilford County, NC. For a host of reasons that need to be explored, the COVID-19 pandemic appears to have exacerbated the opioid crisis.


Subject(s)
COVID-19/epidemiology , Drug Overdose/drug therapy , Emergency Medical Services/statistics & numerical data , Naloxone/therapeutic use , Opioid-Related Disorders/drug therapy , Pandemics , Drug Overdose/epidemiology , Humans , North Carolina/epidemiology , Opioid-Related Disorders/epidemiology , Retrospective Studies
13.
Am J Infect Control ; 49(9): 1204-1205, 2021 09.
Article in English | MEDLINE | ID: covidwho-1222831

ABSTRACT

Our study surveyed over 2000 employees of a community health care system in the Southeast United States for SARS-CoV2 antibodies. Survey included subjects' expectation of the result. Our local area had low community prevalence of SARS-CoV2 but low diagnostic testing capacity during much of the early phase of the epidemic. Despite only 3% positivity rate for antibodies in this population, 17% of subjects expected to have positive antibodies.


Subject(s)
Antibodies, Viral/blood , COVID-19 , Health Personnel , COVID-19/diagnosis , COVID-19/immunology , COVID-19 Serological Testing , Hospitals, Community , Humans , North Carolina/epidemiology , Seroepidemiologic Studies
14.
PLoS One ; 16(5): e0251169, 2021.
Article in English | MEDLINE | ID: covidwho-1220145

ABSTRACT

State and local health departments have been tasked with promoting the use of face coverings to decrease the spread of COVID-19 in their respective communities. However, little is known about motivations and barriers to wearing face coverings in the context of COVID-19 prevention, particularly among communities of color who are at an increased risk of serious illness from the disease. The purpose of this study was to identify common motivations and barriers to face covering use, as well as explore perceptions of messages encouraging the use of face coverings among a racially and ethnically diverse sample. A survey was distributed electronically to North Carolina (NC) residents through NC Department of Health and Human Services listservs in July 2020. Participants self-categorized as Latino/a (33.5%), Black (39.1%), or white or another race (27.5%). The most commonly endorsed motivations for wearing face coverings were to avoid spreading COVID-19 (77%), as well as to protect people who are vulnerable (76%) and one's community (72%). Being uncomfortable (40%) was the most commonly endorsed barrier. Messages that included a clear request (ex. please wear a face covering) and a direct benefit (ex. keep community safe) were more commonly endorsed than those that did not. Commonly endorsed motivations, behaviors, and messages differed by race and ethnicity. Increased attention to message content, message structure, and access to information and resources may aid local officials in increasing consistent use of face coverings.


Subject(s)
COVID-19/prevention & control , Masks , Adolescent , Adult , COVID-19/epidemiology , COVID-19/virology , Communication , Female , Humans , Male , Motivation , North Carolina/epidemiology , Pandemics , SARS-CoV-2/isolation & purification , Surveys and Questionnaires , Young Adult
15.
Am J Manag Care ; 26(8): 325-326, 2020 08.
Article in English | MEDLINE | ID: covidwho-1215923

ABSTRACT

To mark the 25th anniversary of the journal, each issue in 2020 will include an interview with a health care thought leader. The August issue features a conversation with Mandy K. Cohen, MD, MPH, secretary of the North Carolina Department of Health and Human Services.


Subject(s)
COVID-19/epidemiology , Medicaid/organization & administration , Patient-Centered Care/organization & administration , Humans , Mental Health Services/organization & administration , North Carolina/epidemiology , Pandemics , SARS-CoV-2 , United States/epidemiology
16.
Am J Emerg Med ; 47: 187-191, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1193199

ABSTRACT

CONTEXT: The global COVID-19 pandemic has had a major impact on the utilization of healthcare services; however, the impact on population-level emergency department (ED) utilization patterns for the treatment of acute injuries has not been fully characterized. OBJECTIVE: This study examined the frequency of North Carolina (NC) EDs visits for selected injury mechanisms during the first eleven months of the COVID-19 pandemic. METHODS: Data were obtained from the NC Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), NC's legislatively mandated statewide syndromic surveillance system for the years 2019 and 2020. Frequencies of January - November 2020 NC ED visits were compared to frequencies of 2019 visits for selected injury mechanisms, classified according to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) injury diagnosis and mechanism codes. RESULTS: In 2020, the total number of injury-related visits declined by 19.5% (N = 651,158) as compared to 2019 (N = 809,095). Visits related to motor vehicle traffic crashes declined by a greater percentage (29%) and falls (19%) declined by a comparable percentage to total injury-related visits. Visits related to assault (15%) and self-harm (10%) declined by smaller percentages. Medication/drug overdose visits increased (10%), the only injury mechanism studied to increase during this period. CONCLUSION: Both ED avoidance and decreased exposures may have contributed to these declines, creating implications for injury morbidity and mortality. Injury outcomes exacerbated by the pandemic should be addressed by timely public health responses.


Subject(s)
COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Wounds and Injuries/epidemiology , Wounds and Injuries/therapy , Adolescent , Adult , Aged , Child , Child, Preschool , Emergency Service, Hospital/trends , Facilities and Services Utilization , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , North Carolina/epidemiology , Pandemics , Patient Acceptance of Health Care , Young Adult
17.
J Agromedicine ; 25(4): 409-412, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1174769

ABSTRACT

North Carolina employs 78,000+ migrant/seasonal farmworkers (MSFWs) annually. Arrival/departure dates are crop and weather dependent. MSFWs may be employed by a grower or a farm labor contractor (FLC). Like farmworker housing, FLCs may be registered or unregistered. Primary care or enabling services are provided by the NC Farmworker Health Program or community health centers that receive dedicated federal funding for MSFWs. The arrival of NC's growing season, MSFWs, and COVID-19 brought unforeseen challenges even to those experienced in caring for MSFWs. Challenges include congregate activities, consistency/accuracy of COVID-19 related communications, availability of alternate housing, barriers to testing and contact tracing, lack of internet connectivity in farmworker housing and insufficient personal protective equipment. Challenges are discussed in no order of occurrence or level of importance as many are inter-related. To meet these challenges, a migrant health and housing workgroup was convened. Members include the NC Department of Labor-Agricultural Safety and Health Bureau, NC Department of Health and Human Services - Communicable Disease Branch and NC Farmworker Health Program, NC Community Health Center Association and NC Agromedicine Institute. Members work collaboratively along the continuum from local to state levels and across agencies and communities to facilitate strategies to address COVID-19 challenges. Implications exist for practice, research and policy including testing of MSFWs on arrival with a 14-day quarantine before moving to assigned farm, a "strike team" to do on-farm tests for workers in the event of a positive case or exposure; and, research on COVID-19 outbreaks and impact of telehealth on MSFWs wellbeing.


Subject(s)
COVID-19/epidemiology , Transients and Migrants/statistics & numerical data , Agriculture/statistics & numerical data , COVID-19/diagnosis , COVID-19/psychology , COVID-19 Testing , Farmers/psychology , Farmers/statistics & numerical data , Humans , North Carolina/epidemiology , Occupational Health , Quarantine , Seasons , Transients and Migrants/psychology , Work
20.
Infect Control Hosp Epidemiol ; 42(3): 341-343, 2021 03.
Article in English | MEDLINE | ID: covidwho-1131954

ABSTRACT

We implemented universal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing of patients undergoing surgical procedures as a means to conserve personal protective equipment (PPE). The rate of asymptomatic coronavirus disease 2019 (COVID-19) was <0.5%, which suggests that early local public health interventions were successful. Although our protocol was resource intensive, it prevented exposures to healthcare team members.


Subject(s)
COVID-19 Testing/statistics & numerical data , COVID-19/epidemiology , Preoperative Care/methods , Surgical Procedures, Operative/statistics & numerical data , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , North Carolina/epidemiology , Personal Protective Equipment/supply & distribution
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