About the Data

How does NCDHHS define and collect NC COVID-19 dashboard data?

COVID-19 Cases and Deaths

How are lab-confirmed cases and deaths counted in NC?

A “COVID-19 case” or “laboratory-confirmed COVID-19 case” is a person who had a diagnostic laboratory test that was positive for COVID-19. Cases are unique persons. A person may have multiple positive test results, but one person is counted as one case.

Data on cases and deaths, including number, demographics, and county and ZIP code of residence, comes from the North Carolina Electronic Disease Surveillance System (NC EDSS). County and ZIP code case and death totals may not match the total NC cases or deaths; this could be attributed to incomplete lab information.

Because reporting COVID-19 is mandatory in North Carolina, clinicians and laboratories must report all positive COVID-19 diagnostic tests to local or state public health. North Carolina Department of Health and Human Services (NCDHHS) and all local health departments (LHD) enter COVID-19 cases and deaths into NC EDSS. This information can be entered in a few different ways.  

Some laboratories report positive tests into NC EDSS through electronic laboratory reporting. These test results automatically feed into NC EDSS and populate the system with any available information on the laboratory report about the person.

However, not all laboratories currently report electronically. Positive test results from clinicians or laboratories that don’t have electronic reporting are reported to local or state public health via secure fax or electronic files. These test results are manually entered into NC EDSS by NCDHHS or LHD staff.

COVID-19 deaths include people who have had a positive laboratory test for COVID-19, who died without fully recovering from COVID-19 and who had no alternative cause of death identified. Deaths are reported by hospitals and clinicians directly to the local and state health departments. Once reported, NCDHHS or LHD staff manually enter the death by date of death, into NC EDSS.

NCDHHS conducts ongoing data quality checks on NC EDSS data, including ensuring that there are no duplicate cases, and to remove cases that are not NC residents consistent with the Council of State and Territorial Epidemiology guidance. After conducting data quality checks, the data are used to calculate the COVID-19 metrics posted on the NCDHHS website.

Cases by date reported shows cases on the day they were reported. These are displayed with a 7-day rolling average as a trendline.

Cases by date of specimen collection show cases by the date the person was tested. This method is what is often used to track other communicable diseases. As new cases are reported, they are added to the date that the test specimen was collected, and so the number for previous day can change. There is typically time between when the person is tested, the test is run at a lab, and the test result is reported to state or LHD, which is represented by the grey box in the graph. 

Deaths show deaths on the date the person died. Deaths are typically reported within hours or days. As new deaths are reported, they are included in the date the person died, and so previous dates can change.

Where does the demographic information come from? Why are data missing?

Any demographic information for cases or deaths that was included on the laboratory report is included. Information most commonly included is age, and occasionally gender. Additional data on demographics are obtained through case investigations by LHDs. When someone tests positive, the LHD contacts the person to obtain additional information. Some people may choose not to disclose this information to public health or are unable to be contacted. More information becomes available as case investigations are completed, but information is not available for all cases.

Demographics shows the number and percent of cases and deaths by age, gender, race, and ethnicity.  All percentages for demographic data on the NCDHHS website are calculated using cases with known information on that metric (e.g. percent of cases by race is calculated among cases with data available on race).

The number of cases and deaths that are missing demographic information are displayed in the table for ‘Missing Demographic Data’ on the NC COVID-19 Data Dashboard.  

COVID-19 Testing

Reporting positive laboratory tests to NCDHHS is mandatory. However, reporting the total number of tests conducted, including negative tests, is not required. Therefore, total tests come from labs that voluntarily reporting them.

Reporting laboratories submit the number of total tests performed to the Department of Public Safety - State Emergency Response Team (SERT). Some laboratories also report both positive and negative tests through electronic laboratory reporting into NC EDSS. This comprises more than 60% of the laboratory tests that have been reported to NCDHHS, and there are ongoing efforts to increase the number of labs reporting.

Tests that are emailed can be reported in batches (e.g., a lab reports three days of testing data at once) and tests are not always reported on the day they occurred. When a new lab begins reporting, it may report a backlog of tests from the past days or weeks. When tests are reported in batches or a new laboratory begins reporting, those tests are assigned back to the correct date. Therefore, previous days of testing are updated as more tests are reported. The number of tests completed by day is a dynamic number and is dependent on reporting labs.

To calculate percent positive, NCDHHS only uses test results from laboratories that report both positives and negatives through electronic laboratory reporting in NC EDSS. This ensures that the positive and negative tests were from the same day to calculate an accurate daily percent positive. This is because test totals that are emailed, not reported electronically, can occur in batches, so these cannot be confirmed that the positives and negatives occurred on the same day.

Total tests represent the number of tests reported to SERT and NCDHHS for that day. This tells us how much daily testing is increasing throughout the state. This includes both total tests that report electronically, and those that are emailed daily. Because this can be reported in batches, dates may be backfilled and might change.

Percent positive represents the number of positive tests as a percentage of tests. We know that as we test more, cases will go up. This gives us a sense of how many positive tests we are seeing in comparison to how much testing is going on. All data are preliminary and may change. 

COVID-19 Hospitalizations

NCDHHS surveys hospitals across North Carolina daily to monitor their current hospitalizations due to COVID-19 and their current capacity. This is done through the Healthcare Preparedness Program, which is used to assess hospital capacity during other disasters and emergencies.

Hospitals self-report information including the number of people currently hospitalized with COVID-19; the number of staffed inpatient beds, full and available intensive care unit (ICU) beds, the total number of patients on ventilators and available ventilators. This information is collected throughout each day, aggregated and then posted daily. NCDHHS also reports daily what percent of hospitals responded to the survey. Changes in the percent of hospitals reporting can change how many people were reported as currently hospitalized.

Currently Hospitalized represents the number of people currently hospitalized that day in the hospitals that reported. A person can be hospitalized for multiple days; therefore, this should not be interpreted as the number of new people admitted to the hospital each day. It is the number of people currently hospitalized, each day. Changes in the percent of hospitals reporting can affect how many people were reported as currently hospitalized with COVID-19.

Hospital Bed Totals Inpatient hospital beds shows the available staffed beds relative to the total number of staffed beds. ICU hospital beds shows the number of available staffed beds relative to the total number of licensed ICU beds in the state. On any given day, if one or more hospitals do not report, then their empty staffed beds are not included in the count of available beds.

Ventilators shows the total number of ventilators that are occupied not specific to persons with COVID-19.

COVID-19 Congregate Living Settings

A congregate living setting is a facility where people live for an extended period in a shared space, either in individual units with a shared building and common spaces, or with shared rooms or units. Because people are living in close proximity, these are settings that many states monitor for the spread of COVID-19.

NCDHHS tracks cases, deaths and outbreaks in congregate living settings: these include nursing homes; residential care facilities such as adult care homes and group homes; correction facilities such as prisons and jails; and others.

NC EDSS has a field to note whether a case or death was in a congregate living setting. Often, after a case is reported in NC EDSS, a case investigation is conducted, at which point the person is identified as being in a congregate living setting. At that point, the case or death is then marked as being part of a congregate living setting. In some situations, the congregate living setting proactively reports cases and deaths to the LHD or state, and so the case or death is entered with information that it was part of a congregate living setting.

NCDHHS also tracks the number of outbreaks in congregate living settings. An outbreak in a congregate living setting is defined as two or more laboratory-confirmed cases. NCDHHS displays the number of facilities with ongoing outbreaks by county on the data dashboard. The COVID-19 Ongoing Outbreaks in Congregate Living Settings Report lists facilities with an ongoing outbreak which is posted twice a week.

An outbreak is considered over once there is not evidence of sustained transmission - this means 28 days after the last case began having symptoms, or the date they were tested if they didn’t have symptoms. Once an outbreak is over, it is no longer reported as an “ongoing outbreak.”

Cases and deaths in congregate living settings are the total number of lab-confirmed COVID-19 cases and deaths among residents or staff of the congregate living settings that is regulated by NCDHHS. Time is required to determine whether a given COVID-19 case or death is associated with a congregate living setting, gather follow-up information, and enter it into NC EDSS. These cases or deaths could be part of an ongoing outbreak or could be in a congregate living setting that is not experiencing an ongoing outbreak. 

Outbreaks in congregate living settings are the number of ongoing outbreaks in congregate living facilities.

 

Data Download for the NC COVID-19 Data Dashboard

NCDHHS has provided the following dashboards’ data for download: Summary, Cases, Testing and Hospitalization.

The data tabs are located at the top of the Data Download dashboard: Daily Metrics, County Cases and Deaths, ZIP Code Cases and Deaths, Demographics, Hospital Beds and Ventilators.

To download the data, press the download button at the bottom of the dashboard and select a download file format.

 

 

Data Sources for the NC COVID-19 Data Dashboard

North Carolina collects data from several sources and partners to monitor the COVID-19 pandemic in North Carolina. The following data sources are used in the dashboard. New data sources may be added.

North Carolina Electronic Disease Surveillance System (NC EDSS)

NC EDSS, the North Carolina Electronic Disease Surveillance System, is a component of the Centers for Disease Control and Prevention (CDC) initiative to move states to web-based health surveillance and reporting systems. NC EDSS is also part of the Public Health Information Network (PHIN). The electronic system replaced a patchwork of smaller disease-specific surveillance systems and paper-based reporting.

NC EDSS is used by the North Carolina Department of Health and Human Services, Division of Public Health (DPH), the state's 86 local and multi-county district health departments, and eight HIV/STD Regional Offices. Laboratories also report electronically to NC EDSS.

NC EDSS creates a central repository of person-based public health data. LHDs collect and enter the data included in the dashboard, including COVID-19 cases, deaths, and demographic information.

SurveyMax

Hospitals fill out daily surveys through SurveyMax to indicate capacity, including beds, ventilators, admissions, deaths, etc. Previously these data were entered a survey using ReadyOp as a backend, but the survey was migrated to SurveyMax on June 3, 2020.

Personal Protective Equipment

Personal Protective Equipment (PPE) from our federal partners, Federal Emergency Management Agency (FEMA) and the Strategic National Stockpile are tracked and monitored by North Carolina Emergency Management. This information reflects key pieces of PPE requested from and received from FEMA and the Strategic National Stockpile. It does not reflect PPE purchased or received from other sources.

PPE from the Private Sector is purchased, tracked and monitored by North Carolina Emergency Management. Requests for PPE are submitted through ReadyOp and WebEOC by healthcare partners, first responders and county partners. 

WebEOC

County Emergency Operation Centers (EOC) have access to WebEOC to request and track resource requests for fulfillment by the State Emergency Response Team at the State Emergency Operations Center. When a resource request is placed by a county EOC into WebEOC the request is routed to the appropriate emergency support function to review and vet the request. Once approved the resource request is routed for fulfillment (if the resource is on hand) or for sourcing (if the resource needs to be procured).

ReadyOp

Healthcare partners that need to request Personal Protective Equipment (PPE) can complete a survey in ReadyOp to provide information on their PPE needs. The request is routed to the appropriate emergency support function to review and vet the resource. Once approved the resource request is entered into WebEOC and is routed for fulfillment (if the resource is on hand) or for sourcing (if the resource needs to be procured).

Surveillance Strategies

To get a more complete picture of COVID-19 in our state, North Carolina uses evidence-based surveillance tools, including what is known as syndromic surveillance. Syndromic surveillance refers to tools that gather information about patients' symptoms (such as cough, fever, or shortness of breath) and do not rely only on laboratory testing.

In North Carolina, as well as in other states and at the Centers for Disease Control and Prevention (CDC), public health scientists are modifying existing surveillance tools for COVID-19. These tools have been used for decades to track influenza annually and during seasonal epidemics and pandemics. These include the following:

The Influenza-Like Illness Surveillance Network (ILINet). ILINet is a network of clinical sites across the country, including in North Carolina, that is coordinated by the CDC. ILINet sites report data each week on fever and respiratory illness in their patients. They also submit samples (swabs) from a subset of patients for laboratory testing at the North Carolina State Laboratory of Public Health. This network will now test for COVID-19 in addition to influenza.

Emergency department (ED) surveillance based on symptoms (syndromic). In North Carolina, we receive ED data in near real-time from all 126 hospitals in the state using the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). This is an effective way to track respiratory illness, including COVID-19. Specifically, we will use NC DETECT to track trends in respiratory illness across the state and over time.

Data on severe illnesses. Public health scientists will use a variety of sources to track hospitalizations related to COVID-19. These include data reported directly by hospitals (including current numbers of patients hospitalized with COVID-19) and more detailed data from a network of epidemiologists in the state’s largest healthcare systems (including total hospitalizations and intensive care unit admissions for respiratory illness).  Deaths due to COVID-19 have also been added to the list of conditions that physicians are required to report in North Carolina.

NC DETECT

The North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) is North Carolina’s statewide, electronic, real-time public health surveillance system. NC DETECT was created to provide early event detection and timely public health surveillance using a variety of secondary data sources, including data from the NC Emergency Departments (EDs). Each ED visit is grouped into syndromes based on keywords in several different fields and/or diagnosis codes.

For monitoring COVID-19, NC DETECT epidemiologists are using a syndrome called the COVID-like Illness (CLI) Syndrome. CLI Syndrome looks for ED visits with mention of COVID or fever/chills and cough or shortness of breath in the chief complaint or triage notes. Please note that CLI syndrome does NOT indicate confirmed cases of COVID-19.

Recent changes in health care seeking behavior are impacting trends in CLI syndrome and other ED data, making it difficult to draw conclusions at this time. Tracking these systems moving forward will give additional insight into illness related to COVID-19. NC DETECT was created by the DPH in collaboration with the Carolina Center for Health Informatics (CCHI) in the UNC Department of Emergency Medicine.

Public Health Epidemiologists Program

In 2003, DPH created a hospital-based Public Health Epidemiologist (PHE) program to strengthen coordination and communication between hospitals, health departments and the state. The PHE program covers approximately 38 percent of general/acute care beds and 40 percent of ED visits in the state. PHEs play a critical role in assuring routine and urgent communicable disease control, hospital reporting of communicable diseases, outbreak management and case finding during community wide outbreaks.

Influenza-like Illness Network

The U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet), is a collaboration with providers, state health departments, and CDC to conduct surveillance for influenza-like illness. ILINet providers in primary care clinics and hospitals across the state send sample collected from patients with influenza-like illness to the North Carolina State Laboratory of Public Health for testing. With the current COVID-19 pandemic, ILINet has been expanded to include testing for SARS-CoV-2 in both symptomatic and asymptomatic patients. Providers are asked to submit up to 10 samples from symptomatic patients and 10 samples from asymptomatic patients each week. For ILINet surveillance purposes symptomatic is defined as fever (>100F) and cough or sore throat. More information about ILINet can be found at www.flu.nc.gov.

NC State Center for Health Statistics: Behavioral Risk Factors Surveillance System

The Behavioral Risk Factor Surveillance System (BRFSS) is a random telephone survey of state residents aged 18 and older in households with telephones. BRFSS was initially developed in the early 1980s by the Centers for Disease Control and Prevention (CDC) in collaboration with state health departments and is currently conducted in all 50 states, the District of Columbia and several United States territories. DPH has participated in the BRFSS since 1987. Through BRFSS, information is collected in a routine, standardized manner at the state level on a variety of health behaviors and preventive health practices related to the leading causes of death and disability such as cardiovascular disease, cancer, diabetes and injuries. BRFSS interviews are conducted monthly and data are analyzed annually (on a calendar-year basis).