About the Data

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

COVID-19 Cases and Deaths

How are cases and deaths counted in NC?

A “COVID-19 case” is a person who received a positive COVID-19 test result.  People are only counted as a case once, even if they have multiple positive tests.

Starting September 25, 2020, the North Carolina Department of Health and Human Services (NCDHHS) began reporting on two new measures on the NC COVID-19 Dashboard: 1. Antigen-positive cases and deaths, and 2. Antigen tests completed. This change was made in accordance with recently updated case classification guidelines from the Centers for Disease Control and Prevention.

Both molecular (PCR) and antigen tests are diagnostic. This means that they look to see if someone is currently infected with COVID-19. Each test looks for different things to determine if someone is infected.

  • A molecular (PCR) test looks for the virus’s genetic material.
  • An antigen test is a rapid test that looks for specific proteins on the surface of the virus.

Where the test is processed may also differ.

  • Molecular (PCR) tests are processed in a laboratory.
  • Antigen tests are often processed at the point of care, such as in a health care provider’s office.

A molecular (PCR) positive case of COVID-19 is a person who received a positive COVID-19 result from a molecular (PCR) test. An antigen positive case of COVID-19 is a person who received a positive COVID-19 result from an antigen test and does not have a positive result from a molecular (PCR) test. 

Molecular (PCR) positive cases are classified as “confirmed” cases and antigen positive cases are classified as “probable” cases of COVID-19, in accordance with CDC case classification guidelines. Despite the names, regardless of the test used, a person who tests positive is considered to have COVID-19. The terms “confirmed” and “probable” are used nationally to standardize case classifications for public health surveillance but should not be used to interpret the utility or validity of any laboratory test type.

For more information about different types of COVID-19 tests, visit the Food and Drug Administration’s overview of coronavirus testing basics.

Data on cases and deaths, including number, demographics, county and ZIP code of residence, come from the North Carolina COVID-19 Surveillance System (NC COVID). Data on cases and deaths include both molecular (PCR) and antigen positive cases. County and ZIP code case and death totals may not match the total NC cases or deaths; this could be attributed to incomplete information.

Because reporting COVID-19 is mandatory in North Carolina, clinicians and laboratories must report results of all COVID-19 molecular (PCR) and antigen tests to local or state public health. Some laboratories report COVID-19 test results into NC COVID through electronic laboratory reporting. These test results automatically feed into NC COVID and populate the system with any available information on the laboratory report about the person. However, not all laboratories currently report electronically. 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. Positive test results are manually entered into NC COVID by NCDHHS or Local Health Department (LHD) staff.

COVID-19 deaths include people who have had a positive molecular (PCR) or antigen 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 COVID.

NCDHHS conducts ongoing data quality checks on NC COVID data, including ensuring that there are no duplicate cases, and removing cases that are not NC residents, consistent with national 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 the number of new cases on the report date compared to the previous day. These are displayed with a 7-day rolling average as a trendline. Cases include both molecular (PCR) positive and antigen positive cases.

Cases by date of specimen collection show molecular (PCR) positive and antigen positive 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 days 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 the state or LHD. Because of this, the data for the most recent days are considered preliminary and incomplete, which is represented by the grey box in the graph. 

Deaths by date of death 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. Deaths include those among molecular (PCR) and antigen positive cases.

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 on the NC COVID-19 data dashboards. 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 could not 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). Data for both molecular (PCR) positive and antigen positive cases are included in the demographic data.

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

COVID-19 Testing

Labs submit testing data to the State in two ways: at the patient-level, and in aggregate.

Patient-level testing data (positives and negatives) is submitted either electronically through NC COVID or manually via secure fax or electronic communications. Approximately 80% of total patient-level tests are now submitted electronically through NC COVID. The other 20% that are manually submitted must then be hand-entered into NC COVID.

Aggregate testing data is provided by labs that don’t have electronic laboratory reporting. These labs submit the daily number of tests performed to NCDHHS using the electronic COVID-19 Aggregate Test Reporting (eCATR) survey tool.

Test totals are combined from these two sources of testing data to obtain the daily and cumulative report of total tests performed. NCDHHS has been working to improve data reporting processes to minimize redundancy with all labs to move to reporting exclusively through NC COVID to improve data integrity with test totals from NC COVID to obtain the total number of tests conducted.

Tests 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.

Total tests represent the number of tests reported to NCDHHS for that day. This tells us how much daily testing is increasing throughout the state. This includes both total tests that report daily through electronic laboratory reporting, and those that are submitted manually. Because tests can be reported in batches, dates may be backfilled, and data might fluctuate. Tests have been broken out to show molecular (PCR) vs. antigen tests completed starting with data on Sept. 22, 2020 on the “Total Tests Reported” chart. For dates prior to Sept. 22, 2020, test totals cannot be broken out according to test type due to data limitations in the process previously used for laboratory reporting of test totals. However, it is likely that antigen tests were included in aggregate totals submitted by laboratories in daily reports in the past.  

Percent positive represents the number of positive molecular (PCR) tests as a percentage of all molecular (PCR) tests reported electronically directly into NC COVID. We know that as we test more, the number of infections detected may go up. This metric gives us a sense of how many positive tests we are seeing in comparison to how much testing is being done. All data are preliminary and may change. 

To calculate positive tests as a percent of total tests NCDHHS only uses molecular (PCR) test results from laboratories that report both positives and negatives through electronic laboratory reporting in NC COVID. 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 not reported electronically can occur in batches, and it cannot be confirmed that the positives and negatives occurred on the same day. Antigen tests are excluded from percent positivity calculations at this time, but NCDHHS will be evaluating including them in calculations in the future.

Percent Positive by County

North Carolina uses labs reported electronically to provide county level testing data. Antigen tests are excluded from percent positivity calculations to align with current CDC definitions used to calculate percent positivity.

A limitation of this data is that we know that not all tests are reported electronically, and some counties may be more likely to use a lab that does not report electronically. County data serves as a starting place to help counties gauge their testing volumes.

Percent positive shows the trends in positive tests as a percent of total tests for tests that were reported electronically. Counties may not have any labs reported electronically on a given day. These will show up as no tests, and 0% positive for that day.

The percent positive displayed in the county map is the average percent positive during the last two weeks. If a county has only one week with less than an average of 50 daily tests, then that week will not be shown and not included in the average percent positive. If a county has both weeks with fewer than an average of 50 daily tests, then the graph will not be shown. Counties with fewer than an average of 50 daily tests for the two weeks are not shown because there are not enough electronically reported tests in that county to provide a reliable percent positive calculation. The percent positive may fluctuate substantially as there are a smaller number of tests than the state percent positive. All data are preliminary and subject to change.

Testing Turnaround Time

Testing turnaround time measures the time between when a person is tested, and when the result feeds into public health for tests that are electronically reported. Please note that the testing turnaround time doesn’t necessarily include the time between when a person is tested and notified of their results.

There are multiple stages that make up the time it takes from when a person is tested to the time the person receives their results – the testing turnaround time. The first stage is the time between when a specimen is collected to when it is received by a laboratory. Several factors can impact this timing, including how and when the specimen is transported to a laboratory. The second stage is the time between when the specimen is received and when the laboratory has a result. This first and second stage is shown in the dark purple in the graph below. The third stage is the time between when the laboratory determines a result and the laboratory electronically reported to NCDHHS. This third stage is shown in the light purple. The fourth stage, which is not represented in the graph below, is the time between when a laboratory reports a result and the patient is notified of their results. This fourth stage happens between the health care provider and patient and is not reported to NCDHHS. The yellow line shows the 7-day rolling average of the dark purple, when a specimen is collected to when the laboratory has a result.

Individual laboratories may have shorter or longer turnaround times and, therefore people's individual experience will vary. Antigen tests are excluded from testing turnaround calculations because antigen tests are designed to be rapid and are typically resulted within an hour or less. Including these tests in testing turnaround time calculations would potentially artificially decrease testing turnaround times for molecular (PCR) test results, which are the most widely used tests today.

Laboratory results received electronically for previous dates may cause slight variation in day-to-day reporting.

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. The Healthcare Preparedness Program is comprised of eight regions: CapRAC - Capital Region Healthcare Preparedness Coalition, DHPC - Duke Healthcare Preparedness Coalition, EHPC - Eastern Healthcare Preparedness Coalition, MAHPC - Mountain Area Healthcare Preparedness Coalition, MCRHC - Mid Carolina Regional Healthcare Coalition, MHPC - Metrolina Healthcare Preparedness Coalition, SHPR - Southeastern Healthcare Preparedness Region, and the THPC - Triad Healthcare Preparedness Coalition.

The NC COVID-19 Hospitalization dashboard includes both statewide and region views. Hospitals self-report information including the number of people currently hospitalized with COVID-19, the number of confirmed patients admitted in the last 24 hours, the number of suspected patients admitted in the last 24 hours, full and available adult intensive care unit (ICU) beds, the number of staffed inpatient beds, the total number of patients on ventilators, and the number of available ventilators. This information is collected throughout each day, aggregated and then posted daily. NCDHHS also reports daily what percent of hospitals reported. Changes in the percent of hospitals reporting can change how many people were reported as currently hospitalized.

Currently hospitalized reflect the number of people with COVID-19 that are currently hospitalized in reporting hospitals. The number of hospitalizations helps us understand how many people were hospitalized with COVID-19, and how close hospital beds are to their staffed or licensed capacity. Limitation: People stay in the hospital multiple days with COVID-19, and so this reflects the number of people reported by hospitals.  All data are preliminary and may change as data are investigated.

Number of COVID-19 Suspected Patients Admitted – 24 hours represents the number of patients from reporting hospitals that were admitted to an adult inpatient bed during the past 24 hours who are suspected of having COVID-19 at the time of admission. Some of these patients will become confirmed COVID-19 patients and some will be ruled out as not having COVID-19. This information can be an earlier indicator for suspected increases in the total number of hospitalized COVID-19 patients in the coming days.  All data are preliminary and may change as data are investigated.

Number of COVID-19 Confirmed Patients Admitted –24 hours represents the number of patients from reporting hospitals that were admitted to an adult inpatient bed during the past 24 hours who are confirmed with COVID-19 at the time of admission. This provides us with the number of patients that are being newly admitted with COVID-19 which is an earlier indicator for increases in the total number of hospitalized COVID-19 patients in the coming days. All data are preliminary and may change as data are investigated.

Number of COVID-19 Intensive Care Unit (ICU) Patients represents the numerical number of all Adult ICU occupied beds that have a COVID-19 positive patient in them. This number provides us with a breakdown of the COVID-19 hospitalizations that are needing higher level of care which can indicate more severe COVID-19 cases. Limitation: People stay in the hospital multiple days with COVID-19, and so this reflects the number of people reported by hospitals. All data are preliminary and may change as data are investigated.

Hospital Bed Numbers are not specific to patients with COVID-19. These numbers reflect hospital beds as reported by participating hospitals. These numbers do not reflect hospital surge. Empty beds are able to be staffed but do not currently have patients. Unreported or unstaffed beds: The survey to hospitals does not currently collect the number of licensed beds that are not staffed. Therefore, this number includes beds from hospitals that reported, but were not staffed and so were not included in the hospitals survey report. These beds would be empty. It also includes beds that are in a hospital that did not report that day, which could be full or empty. All data are preliminary and may change as data are investigated.

Number of patients on a ventilator (not specific to COVID-19), as self-reported by hospitals. This number does not reflect ventilators from other sources, including those purchased but not yet deployed to hospitals. All data are preliminary and may change as data are investigated.

COVID-19 Hospitalization Demographics

Hospitalization Demographic Data is only provided for Newly Admitted Confirmed and Suspected COVID-19 Patients and is available for the chosen report date. NCDHHS began requiring hospitals to submit detailed demographic data starting on October 1, 2020.

Age is a required demographic data element for hospital systems to collect, although data can in rare cases be reported as “Unknown”. The age groups (0-17, 18-19, 20-29 etc.) are based on requirements provided by the federal government.

Race, Ethnicity, and Gender are all considered PHI/PII data and are not always recorded by hospitals or provided by patients. Some hospitals will report these demographic element as “Not Disclosed” indicating it is not collected by their reporting system and they are not able to provide it to DHHS for reporting. 

“Not Reported” provides the percentage of the demographic metric that was not reported by hospitals for the COVID-19 confirmed or suspected metrics to NCDHHS. “Not Reported” differs from “Not Disclosed” by indicating a hospital did not submit the required demographic information to NCDHHS. NCDHHS is actively working with hospitals to improve compliance with demographic reporting requirements.
 

COVID-19 Contact Tracing

Contact tracing is a proven, effective way to help slow the spread of COVID-19. Contact tracing identifies people that have recently been in close contact with someone who has tested positive for COVID-19. This helps us more rapidly identify those who may have been exposed to COVID-19 and quickly get them the necessary supports and resources that can help protect them and their loved ones. 

Local health departments (LHD) and health agencies have used contact tracing in North Carolina for decades to control the spread of other diseases such as tuberculosis and measles. Local health departments have been using contact tracing for COVID-19 since the first cases were identified in North Carolina. 

To meet the scale needed to respond to COVID-19, we are building on the work of local health departments to expand contact tracing by tapping into additional local health department employees, contractors (through the Carolina Community Tracing Collaborative and Child Care Health Consultants), hospitals, and other community partners. 

COVID-19 Outbreaks and Clusters

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 (nursing homes/skilled nursing facilities) which provide nursing or convalescent care; residential care facilities can include adult care homes, family care homes, multi-unit assisted housing, group homes; correctional facilities such as state prisons and local jails; and others such as Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) homes.

NC COVID has a field to note whether a case or death was in a congregate living setting. Often, after a case is reported in NC COVID, 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.

“Missing” represents the number of cases and deaths that are missing congregate living setting information. All numbers are preliminary and may change as cases are investigated.

Data within the Congregate Living Settings include cases and deaths in both staff and residents. 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. Data include cases that are part of the ongoing outbreaks as well as cases associated with these settings that are not part of an ongoing outbreak. 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 molecular (PCR) positive and antigen positive 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 COVID. 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 settings.

COVID-19 Child Care and School Settings

Child care operators and school principals are required per G.S. 130A-136 to report suspected cases of reportable communicable diseases (including COVID-19) to the local health director of the county or district in which the school or facility is located.

Data on our NC COVID-19 Outbreaks and Clusters dashboard include cases that are part of the ongoing clusters as well as cases associated clusters that are no longer active. 

In a child care or school setting, a COVID-19 cluster is defined as a minimum of five confirmed diagnostic cases with illness onsets or initial positive results within a 14-day period and plausible epidemiologic linkage between cases.

A cluster is considered over if there is not evidence of continued transmission within the setting. This is measured as 28 days after the latest date of onset in a symptomatic person or the latest date of specimen collection in an asymptomatic person, whichever is later. If another case is detected in a child care or school setting after a cluster is declared over, the cluster is not reopened. If additional cases are subsequently reported and a new cluster exists, it will be reported as a second, new cluster in that setting.

COVID-19 case and cluster investigations are conducted by local health departments. Time is required to determine whether a given COVID-19 case is associated with a child care or school setting, gather follow-up information, and enter it into NC COVID. Thus, data included on our data dashboards may differ from data available through media and other sources. Child care or school settings with less than 10 children or staff are not included to protect confidentiality.

Data are preliminary, and these numbers and settings are subject to change as more information is obtained during cluster investigations.

Reports

COVID-19 Patients Presumed to be Recovered

The estimated number of patients presumed to be recovered from symptoms from COVID-19 is used in combination with other measures to provide a general sense of how many people with COVID-19 have likely recovered from symptoms.

NCDHHS estimates a median time to recovery of 14 days from the date of specimen collection for non-fatal COVID-19 cases who were not hospitalized, or if hospitalization status is unknown. The estimated median recovery time is 28 days from the date of specimen collection for hospitalized non-fatal COVID-19 cases. Estimates are used since patient-specific data on the actual time to resolution of all symptoms are not available for all COVID-19 cases in North Carolina.

It is important to note that patients’ actual recovery times could be shorter or longer depending on the severity of illness. This interval was chosen based on World Health Organization (WHO) guidance, and in consultation with Centers for Disease Control and Prevention (CDC) and other state health departments. A median recovery time of two weeks from illness onset for mild cases and three–six weeks for patients with severe or critical disease was reported by WHO. These estimates are unrelated to the number of cases that are or are not still infectious.

These estimates cannot account for other factors that could impact a patient’s recovery time or disease severity, such as age and underlying health conditions. These estimates do not measure the amount of natural immunity to SARS-CoV-2, the virus that causes COVID-19, in the population. Doctors and scientists do not yet know if patients who have recovered are protected with natural immunity from getting COVID-19 again.

Risk Factors for Severe Illness from COVID-19

People who are over the age of 65 and people of any age who have certain underlying health conditions are at higher risk for severe illness from COVID-19. These conditions include chronic lung disease, cardiovascular disease, severe obesity, diabetes, kidney disease, liver disease, and immunosuppressive conditions, including cancer treatment, smoking, and other immune disorders.

These underlying health conditions identified by the Centers for Disease Control and Prevention (CDC) were cross referenced with NC Department of Health and Human Services (NCDHHS) data sources to identify the percent of North Carolinians with higher risk for serious illness. There are limitations to this analysis. The NCDHHS data sources do not contain every underlying health condition identified by the CDC, and the definitions of the specific health condition may not align exactly.

Read more about the CDC’s guidance on persons at risk for severe illness from COVID-19.

What percent of North Carolinians are at higher risk for a severe illness from COVID-19?

An estimated 51.1% of adults in North Carolina are at higher risk for severe illness from COVID-19 based on being 65 or older, having at least one of the underlying health conditions, or both. These data are from the NC State Center for Health Statistics Behavioral Risk Factors Surveillance System (BRFSS) for 2018, which is the most recently available year of data.

What percent of people in North Carolina had one of these underlying health conditions?

An estimated 42% of people in North Carolina has one of the underlying health conditions included in the CDC’s guidance on people at high risk for a severe illness from COVID-19. Fifty-two percent of people in North Carolina who died in 2018, the most recent complete year with data available, had one of these underlying health conditions.

These underlying health conditions include chronic lung disease, cardiovascular disease, severe obesity, diabetes, kidney disease, liver disease, and immunosuppressive conditions, including cancer treatment, smoking, and other immune disorders.

Data on underlying health conditions in North Carolina’s population are from the NC State Center for Health Statistics BRFSS for 2018, which is the most recently available year of data. Data on underlying health conditions in North Carolina deaths are from the NC State Center for Health Statistics Vital Statistics.

What percent of COVID-19 cases and deaths also have an underlying health condition?

Data about underlying health conditions in COVID-19 cases are obtained through case investigations, which take time. Local Health Departments contact each person that has tested positive for COVID-19 to gather this data. Information about the presence or absence of specific health conditions will become more complete as case investigations are completed and information is entered into NC COVID, but this information will not be available for all cases. Therefore, data are not yet available for every case or death.

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 NC COVID-19 Data Download dashboard: Daily Cases and Deaths Metrics, Daily Testing Metrics, County Cases and Deaths, ZIP Code Cases and Deaths, Demographics, Hospital Patient Data and Hospital Beds and Ventilators.

To download this information, 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 COVID-19 Surveillance System (NC COVID)

NC COVID, the North Carolina COVID-19 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 COVID is also part of the Public Health Information Network (PHIN).

NC COVID 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. Laboratories may also report electronically to NC COVID.

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

OpenBeds Critical Resource Tracker

Through a partnership between NCDHHS, Appriss, and hospitals across the state; hospitals are using a new technology called the OpenBeds Critical Resource Tracker to report hospital capacity information. This technology enables clinicians and state department administrators to indicate hospital capacity information, including information on beds, ventilators, and admissions. The OpenBeds Critical Resource Tracker allows hospitals to provide their data through an automatic feed, a CSV file or a manual entry. Prior to the full transition of reporting to the OpenBeds Critical Resource Tracker, hospitals completed daily surveys through SurveyMax to report hospital capacity information.

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 and North Carolina Department of Health and Human Services. Requests for medical and non-medical PPE are submitted through ReadyOp by healthcare partners, first responders, county partners, and non-healthcare entities.

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).  County EOCs began transitioning to requesting PPE via ReadyOp only on August 19, 2020.  WebEOC still remains the system for county EOCs to request traditional emergency resource support.

ReadyOp

Healthcare partners and non-healthcare entities 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 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.

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 samples 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 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.

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).