Data Behind the Dashboards NC COVID-19 Dashboard Data NCDHHS has provided the following data from our NC COVID-19 dashboards: Daily Cases and Deaths Metrics, Daily Testing Metrics, County Cases and Deaths, ZIP Code Cases and Deaths, Demographics, Cases Demographics, Outbreaks and Clusters, PPE, Hospital Patient Data, Hospital Beds and Ventilators, Hospitalization Demographics, Vaccinations - Doses by County, People Vaccinated by County and People Vaccinated Demographics. 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. Population Data NC COVID-19 Dashboards use the 2019 Bridged-Race Population estimates produced by the US Census Bureau in collaboration with the National Center for Health Statistics (NCHS) for demographic populations and is available in CDC WONDER. The Esri 2019 NC Zip Code population is used as stated on the Dashboard pages. ZIP Code Tabulation Areas (ZCTAs) are approximate area representations of US Postal Service (USPS) ZIP Code service areas that the US Census Bureau creates to present statistical data. Data Privacy Suppression Rules NCDHHS applies the following rules to the COVID-19 data dashboards where data is at a county level and includes demographics data: Data will be stratified by county by one demographic group at a time (ethnicity, race, age group, gender) Population data sources, as listed in the Data Behind the Dashboards are used to find 'cell denominators' for county populations. Data for any county demographic sub-group that has a population of less than 500, the data will be suppressed for privacy. For county cell denominators that require suppression, all corresponding demographic data elements are attributed to the 'Suppressed' category. This method displays actual values on the dashboards, while still suppressing which demographic sub-groups the data are attributed to. Additional data suppression is done for demographic sub-groups that can be discovered by subtracting row or column totals (e.g., if a county has only the age group '18-24' that requires suppression, the next two smallest age groups by population are also suppressed). Data are suppressed in ZIP codes where the population is less than five hundred and there are less than five cases/deaths. COVID-19 Vaccine Management System (CVMS) North Carolina’s information on people vaccinated comes from the COVID-19 Vaccine Management System (CVMS), a secure, web-based system provided for free to all who administer COVID-19 vaccinations. It helps vaccine providers know who has had a first dose of which vaccine to make sure people get the second dose of the same vaccine at the right time. It also helps people register for vaccination at the appropriate time and allows the state to manage vaccine supply. 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. ReadyOp Healthcare partners and non-healthcare entities that need to request Personal Protective Equipment (PPE) can complete a form in ReadyOp to provide information on their PPE needs. The request form may have limits on the quantity than can be requested for some items due to inventory on hand or shipping restrictions. 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). 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 on August 19, 2020. WebEOC still remains the system for county EOCs to request traditional emergency resource support. 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).