‘Act NOW... for all our sakes.’ Did Mecklenburg act soon enough to stop COVID-19 crisis?

On March 8, three days before the first confirmed coronavirus case in Mecklenburg County, a nurse sent local government officials an urgent plea.

“Communities that ramp up testing and shut down now (before it’s obvious that they need to shut down) will have the lowest COVID-19 infection rates,” she wrote in a message that was forwarded to Mecklenburg County manager Dena Diorio and Public Health Director Gibbie Harris. “I am asking you to please act NOW, TODAY, for all of our sakes.”

Emails sent to Diorio and Harris in March show that citizens implored local leaders to enact strict social-distancing measures used in other parts of the country and across the globe rather than allowing life to go on as usual.

In the emails, obtained by the Observer through an open records request, some residents begged officials to halt large public gatherings, including St. Patrick’s Day events expected to draw thousands of people to Charlotte.

“It’s incredibly irresponsible for the City of Charlotte and Mecklenburg County to allow, if not encourage, a gathering of approximately 25,000 (!) people for the purpose of drinking in close proximity to each other,” Luis Lluberas, a Charlotte attorney, said in an email dated March 11 that urged the cancellation of St. Patrick’s Day festivities.

Organizers of those events themselves were worried about COVID 19 and voluntarily shut down, although some bars and restaurants across the city still drew crowds.

A day after St. Patrick’s weekend, Mecklenburg banned gatherings of 50 or more people.

Some mayors and healthcare leaders have praised Diorio and Harris, saying their actions have helped reduce caseloads and prevented local hospitals from becoming overwhelmed with new coronavirus patients.

Mecklenburg’s urban density and being home to one of the busiest airports in the nation played a role in the higher number of cases here than other parts of North Carolina, officials said.

But now some county commissioners say they have questions about Charlotte-Mecklenburg’s response to the public health crisis and whether authorities moved fast enough to enact a stay-at-home order to stop the spread of COVID-19, the illness caused by the novel coronavirus.

Lee Riley, a professor of infectious disease at the University of California-Berkeley, said that had Mecklenburg and other counties enacted strict social-distancing measures even a week earlier, the number of infections and deaths could have been reduced.

Early evidence suggests that cities such as San Francisco that imposed social distancing and banned large gatherings earlier have seen less severe outbreaks than in hotspots like New York City, which waited until March 22.

“We know that by the time a community has one confirmed case it is already too late,” Riley said. “The virus has been circulating for two weeks. One person can infect many others.”

Dr. John Allbert, president of the Mecklenburg County Medical Society, said it is understandable local government officials waited before ordering businesses closed, given the severe economic consequences and potential for public backlash.

But large gatherings like the CIAA basketball tournament, which attracted thousands of tourists, St. Patrick’s Day parties and other events that took place in late February and March provided the kind of environment where the virus could spread quickly, Allbert said.

“This is Monday-morning quarterbacking, but if you had it to do over again, we probably wouldn’t have had the (CIAA) basketball tournament and New Orleans would not have had Mardi Gras,” Allbert said.

Following federal and state advice

Mecklenburg has become the epicenter for coronavirus in North Carolina, with hundreds more confirmed cases than any other county. More than 1,500 people in the county have tested positive, about double the 769 in the next closest jurisdiction, Wake County, which is comparable in population to Mecklenburg.

On Tuesday, the state released figures showing the overall death toll in Mecklenburg is 43. Wake had 15 deaths.

Mecklenburg’s peak number of cases is not expected to arrive until June.

County leaders issued a stay-at-home order that became effective March 26, prohibiting almost all non-essential travel, business and social gatherings. Diorio said it was the first stay-at-home order in the state.

In fact, Pitt County and the Town of Beaufort on the coast ordered residents to stay home and limit travel and Madison County in western North Carolina recommended citizens do the same before Mecklenburg’s rules went into effect.

More than a dozen states had already imposed such restrictions. North Carolina issued a stay-at-home order that was effective March 30.

Charlotte-Mecklenburg officials did not make Diorio, Harris or other officials available for interviews. Instead, Diorio provided written answers to questions submitted by the Observer.

Diorio said local leaders followed recommendations from the federal Centers for Disease Control and Prevention and the North Carolina Department of Health and Human Services. That planning included discussions about when to implement a stay-at-home order and what impact would be felt by businesses, she said.

“Speculating today on whether or not we reacted quickly enough, or why a particular decision was made and others were not on a given day weeks ago, is a discussion for another time—after Mecklenburg County residents stop dying from COVID-19 every day and the crisis is over,” Diorio said. “Right now, my constant focus and the focus of this community is making sure Mecklenburg County and our partners continue leading the way in not only managing, responding to, and mitigating the pandemic, but also managing our eventual recovery.”

Huntersville Mayor John Aneralla, who signed an agreement to follow the stay-at-home order along with other mayors in the county, said Mecklenburg leaders have performed admirably given the tough circumstances.

“There is not a perfect decision-making process,” Aneralla said. “If you came to Mecklenburg County on March 1 and said ‘Stay home because we think it may be bad,’ people would not adhere to it... Nobody can say they did it perfect because you don’t know the ramifications three to six months from now.”

Timely decisions?

In a communicable disease outbreak like coronavirus, researchers say time is crucial.

On Feb. 25, the same day a top-ranking CDC official warned that coronavirus could be a public health crisis in the U.S., San Francisco Mayor London Breed declared a state of emergency.

On March 4, when there were no confirmed cases in the state, Ohio Governor Mike DeWine cancelled a fitness expo expected to draw 60,000 attendees a day in Columbus.

In Mecklenburg, however, the county manager made no mention of any major social distancing measures in an update sent to employees.

“While Mecklenburg County Public Health (MCPH) considers novel coronavirus (COVID-19) to be a very serious public health threat, the current immediate health risk to the general public in North Carolina is considered LOW at this time,” Diorio wrote in a March 9 email.

The message came just days before the St. Patrick’s Day weekend.

Tens of thousands of people were expected to attend parties and events planned across the county, including the annual St. Patrick’s Day parade, Rich & Bennett’s 20th Annual Bar Crawl and the Whitewater Center’s Green River Revival.

Elected officials said they began receiving emails urging them to halt the celebrations and enact social-distancing measures.

“I can’t imagine an environment that would more easily enable the spread of a virulent communicable disease in our community.” Lluberas, the resident, said in his email dated March 11.

Harris, the county public health director, replied to Lluberas the same day. She told him that Mecklenburg had seen no confirmed coronavirus cases to that point.

“Please know that we are having serious conversations with our business community about the best decisions regarding mass gatherings and how best to address the economic issues this poses especially for those in our community that can least afford it,” Harris wrote.

The next day, authorities announced the first two cases of people testing presumptive positive for coronavirus in Mecklenburg County.

Following the weekend, on March 16, Harris signed an order banning social gatherings of 50 or more people.

The White House went further the same day, saying Americans should avoid gathering in groups of 10 or more and stop discretionary travel.

North Carolina Gov. Roy Cooper on March 17 ordered restaurants and bars closed except for takeout and delivery orders.

Asked whether allowing St. Patrick’s Day revelers into bars and restaurants impacted the spread of coronavirus, Diorio said there is no way to tell at this point.

Cornelius Mayor Woody Washam pointed out Mecklenburg’s stay-at-home order is more restrictive than statewide rules. Other large counties in North Carolina implemented such rules only after Mecklenburg, which was a state leader, Washam said.

“Hindsight is always better,” Washam said. “There are things we could have done better. But we were in uncharted waters and our staffs pulled together.”

Riley, the University of California-Berkeley professor, said that by March, local governments should have known better than to allow large gatherings. He recalled receiving a call in early February from organizers of a mobile phone convention in the United Kingdom seeking advice on whether to cancel.

“It was happening all around the world,” Riley said. “People getting sick and dying, it’s the most concrete proof to say that (large) events should not be happening.”

When authorities in Ohio decided to shutdown the fitness expo, they assumed coronavirus was already spreading even though they had no confirmed cases, said Andrew Thomas, chief medical officer at Ohio State University’s Wexner Medical Center.

Cancelling the event took political will, but also likely helped many people avoid infection, Thomas said.

“It was a $50 million decision and we were lucky enough to make the right call,” Thomas said. “We followed the lead of the CDC. We determined that we would be consistent with the CDC and at times go above and beyond that.”

Commissioners want answers

Charlotte-Mecklenburg’s coronavirus response has divided elected officials.

While some county commissioners said they had confidence in Harris and other leaders, at least three commissioners said they are upset that they were left out of major decisions. Some commissioners said they had to demand administrators turn over public information about cases that would allow them to hold officials accountable for their decisions.

Commissioner Susan Harden said most board members were unaware the county planned to issue a stay-at-home order until it was announced in a public meeting. Commissioners, who are charged with setting policy for the county, did not take a vote on the order.

Harden said she agreed with private citizens who wrote emails in early March to lobby local leaders to impose strict social distancing measures as soon as possible.

She said she and three other commissioners had grown worried by mid-March the county had not issued a stay-at-home order and began discussing a proposal.

Unlike many North Carolina counties, Mecklenburg does not appoint a board of health, which is typically a panel of medical and public health experts that helps local government set policies. Instead, that role is left to county commissioners.

Harden sent an email dated March 8 asking if there was any additional roles, responsibilities or oversight that commissioners should take on during the coronavirus crisis.

“Not at this time — we will keep you informed,” Diorio replied the next day.

Commissioner Mark Jerrell said he was not sure whether the county had responded adequately to coronavirus because “we were not included in the (decision-making) loop.”

Jerrell said the county should conduct an after-action report to assess the response.

“There are a lot of questions we have to answer,” he said.

Commissioner Pat Cotham said coronavirus has exposed how non-elected officials have too much power in a public health crisis. Commissioners often don’t have the medical expertise to assess whether they are making sound decisions, Cotham said.

“This is a glaring example of why we need a board of health,” she said. “We were caught off guard.”

Diorio said that officials informed Commissioners Chair George Dunlap about a proposed stay-at-home order. Dunlap signed the declaration, which put the measures into effect.

Dunlap did not return a phone call seeking comment.

Uncertain numbers

No one knows for sure how many people in Mecklenburg have contracted coronavirus.

County officials said last week that case counts don’t reflect the true burden on Mecklenburg, saying they may represent as little as 5% of actual infections.

But Mecklenburg should be relieved that social-distancing measures have flattened the curve and helped the county avoid disasters like those in other states, said Allbert, the medical society president.

“It could have been quicker, but it was better than New York and New Orleans,” Allbert said. “If we had waited for the state we would have been in much bigger trouble.”

Harden, the county commissioner, said she would wait before assessing whether Charlotte-Mecklenburg did a good job.

“I don’t want to be giving ourselves a pat on the back because people are still dying,” she said.

This story was originally published April 28, 2020 at 2:31 PM.