Will reopening change Charlotte’s COVID-19 trend? It ‘depends on all of us,’ health director says 

The temptations are everywhere for Charlotteans in the time of coronavirus.

An end-of-summer get-together with friends or family. A visit to movie theaters, bars and concert venues open just over the state line. Or the quick dash into a store without wearing a mask because you forgot it at home.

Many have been resisting the urge for months, and it’s been working to slow down the spread of COVID-19.

With the governor’s announcement that gyms, museums, bowling alleys and some other long-shuttered businesses can reopen at limited capacity Friday, the temptations will be even stronger.

But the relaxed restrictions come just as health experts warn that it’s time to “double-down” on simple coronavirus precautions, like wearing a mask and social distancing.

“We need to be preparing ourselves that this is not going to be over like a hurricane blew through but it’s gone,” said Michael Thompson, associate chair of the Public Health Sciences department at UNC Charlotte.

“We have to be in the mindset that this is a marathon, not a sprint.”

A premature celebration of the region’s shrinking new case tallies and fewer hospitalizations could upend the fragile progress made so far.

Over the next month — with places like bars and large event venues still forced to stay shut — COVID-19 trends in Mecklenburg County could show even more improvement and extend the favorable trajectory that began in late July.

“I think a lot of that depends on all of us,” Mecklenburg Public Health Director Gibbie Harris told county commissioners Tuesday. “Unfortunately, we do not have a vaccine at this point, and we do not have herd immunity.”

The Charlotte region, with its dense population, has been the epicenter of the COVD-19 pandemic in North Carolina for the last five months.

N.C. Gov. Roy Cooper’s announcement Tuesday to partially advance the state’s reopening came as the latest data shows improvement in Mecklenburg’s containment of the virus. This week the average number of people hospitalized in Mecklenburg fell to its lowest point since late June. Similarly, the COVID-19 caseload locally has also been dropping for more than one month.

The Observer asked public health experts what it would take to sustain the encouraging trends.

They all agree: It’s up to us.

Those interviewed suggest:

▪ Fear is not driving people’s willingness to wear face masks or social distance

▪ Health impacts continue to feel abstract for many who don’t know someone who has been sick

▪ Thanking a stranger for wearing a mask can go a long way

‘Delayed gratification’

As stay-at-home orders expired and social distancing decreased, Harris and others have put increased emphasis on how individual, day-to-day decisions impact whether the virus spreads — and how quickly.

This is partly why Mecklenburg has hired six COVID-19 ambassadors responsible for educating businesses, colleges and other community groups about following basic health protocols. Some of the ambassadors already have de-escalation training and experience working with diverse populations, Harris said.

“As we’re loosening up these restrictions, it is time for us to double-down on the things we know that will prevent the spread of this (virus),” Harris said Tuesday. “We’ve got to continue these efforts.”

Dining out, for example, has become a complicated endeavor, with people adopting new norms of wearing masks and sitting far apart from others, said Brian Eiler, an assistant professor at Davidson College who studies social and health psychology.

“When you change routines, people tend to look for feedback on things working. What’s different about the pandemic is the evidence is weird,” Eiler said. “Now, it‘s the absence of disease that is an indicator that some of the policy is working.”

That’s exacerbated by the pandemic’s inherent uncertainty, with no definitive timeline to fully reopen businesses or develop an effective vaccine for the coronavirus, said Melinda Forthofer, a UNCC public health professor who specializes in social epidemiology.

”Right now, people are being asked to sort of withhold or keep themselves from doing what they want to do, but they don’t see an endpoint,” Forthofer said. “We also have a dynamic that is true of many Americans — but concentrated among younger age groups — that we as a society are not used to having to deal with delayed gratification.”

Nearly 45% of all cases in Mecklenburg are among adults ages 20 to 39, according to the latest county data.

Yet even in the sixth month of the pandemic in North Carolina, many in Charlotte still may not personally know someone who’s been infected. In Mecklenburg, the COVID-19 death toll hit 300 on Tuesday.

But for those not grieving or caring for someone who is sick, experts say statistics may have minimal impact.

”Our population is enormous, so we’re still in a situation where many people don’t yet know someone who’s had a serious case,” speculated Forthofer.

“I think many people know someone who’s had a mild case. If you know a family that’s had a 14-year-old who had to be in the hospital, it really starts to bring it home.”

Less fear than before

The next big test of human restraint happens in less than one week.

Medical professionals hope that people abide by coronavirus safeguards on Labor Day and avoid the lax behaviors widely seen during July 4 festivities.

Fear of the coronavirus no longer appears to be a strong motivator to curtail people’s lifestyles, despite cases still surging in large swaths of the country, Forthofer said.

“Where we saw the (coronavirus) peak, it’s no coincidence that it was two weeks after the July 4th holiday,” Dr. Sid Fletcher, Novant Health’s chief clinical officer, told the Observer recently. “It continues to be critical to see what people are doing around all of the things we’ve been preaching from the beginning. Are people masking? Are people avoiding these public gatherings?”

The number of people hospitalized in the county’s acute care facilities surpassed 200 in mid-July, before reaching a record high of 210 on July 26, according to publicly available health data. Since that peak, the number of COVID-19 patients has been on the decline, falling to its lowest number — 125 — over the weekend.

For now, Atrium Health infectious disease specialist Dr. Katie Passaretti expects the trend to persist — though it’s difficult to estimate just how many ICU and hospital beds will be needed this fall.

”I don’t think anyone expects we’ll see no transmission, no matter what measures are put into place,” Passaretti said in a recent interview. “If we continue to see decreases in the overall number of cases, the hospitalizations will continue to decline. They will not go away completely.”

Feels like ‘forever’

Health officials are keenly aware of other looming coronavirus obstacles that could upend Charlotte’s markedly improved trends.

For example, unlike the start of the local COVID-19 outbreak in March, an anxiously awaited second wave may hit at the height of flu season, creating a flurry of respiratory illnesses that could be tricky to diagnose and treat. With the arrival of holidays like Thanksgiving and Christmas and warm weather subsiding, there may be more temptation to hold indoor gatherings, where there’s a greater risk of transmission.

People must stay alert for coronavirus symptoms, Passaretti emphasized, even if they believe it’s only allergies or a sinus infection. Seeking a coronavirus test early and avoiding gatherings will prevent infections — and so will young adults taking more responsibility in group situations, she said.

Rather than inducing fear as COVID-19 lingers, public health experts say instilling hope is what people need now more than ever. And officials can make access to certain prevention measures — like hand sanitizer and cloth face coverings — so easy, it almost takes more effort not to comply, said Eiler, of Davidson College.

Eiler said it is important to remember that coronavirus measures are temporary. Wearing a mask, Eiler said, should be analogous to taking an antibiotic to cure an ear infection.

That attitude shift allows individuals to see the light at the end of the tunnel, he said.

“For people right now, it feels like this is going be forever,” Eiler said. “I think that fear is amplified, whereas hope really looks at these behaviors as a vehicle to change our situation.”

Forthofer said positive reinforcement or rewards, including thanking others for wearing masks, can also go a long way. Such gestures create a sense of community, where people see the collective — rather than individualistic — scope of the pandemic.

“You are performing an incredibly valuable service when you take the right steps,” Forthofer said, like delaying a large family celebration until health conditions improve.

“It’s taking the long view. It’s investing in our future.”

This story was originally published September 2, 2020 at 3:08 PM.