4 reasons the Charlotte area has more coronavirus cases, hospitalizations than rest of NC
The Charlotte region has swiftly emerged as the epicenter of North Carolina’s coronavirus outbreak, only three weeks after officials announced the first local case of COVID-19.
Mecklenburg County’s coronavirus cases — 635, as of Saturday — account for about 25% of all cases in North Carolina, although just 10% of the state’s population lives here. Four people have died from COVID-19 in Mecklenburg County, officials said Saturday.
Mecklenburg’s number of cases compared to its population shows it has the second-highest rate of any N.C. county, behind only Northhampton, a county of 20,000 people where health officials are managing an outbreak of at least 24 cases inside an assisted living facility.
And Mecklenburg, as of late Friday, had the third-highest rate in all of the Carolinas. Charleston County, with 247 cases, has a higher rate than Mecklenburg and any other S.C. county, according to state Department of Health and Environmental Control data.
In North Carolina, Wake County trails Mecklenburg with both its rate and number of cases. Wake County, where about 10.6% of the state’s population lives, has about 12% of the state’s COVID-19 cases, as of Saturday. Durham County has 7% of the COVID-19 cases statewide but only 3% of North Carolina’s population.
And so far, data show people living in Mecklenburg and surrounding counties are more likely than others in the state to be hospitalized if they contract COVID-19. County leaders have said about 1 in 5 patients who test positive for coronavirus have needed hospitalization locally. Data show Mecklenburg and 11 surrounding counties, all part of a regional healthcare coalition, collectively have a hospitalization rate that is higher than any other part of the state.
Experts say a unique combination of factors has contributed to Mecklenburg being hard-hit by the virus. Here are four reasons that help explain why local coronavirus cases have surged.
Travel fuels ‘hotspot’
Charlotte is home to the country’s sixth busiest airport. Charlotte Douglas International Airport — a major hub for American Airlines — had 50.2 million passengers last year. Raleigh-Durham International Airport hosted 14.2 million.
“Obviously, Charlotte is more of an international gateway” than the Triangle, said Michael Thompson, an associate professor of public health sciences at UNC Charlotte.
”The degree to which communities intermingle is how spread happens,” Thompson said. “The more mixing, the faster spread happens. By having an international airport, someone can very rapidly move from one area to another and mix with other networks.”
Around March 9, for example, a South Carolina man who traveled to Italy and flew into Charlotte later tested positive for COVID-19, though officials said he had no symptoms while traveling.
American Airlines drastically reduced its slate of domestic and international flights in Charlotte last month due to mounting spread of the coronavirus and plummeting air travel. But the area remains a transit hub with the confluence of major interstates, including I-77 and I-85.
”You’re bringing in people from various regions, each coming in with their own exposures and redistributing elsewhere,” Thompson said. “You become a hotspot.”
Dense population, high hospitalization rate
Mecklenburg is one of 12 counties that make up the Metrolina Healthcare Preparedness Coalition. All of North Carolina’s 100 counties are divided among healthcare coalitions, organized to assist with emergency response and recovery during natural disasters or a pandemic.
The hospitalization rate for coronavirus in the Metrolina coalition is the highest in the state, according to a Charlotte Observer analysis based on Department of Health and Human Services data.
As of the most recent regional data released Wednesday, 81 patients were hospitalized in Mecklenburg and its surrounding counties. That’s a rate of 3.5 people hospitalized for every 100,000 residents. For COVID-19 patients who are 60 or older in Mecklenburg, about half were hospitalized, local officials said.
By stark comparison, each of the three multi-county healthcare coalitions in the Triangle have fewer than 20 patients hospitalized as of Wednesday, according to the state DHHS. Hospitalization rates in the Triangle area range from 0.7 to 2.8 patients per 100,000 residents.
The Eastern Healthcare Preparedness Coalition, which covers more than a dozen counties in the northeast portion of the state, has the second highest hospitalization rate: 3.2.
Charlotte’s airport and draw for travelers doesn’t alone explain why COVID-19 is hitting the Charlotte area the hardest. Experts say population density and growth are also factors.
Population density is higher in the Charlotte region than any other part of North Carolina. On average, 1,755 people live within each square mile of Mecklenburg County, compared to 1,080 in Wake County and 935 in Durham County, according to 2010 Census estimates, the most recent data available.
”It’s a growing county — it’s just not a surprise that Mecklenburg County’s hospitalizations and virus cases are the highest,” said Tom Williams, a spokesman for Tryon Medical Partners.
Testing ahead of the curve?
Initially, Thompson says, it appeared Mecklenburg’s high case count was driven by “more aggressive” testing.
“The intensity of testing by region can explain these (case) rates,” he said.
While there’s no statewide data available to compare the number of tests in each county, Mecklenburg manager Dena Diorio on Friday asserted local officials are “leading the state in COVID response.”
More than 38,000 coronavirus tests have been administered statewide.
At least 1,200 tests have been conducted in Mecklenburg but that total includes only those administered by hospitals, according to Mecklenburg Public Health Director Gibbie Harris. She says an accurate local count of positive and negative tests is not available because of different reporting requirements among state and commercial labs.
Although North Carolina’s first known coronavirus case was reported in Wake County on March 3, some health experts say it is possible the virus was present in Mecklenburg earlier than that.
”The outbreak got its toe hold in Charlotte earlier than other urban areas in our state, and it had more time to grow before stay-at-home orders were instituted,” said Dr. Christopher Ohl, an infectious disease expert with Wake Forest Baptist Health in Winston-Salem.
Mecklenburg’s stay-at-home order began March 26, restricting residents from venturing outside except for “essential” activities, such as buying groceries and caring for loved ones. Diorio announced the directive on March 24, when there were 143 known cases in Mecklenburg.
Since then, cases have soared by 344%.
In the first week of the local outbreak, spanning March 11 to March 18, there were 30 cases. By the next week, on March 25, there were 185 — an increase of 517%.
Harris and others have attributed the surge in cases to more testing being done but have also said the coronavirus is spreading through person-to-person contact.
Testing capacity increased significantly since private labs — including North Carolina-based LabCorp — ramped up production of critical supplies. Novant Health has testing centers, and Atrium Health administers tests and also has an in-house lab for analyzing results. Tryon Medical Partners provides testing and sends its specimens to LabCorp.
Mecklenburg remains “judicious” with its testing criteria, Harris said Friday. People with mild symptoms have been urged to stay home and consult healthcare providers through virtual appointments.
Socioeconomic impacts
Financial barriers to healthcare in the Charlotte region might have magnified the spread of COVID-19 locally, Thompson said. Low-income and marginalized communities, especially, are at risk.
”We’re piling on to people who are economically disadvantaged,” Thompson said.
Families who are low-income have long faced financial barriers to healthcare, such as lack of health insurance and transportation. In those communities, underlying medical conditions — which leave a person more vulnerable to severe COVID-19 illness — may have gone untreated for years.
In Mecklenburg, data show African-American residents have been particularly hard hit. The Observer reported March 30 black residents have been disproportionately testing positive for coronavirus. Four days later, Harris said the health department is partnering with historically black churches and other community organizations to accelerate awareness and outreach locally.
According to the county’s most-recent data, black residents accounted for about 45% of 466 confirmed COVID-19 cases. By comparison, black residents make up only 32.9% of Mecklenburg County’s population, according to U.S. Census estimates from July 2019.
Several black elected leaders have said more help is needed to address the disproportionate impact COVID-19 has had on black residents in Mecklenburg County.
Corine Mack, president of the local NAACP chapter, said that many black residents may still be pressured to leave their homes and report to frontline jobs, despite exposure risks.
“The inequity needs to be addressed — we need to look deeper at the system and how workers are being treated,” Mack told the Observer this week. “Sick leave, vacation leave and hazard pay are things we can do very quickly to ensure people are taken care of.”
George Dunlap, chairman of the Mecklenburg County commissioners, told the Observer that black residents could be disproportionately exaggerated in the COVID-19 case count if they are more often seeking testing. Public health officials, though, have not yet disclosed the demographics of those tested — instead only reporting those with confirmed infections.
Mack said officials should prioritize testing among all residents living in dense clusters, where social distancing guidelines could be difficult to follow.
“We have a responsibility in Mecklenburg County and the City of Charlotte to elevate these people,” Mack said.
This story was originally published April 4, 2020 at 2:30 PM.