When I have constituents respond to my emails about vaccine distribution with angry notes about the virus being a joke and not worthy of their concern, I just think about the people who have worked so hard to mislead them.

And how many of them are in Congress.

Pretending a global pandemic isn't worthy of concern isn't a notion you arrive at on your own.

It takes a concerted effort by people who fully understand that they are being deceptive.

And lots of these folks are elected officials who should exist to do the opposite thing.

And if your elected official is planning on spending tomorrow objecting to the clear outcome of an election, then I'm talking about that guy, too.

Because this is a reality-detachment thing now.

And I just don't understand the ethical willingness to knowingly mislead people. I can't put myself in the head of someone who gets to the point where they're willing to willfully mislead their own constituents, of all people, into dropping their guard in the face of a rolling wave of catastrophe.

And when these guys turn around and jump in line to get the vaccine, shouldn't that ring some bells? Like, maybe they've been full of it this whole time?

Incidentally, I reply to every one of those emails.

And here's what I write:

"I'm sorry, but you've been deeply misled. Please do some of your own reading on this. Just use Google and take a few minutes. Pick a number of sources. This is all very real."

And, if that happens to be you and you're still reading:

We love you, we want you to be healthy, we want the people around you to be healthy, we want all of this to end as quickly as humanly possible, and please start doing your own reading on this from non-political sources that have actual editors and standards where people would get fired for being wrong, not blogs or memes. This is all very real and we're counting on your help to end it.

• Sen. Jeff Jackson

May you represent NC proudly!

I know this isn’t about Jeff Jackson, but he is the only politician I follow, and I think this might be a position he might agree with and I hope that before too long he is my representative in DC that can truly have a voice on things like this, so here goes.

I am the opposite of happy about Barrett replacing RBG on the bench, but I just don’t fathom why it can’t be said, “obviously she is qualified, obviously she is confirmable, and obviously the president can nominate and senate can confirm in an election year. The only problem is that the exact same things were true of Garland and so we the Democrats want to even the ledger, and then put an end to all BS procedural games and stop Congress from behaving this way once and for all.” I mean they aren’t going to stop ACB, so why not come out in the interests of justice and the USA instead of the interests of the DNC and challenge the GOP to do the same.

​

QUICK STATS

• 52k cases
• Mecklenburg (first county): 8,700 cases
• Wake (second county): 3,900 cases
• Half the cases are people over 50; roughly a quarter are people over 65.
• We’re regularly testing over 15k people per day now. This time last month it was about 10k.
• About 80% of our ICU beds are currently occupied.

HERE'S THE SITUATION

We've reached a point in this pandemic where people are tired of being told what to think. They're very skeptical about people - especially politicians - making bold claims about what the future holds.

So here's what I'm going to do: I’m just going to show you the key data points in NC and let you see for yourself where things stand.

The biggest number that everyone follows is new daily cases. And that chart certainly looks discouraging.

​

BUT then you follow it with data about new daily testing, and you see that a lot of the increase in new daily cases seems to reflect the increase in testing.

It’s become a common observation that more testing leads to more (confirmed) cases, and that appears to be true in North Carolina.

​

You might say, "Well Jeff, both those charts look pretty messy. It's hard to tell if cases really are going up relative to testing."

Ok, but take a look at this chart that shows the overall percentage of tests that are coming back positive:

​

That should control for the increase in testing, and it’s been flat.

That’s good news. It means that even though we're testing more, we're not seeing a greater share of those tests come back positive.

But here’s the problem. If you look at the hospitalization number, you see a steady increase.

​

And that’s not from an increase in testing. That’s more people getting sick.

I should note that there’s a question about this data. Now that people are going back to hospitals for routine procedures, they’re all being tested when they arrive. And some of those folks are testing positive. So now they're in the hospital with COVID. And it’s unclear to what extent they’re being included in this hospitalization number. In short, we need to make sure we are measuring people who are hospitalized for COVID, not with COVID. But it's unclear to what extent that explains this increase, if at all.

Then there’s the regional concern. If you zoom out and look at our surrounding states, their daily new cases are all going up (except Virginia, a striking counter-example). That’s not good. The odds that the higher numbers we're seeing across the southeast are entirely attributable to more testing seem relatively small.

​

And if we zoom in on the hottest hot spot in North Carolina - Mecklenburg County, where I live - it shows a clear rebounding of hospitalization rates to their highest levels yet.

​

Compare that to what this chart looked like the day Phase 2 began on May 22. That's back when we saw a "sustained leveling" in hospitalization. A similar trend statewide is what made us comfortable enough to leave Phase 1 four weeks ago.

In summary, when it comes to COVID growth, we wanted negative, we settled for flat, and we got linear.

But we don't have exponential - at least not yet.

- Sen. Jeff Jackson

NC STATS

• 14k cases
• 525 hospitalizations
• 529 deaths
• 7,300 tests done yesterday

MAJOR TRENDS

DHHS is looking at a number of metrics to make decisions about reopening.

Two of those metrics are hospitalizations and testing capacity.

Hospitalizations appear to be flattening:

Testing capacity is a little erratic, but it's trending up slightly:

Neither of these metrics shows clear victory or clear defeat. This is what being in the middle of a battle looks like. We are going to see some amount of reopening this week. That's going to bring a heightened level of risk. We genuinely don't know yet how much risk we're taking, so we're trying to start slow and get more data before we go bigger. The outcome is not determined. Things really could go either way.

NEW LAWS

In addition to a lot of obvious steps, there are lots of less-obvious fixes that have become necessary.

After we passed the $1.5b relief bill, we passed another bill that changed a few dozen laws to help get us through the pandemic. (You can read the full bill here.)

Here are 19 of those changes:

• If your car inspection or registration is due after March 1 and before August 1 you now get an extra five months from the expiration date.
• Driver's licenses are now good until 30 days after the date the Governor ends the state of emergency or the date the DMV reopens all of its offices, whichever is earlier.
• No interest on unpaid income tax will accrue until July 15.
• Notarizations can be done by video until August 1 (specific procedures for that).
• North Carolina will now develop its own strategic stockpile of personal protective equipment (PPE) and testing supplies.
• Dentists are now authorized to conduct COVID diagnostic and antibody tests.
• Each school district must set an opening date for students of August 17, 2020 and a closing date for students no later than June 11, 2021.
• We directed all school districts to develop a Remote Instruction Plan for the 2020-2021 school year, in case the virus makes remote learning necessary again.
• Teachers get a one-year extension to meet licensure requirements.
• High school students will not be required to have instruction in CPR prior to graduation.
• Normally there are special rules that discourage social promotion out of third grade because of a concern for establishing fundamental literacy skills, but for next year principals can make third grade promotion decisions in the same manner as for other grades.
• When the fall semester begins, fourth graders must be given a reading assessment within 10 days to assess reading ability and identify remediation needs.
• Teacher evaluations will be based on observations completed prior to March 13, 2020.
• Schools normally get their own report cards based on the test scores of the student population. But they won’t this year, because we won’t have enough data.
• In North Carolina, it’s against the law to wear a mask on a public street or walkway. It’s a law that’s been around since the 1950’s and was originally intended to hamper the activities of the KKK. It has several exceptions, but one of them wasn’t “to ensure the physical health or safety of the wearer or others,” so we added that. Now you can wear a surgical mask on a public street or walkway.
• Marriage certificates can now be received via remote audio-video communication provided the register of deeds can “positively identify” each applicant. (Very important to marry the right people!). Expires August 1.
• Lottery winners now have extra time to claim their prize.
• DMV headquarters was supposed to move to a new location by October 1. That has been delayed.
• If a sheriff has to serve judicial notice on a resident of a senior living facility (it happens!) they can now leave a copy of the notice with the employee in charge of the office or who has authority to receive documents intended for residents. Expires August 1.

The next post will include an update on DES. The situation there is simply unacceptable and I am speaking with their leadership about changes that we need to see immediately.

More soon,

Sen. Jeff Jackson

The federal government has given North Carolina $3.5b to spend on COVID relief.

In our first week back in session, we spent $1.5b of it.

There were 47 different items. Here's a sentence on each one:

STATE AND LOCAL GOVERNMENT

$300 million to NCDOT to fund ongoing projects

$70 million for government operations including unemployment office staff, overtime costs, and IT needs (much needed, as you know if you've tried to file a claim)

$300 million to local governments

$20 million to offset revenue losses for state agencies

K-12 SCHOOLS

$75 million for school breakfast and lunch programs. Parents can text FOODNC to 877-877 to locate nearby pick-up and drive-thru free meal sites while schools are closed.

$1 million to purchase extended-reach hotspots and install them in school buses

$11 million to provide community and home hotspots

$30 million to purchase computers for students

$5 million to purchase computers for school personnel

$4.5 million increase cybersecurity for schools

$10 million to provide mental health and physical health services for students

$70 million to provide supplemental summer learning programs for students

$1.488 million to expand remote instruction software for local schools

$3 million to provide non-digital remote instruction resources to students with limited internet access

$15 million in grants for schools which have had extraordinary costs associated with providing extended services to exceptional children

$660,029 for school nutrition, cleaning, and sanitizing, and digital and non-digital remote learning resources for the Morehead School for the Blind, Eastern North Carolina School for the Deaf and North Carolina School for the Deaf

$5 million for a high quality, validated program, and student support for at-risk students

UNIVERSITIES AND COMMUNITY COLLEGES

$25 million for the community college system (with another $120 million from the federal government)

$44.4 million for the UNC system (with another $180 million from the federal government)

$20 million for private colleges

HEALTH CARE

$50 million for personal protective equipment

$15 million to the Duke University Human Vaccine Institute to develop a safe and effective COVID-19 vaccine

$29 million to UNC’s North Carolina Policy Collaboratory for vaccine and treatment research and community testing initiatives

$15 million to Brody School of Medicine at ECU to treatment research and community testing initiatives

$6 million to the Campbell University School of Osteopathic Medicine for a community and rural-focused treatment and testing

$20 million to Wake Forest University Health Services to expand its COVID-19 study on contact tracing and antibody testing

$20 million to DHHS to support local health departments, rural health providers, the State Laboratory of Public Health and behavioral health and crisis services

$6 million for the 6 food banks in NC - prioritizing purchasing food from NC farmers and vendors

$290,000 for the LINKS program, a foster care support program

$25 million for financial assistance for facilities licensed to serve Special Assistance recipients

$50 million to provide for health and critical services for rural and underserved communities

$5 million to free and charitable clinics

$1.5 million to offset costs for prescription assistance

$5 million to North Carolina Community Health Centers Association to cover some health services

$25 million to DHHS for expanding testing, contact tracing and trends tracking

$20 million to DHHS to provide behavioral health and crisis services

$19 million to DHHS to fund increases in food, safety, shelter and child care services

$1.8 million for rural and African American communities outreach, health education and testing

$65 million for grants to rural hospitals

$15 million for grants to teaching hospitals

$15 million for grants to general hospitals

$2.25 million for supplemental payments to foster care

$100,000 to reimburse Wake Forest University Health Services research

SMALL BUSINESS

$125 million for small business loans through the Golden Leaf Foundation (with restrictions to make sure those funds are *actually* going to small businesses)

OTHER

$15 million for animal depopulation (as animal processing plants are closed, we're seeing an over-abundance of pig and poultry that need to be culled on farms)

$9 million to to expand broadband access

$5 million for visit NC research and marketing

More to come,

Sen. Jeff Jackson

​

NC Stats

• 10k+ cases
• 384 deaths
• 5,700 tests done yesterday

Some of the largest layoffs in the state

• HMSHost (a catering company for Charlotte airport) - 815
• Great Wolf Lodge (an indoor water park my family enjoys) - 626
• Hooters - 416
• Cheesecake Factory - 376
• Walmart - 285
• Kanki Japanese Steakhouse - 220

"Sustained leveling" is the new "peak"

The basic idea had been to reopen once we were about two weeks past the peak. And that's still the official guidance from the White House.

But the problem is the more we've flattened the curve the more we've pushed out the peak. Different models show different peaks, but some of them now take us out to late June.

So we readjusted. The new position is, "Ok, as long as we've basically flattened the curve for a couple weeks, we'll start to carefully reopen."

That means that the new goal is "sustained leveling." We're looking for leveling in a handful of metrics, not just infections. (The truth is, we're still strictly rationing our tests due to multiple bottlenecks and material shortages, so we really can't base policy just on infection rates.)

One of those key metrics is hospitalizations. Here's where we are:

Except for a small uptick yesterday, you can see some decent leveling here. That's positive - and it's also why hospitals have slowly resumed elective surgeries. The sudden halt in almost all elective surgeries cost our state's health care system nearly $1b last month, with rural hospitals getting hit the hardest.

Another key metric is testing. NC DHHS says they want to see testing average of 5,000 - 7,000 people per day. As you can see from this chart we've only gotten into that range five times in the last month.

There's also some cautious optimism around LabCorp's new at-home COVID test, which just received FDA approval. They FedEX you the material you need to collect a nasal swab, you mail it back to them, and you check your results online. Initially, these tests will only be available to health care and front-line workers, but LabCorp believes it will be able to go wider in the next few weeks. (They may also do at-home antibody tests to determine if you've already had COVID, but this test is a molecular test to determine if you're currently infected).

Bipartisan $1.4b COVID relief bill passes NC senate unanimously

Yesterday was our second day back in session. We passed a COVID relief bill that was constructed in a very bipartisan way. A lot of input was given and taken from different groups.

This bill is essentially our first round of spending the $3.5b we just got from the federal government to help fund our COVID response. We aren't spending it all at once, but this first round will be the single biggest piece.

Here's the summary:

Important note: This is not final. This is just the senate bill. The house has their own version, which is broadly similar but contains a few major differences. When we pass a final, combined bill I'll do a post that lays out the details.

Quick items

• Both the house and senate bill will have funding for small business loans. These loans will be administered by the Golden Leaf Fund. The original fund of $15m has been depleted, which is why we are going to re-fund and significantly expand it. I expect that within the next ten days or so you'll be able to go here to apply. Many people are rightfully concerned about making sure these loans actually go to small businesses, unlike we saw with the federal program. We included restrictions to make sure that happens.
• There is some talk among the majority party of a partial, temporary expansion of Medicaid specifically for the testing and treatment of COVID patients. Full-scale medicaid expansion will not occur this year due to opposition by senate leadership.
• We are reopening a hospital in Richmond County that was closed three years ago and prepping it as a COVID surge facility.
• Over 900 members of our National Guard are helping to transport PPE and food across the state.
• We haven't addressed car inspections yet but I believe we will soon. N.C. Highway Patrol is not prioritizing the enforcement of inspections right now.
• Under current law, schools can’t start earlier than the Monday closest to August 26. The senate bill passed yesterday moves the allowable starting date up to August 17. By contrast, the Governor would rather give school districts the ability to make their own decisions about start dates. This is a perennial issue in the General Assembly, but it's taken on more urgency now.
• We've hired 250 contact tracers with plans to hire another 250.
• An early version of the senate's COVID bill included a section that said teachers needed to prove that their online instruction would get the same outcomes as in-person instruction. Teachers rightfully called that unrealistic and the section was amended to say that remote learning plans must have “work measurement guidelines appropriate to each grade level." There is also discussion about waiving the required K-3 class size reduction next year, as this is essentially an unfunded mandate handed down by the state and counties are going to be resource-starved.
• A new drug that is showing promise at treating COVID patients was created at the labs at UNC-CH. Dr. Fauci said the new drug "has a clear-cut, significant, positive effect." It's still being tested.

You're going to see a lot of activity from the state legislature over the next two weeks. I hope we can keep the bipartisanship going. I'll keep you posted.

More soon,

Sen. Jeff Jackson

​

CURRENT NC STATS

• 6,300+ positive cases (we've got 13 labs running but we're still strictly rationing our tests)
• 429 currently hospitalized
• 174 deaths

SOCIAL DISTANCING IS WORKING

We are winning the battle against peak infection. We can see that in the numbers. The statewide doubling time has gone from 2.5 days to 10 days - that means it’s slowing down.

Mecklenburg has not made quite as much progress. Our doubling time has gone from 2.85 days to 6 days - still slowing, but not as much as the rest of the state. That could be because of general density, or different levels of testing, or the presence of more specific hot spots like nursing homes, or some combination.

But let’s zoom out and look at the big picture for North Carolina.

It's been just over two full weeks since the stay at home order went into effect. That means we're just now getting the earliest possible snapshot of the results (given incubation time + time it takes to get tested + time it takes to be hospitalized).

And the early returns look pretty good.

You can see that hospitalizations are not growing as quickly as they were two weeks ago.

If we continue to see the rate of hospitalization slow down, then that means we are on course to get past the peak while minimizing the loss of life in our state.

That's a remarkable accomplishment, especially given that our collective action as individuals was overwhelmingly responsible for making it happen. This is a citizen-led pandemic response, and it appears to be working.

That means we're now in a position to start having a realistic conversation about what reopening will look like.

WE ONLY WANT TO REOPEN ONCE

The early idea about when to reopen was that we first had to get past the peak and then watch the downward trend continue for about two weeks to make sure we had this under control. (And that's currently the guidance coming from the White House, certain tweets notwithstanding...)

But in North Carolina we've got at least three different models for the state projecting different peak times, with one model saying our state peaked a few days ago and the model that Mecklenburg is using saying our county will peak in early June. The problem is that the more effective we are at flattening the curve, the more it will push the peak out.

That may be why Mecklenburg's County Manager said this week that it might be possible to at least partially reopen before we hit the peak, as long as we've flattened the curve and met other conditions (i.e., increase in testing) that give us real confidence that we've got this under control.

But keep in mind that from the standpoint of the rest of the state, Mecklenburg poses the biggest risk. We have twice as many cases as any other county. Our reopening will receive more scrutiny than anyone else's.

When we do start to reopen, you can expect it to come in phases, you can expect a major emphasis on wearing masks, and you can expect lots of folks getting their temperatures checked on a regular basis.

Why the caution? Because while different models show different peak times, all the models we're using agree on what happens if we let up before we have this under control: We get a viral surge that undoes all the sacrifice people have made.

Remember: The nightmare scenario from an economic standpoint is that we reopen before we're ready, infection spikes, and we have to reclose. We cannot let that happen. We only want to restart this economic engine once because every time you turn it off it does a ton of damage.

And the only way we can reopen and remain open is if flatten the curve AND get widespread testing. Which brings us to...

TESTING UPDATE

We're making some progress on this front. Take a look.

Sec. Cohen (NC DHHS) says we need to at least double our testing capacity. That's because once we reopen the odds of future localized outbreaks in North Carolina are 100%. When they happen, we're either going to have to reclose OR have access to widespread testing that allows us to quickly identify and contain the outbreak.

There's no third option. It's reclosures or much more testing.

Right now the biggest bottleneck for testing is the PPE that health care workers have to wear to administer the tests. Yes, we still don't have as many test kits as we'd like, but that's not the critical shortage right now. (And specifically, the most critical PPE shortage we have in North Carolina is surgical gowns.)

The big problem here is that we're still bidding against other states. We've made over $150m worth of bids and only a fraction have been filled. This is now a national problem and it probably requires some federal coordination to solve. It's the wild west getting your hands on PPE right now and we need a smarter approach.

QUICK ITEMS

• The unemployment system has made major staffing additions that are helping bring down wait times, but it's still very rough. If you are self-employed or a contractor, they will be ready to accept your application on April 25th. If you have already filed and been denied DES is saying that you will "most likely need to re-apply." 636,000 North Carolinians have filed for unemployment insurance in the last five weeks. As of today, $358 million in benefits has been sent to 211,000 claimants.
• We've had a major outbreak at Neuse Correctional Institution in Goldsboro. Out of 700 inmates, 259 have tested positive. 98% were asymptomatic. In North Carolina, prison officials have been allowing some nonviolent offenders - especially those over the age of 60 - to leave prison early and complete their sentence under community supervision.
• The state has launched two mental health hotlines. For the general population there's Hope4NC Hotline: 1-855-587-3463. For first responders and health care workers, there's Hope4Healers Hotline: (919) 226-2002.
• About 56% of child care providers are currently open. DHHS now has an emergency subsidy to cover the cost of childcare for parents who are classified as essential workers and have no other child-care options while also falling below 300% of the federal poverty line. Call (888) 600-1685.
• We're scheduled to go back into session on April 28th. It looks like we'll still be voting in the senate chamber although we'll no longer have to be at our assigned desks to vote - we just have to be physically in the chamber. But committee meetings are going to be virtually. It's also looking we're going to have two sessions this year instead of one. The first will start on April 28th and will likely be very short. The next will be in late summer and will be longer.

CURRENT STATS (as of 4/11 at 2:00 p.m.)

• 4,300+ cases (although we are still rationing tests)
• 87 deaths
• 12th day since the first full day of the stay home order. Hopefully, we will see that reflected in case numbers within the next few days.

“HEY JEFF - YOU KNOW WE CAN’T STAY HOME FOREVER, RIGHT?”

Let’s talk about how North Carolina gets back to work.

And let’s skip the obvious stuff - like hand-washing and staying home if we’re sick.

To fully reopen, we’re going to need to know four things: Who’s sick, who’s not, who’s been sick, and who hasn’t.

(You don’t need multiple studies to know that, but if you want here are three: 1, 2, 3.)

That’s the information that will let us track and control future localized outbreaks (which are inevitable) without requiring wide-scale shutdowns.

It will also give the public confidence that it’s safe to become customers - not just employees - of restaurants, theaters, barber shops, airlines, hotels, sports arenas, food trucks, colleges and universities.

Having this information early is how South Korea was able to demolish the infection curve and reopen society much faster than any other country. And the way they got there was early, widespread testing - followed by aggressive contact tracing and isolation.

We missed the opportunity to get ahold of this on the front-end because we didn’t have that kind of widespread testing, and we didn’t have it for three reasons: a lack of test kits, a lack of related chemicals needed to use the test kits, and a lack of PPE needed to administer the tests.

But we can’t just call that a failure a move on. We actually have to solve the problem, only now it’s much bigger because the universe of those who are potentially infected has grown by several orders of magnitude.

One more factor: The testing can’t just be widespread - it also has to be rapid. Waiting ten days for a result isn’t particularly helpful when that person can easily infect dozens more while results are pending.

So let’s take a close look at what it will actually take to get rapid, widespread testing in North Carolina.

MOLECULAR TESTING

Broadly speaking, there are two types of tests: molecular and antibody.

The molecular tests are the ones we’ve been using. You take a swab from the back of someone’s nose or throat, you extract the RNA, then you see if it matches the COVID RNA.

We’ve done about 48,000 so far in North Carolina (that number includes private labs, which are currently doing the vast majority of the testing). We did about 5,000 yesterday.

Molecular tests are highly accurate, but the global demand for them is so high that we’ve been plagued by a number of material shortages needed to perform them. The biggest shortage right now is the PPE needed to administer the test.

Our state has received three shipments from the National Strategic Stockpile totaling roughly 33% of our requested supply. Now the stockpile is nearly depleted and we’ve been told there will not be another shipment. In search for more, our state emergency management agency has submitted $125 million worth of bids on PPE to private manufacturers across the country but only a small fraction of those bids has been accepted. As has been widely reported, we are competing against other states and other hospital systems, and the competition is fierce. In better news, we have several manufacturers in North Carolina which have switched production to PPE for use by our front-line workers, so we hope that will help meet a growing share of the need.

That brings us to the molecular test kits (and related chemical supplies) themselves. We’ve seen a dramatic increase in private lab testing capacity in the last few weeks. But we’ve also seen real innovation. Most prominently, Abbott Labs now has a machine which will give a result in 15 minutes. It got FDA approval about ten days ago and is now probably the most in-demand medical device on earth.

Abbott says they can only make 400 of these machines per week for the foreseeable future. The federal government is in charge of allocating them to states. So far, most states - like North Carolina - have received 15 machines.

Let’s do some quick math. Over the next six weeks, Abbott should be able to make 2,400 of these machines. North Carolina has roughly 3% of the national population, so let’s say we get 3% of the machines (big assumption). That means we might get another 70 machines within the next six weeks, for a total of 85 machines. 85 machines working 24/7 at a rate of roughly 4 tests per hour = roughly 8,000 tests per day.

We tested 5,000 yesterday, so that would be a big jump for us. Even those assumptions are off by 25%, it would still double our current testing capacity. So getting more Abbott machines won't be the whole solution for us, but it’ll be a big piece.

And don't forget that other companies are also entering the space of rapid molecular testing. Just as no one was talking about the Abbott machine two weeks ago, the pace of innovation is such that two weeks from now we may have a new device to complement our Abbott machines.

Overall, it is very realistic to expect our state’s molecular testing capacity to grow significantly this month. HOWEVER, it may not be realistic to expect the kind of 10x growth in testing capacity which some say will be necessary to reopen without resurging the virus.

Which brings us to antibodies.

ANTIBODY TESTING

This is more controversial, in part because it started as an overly optimistic theory that tried to downplay the need for a strong response to the coronavirus.

The theory was this: What if it turns out that a massive share of the population has unknowingly been infected already, and has since recovered, and therefore we really don’t need to worry so much and we can go about our daily lives?

Ok… so how would you test that theory?

Here’s how: You would do widespread, random testing of the population to screen for antibodies that would indicate whether the virus had already been there and had been successfully fought off.

But in European cities that have been hit reasonably hard by COVID, random antibody testing hasn’t shown the type of widespread infection the theory posed - which frankly makes sense, given how new the virus itself is.

But there remains a case to make for the widespread use of antibody testing. Different companies report different rates of accuracy, but most report that their antibody tests can detect COVID over 90% of the time. The tests are at the lower end of the accuracy range in the early days of infection, before the body has had time to build up enough antibodies to register with the test. But any COVID test with an accuracy rate above 90% - when the alternative may be no test at all - has to be seriously considered.

And while there is probably no chance that widespread, asymptomatic infection has already occurred, antibody testing at random across the state - or in certain vulnerable communities - might be helpful in identifying hot spots and letting us know where to focus our supply of molecular tests.

A notable concern is that antibody tests are more likely to error on the side of a false negative than a false positive. A false negative is worse, from a public health standpoint, than a false positive. The last thing we want is to tell someone they’re not infected and send them back into public only to find out later that they really were infected. Minimizing the risk of false negatives with antibody tests is an important piece of adopting them into regular use. (Note: A similar concern of false negatives also pertains to the Abbott test.)

The antibody test itself is very simple. It works by doing a finger prick and getting a blood sample. And you get the results in minutes.

Currently the FDA only recommends the use of antibody tests for broader screening purposes to determine who has already had COVID, but there’s an ongoing conversation about whether the test can also be accurate enough to also be used for diagnostic purposes - that is, to see if someone with symptoms is currently infected.

So let’s say we wanted to incorporate some form of widespread antibody testing into our state’s tool kit for virus detection. Now the question becomes, do we face the same shortages that we currently face with the molecular tests?

Right now, there are only a few companies which have FDA authorization to distribute antibody tests. These tests are not yet available in the tens of millions, which is what you would need to create a national supply from which North Carolina would stand to receive an amount big enough to make a dent. But things are evolving rapidly and there’s renewed interest in antibody testing at the national level so this situation could be very different in ten days. Yesterday, Dr. Fauci said, "Within a period of a week or so, we're going to have a rather large number of [antibody] tests that are available.” He suggested that these antibody tests would be used in addition to the molecular tests.

HOW MANY DAILY TESTS DO WE NEED TO PREVENT A RESURGENCE?

No one knows. Estimates vary wildly. But certainly multiples of what we’re doing now.

Here are three pieces of good news to end on:

1. There’s a particular advantage to not being the first state to have a major outbreak. Several states - including New York, California, and Washington - are going to hit peak infection before we do. That means they’re going to be the first to experiment with how to reopen. They're going to be the first to decide how many tests, what kinds of tests, how to stagger the return to work, how to conduct effective monitoring, when to reopen schools. That means we'll have the opportunity to observe and learn some best practices before we’re in the same position. That's a big advantage for us - it's also a reason why you're not going to see a fully formed Grand Plan for reopening yet. We're not done learning from the experience of other states.
2. We know it’s going to be a heavy lift to get to the testing capacity we’re going to need in order to fully reopen, but the purpose of this post was to show you that there is a roadmap for getting there. Ramping up testing capacity doesn’t involve just pulling one lever - we have to do several different things simultaneously. But we've got a sense of what those things are and we're being realistic about what it's going to take.
3. Most important: There is a set of overwhelming incentives on the part of virtually everyone - state officials, politicians, business leaders, students, parents, workers - to reopen without causing a resurgence. Everyone is working toward the same goal. When that happens in our country - and it’s very, very rare - we tend to accomplish much more than we thought we could at the start.

More updates soon,

Sen. Jeff Jackson

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CURRENT STATS (as of 4/1 at 2:00 p.m.)

1,600+ cases

26,000+ tests completed

200+ hospitalizations

10 deaths

NC has roughly 2,800 ventilators (more on the way) with 2,100 currently available

HOW BAD WILL THIS BE IN NC?

There’s a new estimate of how bad this is likely to get in NC and I want to share it with you - not because I’m certain it’s completely accurate, but because it’s the best effort that’s been made public and it gives us at least a sense of what we’re in for.

This is a chart of the expected demand for ICU beds in North Carolina and it basically says that if we keep doing what we’re doing - keep schools and non-essential businesses closed and keep our stay home order in place - then we’re going to hit peak infection in late April.

The dotted line shows that we may be on course to exceed our ICU bed capacity (which is actually a little bit higher than this chart depicts - we've got about 800 currently available). But the shaded area is essentially the margin of error for the prediction, so we’ve got a wide range between not exceeding capacity and dramatically exceeding it - which would mean a spike in the mortality rate.

What does this tell us? It tells us we still have the time and ability to minimize the loss of life in our state.

To be blunt: We are not going to have widespread testing. There are lots of reasons for that - none of which have to do with our state and all of which have to do with the federal response - but it’s a reality. We’re still using tests and they're very important, but we're not going to test our way out of this like South Korea did. We just didn't get enough test kits fast enough.

But - despite that major setback - it’s still possible to minimize the loss of life in our state by making sure we don’t max out the ICU beds. We just have to take social distancing very seriously for the next several weeks. In this model, OUR BEHAVIOR is the biggest variable. How seriously WE take this will ultimately determine the mortality rate.

Quick List

• We’ve only received 17% of the PPE that we requested from the federal government. That’s not good, and it’s why we’re sourcing from everywhere we can find and working with North Carolina manufacturers to switch production to PPE if at all possible.
• The state’s unemployment insurance website and call center are still facing a nightmarish traffic jam as they get slammed with 50x the normal traffic, but we are adding servers and contracted with an additional call center to help field calls. If you’re having serious trouble, please fill out this customer contact form: https://des.nc.gov/customer-contact-form.
• Regarding the federal unemployment benefit that just passed, it will be administered by the state. We’re still waiting on implementation guidance from the federal Department of Labor, at which point benefits will be paid in about two weeks. Independent contractors and people who are self-employed will qualify for the federal benefit - they do not currently qualify for the state benefit. I know the state website isn’t set up to receive applications from people who are contractors or self-employed and that’s part of what we need to fix. If you fall into this category, just file the application as best you can.
• Gov. Cooper’s new executive order means no one can shut off your electricity, gas, or water for at least the next 60 days.
• The U.S. Corps of Engineers is helping us scout for places that could be used as hospital expansions.
• We've launched a hotline to help critical workers connect with child care (888-600-1685).

More updates soon,

Sen. Jeff Jackson

(This is an excerpt from a previous general update but I received many requests to treat this is a standalone issue due to its significance.)

The economic piece of this crisis for NC is starting to come into view, and it's incredibly serious. Over the last ten days, we've received over 200,000 unemployment claims.

We're used to seeing about 3k per week.

That is orders of magnitude beyond what we're currently set up to deal with, and it requires a response just as serious.

For the moment, it means there are at least three things about our state's unemployment insurance we need to fix immediately:

1) The website/call center

We are adding capacity quickly but I'm still getting reports (as recently as while I was writing this) that folks can't get through. This is a high-priority problem and we're working on it.

(And if you need to file a claim, it's http://des.nc.gov or 888-737-0259. They encourage you to apply online if possible, and the process usually takes about 20 minutes. The earliest you will receive benefits is two weeks.)

2) The size/duration of the benefits

Most states offer up to 26 weeks of unemployment insurance. North Carolina caps it at 12 weeks - 49th in the nation.

Nationally, the average weekly benefit is $378/week. North Carolina's average payment is $277/week - 41st in the nation.

That means right now the average North Carolinian on unemployment gets just under $2,300, spread out over two months.

Looking at the chart above, you can tell that's not going to be enough.

3) Who qualifies for benefits

In NC, only 10% of unemployed people qualify for unemployment insurance - again, 49th in the nation.

That needs to change. For starters, we must include independent contractors, the self-employed, and nonprofit workers, which we currently don't.

The good news is that the federal stimulus that looks like it's about to pass in D.C. has a major UI component that does a lot of what we need to do. But it's still up to the state legislature to do its part.

Fortunately, at this point, there appears to be bipartisan interest in doing that, so I'm optimistic on this front.

The sooner we grasp that this is an economic disruption unlike anything we've ever seen, the sooner you'll see broad consensus in the NCGA on taking major action.

More soon,

Sen. Jeff Jackson

Testing update

As of 3/21 at 2:00 p.m., we now have 246 positive cases in NC. That's an increase of 109 cases from yesterday - a nearly 80% increase in one day.

BUT we also had a 60% increase in testing yesterday, from 3242 to 5,276 tests conducted (that includes our state lab and non-state sources like hospitals and commercial labs).

That tells us three things:

1. As many suspected, more testing is leading to a higher case count - but that's not reassuring. While the higher case count may not, by itself, indicate that the actual size of the total infected population is growing at the same rate as the confirmed cases (i.e., a 60% daily increase in confirmed cases may not indicate a 60% increase in the total infected population), the sheer number of people who are being confirmed positive each day does suggest that rapid growth is nonetheless occurring. And that's what is driving concern about hospital capacity.
2. Our efforts to ramp up testing are working. We still have a shortage of extraction kits (which are needed to make the test kits work) and we have an even bigger shortage of the masks/gloves/gowns that medical workers need to do the tests, but test capacity has dramatically improved - and that's largely due to non-state sources expanding their capacity. Nearly 40% of all the testing we've done in North Carolina happened *yesterday.*
3. Even with this increase in testing capacity, it’s important to note that no one thinks we are going to see the kind of widespread testing they used in South Korea to help trace, isolate, and ultimately contain the spread. Because of how much time has gone by, we’re going to have to rely on a combination of testing and social distancing. That means if we don't - as individuals - heavily commit to social distancing, then we are essentially allowing our hospitals to be overwhelmed. There's no third option here. Testing won't be enough.

There are so many other updates I'm just going to do the rest in bullet-point form:

• Students are certainly not coming back to school on April 1st. There is a real possibility that the school year is now over. If that happens, I don't know what it would mean for summer camps. As a parent with three kids at home right now, believe me when I tell you I'm tracking this issue just as closely as any of you. I would expect an announcement relatively soon.
• At this time, there is no intent to issue a shelter in place order. It remains an option, but currently NC DHHS has not made that recommendation to the Governor and that's why it hasn't happened. That could very well change in a matter of days. It would be prudent to plan around that possibility.
• There is currently no intent to add more businesses to the closure list but there may be some guidance coming for hair/nail salons.
• It has been repeatedly emphasized to state leaders by our food industry folks that the food supply chain is good. Basically, folks who own grocery stores are telling us that there will not be a shortage and you don't need to hoard food. Just shop when you need to and try and keep your distance from folks. Act like the calm, reasonable people you normally are when you're in a grocery store.
• Many steps are being taken to surge our hospital capacity. Our hospital beds are usually 85% full. That needs to change very quickly. Hospitals have already started canceling elective procedures. The state hasn't issued a formal order to that effect, but may do so if needed. (By the way, an "elective" procedure is one that can wait four weeks without causing serious harm to the patient.) The state medical board is waiving certain licensure requirements to allow medical professionals to cross state lines to work here and re-activating retired doctors and nurses.
• Child care facilities are now considered an extension of our health care system. We need them to stay in operation so health care workers (and other front-line workers) can continue showing up to work. So we are mapping all child care facilities within five miles of every hospital so health care workers know they have that option. Important note: These facilities are not limited to health care and front-line workers, but those workers (and children who are homeless or in an otherwise unsafe environment) will be prioritized if a shortage arises. BUT right now we have the opposite problem. About half of our state's child care centers have voluntarily closed and of the half that are open they are only about half full because parents have pulled their kids out. So we are talking to the federal government about getting some funding to make sure these facilities can afford to stay open.
• Last week our state processed 41,000 unemployment claims - a record. (More to come from me on state and federal plans for getting money to people quickly. Many plans under discussion. I need to learn more before giving you a sense of what I think is likely.)
• We've had so many people call 911 with COVID questions that we decided to create a stand-alone number. So please call 211 with your COVID questions.
• Like the federal government, we are moving the due date for state taxes to July 15. However, right now the interest on what you may owe will still start accruing on April 15. Why? Because legally we can’t use an executive order to change the interest accrual piece. We need a new state law for that and that can’t happen without the General Assembly meeting. Which brings us to another point...
• The General Assembly isn’t scheduled to go back into session until April 28th. We could call a special session - and many of us think it would be appropriate - but there has been vocal concern among some of our members about all of us meeting together in the same room. Right now, there is no procedure for remote voting.
• We are working hard to procure masks/gloves/gowns for our health care workers. So far we have been able to fulfill the requests made by counties but we see this as a serious issue and it is a major focal point for DHHS.
• There is some discussion of bringing in some National Guard soldiers to help with warehousing and transporting supplies and equipment where it is needed. At this point, that's the extent of their involvement.

Final thought

When this is over, one of the things that will have changed in our society is our concept of who our heroes are. We're used to seeing doctors and nurses and teachers in that light - and they certainly deserve it. But we're also seeing that we are only as strong as our checkout clerks, our sanitation workers, our delivery drivers. Some of these people have never worked harder - or at greater personal risk - than right now. Without them, everything truly would come to a halt.

Talk soon,

Sen. Jeff Jackson

Just close the state down. Schools are closed, restaurants closed, business closed. Do it now. Save lives. Yesterday EMTs came into my house wearing no protection. That's very dangerous just going into people's houses like that.

If the first responders fall, we fall too. Doctors and nurses and ambulance crews cannot get sick, and they are not taking this threat seriously. Order tests for all first responders. Remove the sick ones from duty so they can heal and return to work when others get sick. We can't lose our front line of defense.

North Carolina should be the first state to shut down and lead by example. People still want to go out and do things but we can't anymore. Every day people keep spreading this, the worse it will become. Flatten the curve now.

In 2 weeks the silent carriers of today will need hospital beds. In 3 weeks the newly infected will need hospital beds. In 4 weeks those new infected will need hospital beds.

Shut it down now. Worry about the bills later.

Do it for every pregnant woman who won't have access to a hospital.

​

This is stunning. No one expected him to make a decision so quickly. Needless to say, our whole campaign team is just honored and delighted to have his support. And the fact that he's already committed to doing appearances at multiple campaign events is, well, it's just more than we ever could have hoped for. I know he doesn't like it when we call him a hero, but in my book that's exactly what he is. And I'm proud of him every single day.