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In North Carolina, there have been 938,784 cases of COVID-19 since last spring, according to the state’s dashboard as of Wednesday afternoon, and more than 12,000 people have died as a result.
Such overwhelming numbers depict a grim toll, but they may underrepresent the coronavirus’s spread and impact.
Under state health guidelines, only congregate living settings, schools and childcare facilities are required to report clusters or outbreaks of COVID-19 cases to their local health departments. Other settings — such as churches, public venues and most businesses — are not.
Members of the latter category may voluntarily report COVID-19 cases to the health department, but others do not, thereby “underrepresent(ing) the full scope of clusters and associated cases,” according to the introduction of the NCDHHS COVID-19 Clusters in North Carolina report.
Since the pandemic’s onset, health experts around the world have endeavored to isolate conditions under which COVID-19 spreads. But with much of the requisite data voluntarily reported, their work is subject to a wide margin of error.
The News + Record reached out to NCDHHS several times seeking clarification of the state’s COVID-19 reporting requirements — why several key groups were excused from reporting clusters and whether it might skew cumulative data. Some requests went unanswered, or were answered with language from the state clusters report.
When the News + Record filed a public records request regarding COVID-19 clusters in local churches in late January, NCDHHS Legal Communications Specialist Charles Epstein responded with a link to its clusters report, and the same language in the introduction stating that such data “underrepresents the full scope of clusters and associated cases occurring across the state.”
Epstein did not respond to the News + Record’s queries regarding whether any of the reported clusters at N.C. religious gatherings took place in Chatham.
NCDHHS Press Secretary Catie Armstrong likewise confirmed the state’s COVID-cluster count probably does not reflect a complete image, but did not offer specifics.
When asked if “our big picture idea of where there have been clusters might objectively be missing some information,” she responded: “Yeah. It would depend on the specific situation or specific setting, but yeah.”
While no data set is perfect — and some COVID-19 cases aren’t diagnosed or can’t be linked to a specific setting or cluster — the data represented in the state clusters report is limited to clusters voluntarily reported or identified through case investigation and contact tracing.
In addition, voluntary data from such workplaces and settings are published in an aggregated table based on category settings. Specific locations and case counts are not listed as they are for schools and congregate living facilities, potentially obfuscating health experts and the public’s efforts to identify where COVID-19 may spread most easily.
That's an issue Ilana Dubester, the Hispanic Liaison’s executive director, has raised since early on in the pandemic, when COVID-19 cases at the Mountaire plant in Siler City led to a large outbreak in the town, impacting many Hispanic and immigrant residents. In addition to urging state leaders to provide workplace protections for essential agricultural workers, she's also emphasized a need for transparency in reporting data regarding outbreaks.
"To this day we can’t find out how many are infected at each plant, so we don’t know if what they’re doing is good enough," Dubester said at a March 27 Zoom panel hosted by Chatham County Library to commemorate Women's History Month. "Not because the data isn’t available, but because the data isn’t allowed to be shared with the public."
Mountaire reported 153 cases of COVID-19 at its plant at the height of the first wave of the pandemic, but a December report by the Food & Environment Reporting Network showed the number of positive cases at 10 North Carolina meatpacking plants — including Mountaire — was 75 percent higher than reported publicly.
Of the 10 meatpacking facilities in North Carolina whose case counts were higher than reported, the Food & Environment Reporting Network report found that 1,939 workers at those facilities had contracted COVID-19 by June 12, according to internal health department records. That revealed a gap of over 800 cases among the 10 facilities that were never reported publicly — and media reports have only confirmed 1,103 cases at those facilities in that timeframe.
Total case numbers likely represent a more accurate count of total infections, even if they are not delineated by clusters.
“(NCDHHS) decided to publish school child care clusters and long term care, congregate living outbreaks. That’s where they focus,” Chatham County Health Dept. Director Mike Zelek told the News + Record in February. “From our standpoint, in terms of reporting, that doesn’t mean that if it’s in a church or another workplace, that it wouldn’t necessarily be reported to the state, it’s just that it’s not published on the website at that level.”
The state clusters report listed 1,555 total clusters — with 22,023 associated cases and 155 deaths — as of Wednesday. Reported clusters are broken into the following categories: workplace; shopping and services; food and drinks; childcare; schools and higher education; health care and community living and events.
The N.C. Dept. of Labor reported 26 workplace fatalities related to COVID-19 in 2020, according to a March 9 report by the News & Observer. Labor advocates say that figure is likely a severe undercount, given the reporting system relies on voluntary reporting from employers.
The state reported 91 total workplace fatalities in 2020 — with the previous annual high of the last decade at 55 fatalities. That was in 2019. Most of the 26 COVID-19 related deaths were among health and long-term-care service workers, the N&O report said, with employees at meat-processing plants also making up a significant share of deaths.
Jennifer Haigwood, director of communications and policy development at the Department of Labor, told the N&O that it was “unlikely that work-related fatalities are significantly being undercounted.”
“Identifying the source of a COVID-19 illness is very difficult and is not always possible. Attempts are made to contact trace to identify a source,” Haigwood said.
A COVID-19 outbreak at the Siler City Post Office yielded similar discrepancies in reporting data. At the time of the News + Record’s Jan. 24 report, a spokesperson for the U.S. Postal Service declined to comment on specific COVID-19 case counts at the office, citing privacy law, but sources — including employees of the Siler City office — said 75% of staff had tested positive with COVID-19.
One employee, who spoke to the News + Record on the condition of anonymity, said at the time they were concerned by the “lack of public health infection control practices within the USPS.”
“Most carriers won’t talk to you for fear of termination or retribution. We have been told repeatedly NOT to speak with the media by our supervisors and union representatives,” the employee said in an email. “The USPS is more concerned about ‘bad’ media and focusing on distribution and operations.”
Though multiple employees confirmed the outbreak, the News + Record never obtained an official count. CCPHD Communications Specialist Zachary Horner said at the time that the department does not track cases by employer, and referred all questions about those reports to the post office.
The NCDHHS clusters report listed 93 reported COVID-19 clusters for government services, or 698 cases and three deaths at the time.
Zelek said the voluntary reporting of coronavirus data emphasized the importance of “building relationships and building trust” with the department.
“Without that relationship, we may not get the information that would help us reduce the likelihood of spread of COVID,” he said in February. “And so we’ve worked really hard, throughout this pandemic to build those relationships and really work with individual settings to respond to an issue.”