As more people get vaccinated, which COVID numbers matter most in North Carolina?

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Hayley Fowler
·6 min read
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More than 3.8 million people in North Carolina have received at least one dose of the coronavirus vaccine, a hopeful sign the worst of the pandemic may be behind us.

But health experts also warn of stagnant numbers that have long been touted as helpful measurements of the spread of COVID-19.

“There is this perception that COVID is on the decline, and unfortunately that is just not true,” said Dr. Erica M. Pettigrew, a physician at UNC and the medical director at the Orange County Health Department. “Our number of new daily cases was decreasing steadily from mid-January to mid-March, but since then it has plateaued.”

So which metrics matter most, more than a year into the pandemic?

Most experts say there isn’t one all-telling number, but a few key figures paint a broad picture of where North Carolina is at — and why it matters.


Health experts have long used the number of daily hospitalizations as an overall indicator of COVID-19 spread.

Infectious diseases expert Cameron Wolfe, an associate professor at the Duke University School of Medicine, told NBC the hospitalization rate continues to be “the most hard and fast number.”

Pettigrew said she tracks North Carolina’s COVID-19 hospitalizations daily and considers them a crucial measurement becausethe people with the most severe cases are the ones who typically need to be in a hospital.

Though hospitalizations don’t “paint the whole picture,” Pettigrew said, they highlight trends in hospital capacity.

At least 1,064 people were hospitalized with COVID-19 in North Carolina as of Sunday, according to state Department of Health and Human Services. The figure dipped as low as 882 at the end of March but has lingered above 1,000 since April 13.

State health officials consider North Carolina’s trajectory of hospitalizations to be “leveling.”


About 2.8 million people — or 27% of the state’s population — are fully vaccinated against COVID-19.

Among those 65 and older, more than 70% are fully vaccinated.

Pettigrew said she pays close attention to the percentages, which can be an indicator for vaccine hesitancy as much as a metric for measuring herd immunity.

“If they already got one shot, then we know they do not have vaccine hesitancy and they have found their way to a provider (or a vaccine provider came to them),” Pettigrew told McClatchy News in an email.

Some epidemiologists have said the percentage of people who need to be vaccinated in order to protect the rest of the population is somewhat of a “moving target,” NBC reported.

Dr. Anthony Fauci, the nation’s top infectious disease expert, has warned against using the term “herd immunity.”

“We really, really need to be careful about this elusive terminology,” he said, NBC reported. “We should focus on getting as many people vaccinated as quickly as we possibly can,” Fauci said, instead of focusing on an “arbitrary percentage.”

As more people get vaccinated, Pettigrew also said it’s important to take a close look at the rate of vaccine delivery. In North Carolina, she said, officials are “starting to see that demand is no longer outstripping supply.”

“Local vaccine providers across the state, including in Orange County, are having trouble filling slots,” she said.

Daily cases

The number of new daily cases over the last four weeks is a mirror image of what North Carolina experienced during its first peak in July, Pettigrew said.

“In other words, N.C. stopped decreasing in cases over four weeks ago,” she said. “This concerns me greatly.”

The seven-day average of new cases dropped to 1,500 on April 7 but has since crept back up, staying closer to 2,000 since April 13.

State epidemiologist Dr. Zack Moore told The News & Observer last week the latest figures were troubling.

“No one of our measures tells the whole story by itself,” Moore said. “But when you look at it in context of what we’re seeing with our case rates and what we’re seeing elsewhere in the country, it definitely is a cause for concern.”

Positivity rate

The percentage of COVID-19 tests that came back positive was a useful figure early on when cases were under-counted due to a lack of widespread testing, experts say.

While the metric has lost some of its luster now that vaccines are widely available, Pettigrew said it’s still one of the measurements she checks daily in North Carolina.

“When this number gets higher, such as (April 11) when it was 8.5%, that worries me that we may not be testing enough — and thus the daily case counts may be artificially low,” she said.

The seven-day average of the percentage of positive tests in North Carolina has crept up since early April.

At the start of the month, the seven-day average was 5.3% — roughly in line with the 5% target health officials have long recommended. As of April 17, the latest day for which data is available, the figure was 6.8%.

On Monday, state health officials reported the highest weekly percent positive rate of COVID-19 tests in two months.


In North Carolina, case rates have fallen significantly among people over 65.

With more older people receiving the vaccine nationwide, most new COVID-19 cases are among younger people who are less likely to require hospitalization, The Miami Herald reported.

That means a rise in cases hasn’t been matched by a rise in hospitalizations, which can make it difficult to interpret the data.

That’s true in North Carolina, where the bulk of recent cases have been among people between the ages of 25 and 49, according to the state health department.

With the arrival of vaccines, demographics have also become a crucial indicator of vaccine hesitancy.

“Some of it may stem from misinformation, and public health educational efforts could go a long way,” Pettigrew said. “Other people, including many people of color, may have justifiable hesitancy due to a history of racism which has permeated medicine and research.”

North Carolina’s COVID-19 alert system

Health officials categorizes the state’s 100 counties as red, orange, yellow or green, according to the level of spread based on local case rates, percentage of positive test results and hospital impact.

As of April 15, one county was in the red zone, indicating critical community spread.

The majority were yellow, which indicates significant spread, and one was green with low community spread.

“Although levels are far below the post-holiday peak in January, most of the state continues to experience significant or substantial community spread with concerning increases in younger adult age groups,” health officials said in the latest report.

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