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North Carolina has begun reporting the number of COVID-19 cases who have recovered from the infection. The Toe River Health District has been sharing the number of recovered cases in Mitchell and Yancey counties with the North Carolina Department of Health and Human Services.

RALEIGH — According to new data released by the North Carolina Department of Health and Human Services, it is estimated that 11,637 people in NC have recovered from COVID-19 as of Monday, May 18.

The department estimates that the median time to recover from the virus is 14 days since the time the virus sample, or test, was taken for cases who were not hospitalized. For cases who were hospitalized, the recovery time is estimated at 28 days since the virus sample was taken, according to NCDHHS.

The department notes that these recovery times vary depending on the severity of an individual’s particular case, nor do estimates account for the natural immunity to SARS-CoV-2, the virus that causes COVID-19, that is present in the population. NCDHHS is using guidance from the World Health Organization and the Centers for Disease Control in order to determine the interval time for COVID-19 recoveries. The department’s estimates are unrelated to the number of cases that are or are not still infectious.

NCDHHS states that doctors and scientists still do not yet know if patients who have recovered from COVID-19 are protected with natural immunity from contracting the virus again.

“We know folks are recovering from this virus. We know some are unfortunately losing their battle with COVID-19, but many, many more, the vast majority of folks, are recovering from this. We’ve worked with the CDC on a shared understanding on how we define recovery,” NCDHHS Secretary Dr. Mandy Cohen said during a press conference on May 8.

Discrepancies in reporting methods initially prevented states from releasing the number of recoveries or determining under which criteria to consider a case as recovered. NCDHHS did not report this information at first because there was no agreed upon or standardized definition of “recovered” between the CDC and NCDHHS, according to Dr. Cohen during an April 16 news conference. Thirteen states and the territory of Puerto Rico continue to not report the number of COVID-19 recoveries, as reported by the COVID Tracking Project.

As of 5 p.m. on Monday, May 18, NCDHHS reports 19,023 confirmed cases of COVID-19 in NC, 661 deaths, 255,755 completed tests and 511 cases currently hospitalized.

When the number of COVID-19 recoveries is subtracted from the number of laboratory-confirmed cases, it can be estimated that the number of active cases in NC is approximately 8,014 (this number was not provided by NCDHHS). The department continues to compile the number of positive tests since the first case of COVID-19 was recorded on March 3.

Toe River Health District has been reporting the number of COVID-19 recoveries within the tri-county region since Mitchell County’s first recovered case was reported on April 6. As of 11 a.m. on Thursday, May 14, there have been a total of five COVID-19 cases in Mitchell County with all five cases considered as recovered. In Yancey County, eight positive cases have been recorded with one case considered recovered. Avery reported its first case of COVID-19 on Monday afternoon, May 18.

According to TRHD Public Information Officer Mason Gardner, TRHD uses the symptom-based strategy, which is one of two strategies laid out by the CDC to determine when a patient can discontinue isolation.

Under this strategy, a patient was who directed to stay at home and care for themselves may discontinue their isolation after having been recovered for three days, or 72 hours, and at least 10 days have passed since their symptoms first appeared. Recovery is defined as a resolution of fever without the use of fever-reducing medication.

In addition to the aforementioned criteria, TRHD also determines a recovered case based on negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive respiratory specimens collected at least 24 hours apart (total of two negative specimens). TRHD states that there have been reports of prolonged detection of RNA without direct correlation to viral culture.

“All of our testing numbers as well as our recovery numbers are being sent to the NCDHHS for reporting, tracking and data collection purposes,” Gardner said.

TRHD reiterates that the SARS-CoV-2 infection is still not entirely understood. Patients with Middle East Respiratory Syndrome, which is also a coronavirus and is in the same family of COVID-19, are unlikely to be reinfected shortly after they recover. However, it remains unknown whether or not COVID-19 patients will be observed with a similar immune protection response.

It is understood that patients are thought to be most contagious when they are symptomatic, or experiencing the worst of the illness. The virus has also been detected in asymptomatic individuals.

“How long someone is actively sick can vary so the decision on when to release someone from isolation is made using a test-based or symptoms-based strategy in consultation with state and local public health officials,” Gardner said. “The decision involves considering the specifics of each situation, including disease severity, illness signs and symptoms, and the results of laboratory testing for that patient. Someone who has been released from isolation is not considered to pose a risk of infection to others.”

TRHD anticipates that it will start antibody testing in the near future. The Food and Drug Administration has yet to approve an antibody test for COVID-19. TRHD does not send samples to be used for developing vaccines or treatments, however there are various pharmaceutical companies that manage this type of collection and are engaged in vaccine research.

Additionally, TRHD conducts contact tracing based on state and communicable disease guidelines. TRHD will contact the patient and use the Contact Tracing Form to determine the people the patient has been in contact with since the onset of the infection. The period begins 48 hours prior to the patient displaying symptoms.

“Close contacts are defined as having direct contact with, or been within six feet for at least 10 minutes of a case-patient while not wearing recommended personal protective equipment,” Gardner said. “Caregivers and household members of the case-patient are also considered close contacts.”

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