RALEIGH, N.C. — In the days and weeks before North Carolina confirmed its first COVID-19 case, internal emails reveal the state was already monitoring more than 130 travelers, including multiple "persons under investigation."
Not only did the North Carolina Department of Health and Human Services withhold that information from the public, records show some of its own doctors were left in the dark.
Infectious disease specialist Dr. Grace Auten of Morganton criticized the health department's transparency in a February 26 email.
Dr. Auten, a physician at the state's J. Iverson Riddle Developmental Center, initially expressed concern that she couldn't find "any information whatsoever" about the screening, quarantining and testing of patients.
She later warned people may not take the virus as seriously without more transparency.
"Not reporting the information that I (and many others) are looking for can create a situation where the public may: 1. lose trust in the health departments and the CDC 2. become complacent, thinking there is no risk since there is no information," Dr. Auten wrote in an email to State Epidemiologist and Epidemiology Section Chief Dr. Zack Moore. "I understand the need to protect the privacy of individuals involved, but in order to convince the public to continue to be vigilant, as much information as possible should be shared. I sincerely hope transparency will improve."
An email shared internally by Dr. Auten's supervisor said "panicking and making accusations is not helpful."
Dr. Moore defended the state's decision in a response.
"The specific decision about not releasing traveler information or information about persons under investigation is based mainly on privacy concerns, since early experiences demonstrated that media were quickly able to identify individuals despite providing only very general information," he said. "This could deter people from reporting illness to their local health departments and have other negative impacts on the individuals and on our ability to monitor and respond effectively. We have also seen that information about travelers or persons under investigation is often misinterpreted by the media and public to mean that cases are present and posing a direct risk. Plans have been developed for communications when we have a confirmed case in NC."
Gov. Roy Cooper confirmed North Carolina's first case on the afternoon of March 3.
"One of the PUIs tested positive at the state lab this afternoon," an NCDHHS administrator wrote in an email 15 minutes before the governor's press conference that day.
Emails show that the traveler wasn't North Carolina's first person under investigation. Instead, records reveal the state quietly started tracking at least 132 asymptomatic travelers from about a dozen counties in mid-February.
"Our local health departments are responsible for connecting with and monitoring these travelers," NCDHHS Assistant Secretary for Public Health Mark T. Benton said in an email on February 16. "None have raised concerns with their ability to handle this task to-date. With the exception of Wake & Mecklenburg counties, most have 1-2 travelers to monitor for a maximum of 14 days."
In the same email Benton noted while North Carolina had no confirmed cases at that time, the state's sole PUI was a child tested out of an abundance of caution "who is considered to be very low risk, but (whose) family traveled to mainland China (not Wuhan City, not Hubei Province), and who had been passing among themselves a respiratory illness prior to their international travel."
By February 29, the state identified what appeared to be at least two other PUIs, one of whom later tested positive for the flu, according to records.
"Throughout our response to the pandemic we have sought to expand the information we share," NCDHHS Communications Manager Kelly Haight Connor said Wednesday in response to our questions. "As this pandemic evolves, we will continue to assess the appropriateness of data reporting to balance transparency, public health and individual privacy. None of the PUIs from that time tested positive. We would have shared information if they had, as we have for all positive cases since the first one in March."
NCDHDS asks every PUI to fulfill several recommendations while awaiting test results, including isolation.