The shutdown of the restaurant industry as COVID-19 surged through the Triad hit Paul Magee, a 50-year-old chef and musician in Winston-Salem, hard.
“He was actually cooking that day — St. Patrick’s Day,” his friend, Tristan Matthews, recalled. “We both got laid off the same day. He texted me and said, ‘What are we going to do?’ I said, ‘I don’t know.’”
Magee died at home on April 4. Although his death is currently classified as “pending,” his friend, Tristan Matthews said he believes Magee died from a drug overdose.
The COVID-19 pandemic has stressed North Carolinians in ways that would have seemed unimaginable before schools shut down and stay-at-home orders went into effect in mid-March.
In addition to the toll taken by the virus itself, the sudden shutdown has plunged the United States into the worst economic crisis since the Great Depression and marooned people in their homes, trapping some in abusive relationships and isolating others from vital support.
The collateral damage of the pandemic response has given rise to claims among many in the conservative reopen movement that so-called “deaths of despair” are worse than the virus itself. And some analysts have argued that the stress of financial stress and exposure to COVID-19 among communities of color set the stage for an explosion of rage and protest that has swept the country since George Floyd was killed by the Minneapolis police on May 25.
“Safety is a top priority,” State Insurance Commissioner Mike Causey told Triad City Beat during a May 22 interview as North Carolina was moving into Phase 2 of reopening. “I have traveled the state. I’ve been to different regions of the state. For the past couple weeks, speaking to county commissioners, elected officials, fire chiefs, what I’m hearing from the public, lately people are more concerned about their personal financial situation and the economy than COVID-19 and the coronavirus.”
But if mortality is the most acute measure of collective well-being, local data and the observations of people who work in public safety and mental health suggest that Triad residents have weathered the pandemic so far with remarkable resiliency.
Beyond the toll in human life exacted by COVID-19 itself, a TCB review found that the number unnatural deaths from accident, suicide or homicide — what might be considered indicators of collateral damage — in Guilford and Forsyth counties remain more or less even with the time before the pandemic.
Those findings are consistent with the observations of people who work in the fields of public safety and mental health.
“We aren’t seeing a sudden spike in suicides,” said Alex Espita, director of community education for Mental Health Greensboro. “What we have seen is an increase in people seeking support services. As to suicide rate, we haven’t seen that spike. It wouldn’t surprise me if a couple months later we did.
“I would have expected to see more suicides,” she added. “It’s surprising, yes, but in a good way.”
Espita said her agency has noted an increase in hospitalizations for mental-health issues and an increased demand for resources.
“I’ve seen a lot of people talking about an increase in depression and hopelessness,” she said. “It’s putting more pressure on services that are already stretched to the max.”
But Ron Glenn, public information officer for the Greensboro Police Department, said mental health-related calls such as requests for involuntary commitments have remained relatively consistent during the pandemic, compared to the period before.
From March 16, when schools across the state closed by the order of Gov. Roy Cooper, to May 21, just before Phase 2 of reopening, death certificates on file at the Guilford County Register of Deeds recorded 11 suicides, while there were seven on file at the register of deeds in neighboring Forsyth County. During the same period the previous year — March 16-May 21, 2019 — Guilford County recorded 13 suicides while Forsyth County saw nine.
The presence of major hospital systems in Guilford and Forsyth counties, including Wake Forest Medical Center, Cone Health and Novant Health, means that deaths on record for the two counties cover residents of a much larger geographic footprint. Among the hundreds of deaths in Guilford and Forsyth counties in which the manner was classified as something other than natural, the sample includes residents of 31 counties. The vast majority of the decedents in the sample were residents of the Guilford and Forsyth or the surrounding counties of Rockingham, Alamance, Randolph, Davidson, Davie, Yadkin and Stokes.
Andrew Brod, an economist at UNCG, cautioned that a review of mortality data for only two counties is likely to yield only limited insight.
Another limitation of the TCB review is that it only includes accidental deaths, homicides, suicides and “pending” — a classification for those in which a medical examination is requested and a final determination typically takes months. Accidents, homicides, suicides and “pending” deaths account for a relatively small share of overall deaths, while the vast majority of people die of natural causes. This review then does not take into consideration the leading causes of death in both counties — cancer and heart disease — which could be aggravated by the economic and social stresses surrounding the COVID-19 pandemic. Nor does it provide any insight into whether more people in the two counties are dying prematurely from natural causes, which could be an indicator of heightened stress. Some reports also indicate that fewer people are reporting to hospitals for heart attacks, strokes and other serious conditions, raising the question of whether people are dying at higher rates because of justifiable fear of exposure to coronavirus if they come to a hospital for treatment.
COVID-19 itself remains a bigger killer than suicides: For the same period in which 11 people died by suicide in Guilford County during the first nine weeks of the pandemic, 69 people died from COVID-19. In Forsyth County, the seven suicides during that period compare to 17 deaths from COVID-19.
The leading cause of accidental deaths in both counties, both during and before the pandemic, is falls. The vast majority of people who die from falls — more than 8 in 10 — in the two combined counties are 65 years or older. Those numbers are up in Forsyth County and down in Guilford County, but it’s hard to draw a correlation with the pandemic response.
One silver lining of the shutdown is a reduction in traffic deaths: Fewer people driving means fewer accidents. The numbers bear it out, with traffic deaths roughly cut in half in both Guilford and Forsyth counties during the shutdown.
By the same logic, it could be predicted that more people staying home and cooking would mean an increase in fatalities from house fires.
“I think if we looked at the number of fire calls for cooking-related fires [statewide], those numbers would be up,” Causey said, “but thankfully the fire deaths have not gone up.”
The local numbers align with Causey’s observation: In Guilford County, death certificates show only one housefire death during the shutdown, compared to two during the same period in the previous year. And in Forsyth County, the number of housefire deaths was down to three, from four.
The trends could be a result of safety program underway prior to the pandemic.
“Three years ago, in 2018, we had 138 fire deaths in North Carolina,” Causey said. “We started a program called Smoke Alarm Saturday, where we tried to educate people. I went across the state with firefighters to install smoke alarms in low-income housing. About a fourth of the smoke alarms we checked were not working. They didn’t have a battery. Last year, those numbers came down a bit.”
Forsyth County Sheriff Bobby Kimbrough told TCB he sees the pandemic and its repercussions putting a strain on families.
“We’re responding to more social issues — calls from people needing interventions, people needing help with what I call social issues,” he said. “Son and mother not getting along. Unruly kids that should probably be at school and letting that energy go.”
Ron Glenn, the spokesperson for the Greensboro Police Department, said his agency has seen an increase in calls for domestic violence, but those calls often don’t get counted as incidents.
“I think during the pandemic we saw more calls for domestic violence,” he said. “Our reports on domestic violence remained the same…. There may have been more people who called because they were in the house together, but when the officer arrives, there’s not an incident.”
Kimbrough said he believes the worst repercussions are yet to come as a result of the loss of educational time due to the schools shutting down. He noted that the Winston-Salem/Forsyth County School District reported that about 5,000 students had not logged on to the online learning platform as of mid-May.
“That’s 5,000 kids that are going to be falling behind,” Kimbrough said. “As a result, that’s 5,000 kids that are going to be showing up next year with a deficiency. We’re going to have to figure out what we are going to do with them. That’s a social issue that’s become an education issue that has the potential to become a criminal-justice issue.”
Data from death certificates from the two counties shows that homicides are up in Guilford County and down in Forsyth County, suggesting little correlation with the pandemic. Homicides have remained a significant issue in both Greensboro and Winston-Salem for at least the past three years, with the city of Greensboro approving funding for the Cure Violence program in October 2019 and grassroots groups like Rally Up Winston-Salem working on deescalating violence in that city.
There’s some evidence of a rise in drug overdoses in Forsyth County during the shutdown. The Forsyth County Sheriff’s Office counted 40 overdoses, both fatal and nonfatal, from March 16 through May 26, 2020, compared to only 27 for the same period in 2019. The sheriff’s office’s jurisdiction includes all areas of the county with the exclusion of Winston-Salem and Kernersville.
It’s difficult to track a change in drug overdoses through death certificates because only a small number of overdoses are initially classified as such. Most are initially classified as “pending” and only determined to be overdoses months later. But extrapolating from the percentage of “pending” deaths ultimately determined to be overdoses in 2019, an estimated 34 people died from overdoses in Forsyth County during the shutdown, compared to 33 during the same period in 2019. In Guilford County, an estimated 25 people died from overdoses during the shutdown, compared to 32 during the same period in 2019.
Tristan Matthews said he believes the COVID-19 pandemic contributed indirectly to his friend, Paul Magee’s death. Magee died at home, apparently as a result of a drug overdose.
Matthews said Magee carried some frustration from experiencing setbacks in the music industry, but he loved to cook and to be around people. Matthews said he believes his friend’s layoff set off a chain of events that led to his death.
“I think that did take a toll on him, because the last time I spoke to him he had a confusion in his tone about the whole thing,” Matthews said. “Besides music, that was all he had was working — cooking. He’s a people person. To not be able to do that was isolating.”
Among the food-service workers, musicians and artists in downtown Winston-Salem, Magee was a beloved figure and his death sent ripples of grief through the community.
“Literally everybody that I spoke with after he passed had more or less the same story about how great he was and everything he did for them,” Matthews said. “If you were a genuine spirit, he genuinely gave his all to you.”
Before Magee died, he and Matthews had talked about starting a catering company together.
“He just wanted that one more string of hope, that one thing that would have kept him going,” Matthews said. “I really believe the whole COVID thing pushed him over the edge. He was a great friend. If you talk to any of his other friends, they would tell you the exact same thing. When we met each other, we didn’t know how many webs of connection there were between us with people that we both knew. That was a dark day in downtown Winston-Salem when we found out he passed.”
Rachel Spinella contributed to this story.