By Nathan Ham
The last few weeks have brought a significant rise in positive COVID-19 cases across much of the High County with 16 percent of the tests conducted last week returning positive results for the coronavirus and the death count increasing to 15. Glenbridge Health and Rehab has experienced 11 of the 15 deaths and a total of 45 positive cases among residents and 15 positive cases among staff members. Currently, just one resident has an active case.
“We have the ability to house 23 beds for COVID-19 patients, that would be our maximum,” said Rob Hudspeth, Senior Vice President of System Advancement at Appalachian Regional Healthcare System.
Hospital stays were not that common during the spring and summer months. May had zero hospitalizations from COVID-19. June and July saw on average of just two to five COVID-19 hospitalizations each day. Those numbers have been increasing to their highest levels over the past two weeks.
On Monday morning, Watauga Medical Center had 13 of those 23 COVID-19 beds filled with patients but discharged three by the end of the day. On Tuesday they had eight. The average stay for a patient dealing with COVID-19 has been five to seven days, with more severe cases staying longer.
With a limited number of critical care staff available, it is key for ARHS to have a plan in place for knowing how many COVID-19 patients they can house without overworking the staff and putting a real strain on the amount of personal protective equipment and supplies
“What becomes challenging for us is staffing and supplies. A caregiver has to put on personal protective equipment every time they go into a COVID-19 room. Unless it’s re-useable, they’ll discard it when they come out. If they go into a room five or six times a day, you can imagine how quickly we can run through our PPE, so that’s concerning,” Hudspeth said. “Also, there are only so many nurses with critical care training available and those that do have critical care training can only work so many hours. The way we have prepared for this since March, we are caring for people today but also preparing for what could happen tomorrow, next week and next month.”
“With these community hot spots and outbreaks increasing, our concern is the impact it could have on hospitalizations. We are concerned about our patients and about our staff that provides care for them. Continuously increasing hospitalizations lends to staff fatigue and burnout, which is something we’re keeping a close eye on.”
If it continues to grow, at what point does it become unmanageable? Right now we can care for 23. Beyond that, our surge plan dictates sending patients to other facilities,” said Hudspeth. “Who takes those patients and where they go would be based upon the patients’ needs, what those hospitals are experiencing, and their ability to care for them. There’s just not a playbook for this. You can have a plan, but the variables are constantly changing so we have to keep course-correcting”
This week, courtesy of Watauga County Emergency Management, Watauga Medical Center set up a temporary pod behind the emergency department to isolate and expeditiously treat low acuity, non-emergent patients who do not have COVID-19.
“We’ll continue to screen patients for COVID-19 as they enter through the front of the ED. From there we’ll segregate them based upon acuity. We don’t want those low acuity patients sitting for hours when we could instead treat them quickly and send them home.”
Hudspeth also noted that the hospital is prepared with several ventilators for those patients that may need them. “Watauga Medical Center is part of the State’s emergency response system where hospitals share a daily snapshot of ventilators and PPE. We have our own supply. But if we need more, we also visibility of where to get them.”
“Our operational leaders and clinical care teams began planning for these scenarios last spring. Some of the models we analyzed in March projected a surge in April. Some projected June when the seasonal residents arrived. Others predicted a spike to occur in August, with the return of students. Next, we’ll be considering the impacts of cold weather and seasonal flu during the pandemic.”
“We are moving through it, we just have to stay vigilant and responsible to each other in taking precautionary measures. Using common sense and adhering to the 3Ws will continue to be important as we go into Phase 3 of the reopening,” he said.
What the Data Shows
The latest weekly update from AppHealthCare shows a steady increase in positive coronavirus cases, especially in Watauga County. The majority of these positive tests are coming from individuals in the 18-24 age bracket, many of those likely coming from students at Appalachian State.
Appalachian State’s football team has had to deal with positive cases adding up since the season started. 78 members of the team between coaches, staff members, and players, have tested positive for COVID-19. Right now there are 4 active cases on the team. Other cases have spread from social gatherings, student housing on and off-campus, and worship service gatherings. Currently there are no university-related hospitalizations
“We recognize the toll this pandemic has taken on the daily lives and routines of everyone in our community. This is a stressful time and there are a lot of unknowns, but there are things we can do together to prevent the spread of this virus. We urge everyone to please practice your 3Ws by wearing a face covering, distancing from others outside your immediate family or those you live with, practice good handwashing, and stay home if you are sick to help protect others in our community. Let’s join together to support the Show Your Love campaign by protecting our loved ones and neighbors,” said Jennifer Greene, the Health Director at AppHealthCare.
Looking at the data through October 9, Watauga County had reported 1,151 positive cases. A total of 63 percent (725 people) of all the positive cases in Watauga County are in the 18-24 age group. Another 17 percent (195 people) are in the 25-49 age group while so far, the oldest age groups of 65-74 and 75 and over have only added up to a combined eight percent (92 people) of positive test results. 51 percent of the positive tests (approx. 586) are male while 49 percent (approx. 564) are female.
Testing numbers have steadily risen since late August, rising from 1,042 tests the week of August 23-29 to 1,772 tests during the week of September 27 – October 3. Since testing began in Watauga County, 17,840 tests have been collected. The tests taken from September 27 through October 3 make up approximately 9.9 percent of that total number.
From August 23 through October 3, there has been a steady increase in the weekly number of positive cases. It started out at 71 positive cases from August 23-29 and rising each week. The week of September 27 – October 3 saw 295 residents in the county test positive. During the same time frame, active cases have risen each week, starting at 104 during the last week of August up to 436 from September 27 through October 3.
The percent of positive cases in Watauga County has increased with the greater increase in testing, though at a higher rate than health officials wanted to see. From August 23-29, the positive cases made up 6.6 percent of the total testing. Last week, the number of positive cases unfortunately made up 16.6 percent of the total tests. Two weeks ago, the percentage was 13.7 for positive tests out of total tests.
Appalachian Regional Healthcare System is maintaining active lines of communication with public health leaders and community partners as COVID-19 trends continue to change and hospital workers are working hard each day to provide the proper care for patients that are dealing with the complications of the virus.