County Hears About 'Rapidly Evolving Situation' -Brevard NC
Last updated 3/25/2020 at 5:40pm
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During Monday's Board of Commissioners meeting, Public Health Director Elaine Russell gave a COVID-19 briefing, calling it a "rapidly evolving situation," with re-commendations and resources that are changing every several days.
She said the situation is transitioning from travel-linked and lab-confirmed cases to a "community acquired dynamic."
Russell went on to give an overview about Transylvania Regional Hospital's (TRH) capacity and equipment, COVID-19, who is at greatest risk, testing information, current responses by officials and prevention tips.
Transylvania Regional Hospital
According to TRH's Michele Pilon, if the hospital can secure physical beds and equipment, it will have capacity for 59 inpatients, an increase of 29 patients from current capacity. This will include 47 medical/surgery beds, nine ICU beds and three step-down beds.
TRH currently has two stationary ventilators and one travel ventilator and is expecting two additional ventilators. If needed, additional ER triage could occur in two vacant spaces on campus, as well as in a tent, if necessary.
If needed, TRH will use its current ER for infectious patients and overflow additional patients to the outpatient area, allowing for 16 regular beds, three isolation beds (two are negative pressure) and two critical care beds.
There will also be increased capacity available at all of the Mission Health System hospitals if needed, Pilon said.
COVID-19 is a mild-to-severe respiratory illness that includes symptoms of fever, cough and shortness of breath.
It is spread person to person: via air by coughing and sneezing; close personal contact, including touching and shaking hands; touching the nose, mouth, or eyes before washing hands; and may be contracted by touching a surface with the virus on it and then touching the nose, mouth, eyes, but this is not thought to be the main way of spreading the virus.
The greatest risk of severe illness is for those:
•65 plus years of age;
•Living in a nursing home or long-term care facility; and
•With existing health issues: chronic lung disease, moderate to severe asthma; heart disease with complications; immune system compromised, including cancer treatment; and severe obesity or uncontrolled diabetes, renal failure and liver disease. Health officials are also monitoring to see if pregnant women are at higher risk.
In a severe illness there is a progression to pneumonia, which can require ventilator support. Russell said this is the one of the key issues concerned with in relation to "surge capacity" in hospitals and why work is being done "to flatten the curve."
There are no medication options at this time, she said, with trials being conducted or through off-label use, which is using pharmaceutical drugs for an unapproved indication or in an unapproved age group, dosage or route of administration. Russell said an IV drug and two malaria drugs are being looked at for possible use to combat the virus.
The Centers for Disease Control and State Public Health labs maintain a very strict algorithm for testing, she said.
There are a "few (testing) kits" at the health department, she said.
There are commercial lab capacity through Lab Corp, Quest and ARUP, based on a physician's order, but there are supply-chain issues, she said.
There have been collaborations to provide community drive-through testing sites, such as at Pardee in Hendersonville, but they are also facing supply-chain issues, Russell said. Testing access remains problematic nationwide, she said.
The N.C. Department of Health and Human service is now transitioning into mitigation efforts as the outbreak spreads into community-acquired cases.
There has been daily communication between lead agencies and active monitoring by the local Epidemiological (Epi) team, along with working with community partners, Russell said.
Russell said they are daily gathering accurate data and factual information in the face of misleading information that can be found in the media at the state and national levels.
•Wash hands often and thoroughly: using soap and running water for 20 seconds, including all surfaces.
•Avoid touching eyes, nose, and mouth with unwashed hands.
•Avoid close contact with people who are ill.
•Cover mouth and nose with a tissue when you cough or sneeze.
•Clean and disinfect frequently-touched surfaces with EPA-approved cleaning solution (follow package instructions).
•Practice social distanc-ing: avoid non-essential travel, stay home as much as possible, limit group sizes, maintain 6 feet of distance from other people.
•Be conscious of exposing older adults and those with compromised health to any illness.
•It is not recommended that people wear masks if they are well. Need to conserve resources.
Commissioner David Guice asked about the relationship between the county and TRH, which is now managed by the for-profit company HCA. County Manager Jaime Laughter said the county has been in communication with the hospital about its capacity, including beds and equipment, to deal with COVID-19.
She said the county has no direct control over the for-profit but it's a "very positive sign that the communication lines are open and are working to establish the capacity."
Russell agreed there is strong communication between local health officials and TRH and at Mission Hospital.
Guice also asked what the county's current situation was with supplies and equipment, such as masks. Laughter said that based on conversations the county is "deficient," as far as supplies and equipment.
"Ultimately, we are trying to conserve what we have now, knowing it will become more critical down the line," she said.
Laughter said some protocols have been changed, such as making sure sheriff's deputies have the appropriate protective gear when responding to calls at the same time as EMS and DSS workers practicing social distancing. The county is also looking at having a community drive, where the public, for example, could donate masks.
Commission Chairman Mike Hawkins talked about the actions taken at the state and federal levels to curtail COVID-19 and the impact those actions have had on the public, including local businesses and their employees.
He asked whether county officials believe those actions have been "appropriate" and "useful."
Russell said she does support the measures involving social distancing and scaling back business operations for the foreseeable future.
"We have to take these measures, so that we can preserve and protect the capacity that we have in our medical systems, so that we can stagger out the flow of elders who are going to be significantly impacted by COVID-19," she said.
Hawkins asked what other actions does staff believe need to be taken at the county level.
Russell said the county needs to "monitor the emerging number of community acquired cases that will emerge in the coming seven to 10 days to see if we need to further ratchet down the protective measures that we have in this community."
"Those would be serious steps," she said. "I do not want to take them lightly. I do not want to place any greater burden on the economic framework of our community, but it is a delicate balance between protecting the health, life and safety and economics."
Guice said he has a lot of concern about the impact on the business community and the social distancing rules. He said restaurants and other certain venues have been closed, while other venues remain open, such as at Walmart and Ingles.
Guice said he wasn't advocating that these and other similar places close but that "if things spread, as we are being told, it's obvious to me we are going to have more cases."
Guice suggested the public is being given "mixed signals."
Guice said that in a conversation with Tim Moore, the N.C. Speaker of the House, the lawmaker suggested delaying certain requirements to help businesses, such as fees and other "regulatory barriers." Guice also pushed for the board to be actively listening and being responsive to local business owners.
"Some business owners just want to know how they can help," he said, noting there are empty restaurants with kitchens that are willing to feed the public.
Commissioner Page Lemel noted the Business Support Task Force (see related story on page 8A) that was formed last week and its goal to help local businesses, plus other efforts that are taking shape in the community.
Lemel said Guice was "spot on" when he also highlighted the impact the current situation could have on summer camps.
Lemel, who owns and operates Keystone Camp, said if summer camps lose a season, then it loses the whole year financially and that is "petrifying."
"But our industry is also united in trying to mitigate this ourselves," she said.
Commissioner Jason Chappell said the Land of Sky Regional Council is working on having regular meetings to provide resources to help businesses.