The Transylvania Times -

Accordius Gives An Update On Virus Impact – Transylvania County, NC


Last updated 10/7/2020 at 4:21pm

Of the nine deaths related to COVID-19 in Transylvania County since the pandemic started, six have occurred at Accordius Health in Brevard.

On Wednesday, Sue Robinson, administrator at Accordius Health on North Country Club Road, said there were currently no residents with COVID-19.

"We still have one positive staff member," she said.

The outbreak, which is defined as two or more cases within a congregate living facility, spread to 85 cases among Accordius staff and residents combined, with six deaths among residents. As of Wednesday, Transylvania Public Health was reporting 350 cases of COVID-19 among county residents. (To see the latest graphic, click the graph or the link: )

At Accordius Health, Robinson said life continues for residents, but with restrictions.

"We are not able to offer indoor visitation yet," she said. "We are still doing weekly testing. The Transylvania Health Department has been very phenomenal. They had been doing our testing, but we recently received our facility specific machine, so we are testing our residents and staff in house. We are excited to use that because as people become symptomatic, we can test immediately without having to schedule something."

Residents have access to many activities, such as hallway bingo and Bible studies, and when the weather is nice, Robinson said residents get to take walks outside and tour Accordius' garden named Alice's Garden after a previous resident, built in memory of her and constructed through donations.

"There have been many groups and organizations in Transylvania County that have reached out and been so supportive," she said. "They've provided baskets of snack for the staff. We had a church that had a prayer meeting out in the parking lot, so that when we opened some of the windows, residents could hear some of the singing."

She said, despite the tragedy, "We know we are not in this alone."

"The community has really come together and helped us with that," she said. "It's been very touching. The over-whelming amount of kindness has really meant so much, and we are doing everything we can to make sure our residents are loved and cared for."

Cedar Mountain Home and Kingsbridge House

A spokesperson for the Cedar Mountain House (in Cedar Mountain on Sherwood Ridge Road) and the Kingsbridge House (in Brevard on Sugarloaf Road) "remain COVID-free at this time," with infection-control measures maintained as well.

"We are very blessed that we have not had to fight this virus firsthand," said Holly Long, executive director for Cedar Mountain House. "Our amazing team members have been so diligent in following all infection control measures and taking additional precautions even outside the workplace.

"They are truly heroes, and I am thankful to have them here caring for our family of residents at Cedar Mountain House."

In accordance with state regulations, the spokes-person said, both communities have opened for outdoor family visits, are maintaining social distan-cing and screening all visitors. Both residents and visitors must wear masks for these visits.

"Throughout the pandemic, teams at both communities have worked to create out-of-the-box activities to keep residents and their families engaged in a safe way," the spokesperson said. "Residents have taken virtual field trips all over the world, and recently enjoyed a week of 'camping' at the community. Families have also enjoyed regular video calls with their loved ones as well as window visits."

Tore's Home Inc

Tore Borhaug, owner of Tore's Home, Inc, in Brevard, said testing for residents and staff continues on a weekly basis.

"We believe that this strategy, along with the use of personal protective equipment, has allowed us to stay ahead of the virus thus far," he said. "That being said, we also believe that due to the increased rates of positive asymptomatic people in our county there is also an element of luck that determines if an outbreak is going to occur in our community.

"Due to such an increased number of positive COVID-19 test results, we will continue with weekly testing as long as such testing is available or we gain access to a vaccine or other conditions determine that testing is no longer available or practical."

He said they also continue to evaluate, weekly, whether or not to open for visitation with families of residents.

"We are trying to balance the need for loved ones to see each other along with safety concerns, which is a difficult balance to find during these difficult times," he said.

He said he is "extremely impressed" with staff who have demonstrated "heroic efforts" in caring for the residents throughout the pandemic.

How Deaths Are Recorded

Tara Rybka, the public educator at Transylvania Public Health, explained how deaths are recorded in Transylvania County.

The policy and procedure of recording a death vary from state to state.

"Deaths are complicated because in North Carolina, COVID- deaths are counted if they are people who have had a lab-confirmed case of COVID-19, they have not recovered completely and, then, they have died," Rybka said. "They have not had an alternative cause of death. An alternative cause of death is if someone is diagnosed with COVID and they are sick, they walk into the doctor's office and get hit by a bus. Obviously, COVID-19 didn't kill them, the bus did, so there is an alternative cause of death, though that's an extreme example, but an obvious one."

COVID-19 can also be a contributing factor when one has had COVID, returned to "baseline," or stable health, but has "underlying conditions," or even permanent damage, from contracting the disease, and later died from respiratory illness due to damage to the lungs.

"There are lots of other ways COVID can interact, and that's called a comorbidity," she said. Comorbidity is the simultaneous presence of two chronic diseases or conditions in a patient.

Rybka said there can be a delay in reporting deaths because medical records require research to determine what is sometimes a combination of health problems.

"COVID-19 deaths include people who have had a positive molecular or antigen test for COVID-19 who died without fully recovering from COVID 19, and, again, that's defined as a return to baseline health before they got sick and had no alternative cause of death identified," she said. "That alternative cause of death would be some other cause of death unrelated to COVID. COVID could be a contributing factor, but not the cause of death. Because it causes such multisystem damage, it can be difficult to tease that out."

Rybka said Transylvania Public Health "relies heavily" on guidance, such as from the Centers for Disease Control (CDC), which acts as an advisory board that makes recommendations.

"North Carolina is a decentralized state," she said.

This means local county health directors have the power to make decisions based on guidelines, not the state, unlike South Carolina, a centralized state, in which the Department of Health and Human Services tells counties what to do.

"In North Carolina, counties make decisions based on guidance from the state, which is why it's called guidance, not regulation," she said. "If we were ever challenged on it, we would want to make sure that whatever we are doing is fully backed by the epidemiologist at the state level. Sometimes there is push back between the two, but at the end of the day, the counties are reporting cases to the state, and the state is reporting cases to the CDC. That's how it works in North Carolina."

In August, the CDC reported that, of the 154,504 deaths recorded from Feb. 1 through Aug. 19, 9,210 (6 percent) were listed to have died from COVID-19 being the single cause of death, while the other 94 percent had an average "2.6 additional conditions or causes per death," and of those previous comorbities, a majority were of "advanced age."

"What that means is that 6 percent of the COVID deaths were among otherwise healthy people who had no identified comorbities," Rybka said. "The remainder had comorbities. If you look at North Carolina, over 50 percent of adults in North Carolina have one of the underlying health conditions that put them at risk for COVID for severe outcomes from COVID. When you start looking at what those underlying health conditions are, a lot of people have them, such as cardiovascular disease, diabetes, some kind of chronic lung disease, kidney disease and then other conditions, like being in recovery from cancer. One can have a suppressed immune system, or people who had a transplant and are on immunosuppressive drugs to not reject that transplant."

On completing a death certificate for a COVID-19 death in North Carolina, the death certificate has two sections that list all known health issues.

"Part one describes what the person died from, and so someone who died from COVID may die from a respiratory failure caused by COVID pneumonia, so COVID is the underlying cause of death," she said. "COVID didn't kill them outright, but it caused pneumonia that damaged their lungs to the point that they could no longer breathe on their own and that's what actually caused their death. In that instance, that is the primary cause of death."

The second part lists all other health conditions that the person had at the time of death, such as diabetes or a broken hip from a car wreck that initially brought that person to the hospital.

"In section two of the certificate, it acknowledges that person also had COVID when they died," she said. "COVID did not kill them. It is not a part one cause of death. It's just listed on the death certificate, where we collect all other kinds of information."

There is CDC guidance for medical examiners and corners on how to fill out a death certificate, she said.

Rybka said the number one risk factor in North Carolina for death from COVID stems from cardiovascular disease, not lung disease.

She added that COVID-19 deaths in North Carolina are manually entered by local health departments into an electronic reporting system that track COVID cases and deaths.

"We have had some death certificates come in, where the medical records clearly indicate this person died of COVID-19, and it was not listed on their death certificate," she said. "We've had a death certificate that was listed as comorbidity, and this person never had a positive COVID test, because death certificates are not how we are counting a COVID death."

This varies in other counties that may rely on what's written on the death certificate, "depending on circumstances."

Before a COVID-19 death is determined in Transylvania County, Rybka said there are nurses who research the medical records of the deceased, along with state officials.

"We can have a case who is no longer alive, but they aren't necessarily considered a COVID-19 death if there was an alternative cause of death," she said. "Again, the state public health reviews those cases. We've had them contact us and talk us through some cases. "We've reached out to them and say, 'How to we code this? Is this a COVID-19 death or not?'"

Rybka said Transylvania County "has been fortunate" in its low number of cases compared to other places that have been designated as high-risk areas.

"We can do a proper case investigation and proper contact tracing," she said. "We can also do proper death investigations. In the electronic disease reporting system that North Carolina uses, there is a whole death investigation that must be completed that our nurses have to fill out in order to count something as a COVID-related death."

Public health departments in North Carolina are required to have a pandemic plan, she said, and, "in theory," there are "response mechanisms" in place.

"The challenge here is that COVID has behaved differently than pandemic flu," she said. "The disease itself moves and travels and spreads a little bit differently than flu spreads, and we simply don't know much about it. New strains of the flu pretty much travel and spread the way other strains of flu spread, and we know how to respond to it, and we know how to react to it."

However, COVID-19 spreads in a new, unknown way, she said.

"We know some things about coronavirus in general, and we can extrapolate that information, but this really is novel," Rybka said. "It really is a new virus. And, so, it really can be a challenge to know exactly how to respond, and that's been difficult."

Unfortunately, she said, in reporting on and tracking the unpredictable virus resulted in uncertainty that has "undermined a lot of public trust and expertise."

"Your best guess is 'A' on Monday, and by Friday you've discovered a whole new set of scenarios, and that's hard," she said. "It's hard for us to communicate that information to the public, and it's hard for the public to stay caught up."

As winter flu season approaches, Rybka said Public Health examines winters that have already delivered on flu season in the Southern Hemisphere to postulate on how flu season will affect the coronavirus-afflicted U.S.

"Places like Australia have already had their flu season, and so it's starting to travel around the world," she said. "So, as the Northern Hemisphere begins to enter our winter, given what we've seen in some other countries, is that the flu is low because of the other precautions that are being taken. If you are staying 6 feet away from everybody and everybody is wearing a mask, you aren't going to spread flu to anybody else. So, we are hoping for that, but the flip side of that is that people are still getting flu. But because of the fear of COVID, they are not getting diagnosed with the flu, and that could be a possibility."

She said Transylvania Public Health is "strongly encouraging" flu shots.

"You don't want to have both at the same time, and that would be a fear, especially for folks who are already at higher risk for severe outcomes," Rybka said. "You certainly don't want to have two respiratory illnesses at once."


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