BOONE — Appalachian Regional Healthcare is reemphasizing the need for community members to be “socially responsible to each other” while the hospital system experiences a surge in COVID-19 cases, according to Rob Hudspeth, senior vice president for system advancement at the ARHS.

The hospital system is experiencing what it calls phase three of its four-phase COVID-19 surge plan. Phase one is classified as “enhanced operations” with one positive COVID-19 case in primary service area. Phase two is an “initial patient surge” with six positive COVID-19 patients hospitalized. Phase three — where the hospital currently sits — is an “advanced patient surge with 25 positive COVID-19 patients hospitalized. The last phase, or the “critical patient surge,” includes 35 or more positive COVID-19 patients in the hospital.

“We don’t want to cause panic, but we do want people to have concern and continue to take action,” Hudspeth said.

Hudspeth explained that Watauga Medical Center initially started out with 10 beds dedicated for COVID-19 patients. The COVID-19 has since expanded to 20 beds, then 24 beds. Hudspeth said medical staff were becoming concerned because 23 of the 24 beds were in use as of Dec. 1. The hospital began preparing for an additional 10 to 14 beds for COVID-19 patients as of Dec. 2. The following Tuesday, the COVID-19 unit grew to 27 patients.

“I think some people in the community thought we were going to be OK because we’re out here in rural Northwest North Carolina and it hasn’t been here yet,” Hudspeth said. “Well, it’s here.”

Watauga Medical Center was OK on the amount of personal protective equipment and ventilators, Hudspeth said.

At the beginning of the pandemic, ARHS enacted an emergency management protocol and implemented an incident command center. The incident command center was largely made up of ARHS staff, but also involved regular communication with county personnel, AppHealthCare, emergency management and Appalachian State University, Hudspeth said. The incident command center would be involved in strategic decisions about supply chain management, whether or not to allow hospital visitors and restricting travel for employees.

While COVID-19 trends weren’t spiking as local health officials had feared, the incident command center was operating at a reduced capacity but still remained active. ARHS Director of Marketing Vicki Stevens said the incident command center has ramped back up now that the hospital is experiencing a surge.

Stevens said the surge plan phases are based on COVID-19 and the hospital’s capacity to care for the patients. ARHS first started to observe the beginning of a surge in early October; Stevens said the hospital’s overall amount of patients — also known as its “census” — grew from 49 total patients to 66 in one day. Hudspeth said he noticed the surge when WMC went from nine COVID-19 patients to 16 the next day.

Hudspeth said hospital staff grew concerned that they could continue to see an uptick in cases after the Thanksgiving holiday and as people potentially began congregating indoors due to the winter weather.

The hospital had a 93-patient census total as of Dec. 2; Hudspeth said the hospital doesn’t typically have that many patients there at one time. The census had dropped slightly by Dec. 8, with 87 total patients. Hospital system staff take into account the amount of patients in the hospital overall — even if they aren’t COVID-19 patients — as the more patients in the hospital, the more staff experience fatigue and more resources are utilized.

ARHS had previously entered a contract with a nurse staffing agency to contract 15 additional staff to handle the COVID-19 unit. Other regional health care systems have done so as well as their own full-time staff experience fatigue, making it more difficult for ARHS to ask for additional staffing, Hudspeth said.

During the last few weeks, ARHS officials have realized that other regional hospitals experiencing the same surge are they are, Hudspeth said.

In addition to taking in more COVID-19 cases and seeing a rise in overall patients, Hudspeth said non-COVID-19 patients are entering the hospital at an advanced level of sickness. Hospital officials have noticed that some non-COVID-19 patients are avoiding the hospital or not seeking regular treatments as they should be, and are coming into the hospital at an increased level of sickness.

“We need people to realize that maintaining their own health is really important,” Hudspeth. “Let’s say you have hypertension and you feel a little bit weird, you put that off because you haven’t been taking your medication or you didn’t have a followup appointment with your doctor because you’re scared you’re going to get COVID-19 (and then) you end up in the emergency department. The cascade occurs where you get admitted, and that’s another bed.”

ARHS officials are asking the community to do its part during this time by getting a flu shot, managing one’s health and practicing the three Ws — wearing a mask, waiting six feet apart from others and washing hands often. Hudspeth said the three Ws is the community’s best defense until a vaccine can be distributed.

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