COVID-19 test kit

A COVID-19 test kit is pictured.

RALEIGH — As the United States on March 26 surpassed China and Italy to become the nation with the most confirmed COVID-19 cases in the world, North Carolina this week announced a shift in its response, and Appalachian Regional Healthcare System is preparing for a potential influx of patients at local hospitals.

The number of confirmed U.S. cases was at 85,653 as of 11 p.m. Thursday, March 26, according to figures reported by Johns Hopkins University & Medicine, with 1,290 deaths related to the virus and 713 people reported to have recovered. The number of cases had more than quadrupled in the week since March 19, when the university reported 19,100 confirmed cases.

In the same timeframe, North Carolina’s confirmed cases grew from 134 on March 19 to 729 on March 26, according to the Raleigh News & Observer. Gov. Roy Cooper announced on March 25 that two COVID-19-related deaths have occurred in the state, including a Virginia resident who had traveled to N.C. A third death was announced by Harnett County on March 26.

“These will not be our last (deaths),” Cooper said.

As local governments across the state began to issue stay-at-home orders, Cooper stopped short of issuing a statewide mandate at his March 25 briefing, but said, “We will be issuing additional orders soon.”

In Watauga County, the fourth positive test result — a person who had travel history and who had been in isolation since being tested — was reported on March 26 by AppHealthCare, the public health department serving Watauga, Ashe and Alleghany counties.

“We recognize that another case may cause increasing concern in the community,” said Jennifer Greene, AppHealthCare director. “Remember, you can help us slow the spread of this virus. Stay home to the greatest extent that you are able, especially if you are a person who is at a higher risk for severe illness.”

“Though our local numbers are low compared to some other counties in our state, we also know that there is evidence of community transmission in North Carolina,” Greene said.

New testing guidance

In the past week, the CDC, N.C. DHHS and AppHealthCare announced new guidelines for testing, prioritizing those with urgent medical needs as well as health care workers.

“Based on recommendations issued by the N.C. DHHS, most people do not need testing for COVID-19,” AppHealthCare stated. “When you leave your home to get tested, you could expose yourself to COVID-19 if you do not already have it. If you do have COVID-19, you can give it to someone else, including people who are high risk. If you are sick and unsure if you should get tested, please call your health care provider.”

The announcement came amid a nationwide shortage on personal protective equipment for health care workers, N.C. DHHS noted, as well as media reports of continued test kit shortages and test results taking up to seven days or more.

Appalachian Regional Healthcare System Vice President for Advancement Rob Hudspeth said that ARHS is following the new testing recommendations. On March 18, the health care group that includes Watauga Medical Center in Boone and Cannon Memorial Hospital in Linville announced a new partnership with telehealth provider RelyMD to “ease the burden on the health departments’ testing and to help people get a medical screening from the comfort and safety of their homes,” Hudspeth said.

While echoing N.C. DHHS and AppHealthCare in stating that most people do not need testing for COVID-19, ARHS now advises that if you are sick and unsure if you should get tested, you can call your health care provider or connect with a RelyMD provider online at on your computer or mobile device. The screening costs $49 with the coupon code BEWELLARHS.

People who experience shortness of breath and difficulty breathing, chest pain or pressure, bluish lips or face or confusion or disorientation should call 911 or contact their primary health care provider, according to ARHS.

Preparing for a potential surge

Asked when North Carolina can expect COVID-19 cases to peak, N.C. DHHS Secretary Mandy Cohen said on March 25 that officials are still working to determine what trajectory N.C. is on, but that they feel like the state is trending lower compared with other states.

Regardless, Hudspeth laid out the steps that ARHS is taking in preparation for a potential surge in patients due to COVID-19.

“Two weeks ago we formally established an incident command center to integrate facilities, equipment, personnel, procedures and communications within our organizational structure specifically aimed at responding to catastrophic levels of COVID-19,” Hudspeth said. “We communicate daily with N.C. DHHS, AppHealthCare, Toe River Health District, emergency management, Watauga and Avery County Schools, Appalachian State University, the N.C. Hospital Association, state and federal legislators and many law enforcement agencies to ensure synchronous response to COVID-19.”

“We’ve converted two large inpatient bed units into isolation areas — and have developed contingency plans if demand exceeds our bed capacity,” Hudspeth said.

Recently, ARHS barred all visitors from its hospitals (with a few exceptions) and mandated that all employees enter through a single entrance where they are required to get a temperature screening.

“Employees with a temperature of 100 (degrees Fahrenheit) or greater are not allowed to work. Today the temperature screening mandate was extended across all ARHS (clinical and non-clinical) facilities,” Hudspeth said on March 26.

Another action was the postponement of all elective surgeries and procedures, Hudspeth said, following guidance from the U.S. surgeon general, the American College of Surgeons and the CDC. Hudspeth said the measure will help “ration much-needed personal protective equipment, keep hospital beds open and ... shield patients from the virus.”

COVID-19 testing sites in Watauga and Avery County are located off site from hospitals to protect employees, Hudspeth said, and ARHS has created new supply chain and logistics channels to ensure continuity of supplies.

The Broyhill Wellness Center, closed to the public, is temporarily being used for child care for ARHS employees’ children.

One measure being implemented elsewhere, but that ARHS has yet to take, is utilizing retired doctors and nurses, Hudspeth said.

“Some external volunteer roles are being utilized, but in very limited roles,” Hudspeth noted.

Cohen said on March 25 that “hundreds” of health care professionals have answered the state’s call for volunteers.

Thomas Sherrill contributed reporting to this article.

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