BOONE — The number of people hospitalized with COVID-19 at Watauga Medical Center is on the rise as cases continue to spike in Watauga County and at Appalachian State University.
The recent surge has local health officials concerned about the strain on staffing and other resources. AppHealthCare Director Jennifer Greene told the Watauga County Board of Commissioners on Tuesday, Oct. 6, that continued COVID-19 spread without additional resources will be “unsustainable” for the health department, and that more “surge staff” have been requested from the state.
As of Oct. 6, 10 people were hospitalized with COVID-19 at Watauga Medical Center, down from 11 the day before, according to Rob Hudspeth, senior vice president for system advancement for the Appalachian Regional Healthcare System. Previously, the hospital was seeing an average of two to five COVID-19 hospitalizations on any given day, with a high of seven on one day over the past three months, he noted.
The increase prompted the hospital’s opening of a second COVID-19 unit over the weekend. The first unit has seven beds, and the second unit has six beds, according to ARHS.
“In the past two weeks we have seen an increase in community spread of COVID-19, which has correlated with an increase in patients in the hospital,” Hudspeth said. “It’s a concerning trend.”
After growing by 222 the previous week, Watauga County’s reported total case count jumped by 308 cases from Sept. 29 to Oct. 6, to a cumulative 1,384 cases, according to AppHealthCare’s COVID-19 dashboard, and 325 cases were active as of Oct. 6. An additional 406 people were being monitored due to exposure to a confirmed case, the health department reported. The number of COVID-19-related deaths in Watauga rose to 13, with at least 11 deaths associated with the ongoing cluster at Glenbridge Health & Rehabilitation, a nursing facility.
An additional concern for local health officials is that Watauga County’s percentage of positive tests has been trending above the statewide trend for some time, especially in the last two weeks, Greene told the commissioners. Greene said Watauga’s percentage stood at 9.2 percent, compared with the statewide rate of 6.4 percent. State leaders have said they want to see the percentage at 5 percent or lower.
Appalachian State’s reported total case count grew by 224 cases between Sept. 29 and Oct. 6, up from an increase of 167 cases the week before. As of Oct. 6, Appalachian reported a total of 852 cases, with 231 active. Of the active cases, 220 were among students, and 11 cases were employees. On Oct. 1, the university announced that seven new active clusters (five or more cases that are linked) had been identified in dorms, athletic teams and fraternities. This added to seven other active clusters on campus.
Any App State student or employee living on campus or in Watauga County is counted in AppHealthCare’s numbers for Watauga. Appalachian State also includes students and staff who are residing in other counties in its reported numbers.
“It’s important to point out that the majority of new cases we are seeing are among the 18- to 24-year-old population,” Melissa Bracey, AppHealthCare spokesperson, said last week. According to N.C. Department of Health and Human Services data — which lag behind AppHealthCare’s dashboard due to manual entry of antigen test results — 64 percent of Watauga County’s cases are among 18- to 24-year-olds.
AppHealthCare stated in its weekly situation update, dated Oct. 2, that most exposures are occurring due to close contact through living or working closely with others or attending social gatherings.
An Appalachian State student, Chad Dorrill, is the youngest resident of Watauga County to die with COVID-19, Bracey confirmed. The death of the healthy 19-year-old due to COVID-19 complications — doctors reportedly told the family the virus could have triggered Guillain-Barré syndrome, a rare neurological disorder in which the body’s immune system attacks nerves — sent shock waves across the campus and state, prompting national media coverage.
Greene noted that the N.C. Department of Health and Human Services has requested two calls per week with AppHealthCare and Appalachian State representatives, and that AppHealthCare and university representatives have daily calls.
As of Oct. 6, Appalachian State had not announced a change to its mix of remote, hybrid and in-person classes. In an update to campus on Oct. 2, Appalachian Chancellor Sheri Everts said, “Our current on-campus density is low; our available response resources remain high; we can offer flexible course delivery options to those who need it; and, should we need to, we are ready to pivot to all-remote learning.”
As of the Oct. 2 update, active cases in residence halls represented 1.2 percent of the residence hall population, Everts said, and the university was using 28 percent of its available quarantine space. Most of Appalachian’s students live off campus in and around Boone and are taking the majority of their classes remotely, she said, adding that “we need better compliance with wearing face coverings off campus, adhering to quarantine and isolation instructions and answering contact tracing calls from public health.”
In response to a question about what would prompt a decision to transition to full remote instruction, Appalachian spokesperson Megan Hayes pointed to the information in the Oct. 2 update and added, "The majority of our students are learning in hybrid or fully remote formats and to date, we have no confirmed cases of classroom transmission.
"While there's no playbook for a global pandemic, we continue to review our data and discuss with public health what next steps might be most effective given that information. We are watching very closely the cluster numbers, which includes cumulative and active cases, in residence halls," Hayes said.
Greene told the commissioners that AppHealthCare has discussed a testing team that would target off-campus student locations.
“Regardless of what actions the university takes, we know we have a lot of folks who are renting apartments off campus,” she said. “It’s important to know we’re going to be in this for a while.”
The health department also issued a statement on Oct. 5 urging faith organizations to help slow the spread of COVID-19, as some recent cases have been linked to worship services.
“We appreciate and value the partnerships with our faith community and acknowledge this is not the only COVID-19 risk we are seeing currently, but is one that has had enough activity in the past week to draw attention to this as a serious matter,” Greene said in the statement.
Hudspeth said that if the second COVID-19 unit fills up at Watauga Medical Center, “we have the ability to open another 10-bed isolation unit for COVID-19 patients.” After that, “if we reach full capacity in those 23 beds, we would initiate the next phase of our surge plan, which could involve diverting patients to other facilities,” he said.
“When we see a spike like this it begins to feel like we’re back in March, when we were concerned about how far it could spread,” Hudspeth said. “Obviously, further spread can have significant impacts on our resources and staffing.”
“I cannot say enough about how our staff has embraced the challenges associated with COVID-19 over the past seven months,” Hudspeth added. “The people on the front lines — our providers, our nurses, our caregivers –—they really are the heroes. If you can imagine walking in their shoes for one day — gowning up with PPE, entering a COVID-19 room and providing care and compassion to an infected patient — you would realize it’s really a tough job. During these past two weeks, with this increase, it has become even tougher for them.”
Greene also spoke about the increased workload and its impacts on the health department staff.
“We are working very hard to keep up with the volume,” Greene said. “We’re asking for more support from the state.” Staff are doing testing every day, and call center staff are fielding about 1,000 calls per week. Contact tracers often have to reach out to people multiple times, she said.
“That adds to the volume when you’ve got 80 cases a day and you’ve got 40 of them that haven’t answered from the day before; it can pile up pretty quickly,” she said.
Staff are currently unable to address their regular health department duties; all are focused on COVID-19, Greene noted.
Greene told county commissioners that the department is continuing to plan for what a mass vaccination would look like.
“I fully anticipate it will be some time before we have a mass quantity of vaccine,” she said. “We are still engaged with DHHS folks with hopes of having a vaccine at some point that we could get out to priority populations; that will be determined by the state in terms of who gets that. We expect that with the health care workers initially.”
Kayla Lasure contributed reporting to this article.