HIGH COUNTRY — A year full of challenges all started with one case announced on March 3, 2020. A Wake County resident was exposed to the COVID-19 virus in Washington State. Since that day, more than 850,000 people have tested positive and more than 11,000 people have died in North Carolina.
In the High Country alone, more than 8,200 people have tested positive for COVID-19 and more than 100 people have died during the past year.
The COVID-19 virus didn’t just take a toll on those who became infected, it took a toll on almost every aspect of society.
One year later, the battle against COVID-19 is still raging, but hope is in sight for many health care workers with infections lessening and vaccines getting into people’s arms.
The month that never seemed to end
Jennifer Greene, AppHealthCare health director, remembers the first COVID-19 case vividly. The call came on a Saturday from the North Carolina Department of Health and Human Services: COVID-19 was in Watauga County.
“I'll never forget it,” Greene said. “We were there working to prepare testing and contact tracing and all of the work that we knew we would have to do, but then we get a call and it's real.”
COVID-19 materialized in Watauga County when the first case was announced on March 15. Ashe and Avery counties didn’t experience their first case for weeks, after Watauga. It was more than a month after Watauga’s first case for Avery County to have its initial case— the last county in the state to have no infections.
But Greene and other health care providers were as ready as they could be. They had been preparing for COVID-19 weeks in advance, since the first news reports from China came out in January about a new virus that spread easily.
“We always knew that there was a potential that we could be working on a bigger scale,” Greene said. “I don't think any of us thought that we would be working in a pandemic for quite this length of time.”
Greene said AppHealthCare — which covers Ashe, Watauga and Alleghany counties — had practiced for shorter and smaller scale challenges, but nothing to the magnitude of COVID-19.
After being notified of the first case in Watauga County on March 15, Greene said she felt some fear and anxiety as the health director.
“My job is to help protect the public's health,” Greene said. “It felt like a big, heavy weight to try to make sure we've done everything we can to protect, not only the people affected directly, but anyone who had been in contact.”
As COVID-19 started unfolding in March, hospitals and health care providers started preparing for cases.
“The vast majority of the work was just all preparatory work and trying to sort through all the information out there,” said Jimmy Phillips, an Appalachian Regional Healthcare System respiratory therapist. “What was happening? What was needing to be done? Because it was new to everybody. Just constant information gathering and lots of preparatory work.”
Greene said the department had many conversations with state-level epidemiologists to try to ensure they were doing all they could to protect people in the community.
Preparation was key as cases started increasing in the High Country. Watauga County had six cases by the end of March. Ashe County had its first case on April 3 in a resident who had a travel history.
“It was about preparedness,” said Melissa Lewis, an infection control nurse at Ashe Memorial Hospital. “We did not know what we were going to get and what we were not going to get.”
In March, many other aspects were also affected as state officials tried to limit the spread of COVID-19.
On March 14, the day before Watauga County had its first case, Gov. Roy Cooper announced public schools would close for two weeks. Appalachian State University and the University of North Carolina system had extended their spring break.
"Just under a year ago, we began re-building an entirely new university infrastructure — even as we were using it," said App State Chancellor Sheri Everts. "From the beginning, we did everything possible to maintain the continuity of our students' learning experience. We knew there would be no "one-size-fits-all" approach that would work for more than 20,000 students and 3,000 faculty and staff."
For Watauga County Schools, the pandemic resulted in online learning for the rest of the 2020 school year and even into the 2020-21 school year. In October, WCS started operating on to a two-by-three schedule with students attending school two days in person and three days virtually.
WCS started providing meals by pick up or even by delivery in some cases to ensure that all children were fed since children weren’t in school to receive meals. The shift in operations caused issues not only in an educational aspect, but also for some families in relation to providing child care. Parents struggled to make arrangements as some worked from home while others could not.
That same March 14 day, Cooper also banned gatherings of more than 100 people. Three days later, on March 17, Cooper ordered bars and restaurants to close for dine-in customers and only allowed take-out.
It was a move that meant economic impacts for much of North Carolina, including the High Country.
The summer that wasn’t: High Country sees economic impact of COVID-19
The COVID-19 pandemic’s effects in places such as the High Country have brought about unexpected results. In a year when many across the country were looking for a "getaway destination," places such as Avery, Ashe and Watauga counties proved to be a reprieve from crowded cities.
Right away Cathy Barr, the economic development director for Ashe County, said she was worried small businesses would fail. She immediately started to spread the word that the government was awarding Paycheck Protection Program loans that could be completely forgiven if used for specific business-related expenses like payroll.
“My hope was that it would help the business sustain itself until times were better,” Barr said.
Businesses would need the help as stay-at-home orders and capacity limits slowed profits. In the second quarter of 2020, the Bureau of Economic Analysis released a report stating the real gross domestic product decreased at an annual rate of 32.9 percent — one of the worst on record.
Cases steadily increased throughout the summer in the High Country. By August, Watauga County had more than 270 cases, while Ashe County was sitting at 119.
Despite all the restrictions in place, the High Country remained a place for people to go and businesses found new ways to provide services in a safe and effective manner.
“There's no doubt that everybody has felt some sort of new challenge wash across them throughout this process,” said David Jackson, president of the Boone Chamber of Commerce. “When we first saw this happen, there was so much uncertainty and businesses were forced to close for some time.”
As the summer progressed and the COVID-19 pandemic was rising, businesses had to adjust and Jackson said local businesses showed a lot of ingenuity and creativity early on during the pandemic.
Businesses had to rely on more online delivery methods and assess ways to allow for curbside pickup. Many adjusted store layouts to provide ways for patrons to shop while social distancing.
While many major tourist destinations, such as Tweetsie Railroad, closed down due to state guidelines, the High Country still saw many summer visitors.
Kitty Honeycutt, the director of the Ashe Chamber of Commerce, said the country saw many visitors trying to “escape” the bigger cities to be outdoors and have a change of scenery.
Likewise, Avery and Watauga counties saw an increase in visitors.
Ken Walter, Avery County Economic Advisory Committee Chairman, said the county unexpectedly had an increase in sales tax revenue. Walter said it was surprising to see the number of people coming to the county, especially since COVID-19 caused the cancelation of popular festivals like the Woolly Worm Festival and the Grandfather Mountain Highland Games.
After tourism restrictions were lifted statewide and locally in Boone, Jackson said the town returned to a normal, if not increased, level of people traveling to and from Boone. But 2020 was different for visitors.
“There was a lot more emphasis on shorter, day trips,” Jackson said. “That means a new clientele for us. This has been an introduction period to a brand new stream of people.”
Jackson said the location really allowed for visitors who maybe didn’t want to travel for a long period of time to instead visit the High Country and all the outdoor attractions that provided a safer atmosphere during a pandemic.
Jackson said one of the positives of the pandemic is how businesses have gotten to “know” each other again.
“I think we've got a stronger community now than we did last February,” Jackson said. “I think leaders have emerged, and I think people have come to trust one another again on a local level.”
As summer neared to a close, health care and community leaders turned to an emerging issue: surging COVID-19 cases.
Cases rise to new levels as pandemic rages on
From Aug. 1 to Oct. 31, Ashe County had 400 new cases. During that same time period, Watauga County had approximately 1,600 new cases.
Rob Hudspeth, senior vice president at ARHS, said when ARHS only had three to four COVID-19 patients in June and July, it felt like, somehow, the High Country would avoid the devastation some urban areas were seeing.
“I wasn’t being naïve,” Hudspeth said. “I knew that it would be here. I just feel like we live in a special place where it’s not like the rest of the outside world. I felt like we might be able to take care of each other in ways that other communities cannot.”
As cases started to rise, a concern was that Appalachian State students — who came back for classes starting in mid-August — would cause spread. Through the summer, the UNC system and App State had announced students would be living back on campus, but the majority of classes would be online.
“Just looking at the university population as a whole, we wanted all the students to be safe,” Greene said. “Our students do important things in our community. They're working in jobs and working for employers that need a healthy workforce.”
Greene said the main concern for her department was to try and figure out how to prevent spread and educate people on COVID-19. The agency launched the Show Your Love campaign that encouraged people to follow the three Ws — wear a face covering, wash hands and wait six feet apart.
In October, the High Country saw the highest number of COVID-19 cases. On Oct. 9, Watauga County alone had 377 active cases — of which 169 were App State students.
"In the last year, we have faced many situations the likes of which our university has never seen, with new unknowns and increasingly difficult challenges each day," Everts said. "Through tragedy and hardships, our university community came together to support one another, bolstering existing resources and developing new ones to provide critical and crisis support, and build and maintain everyday connections across virtual spaces."
ARHS has had 428 patients hospitalized at Watauga Medical Center due to COVID-19 as of Feb. 22. Those patients stayed in the hospital for more than 2,000 days collectively. AppHealthCare has had 132 patients hospitalized in its three-county district as of Feb. 25.
Of the 34 available COVID-19 beds at Watauga Medical Center, ARHS had a high of 28 patients hospitalized at one time.
To health care workers, the surge in cases was no surprise.
“It was just a gradual buildup of a constant inflow of patients through our system,” Phillips said. “It wasn't overwhelming, per se, the way it started, but it certainly got very hectic and very busy in the fall and early winter. That's when it really impacted us the most here.”
Health care workers dug deeper to find extra energy to do what was needed, Phillips said.
Lewis felt overwhelmed when the cases were surging in Ashe County. She said Ashe Memorial Hospital needed to ensure all of their team members stayed healthy to be prepared in the event of increased hospitalizations.
She said they spoke frequently with AppHealthCare, emergency management and other agencies to see “what was coming down the pipe” to try to prepare for a surge.
The main concern for Eric Bishop, an ARHS doctor who specializes in psychiatry, was COVID-19 spread to inpatient units.
“Person-to-person interactions are just as important as medicine on an acute stay unit,” Bishop said. “With some good decisions, vigilance by our staff and patients, and luck, I think we have managed the unit quite well.”
Carol Roten, a nurse at Ashe Memorial Hospital, said when cases begin to rise she felt anxious because they were still treating the same number of patients in addition to those with COVID-19. But she said they dug in their heels and devised a plan knowing they would most likely have to improvise.
The rise in cases didn't come without frustrations. When he would go out in the community – which he tried to avoid – Phillips grew frustrated with the lack of people adhering to the basic protections health care workers begged them to follow.
“I’d stand there watching this, hoping that I don't have to take care of y'all,” Phillips said. “It's like you know you or your family is going to be in my future.”
For the past year, Phillips said he has driven his family “crazy” because he has refused to go out to eat or go out in public because he knew that was the only way to keep himself and his family safe. When he went out, he would go at odd times when less people were there.
For Hudspeth, walking into a grocery store and seeing people without masks on or not social distancing made him question if they were spreading an effective message.
COVID-19: A deadly disease
With the surge in cases came the inevitable deaths.
Greene gets notified every time someone dies in Watauga or Ashe counties. She knew a death related to COVID-19 would likely come during the early months of the pandemic, but it still shook her when it happened. For Ashe County, the first death came on May 25. The first deaths in Watauga County came between Sept. 6-9 in three residents at Glenbridge Health & Rehabilitation. Avery County had its first death Sept. 3.
“It's weighed on me a lot,” Greene said. “At different points I think I realized there are things outside of my control. And at other times, it's been pretty challenging.”
As of Feb. 25, between Ashe and Watauga, 75 people had died from COVID-19. Avery County had its first death in the county on Sept. 3 and a total of 30 people have died related to COVID-19 as of Feb. 10.
For frontline health care workers, seeing COVID-19 deaths was inevitable. COVID-19 has killed more than 500,000 people in the United States and more than 11,000 people in North Carolina. Hudspeth recalls the first death his agency had.
“It was not easy on our staff,” Hudspeth said. “As a matter of fact, it really ramped up the tension for our employees. They began to see it as real. Many expressed fear that they themselves might contract it while at work. For me personally, I knew the first death was just the beginning.”
Hudspeth said looking at the data, it was clear that the elderly were more at risk of dying from COVID-19, but it became clear that death was also a possibility for younger people.
On Sept. 28, Chad Dorrill, a 19-year-old sophomore exercise science major at Appalachian State, died due to complications with COVID-19.
“The hearts of the entire Appalachian community are with Chad’s family and loved ones during this profoundly difficult and painful time,” App State Chancellor Sheri Everts wrote to the university at the time. “Tributes shared by friends and loved ones show the positive impact Chad had on the communities he loved and called home, which included App State and Boone.”
For Roten, when the deaths increased, she said her and her coworkers started feeling hopeless.
“We still feel the same pain,” Roten said.
Phillips never wants to lose a patient. It’s always hard for him, but he said he felt like the High Country was lucky it hadn’t had a COVID-19 related death earlier.
“It was inevitable, and it's always sad,” Phillips said. “It takes a toll on you that kind of brings it closer to home that people are actually now dying in the community and it just brings another level of how serious this disease is.”
Fatigue sets in
The stress and anxiety of dealing with the highly contagious virus on a daily basis has left many health care workers feeling drained mentally and physically.
“The staff are tired,” Greene said. “They have worked incredibly hard for so long and we're not done yet. We've got a ways ahead of us.”
Some have started to feel numb at moments and completely overwhelmed the next. Greene said she thinks health care workers have had to retrain their brains somewhat because the past year has been stressful and sometimes overwhelming.
“I am concerned about what that's going to look like post COVID-19 because I think a lot of us have been under such stress for so long,” Greene said.
Her workers have at points been completely overwhelmed. Greene said the department has had employee assistance program counselors come in and talk to the leadership team because they have had concerns about people remaining healthy through the pandemic.
Roten feels physically and emotionally drained after a year. She said it's made her reevaluate what's important. As a nurse, it’s also been a struggle for Roten to provide support for the staff and the community.
“We felt like we ran out of our own ability to take care of ourselves,” Roten said. “We have to make sure we look out for one another.”
Phillips said it’s hard to put into words how mentally and physically exhausting the past year has been. Workers in the medical profession have always worn masks — that hasn’t been new to them. But during COVID-19, Phillips said workers would wear two masks and complete protection gowns for 12-14 hour days, sometimes six or seven days a week.
At some points, Phillips said they would be working seven to 10 days without a day off. Along with the work itself on a daily basis, the fear of getting COVID-19 was always on Phillips’ mind.
“My hardest thing is just trying to fight the fear of getting it because I see what it does to people my age and a lot younger,” Phillips said.
Brittney Baird, an Ashe County native and registered nurse, was less than 18 months into her career when the pandemic struck. From the onset of the pandemic to now, she notes how areas such as PPE supplies have progressed and its effect on how they are able to do their jobs.
“(Compared to a year ago) I don’t think we’re as scared about running out of (personal protection equipment) as we were. We have reusable gowns now, where before we used disposable gowns that departments could run low or run out of,” Baird said.
For her, morale seems to be low.
“We’re tired,” Baird said. “It’s taken a toll on us.”
Baird has seen people who are 90 years old who have health conditions prior to contracting COVID-19 who don’t have too many issues after getting COVID-19. But then they see 30- and 40-year-olds who struggle to breathe, whose lungs collapse and who develop blood clots and go on ventilators.
“It’s just hard to watch, because you don’t know even now how this virus is going to affect each individual,” Baird said.
Sheri Cornett, an operating room technician with Cannon Memorial Hospital in Linville, said it’s hard for staff to watch someone their own age, or maybe they went to school with them or have children who have played sports together get COVID-19 and it costs them their life.
“It’s just hard because there’s a part of you that’s concerned over whether you will get it or whether you will transmit it to a loved one whose immune system can’t fight it,” Cornett said. “Although we aren’t the size of California or New York, this virus has hit us in this region and has affected many of our families locally.”
Bishop said he thinks he feels the same way a lot of his patients do.
“I feel anxious about inadvertently spreading the disease to a family member, friend or patient,” Bishop said. “I feel isolated in that I have consciously stayed away from family and friends. I feel fatigued.”
For ARHS, it’s really been a struggle throughout the year. ARHS has seen increases in chronic disease progression, substance abuse and mental health disorders. Hudspeth said people are coming into their hospitals sicker and staying longer, exhausting hospital resources.
After a year, Hudspeth said health care workers just feel exhausted. During a daily huddle in mid-January, Hudspeth said one of the nursing leaders talked about the difficulty of each day.
“He spoke emotionally about seeing friends and relatives, people we know in the community being affected,” Hudspeth said. “He also talked about the burnout and overwhelming anxiety his staff faces. I could tell he was physically and emotionally spent. He’s the kind of guy that when there’s a fire, he runs toward it.”
The next day, Jan. 16, was the mass vaccination event at Watauga High School.
“I show up and who do I see but that same nursing leader,” Hudspeth said. “He was volunteering as an EMS worker. The man who was so exasperated the day before was there to give an entire Saturday to vaccinate and provide emergency assistance. Here’s a guy that has been working 60-80 hour weeks leading us through the COVID-19 trenches at the hospital. That was a defining moment for me in terms of understanding the type of people that work for us.”
The light at the end of the tunnel
News of a COVID-19 vaccine first arose in early November with news that Moderna and Pfizer had a vaccine that was pretty efficient.
On Nov. 10, Anthony Fauci — the director of the National Institute of Allergy and Infectious Diseases and medical adviser to then President-elect Joe Biden — said in an interview on MSNBC that the U.S. could start to vaccinate high-risk people by December.
Greene was skeptical at first when she heard the news about a vaccine being available by December. She didn’t think it would be quite ready by then.
“I was hopeful at the same time,” Greene said. “We know (vaccines have) changed the course of history for big, communicable disease problems in our country.”
Phillips said hearing news about a vaccine was amazing and encouraging as he said he's always been a fan of them. He said he and others were ecstatic and all around cheerful at the news. Just as with Phillips, Lewis and Roten were excited about the vaccine news and felt relief that it was on the way.
“Even though nothing is 100 percent, it kind of helps that reassurance that maybe we are moving positively for the country toward ending this pandemic,” Lewis said.
AppHealthCare and ARHS received vaccine vials around the week of Dec. 21, and quickly administered their respective allocations.
When vaccines did become available, Hudspeth said ARHS shifted from a reactionary strategy to a “let’s get everyone vaccinated as quickly as possible.” But it wasn’t all smooth running when it came to administering vaccines.
“It's definitely been incredibly stressful for public health staff and all the vaccine providers trying to navigate all the rules, the systems and the way that we have to roll out vaccines for people,” Greene said.
Early on, it became apparent that slow vaccine manufacturing would not allow high vaccine allocations each and every week to the High Country. At one point in late January and early February, only 500 total vaccine doses were allocated to Watauga County each week. For two weeks, AppHealthCare received no new doses.
“I was incredibly frustrated at the way things rolled out and very upset that we got no doses for two weeks,” Greene said.
With more and more vaccines being manufactured and distributed at the national level, Greene said she believes the nation, and High Country, is on the right path to moving on from this pandemic.
As of Feb. 26, Watauga County had administered 12,754 total vaccines, Ashe County had administered 5,956 total vaccines and Avery County had administered 5,113 total vaccines.
For Everts, vaccines getting into the arms of people means moving closer to having students back in the classroom.
"We are looking forward to the days when our classrooms will be full of students, when we will enjoy sports and arts events in person again, and when we will be able to join together, as a community, to celebrate our university's important milestones," Everts said. "Our post-COVID campus will be enhanced by the lessons we have learned, the new systems we have built and the work we have done as a community to become even more resilient as we face adversity together, with an ever-stronger focus on our academic mission."
And once vaccines get into enough arms, the High Country and the world can begin to get back to normal.
“I want kids in school,” Lewis said. “I want kids to be able to go to school and want them to play their sports. I want businesses to start picking back up. I guess I want to fix the world.”
Jamie Shell, Bailey Little, Chanda Richardson and Luke Barber contributed reporting to this story.