Buncombe responds to COVID-19: March 18

The good news: As of March 18, Buncombe County still has had only one contact with a confirmed case of COVID-19, the disease caused by the new coronavirus. The bad news: The total number of confirmed cases in the state rose to 63, up from 40 the previous day.

While all of those individuals had either traveled outside the state to areas with higher COVID-19 activity or been in contact with another confirmed case, “We do expect that community transmission [without such contact] is occurring in North Carolina and we should all act accordingly,” said Dr. Jennifer Mullendore, Buncombe County’s interim health director.

In addition to the strong steps Buncombe County and the state have already taken — including declaring a state of emergency, closing public schools, limiting public gatherings to fewer than 100 people and ending dine-in service at restaurants and bars — the county may soon order additional restrictions, according to Fletcher Tove. The county’s emergency preparedness coordinator said that a local mandate to shutter businesses and facilities that bring people into close, sustained contact is being developed and could be announced soon.

The new rule could apply to gyms, pools, spas, hair salons, barber shops and other businesses, Tove said. A working group expects to pass a proposed order to the Buncombe County Board of Commissioners soon. He did not provide a timeline in response to questions pressing for more details about when the new restrictions might go into effect.

Grocery stores and pharmacies will remain open, Tove stressed in Buncombe County’s daily briefing — as did Mike Sprayberry, the state’s director of emergency management, in a separate state briefing held later. “The food supply and the chain of supply for food is working well,” Sprayberry said.

“Try not to engage in panic buying. We’re in it for the long haul. This has just begun,” Sprayberry continued. He and Tove both urged members of the public to purchase reasonable quantities of needed food and other essentials and to avoid hoarding.

State and local officials reiterated the following guidelines for social distancing:

• People considered at high risk for the most severe consequences of COVID-19 should remain at home and avoid contact with those outside their immediate households.
• High-risk individuals include those ages 65 and older; people with health conditions such as heart or lung disease; those with compromised immune systems; and, new to the list, pregnant women, according to Dr. Betsey Tilson, the state’s medical director.
• People not in the high-risk category should limit their exposure by taking only necessary trips, working from home when possible and avoiding large groups.
• Children who are out of school should not have playdates or sleepovers with children outside their own household.
• Unless providing critical assistance, people should not visit nursing homes or assisted living facilities.
• Frequent, thorough handwashing remains a key recommendation, especially upon returning home, before eating and before coming into contact with high-risk individuals.

At the same time, officials said, it is OK to go outside for a walk, to go hiking and to work in the yard, as long as people maintain at least 6 feet of separation from one another and limit contacts to less than 10 minutes whenever possible.

Local testing update

Mullendore said communicable disease staff with the Buncombe County Department of Health and Human Services have tested 12 individuals. The results of six of those tests are still pending.

The county health department has also received reports of 157 individuals having been tested by other local health providers through commercial or institutional labs. Community specimen sites operating at UNC Asheville and Biltmore Baptist Church yesterday collected samples from 90 individuals, bringing the total number of tests known to have been conducted in the county to just under 260, Mullendore said.

Dr. William Hathaway, chief medical officer at Mission Health, said that about half of those tested had come through the Mission system. Results there, he added, are still taking three to four days to come back.

To qualify for testing, a person must either have symptoms (such as cough and fever) and have been in contact with someone who’s tested positive for the disease or have symptoms and a negative result on a rapid flu test.

The 10 people identified as coming into close contact with the individual who visited Buncombe County March 10-13 and tested positive for COVID-19 have not themselves been tested, though they have been required to self-quarantine for 14 days. Mullendore said they will be tested if they develop symptoms.

Watching and waiting

No COVID-19 cases have been confirmed at Mission or surrounding hospitals, Hathaway reiterated. But increased restrictions on visitation remain in effect to protect health care staff and patients from contracting the disease.

Hathaway said many have asked whether the hospital system plans to postpone previously scheduled surgeries and procedures to conserve resources for an anticipated surge of sick patients; AdventHealth Hendersonville made that decision effective March 16. Mission is balancing the potential negative consequences of such action against projections for COVID-19 impacts, he explained.

“We’re looking at this on a case-by-case basis for how we approach those decisions. As that changes, we will provide updates,” he said.

At this time, Mission has no concerns about its supply of masks and other personal protective equipment, Hathaway said, calling the system’s stockpile “adequate all around.” Mullendore pointed out that health workers collecting specimens for testing must wear appropriate protective equipment. The more such supplies are used for testing, she noted, the less will be available for protecting doctors and nurses treating infected patients later.

Asked about Mission’s supply of ventilators for patients in severe respiratory distress, Hathaway said the system has 20-35 patients using such equipment on a typical day. Another 60-70 rooms could accommodate ventilation equipment, and the system has about 84 units in its supply.

“We have the ability for more than three times our usual ventilator supply,” Hathaway added. “”I pray that we have an adequate stock. Hopefully, we’re not surged to that degree. But I think that we’re in as good a shape as we can be right now.”