For the past couple of weeks, the authoritative word on the local coronavirus situation has come from state and county government officials.
By contrast, Antony Chiang’s perspective as CEO of the $1.5 billion Dogwood Health Trust is nongovernmental and regional, encompassing the 18 counties of Western North Carolina and the Qualla Boundary of the Eastern Band of Cherokee Indians. Chiang spoke to local news media by teleconference on March 25, providing insight into how Dogwood is responding to the COVID-19 crisis.
Chiang said the foundation expects to spend $10 million — 20 times the amount Buncombe County’s government has allocated so far — on efforts to stem the spread of the virus and mitigate its impacts. The trust’s spending target for the year, its second as the steward of the proceeds from the sale of nonprofit Mission Health to for-profit HCA Healthcare, is $40 million to $50 million.
With nearly 30 confirmed cases of COVID-19 in WNC at the time of his remarks, Chiang said, a robust regimen of testing that included aggressive tracing of the close contacts of those who test positive, along with limitations on travel from outside the region, could result in a “seminormal situation” in a matter of weeks.
But that solution, which Dogwood has been pursuing in concert with other local institutions and philanthropies, as well as national and international suppliers, hasn’t yet proven feasible. Due to worldwide shortages of testing equipment and supplies, Chiang explained, testing hadn’t currently achieved the scale necessary to make a significant difference in the disease’s regional trajectory.
While Dogwood continues to work with potential testing partners, Chiang pegged the chances of securing game-changing regional access to large-scale testing at 50-50.
Limiting the spread
Reducing the rate of new infections is thus the region’s most important strategy for protecting its health system’s ability to cope with the expected influx of patients who experience the most severe consequences of the disease, Chiang said.
Statistics from other parts of the world with large numbers of COVID-19 infections reveal that about 1 in 100 of those who catch the disease require intensive hospital treatment with a ventilator, Chiang said. Based on that rough estimate, he explained, the local health system will enter “stress mode” when the number of diagnosed cases in the region reaches about 1,000.
In both WNC and around the world, the number of confirmed infections is currently doubling about every three days, Chiang said. If the local progression in cases continues at that rate, by the time this article appears in print, the region will have between 120 and 160 cases.
If the increase in cases continues along that track, the region’s approximately 125 ventilators — about 85 of which are available for use on a typical day — could fall short of the need around mid-April, Chiang said. “And then we’ll start to have those same kinds of bad stories that we’re reading about and seeing about in Italy,” he added. As of March 25, according to data collected by Johns Hopkins University, 8,215 Italians had died of COVID-19, more than 10% of the country’s 80,589 confirmed cases.
Complicating response efforts, Chiang continued, are statistics that have suffered from a “data lag” worldwide. For every verified, reported case of the disease, 10 cases go uncounted in people who are asymptomatic, have mild symptoms or otherwise fly below the radar (often because of the limited availability of testing). Thus, policymakers and elected officials have consistently based decisions on data that trails two weeks to 17 days behind the actual numbers of people infected with COVID-19 in the community, according to Chiang.
To avoid an outcome like that in Italy, Chiang said the 22 employees and contractors now working at Dogwood Health Trust have been considering “hundreds” of funding requests. Projects on the docket include securing commitments for several hundred quarantine beds in local hotels, purchasing supplies for hundreds of thousands of drop-off meals for senior citizens and ongoing efforts to secure testing supplies, personal protective equipment for health care workers and additional ventilators.
Of vetting the competing priorities, Chiang said, “It’s a challenge because you could spend $10 million just on the K-12 system. You could spend $10 million just on preparing our regional health care providers.”
Ventilators are an especially big-ticket item, running up to $40,000 each, he said. Boosting the region’s reserve by 25% would cost $750,000, assuming the machines could be acquired at all in a global marketplace that’s desperate for them, Chiang said.
“I will freely admit these are tough decisions, and we’re very focused right now, at least in these early couple of weeks, on where we think an investment will flatten the curve and prepare the region,” Chiang said. “And then we’ll start turning our attention more to the social impact side.”
Referring to Dogwood Health Trust’s mission of investing in “social determinants of health” — the many aspects of a person’s life that influence well-being, including housing, education, access to transportation and employment — Chiang conceded that COVID-19 had thrown “a huge monkey wrench” into those plans.
Of the community partners working with Dogwood on several pilot projects, Chiang said, “They don’t have the bandwidth right now to talk with us about solving an educational attainment disparity [for example]. So those investments are going to get delayed, unfortunately. But they’ll hopefully get balanced by investments in flattening the curve, investments in preparing the region for the crisis. And again, hopefully, we won’t have the crisis.”
Chiang said he remains committed to moving forward on Dogwood’s pre-coronavirus initiatives as quickly as possible. “But if I’m being very authentic and very direct, we will have to assess literally every week that goes by what’s happening.”