ASHEVILLE – As the state of North Carolina set a new record high for coronavirus hospitalizations July 7 so, too, did Mission Health.
As of 7:30 a.m. that morning, there were 23 patients hospitalized with lab-confirmed COVID-19 in the system, and all of them were at Mission Health’s flagship in Asheville, Mission Hospital.
Through June, Mission Health — which operates six hospitals in Western North Carolina as well as numerous clinics — maintained an average of 15-20 hospitalizations due to the illness.
“It’s hard to know if this one point is going to signify an increase overall, a new average higher number,” Mission Chief Medical Officer Dr. William Hathaway told the Citizen Times. “But we’re obviously very concerned that it is, that it could represent that.”
Statewide, coronavirus hospitalizations were at 989, according to the North Carolina Department of Health and Human Services. That’s seven more than the previous day and the fifth straight day of record hospitalizations.
Hathaway said neither Mission Health nor Mission Hospital are anywhere near capacity and that there are protocols in place for dealing with a surge in Western North Carolina, if one comes.
But he stressed the importance of adhering to public health guidance, saying that, with a virus this contagious and with so many unknowns, “anything is possible.”
ICUs not at capacity, could be expanded
In addition to the 23 lab-confirmed COVID-19 patients, there are 20 patients in-house in Mission Health hospitals who are awaiting test results for the virus. Of those, 15 are at Mission Hospital, three are at Blue Ridge Regional and two are at Transylvania Regional.
An average of 3.6% of inpatient tests at Mission come back positive, according to system spokeswoman Nancy Lindell.
At Mission Hospital, specifically, the majority of confirmed COVID-19 patients are isolated in a pulmonary unit. But an average of five to 10 patients with the illness have been in the intensive care unit over the past month, where they are also kept away from non-COVID-19 patients.
On July 7, there were seven COVID-19 patients in the ICU. There are 91 designated ICU beds in Mission Hospital, but that number can increase significantly, if necessary.
When the pandemic first hit, Buncombe moved quickly to implement social distancing restrictions ahead of the state and initially was able to flatten the curve of rising cases. Hathaway said this enabled Mission to learn from what other systems were experiencing nationwide.
The system made plans to expand ICU capacity and create additional bed space ranging from 800 to 1,300, “depending on what the onslaught was,” Hathaway said.
Nonessential surgeries were halted and in-house hospital numbers plummeted, creating a wealth of open beds. The procedures have since been reinstated, but Hathaway said they could be stopped again, if necessary. Other restrictions could also be implemented.
“We have never had to and we pray to God that we never will have to create new beds or expand beyond our normal capacity, but we’re prepared to do that if we do have to,” he said.
Staffing an expanded bed capacity
Bed availability is one thing and staffing is another, however.
Hathaway said ICU nurses and others who tend to such patients are required to have a certain skill set, so “it’s a blend of human capital and physical capital to be able to expand (capacity).”
Asked if he thought there would be a need to increase staffing this month, Hathaway said he hopes not, but that there are protocols in place and that, in the case of a surge, they are prepared to employ traveling nurses, as well.
He said he isn’t worried, at this point. But he admitted that the unknown potential of coronavirus cases creates a wide range of possibilities. He stressed that people need to continue taking precautions seriously.
“If we had an exponential rise like they have in other (states), where they’ve gone to Phase 3 or wide-opening the economy, opening bars, as an example, who knows what could happen?” he said. “That unknown gives me concern, but right now we’re good, I think. We’re OK where we are.”
Slow increase over several months
Hathaway said Mission Health has been tracking COVID-19 cases on a daily basis since the first positive test at Mission Hospital was returned March 20.
“I remember, early on, we were counting the cases,” he said. “Every time there’s a new case, I’d get a phone call. … They were so few and far between.”
For the first six to eight weeks, Hathaway said the inpatient numbers remained between two and six. A spike came in Buncombe when the virus began hitting nursing homes in May, and Mission Hospital saw an impact as infected staff members needed care.
“At the very end of May, we saw a slight (uptick) in our in-house numbers, running between 15 and 20 on average,” said Hathaway. “We were as low as 14 at the beginning of last week and then we had a bump up at the first of the week.”
Buncombe health officials have warned that, as the impact of COVID-19 continues to worsen in the nation and the state, “there remains the potential that cases will overwhelm our health care system in July.”
Hathaway said he doesn’t think that’s likely, “but it’s possible.”
So far, he said, the numbers “look pretty good.”
‘No one is completely invincible’
Hathaway noted that, though Buncombe has seen an increase in overall cases, there has not been a significant spike in local hospitalizations, yet.
He suspects this is due, in part, to the fact that many new cases are occurring in young adults, who are at a lower risk of severe illness.
He said this shouldn’t “instill a false sense of security” that it’s OK if those individuals get infected.
“The more people who get it, the more likely it is that older folks and vulnerable folks would be affected and end up in the hospital,” he said. “So, we have the responsibility to everybody to protect ourselves, even if our own risk is not that high from getting it. … No one is completely invincible with respect to what can happen with this virus.
“It distresses me personally to see the gatherings that we saw over the holiday weekend, the gatherings that we see in public places. … We really need to be maximally attentive to trying not to get it and then not spreading.”
Mackenzie Wicker covers Buncombe County for the Asheville Citizen Times. You can reach her at email@example.com or follow her on Twitter @MackWick.
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