Liora Engel-Smith and Rose Hoban

As North Carolina contends with its first case of coronavirus, some in the state have been long preparing to support health care providers should an outbreak such as COVID-19 become widespread.

One of those people is Dale Hill of WakeMed, the Raleigh-based health care system. Hill, operations manager for preparedness for the health system, is part of the Capital Regional Advisory Committee, or CapRAC, a unit that responds to disasters and hazards in Franklin, Wake, Johnston, Harnett and Lee Counties.

Hill thinks about disasters for a living, from floods and hurricanes to unlikely events such as severe earthquakes, even a volcanic eruption.

graphic including an image of coronavirus(COVID-19)

But of late, Hill has been considering another hazard, one that has been on the minds of many: a potential for widespread coronavirus infections. As of Tuesday, the Centers for Disease Control and Prevention tallied roughly 60 infections and 6 deaths across 12 states in the U.S. One of these cases, North Carolina health officials said on Tuesday afternoon, involves a person in Wake County. Health officials declined to provide detailed information but said the patient, who had been in Washington state and was exposed at a long-term care facility, is doing well in isolation at home in Wake County.

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Legacy of natural disasters

On Monday, before the infection made the news, Hill said the CapRAC is ready to assist area facilities should they run out of masks, gowns and other personal protective equipment. The committee can also set up mobile emergency departments should the need arise, he added.

Hill showed reporters around the nondescript 50,000 square-foot facility that featured medical trailers, gurneys and 20-foot high shelves filled to the brim with medical supplies, everything from oxygen tanks, gauze and full-coverage Tyvek suits, to Post-it notes and coffee makers.

A gurney with supplies on it is visible in a warehouse. The gurney is part of WakeMed's emergency preparedness supplies.
WakeMed’s warehouse has supplies required to set up a mobile emergency department, including gurneys and other equipment. Photo credit: Liora Engel-Smith.

Supplies also included other such mundane items as folding chairs and tables, disposable pillows, linens, air mattresses and cots.

“We’ve gotta be able to feed ‘em, treat ‘em, transport ‘em and give ‘em somewhere to sleep,” said James Creech, logistics and training specialist at WakeMed.

Hill said the team is ready to respond to the need in the five-county territory it covers. Across North Carolina, seven other such teams, each covering a part of the state, operate similarly, he added.

A map of the eight healthcare preparedness regions in North Carolina. Each region has a team that can respond should disaster strike.
North Carolina has eight health care preparedness teams, and each is assigned a region. Source: NC DHHS.

CapRAC can turn almost any building or parking lot to a mobile medical unit, Hill said. During Hurricanes Matthew and Florence, WakeMed, as part of the State Medical Assistance Team, used this equipment to set up a care facility inside a megachurch in Clayton.

In the case of infectious diseases, such as coronavirus-induced pneumonia, which requires treating the air, CapRAC can even set up air scrubbers to create makeshift isolation rooms, Creech said.

The team also has several battery-powered ventilators and intubation equipment, he added.

A man with a beard holds a yellow paper gown that is used by WakeMed's emergency preparedness team in the case of infectious diseases such as coronavirus
James Creech, logistics and training specialist shows a protective gown the CapRAC team might use in the case of treating a patient with an infectious disease such as coronavirus. Photo credit: Liora Engel-Smith

Hill said the team will use the trailers to transport supplies anywhere in the five-county region.

“If we were to set up at a community college, for example, there’s plenty of rooms that we could set up cots and things like that, where we would take these different cabinets here, roll into a wing, so to speak, and that would be like your supply area for that hospital wing that we’ve set up in another building,” Hill added.

The first mobile hospitals came out of North Carolina, created in the wake of the terrorist attacks of 2001. That first “hospital on wheels,” MED-1, was created at then-Carolinas Medical Center in Charlotte and deployed to southern Mississippi in the wake of Hurricane Katrina.

Increased demand anticipated

Though there have been some reported shortages of masks and other protective equipment worldwide as coronavirus spread, Hill said WakeMed has not been affected as of yet. He said CapRAC has made projections of how many masks and gowns they’d need per patient in case they have to respond to widespread infection. CapRAC will also share its supplies with facilities in the five-county area they serve if shortages arise. In North Carolina, where some hospitals — particularly rural ones — have been under financial pressure, that support may be necessary.

Other hospitals in the state report they’re well equipped for now but will, as time goes on, rely on the state stockpile for replenishing supplies, said Catherine Passaretti, Atrium Health’s Medical Director of Infection Prevention.

Plastic drawers with tape, gloves and other medical supplies are visible. These are supplies WakeMed may use in case of a medical emergency, such as a widespread coronavirus outbreak.
Supplies at a portable nurses station are ready to be packed into trailers in a medical emergency. WakeMed can share supplies and other assistance to hospitals within its 5-county region. Photo credit: Rose Hoban

This week, the federal Department of Health and Human Services loosened rules to allow health care workers to use “certain industrial respirators during the COVID-19 outbreak in health care settings.”

The FDA and Centers for Disease Control and Prevention noted that the supply chain for personal protective equipment could become stressed as demand increases, leading to shortages.

“The FDA and CDC are taking steps to address the observed and anticipated shortages by expanding the use of respirators that are NIOSH approved, but do not currently meet FDA regulatory requirements,” said a Monday press release from the agency. The move allows for health care providers to use appropriate masks and coverings that might only be currently approved for construction and other industries.

Those shortages may already be here for many. In remarks Tuesday, World Health Organization Director-General Tedros Adhanom Ghebreyesus expressed concern about “the severe and increasing disruption to the global supply of personal protective equipment – caused by rising demand, hoarding and misuse.”

shows how and when to use a face mask to resist infection with coronavirus, COVID-19
When and how to use a disposable face mask. Infographic courtesy: World Health Organization

Last week, in a joint letter to Congress, leaders from the American Hospital Association and the American Nurses Association asked for an additional billion dollars to cover costs of additional equipment, training and construction to provide for treating “potentially large numbers of persons” affected by COVID-19 infections.

Additional reporting in Charlotte was contributed by Yen Duong

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Liora Engel-Smith joined NC Health News in July 2019 and covers policies, programs and issues that affect rural areas. She has previously worked for the The Keene Sentinel in New Hampshire and the Muscatine...