By Melba Newsome

If you ask Bryan Hodge about the number of diagnosed coronavirus cases in western North Carolina, he can rattle off the exact number in each of 16 counties. He readily admits that, in addition to being obsessed with tracking the information, he also gets regular updates from his wife.

Hodge is director of MAHEC’s Rural Health Initiative and has been tasked with leading the rapid response for the coronavirus pandemic.

“We have tried to be as proactive, thoughtful and strategic as possible,” he says. “But obviously, this is calling for a lot of flexibility and, given the pace of change, that requires us to reimagine what our role is and how we can best help.”

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Getting one’s arms around this pandemic is an enormous challenge even under optimal circumstances. In a region where too many poor, unwell and uninsured people are paired with too few health care resources and providers, the task seems particularly daunting. While rural communities lack the population density of infection hotspots like New York City, the first confirmed cases in western N.C.  came from the region’s most isolated areas.

Where it all started

COVID-19 infections in the state’s two most western counties, Cherokee and Clay, were linked to a visitor from New York who attended a contra and square dance at John C. Campbell Folk School in Brasstown on March 10. The patient later exhibited symptoms and tested positive for COVID-19 on March 18. Nine of the 16 reported cases in those two counties have been linked to that one gathering of about 90 people.

Macon County Public Health traced a second case to a different New Yorker who visited the Asheville area between March 10-13.

New York Times data show that the virus is now growing dramatically faster in rural areas than it did in metro areas at a comparable stage. As of April 11, the western 22 counties have reported 318 of the state’s 4,310 cases reported on that date. While those numbers might seem low given the overall number, Hodge believes it’s just the tip of the iceberg.

“We don’t have a good enough sense of who’s infected at this time and that’s a really vulnerable position to be in,” he says.

What’s the matter with Henderson County?

If what’s going on in Henderson County is an indication, Hodge’s prediction and worry might be well justified. AdventHealth Hendersonville CEO and President Jim Bunch said that they are forced to pay up to 10 times more than normal for PPE.

The number of cases doubled from 25 to 50 over the April 3 weekend and as of April 11, stands at 68. A single confirmed case was identified at Cherry Springs Village assisted living on April 1, prompting health officials to conduct the additional testing that found 23 more cases there. The county’s deaths are all connected to long-term care facilities.

Health Director Steve Smith acknowledged that the news is unnerving but assured residents the county has the ability to test for the virus.

“This is absolute hunker down time,” he said.

All hands on deck

These days, MAHEC’s usually bustling Biltmore Forest campus is quieter than usual. To lower the risk of exposure and infection, many of their non-clinical employees now work remotely, classes are virtual and a growing number of clinical visits are conducted via telehealth. Inside the care facilities, patient flow patterns have been altered to separate the ill and the well. The drive-up respiratory clinic allows people to get COVID-19 testing without ever leaving their vehicles.

Still, when a hospitalist said she needed to brush up on her ventilator skills, the professional development team created a training video for her.

Shows the building facade at dusk, the center is providing a lot of services for people with COVID-19
Image courtesy: Mountain Area Health Education Center/ MAHEC Center

Hodge says the worry is that when the virus arrives full force in rural America, the stockpile of PPE, ventilators and other supplies will have been depleted by urban areas. MAHEC leaders have also been working to identify the needs of the region and hope they have the resources to plug any gaps. The education center used furloughed medical students to conduct an assessment for first-line care providers to determine their needs in light of the pandemic.

The students also worked with the Sheps Center at UNC-Chapel Hill to create a comprehensive database of WNC primary care practices and an online platform for data collection, tracking, and reporting. The platform includes an “Assistance Needed” alert button to notify MAHEC Practice Support that the provider or practice needs immediate assistance.

Funding innovation

Dogwood Health Trust recently allocated $10 million to address COVID-19 needs throughout western N.C.’s 18 county and Qualla Boundary region. Leaders at the nonprofit foundation dedicated to improving health in western North Carolina hopes that by providing increased access to testing, advocating social distancing measures, and shoring up regional health care resources, they can flatten the curve.

“We have tremendous opportunity to coordinate as a region, supporting one another in supply channels and coordinating the production of key products so that they’re equitably distributed to our most critical healthcare partners throughout our region,” CEO Antony Chiang said in a statement.

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So far, the results have been laudable. The trust brought together two area businesses to produce hand sanitizer for people on the frontlines of the pandemic. Cultivated Cocktails is turning ethanol normally used to make whiskey into sanitizer that Southeastern Container will then bottle.

Dogwood tackled the shortage of PPE by partnering with Kitsbow, a cycling apparel company in McDowell County, to produce reusable masks and face shields for paramedics and healthcare workers.

What’s ahead

MAHEC CEO Jeff Heck says that while the medical community is rightly focused on testing, hospitals and hospital beds, he worries another crisis is looming. The fear of infection is preventing people from seeing their primary care physician for issues unrelated to COVID-19, making the community sicker and putting the viability of primary care practices at risk.

“The volume of some practices will diminish by around 30 percent, the potential margin for a primary care physician,” says Heck. “Some practices are going to close because they can’t make it financially. So, we will have another crisis on our hands.”

On April 6, Buncombe and Asheville extended the stay-at-home order indefinitely. At the same time, the Public Health Emergency Preparedness Director said that social distancing measures were working and estimated cases will begin to peak between April 13-27.

Heck isn’t ready to declare victory, however.

“I graduated from medical school 43 years ago. I have never seen anything like this and I would say neither did my parents or my grandparents, except maybe for the 1918 flu pandemic.”

Clarification: Some changes were made to clarify how MAHEC is currently staffing their work, based on comments we received post-publication.

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Melba Newsome is an award-winning freelance writer with more than 20 years' experience reporting on news and features. Her feature credits in many prominent publications including the New York Times, Bloomberg...