By Melba Newsome

To date, only Avery county in western North Carolina has no reported cases of COVID-19. Health officials in this remote, sparsely populated region say that high rates of poverty, older populations, and epidemics of obesity and diabetes along with scarce healthcare resources led them to begin planning early and be particularly aggressive in confronting this looming crisis. 

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“Everybody knew the global pandemic was gonna be an issue of concern for us,” says David Badger, Cherokee County health director. “We were planning from a public safety perspective. Back in mid-February we were meeting every week about how the virus would evolve and how we would be prepared.” 

Guarding against the virus

Madison County had its first and only COVID-19 case to date on April 24, in large part because of their preparation efforts which included a successful handwashing and social distancing campaign. “Some say we have overreacted, that we just need to get this over with herd immunity,” says health director Tammy Cody. “We’re hopeful that we never know if we were overprepared but if we were underprepared, that would definitely have been obvious.”

The Eastern Band of Cherokee Indians (EBCI) set up mobile drive through testing sites on the Qualla Boundary and conducted more than 900 tests. “We needed to determine if the virus was in the community,” says Cherokee Indian Hospital executive medical director, Richard Bunio. “Initially, the cases were coming from out of state. Was the virus going to take hold here like it did in New York City? We just didn’t know.” 

Ultimately, that uncertainty drove the ECBI to shut down their casinos and block the Boundary’s few entry points to keep visitors out. 

The town of Andrews erected physical barriers to prevent anyone beyond its neighboring counties from entering. All part-time residents were ordered to quarantine for 14 days when they arrived. Cherokee County briefly considered closing its borders but, with more than 50 access points, that wasn’t a feasible option. 

Graham County took the most restrictive measures by far. Nearly a week before Gov. Roy Cooper issued a statewide stay-at-home order, county officials closed all lodging and accommodation businesses and blocked U.S. Highway 129 and NC 28, the two roads into the county. Entrants had to show a county address or proof of property ownership. Everyone else had to apply for an entry permit.

a man stands at a podium with a number of grim faced advocates for Medicaid expansion standing behind him
Dale Wiggins, here pictured during a January press conference in Raleigh, is the chair of the Graham County Board of Commissioners. Wiggins has bucked the trend before, most recently when the Republican publicly supported expanding the Medicaid program. Photo credit: Rose Hoban

“We’re remote and limited in resources. There is no hospital in the county and only two ambulances running at a time,” Graham county manager Rebecca Garland told Carolina Public Press at the time. “With a 40-minute commute to the nearest hospital, we’re trying to do everything in our power to protect the residents and our resources. If our paramedics get sick, we’re in a worse situation than we were before.”

The virus comes to WNC

Many claim that closing borders wasn’t necessary since its remoteness and sparse population insulated the area from COVID-19. But the first COVID-19 cases in the region were confirmed in Clay and Cherokee counties in mid-March after a woman from New York visited family in the area. A day after attending a contra dance at the John C. Campbell folk school with 90 others, she began experiencing symptoms and subsequently tested positive for the coronavirus. Seven cases were later confirmed.  

“I think the early notification, early testing and isolation may very well have halted the spread of the virus in this small community,” says primary care physician Brian Mitchell, who worked with the Dogwood Health Trust and county medical officers to get a handle on things. 

The main entrance to the new Cherokee Indian Hospital, called “The Basket,” is modeled on the work of a local artist. Photo credit: Taylor Sisk
Swain County’s Cherokee Indian Hospital is the centerpiece of a health care system that’s available to the Eastern Band of the Cherokee Indian. Photo credit: Taylor Sisk/ NCHN

According to Mitchell, some of the seven have remained positive, while others become negative but all remain asymptomatic. There have been no additional cases reported in the Brasstown community since March 24.

Some residents disapproved of the aggressive measures and others alleged that Graham County was overstepping its authority to close roads and impose a curfew. But Norma Houston of the UNC School of Government, an expert on legal issues that affect local governments, says HB917 enacted in 2019 gives the county legal standing.  

“North Carolina authorizes cities and counties to declare a local state of emergency and impose restrictions and prohibitions, including restricting the movement of people in public places, and limiting ingress and egress coming into or leaving an emergency area,” explained Houston. “There is also specific authority to close roads.”

Victims of success

Measures taken by counties such as Graham, Yancy, Madison, Cherokee and Avery have resulted in the lowest infection rates in the state. Those low numbers have also caused some to wonder if these restrictions were ever necessary.

Graham county commissioners removed the barriers on April 19, three weeks after they went up, stating that the $92,000 weekly cost wasn’t sustainable. The stay-at-home order and a 10 p.m. curfew remained in place and all non-residents must observe a 14-day self-quarantine. A week later, the county announced its first COVID-19 case. 

On April 27, Cherokee County commissioners voted to roll back their restrictions and signed a resolution for the governor to let counties make their own decisions on business reopening. Mitchell believes this is a mistake.

“We have succeeded by social isolation and staying at home. We do not have a vaccine or any adequate treatment, therefore, we risk a recurrence if we ease restrictions,” he says. “We need that 14-day period of either decline or leveling off or new infections, and the capacity to test and contact trace any positive cases. Maybe by May 8th, when the governor looks at the figures, we can ease restrictions, but we’re just not there yet.” 

Tammy Cody worries about neighboring states re-opening and residents who will venture out and gather with others who may be infected with COVID-19, while still asymptomatic. 

“I do not believe we will ever return to the old normal. I am not sure what the new normal will look like, but it will be different than what it was a year ago,” says Cody.

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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...