By Rose Hoban

The coronavirus pandemic has taken a toll on hospitals. Most hospitals lost millions in revenue when they stopped performing elective surgeries in mid-March, then spent millions gathering supplies and training staff to be ready for a potential surge in cases.

But the pandemic may have the opposite effect on one shuttered rural North Carolina hospital. Sandhills Regional Medical Center, located in the Richmond County town of Hamlet, which has had new life breathed into it as a result of COVID-19.

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In April, the state contracted with FirstHealth of the Carolinas to rent the facility, which has been standing mostly empty since it closed almost three years ago. In the weeks since, vacant rooms have gotten a thorough cleaning. Personnel from some of North Carolina’s eight State Medical Assistance Teams, along with Army and Air Force National Guard members and the Department of Health and Human Services have brought in beds, equipment and supplies in anticipation of a surge of patients filling North Carolina hospitals.

The idea was to ease pressure on North Carolina’s health care system by creating a space for up to 70 “regular” patients who might need care but who could not be housed at a hospital caring for a surge of patients suffering the effects of COVID-19.

“It’s a geographical anomaly because it’s two hours from everything,” said Commander Sergeant Major Brian Webb from the Army National Guard, one of the leaders getting the hospital ready.

“It could be anywhere from a long-term health care facility that someone, something happened they had to be transported to the hospital, non-COVID obviously and they’re better,” Webb said. “Maybe there’s an outbreak in their (nursing home). They come here to get that care they still need before they can go back.”

Or the space could be used for someone who is no longer in need of ICU care, but who still needs a few days at a hospital before heading home.

“This is not a long-term facility,” Webb said.

Reuse, recycle

“There’s been about 130 closures in the 2000s of rural hospitals,” said Mark Holmes, who studies rural hospital closures at the Sheps Center for Health Services Research at UNC Chapel Hill. “Roughly about half of them get repurposed for something in health care, whether that’s an urgent care clinic or an after-hours clinic, or specialty care, primary care, something like that.”

Holmes said some old rural hospitals, which tend to be smaller, have become nursing homes or other types of long-term care facilities. That’s what happened to a hospital in Blowing Rock, which closed in 2013.

State Medical Assistance Team

North Carolina has a network of hospitals, health care providers and state assets organized to respond in the event of a medical disaster, such as an outbreak, or natural disaster, such as a hurricane.

The state maintains equipment, everything from first responder kits to a portable hospital in an 18-wheeler trailer that can easily be mobilized stored in warehouses around the state ready to be deployed.

SMATs also include personnel who can be deployed for shorter or longer periods, to staff these emergency medical facilities. These teams are organized by eight Regional Advisory Committees, Each county and hospital in North Carolina is included in at least one of these eight teams.

Other old facilities have more unconventional uses.

“They might be used by the local community college or one became a carwash,” Holmes said. “A couple have been converted to condos and one became a church. So, a wide variety depending on where it is and the state of the building.”

North Carolina has had 11 rural hospital closures since 2006. At 64 beds, Sandhills Regional was one of the largest of the facilities to be mothballed.

Since the closure in 2017, part of the facility has been used as a skills training site for the local community college.

Mostly new

North Carolina has had a need for temporary medical facilities frequently in recent years. During Hurricane Matthew in 2017, the Department of Health and Human Services stood up a shelter to house medically vulnerable people evacuated from areas of the state flooded by the record rainfall.

State officials repeated that feat during Hurricane Florence in 2018, creating four such medical shelters. One of those was in C3, a megachurch in Johnston County that converted a clean, roomy gymnasium, auditorium and child care spaces into temporary medical facilities. The state also created a medical shelter in older, more dilapidated buildings at the old Cherry Hospital in Goldsboro, a move that drew some criticism because of the state of the physical plant.

woman sits at a nurses station looking at a laptop. She's wearing a mask to prevent transmission of COVID-19
Captain Danielle Fowler, RN with the Air Force National Guard keeps watch over a nurses’ station in the old Sandhills Regional Medical Center. Photo credit: Rose Hoban

The building at Sandhills Regional provides a welcome alternative to creating a medical facility from scratch. The hospital, built only in 2005, is roomy and has space to easily move around medical equipment. Each individual patient room has a functioning sink, FirstHealth has been maintaining the HVAC system, and there are even medical gasses, such as oxygen, available through ports in the wall.

“Having something that was ready to go, equipment in place, you know, within a day or two, turn it on and go would be a huge advantage,” said Department of Public Safety spokesman Keith Acree.

Another advantage in the age of COVID is that the rooms at Sandhills are separate, rather than housing people in one large space which could facilitate transmission of pathogens.

Acree, Webb and others were careful to say, though, that Sandhills would not be used for COVID patients.

“The center will not be used as a homeless shelter or care center for infectious disease patients,” FirstHealth spokeswoman Gretchen Kelly told NC Health News in April.

Hospital is dormant but at the ready

Walking through the hospital is a little bit like walking back in time to late 2017. A flyer posted in the elevator advertises a blood pressure screening event to be held in October of that year. On the whiteboard in the old intensive care unit are handwritten notes of what phone extensions needed to reach the X-ray and lab departments, departments that no longer exist unreachable by a defunct phone system.

There’s even “hospital art” remaining on the walls – nondescript landscapes in mostly pastel colors.

The hallways are wide and well-lit, patient rooms have plenty of space, and are now kitted out with hospital beds that are a step up from the medical cots used in hurricane shelters.

Another step up – the old gift shop has been turned into a temporary USO canteen to provide Starbucks coffee and snacks to the 70-some National Guard members who’ve been deployed there.

Several of the National Guard leaders who were veterans of the hurricane relief efforts said this was a definite improvement.

two people in fatigues use a infrared thermometer to check the temperature of a third person outside a set of doors into a COVID surge facility
National Guard members check the temperature and ask COVID-19 screening questions of anyone entering the temporary overflow facility at the Sandhills Regional Medical Center. Photo credit: Rose Hoban

But for now, Sandhills isn’t needed. Efforts around the state to “flatten the curve” of COVID-19 infections have reduced the patient load on hospitals to the point where it’s manageable. Acree said the state has a lease at Sandhills through July, paying $240,000 to lease 80,000-square-feet of the building. Then the state has the option to continue renting on a month-to-month basis until next year.

As of Sunday, the facility will be “dormant” but will be ready for use within a couple of days, now that it’s set up and ready to go, perhaps even in the case of a hurricane.

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...