By Thomas Goldsmith and Hannah Critchfield
Jan. 31: U.S. Health and Human Services Secretary Alex Azar declares a domestic public health emergency.
Late in February, Mark Shepherd kept trying to tell people that Henderson County was heading for hard days, for trouble and sickness caused by a new virus that would spread like mountain wildfire.
Shepherd is a trauma and critical care physician assistant and assistant chief of the Henderson County Rescue Squad in western North Carolina. He wanted to deliver a warning about getting ready for COVID-19, compelled by his training in viral outbreaks and his observation of the disease’s eruption in China and Italy.
Well before COVID-19 reached Hendersonville, Shepherd had worked with the rescue squad to make sure all tools necessary to fight the disease were in place. That meant more training for the largely volunteer staff, taking stock of personal protective equipment or PPE, giving fitness tests, and making clear relationships among several groups and agencies.
And when the pandemic arrived in western North Carolina as predicted, Shepherd helped drive what became known as the Henderson County “strike team” in responding to an outbreak at Cherry Springs Village, an assisted living center in Hendersonville. Their work likely helped save the lives of people such as Alicia Rodgers and Margaret Osteen, long-term care residents in Henderson County, even as the COVID-19 related death count mounted in their adult care home and in nearby long-term care facilities.
Jimmy Brissie, the county emergency management director, and Dr. Anna Hicks, a local geriatrician, put the team together with Shepherd’s rescue squad as a principal element. Despite its name, the strike team is not a paramilitary operation, but in Henderson County became a pioneering collaboration among Cherry Springs staff and owners at Affinity Living Group, physicians, nurses, county EMS staff and volunteers, area churches, the county health department, a family liaison, a local hospice and people to help with logistics.
“We started asking: How do we help break a bad situation into more manageable pieces? What does it look like?” Brissie said. “It looks like a strike team — it’s something we use a lot in the emergency world, where we bring in some additional resources to that facility to get them through that [crisis] mode.”
Comprising at least eight members, the strike team acts as extra staff in a broad variety of roles who arrive to help a facility within the first 48 to 72 hours of an outbreak. In the case of Cherry Springs, some of these outside staff would stay for 30 days.
“This is our community so everyone will be there as long as it takes,” Shepherd said.
The group took on such tasks as:
- Making sure the center could avoid evacuating residents by shoring up supplies of personal protective equipment (PPE), the national inadequacy of which has brought about countless infections and death, and training staff on exacting decontamination techniques.
- Setting up a “decon” tent so that staff could put on and take off PPE correctly, as well as monitoring all such equipment changes for 72 hours.
- Setting up additional vital equipment such as oxygen concentrators and IV drips.
- Checking on the sanitation of non-resident areas so that staff could take the right steps to stay clean.
- Ensuring important social interaction for residents with dementia by arranging check-ins by staff, a common sitting area and the chance to go outside.
- Providing counseling for residents and families by hospice people.
- Arranging peer support for staff members experiencing new levels of stress.
Feb. 5: Henderson County Department of Public Health confers with county EMS and other agencies, puts COVID information on its website.
March 3: Henderson County Public Health Department sends out COVID-19 public health advisory.
March 11: World Health Organization declares a global pandemic.
Across the state, viral outbreaks spread rapidly in long-term care facilities, accounting for nearly half of North Carolina’s COVID-19 cases and three in five deaths from the disease.
Cherry Springs was no exception. What these facilities have in common is that many people live together in relatively small spaces, staff must often have close personal contact with residents, and meals and activities take place in communal congregate settings.
As opposed to other COVID-19 incubators such as cruise ships and prisons, many of the residents are medically fragile and particularly at risk for the worst outcomes of the highly contagious virus.
By mid-March, county resident Laura Moore also had the sense that trouble was ahead. Moore’s sister Rodgers, 50, was a resident of Cherry Springs Village assisted living center, a congregate care facility where she was at risk of contracting the emerging coronavirus.
Rodgers, who has lived with a disability since an automobile accident 33 years ago, returned from a supervised outing on March 14. Cherry Springs staff told her on March 12 that the center had been locked down because of COVID-19 and that she would not be able to leave. They relented and she was allowed to go out for a brief birthday celebration.
But, upon her return, she lived in quarantine for two weeks.
March 21 – Henderson health officials learn of the first COVID-19 case in Henderson County
About 10 days after the first case of COVID-19 emerged in the county, Moore received troubling news about her sister.
“March 30 is when we knew that Alicia had a slight fever,” Moore said during a recent telephone interview. “It was not a very high fever, just enough for us to be a little concerned.”
The fever continued for several days.
“We were able to talk to a nurse outside the building at one time,” Moore said. “She said, ‘I just don’t know what’s going on with Alicia not getting over this fever.’”
As Rodgers, her roommate Osteen, other residents, and staff battled the disease using science and their hearts, the strike team gelled into a remarkable force, even when faced with heartbreaking results.
March 24: First North Carolina resident, from Cabarrus County, dies of COVID.
A sort of trial by pandemic — what one resident’s daughter called “two months of hell” — was unfolding at Cherry Springs Village. Eventually, 59 people there contracted the novel coronavirus. Beginning April 8, 10 Cherry Springs residents died because of it, according to federal regulators.
The team couldn’t save them all from the deadly new virus but kept working to prevent as many deaths as possible.
“People were dying, no matter what we did,” Hicks said. “And the emergency management team came to mind because it was like it was a disaster. It felt like being in a natural disaster.”
Cherry Springs Village wasn’t new to trouble. In 2019, state regulators cited the adult care home when a bedbug infestation had lasted for more than a year. But the pandemic was without precedent, both for residents and for the newly coordinated team that was learning to fight COVID on the fly.
March 27: NC Gov. Roy Cooper issues a statewide policy known as “Stay at Home.”
“In the emergency services world, if there’s a wildfire, we may send in a strike team of additional firefighters to help control it,” Brissie said. “And in a sense, this is very much like a wildfire. It’s just a communicable disease. The goal is to send additional resources in to control it.”
In long-term care facilities, a strike team’s first blow comes from health officials, who do rapid testing of staff and residents. The health department would arrive within 24 hours of the first positive case at Cherry Springs. Emergency management staff follow, bringing additional PPE supplies and setting up spaces where staff can remove contaminated equipment after use. Then comes the additional staffing.
When it comes to long-term care facilities, the most valuable resources consist largely of people who can do the necessary work. Many of the long-term care facilities that have seen high death rates also have low ratings for staffing by the Centers for Medicare and Medicaid Services.
Brissie said the team sought “people that have some special training or special skills that can come in and supplement what local resources are in place.”
Those skills include training in medical, rescue, decontamination, sanitation and logistics, but also take in the ability to work with people. Moore said her family originally was convinced that Cherry Springs Village would work for them because the staff was “nice” and offered activities that would appeal to Rodgers. With the cognitive level of a 14-year-old, she’s young compared to many long-term care residents, Moore said: “She’s a very outgoing person.”
That quality among the staff gave families reassurance at this dark time.
March 31: Cooper signs executive order 124, putting a lid on utility companies that shut off services and charge late or reconnection fees, tries to discourage evictions.
By now, several of the nearly 60 Cherry Springs residents who would catch COVID-19 were beginning to show symptoms consistent with the disease in geriatric patients — sudden loss of appetite and fatigue, a dip in cognition, and a low fever.
April 1: State health officials say North Carolina has received a smaller number of high-quality N95 masks than requested, about 312,000 after asking for half a million.
April 1: The first resident at Cherry Springs is confirmed positive for COVID-19.
Dr. Kevin O’Neil, chief medical director at Affinity Living Group, notifies the local health department.
Laura Moore, Alicia Rodgers’ sister, and Tammy Summey, daughter of Margaret Osteen, learned on April 1 that their kin would be tested for COVID-19.
It was a frightening time.
The coronavirus had relatively recently come to bedevil the nation and North Carolina. Moore knew that her sister’s fever could easily be a symptom of COVID-19.
“Thursday of that week, April 2, is when they tested Alicia, and they said there will be two days before the results come back,” Moore said, recalling the tension of the moment. “I’m thinking, two days, okay that will be a Saturday, Sunday night, we may not actually hear until Monday.”
There was nothing for them to do but wait.
April 2: President Donald Trump tells the nation that the United States is in “a very critical phase of our war against the coronavirus.”
Henderson County Health Department begins mass testing of all residents and staff at Cherry Springs, including Alicia Rodgers and Margaret Osteen.
COMING TOMORROW: Residents of Cherry Springs Village are told whether they are positive for COVID-19 as the Henderson County Strike Team combats the deadly disease and the threat of more to come.
What’s the difference?
People sometimes confuse them, but there are fundamental differences between nursing homes and assisted living facilities, the two principal types of residential long-term care in North Carolina.
Assisted living facilities, known by the state as adult care homes, are congregate room-and-board housing for people who need 24-7 supervision and help with at least two activities of daily life — bathing, keeping up with medication, going to the bathroom, dressing, etc. Residents get personal care supervision on site of the kind that home health aides supply for some people still in their homes.
Nursing homes, regulated by the federal Centers for Medicare and Medicaid Services as skilled nursing facilities, or SNFs, are for people who have “have remedial ailments or other ailments, for which medical and nursing care are indicated; who, however, are not sick enough to require general hospital care.” Generally, SNFs function more on a hospital model than do assisted living centers.
Correction: This story has been changed to reflect that Mark Shepherd is a critical care physician assistant.