Are you a health care worker? We’d love to hear from you. Email editor at northcarolinahealthnews.org

By Hannah Critchfield

Hurricanes have long been considered a hazard of living in North Carolina.

For many health providers and local officials, though, these natural disasters have become a routine part of the yearly calendar.

Come late summer, county managers test their generators, health centers prone to flooding install water pumps in their basements, National Guard personnel prepare to evacuate patients, and hospitals stockpile large rooms with beds should staff need to sleep overnight due to road closures.

“In a typical year, we see one or more bad tropical storms or hurricanes here,” said Cynthia Charles, vice president of communications and public relations at the North Carolina Healthcare Association, which represents about 135 hospitals throughout the state. “So we’re fortunate to have hospital-based emergency planners and managers who are very experienced.”

This season is different. Because even in the eye of a hurricane, a pandemic continues to rage.

As Tropical Storm Isaias hit North Carolina this week, local counties, hospitals and health centers experienced their first taste of how hurricane preparedness may be impacted by the global COVID-19 outbreak.

It’s a situation Gov. Roy Cooper referred to last week as “double trouble.”

Even in normal years, hurricane response teams, which coordinate at the regional, state, and local level, are trained to adapt to rapidly changing needs in diverse communities.

“Sometimes, days after the storm, we have worse conditions from flooding,” said Brian Floyd, president of Vidant Medical Center and chief operating officer for Vidant Health Hospitals. “And even then, some communities or counties are severely impacted by flooding, and others are not. Our teams have lived through it all quite a few times.”

This year, there’s even more need for flexibility with the pandemic complicating already complex planning for shelters and storm mitigation.

Nonetheless, as emergency managers eyed Isaías there was some sense of gratitude that this, the first storm to make landfall in North Carolina, wasn’t a “big one.”

“We take all of them seriously,” said Cumberland County emergency services director Gene Booth. “This is definitely not a Matthew, Florence, nor a Fran.”

More space for housing

“In times past, for example, we’ve brought [hospital] staff in to give them on-facility overnight stay in large rooms,” said Floyd. “We have to ensure we have enough staff to care for our patients, so if a storm has flooding or something that could cut staff off from being here in the hospital, then we might reach out to them ahead of time and offer that sheltering option.

“We can’t do that during this pandemic.”

Instead, hospital systems like Vidant Health are working with local emergency management to find nearby hotels willing to house staff.

Charles, whose organization represents hospitals and other large providers, said many coastal hospitals attended roundtables with the state over the weekend centered around how to safely evacuate patients while maintaining social distancing if necessary.

Though hospitals have acted as makeshift shelters during previous hurricanes, this year, that won’t be happening, according to Charles.

Mike Sprayberry, the state’s director of Emergency Management, has advised North Carolina residents to avoid seeking out shelters during Tropical Storm Isaias if at all possible. They should instead stay with family or friends inland, or, if they can afford it, rent a hotel.

During the COVID-19 pandemic, putting people into tight quarters such as this gym used during Hurricane Florence will not be possible because of the need for social distancing. Instead, emergency managers are spreading people out, requiring them to wear masks and making plans to house people in hotel rooms if they require isolation. Photo credit: Taylor Knopf.

Those traditional shelters, in gymnasiums and classrooms filled with cots, will be less full. According to Gov. Cooper, each shelter has been planned to give storm evacuees about 115 square feet of space. People will be screened for COVID-19 symptoms as they arrive and everyone in a shelter will also be required to wear masks throughout their entire stay. Shelters also have supplies of personal protective equipment.

Counties such as Dare County, which stretches along over 100 miles on the Outer Banks, are implementing new plans to house evacuees based on these guidelines. Dare typically partners with Nash County to shelter people in a large congregate setting, according to Bobby Outten, county manager and county attorney for Dare County.

“We’re doing all the things that we normally do to provide for people during a hurricane,” said Outten. “But it won’t be a mass group of people in a gym this year. It would be in a hotel room or somewhere non-congregate like that. The state has made arrangements for spaces, and we’re working with them.”

Sprayberry told reporters at a press briefing Monday that the state had also identified more than 2000 hotel rooms around the state to be used for “non-congregate” sheltering.

The county’s emergency operations call center, which typically staffs about 100 people during hurricane season, has moved to a much bigger room where employees can keep six feet apart.

Can’t always move from a flood zone

Community health centers, which provide health care through federal assistance and tend to serve more economically at-risk populations, face added challenges during this storm season.

“We have a health center in Ocracoke, and they’re still recovering from the last hurricane,” said Leslie Wolcott, communications and emergency preparedness manager at the North Carolina Community Health Center Association. “We serve underserved areas, but that also makes the sites more vulnerable.

“You need to be where your patients are, because they may not have transportation opportunities,” she explained. “So when a health center is in a vulnerable spot to flooding, it’s not as simple as tearing it down and building one in a better place.”

But Wolcott said the pandemic may have paved the way for one means of providing safer health care access during a hurricane.

“The community health centers have moved very strongly towards telehealth during the pandemic, particularly as the state has started reimbursing them for it,” said Wolcott. “Telehealth ensures patients don’t have to face the risks of coming in-person, with flooded roads and down power lines, to get good advice. Of course, that depends on cell networks or internet being functional, which is not guaranteed in a storm.”

‘One more thing to deal with’

Regardless of how Isaias impacts North Carolina counties, many health care experts and local officials said they feel well equipped to face both disasters at once.

“This pandemic has been going on since March,” said Outten from Dare County. “We didn’t just start thinking about, ‘What are we going to do in a hurricane?’ on Friday. There’s a plan in place, one that both our emergency management and state emergency management are aware of.

“We’re just implementing that plan like we’ve done in any other hurricane,” he added. “A pandemic is just one more of the things we have to deal with.”

Outten concedes there may be unexpected lessons from this week’s trial run at a pandemic-laden hurricane season.

“You learn something from every hurricane, and this time we’ll learn something about the pandemic,” he said. “There’s always something that we didn’t anticipate or didn’t know about or that’s unusual. And you’ve got to be prepared for that too.”

Hannah Critchfield

Critchfield is NC Health News' Report for America corps member. Report for America is a national service program that places talented emerging journalists...