Health-Care Workers and Officials Prepare for COVID-19 Peak

When I first spoke with Melissa, a nurse working at a Charlotte-area hospital run by Atrium Health, on March 31, she still held onto a bright optimism about how her employer was working to protect her and her coworkers, keeping a healthy stockpile of N95 masks at a time when reports of theft from other area hospitals were circulating in the hallways where she worked.

Despite the fact that she was wearing the same mask for an entire 12-hour shift, Melissa, whose name has been changed in this story so she could speak freely about her hospital’s strengths and shortcomings, felt that she and her coworkers were in good hands.

“I do feel confident that we are becoming more prepared and we’re getting a ton of masks in,” she said. “We’re being told to wear these for as long as we are just because we want to make sure that in two to three weeks when we think [the COVID-19 pandemic] is going to peak, we’re going to be able to accommodate that and not be scrambling then.”

When I spoke with Melissa again just a week later, however, her tone had changed. Gone was the brimming confidence that she had expressed going into April.

She described how she still had to wear the same mask throughout an entire shift “or until I sweat on it and it’s gross and soggy,” but now the hospital had begun sanitizing masks and reusing them up to three times.

She said a third of the masks at CMC-Main had to be discarded rather than sanitized because nurses’ makeup had gotten on them, so nurses were being told not to wear makeup into work anymore.

“I get the whole rationale behind that, but the fact that we have to reuse masks and they’re sterilizing them up to three times with UV sanitation doesn’t make me feel confident. Where is the data that shows that is effective?” she asked. “That’s what’s frustrating the most right now is that I don’t get the why. It’s changing so quickly, I don’t think anyone knows the why and no one really seems to care, but is that putting us more at risk having to sanitize all of those masks?”

The resanitization of masks intended for single use has become a reluctantly widespread practice across the country, and one mask-sanitizing system invented in Ohio in March and fast-tracked through the FDA approval process is able to clean 80,000 masks in a day.

Policies around who gets masks and how have also tightened up, Melissa said, and employees have become protective of their department’s protective gear.

“It’s like Black Friday at Walmart. ‘Where did you get that? That looks like our mask. Who gave that to you?’” she said, recalling normal conversations on her floor. She explained that she isn’t allowed to give a mask to a co-worker if they don’t work in her department. “It feels awful as a human, having to feel like someone in need who is your co-worker, you cannot assist them when you see the box right in front of you. The way we’ve been cracking down on that sucks.”

Requests for comment from officials at Atrium Health and Novant Health regarding COVID-19 treatment policies, PPE and other preparations were denied, though public comments from both systems’ CEOs below have given some insight into the priorities of leadership. 

Reports vary on just how many cases we’ll see in Mecklenburg County during the COVID-19 peak, or when we’ll see them, and new models are released every day with different numbers.

Health-care workers and officials have bee actively working over the last two weeks to be prepared when that time comes. 

As of April 7, most experts were in agreement that social distancing in North Carolina was having a positive effect on the numbers, and projections were showing decreased numbers of cases in the state if people continued to follow the stay-at-home order.

On April 6, a collective of North Carolina scientists unveiled a forecast based on three different projection models, stating that if social distancing policies are carried out through May, North Carolina could see 250,000 COVID-19 cases total, as compared to 750,000 cases if those policies were stopped at the end of April.

According to Aaron McKethan, founder and CEO of NoviSci and senior policy fellow and adjunct professor at Duke University, the social distancing policies are crucial to curbing what’s been the biggest threat of the pandemic: hospital overcrowding.

“Maintaining some form of social distancing policies as those in place right now will give us the best chance to make sure our health system has enough capacity to manage COVID-related infections,” he said at a press conference. “We’ve shown that lifting all social distancing polices completely after April 29 leads to … a 50% probability that hospital acute and [intensive care unit] bed capacity will be outstripped.”

Local models show how social distancing affects the potential for overcrowding here in Mecklenburg County. According to a model unveiled by Mecklenburg County Manager Dena Diorio on April 3, experts estimate that, with social distancing, the virus would peak in Mecklenburg County on May 11 with 4,692 hospitalizations, including 1,842 patients on ventilators and 1,482 in the ICU.

Without social distancing, experts say the peak would come quicker and be more widespread, with up to 8,500 hospitalizations, including 1,663 patients on ventilators and 3,288 in the ICU, and all happening under a shorter timeline than the projections with social distancing.

During a virtual Mecklenburg Board of County Commissioners meeting on April 7, Atrium CEO Gene Woods said the most recent models have shown that successful social distancing efforts in Mecklenburg County have effectively pushed back the projected peak date to May. 

That fact is crucial, as was emphasized by an April 3 Castlight Health report that named Charlotte as one of seven U.S. metropolitan areas in which high-risk patients may not be able to access critical resources during the COVID-19 pandemic. The study looked at the number of patients on ventilators before the pandemic and the scarcity of ICU beds to determine which areas were at highest risk of running out of resources.

In the lead-up to the peak, local health-care leaders have worked to ensure that there will be enough beds to house patients if the oncoming COVID-19 peak were to overwhelm area hospitals. On April 2, the CEOs of Atrium and Novant Health co-signed a letter asking the county to fund the establishment of a field hospital on the UNC Charlotte campus that could be used to treat up to 3,000 COVID-19 patients. 

“Using the latest epidemiological statistical analysis to predict community spread, we are anticipating potential additional volumes of approximately 3,000 hospitalized COVID-19 patients beyond our currently planned surge capacity,” read a letter signed by Woods and Novant Health CEO Carl Armato. “In addition, our models suggest the surge will occur between mid-April and mid-May 2020. As seen in other cities across the nation, such a surge can quickly overwhelm hospitals, and a field hospital can act as an important relief valve. Therefore, the time to act is now to implement solutions needed to adequately care for our patients and community.”

However, at the April 7 commissioners’ meeting, Woods, Armato and Diorio announced that they would change course. The success of social distancing locally and the ability of Woods and Armato to increase capacity at their respective hospitals by 50% convinced the group that a 3,000-bed field hospital would not be necessary, and they instead requested a 600-bed field hospital closer to Uptown.

Also playing a role in this decision was the county’s realization that they would not receive direct funding from the Federal Emergency Management Agency nor the NC Emergency Management to staff or supply the field hospital.

The U.S. Army Corps of Engineers is currently evaluating sites closer to Uptown, including on the Atrium and Novant properties, to house the new field hospital.  

“I’m really cautiously optimistic about where we are in Mecklenburg County as I look across the state of North Carolina, as I look in some of our other markets and as I talk to other CEOs,” Armato said at the April 7 meeting. “The teamwork that Gene and I have put together with our two organizations, we’re going to stand up and not only be ready for the surge, we’re going to help pull our city out of it so we can get back to taking care of all people.” 

As for Melissa, she said she’s confident that leadership at her hospital has properly prepared her and her coworkers for an influx of patients, though she remains concerned about the PPE supply. She and her coworkers have been meeting daily to go over different approaches to a situation in which nurses are faced with double their normal amount of patients so they’re prepared.

“We’re doing good,” she said. “I’m glad that we have something in place. I’m not sure that other hospital systems that have been overwhelmed had something like this in place, like, ‘Let’s step back, let’s organize the chaos, worst-case scenario, what are we going to do?’ I think we’ve already put our minds in the worst-case scenario.”

And she’ll continue to show up every day to treat whomever comes in the door, all the while hoping that scenario never plays out.