COVID-19 & N.C.: Three messages from Tar Heel health experts

With the cases of COVID-19 increasing across our state, and the images we are seeing from other countries, concerns about the potential impacts to North Carolina are high. At the same time, with so much information circulating, people can feel overwhelmed without a clear sense of how to best fight this pandemic. We have been fortunate in our state to have the leadership of Gov. Roy Cooper, Department of Health and Human Services Secretary Dr. Mandy Cohen, and our State Health Director Dr. Betsey Tilson who have acted decisively to help protect our citizens during these challenging times.

As six former State Health Directors for North Carolina, we are speaking with one voice to urge each North Carolinian to take three critical steps to slow the spread of COVID-19. We acknowledge that for many, these recommendations may be more difficult to follow. Barriers like lack of health insurance and paid sick leave and limited telework options can create additional hardships for many families.

If you’re not sick enough to need medical care, a positive COVID-19 test will not change what you or your doctor do. Anyone who has fever and signs of respiratory illness including cough should stay home until at least 7 days after the first day of illness AND until they have been without fever for three days and other symptoms are improving. People who have been in close contact with an ill person are urged to stay home as much as possible and monitor themselves for signs of illness. During this phase of the outbreak, testing is most important for severely ill patients, health care workers, and persons in nursing homes and other vulnerable populations.

Testing also places significant strain on supplies like masks and gowns that we will need to meet the expected rise in COVID-19 patients requiring hospitalization. We have a deep gratitude to the health care workers, first responders, and public health workforce who are working around the clock to keep others well. We need to do our part by not adding to the overwhelming caseloads they are beginning to face by taking these three critical steps: stay home, stay informed, and seek medical care and testing only if you have significant symptoms.

The COVID-19 pandemic reminds us that we are all interconnected and that we must commit to actions that keep our communities healthy. Together we will make it through these challenging times and emerge stronger and more prepared.

As the leader of UNC Health, a system of 11 hospitals across our state and the dean of the University of North Carolina School of Medicine, to say the last several weeks have been stressful would be a vast understatement. Our collective mission is to promote the health and well-being of the people of North Carolina. In this COVID-19 pandemic our two priorities are: The appropriate diagnosis and care of our patients and; The safety of our co-workers.

Individuals across our state are stepping up to help in this crisis. In our system, we have created a leadership team to oversee vast preparation and operational strategies. The level of coordination from our senior executive team, our affiliate leaders and every clinical and operational aspect of our system has proven truly remarkable. The collaboration with other health systems in our state and the leadership of the governor and legislative leaders has been extraordinary.

We are prepared for the initial levels of patients admitted to our hospitals with COVID-19. However, if we get to a situation similar to Italy, Seattle or New York City -- if intensive care unit space or more beds are needed beyond our current capacity -- it would be catastrophic in North Carolina, as it will in many places across the country.

To treat our patients and ensure the safety of our co-workers, we need diagnostic testing capacity and supplies, including reagents (chemicals), swabs and personal protective equipment, including masks and face shields. One of our researchers, Dr. Melissa Miller, developed an in-house diagnostic COVID-19 test. She received the direct help of our U.S. legislative delegation and the FDA. She was able to increase our testing capacity and provide faster turnaround time that was desperately needed. Now we need the supplies, including swabs, to keep going and these are in extremely short supply.

Most importantly, we and all the health care systems and providers are in dire need of the various types of personal protective equipment. Despite what many may read, every place of care in the country does not have an adequate supply for the next two months of patient care. This current situation is the equivalent of sending our army into battle with vastly inferior equipment. We are asking our health care co-workers to put their lives on the line without adequate protection -- as a country we would never do this for our military soldiers.

The risk in caring for patients with COVID-19 for our health care co-workers is thought to be acceptable, but only with adequate personal protective equipment. We will be good with supplies of personal protective equipment for the next couple of weeks. But as the pandemic continues, we and others will try to extend our personal protective equipment supplies by reusing them and many other novel ways to extend usage by making new ones with homemade supplies. We would never send our troops into action with homemade guns or other artillery. We are being told as a last resort to use bandannas; we would never send our troops to battle with a BB gun.

On behalf of nurses, physicians, respiratory therapists and so many other health care co-workers everywhere, we are asking for a true national response to this lack of personal protective equipment. If mobilized appropriately the supply could be replenished in 2-3 weeks and save thousands of health care co-workers.

When you watch what is happening in other communities and are scared about what you see, you should ask yourself a few questions: Will it hit my own community? Why can’t we stop this? What should we do? These are difficult questions, but the answers are clear.

This pandemic has turned into a wave rolling across our country, hitting our state and threatening eastern North Carolina. The data are clear: it has started to impact our region and the problem continues to grow.

We can’t stop this wave from hitting us. However, we can lessen its impact here and now in eastern North Carolina. The question is whether we will take the necessary actions to reduce the spread of the virus? When you see the disasters affecting communities around the world, you are seeing the towns, cities, regions or countries that did not take action to slow or stop the wave.

What you don’t see are the ones that are not suffering as much. The ones whose health care system is able to respond to the demand. The ones whose economies are already recovering. These are the stories of the communities who took the actions to slow the wave. What we do now will determine our story.

The fact is we have a short window of opportunity, as the virus is moving much faster than we normally make decisions. We know the story and outcome if we do nothing more – we see it on the news and on social media every day. We know from history that bold and definitive actions can change the course for the better.

Each of us has a responsibility to act immediately and to take action to help our communities respond to this crisis. Now, more than ever, we need every person, organization and government agency working together to protect our loved ones.

Practice social distancing, stay home as much as possible, call before visiting a health care facility if you have a fever, respectfully encourage others through social media to do their part. These actions, combined with every day hygiene habits like proper handwashing, coughing and sneezing into the crook of your arm and cleaning surfaces, will help us flatten the curve and keep our loved ones healthy.

We are calling on local officials throughout eastern North Carolina and the state to take more decisive action in response to this crisis to include making the bold and right decision to ask North Carolinians to shelter in place. This means staying close to home as much as possible and only going out if absolutely necessary, such as buying groceries or picking up medications. This is the right thing to do to save lives and is the right thing for our long-term economic interests. Community members must encourage the political bodies to be decisive, take action now and then support them.

We would also like to thank all health care workers and every person on the front lines for their tireless efforts to care for those in need. This is a difficult time for doctors, nurses and care teams. We stand ready to care for those in our region, and we need local communities to do their part.

We are confident we can flatten the curve. However, we must all stand up together, as one community, to get through this crisis.