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Cases are climbing 'because we've been looking,' public health director says

Public Health Director Steve Smith answers a question as nursing director Crystal O'Dell and medical director Diane Curran look on.

By Lightning Reports, Published: April 6, 2020

Public health officials and a top infectious disease doctor fielded questions on Monday about providers' coronavirus response, one day after the health department confirmed 23 new Covid-19 cases at an assisted living center in Hendersonville.

The new cases at Cherry Springs Village nearly doubled Henderson County’s case count to 51, vaulting the county ahead of larger Buncombe, which had 31 on Monday. Henderson County had recorded three deaths from the pandemic on Monday.
Public Health Director Steve Smith, nursing director Crystal O’Dell, medical director Diana Curran and Pardee’s top infectious disease specialist, Chris Parsons, answered questions outside the entrance of the public health department.
“I know it’s unnerving for some people to have the higher case count in Henderson County but I think that is true today because we’ve been looking,” Smith said. “We’ve been going out to find these cases. Honestly, I’m concerned about the status of these kinds of facilities statewide. I think they’re very susceptible and of course the people that rely on them for care are very susceptible.”
While independent living facilities like Cherry Springs don’t ordinarily have medical personnel on site, its corporate owner, Hickory-based Affinity Living Group, has committed to deploy “medical care capacity on site in that facility to do some more advanced care, triaging assessment so that they can keep people in place if their symptoms are manageable there and minimize transfers” to hospitals, Smith said. “Some local physicians have been helping them out already on a voluntary basis.”
Here are other answers in the media session on Monday:

Is the supply of testing kits a problem?

Smith: “It’s not for us at the moment. We committed to a very strategic plan early on to calibrate our testing capacity here locally for those that are at highest risk — health care workers, long term care facilities, hospital patients. That model’s been working really well for us. We expect testing capacity in the next couple of weeks to ramp up pretty quickly. All hospitals and public health have a supply of test kits.” Eighty percent of those who get Covid-19 will have mild symptoms. “We really don’t want to promote those people coming out to get tested if they’re able to stay home with mild symptoms because just coming out would create exposure risks.” The health department sends tests to the state public health lab in Raleigh. Pardee sends tests to a lab at UNC Health in Chapel Hill and gets results in 24 hours. With the recent FDA approval of in-house testing, Pardee should soon be able to read tests in hours, Parsons said.

What was the process to test residents and staff at Cherry Springs Village once the Covid-19 case was confirmed?

Smith: “I want to give a lot of credit to the people that are standing beside me today. We knew long-term care facilities were going to be a high-risk environment. We’re very fortunate in this community with all of those partners to have a pretty heightened sense of surveillance in Henderson County. Our facilities have trusted us and given us an early indication of someone that might be symptomatic. What our strategy has been when we identify that first case is to go in and do a pretty big testing regimen around close contact and others that might have been symptomatic, just to get a real good moment-in-time slice of what may be happening, as an effort to minimize transmission and get some good solid data to operate on.”
O’Dell: “Once that first case is identified a team of nurses will go in to help the long-term care facility identify who would be considered as a close contact and we assist in testing those that we screen as needing to be tested and follow up afterwards with long-term surveillance. … We assist long-term care facilities with isolation and quarantine protocols to try to decrease further spread within the facility.”
Smith: “Today we consider everyone in that (Cherry Springs) facility to be either a confirmed case or a close contact. I think it’s likely that there will be more cases identified.”

Kimberly King, WLOS: An employee told the station that on March 28, a staffer was sick and sent home and yet her son was allowed to come back and work in the subsequent days after being exposed.

Smith: “We’ve been getting a lot of representations from people and families and staff about some of these circumstances. It’s really hard to dig through all of that and figure out what’s accurate or true at a point in time. I would say for anybody that might have been symptomatic, just by virtue of being a contact with that person wouldn’t necessarily exclude them from work activities. From the moment we identified this case and moving forward, the parent company has been very responsive and has been abiding with the direction that we give. In Henderson County there are 1,700 plus beds in 30-plus (long-term care) facilities and it would be impossible for us to police all of those facilities at a point in time. Our strategy is to keep really hammering away about the need for protective measures.”

O’Dell: “There is some CDC guideline basis for that, for health care workers, and because a health care worker is going to have more exposure than the normal public, there is some guidance that allows an asymptomatic health worker who has had contact with someone with suspected or known Covid-19 to continue to work as long as they’re asymptomatic. If we didn’t allow for that we would have critical staffing issues within our hospitals.”

Is any of the three deaths associated with Cherry Springs?

Smith: “I think all three deaths are associated in some way with a long-term care facility but to my knowledge they are not associated with Cherry Springs.”

Do you know when peak will be?

Smith: “A lot of our health care institutions don’t want people focusing on confirmed case count because we assume community transmission. So it’s just a proxy indicator. We perceive a lot of cases out there that we aren’t testing or haven’t identified.”