Hanesbrands has converted production to generate additional masks during the coronavirus crisis. The companies' headquarters in Winston-Salem are seen here. Photo courtesy of Hanesbrands

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Increasingly, the business community and elected officials are stepping up to the plate to stave off a critical shortfall of hospital equipment needed to address the COVID-19 pandemic.

As the number of positive cases grows, health care providers in North Carolina’s 100 counties are scrambling to receive the supplies they need to care for an expected wave of patients. Many of them could be critically ill when they arrive at hospitals.

Late Tuesday, Attorney General Josh Stein joined 15 other state attorneys general in calling on the Trump administration to fully invoke the Defense Production Act to get protective gear, ventilators and other supplies manufactured and shipped out.

“We are on the brink of catastrophic consequences resulting from the continued shortage of critical supplies,” the attorneys general wrote.

“The federal government must act decisively now and use its sweeping authority to get as many needed supplies produced as soon as possible for distribution as quickly as possible.”

[The latest: North Carolina coronavirus daily updates]

“The shortage of COVID-19 tests and the dwindling supply of personal protective equipment are the two most pressing needs,” said a statement by the N.C. Nurses Association provided to Carolina Public Press.

“As this crisis evolves, the number of ventilators and (intensive care unit) beds — and the trained nursing staff to adequately treat patients with that equipment — will become a critical need.”

There is much more to do in the days ahead, medical professionals say, if the coronavirus pandemic is to be tamed.

Protective gear

At the state level, a growing number of North Carolina-based companies are ramping up operations to provide larger quantities of protective gear.

HanesBrands, based in Winston-Salem, is setting aside apparel production in favor of cotton masks that doctors and nurses can use when N95 masks — the most suitable masks when medical professionals address COVID-19 — are not required or available.

The company expects to produce 1.5 million masks weekly, with the national textile consortium that it belongs to churning out 5 million to 6 million a week using HanesBrands’ design and patterns.

Lowe’s, whose headquarters is in Mooresville, announced this week that it is working with supply distributors to donate $10 million in products, including protective gear and respirators to hospitals nationwide.

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During a press call with reporters Wednesday afternoon, Dogwood Health Trust CEO Anthony Chiang discussed his Asheville-based foundations’ efforts to improve the availability of PPE.

Dogwood has been working with a number of businesses in the region, Chiang said, who are trying to address the demand for more personal protective equipment. Dogwood is providing “capital and advance funding” to help these companies, which hope to deliver face shields, face masks and sanitizer to medical professionals.

During a press conference Wednesday, Gov. Roy Cooper blamed the lack of adequate protective equipment for a change in the state’s policies on testing. Although he also blamed the federal government for not doing enough to provide testing supplies, he said private companies in North Carolina were helping address that issue. However, the lack of personal protective equipment creates a bigger problem.

The governor described the national market for protective masks and other supplies as the “wild west” at the moment. The state saw this coming and began work to acquire more materials in January, he said, but there’s still far from enough.

As a result, the limited supplies are being focused on caring for the sick and not on testing people with mild symptoms.

Hospital beds

In a ranking of staffed hospital beds per 1,000 population in 2018 by Kaiser Family Foundation, North Carolina tied for 19th place. The list included ties, resulting in a total ranking of 24.

A potential bed shortage at hospitals, especially in intensive care units, is now viewed as a significant issue, so the N.C. Department of Health and Human Services has waived the licensing process required for hospitals to increase their bed count.

“On any given day, our hospitals — by design — operate at 90% to 100% capacity,” DHHS said.

“That’s why we have sought waivers to allow critical access hospitals to operate above their licensed capacity.”

During a press conference Wednesday, the governor discussed creative approaches to creating hospital space and beds. Asked by one reporter whether he would consider mobile hospitals similar to military MASH units, Cooper did not answer directly, but said the Army Corps of Engineers has been brought in to help North Carolina find creative solutions.

Ventilators

If COVID-19 cases increase significantly and infected people are admitted for treatment, the biggest obstacle facing hospitals may be a meager supply of ventilators.

“I think there will be a significant shortfall, which will depend on how many people are going to the hospital at one time,” said Rob Handfield, a supply chain expert at N.C. State University’s Poole College of Management.

“There may also be a shortage of the components used to assemble the ventilators,” Handfield said.

“Plastic molded injected parts are often produced in China, which has obviously had their own problems with capacity. We will definitely have a shortage and some very difficult situations.”

One workaround to the shortage of ventilators may be to increase production of CPAP machines — used to control snoring and sleep apnea — that are easier to manufacture and could help patients with less severe respiratory problems.

Chiang, of the Dogwood Health Trust, expressed concern about the low availability of ventilators in Western North Carolina. “We have, on average, a lower percentage of ventilators than most parts of the country,” he said.

“When we get past 1,000 reported cases (in Western North Carolina), we’ll push our health care system into stress mode.”

Unfortunately, the region has to compete with the huge backup of orders for ventilators nationally, Chiang said.

The solution at hand

With hospitals chasing down supplies and a proven vaccine for COVID-19 not yet in sight, health experts continue to hammer home their message: Frequent attention to personal hygiene is the best way to “flatten the curve” and bring the incidence of infections under control.

Washing hands frequently with soap and water for at least 20 seconds, not touching the eyes, nose and mouth with unwashed hands, avoiding close contact with people who are ill and practicing social distancing should become daily rituals, experts say.


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Neil Cotiaux and Frank Taylor

Neil Cotiaux is a Carolina Public Press contributing writer based in Wilmington. Frank Taylor is Carolina Public Press' managing editor, based in Asheville. Email info@carolinapublicpress.org to contact the Carolina Public Press news team.

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