Editor’s note: COVID-19 poses an increased risk for severe illness or death in people over 65 years of age. Carolina Public Press previously identified 20 North Carolina counties that have the highest percentage of their population in the high-risk age range for COVID-19, nearly all of them rural. This is the second installment in a six-part series looking at the health care systems in those counties. This article focuses on Brunswick County.
Smack dab in the middle of the U.S. Eastern Seaboard, North Carolina’s Brunswick County is a magnet for retirees.
Northerners tired of cold winters and “halfbacks,” many of them former New Yorkers who have had their fill of packed retirement communities in Florida, continue to propel a steady flight of retirees to the area between Wilmington, N.C., and Myrtle Beach, S.C.
[The latest: North Carolina coronavirus daily updates]
Population estimates from the N.C. Demographers Office show more than 30% of Brunswick County’s 142,000 residents are 65 years or older.
Three hospitals serve a variety of medical needs for Brunswick and vicinity: Wilmington-based New Hanover Regional Medical Center, just across the bridge from Brunswick’s golfing communities, with 800 beds; Novant Health Brunswick Medical Center, a 74-bed arm of its Winston-Salem parent; and Dosher Memorial Hospital, a 25-bed critical access hospital in Southport that also serves Caswell Beach, Oak Island, St. James and Bald Head Island.
In early June, Brunswick County residents began looking at COVID-19 more seriously with news that the disease caused by the new coronavirus had infected one resident and two employees at Autumn Care of Shallotte, a congregate living facility.
Shortly after, another outbreak occurred at Universal Health Care of Brunswick. The latest publicly released information shows 19 residents and 11 employees testing positive at that facility as of June 23.
Now, however, attention is shifting to the more than 400 confirmed cases across Brunswick County.
Positive cases have spiked among individuals 25-49 years old, and about a quarter of all positive cases have impacted the Hispanic/Latinx community, which accounts for 5% of the county’s population.
“There are several reasons that can be attributed to these increases, including lax social distancing through gatherings with family and friends and increased exposure due to working in the service industry,” said a statement from Cris Harrelson, Brunswick County’s health services director.
As for the toll taken on Hispanics, Harrelson cited staff who interact with the public at retail stores, the unavailability of health insurance in construction, retail and food services, close-knit housing arrangements and language barriers.
Early collaboration in Brunswick County
As the first positive cases of COVID-19 surfaced in the county, the Health Department consulted with Brunswick Senior Resources, a nonprofit, and decided to close all senior centers and to begin providing home delivery and drive-thru pickup of meals.
County health officials also worked with Novant Health and New Hanover Regional Medical Center to promote public testing for the coronavirus and to embark on contact tracing to pinpoint individuals who had been in contact with an infected person “for more than 15 minutes during the infectious period without the protection of face coverings.” Those who test positive are being asked to self-quarantine.
At Novant Health Brunswick Medical Center, President Shelbourn Stevens has forged relationships with the medical directors of long-term care facilities over the past 10 years, and those relationships have expanded since the outbreaks at Autumn Care and Universal Health Care.
“The county has had some daily phone calls, and we’ve been included in those phone calls to get them the resources that they need so those patients can stay isolated in one room or wing at the facility and not have to come to our hospital,” Stevens said.
Novant also inaugurated drive-up testing for COVID-19 in March and expanded its bed space from 74 to “a little over 100 beds” to meet potential demand during the pandemic.
More broadly, Stevens has worked with colleagues at NHRMC to achieve greater hospital-to-hospital coordination.
With NHRMC being the tertiary hospital for the region and infected individuals becoming extremely sick, Stevens said, “There were some concerns with New Hanover bed capacity and how could we work together. So, if somebody did go up there to Wilmington and they’re getting that capacity full and lived in Brunswick County, could they off-load some patients because we had capacity?”
The two hospitals also considered the convention center in Wilmington as an overflow hospital at some point and how the two could staff it, Stevens said, but so far they haven’t “had to really go too far down that path.”
For its part, New Hanover Regional has an AirLink helicopter based in Brunswick County to enable the rapid transport of patients needing critical specialty interventions at NHRMC or other trauma centers.
Dosher Memorial Hospital, although small, is also ready to help.
“As a critical access hospital, Dosher would not be the appropriate first-choice facility for a COVID patient who needed a high level of supportive care,” said Brad Hilaman, CEO and chief medical officer.
“Yet, we have had a surge plan in place since mid-March in the event that we needed to take patient overflow from other area hospitals. While we are hoping that the current increase in cases does not overcrowd our local hospitals, our medical staff is willing to do whatever it takes to serve any patient who walks in here who needs treatment.”
Brunswick County’s Health Department remains in contact with long-term care facilities as well as with the three hospitals concerning the adequacy of personal protective equipment, officials said. If PPE is needed, an order can be placed with N.C. Emergency Management, health services director Harrelson said.
“At this time, all long-term care facilities and hospitals have enough PPE to meet their needs,” he said.
Julian March, a spokesperson for NHRMC, told Carolina Public Press that it has 180 ventilators on hand.
Novant has made some “large purchases” of ventilators that were placed in a centralized warehouse for use across its system, Stevens said.
Coordinated messaging in Brunswick County
In addition to collaborating on operational issues, the Health Department and hospitals are engaging in an outreach program to the Hispanic community.
Spanish-language flyers and social media messaging as well as on-site translation are being used to promote COVID-19 prevention and compliance with the “Three W’s” – wearing a mask, waiting 6 feet apart and washing hands frequently.
Messaging was also coordinated among the hospitals when elective procedures were suspended and visitation policies were altered.
“We all tried to do that together so that it wasn’t confusing to the community,” Stevens said.
For all hospitals, postponing nonessential surgery and procedures to free up bed space and conserve equipment took a big bite out of revenues.
Across Novant’s four-state system of 15 hospitals and hundreds of outpatient facilities and physician clinics, the projected financial loss from postponement totaled $170 million in March and April and is projected to cost another $130 million for May and June, said Kristen Barnhardt, a corporate spokesperson.
By contrast, Novant Health received about $80 million in federal funding from the CARES Act to offset losses as it admitted 1,000 COVID patients across its system.
At NHRMC, the medical center and its physician group received about $28 million in CARES Act funding.
“NHRMC does not expect to receive funding to cover all losses but plans to apply every available resource for COVID-19 funding,” March said.
Crisis management
For Stevens, emergency planning is nothing new. He began his career with Novant 30 years ago as a respiratory aide at 900-bed Forsyth Medical Center and transferred to Brunswick County in 2006. In 2012, he was named president there.
In September 2018, when Hurricane Florence belted most of North Carolina’s coastline, Stevens and 180 colleagues sheltered in place at the hospital for six nights, caring for patients as flooding and downed trees blocked roads and while more than 50 of his associates learned that their homes had sustained significant or total damage.
Given his experience with hurricanes Matthew and Florence, “I don’t want to say crisis becomes natural to us, but I would say we’re used to it,” Stevens told Carolina Public Press.
“You kind of immediately go down your list in your head of what supplies we’re going to need, let’s call and check on this … keep checking into it three times.”
As a result of his respiratory training, Novant tapped Stevens to serve as administrator of the system’s respiratory retention plan in 2019, just before the pandemic struck.
“So pre-COVID, I guess my name rose to the top because of my background … so physicians, nurses, respiratory therapists, anybody that may be taking care of these patients would have the appropriate mask and be fit-tested and know how to use them appropriately,” he said.
Partnering, post-pandemic
Novant’s current collaboration with New Hanover Regional Medical Center could expand into a more formal relationship as the pandemic fades.
In a yearlong process, NHRMC, a county-owned hospital, is exploring the creation of a formal arrangement with one of three potential partners – Novant, Atrium Health or Duke Health – to bring additional capital to the table and enhance its capabilities in coming years. NHRMC reported $110.8 million in operating income for the year that ended Sept. 30, 2019.
Novant is offering $2 billion to New Hanover County to buy NHRMC, with the assurance that UNC Health and UNC’s School of Medicine will continue a medical education program at the Wilmington hospital should Novant emerge as the winning bidder.
While the future of NHRMC is of intense interest in Wilmington, residents of rural surrounding counties like Brunswick that rely on the facility for many of their most serious health needs are also paying attention.
Correction: Shelbourn Stevens is president of Novant Health Brunswick Medical Center. The article as initially published gave his title incorrectly.
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One important element was not covered in this article, which otherwise is excellent. A significant percentage of residents in the western corner of the county receive all or of their medical care through Horry County, S.C., providers. I am a big fan of Novant and am hoping their bid is the successful one with New Hanover. Think this would benefit everyone.