North Carolina could see 110 people testing positive or presumptive positive for coronavirus by the end of the week, with cases reaching 4,000 by April 2, an epidemiologist at UNC-Chapel Hill said Monday.
Such an increase could put tremendous pressure on hospitals. About 20% of people infected with the virus become seriously ill. If the projections for North Carolina hold true, hospitals could see an influx of highly infectious patients within a few weeks.
“It’s going to put an incredible strain on the health care delivery system” that’s already fairly full, said Dr. Joseph Rogers, chief medical officer of Duke Health Systems. Duke Health is looking how other health centers have handled a surge in coronavirus patients while continuing to treat others who need inpatient care, he said.
“It’s going to be tough,” Rogers said. “I believe we will find ways amongst all of us in health care delivery to accommodate our citizens and to accommodate the residents of North Carolina.”
Alan Wolf, a spokesman for UNC Health Care, said the system is “considering a wide range of scenarios and options as we work to make sure our hospitals are prepared for corona cases.”
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The hospitals and clinics that are part of UNC Health Care canceled most non-urgent primary care appointments, and some specialty care appointments for Monday and Tuesday.
“We want to be able to prevent exposure of coronavirus patients and healthy patients,” Wolf said. “We want to make sure providers and staff are able to focus on sick patients.”
The Duke Health is also considering how to reduce clinic visits by asking people who are stable or coming in for routine care to reschedule appointments for later in the year. Doctors groups are going through their appointment schedules now to see who can wait, Rogers said.
The projections for coronavirus cases in North Carolina are “very preliminary” said Kimberly Powers, an associate professor of epidemiology at UNC-Chapel Hill. The numbers are based on a model that takes into account just the growth in reported cases in the state so far. Under this model, North Carolina is projected to have 1,000 positive or presumptive positive COVID-19 cases by the end of next week.
The model does not take into account expanded testing, which the federal government promises is coming, and changes in people’s behavior meant to limit the spread of the virus, Powers said. “Things are changing so rapidly,” she said.
On Saturday, Gov. Roy Cooper announced an executive order that banned gatherings of more than 100 people and shut down K-12 public schools for at least two weeks. Government agencies and private companies are encouraging people to work from home, if possible. Cooper’s order does not cover bars and restaurants, but some are shutting down voluntarily or limiting in-person service, The News & Observer reported. Library systems in the Triangle have closed, as have some retail stores.
Testing for the virus has been limited, and some people who have symptoms of the disease say they have been denied tests. The federal government said it has plans to address the shortage of tests, The New York Times reported.
Expanded testing would probably turn up more cases, Powers said, while the order for people to stop congregating in large numbers could reduce the virus’ spread.
“The hope is that — with the very dramatic measures to really limit contact — is that we can see this rate of growth go down,” she said. “Where it lands and where it ends up in the long term depends on how things unfold minute by minute, hour by hour, week by week.”l
A more sophisticated model is in the works to predict numbers based on recent changes, she said.
Duke is opening its first drive-up coronavirus testing center on its Durham campus on Tuesday, Rogers said. It’s the first of three planned Duke drive-up testing sites. People who use them must have a doctor’s prescription.
Wolf at UNC Health said contingency plans are being discussed “to make sure we’re prepared for all the patients who need care.”
Canceling elective surgeries and upfitting spaces to create more negative pressure rooms are part of the contingency plan discussions, he said. Air circulation in negative pressure rooms prevents contaminated air from escaping.
Rogers said all hospital groups are thinking about the point where they cancel elective surgeries, increase space for patients who need intensive care, and redeploy staff to care for those patients.
Some patients scheduled for elective surgeries at WakeMed have decided on their own to postpone them, said Barb Bisset, executive director of preparedness and WakeMed’s emergency management program. “Patients are realizing it’s not the time to have elective surgeries,” she said.
The WakeMed medical staff is considering if and when the hospital should tell patients to reschedule elective surgeries, she said.
The hospital has a “capacity management” plan it uses regularly that will guide how it would handle a surge in patients, Bisset said.
WakeMed started screening hospital visitors Friday, asking questions to determine if they are ill. Patients are limited to one visitor on hospital property. WakeMed is trying to discourage large numbers of visitors in keeping with recommendations to reduce the size of public gatherings, Bisset said.
Duke Health started screening hospital visitors Monday, according to its website.
Duke is working on its own projections for coronavirus spread in the state that consider what happened in Washington state, Wuhan China, and the Lombardy region of Italy, Rogers said.
North Carolina can lower the spread of infection by adhering to guidance about changing personal habits, Rogers said.
“We have an opportunity to bend that curve if we practice social distancing — trying to avoid gatherings of large groups of people,” he said.
“There is a real threat to us,” he said. “We can take responsibility for changing the trajectory of the disease.”