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Looking for signs of progress while bracing for ongoing COVID-19 battle

GREENSBORO — When co-workers saw the raw blister on the nose of a nurse who cares for the sickest COVID-19 patients, they did what they naturally do.

They quickly treated her wound and checked the fitting of her mask.

“What I saw was pretty inspiring. They don’t want to leave those patients alone,” Dr. Mary Jo Cagle, chief operating officer at Cone Health, said about witnessing how staff are caring for each other and their patients in intensive care at the former Women’s Hospital campus.

The campus, which is being used solely to treat COVID-19 patients, is a window into Guilford County’s fight against the coronavirus pandemic. The hospital isn’t overflowing with patients, leaders say, due to the state’s stay-at-home order set to expire Friday, if certain data supports easing restrictions.

Terry Akin, Cone Health’s chief executive officer, credits local and state leaders for taking action early in the pandemic to avoid overwhelming community hospitals and health care workers. This includes multiple measures designed to slow the spread of coronavirus, including closing the state’s public schools March 16 and moving to online instruction.

“These were not easy decisions,” Akin said, also noting the cancellation of the Men’s ACC Tournament, the delayed opening of the new Steven Tanger Center for the Performing Arts, the postponement of the High Point semiannual furniture market, and many more.

“We are convinced it has made a big difference,” he said. “It’s working.”

What the numbers show

It was only two months ago today — on March 3 — when state health officials identified North Carolina’s first confirmed case of COVID-19. A Wake County resident had traveled to the state of Washington and was exposed at a long-term care facility dealing with an outbreak of the highly contagious respiratory illness.

Guilford County first identified coronavirus infections in mid-March that were only related to travel. As time went by, health officials identified cases attributed to community spread, which means there wasn’t a known source of infection.

On March 24, a person from Cabarrus County was the first North Carolina resident to die in the state from complications of COVID-19, state health officials said in a news release at the time. The person was in their late 70s and had several underlying medical conditions.

Guilford County then reported its first COVID-19 associated death March 31. As of Saturday, state health officials say Guilford has had 31 deaths related to the illness and 437 cases of coronavirus

The county health department’s data, last updated Friday with 30 deaths, shows those age 65 and older account for about 28% of cases but the vast majority, 83.3%, of deaths locally.

By comparison, people age 50 to 64 made up 25% of cases and 10% of deaths. Those age 25 to 49 accounted for most of the county’s cases, about 38%, and 6.6% of deaths. Statistics show 53.3% of those who died were white, 40% were black and 6.6% were Asian.

Among those that families lost to COVID-19 are two residents of Clapp’s Nursing Center, who became ill during an outbreak there, its administrator confirmed on Monday.

“It’s important to understand the underlying factors that drive these death rates,” said Dr. Iulia Vann, Guilford County’s interim health director. “If you take a look at Guilford County’s most recent Community Health Assessment, you will notice that our county’s life expectancy is about 78 years. Even if this average is a little bit better than North Carolina as whole (77 years), we are falling behind Mecklenburg, Wake and Durham where the life expectancy is over 80 years.”

In those counties, Mecklenburg has 1,699 reported cases and 49 COVID-19 associated deaths as of Saturday, according the N.C. Department of Health and Human Services. Wake County has 870 cases and 19 deaths, and Durham County 750 cases and 22 deaths.

The life expectancy in a geographical area, Vann said, gives officials an understanding of the overall health in that area. She said their data show the majority of deaths in Guilford County are in residents in the 65 and older age group, who already struggled with other health issues.

“Our chronic disease rates — coronary heart disease, cancer, lung disease, etc., which correlate to the CDC’s risk factors for COVID-19 — are also higher than in other parts of the state, especially among our African American population,” Vann said.

She said older populations are at higher risk for hospitalizations and decreased pulmonary function, which can lead to the use of ventilators.

However, along with the warnings for older residents is a reminder that all ages, Vann said, need to take precautions.

“There are asymptomatic cases that we are identifying, which is very concerning from the standpoint that these people feel like their normal selves and yet are spreading the virus to the people around them and in certain cases to older, frail and more vulnerable people. And for this group the infection can be fatal,” she said. “We need to work together to protect them.”

The health department is also tracking hospitalizations in Guilford, which were at 102 on Friday, as well as recoveries, which were listed at 163 that day, the latest information available.

All residents, Vann said, should continue to practice social distancing, wear face coverings, wash their hands and/or use hand sanitizer, and avoid crowded places.

“We want to emphasize the fact that we are not out of the woods yet,” Vann said. “We continue to identify positive cases (in all age groups) in the community and with more testing becoming available we anticipate this number to grow.”

Other counties are encountering different challenges related to an increasing number of cases. In Forsyth County, local health officials reported nearly 100 new cases last week, many of which they can connect to an outbreak at the Tyson Foods processing plant in Wilkesboro.

Forsyth’s overall cases stood at 268 on Saturday, county data show. State data put the county’s death toll at five. The latest information on recoveries showed 124 as of Friday.

Progress in phases

Health experts are encouraged by signs that more coronavirus testing is becoming available.

“This is one area in which we are seeing a positive trend,” Vann said.

Labs have increased their capacity, she said, and “the turnaround time for the results has improved considerably from eight to nine days for some commercial labs to two to three days now.”

While still in the planning stages, the health department is partnering with Cone Health to offer more community testing.

Cagle said Cone Health is also working with health departments in Alamance and Rockingham counties to offer additional testing, as well as contact tracing to more quickly find people who may have been exposed to someone with COVID-19.

Once the community testing logistics are finalized, Cone Health also expects to deploy mobile clinic vans to neighborhoods most in need.

“We’re encouraged” by these next steps, Cagle said.

Vann also noted another positive.

“We are receiving some protective equipment, something that we haven’t seen in almost two months.”

A plan forward

Like other health systems across the country, Cone Health had to temporarily discontinue some of its services, such as elective surgeries.

When asked about the timing for resuming regular operations, Cagle said a task force has developed “a plan forward.”

The first phase would be to resume some procedures by May 11, at a reduced volume, if certain metrics are met to ensure it would be safe for patients and staff, she said.

“Our analytics team is watching data at the national, state and local level,” she said. “Local data is the most important.”

Cagle is hopeful that they are beginning to see the rate of infection begin to possibly plateau.

Akin said the tendency is to breathe a sigh of relief when the numbers are starting to slow. However, he said, it’s not time to disregard precautions that have worked so well.

“I believe we can phase in under the right circumstances,” he said.

Another statistic they are watching is a decline in emergency room visits, likely because people are concerned about COVID-19.

“We don’t want people to be afraid to seek care,” Cagle said. “Our emergency rooms are safe and clean. Everyone is wearing a mask.”

Adjusting to such shifts in patient volumes, Cone Health is staffing accordingly, which means some employees may temporarily experience reduced hours and income.

“We’re trying to do what we can to support them,” Akin said.

Akin said physicians and other staff have been incredibly supportive throughout this crisis.

Health systems across the country have had to take steps from executive pay reductions to furloughs to ease the financial strain of the pandemic. While Cone Health has avoided enacting systemwide furloughs, executives are taking a pay reduction for an undetermined period of time. Akin said he is taking a 35% pay reduction and the cuts decrease to the 10% level for executive directors.

For the long haul

As health experts coordinate patient care for those with COVID-19, Guilford County’s Emergency Management team is also closely monitoring the pandemic’s impact on the community.

The division’s director, Don Campbell, said the ongoing crisis comes with both challenges and opportunities to learn.

“This event has definitely been a change from our normal disaster operations but for the most part our plans have held up under the new challenges,” he said. “With the goal of social distancing, we have relied on our ‘virtual emergency operations center’ system, along with numerous conference calls and webinars to keep our response system going.”

Campbell said they have started to adjust their plans and procedures to help them become more sustainable.

“We anticipate being in some sort of COVID-19 activation through the remainder of 2020 and potentially beyond,” he said.

He feels like the county’s preparedness level is strong, and that the circumstances are encouraging leaders to be creative solution seekers.

“We are still concerned with the availability of certain personal protective equipment items, but some of the items in short supply in the past are slowly becoming more available,” he said. “We still have a ways to go, but I am happy to report that progress is being made in some areas. Funding has not been an impediment at this time, as we have plenty of leadership and financial support to put our plans in place.”

Whether it’s a tornado or another type of disaster, Campbell said there seems to be no shortage of emergencies in recent years.

“My hope is that this event gets people thinking more about having some resources on hand in their home to make it through the next emergency,” he said. “While we do not recommend (nor see a need for) hoarding items, having essentials on hand moving forward would help everyone get through future emergencies and disasters.”

A community in action

Akin praised the community for adhering to the stay-at-home order, knowing that many sacrifices are being made along the way.

“I feel for our small businesses and anyone who has lost income,” said Akin, a former chairman of the Greensboro Chamber of Commerce.

Despite the economic hardships they face, many local businesses are rising to meet the needs of their community by donating supplies and feeding front-line hospital staff. That show of support, Cagle and Akin agree, is what sustains health care workers’ spirits in times like these.

Individuals and groups are also making a difference with their contributions and donations to help medical staff through long, emotional weeks. With no certain end date for the pandemic, ensuring health care workers are also caring for themselves is more important than ever.

“It’s important for staff to replenish,” Cagle said, adding that many support services are available for those who work in the ICU with COVID-19 patients. “We do what we do because we love to give.”

Akin said it’s no surprise to him that Cone Health’s medical teams are tirelessly giving their all to caring for patients, especially those battling COVID-19.

“Our doctors, nurses and other staff are doing heroic work,” Akin said. “It’s inspiring.”


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A 'very different' school year: Under 300 students remain on campus at A&T, UNCG as semester winds down

GREENSBORO — Before the pandemic, the N.C. A&T campus would be hopping on the final day of semester classes.

Students would be hanging out in the sun. Longboarders would roll through campus, and there would be Double Dutch. Inside the new student center, the game room with the pool tables would be packed, the first floor lobby would be jammed with students and the lunchtime line at Chick-fil-A would be crazy long.

Now? The sun still shines, but the skateboards and jump ropes have been packed away. The student center and most all other campus buildings have been locked up tight. About the only people Cortez Starkes sees on campus these days are his suitemate, the cafeteria workers and the exercise group that meets each night in the quad outside his temporary residence hall.

Because of COVID-19, college students at A&T and across the nation left campus and take classes online, and nearly all university employees are working from home. But Starkes, who will get his master’s in business administration this week, is one of only a few students still left on campus at the city’s two state universities.

“It’s like a ghost town,” Starkes said Thursday on the final day of A&T’s spring semester classes. “It’s really quiet.”

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At the start of the spring semester in January, UNCG and A&T together had about 11,000 students living in university residence halls and apartments. As COVID-19 began to spread into North Carolina, the two universities and all other UNC System schools ordered their students to leave campus in mid-March.

All of North Carolina’s public universities let a few students to stay: students who couldn’t get home right away, a number that included many international students; students who had a sick parent at home; students who didn’t have internet access to continue their classes online; and students who had unstable home situations or no place to go.

Across the UNC System, 95% of the 65,000 students living in university housing had vacated their dorm rooms by the end of March. UNCG granted exemptions to about 150 students. A&T allowed about 330 to stay. By the end of April, as students figured out how to get home or made other living arrangements off campus, the on-campus population had shrunk even more — to about 90 at UNCG and about 170 at A&T.

Both Greensboro universities took similar steps to house the students who remained. They moved two students into four-person suites or apartments so each person could have their own room and, where possible, their own bathroom. The main dining hall remained open for takeout meals. The student health center stayed open, too, and campus police and security guards continued to patrol campus. Students can get help in-person from housing office employees who live in the dorms and online from academic, career and mental health counselors.

A&T did some other things to keep on-campus students entertained and engaged. It bought several video game systems and laptop computers to loan out. It covered moving expenses for students who had been living in university-leased apartments several miles from campus. The housing office also arranged for twice-weekly online group workout sessions.

“We are a culture of care,” said John Lowney, A&T’s executive director of housing and residence life. “We are intentionally caring about our students. The students are at the center of what we do.”

UNCG, meanwhile, has twice delivered to students care packages that contain snacks, plants, puzzles and other fun items. And a UNCG employee is assigned to check in with each student weekly to make sure they have what they need to complete the semester successfully.

“We know that living alone can be isolating,” said Cathy Akens, UNCG’s vice chancellor for student affairs. “We wanted them to know there was someone who cared about what they’re doing and how they’re doing.”

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Bas Leyte, a rising sophomore at UNCG, is OK with alone time. He plays varsity basketball for the Spartans, and he has spent thousands of hours in the gym by himself working on his game.

But a nearly empty campus, usually home to 20,000 students, is a little unnerving.

“It is what it is,” Leyte said in a phone interview last week . “I don’t have a big problem with what’s going on at this time. I’ve got a routine going before I drive myself completely crazy.”

On weekdays, Leyte is out of bed by 9 a.m. He works out in his new-to-him on-campus apartment with dumbbells and resistance bands, following a program set up by UNCG’s strength and conditioning coach. He heads over to the cafeteria about midday to pick up lunch and bring it back to his apartment.

Next is classwork and a FaceTime call with his mom back home in The Netherlands, which is six hours ahead of Greensboro. His parents and two sisters are healthy, Leyte said; “they’re doing their part” to stay safe.

About 3 p.m., it’s time for another workout. This time, it’s basketball drills, sometimes by himself near his dorm, sometimes with teammates at a nearby city park. He’ll dribble and pass and work on footwork. There’s no shooting because the city has covered up all the basketball goals and UNCG’s gyms are closed. Sometimes he’ll run, but he’s taking a break from jogging because the pavement is tough on his knees.

“I’m in pretty good shape right now,” Leyte said. “But there’s only a certain amount of shape I can be in considering this situation.”

Around 6 p.m. Leyte will fix dinner. (Chicken fajitas, he said, are his go-to.) At night he’ll watch shows on Netflix and play video games. He’s bingeing the drug lord drama “Narcos,” something his head coach recommended. His video game of the moment is Fortnite, which he usually plays with his classmates from the New Hampshire prep school he attended before enrolling at UNCG.

Weekends, he said, “are for relaxing”: more shows, more video games and a break from school work and basketball.

Most days, Leyte said he sees almost no one except his suitemate, another UNCG basketball player. Until students had to leave campus, the two shared a dorm room. These days, they pretty much keep to their own rooms.

“We don’t want to get too close to each other,” Leyte said. “We take the social distancing pretty seriously.”

Leyte celebrated his 19th birthday on April 4 by himself. His coach sent over an apple pie cake — “It was delicious,” Leyte said — and he did homework.

Leyte said he probably could have gone home when UNCG closed its campus. But the Netherlands has been more locked down than the United States, and Leyte was worried that he wasn’t going to be able to work out or play basketball despite his mother’s offer to rebound his shots. And even if he could make it home, could he get back to Greensboro before the fall semester in August? His coaches are here and basketball is here, so Leyte chose to stay on campus until he could move into an off-campus apartment in early May.

Leyte said he’s alone but not lonely. He’s making the best of a quiet campus and an unprecedented situation.

“I’m trying to be positive,” Leyte said. “I don’t think being negative about it would help anybody.”

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It’s not hard for Cortez Starkes to count the number of people he sees each day on the A&T campus.

There’s his suitemate, whom he has lived with for the past three semesters. He might see one other person when he goes out for a run. The other day, when he went to the dining hall to get food, he counted three cafeteria workers and one other student.

And if he looks out the window about 6 each night, he’ll see seven to 10 people exercising together in the quad outside his residence hall.

“That’ll be the most amount of people you’ll see at any one time,” Starkes said. “Other than that, you don’t see anybody.”

Though Starkes compares the feeling of living on a nearly empty college campus to being grounded, it’s not like he’s stuck in his dorm room. He’ll grab meals at the cafeteria or the 1891 Bistro, the only two eating spots still open at A&T. He’ll drive to get fast food. He walks his service dog, Nyla, a mix of terrier and American bulldog, several times a day. And he’ll use the computer lab or laundry room in his residence hall.

“It definitely doesn’t feel like you’re in school,” Starkes said.

“At times you feel like you’re the only person in the building.”

The 25-year-old Starkes was living and working as a graduate assistant in a university-leased apartment complex when A&T announced in March that students would have to leave campus. (Graduate assistants work for the university housing and residence life office and oversee the resident assistants.) Problem was, Starkes had been on his own for the past eight years and had nowhere else to go. He hasn’t lived at home in his native Greenville, S.C., since going off to college in 2012. After graduating from Gardner-Webb University in 2016 and before enrolling in A&T’s MBA program two years later, he rented an apartment in Charlotte.

A&T agreed to move Starkes and his roommate, also a graduate assistant, to a four-bedroom suite on the main campus. The two are pretty tight. Starkes said they watch TV and play video games together in the suite’s common area but try to keep their distance the best they can. They don’t wear masks inside, but Starkes said they’re careful to wash their hands each time they leave and return to the suite.

Starkes said he’s keeping in touch with family back home. On Easter Sunday, he picked up pot roast and collard greens from a restaurant near campus and joined about a dozen other adult family members on a Zoom call. One of his uncles, a pastor, led them in prayer. Everyone showed off the meals they had made or bought. Normally, the whole family — parents, grandparents, uncles, aunts, cousins — would have gone to church, shared Easter dinner and hunted for Easter eggs. But in this time of coronavirus, a virtual get-together was the best everyone could do.

“It was nice to see everybody,” Starkes said. “But at the same time I missed everybody being all together.”

To pass the time, Starkes is applying for jobs, finishing up his classes and getting ready to move to Raleigh after graduation. He has nothing but praise for A&T during this unusual time. “I think they did they best they could to accommodate students,” he said.

But, he added, “it was very different this year. Very different.”


Z-no-digital
An interesting article in today's newspaper

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Saturday's COVID-19 numbers

Number of N.C. cases: 11,509 as of 11 a.m. Saturday, according to the N.C. Department of Health and Human Services. That’s an increase of 586 cases since Friday.

In the Triad: Guilford County has 437 cases, Forsyth (266), Randolph (228), Davidson (180) Alamance (121) and Rockingham (26).

Deaths: 420 statewide, an increase of 21 since Friday, according to state health officials. That includes 31 in Guilford, one more than on Friday, the state says.

Hospitalizations and recoveries: County data has not updated since Friday, when Guilford was reporting 102 people hospitalized, and 163 recovered from the coronavirus.

Across the U.S.: There have been 1.09 million confirmed and probable cases in the United States and its territories as of Saturday, an increase of 30,326 new cases, according to the most recent update from the Centers for Disease Control and Prevention. The CDC reported 64,283 total deaths, an increase of 1,829 in one day.