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Nina Oliver: Health Department responded quickly, investigated Citadel outbreak

By Nina Oliver

Admittedly, COVID-19 has brought many challenges to everyone throughout the United States. Here in Rowan County, we have the good fortune of having excellent leadership in the medical community.

Gary Blabon, president of Novant Health Rowan Medical Center, has been with us every step of the way during this crisis. Novant Health Rowan has been especially supportive and has offered supplies, resources and physician expertise to the county, specifically regarding the Citadel. Under Gary’s leadership, the community has two amazing experts, Dr. Tom Trahey, chief medical officer of Novant Health Rowan Medical Center, and Dr. Yomi Agbebi, lead infectious disease physician. They have worked tirelessly to provide assistance to the Rowan County Health Department in developing treatment plans and care protocols for the skilled nursing facility.

We will continue to collaborate with the professional expert advice provided by Drs. Trahey and Agbebi.

While we appreciate Dr. John Bream’s passion and concern, the frustration expressed in his opinion column published in the Salisbury Post is misdirected.

The Rowan County Health Department and Novant Health Rowan Medical Center responded quickly to positive case information received from the official North Carolina State reporting system. We then worked with the facility and Novant Health Rowan to perform testing within 24 hours and implement on-site plans for containment. Our personnel then hand delivered the tests to the state testing facility in Raleigh and received results according the highest priority timeframe.

As with any outbreak, the health department conducts extensive case investigation. According to the Centers for Disease Control and Prevention, given their congregate nature and pre-existing risk population (e.g., older adults often with underlying chronic medical conditions), nursing home populations are at the highest risk of being affected by COVID-19. The health department responded urgently to test and set on-site standards for containment.

The Rowan County Health Department’s primary authority includes investigating and tracing potential community spread and assisting the facility with implementation of plans to limit on-site spread. The health department is not permitted to contact family members of those who test positive for COVID-19 if there is no risk of exposure. Patients at long term care facilities are not patients of the health department, and our response is to notify the patient or facility where the patient resides.

In this case, the health department relies upon the long-term care facility to communicate patient status to those family members who are entitled to receive status updates.

Immediately upon notifying the Citadel of the risk of an outbreak, the Citadel agreed to follow CDC and N.C. Department of Health and Human Service guidance as it was issued. Rowan County organized multiple daily calls with the Citadel administration and Novant that included extensive guidance on appropriate disinfection, appropriate need for and use of personal protective equipment, accessing PPE, accessing testing supplies, testing for residents and staff, infection control measures and investigation information.

Below is a recent timeline of factual events:

• April 7: First Citadel case identified by the Rowan County Health Department. The department had a preliminary discussion with Citadel administration regarding infection control measures, containment and prevention.

• April 8: Received confirmation of additional positive cases at the Citadel. The health department identified and reported the Citadel outbreak to the N.C. Division of Public Health as required by law.

• April 8: The health department had a conference call with Dr. John Bream to discuss Citadel situation per Dr. Bream’s request.

• April 9: Conference call between Novant Health Rowan Medical Center, the Citadel, and health department. A Rowan County Health Department communicable disease nurse conducted a site visit at the Citadel. Novant donated specimen collection kits to Citadel to complete resident testing.

• April 10: Conference call between Novant Health Rowan Medical Center, Citadel and health department to discuss situation progression. The health department received Citadel resident specimens at approximately 8:45 p.m.

• April 11: Rowan County Health Department packaged resident specimens and emergency management delivered specimens to N.C. State Lab in Raleigh. We received testing supplies from the state to facilitate testing Citadel staff.

• April 13: The Rowan County Health Department received test results and sent to Citadel administration (approximately noon) and coordinated investigation process with Citadel administration.

• April 13: Conference call between Novant, Citadel and health department took place. Citadel administration conveyed that they started the process of notifying families, continued the discussion regarding infection control measures, containment and prevention. There were 21 specimen collection kits given to the Citadel for testing of staff.

• April 14: Emergency management worked with Citadel administration to order necessary supplies. Citadel administration conveyed that they continued the process of notifying families. A Rowan County Health Department communicable disease nurse and environmental health specialist conducted a second site visit.

• April 15: Conference call between Novant Health Rowan, Citadel and Rowan County Health Department took place. Citadel conducted staff testing, with 21 additional specimen collection kits given for testing of staff. Continued the discussion regarding infection control measures, containment and prevention.

• April 16: Rowan County Health Department had a conference call with the State Outbreak Coordination Team.

• April 17: Began to receive staff test results from State Lab. Rowan County Health Department began staff investigations and interviews.

• April 18: Received additional staff test results; continued staff investigation and interviews.

• April 19: Discussion with Citadel administration regarding status of residents and staff management.

• April 20: Conference call between Novant Health Rowan Medical Center, Citadel and Rowan County Health Department. Continued the discussion regarding infection control measures, containment and prevention.

The Rowan County Health Department will continue to work in collaboration with Rowan Medical Center in compliance with all state and federal rules, regulations and laws.

Nina Oliver is the Rowan County public health director and the head of the Rowan County Health Department.

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