Many pandemic trendlines are positive, as reflected in the easing of mandates and restrictions across North Carolina and the U.S.
But at Chatham Hospital, Dr. Andrew C. Hannapel, the institution’s chief medical officer, tells the News + Record there’s reason for concern — as well as optimism. As in past conversations with the CN+R, Dr. Hannapel is still sounding a warning bell: this time about COVID admissions (fewer elderly, but more young people), vaccination reluctance, strains of the virus and why — despite being fully vaccinated — he still masks up.
Dr. Hannapel received his Doctorate of Medicine from George Washington University in 1992. He did his internship and residency at the Womack Army Medical Center Fort Bragg and served in the U.S. Army until 1998, when he joined the Department of Family Medicine at UNC.
Since then, he’s served as faculty for the family medicine residency program, training and teaching medical students, physician assistant students and family medicine residents. In 2016, he became the first Chief Medical Officer at Chatham Hospital. The following year, he began the work that has resulted in a family medicine residency training tract opening June 2019 at the Piedmont Health Services Siler City Community Health Center, and the opening of the Maternity Care Center at Chatham Hospital last year.
The lifting of some of the mask and public gathering mandates by Gov. Cooper seems to be a good sign for North Carolina’s fight against COVID-19. What are you seeing on the ground level at Chatham Hospital? What trends, good and bad, are on your radar?
The lifting of the mask and public gathering mandates are a good sign that we are moving in the right direction. North Carolinians must continue to practice the behaviors of the 3 Ws to protect themselves, neighbors and families.
At Chatham Hospital, we continue to wear our masks and eye protection devices to protect our workers, our staff and our patients. We continue to see COVID-19 cases, although fewer in number when compared to January. When they do come to the hospital, they are very sick and of varying ages. In fact, we are seeing a lower number of elderly COVID patients from nursing homes and congregant living, and larger proportion of younger (30-50 year old) COVID patients requiring hospitalization.
The Chatham community continues to benefit from our relationship with UNC where they take on our sickest patients requiring higher ICU needs with oxygen and ventilator support. So while we are doing much better as a county, state and country, we continue to have people sick from COVID requiring hospitalization and intensive care. We still have significant community spread of COVID-19. We are not out of the pandemic. Yet.
With fewer people hospitalized, is there more of a sense of normalcy there at the hospital?
This is our new normal. Chatham Hospital will continue to have COVID patients along with our regular patients. We are seeing non-COVID patients who require higher levels of care. What I can’t tell you is the exact reason why — is it that people are sicker when they come to the ER and hospital, due to a delay in seeking care or concerns of coming to the hospital because of COVID-19? Is it less regular health care and access because of the pandemic? I know that we work at Chatham Hospital to keep Chatham residents here when they need to be hospitalized, unless they need care or services that exceed our resources. Again, we benefit from our strong relationship with UNC Medical Center.
About half of Chatham residents have at least gotten partially vaccinated. Those numbers will continue to go up because supplies now seem to be plentiful. What’s concerning, though, are two things: first, the number of those who’ve gotten the initial vaccination but skipped out on their appointment for a second Pfizer or Moderna shot, and second, the reluctance of a still significant part of the populace who say, “No, not getting it.” What’s your reaction?
Getting vaccinated against the virus offers us all the single greatest chance to return to life as we knew it before the pandemic.
Some would argue life has changed. Undeniably our lives have changed. But when we think about our children returning to school, gathering for family reunions, engaging with our faith-based organizations, we must account for every single person’s safety. When we have only one-third of our community fully vaccinated, we cannot assure every single person’s safety. When people take only one of the full two doses of vaccine, they are not sufficiently protected against the virus. Those who can receive the vaccine should step up and take it. (There are some in our community who are unable to take it due to health-related concerns or because they’re under 16 years old.)
Chatham County vaccine rates are as follows (CDC and NCDHHS data as of May 2, 2021):
• Fully Vaccinated: 25,620
• % of population: 34.3%
• Vaccinated Population >= 18 years old: 25,452
• % of vaccinated pop >=18: 42.7%
• Vaccinated Population >=65: 12,124
• % of vaccinated pop >= 65: 65.1%
There are no approved vaccinations for the population <16 years old.
For those in our community who say they will not get the vaccine, I ask: Consider your great aunt. Consider the elderly and vulnerable in your family and communities. Consider your children. Consider your co-workers. Consider your neighbor. All of us are responsible to protect and provide for those who cannot do this for themselves.
This is our duty as Americans — to come together with purpose to fight the virus. We need to recognize that the enemy is the virus, and not our neighbor.
We’ve discussed the mask issue ad nauseum, it seems, but you can still go into some retail businesses in Chatham County where — despite signs on the door — staff inside aren’t masked. One local business even has a sign outside proclaiming that COVID-19 is a government hoax. What are you advising, as a health professional, when it comes to masking up (indoors, outdoors; vaccinated vs. not vaccinated, etc.)?
On the question of masking: there is a lot of information and misinformation about masking, particularly as our lives and opportunities open up. Some of the misinformation simply ignores science. Some misinformation is to scare and purposely divide people. I care about information that is true and proven based on the science. Masking has proven to make a difference in this pandemic. It’s not complicated. Is it a mandate? Yes. Is it an inconvenience? Sure. Is it lifesaving? Absolutely.
Let me share my personal standards for masking: I am a fully-vaccinated physician exposed to COVID-19 patients on a weekly basis. Even though I am fully vaccinated, I wear my mask in all group settings where I am in the company of people I don’t know or know their vaccination status. Masking is a very personal issue for me. I don’t ever want to ask myself: could I have done something more to prevent someone from getting COVID?
What do you see happening with COVID trends and numbers as summer approaches?
The trend of younger, relatively healthy patients being hospitalized due to severe COVID-19 infections is very concerning, especially when we now have vaccine available to everyone 16 years of age and older. We know the vaccine works against all of the COVID strains and/or variants we have seen, and prevents hospitalizations and deaths.
The trend of variants is such that we are now seeing the B 1.1.7 (UK variant – 45%) and B 1.526/.1/.2 (NY variant – 46%) as the predominant strains with higher transmission and infectivity. We see that the increase in these strains coincided with the increased positive test rates and hospitalizations in the past several months. We saw a North Carolina high of greater than 5,000 hospitalizations that peaked January 10-12, then fall to a low of 860 COVID hospitalizations/day in mid-March. Since that time, we have seen an increase and plateau to 1,100-1,150 hospitalizations/day. This is still higher than our peak during summer 2020. However, we are now seeing trends in lower positive test rates that speak to the work that North Carolinians and Chatham County residents are doing — including most important: masking, distancing, washing hands and above all, vaccinations.
Remember, we see an increase in positive testing and then two to four weeks later an increase in hospitalizations. I suspect that the increase in hospitalizations we are seeing now is a result of the opening up of our region in March and April (spring break, in-person school re-opening, opening of gathering places-gym and restaurants and the general increase interaction of people in groups).
Finally, how’s your staff there? We focus (in a feature in this week’s edition of the News + Record) on your nursing team this, but last time we checked in, we discussed the hardships that medical staff and other front-line workers were facing. It’s been a few months – have you and your staff had a chance to catch your breath?
We have had a chance to catch our breath and reflect – a little (see above about the high hospitalization rates of non-COVID patients.)
Let me address it this way: When I was in the Army, I learned that soldiers in high stress situations (combat) would push themselves, and once past that situation, they would be mentally, emotionally and physically exhausted, and begin to reflect on the trauma of their experience.
While we are resilient and seasoned professionals, I am concerned about the cumulative stress and fatigue for our staff, employees and providers. UNC Health has offerings of support and care opportunities for their personal well-being. Exhaustion is a very real factor right now and is reflected in our entire community and country. As we lift our heads from the pandemic and look to the horizon, we are able to reflect on the past 15 months. Our community is witnessing the impact on our individual and collective mental health. How do we address this with the limited and under-resourced mental health system that we have in our county and state? That is the challenge going forward. I will say it again — we are not out of this pandemic.
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