Mountaire, nursing homes and drive-thrus: The story (so far) of COVID-19 testing in Chatham County

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As of Sunday, Chatham County’s 578 reported positive COVID-19 cases made up 2.5 percent of the state’s total cases. The county only makes up 0.7 percent of North Carolina’s population.

Why is this the case? To Piedmont Health Services CEO Brian Toomey, it’s simple.

“Chatham County has been willing to talk about it and address it and be sure the community is willing to engage with this,” Toomey said. “It’s the way everybody should do it. You’re in front because you’re leading — not because there’s something wrong with you. Chatham County should be proud.”

The infrastructure that produces the numbers of positive COVID-19 cases in Chatham County, North Carolina and around the country is testing, and the state government has relied on numbers of tests conducted as part of its procedure for “re-opening” businesses and other operations. Testing in Chatham County has taken different forms since the first COVID-19 cases were identified in the county in early March — and according to health officials, it’s played a major role in how the county has responded to the novel coronavirus crisis.

When testing happens

The test for COVID-19 is a bit invasive, to put it mildly. A six-inch long Q-tip-like swab is inserted into the nostril and pushed back to the cavity between the nose and mouth. The swab is held in the cavity for 15 seconds and rotated several times. The procedure is then repeated through the other nostril.

Testing has been a common thread throughout the COVID-19 response. The first Chatham resident to contract the virus was tested after he was determined to be a contact to a case in Georgia. Two more cases were announced two weeks later, at which time county Health Director Layton Long said that “as testing for the new coronavirus ramps up, we are expecting to see more cases.”

Increased testing has led to increased numbers, as Long predicted. The News + Record began posting a daily tracker of cases on its social media accounts on March 31, when there were 16 positives in Chatham County. As of Sunday, May 24, 54 days later, that number has grown to 578, an average of more than 10 new cases reported a day.

Why is that the case? While testing numbers for all counties are not available, officials have stated that Chatham has been on the receiving end of more testing than many other counties, particularly due to the mass testing at The Laurels of Chatham long-term care facility in Pittsboro and Mountaire Farms poultry processing plant in Siler City. As of Friday, there had been 1,707 COVID-19 tests conducted in Chatham. The number of cases in the county as a result of this testing, Long said, has “predictably risen.”

The Laurels of Chatham received universal testing courtesy of UNC Health on April 10 after six people associated with the facility had tested positive earlier in the week. The tests returned an additional 51 positives. Mountaire Farms became the site of another Chatham outbreak in mid-April, and testing was offered for symptomatic employees and family members on April 23-24.

Piedmont Health — a regional medical provider which includes Chatham in its coverage area — conducted tests at its Moncure and Siler City clinics in the early weeks of the pandemic — 149 in the first four weeks, most of March. Just two positives were returned.

“We were thinking, ‘Hey, despite the first case in Chatham, we’re OK,’” Toomey said. “That was a mistake. The next week by itself, we tested 90 people in all of our sites and of those 90, we had 51 positives.”

Focus on Mountaire

The testing at Mountaire Farms in Siler City received a sizable amount of media coverage and attention from community members as members of the N.C. National Guard descended on the Third Street facility on April 23. The Guard was assisted by the N.C. Dept. of Health and Human Services, N.C. Emergency Management and Piedmont Health.

Dr. Shannon Dowler, the chief medical officer for North Carolina Medicaid and the Vulnerable Population Workstream Leader for Health and Human Services during the COVID-19 Response told the Defense Visual Information Distribution Service (DVIDS) in mid-April that the call came from within the Chatham community.

“They had noticed an increase in cases in the plant workers in their community they served,” she said. “As we dug into the numbers we saw that in fact, we were starting to see a trend and a rise in cases, so we wanted to partner with the local community to make sure that we did reasonable testing and surveillance to get ahead of this so that we can plan where it might be traveling to next.”

Both Toomey and Long were highly complimentary of the work at Mountaire. Toomey called the N.C. Guard the “unsung heroes” of this event who “haven’t been given enough credit in this process.” Long said in a May 1 press release that it “was a team effort and was the first of its kind in North Carolina.”

The DVIDS report stated that more than 170 tests were performed on the first day with around 400 expected to be completed by the end of day two. Mountaire spokesman Catherine Bassett told the News + Record the company was “still waiting” for positive test numbers “from the agencies involved in the testing,” but had no intentions to “release those numbers publicly.”

Bassett said the company has been “following all CDC guidelines” on employees testing positive returning to work — that “employees should return to work only if they have had no fever for at least three days, their symptoms have improved, and it’s been at least 10 days since their symptoms first appeared.” She added that Mountaire has been continuing to implement safety precautions like plexiglass dividers on the production line, deep-cleaning facilities every night and temperature checks before every shift.

“All of our processing plants have had visits by the state health department and the CDC and each time we were applauded for the proactive steps we’ve taken to prevent the spread of this virus,” Bassett said. “We’ve done everything possible to protect our workforce because we know how valuable they are to our business.”

The senior sick

Toomey said all the attention being on Mountaire, while understandable, is missing the “highest risk places” for death — nursing homes.

“There’s a lot of things that keep me up at night, but frail elders feeling helpless in a place, and workers as well, that’s just a horrible thought for me,” he said.

Piedmont Health operates SeniorCare services under the PACE (Program of All-inclusive Care for the Elderly) moniker. The Pittsboro SeniorCare center, which provides medical and social services to seniors living at home by busing them to the facility, is 417 feet from the Laurels of Chatham, according to Google Maps. Some of PACE’s participants in Chatham live in Laurels and the Siler City Center of Genesis Healthcare — the two nursing homes with COVID-19 outbreaks in the county.

Since the initial 57 positive cases of residents and staff tested at the Laurels, the numbers have continued to grow. As of Friday, 40 residents and 69 staff had contracted COVID-19, with 21 residents dying. At Genesis, 15 staff and 33 residents tested positive for the virus and two of those residents have already died.

Long-term care facilities were a target of testing and concern from the beginning of the pandemic in Chatham County.

“In terms of their medical vulnerabilities, the physical isolation, the shelter in place, plus the social distancing that we’re have to do in this situation, I think just compounds the problem,” Dennis Streets, the director of the Chatham County Council on Aging, told the News + Record in April. “A lot of them do have conditions, chronic conditions, often more than one that might be respiratory in nature, which is one of the big factors with this disease as well as other factors like heart disease.”

Nursing homes and other congregate living facilities have also become a focal point of the state government’s response to COVID-19. Early executive orders from Gov. Roy Cooper enacted stronger restrictions on visitation and heightened monitoring of residents in such facilities, and each of the three phases of Cooper’s original “re-opening” plan included “continu(ing) rigorous restrictions on nursing homes and congregate care settings.”

Toomey said more people need to pay attention to what’s happening in these facilities and less on Mountaire. Testing at the latter, he said, has shown no deaths, while facilities for seniors have produced nearly 400 as of Friday.

“We can’t lose sight of where the fatalities and the mortalities are,” he said. “They’re all important.”

Enough, but limited

Piedmont is currently continuing to offer drive-thru testing at its Moncure and Siler City locations, and will host a special testing event in Lee County on May 27-28, modeled after the Mountaire event. Anyone with COVID-19 symptoms, close contacts of known positive cases and anyone at higher risk for disease are eligible to be tested.

The qualifications for receiving a test have expanded from the early days of the virus, when supplies were limited to frontline health workers, emergency responders and others showing all the known symptoms of COVID-19. Long said in early April that his department had to “prioritize testing to close contacts and those who showed symptoms due to a limited supply of tests available to us.”

Toomey said Piedmont Health has access to enough tests to provide them to those who qualify — a sort of “Phase 2” of testing.

“But when you look at those guidelines, everybody wishes they were expanded, because that way we could know more,” he said. “There are just not enough supplies and there’s just not enough PPE for us to do what we want to do. It’s enough for now but it’s not nearly what we all want or need to feel safe and secure going forward. We’ve got to get to a place where everybody can know, but we don’t have enough tests.”

Testing has been a key measurement in the state government’s decision to return to “normal,” with one of the barometers being asking whether the state has the capacity to test an average of 5,000-7,000 people per day. As of Friday, the state reported that 303,224 tests had been conducted, with the numbers of tests conducted per day higher than 7,000 over the previous 10 days, and that increase was one of the deciding factors for North Carolina moving into Phase 2.

“North Carolina is using the data to guide our decisions about when to lift COVID-19 restrictions, and overall our key indicators remain stable,” Cooper said last Wednesday. “Safer At Home Phase 2 is another careful step forward, and we have to continue taking this virus seriously to prevent a dangerous spike in infections.”

Toomey encouraged those showing symptoms to get tested, and said all Chatham residents should be thankful for the county’s leadership during the pandemic.

“The commissioners the county manager, the health department — they haven’t tried to put this on somebody else,” he said. “They’ve looked at this problem straight on and have done this with the best interest of Chatham County residents. They can feel really good about this leadership, and you cannot say that about the other 99 counties in North Carolina.”

Reporter Zachary Horner can be reached at or on Twitter at @ZachHornerCNR.


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