Serving, and surviving, on the pandemic’s front line

‘We started this like a sprint and quickly moved into a marathon, and now we’re in an ultramarathon. This is life for the foreseeable future.’

Posted 10/23/20

The coronavirus pandemic continues around the world, but here at home a focal point in the battle has been Chatham Hospital in Siler City. This week, we speak with Dr. Andrew C. Hannapel, Chatham …

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Serving, and surviving, on the pandemic’s front line

‘We started this like a sprint and quickly moved into a marathon, and now we’re in an ultramarathon. This is life for the foreseeable future.’

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The coronavirus pandemic continues around the world, but here at home a focal point in the battle has been Chatham Hospital in Siler City. This week, we speak with Dr. Andrew C. Hannapel, Chatham Hospital’s Chief Medical Officer, about what it’s been like on the front lines.

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.

He did shifts in the old Chatham Hospital Emergency Room until 2009, when he started to work close to full-time in the Chatham Emergency Department and later as a hospital physician, developing the hospitalist service and family medicine rotations at Chatham Hospital.

In 2016, Dr. Hannapel 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 month.

It’s becoming clear, seven months into the COVID-19 pandemic, that it’s not going away anytime soon. We’ll go back to the beginning in just a minute, but for now … can you share with us how you’re looking at the pandemic today, and how you and your staff have had to adjust your thinking about it, particularly as we move toward another winter (and with cases on the rise in some places)?

COVID-19 is not going away anytime soon. In fact, North Carolina is on the rise again with new cases topping 2,000/day and total cases approaching 250,000 and deaths 4,000. While all these are very concerning, the most predictive number is that hospitalizations are increasing and above 1,100, and quickly approaching the peak numbers we had at the end of July.

The predicted peak of this surge is in six to seven weeks, IF we continue with the current measures of physical distancing, mask wearing and current closures. However, we know winter is coming and that means people will be inside more and that increases the spread. The models cannot take this into account.

We started this like a sprint and quickly moved into a marathon, and now we’re in an ultramarathon. This is life for the foreseeable future.

Chatham Hospital has been a focal point throughout the pandemic, but probably in ways most of us can’t imagine. For a time Chatham County was a hotspot for cases, and in addition to treating those affected, you were also doing COVID-19 testing — all the while trying to keep your staff safe. Looking back, what part of all of this has been the most difficult for you, personally, as a physician, since the first case was reported in Chatham County back in March?

The most difficult part of this for me is keeping our people safe while they provide care for those sick with the virus. Also, the people, our patients, sick with the virus, were the ones suffering. In seeing this we are constantly aware of the burden to patients and families — whole communities, and what they carry when disasters like this pandemic are upon us. The courage of our staff to come to work and continue to render care to the sick, and in doing so, risk their own health and the safety of their families, is a constant reminder of the need to look out for them, protect and support them.

Remember that there has been a lot of new information in the beginning and throughout the pandemic. Putting that into place with confidence that all of our staff and healthcare providers would be safe while providing the best care for our community was difficult. The information changed constantly as we learned more about the virus and how to treat it. Also — how best to protect our staff with masks and eyewear ... the concern that we would not have enough PPE to protect our people. The measures that we had to take to keep patients and healthcare workers safe meant no visitors for our patients.

This was very difficult. Mostly for our patients and families — but also for our staff. We know that patients need their families and support of loved ones to affect their recovery. I was privileged to see our staff provide high quality, professional and real care — empathic and supportive to all our patients during this time.

Let’s talk about care. This is such a complex problem because the learning curve for COVID-19, specifically treatments, probably hasn’t been easy to follow for medical professionals. What was foremost in your mind and effort during the spring months, when things were so complicated and healthcare providers were learning on the go? Your charge is to help people get well, so it must have been an extraordinary time …

Chatham Hospital benefits from being part of UNC Health. We are directly supported by a healthcare system, medical center and medical school that is at the forefront of research and understanding of SARS-COV2. The up to date information flowed from UNC in a regular fashion. How to take care of our staff, our patients, our community ... The access to this information and the transparency of data was revolutionary.

You saw the Johns Hopkins website — phenomenal information at many levels — all the way down to county and zip codes. Well, UNC developed similar dashboards for UNC Health that gave us patient data, materials and supply chain data (PPE). Also N.C.’s Department of Health and Human Services has been providing this data — transparency, really remarkable.

The other benefit of UNC Health is that by mid-March they had developed their own COVID-19 PCR test. Dr. Melissa Miller and her lab are responsible for that. We had access to that resource early on. The Chatham community had the ability to have testing that not all systems had.

So, it is information and knowledge dissemination and tools (testing) to affect major decisions for patient care...

Also — the medical experts at UNC, infectious disease and critical care specialists. The UNC AirCare team that transports the sickest patients. When we were in the midst of the surge of COVID-19 cases in Chatham County, UNC Medical Center had our back. They took our most severely ill patients to their COVID floor and COVID ICU. Remember that at one time, more than one-half of the ICU patients were from Chatham County and Chatham Hospital.

We tend to forget that, in the midst of increasing numbers of cases, Chatham Hospital was also, number one, caring for the needs of patients with other health challenges, and number two, working toward the opening of the new Maternity Care Center. How did you and your staff make all that work?

We had a plan, a tiered approach for handling increasing numbers and acuity of patients presenting to Chatham Hospital. We are linked to the UNC Health system through UNC Medical Center. This allowed us to transfer the critically ill patients to UNC.

This tiered system is separated into the inpatient department and the emergency department. We progressed to the 2nd tier for inpatient care (opening up the pre- and post-surgical areas for acute and subacute hospitalized patients) and stayed at the 1st tier for the ED. We still have those plans and procedures available and ready to use in the coming months.

The construction of the Maternity Care Center began Feb. 28. We had a dedicated general contractor who put into place safety measures that kept his workers safe. They worked with our infection control team and physical plant engineering to keep the workplace and patient space separate. Sounds like an obvious, “no-duh” type of thing to do. But this is complicated. Air flow and air quality is monitored. Hepa-filters filter the air in the construction area to make sure that particulate matter does not get into patient care areas. AND the air in patient care cannot mix with the work place area.

These people are the heroes. They made sure the construction could continue and allowed us to open on time — Sept. 8, 2020.

We have an ill patient population in the hospital — acute inpatient, and a sub-acute patient populations. Subacute patients receive medications, physical, speech and occupational therapies to aid in their recovery from their acute illness. Sub-acute patients were moved to the pre- and post-surgical areas to remove them from potential exposure to COVID patients. Our surgical cases are mostly elective. These were shut down from late March through June to accommodate the anticipated and realized higher volumes of acutely ill patients.

Chatham Hospital is a service provider, ultimately, but the community’s needs necessitated you collaborating and integrating your work with other entities in and around Chatham. Can you talk about how you’ve partnered and teamed up?

I am so pleased that you asked this question. The team at PHS — Piedmont Health Services and the Chatham County Health Department — really worked together to ramp up and provide the community with services that were needed. The outbreak of COVID-19 at Mountaire took a tremendous effort by our community partners and Mountaire to take the necessary steps to manage and control this outbreak.

This was the first major outbreak in NC. It took UNC Health time to stand up a Respiratory Diagnostic Center at Chatham Hospital for testing. Especially, the work by PHS to provide the testing at their clinic and sound the alarm bells that brought the state health department and state government and their resources for mass testing to bear. Remember that a civilian test team of the N.C. National Guard came on site at Mountaire to conduct that testing. This was not easy. This became the model for testing at animal processing and meatpacking plants in the state.

There’s probably no way to adequately describe what these months have been like for your staff — not just the frontline care providers and doctors, but staff who keep the hospital clean, who help handle family members of sick patients, and who do other things that might not be noticed by anyone stepping into the hospital. What can you say, or share, about what your staff has been through?

Courage. Devotion to and care for our patients. Steadfastness. Adaptability. Situational awareness. Looking out for each other. Teamwork.

I already spoke to the courage it takes to come to work and care for the sickest of patients with the potential to impact their own health as well as their family. This is more than just punching the clock and getting a paycheck. These nurses, doctors, physician assistants, medical and nursing assistants, registration clerks, cafeteria and dietary personnel, plant engineering and maintenance, environmental services, materials and supply chain, security, OTs, speech and PTs, department directors, administration and executive teams — ALL OF OUR TEAM — each contributed and executed their part in the plan to stand up Chatham to care for our community during this COVID-19 pandemic.

How has COVID changed, or how is it changing, how hospitals work?

It is changing everything. There isn’t a place in the hospital or healthcare in general that has not been changed.

Where do you see all of us and our relationship with the coronavirus a year from now?

Coronavirus will still be with us, next year and the years to come. So much depends upon the response of this country to unity of purpose. Nothing will ever be the same or go back to “normal.” Never. But how we adjust and come to agreement on priorities in this country and develop and implement a plan to affect those priorities is paramount to where we will be in a year — or two years.

Let’s wrap up with two topics. First: masks. How important are face coverings now?

Masks are the SINGLE MOST IMPORTANT ACTION that the American public can do to protect themselves and, most importantly, each other. I know and believe that individual freedom is a guiding principle in America. But individual freedom stops being so when its action directly infringes on fellow Americans’ freedoms. To wear a mask is a gesture of respect, a community service and our patriotic duty to protect fellow Americans.

And second: what can you tell us, from your perspective, about potential vaccines?

From what I have read and heard from our UNC infectious disease specialists, there are many in various stages of development. The process of the COVID-19 vaccine development has been accelerated by doing several steps of this development at once without sacrificing safety.

Prior vaccine development was limited by doing each step separately and consecutively. The federal government support through funding guarantees and grants allows these companies to do these individual steps concurrently. This cuts down the amount of time from development to approval without affecting safety. I have confidence that the FDA will not grant approval unless the vaccine(s) are safe and effective.


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