Editor’s note: COVID-19 poses an increased risk for severe illness or death in people over 65 years of age. Carolina Public Press previously identified 20 North Carolina counties that have the highest percentage of their population in the high-risk age range for COVID-19, nearly all of them rural. This is the third installment in a six-part series looking at the health care systems in those counties. This article focuses on Moore and Chatham counties, at the state’s center.

At Pinehurst Resort, which calls itself The Cradle of Golf, the novel coronavirus that causes COVID-19 has placed business at a handicap.

The world-renowned golf resort in the Moore County village of Pinehurst has welcomed guests since 1895, and with the possible exception of the influenza pandemic of 1918, COVID-19 represents its biggest health and safety-related threat ever.

The famed resort is now open again after a mandatory shutdown.

[The latest: North Carolina coronavirus daily updates]

For arriving guests, a walk around the grounds presents some eye-catching changes: bunker rakes have been removed and golfers may rake bunkers with their feet, spa clientele must wear masks at all times, the steam room and sauna are off-limits and restaurant menus are disposed of after a single use.

Moore County, which is mostly rural, places among 20 N.C. counties that have the highest percentage of their population in the high-risk age range for COVID-19.

Ordinarily, the more than 40 golf courses in a 20-mile radius of Pinehurst draw a steady stream of visiting seniors as well as some baby boomers.

But Phil Werz, president and CEO of the Pinehurst, Southern Pines and Aberdeen Area Convention and Visitors Bureau, told Carolina Public Press the region’s occupancy rate has plummeted from 71% in May 2019 to a bit over 40% now.

While business in Pinehurst is hurting, the diminished number of seniors visiting golf country may be good news from a health perspective.

As of July 1, Moore County had reported a total of 484 cases of COVID-19 and 13 deaths attributed to the disease.

At Pinehurst Healthcare and Rehabilitation Center, a congregate living facility, 24 staff members and 60 residents have contracted COVID-19 and five residents and one employee have died.

“The infection appears to have been transmitted by staff,” said Robert Wittmann, the county health director.

“Those in the 65-or-older age range have been a point of emphasis in our communications, as they are one of the populations most at risk of complications from the virus,” Wittmann said.

“We’ve offered to work directly with all of our long-term care facilities in the county to facilitate testing of staff and residents.”

The department has offered free testing and lab processing to all long-term facilities even if they have had no positive cases, said public information officer Matt Garner.

“Our offer is for a one-time testing for their residents and staff. Any testing done on a periodic schedule beyond that would be at their own discretion.”

The health department is conducting contact tracing and is making use of the N.C. Department of Health and Human Services’ offer to send staff into local areas to assist, Wittmann said.

Contact tracing allows health workers to identify individuals who have come in contact with an infected person so they can get tested and minimize community spread of the disease.

While Wittmann’s office is responsible for contact tracing, FirstHealth Moore Regional Hospital is the primary provider of initial testing.

The Pinehurst-based facility is operated by FirstHealth of the Carolinas, a network of four nonprofit hospitals, which all provide COVID-19 testing. Testing is also available at FirstHealth care clinics across its system and the Pinehurst hospital offers drive-through testing based on provider referral.

FirstHealth regularly updates multi-county test results on its website. At July 1, it reported 10,674 tests of which 1,301, or 8%, were positive.

Contact tracing is performed internally and in conjunction with a local health department.

The health system has no concerns about its stock of personal protective equipment.

“Thanks in large part to the generous donations from our community, we have the personal protective equipment we need, and access to more,” FirstHealth spokesperson Emily Sloan said.

“Furthermore, we placed large orders through multiple vendor sources early on in this crisis and our clinical teams have implemented appropriate utilization practices to conserve critical PPE.”

Double trouble for public health in Chatham County

In nearby Chatham County, bordering Moore to the northwest, the new interim health director has his hands full.

Part rural and part suburban, Chatham County is considered part of the Durham-Chapel Hill metropolitan statistical area but is made of small towns like Goldston, Pittsboro and Siler City, plus broad areas of forest and farmland.

Michael Zelek, the new interim director, is keeping a close eye on the congregate living centers.

But he’s also paying close attention to Mountaire Farms in Siler City, a poultry processing plant that employs more than 1,700 workers.

Faced with outbreaks at not one, but two nursing homes in the county and at the poultry plant, Layton Long, Chatham County’s ex-public health director, decided to postpone his May retirement and spent a month engaging in a handoff to Zelek, then a division director, who took over on June 1.

“This was an awkward time to be retiring and getting new leadership but certainly this one seems to have gone seamlessly,” observed Karen Howard, a member of the Chatham County Board of Commissioners.

Like Moore County, the largest percentage of Chatham County’s population falls in the over-65 age group.

The county has also attracted a growing number of Latinos, many of them drawn to work at the poultry plant. About half of Siler City’s population is Latino.

Howard thinks that Zelek, who worked with a children’s foundation in Nicaragua for three years before earning a Masters of Public Health at UNC, is well-suited to address cultural sensitivities among the area’s immigrants while also looking out for the elderly.

While the exact number of positive cases at the poultry plant has never been disclosed publicly, as of July 1 a total of 206 residents and staff members had tested positive for COVID-19 at the two nursing homes, where 38 residents had died.

“Administration from The Laurels of Chatham attended a meeting we hosted to discuss COVID-19 response strategies before any cases were identified in the county or at the facility,” Zelek told Carolina Public Press.

Weekly calls with congregate living centers continue. 

At Chatham Hospital, a 25-bed critical access facility in Siler City that is part of the nonprofit UNC Health system, coronavirus cases have filled less than 20% of total available beds, a number that includes surge beds set aside as the pandemic hit.

“There have been about 40 individuals either admitted to Chatham Hospital or the UNC Medical Center due to COVID since the pandemic began,” said Jeffrey Strickler, the hospital’s president.

“We have transferred a number of COVID-positive patients to UNC Medical Center by ground ambulance.”

The supply of personal protective equipment is “robust,” Strickler said, an improvement over April when he called the supply “adequate.”  

Mountaire’s COVID-19 policies

While drive-thru testing for COVID-19 is available to the community at Chatham Hospital – including to employees and contract workers from Mountaire Farms – there is some dissatisfaction with Mountaire’s response to the pandemic, even though the company voluntarily disclosed the plant’s outbreak and shared testing that showed scores of workers were infected.

Some members of the community say the company has not been specific enough in keeping the public informed about test results and allege that Mountaire has refused to allow contract workers access to its onsite wellness clinic.

While Mountaire is able to say that employees get testing, “to me that’s an artificial shield and it doesn’t benefit Mountaire and it certainly doesn’t benefit the greater community,” said Howard, the county commissioner and a former attorney.

“And when someone tests positive, they need to know that their families are going to have a means of survival … otherwise you end up with the risk of someone not getting tested because they’re afraid of not being able to work.”

On June 17, faced with ongoing concerns, Mountaire’s corporate headquarters in Delaware issued a statement about its response to the pandemic.

In it, the company addressed a variety of issues related to safety, pay and leave policies but omitted any specific mention of what contract workers may or may not qualify for.

In addition to taking workers’ temperatures and mandating face masks and face shields at all processing facilities, the company said it had implemented additional social distancing on production lines and had installed plexiglass and other barriers “wherever possible.”

According to Mountaire, the company has also implemented a “special hourly sick-pay program that encouraged employees who are sick to stay at home” while relaxing attendance rules “so employees didn’t have to fear losing their jobs if they are sick.”

The company also put in place a $1-an-hour pay raise “for all hourly employees” through June.

Across the border in Moore County, Wittmann, the health director, said the infections that arose at the Siler City plant have made their presence felt in Moore as well, but only to a limited extent.

“Some employees of Mountaire Farms reside in Moore County,” Wittmann said. “However, we have not seen a significant number of positives as a result.”

Howard summed up the challenges facing health departments, hospitals, congregate living centers, employers and the public at large in the region at the state’s center.

“We have got to work collaboratively if we’re going to protect public health,” she said.