Dear Dr.

Cohen,

I have sent numerous emails to you over the past several months asking questions about COVID-19 and
imploring you to have DHHS make clear, cogent directives to protect the people of this state.

After hearing recent safety-related concerns regarding infection control practices in some hospitals, I
spoke with Ms. Hattie Gawande of your office about hospital COVID-19 reporting requirements. Ms.
Gawande confirmed by email that hospitals, although directly regulated by NC DHHS, are not required
to report COVID-19 outbreaks among employees and medical staff.

This week, we obtained information about a major cluster outbreak of COVID-19 at a hospital among the
employees and staff. There have been at least forty staff at New Hanover Regional Medical Center who
have been diagnosed with COVID-19, and the infection has spread across disciplines: surgical, surgical
specialty, OBGYN, and medicine, including physicians, nurses, and technicians.

The cluster outbreak of an initial six to ten anesthesia technicians in the main operating room threatens
the safety of all residents of NC. As you are aware, NHRMC is the only major trauma center in the
region. If the operating room at this hospital can no longer safely operate, there are no alternative
trauma designated hospitals in the region. Trauma centers are vital community assets. According to the
American Trauma Society, having fast access to specialized physicians, nurses, resources and equipment
can mean the difference between disability and even death. The Centers for Disease Control has
reported a 25 percent reduction in deaths for severely injured patients who receive care at a trauma
center compared to a non-trauma center.

At the present moment, there is no DHHS requirement for routine testing of patients for COVID-19
before surgery. The guidance you released back on May 1st regarding the resumption of elective
surgeries discusses the use of screening tools, questionnaires and the like, to determine who is "at-risk"
for COVID-19 to determine who to test. While this procedure may have been acceptable when there
was a low prevalence of COVID-19 in the community, it is well acknowledged that with an increasing
prevalence of active infection, such screening tools are inadequate. Relying on such tools to determine
who requires COVID-19 testing before surgery invariably allows asymptomatic, COVID-19 positive-
patients to undergo surgical procedures and more importantly, aerosol-generating anesthesia
procedures, placing operating room staff at high risk for disease transmission.

You have also failed to mandate the use of proper personal protective equipment (PPE) by staff in
hospitals. As you are aware, anesthesia induction by conventional methods may produce high quantities
of COVID-19 aerosols capable of infecting any staff present in the operating room. Currently, at NHRMC,
the surgical technicians who are present throughout the induction of anesthesia and assist throughout
surgical procedures are not being provided with N95 masks or other suitable PPE to protect them from
COVID-19 aerosols generated during anesthesia induction. Moreover, the anesthesia technicians who
are tasked with servicing and changing the anesthesia circuits, which are heavily contaminated with
respiratory droplets, are not being provided with adequate PPE. This is likely the cause of this cluster
outbreak at NHRMC. These staff, before their COVID-19 diagnoses, have been circulating throughout the
operating rooms for several days. As you are aware, this leads to the real possibility of a much larger
outbreak at this facility in the coming days.
I urge you to take immediate action to protect our hospital capacity and, by extension, the people of
North Carolina. I request that DHHS mandate proper COVID-19 testing prior to surgical procedures, and
proper use of PPE at all of our hospitals. I also request that DHHS mandate hospital reporting of COVID-
19 positive physicians and staff. The people of North Carolina have a right to make informed decisions
regarding where and when to seek medical and surgical treatment.

Thank You for your Consideration

Rep. Jimmy Dixon

Member House Committee on Health
(910) 590-1740
(919) 715-3021