South Carolina emerging as coronavirus hot spot, as hospitalizations rise and virus spreads

As the coronavirus pandemic continues to pummel states across the country, South Carolina is dealing with a brewing crisis of its own with daily case records akin to those in more notable hot spots across the south and west, prompting some local health officials to ready surge plans should hospitals become overwhelmed.

"It's not much better here than it is in Florida or Texas," Dr. Helmut Albrecht, the Chair of the Department of Internal Medicine at Prisma Health, the largest nonprofit health organization in the state, told ABC News. "It has still not plateaued -- every week is worse than the last. I don't think we can set new records anymore.”

A Harvard Global Health Institute tool used to track the severity of the outbreak recently ranked the state as the third highest in the country in terms of risk level -- behind only Florida and Arizona -- and the data indicates the virus is showing no signs of slowing down. An ABC News analysis of the data found the state is seeing increases three major categories: cases, hospitalizations and deaths.

An internal state report obtained by ABC News warned of hot spots and rising cases across the entire state, but with a particularly troubling focus on coastal counties to the south -- a trend reflected in the Harvard tracker.

In Charleston County, for example, the report warned that there is “no sign of cases slowing down.” In Horry County, home to the popular tourist destination Myrtle Beach, “cases continue to sharply rise … widespread travel to the area contributing to cases," says the report, dated July 4.

"New hot spots continue to develop. Consecutive hot spots week after week becoming the norm," it says.

Dr. Rick Foster, a former head of the Alliance for a Healthier South Carolina, a coalition of public health leaders, echoed that sentiment and suggested that an influx of both in-state and out-of-state tourists likely aggravated the bump in cases along the state’s coast.

Despite Governor McMaster saying the state is "breaking records" with testing, experts in South Carolina say basic but critical issues with testing and contact tracing are making it difficult for state officials and health care providers to keep up with the rapid spread of the virus.

"I think we need to massively increase testing capability,” Albrecht said. “Right now, our delays from commercial and public health labs has gone up."

Albrecht lamented slow turnaround times for viral tests -- one week, on average, he said -- as being “not useable.”

"By that time you have not only the patient to deal with but three to five others," Albrecht continued. "We haven't been able to surge the testing supplies as much as nature has been able to surge cases. The more cases you have, the more you have to test. We don't have that surge capability with testing."

The South Carolina Department of Health and Environmental Control did not respond to ABC News' request for comment for this report Tuesday.

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South Carolina was one of the first states to reopen on April 24, though Gov. Henry McMaster, a Republican, never fully shut the state down and reopened it without meeting the White House's recommended guidelines. The state also does not have a mask mandate, which the Centers for Disease Control and Prevention recommends to slow the spread of the virus. McMaster's office did not provide comment for this report when reached late Tuesday.

At a press conference on June 26, McMaster stood firm on his decision, calling statewide mask mandates "ineffective" and "impractical... because it is not enforceable.”

He acknowledged the rise in cases and urged people to social distance, but praised “progress” in the state’s reopening.

“We are opening, we've been reopening, as you know we did not close as much as other states. We're still seeing progress in the reopening according to the guidelines from accelerate S.C.,” McMaster said.

But now the internal state report warned the state is "starting to see hospital strain." On Tuesday, 1,324 were hospitalized in the state, a new record.

Dr. Christine Carr, a professor at the Medical University of South Carolina, called the influx of hospitalizations -- which she attributed in part to carelessness in the community -- “concerning.” She said beaches have been overflowing and citizens have gone mask-less for weeks.

"There's a ton of community spread right now,” Carr said. “It’s people that don't know what they don't know -- they have no idea how many people they are infecting.”

Statewide hospital capacity is steady for now at 69%, according to Melanie Matney, the chief operating officer at the South Carolina Hospital Association (SCHA), and ICU capacity is at 72%. Matney said that while those figures are sufficient for the time being, health care officials and providers are watching those numbers “very carefully.” Some individual hospitals are reporting higher capacity rates on their own, Matney added.

With cases on the rise, Matney said the SCHA may soon implement a so-called surge plan, which was developed back in April in case of emergency. She said health officials are “expecting” cases to rise following the Fourth of July weekend, much like they did after Labor Day.

Matney said the surge plan, which could be implemented in a matter of days, would activate sites across the states as health care overflow facilities. They include several hotels and the volleyball center at the University of South Carolina, which would be used for less sick patients to free up room for critical ones in the hospitals.

As hospitalizations continue to climb, Matney said the "main worry" remains staffing concerns. According to the state’s health department, nearly 2,300 health care workers have already tested positive for COVID-19. Matney said the SCHA surge plan would possibly activate nursing students or out-of-state nurses to help in their hospitals.

“They're ill or quarantined for exposure, so it’s very complicated,” Matney said.

At Tidelands Health, a small health care system with locations in communities near the coast, staffing struggles are top of mind. According to Bruce Bailey, the president and CEO of Tidelands Health, at least 42 staff members have tested positive for the virus – a situation that has exacerbated challenges in treating the influx of patients.

"Our [emergency rooms] are at capacity, and a lot of this is staffing -- just having the nurses and the doctors to manage the surge of patients," Bailey said. "We have bed availability, we have ventilators, we have [personal protective equipment], but the real challenge is finding enough nurses and doctors and the specialists to meet the surge in demand."

Last week, Tidelands Health reached out to the National Guard for support and assistance with staffing. No plan has been made, Bailey said, but talks are scheduled to continue this week.

What to know about coronavirus:

• How it started and how to protect yourself: Coronavirus explained
• What to do if you have symptoms: Coronavirus symptoms
• Tracking the spread in the U.S. and worldwide: Coronavirus map