Before January of 2020, much of the world had never heard the word “coronavirus”, let alone any idea of what it meant. That was especially true in the United States where many felt that, while sobering, the situation developing in China would most likely stay in China.
Then, on January 20th, the United States had its first patient that was confirmed to be infected. The patient, a 50 year old woman in California, had recently returned from Wuhan, China where cases had spread throughout Wuhan and to other regions while numbers increased almost exponentially on a daily basis. The virus was then reported in other countries, including South Korea and Japan. Ten days later, on January 30th, the virus had killed more than 200 people in China and was confirmed in 18 different countries.
Within hours, the World Health Organization (WHO) declared a Public Health Emergency of International Concern, a rare declaration typically reserved for only the most serious health crises. As WHO Director-General Tedros Adhanom Ghebreyesus said in his statement at a news conference, “Over the past few weeks we have witnessed the emergence of a previously unknown pathogen that has escalated into an unprecedented outbreak. We must act together now to limit the spread.”
On Friday, January 31st, the United States Secretary of Health and Human Services, Alex Azar, declared a Public Health Emergency for the United States. In a press conference that same day, the administration stated that 6 more patients had been confirmed, announced mandatory quarantines plus major travel restrictions that were going into effect the following Sunday to limit contagion. That pre-emptive move is largely credited with providing valuable time for preparation before the virus became more prevalent in the US.
Now, with the recent deaths of six Americans and more than a hundred confirmed cases confirmed in ten different states, Americans are paying much closer attention to the virus’ progress, where it came from and what’s likely to happen in the future.
It’s only natural for people to feel a hint of panic. Don’t. The risk to people in Colorado continues to be low. Furthermore, getting the answers to basic questions is the best defense in any health crisis, and this situation is no different.
The US Center for Disease Control (CDC) describes coronaviruses as a large family of viruses that are common in people and include many illnesses, some of which are mild—like the common cold—and some that are more severe. The virus is also common in many different species of animals, including camels, cattle, cats, and bats. On rare occasions, animal coronaviruses have the ability to infect people and then spread from one person to another in something called “community spread”--as happened with MERS and SARS. This coronavirus—which is now referred to as COVID-19—has that same capability.
In December of 2019, a doctor in Wuhan, China sent out a warning that he was seeing a “mysterious pneumonia” in some of his patients. Upon investigation, it was discovered that many of the first individuals infected had connection to a large seafood and live animal market in Wuhan, leading researchers to believe the virus had spread from animal to humans. Later, a growing number of patients reportedly did not have exposure to animals markets, indicating the virus could be spread from person to person. That became even more apparent when countries outside of China, like the United States, reported patients who are not sure how or where they became infected.
At this time, the specific origin of COVID-19 is still not known, although researchers in China are testing a variety of different animals to see where a specific connection may exist. But the genetic similarities between the virus that’s infecting people in the United States to the virus that showed up in Wuhan suggest that it’s the same virus. That’s a good thing and increases the likelihood that the origin will be discovered.
Unlike the common cold or the flu, which typically effect the upper respiratory system—i.e. sore throat and congested sinuses—the coronavirus effects the lower respiratory system. The most commonly reported symptoms include a fever, a dry cough and shortness of breath. COVID-19 also seems to have much greater impact on older individuals or people with underlying complications like respiratory diseases, diabetes or suppressed immune systems. Luckily, children do not seem to be that impacted.
The vast majority of people who become infected show little to no signs of being sick. In fact, approximately 80% of patients experience only mild illness, so mild, in some cases, that some patients are unaware that they have become infected. Approximately 14% experience “severe disease” requiring hospitalization. Roughly 5% of those patients become critically ill. The fatality rate is estimated to be around 2%. The Spanish flu, which swept the globe in 1918, had roughly the same rate.
The flu—various strains of which circulate throughout the US and other countries every year--typically has a fatality rate of .01%., making COVID-19 about twenty times more fatal. However, it should be noted that the CDC estimates that between 9.3 million and 39 million people are diagnosed with influenza each year. As of Monday, there were 102 people in the United States who tested positive for COVID-19.
That brings us to the issue of testing.
Testing serves one function in a wide scale health crisis. It’s not to determine treatment; the treatment will be the same as it would be with any lower respiratory viral infection. Testing is important because it gives highly valuable information to officials and researchers about where the virus is showing up, where it’s spreading and how many people are infected.
In January, the WHO began distributing COVID-19 testing kits to China. Over the following weeks, they added distribution to other countries as confirmed cases showed up, and, as of Monday, had sent kits to roughly 75 countries. However, the US decided to create its own test, which was more complicated and would test for the presence of other viruses.
In the first week of February, CDC began distributing the kits to state labs, but it was quickly discovered that, in all but a few states, the tests were flawed. They correctly identified COVID-19 but gave false positives on the presence of other viruses, which put the whole testing kit in question.
Although it’s not clear who made the decision, the CDC decided to come up with a new test, despite there being alternative testing kits available for immediate distribution.
That delayed any mass testing in the US by roughly 4 weeks at a time when additional knowledge about the scope and location of the virus was vital. Nonetheless, at this time, testing kits are being distributed in limited numbers around the nation with plans to “massively” increase production in the next weeks.
Prior to now, all testing was done by the CDC, which delayed results. Now that there are test kits in Colorado, tests can be sent to the CDPHE, which will have a testing capacity of 160 samples per day. “Being able to confirm or rule out cases of COVID-19 at the state level allows us to be more nimble in responding to and controlling this disease if it occurs in Colorado,” says State Lab Director Scott Bookman. “The time frame for testing cases should be quicker than ever.” CDPHE estimates a patient’s results can be communicated to providers within 24 hours from the time the sample is received.
With testing soon to be implemented nationwide, the public can expect to see a sudden, and possibly drastic, rise in the numbers of people infected. Again, don’t panic. This does not necessarily mean that COVID-19 has become more widespread or severe than it was previously thought. It simply means that health officials are getting a real time idea of where the virus is present and how many people have become infected.
In a press conference on Monday, Secretary Azar emphasized that immediate risk to the public is low, which CDPHE says is especially true in Colorado. But, as Azar also stated, the national risk level could change quickly, and the public needs to be prepared for a potential interruption in their regular schedule. Planning now to have ample food and water on hand or mitigating with employers working from home, if needed, is advisable.
Having a good supply of medication taken over the counter is also recommended as it appears some supply chains from China, a major supplier of pharmaceuticals to the US, have been interrupted due to the outbreak. This last point was addressed with Tom Davis, owner and pharmacist with Kiowa Health Mart in Eads. “Disruption is a regular occurrence in the pharmaceutical industry,” he says, “so I haven’t noticed anything unusual in that area since the coronavirus was discovered in China. But,” he adds, “we’re trying to be proactive and prepared in case that becomes an issue.”
As of Monday, March 2, the status, worldwide, includes more than 89,000 cases confirmed in 58 countries with the death toll topping 3,000. In the US, there are nearly 100 confirmed cases with 6 deaths and virus confirmed in 12 states including Washington, Oregon, California, Arizona, Texas, Florida, Rhode Island, Massachusetts, New York, Wisconsin, Illinois and Nebraska. That situation will inevitably change.
Closer to home, Dawn Back with KCHD states, “We should not, as a community, be complacent, especially as a hospital. And we’ll be using sound evidence and be proactive in preparations screening and responding, despite our rural environment.” In the event that people in this area begin to display symptoms, Kiowa County Hospital District has provided the following informational statement.
“Local measures to ensure that we are ready to face this outbreak are well underway at Kiowa County Hospital District. In fact, preparations were well underway long before this current outbreak. KCHD has a current (updated yearly) disaster preparedness plan, as well as current infection control policies and procedures in place. All of the staff at KCHD have been fitted for the specific mask needed for this outbreak (N95) last year, and all newly hired staff are fitted during new hire orientation. Yearly fittings for these masks were recently completed in February 2020. Local KCHD medical & nursing staff are working together with our public health partners and have attended the CDC (Centers for Disease Control) and CDPHE (Colorado Department of Public Health) online webinars to assist with the planning for such an outbreak.
Current recommendations by the medical & nursing staff are based on the current CDC guidance that containing the virus and preventing the spread is the number one priority. Staying at home, when possible, is the best method of preventing the spread of this disease, as well as calling ahead to the hospital or clinic when you do need to come in.
Treatment currently includes getting plenty of fluids, rest and taking medications like Tylenol or Ibuprofen to reduce fever. Antibiotics are NOT recommended because this is a virus not a bacterium. Some patients may be able to get this treatment at home without risking spreading the virus to others.
Therefore, please take the following precautions:
1. Wash your hands frequently – for at least 20 seconds and drying them thoroughly.
2. Avoid touching your eyes, nose and mouth. The virus can’t grow if it can’t get into your body.
3. If you have the following symptoms – it is very helpful to call the clinic or hospital to speak with a nurse or provider before coming in:
Fever, cough, body aches, sore throat, nasal congestion
4. If you have a fever that does not come down with Tylenol or Ibuprofen, trouble breathing or severe weakness- come to the hospital right away.
6. If advised to come into the clinic or hospital by a nurse– grab a mask at the door and put it on. Advise the staff immediately upon entering of your symptoms.
7. If advised to stay home, clean and disinfect frequently touched objects and surfaces such as doorknobs, desks, handrails. Cover coughs and sneezes with tissue or your inner elbow shirt sleeve. Stay at home and do not have visitors come over. Report worsening symptoms immediately to clinic or hospital staff.”
Anyone with symptoms should call the Eads Clinic at 719-438-2251 or the hospital 719-438-5401 and ask to speak to a nurse.
Anyone with questions about KCHD’s plan should contact Ellen Lane, RN, MSN, CCRN- Infection Control and Prevention Nurse at 719-438-5401 or Kiowa County Public Health at 719-438-5782 or 719-336-8721
For more information, go to the CDPHE Coronavirus webpage at https://www.colorado.gov/pacific/cdphe/2019-novel-coronavirus or call CO-Help for information at 877-462-2911.