Communities are bracing for the arrival of the novel coronavirus, officially referred to as COVID-19, which “represents a tremendous health threat,” according to Nancy Messonnier, M.D., director of the Center for the National Center for Immunization and Respiratory Diseases. During a news briefing this week, the Centers for Disease Control and Prevention (CDC) said the spread of the new virus is “inevitable” and Americans should prepare for “potentially major disruptions to their daily lives.” On Friday, the World Health Organization (WHO) raised the threat assessment to “very high” because of rapidly increasing numbers of cases.
Locally, officials are doing what they can with the limited details they know.
“DeKalb County has a plan”
Anthony Clifton, director of the DeKalb County Emergency Management Agency, said the specifics of the local response depend on the level of disruption that happens, but his office is considering every possible scenario to keep government services functioning. Clifton said he met Feb. 26 with DeKalb County Commission President Ricky Harcrow concerning the outbreak.
“We had a discussion and will enact a plan, follow procedures and hope those are effective,” he said.
In Alabama, there have been no confirmed cases of COVID-19, but the CDC has confirmed 60 cases in the U.S., which include 45 people who were repatriated from Wuhan, China or the Diamond Princess cruise ship.
While it may seem like a faraway problem, DeKalb County is intersected by a major interstate spanning 445 miles that meets a junction in neighboring Dade County, Ga., and just a couple of hours away from the world’s busiest international airport, Hartsfield-Jackson Atlanta.
Screenings of passengers returning from China are being increased using quarantine stations at 20 U.S. airports to identify people who are sick and educate those who may develop symptoms later, including fever, cough, body aches, fatigue; sometimes vomiting and diarrhea. COVID-19 is believed to be spread by an infected person for several days before their symptoms appear.
“America has done a very good job of containment so far, and our medical system is much better than other countries. Plus, we don’t have China’s massive population living closely to one another in big cities. We kept SARS (Severe Acute Respiratory Syndrome) out in 2002 and the Ebola outbreak in 2013. So far, we are doing a good job of containing this one too.”
Governments are restricting travel and canceling events while researchers aggressively work to create a vaccine like the ones they already encourage people to get to prevent any of several different types and strains of influenza viruses or to reduce their severity. What makes the situation so frightening now, Clifton said, is a lack of understanding about how COVID-19 works and how to treat it.
Schools and Social Distancing
The elderly and young children are usually the most susceptible to influenza viruses, according to the CDC.
Japan closed all schools for the rest of the current term to prevent the spread of the virus, affecting 13 million students.
We aren’t to that point in America, but Clifton said DeKalb EMA is coordinating with local schools “to discuss the hows and ifs of going to teaching over the Internet so we’re not losing school days if we ever need to do that.”
DeKalb County Superintendent Jason Barnett said the county has not discussed e-learning, which would be challenging to set up in rural areas lacking broadband internet service and with some families not owning PCs or smartphones. He does not believe there is reason for alarm in North Alabama at this time, as there are no known cases in Alabama, according to the Alabama Department of Public Health (ADPH).
“That being said, we are staying aware and informed on the happenings and transmission of the illness across the globe. To that effect, I have been informed [the CDC] is preparing specific guidance for schools that will be released shortly, and we will be sure to review those and take any needed action steps,” Barnett said.
“Dr. Karen Landers at the ADPH has become a trusted source and has provided wise counsel to me over the years with these decisions. She is a pediatrician, as well as an infectious disease specialist, who is especially knowledgeable and valuable in these cases,” Barnett said.
Fort Payne Superintendent Jim Cunningham said all personnel are actively taking daily measures to address viruses and influenza in schools.
“We encourage students and staff to wash hands often with soap and water for at least 20 seconds. We also make hand sanitizer available throughout the schools. Our staff educates our students to cover a cough with tissue or shirt sleeve. We have nurses at all four of our schools that address sick student’s needs and keep them separate from other students until parents can pick them up,” he said.
Fort Payne Schools clean and disinfect surfaces like door knobs, bathrooms, classrooms, and buses daily.
“We use electrostatic sprayers to impart charge to molecules of fluid to achieve uniform coverage and effective application of the disinfectant. We use disinfectants that sanitize and kill cold and flu viruses,” Cunningham said.
A framework for virtual learning through technological platforms is being prepared that would allow students to continue their education in the home through online learning during a specific event.
“Our administrative staff, along with our technology coaches and curriculum coaches, are now preparing... specific to subject and grade level content,” he said.
Concern but Not Panic
Clifton said it’s premature to declare a crisis based on what EMA knows at this time.
“It’s coming, but we know every Fall that the flu is coming. That’s just a fact of life. We do not consider this to be a grave danger locally. To put it into perspective, the ordinary everyday flu that we get vaccinated against each year kills 30,000 Americans annually. That’s more Americans than died during the Vietnam War killed every year,” Clifton said.
“The last time the nation faced a major public health threat was the H1N1 virus in 2009, which killed twice as many people as the ordinary flu because, like now, we knew so little about it. Today, we don’t know if we’ve gotten an accurate death count from China or exactly how many cases have gone undocumented because patients had a milder illness and didn’t go to a doctor to get their cough or fever treated or if a life-threatening pneumonia was unrelated to COVID-19,” he said.
Without lab screening, it can be unclear whether someone caught this new virus or the regular flu. Health officials are drawing from past experience to try and predict what will happen next.
“[H1N1] did not disrupt the daily activities of our businesses, schools and industries, but it did allow us to gain access to additional assets, if needed. On the heavier end of the scale, if we experienced problems with food getting transported to grocery stores and restaurants, we do have procedures for distributing food, water and medicine so there is no mass chaos. The public can rest assured that nobody is going to go hungry. Even in the unlikely case of a mass fatality event, our plans ensure the continuity of government.”
He said public health has come light years since the Spanish Flu of 1918, which killed an estimated 40-50 million people worldwide.
Going Viral: The Danger of Disinformation
That pandemic a century ago offers lessons relevant for today.
To maintain morale, wartime censors minimized early reports of illness as it killed thousands of soldiers on both sides. That pandemic gained its name because Spain was at the time the only European country where the press were freely printing reports of the outbreak, creating a false impression that the country was especially hard hit. Political leaders want to keep the public calm, but incorrect reassurances can undermine public trust.
“The Times-Journal and other media become real important to making sure the public receives accurate information so reasonable precautions can be taken,” Clifton said. “Things can feel sensationalized because of these pictures and videos we see from China, but the whole world is not going to fall apart. Social media won’t be a reliable source of information because what a friend says isn’t fact-checked, and some will try to take advantage of people by scaring them.”
Officials are not just fighting to contain a virus and save lives -- they are also in a fight to contain the social and economic damage a global pandemic could do. If people are afraid to go shopping or sit in a restaurant, the psychological impact could severely hurt brick and mortar businesses already struggling to compete with online vendors.
Stocks closed at a record high on Feb. 12 but have tumbled nearly 20 percent to the market’s worst week since the 2008 financial crisis as investors worry about the potential economic impact, according to CNBC.
The Front Lines: Hospitals
County health departments are posting signs cautioning people with flu-like symptoms not to enter their facilities. Instead, they recommend calling ahead to a physician, urgent care center, or hospital emergency room to arrange for isolated screening and care following protocols to avoid hospital outbreaks. Health care providers will be key to detecting cases early, tracing contacts and preventing community transmission, according to WHO.
A large outbreak would put a stress on medical providers like the ones at DeKalb Regional Medical Center, which is licensed for 134 beds and utilizes 34 active physicians.
“Although we do not know at this time whether the impact in the U.S. will be mild or severe, DeKalb Regional is preparing in the event the virus spreads to our community,” said Dr. Scott Argo of DeKalb Family Medicine. “Despite the early hospital preparations, there is no vaccine or treatment for the coronavirus, and communities and individuals should prepare other means of protecting themselves.”
Antibiotics only work on bacterial infections, not viruses, and the CDC warns that the over-prescribing them can lead to deadly bacterial infections able to defeat the drugs designed to kill them. Doctors can only treat fever and keep patients hydrated. Severe cases may require hospitalization and support such as mechanical ventilation.
Local officials do not expect they’ll have to take dramatic steps like the ones used in China —including placing some 100 million citizens on lockdown, shutting down public spaces, building enormous quarantine hospitals in days’ time and ramping up 24-hour manufacturing of medical equipment.
Clifton said protective public health tactics during an outbreak could include reducing mass gatherings, dismissing students from schools for a while, and implementing “social distancing” measures.
“Do the same things we already do to avoid catching the flu,” Clifton said. “Wash your hands for two full minutes with soap and warm water. Keep disinfectant on your desk. If you feel sick, for God’s sake, stay home. If you can telecommute for work, do it. If you can avoid traveling for work, skip it. Go buy some extra boxes of rice or Mac and Cheese to cook if you feel sick -- enough to feed your family for two or three days -- instead of running to Walmart when you get hungry and making everybody there sick. It’s common sense and doing the same things you should be doing when you feel like you have the flu, a cold or the ‘crud’ going around.”
Barnett said ADPH produces a helpful guide called “Do 10 - Fight the Flu,” which describes the top 10 things to do to fight the flu and avoid infection, almost all of which also apply to COVID-19.
“I encourage all community members to take regularly suggested precautions during this time to prevent any illness,” Barnett said.
Will Springtime Take Care of the Problem?
Many hope the spread of COVID-19 slows because viruses that cause influenza tend to regress because colder, drier air allows viruses to travel longer distances as they become airborne. As humidity increases, on the other hand, the droplets in a cough or sneeze become heavier with moisture and fall to the ground. Remaining hydrated is important since the mucous in our nasal cavities serves as a filter to trap and then expel viruses and bacteria, according to Robert Glatter, MD, writing in Forbes magazine.
In the case of H1N1, officials were able to stop a pandemic and worldwide flu activity returned to typical seasonal patterns within a year. Unfortunately, no one knows for sure if this new coronavirus will dissipate as the regular flu season begins to wane.
“We’re hoping for an early Spring because the environment could take care of 90 percent of the problem,” Clifton said.
It’s a scary situation, but DeKalb County residents can take comfort in knowing that their community leaders are taking these microscopic invaders seriously and do have a plan of attack.
WHO has busted some of the myths surrounding this new virus. See the answers to some of the most common questions on the WHO website, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters
Readers can find up-to-date information on COVID-19 at the Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/coronavirus/2019-ncov/index.html