Is the coronavirus here already? We don’t know.
Should you be panicked? No. Prudently cautious? Yes.
Oh, and leave the face masks to the professionals who will need them—they won’t shield you from infection.
That was the message offered by Loudoun County Public Health Director Dr. David Goodfriend during a Tuesday morning briefing to Leesburg’s Daybreak Rotary Club, part of a public communication ramp-up intended to stem public fears that have generated a run on hand sanitizer, bottled water and even toilet paper at area stores in recent days.
As of Tuesday, more than 91,000 people worldwide had been infected and more than 3,000 had died from COVID-19, according to the World Health Organization. The vast majority of those cases have occurred overseas, primarily in mainland China, and have also affected portions of Italy, Iran, South Korea, and Japan. But, as the virus has continued its worldwide spread, more U.S.-originated cases are being reported.
Goodfriend said there already could be cases in our region, but patients haven’t been tested for the virus so far because of a shortage of testing kits.
“With those one-offs that we’re hearing about in New York, Rhode Island, et cetera, easily there are other cases around and there may be cases in the National Capital region. We just haven’t tested for it,” he said. “Just because we don’t know about it doesn’t mean it is not here.”
Goodfriend’s been down this road before. Over his two decades leading Loudoun’s Health Department, he’s dealt with public fears over outbreaks of malaria (2002), H1N1 (2009) and even Ebola (2014).
“We’re fortunate being in Loudoun County … that having Dulles Airport here and then the National Capital Region, we’re a high-risk community so the county is always prepared,” he said.
While most communities rarely have to think about pandemic-level planning, Loudoun’s leaders know anything can happen.
“For us, the next plane coming into Dulles could bring in whatever,” Goodfriend said. “The county, I think, is in a good position for it.” And he said the county is better prepared than it has been for previous outbreaks, with a new hospital and more emergency department and urgent care capabilities.
“And we’ve learned a lot both from H1N1 and the 2014 Ebola, which put a real strain on the hospitals even though it didn’t impact a lot of people, it took a lot of resources at the hospital level to deal with Ebola,” Goodfriend said.
County Administrator Tim Hemstreet said Loudoun County’s response is in coordination with the state, the region, the Metropolitan Washington Airports Authority, and the Washington Metropolitan Area Transit Authority. He said there are regular phone calls across the region. The county also has a page on its website for the latest information, atloudoun.gov/5307/Novel-Coronavirus.
The Airports Authority, which oversees operations at Reagan National and Dulles airports, is closely following the Centers for Disease Control recommendations. Dulles Airport last month became one of the first international points of entry to begin screening deplaning passengers. And MWAA spokesman Rob Yingling said the airports remain in close contact with federal, state and local health officials.
Schools ‘agile, responsive’
The county’s public school system is also readying its defenses. Loudoun County Public Schools has even dedicated a section of its website to questions, answers and protocols surrounding the coronavirus for parents and guardians to stay up to date on the latest news. According to a statement posted there, the CDC has indicated that it is preparing additional guidelines for K-12 schools, and the school staff plans to implement the updated guidance when it is available.
Asia Jones, the assistant superintendent for pupil services, said the staff is in constant communication with the county Health Department, which helps keep them up to date on the latest CDC regulations and their recommended best practices. The school division’s existing hazard emergency plan includes procedures even in the cases of a pandemic, should coronavirus fall under that category. Just as in situations with the spread of the flu virus, school leaders are monitoring attendance rates across all schools and share that information with the health department if dropping attendance is tied to the spread of some type of illness. School staff also is keeping up with its daily cleaning practices, which includes cleaning all “high touch” surfaces regularly.
“We are trying to be as agile, responsive and in front of this as possible,” Jones said.
She emphasized the crucial roles that parents and guardians play in being the front-line of defense for any illness and keeping in close communication with the school system if their students experience any symptoms akin to the coronavirus.
Goodfriend said that, with evidence the virus is not transferred through the air, keeping high-contact surfaces clean—door knobs, bathroom facilities and elevator buttons, among them—is important. It still isn’t clear how long the virus can live on a surface, whether a few hours or a couple of days. But Goodfiend also said the virus doesn’t appear any heartier than anything else, and since most cases have been from person-to-person rather than from services, “it is very likely less hearty.”
And there is little merit is closing a school for a full washdown, as has been done in some areas, he said: “A lot of that is reassurance for parents.”
“Usually with a school system we say, let’s just cross our fingers until Friday comes, and the weekend will kill whatever is in that school,” he said.
Hospitals ‘stay one step ahead’
Northern Virginia’s largest hospital system has been preparing for COVID-19 since news reports of its transmission in China began circulating in January.
Dr. Kari Scantlebury, an emergency medicine attending physician at Inova’s Fairfax Hospital, also serves as a lead physician advisor for Inova Health System’s emergency management and disaster preparedness, and said they’ve been thinking since January about how to isolate patients when needed.
“The goal is to stay one step ahead in terms of planning so when we need to escalate we’re ready,” she said.
Symptoms of the coronavirus are very similar to influenza, Scantlebury said, and Inova does have at its disposal rapid flu tests with enough accuracy to rule out the flu if necessary.
Right now, if a patient reports to the emergency department’s triage nurse that they have just traveled to an affected regionand have symptoms similar to coronavirus, they are led to one of Inova’s many private negative pressure rooms. Those rooms do not allow air to escape, so as not to spread any potential virus to hospital staff or other patients. Staff is then notified to don personal protective equipment—in this case, an N95 mask, a gown, gloves and goggles—and the patient is then informed of this practice as a precaution. Once the patient is clinically stable and their travel history has been recorded, hospital staff then reach out to their infection protection personnel, who are now on call 24/7, Scantlebury said.
Those personnel pass that information to the local health department, which can choose to tap into its resources to conduct an investigation. The health department makes the determination whether to test a patient for coronavirus, she said.
If the health department chooses to have the patient tested for coronavirus, a blood sample is taken and sent for testing in Richmond, with a 24-hour turnaround, she said. In the meantime, hospital staff would continue to run their routine tests to rule out other infections or viruses, like the flu, pneumonia or strep.
Scantlebury said it’s both a blessing and a curse that the incidence of COVID-19 comes during a prolonged flu season.
“We’ve already been in the thought process of what our surge capacity is going to look like, how we can maximize our space, and minimize the admissions of those who can be monitored at home,” she said. “It’s a curse in that we’re already doing everything we possibly can.”
Goodfriend said it will be important to keep the health system functioning normally, even if illnesses ramp up, possibly putting a strain on emergency rooms, especially if patients go to the ER who don’t need to.
And Scantlebury is quick to credit the collaboration and coordination of the entire health care community, which includes first responders, inpatient teams, discharge staff and primary care physicians, in readying for the local arrival of coronavirus.
“This isn’t just one group doing really good work. This is the whole medical community working together,” she said.
“COVID-19 is going to be one of those things where it’s only a matter of time before we start seeing patients,” Scantlebury continued. “The only thing we can do is try to minimize our exposures.”
Wash your hands
For those worried about the spread of the virus, Scantlebury and Goodfriend advise a back-to-basics approach: wash your hands, stay home if you or your child is ill, and keep hand sanitizer and sanitizing wipes at the ready.
As test kits become more available in the weeks ahead, doctors and patients will have better information.
“In Loudoun County, we always say, if you see flu in the summer, think Lyme disease,” Goodfriend said. “If it looks like you have the flu in March and April you might want to think coronavirus. And it would be great at this point if we had the tests and we just send it to the lab to get the answer, but we’re not there yet.”
At this point, he said there is no reason to cancel large events—although don’t head out if you’re sick—or to cancel travel plans, but monitor the CDC’s recommendations at cdc.gov/travel.
Overall, the best defense is commonsense.
“There is no treatment for this. The best thing is to stay home and get rest and get over it unless you’re sure it’s real and then go to the hospital and get supportive care,” he said.
And, “it’s not too late to return your masks.”