Though the new coronavirus hasn't yet been spotted in Missouri, local residents and health care providers are already bracing for the possibility of an outbreak.
"We do have a plan," Fulton Medical Center CEO Donald Buchanan said.
The novel coronavirus, which causes the disease COVID-19, has infected more than 90,000 people worldwide, and more than 100 cases have been confirmed in the United States. That includes several cases in neighboring Illinois. Washington state reported nine deaths as of Wednesday morning.
Following a briefing Tuesday between Gov. Mike Parson and members of the State Emergency Management Agency, Parson stated no cases have yet been detected in Missouri. However, as of Tuesday, only 15 people in the entire state had been tested for the disease.
Due to a limited number of test kits, they're only being administered to people who meet CDC criteria: those who have a fever, severe lower respiratory illness and/or shortness of breath; and who have traveled to an affected area within 14 days of symptom onset or had close contact with another COVID-19 patient. Those who are hospitalized due to severe symptoms matching the above without a clear diagnosis may not need to show a potential source of exposure to be tested.
Coronaviruses make up a large family of viruses. Those that can infect humans range in severity from mild (causing a common cold) to potentially fatal. This particular coronavirus, which causes COVID-19, was first detected in Wuhan City, Hubei Province, China, according to the Centers for Disease Control and Prevention. Early infections were apparently linked to live animal markets, but the disease is now spreading from person to person.
In about 80 percent of cases, the symptoms are mild (cold- or flu-like), but it causes severe respiratory illness or even death in some. Fatalities are highest among the elderly and otherwise immune-compromised and lowest among children.
Local plans
Buchanan said the hospital has received testing kits.
"But we've more or less been told to let (Missouri Department of Health and Senior Services) handle it," he said Wednesday.
He said if someone visiting the hospital meets CDC criteria for testing, they'll call the DHSS and isolate the patient in a negative-pressure room until the patient can be tested.
"They come in and test them and determine what to do with them next," Buchanan said. "They'd probably send them to a place that specializes in this kind of thing."
He said while the hospital has seen an uptick in flu recently, they've not had to test for any potential COVID-19 cases so far.
"No one's come in who meets the criteria," Buchanan said.
Buchanan said hospital administrators haven't talked to city or county officials about planning a response, but he plans to reach out to the Callaway County Ambulance District in the near future.
Sharon Lynch, director of the Callaway County Health Department, said her department is ramping up planning now. A meeting with county and local officials is planned for Friday. The health department plans to stock a couple of testing kits, which it will provide to the hospital or other local doctors as needed.
"We just don't have a lot of information yet, but we're trying to give out a lot of info we do have," Lynch said Wednesday.
She's concerned about if the local health care system can handle a large volume of COVID-19 patients.
"A big concern is, if we have a whole lot of sick people at once, how we're going to handle that," she said. "I don't think anybody anywhere has that information. Any system can get swamped."
She said the health department intends to "keep calm and carry on."
Local nursing homes are also alert to the danger COVID-19 poses to older adults, Presbyterian Manors of Mid-America Chief Marketing Officer Karen Harriman said. (PMMA operates Fulton Presbyterian Manor.) She added PMMA has a staff member trained in communicable disease prevention helping coordinate their efforts.
"We've been scrambling to get things in place and make sure we can stave this off," she said.
Harriman said most of the safety measures recommended by the CDC are already in place at PMMA locations due to concerns about flu.
Local impact
Aside from the potential public health impact, at least one local business expects to see economic impacts in the near future.
"At this point, we haven't been affected at all," said Larry Doyle, co-owner of the Fulton Oriental Store. "But when we resupplied, they told us there's going to be a shortage of everything, because the ships aren't able to unload."
The store stocks snacks, condiments and ingredients from all over the Asian continent - including South Korea and China, two of the countries most heavily impacted by COVID-19. Doyle and his wife work with importers located in Chicago to bring in wares in weekly shipments.
"We're concerned for further down the road, yes, but at this point, we're not real worried," Doyle said.
In late February, shipping association shipping association BIMCO warned China's export capacity has seriously suffered due to COVID-19, and it might not be restored until April or later.
At Walmart and other local stores, hand sanitizer, sanitizing wipes and cleaning sprays have been flying into carts. On Tuesday, New Bloomfield resident Karen Gruber visited Walmart only to be faced with nearly-empty shelves where cleaning products once sat.
"I'm a cashier at New Bloomfield Elementary," she explained. "The kids have to put their finger on the scanner, and I think I should try to keep that clean."
Ultimately, she opted for canister of bleach-based cleaning wipes.
Prevention
According to the CDC, because there's currently no vaccine or treatment for this disease, the best way to prevent the virus's spread is by avoiding exposure. That means avoiding close contact with people who are sick and avoiding touching one's nose, eyes and mouth.
"If you touch a dirty surface and rub your eye, you've just inoculated your eye with whatever's on your hand," Lynch said.
The CDC recommends standing more than 6 feet away from a potentially infected person, though not everyone with COVID-19 has shown noticeable symptoms.
"If you're walking down the lane in Walmart and someone's hacking a lung up, turn around and go the other way," Lynch said. "Use those sanitary wipes to clean the cart, too."
The CDC also recommends frequent and thorough handwashing: Wash for at least 20 seconds under warm water. Soap works to break up the envelope that protects each virus and is the best way to kill it, but a hand sanitizer containing 60 percent or more alcohol should also work.
This virus hitches a ride in droplets of mucus and saliva. Those who are sick should make sure to cough and sneeze into their elbow, shoulder or inside their shirt, rather than into the air or onto their hands. The virus may also linger on surfaces, according to the CDC, which recommends cleaning frequently touched surfaces with disinfectant. Lynch said bleach and hydrogen peroxide-based solutions should be effective; vinegar is less so but still better than nothing.
Face masks aren't useful to the uninfected, the CDC maintains. Instead, they should be used only by health workers and those who have COVID-19 symptoms. If possible, those who are sick should stay home, according to the CDC.
"The thing that worries me, and that I don't have an answer for yet, are people who're working in food service," Lynch said. "They're people who have to go to work, but the potential to spread it. I just know there's an issue there. I think that's something we're going to have to work for as a society."
While home sick, try to stay in a single room to avoid spreading the virus around your house, Lynch suggested.
"You should stay home for at least 24 hours after your fever's gone away without medication," she said. "If you're on fever suppressants, that doesn't count."
For more information, visit the CDC website.