Local Preparedness For COVID-19 Good, But Doctor Says Virus Needs Respect
March 27, 2020 at 12:14 a.m.
Local Preparedness For COVID-19 Good, But Doctor Says Virus Needs Respect
By David [email protected]
“I’m very comfortable where we are as a community right now in preparedness. I’m very appreciative of some tough decisions in regards to pulling those heavy levers of social distancing that have already been made. That helps. This is not a fire drill today,” he said during a press conference Thursday afternoon after the Kosciusko County Health Department announced the county’s first confirmed case of COVID-19.
“Our first case came to our attention around noon today. Confirmed with solid reporting from the State Department of Health,” Remington said, noting he couldn’t disclose a lot of clinical information for the patient’s privacy. “From what we know, it’s an outpatient, not admitted. An adult. Don’t know anything about underlying diseases and do not extensively understand contact information at this point. That’s our job moving forward – trying to understand this case.”
Whether this first case represents community transmission or not will be up for discussion, he said. Community transmission means that the source of infection for the spread of an illness is unknown.
“And I think over the next couple of days, we’ll have more cases. And we’ll try to answer that question, ‘Is there community transmission?’” he said.
As they look at the case, Remington said they’ll want to know if there were household contacts, if the person traveled or had been admitted to a hospital somewhere.
“We need to move forward with community understanding and planning. It doesn’t change drastically today. Thankfully, big levers have been pulled already, so this is not a fire drill today. I’m so thankful for that,” Remington said, adding praise to schools, Gov. Eric Holcomb and to Warsaw Mayor Joe Thallemer for their early decisions. “So there’s nothing new to necessarily do from a heavy lever of community distancing and traveling restrictions and all that.”
He said the county needs to have good emergency management planning going forward. “Just kind of a bellwether event, it doesn’t mean disasters in our ERs tomorrow, but this is a good spring board, and next week, we’re having those kind of discussions – emergency management, talking to the business community and all of those things. We’ll try to engage more there,” Remington said.
Those discussions will be held to answer people’s questions.
“I think all of us were hoping it would never show up here, and we knew that wasn’t likely, but now it’s here. I think you start doing that,” Remington said.
He said the KCHD was trying to provide good “eyes on the ground ... being liberal with our sharing of the understanding of the current epidemiology.”
The lingering question about COVID-19 is how is the county doing with testing. While that question will probably be moot in a couple of weeks, Remington said, “We still need to do a lot of testing, we’re still one of those areas that hasn’t seen a huge burden of confirmed cases, as compared to other areas of the country.” He said they need to get more testing in Kosciusko County, but it is ramping up.
“The number of tests that are being done, I think, is improving. There’s still a bit of a lag in getting those results. I’m pretty confident that we’ll hear of positive results. No one is forced to tell us, through state statute, of negative results,” he said.
Referring to National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci’s comments earlier this week about examining areas where coronavirus hasn’t taken hold yet, Remington said, “We sure could learn more in these counties that haven’t seen a lot of testing and don’t have a lot of positive cases yet. To throw out more and more testing in New York City is clearly not probably the biggest thing to do.”
He thinks the supplies for testing will probably improve, and the testing methodology will “quickly change and get better, more available, quicker turnaround. So we’ll know more.”
Once it’s known the coronavirus is in a community, Remington said a lot of tests “don’t necessarily tell you a lot more of what you need to do.”
He said a person doesn’t have to be tested to get the help they need. “So you manage it clinically, not perfectly, knowing the pathogen. So a patient presents with fever, cough and chills, and you have to entertain that COVID-19 is part of the differential diagnosis,” Remington said. If a person gets tested, and eventually if they’re looking good, then it’s stay at home and self-isolate, assuming COVID-19 may be the pathogen. On the other hand, if the person gets more and more ill, then they should seek care and call their medical provider. “If you’re desperately short of breath, then call 911.”
Only a small percentage of people who contract coronavirus will need to be admitted into a hospital. Most will be managed as outpatients.
“As of our conversation this afternoon, there is no specific proven treatment, at least that I’ve heard of. A lot of things starting to come to discussion, but we don’t have a magic bullet for this just yet. We don’t have a vaccine at this point,” Remington said.
The more difficult question in all of this, he suggested, is who gets quarantined without a confirmed lab test positive. “Patients with no symptoms but a household member, of say a presumed case, but who has not been tested, what do you do with them? Very challenging,” he said, noting the CDC has guidance on that on its website.
For a person who is ill, Remington said the current guidance is they self-isolate and then can free themselves from that self-isolation given several things: They should be fever free for at least 72 hours. The illness outset is at least seven days or longer before going back out into the community. And finally that the person’s health has “clearly” improved.
“So in the absence of testing, and you have self-isolated out of a ponderance of caution with respect that COVID maybe caused your clinical illness, that’s what you do,” Remington said, adding that healthcare workers are a “little trickier.”
The 14 days of self-quarantining is in regards to people who probably were exposed to coronavirus but aren’t ill. There’s a little bit of lag time and incubation period of several days with the virus.
“So if in 14 days, after your last exposure with the contagious patient, and you’re not ill within 14 days, you can be pretty confident you’re OK and you’re not going to be shedding this virus to others and you can go back (out). Independent of any testing,” Remington said.
He emphasized that people with no symptoms should not be tested. It puts them at risk stepping into a healthcare environment and consumes personal protective equipment.
“And someone mildly ill, and they’re doing OK, I don’t know that they need to overly seek the test, although we need some more testing in this community to understand what’s going on,” Remington said.
He does wish the county had a lot more testing to this date so it knew more, but that’s been an issue across the country. Being a rural community, he said that’s why the testing may be limited but also helped limit the spread of the virus.
“We don’t have congregated settings. We don’t have an international airport in town with throngs of people in the terminals. All that makes a difference with these kinds of things. We don’t have crowded streets ... I think that’s why rural counties don’t see this pretty quickly,” Remington said.
He does “feel confident” about the local hospitals’ preparations for the pandemic and that they have the resources they need.
“They have very sophisticated preparation strategies. Both of our hospitals in town, and I sense Goshen – who serves the northern tier of our county out of Syracuse – do. They’ve been putting a ton of energy and preparedness and steps. Space they could use if they need it. I have not heard of a shortage of personal protective equipment on the hospital side at this point in this community. At least for the demand as we know it now,” Remington said.
He said they are trying to help the long-term healthcare facilities where there is a feeling of vulnerability. They’re trying to help nursing homes get the personal protective equipment that they desire, and the State Board of Health sees that as a priority.
Remington said he’s not heard of a shortage of nurses and other healthcare professionals at this time. “But these kind of things consume healthcare workers, too, so that’s why some of the strategies now, with some mitigation ... for testing is also out of the respect that you are putting a healthcare worker at some risk and consuming personal protective equipment as you get a test. So that’s part of the equation as we think of testing,” he said.
Coronavirus should be “respected” as a real issue, Remington said. “It’s not a fake issue. It’s not fake news, just because you don’t know of anybody who is ill today. It has a significant case mortality rate as we know it today. It’s more lethal than influenza, which is bad enough, statistically.”
Asked for further explanation, he said, “In the aggregate, the case mortality rate for influenza, I think, is typically quoted as 0.1%. Not even 1 person out of 100 would die from influenza. So here comes coronavirus, and it looks like it’s around 2.5%. So for every 100 people who get it, 2.5 will succumb to it. That’s a big difference.”
He said the vast majority of people will not succumb to it.
“But this is a pathogen that has shown extensive community spread. It has really learned to spread from human to human to human and it seems very efficient at doing that. So there’s a volume thing with this, unlike MERS, SARS and Ebola. ... This will have lots of people infected, and that’s the issue.”
“I’m very comfortable where we are as a community right now in preparedness. I’m very appreciative of some tough decisions in regards to pulling those heavy levers of social distancing that have already been made. That helps. This is not a fire drill today,” he said during a press conference Thursday afternoon after the Kosciusko County Health Department announced the county’s first confirmed case of COVID-19.
“Our first case came to our attention around noon today. Confirmed with solid reporting from the State Department of Health,” Remington said, noting he couldn’t disclose a lot of clinical information for the patient’s privacy. “From what we know, it’s an outpatient, not admitted. An adult. Don’t know anything about underlying diseases and do not extensively understand contact information at this point. That’s our job moving forward – trying to understand this case.”
Whether this first case represents community transmission or not will be up for discussion, he said. Community transmission means that the source of infection for the spread of an illness is unknown.
“And I think over the next couple of days, we’ll have more cases. And we’ll try to answer that question, ‘Is there community transmission?’” he said.
As they look at the case, Remington said they’ll want to know if there were household contacts, if the person traveled or had been admitted to a hospital somewhere.
“We need to move forward with community understanding and planning. It doesn’t change drastically today. Thankfully, big levers have been pulled already, so this is not a fire drill today. I’m so thankful for that,” Remington said, adding praise to schools, Gov. Eric Holcomb and to Warsaw Mayor Joe Thallemer for their early decisions. “So there’s nothing new to necessarily do from a heavy lever of community distancing and traveling restrictions and all that.”
He said the county needs to have good emergency management planning going forward. “Just kind of a bellwether event, it doesn’t mean disasters in our ERs tomorrow, but this is a good spring board, and next week, we’re having those kind of discussions – emergency management, talking to the business community and all of those things. We’ll try to engage more there,” Remington said.
Those discussions will be held to answer people’s questions.
“I think all of us were hoping it would never show up here, and we knew that wasn’t likely, but now it’s here. I think you start doing that,” Remington said.
He said the KCHD was trying to provide good “eyes on the ground ... being liberal with our sharing of the understanding of the current epidemiology.”
The lingering question about COVID-19 is how is the county doing with testing. While that question will probably be moot in a couple of weeks, Remington said, “We still need to do a lot of testing, we’re still one of those areas that hasn’t seen a huge burden of confirmed cases, as compared to other areas of the country.” He said they need to get more testing in Kosciusko County, but it is ramping up.
“The number of tests that are being done, I think, is improving. There’s still a bit of a lag in getting those results. I’m pretty confident that we’ll hear of positive results. No one is forced to tell us, through state statute, of negative results,” he said.
Referring to National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci’s comments earlier this week about examining areas where coronavirus hasn’t taken hold yet, Remington said, “We sure could learn more in these counties that haven’t seen a lot of testing and don’t have a lot of positive cases yet. To throw out more and more testing in New York City is clearly not probably the biggest thing to do.”
He thinks the supplies for testing will probably improve, and the testing methodology will “quickly change and get better, more available, quicker turnaround. So we’ll know more.”
Once it’s known the coronavirus is in a community, Remington said a lot of tests “don’t necessarily tell you a lot more of what you need to do.”
He said a person doesn’t have to be tested to get the help they need. “So you manage it clinically, not perfectly, knowing the pathogen. So a patient presents with fever, cough and chills, and you have to entertain that COVID-19 is part of the differential diagnosis,” Remington said. If a person gets tested, and eventually if they’re looking good, then it’s stay at home and self-isolate, assuming COVID-19 may be the pathogen. On the other hand, if the person gets more and more ill, then they should seek care and call their medical provider. “If you’re desperately short of breath, then call 911.”
Only a small percentage of people who contract coronavirus will need to be admitted into a hospital. Most will be managed as outpatients.
“As of our conversation this afternoon, there is no specific proven treatment, at least that I’ve heard of. A lot of things starting to come to discussion, but we don’t have a magic bullet for this just yet. We don’t have a vaccine at this point,” Remington said.
The more difficult question in all of this, he suggested, is who gets quarantined without a confirmed lab test positive. “Patients with no symptoms but a household member, of say a presumed case, but who has not been tested, what do you do with them? Very challenging,” he said, noting the CDC has guidance on that on its website.
For a person who is ill, Remington said the current guidance is they self-isolate and then can free themselves from that self-isolation given several things: They should be fever free for at least 72 hours. The illness outset is at least seven days or longer before going back out into the community. And finally that the person’s health has “clearly” improved.
“So in the absence of testing, and you have self-isolated out of a ponderance of caution with respect that COVID maybe caused your clinical illness, that’s what you do,” Remington said, adding that healthcare workers are a “little trickier.”
The 14 days of self-quarantining is in regards to people who probably were exposed to coronavirus but aren’t ill. There’s a little bit of lag time and incubation period of several days with the virus.
“So if in 14 days, after your last exposure with the contagious patient, and you’re not ill within 14 days, you can be pretty confident you’re OK and you’re not going to be shedding this virus to others and you can go back (out). Independent of any testing,” Remington said.
He emphasized that people with no symptoms should not be tested. It puts them at risk stepping into a healthcare environment and consumes personal protective equipment.
“And someone mildly ill, and they’re doing OK, I don’t know that they need to overly seek the test, although we need some more testing in this community to understand what’s going on,” Remington said.
He does wish the county had a lot more testing to this date so it knew more, but that’s been an issue across the country. Being a rural community, he said that’s why the testing may be limited but also helped limit the spread of the virus.
“We don’t have congregated settings. We don’t have an international airport in town with throngs of people in the terminals. All that makes a difference with these kinds of things. We don’t have crowded streets ... I think that’s why rural counties don’t see this pretty quickly,” Remington said.
He does “feel confident” about the local hospitals’ preparations for the pandemic and that they have the resources they need.
“They have very sophisticated preparation strategies. Both of our hospitals in town, and I sense Goshen – who serves the northern tier of our county out of Syracuse – do. They’ve been putting a ton of energy and preparedness and steps. Space they could use if they need it. I have not heard of a shortage of personal protective equipment on the hospital side at this point in this community. At least for the demand as we know it now,” Remington said.
He said they are trying to help the long-term healthcare facilities where there is a feeling of vulnerability. They’re trying to help nursing homes get the personal protective equipment that they desire, and the State Board of Health sees that as a priority.
Remington said he’s not heard of a shortage of nurses and other healthcare professionals at this time. “But these kind of things consume healthcare workers, too, so that’s why some of the strategies now, with some mitigation ... for testing is also out of the respect that you are putting a healthcare worker at some risk and consuming personal protective equipment as you get a test. So that’s part of the equation as we think of testing,” he said.
Coronavirus should be “respected” as a real issue, Remington said. “It’s not a fake issue. It’s not fake news, just because you don’t know of anybody who is ill today. It has a significant case mortality rate as we know it today. It’s more lethal than influenza, which is bad enough, statistically.”
Asked for further explanation, he said, “In the aggregate, the case mortality rate for influenza, I think, is typically quoted as 0.1%. Not even 1 person out of 100 would die from influenza. So here comes coronavirus, and it looks like it’s around 2.5%. So for every 100 people who get it, 2.5 will succumb to it. That’s a big difference.”
He said the vast majority of people will not succumb to it.
“But this is a pathogen that has shown extensive community spread. It has really learned to spread from human to human to human and it seems very efficient at doing that. So there’s a volume thing with this, unlike MERS, SARS and Ebola. ... This will have lots of people infected, and that’s the issue.”
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