Hospitals are double-checking their inventories of N95 face masks. Actors pretending to suffer from the new coronavirus illness are testing front-line health care workers. And public health officials are mulling what the tipping point should be for schools to close.
Erie County Health Commissioner Dr. Gale Burstein calls this the calm before the storm.
"We may have to take extreme measures to protect ourselves," she said. "There’s no reason to think we can keep it out forever."
There are no known cases of the novel coronavirus illness in New York State, but health experts believe it's just a matter of time.
So how ready will the Buffalo Niagara region be when that day comes?
For individual and suspected local cases, health officials say they feel confident.
But for a large-scale public health emergency? Public health and hospital organizations have some protocols in place, but turning those plans into reality requires much more preparation.
"We’re well-positioned to deal with the onesies and twosies," said Tim Kornacki, Kaleida Health's director of emergency management. "Where any hospital is going to be challenged is if there multiple people with the diagnosis."
So health departments and private health care providers have been upping their preparations for a potential local outbreak. They've participated in rounds of calls with the state Department of Health and the U.S. Centers for Disease Control and Prevention, conducted internal drills, adjusted patient intake procedures and taken stock of their personal health protection supplies.
Government health officials, meanwhile, are staying in contact with schools, border agents and private health providers to provide accurate information and promote best practices.
The vast majority of people who contract the new coronavirus recover. Rough mortality rate estimates currently hover around 3% or less. But health leaders around the world are on high alert because that small percentage can still translate into a large number of deaths as the disease becomes a major global pandemic. So far, 3,000 individuals have died from the virus, with most of the deaths in China.
Containing and tracking the "coronavirus disease 2019," commonly called COVID-19, is difficult. Many infected individuals show relatively mild symptoms commonly associated with the flu – or in children, no symptoms at all – and can unknowingly spread the disease.
In the United States, only the CDC had the ability to test for the virus but New York Gov. Andrew M. Cuomo tweeted that he spoke Saturday with Vice President Mike Pence and learned the FDA has approved testing that can start immediately at the state Department of Health Wadsworth Center clinical laboratory in Albany. Other states also hope to start testing soon.
"This is a rapidly changing picture," Burstein said.
Local health care providers say they are adjusting their patient intake procedures and checking supplies to prepare for new cases. Most hospitals have had long-standing plans and isolation procedures in place for large-scale emergencies and disasters.
Kaleida has developed contingency plans to stockpile supplies and equipment to protect both patients and hospital staff in case of an outbreak, Kornacki said. That includes judicious use of the high-grade, specially fitted N95 face mask, which provides the most effective protection from airborne viruses. The majority of these masks are produced in China and are currently subject to exceptionally high demand within that country, he said.
He also said the hospital system has undertaken "hidden drilling" since late last month.
Without any notification or warning, the administration has sent actors to Kaleida hospitals who pretend to be patients with symptoms and travel histories consistent with COVID-19. If the staff responds appropriately, all is well. But if they don't, they receive on-the-spot corrective training, he said.
"Generally, we’ve done really, really well," he said. "They followed the proper protocol."
From the moment a person walks into an emergency room waiting area, he said, there's a kiosk offering hand sanitizer and free face masks that can be worn by anyone anyone feeling sick, he said. At registration, patients are asked by front desk staffers about their travel history. If they are suspected to have the virus, they are masked and whisked to a separate waiting area, he said.
Similar efforts are occurring at other areas hospitals and other urgent care providers. Both Kaleida and Catholic Health emergency departments are equipped with negative pressure isolation rooms that prevent airborne germs from recycling through the rest of a hospital's climate control vents.
"In addition to prominent signage with coronavirus screening information at our emergency departments and primary care centers, intake and triage staff at these facilities have been trained on procedures for questioning patients on signs and symptoms, travel history and possible exposure to determine treatment and isolation protocols," Dr. Kevin Shiley, Catholic Health's medical director for infection prevention and control, said in a statement.
Isolation and social distancing
Local health departments also have protocols to deal with any reported individuals who are suspected to have or been exposed to the new coronavirus.
Those who have no symptoms but may have been exposed to the virus are usually quarantined, while those who have symptoms that suggest they might have COVID-19 are isolated, usually at home unless they show serious symptoms. Despite the difference in terminology, the reality is the same – individuals are segregated from the general population for 14 days, Burstein said.
She declined to say whether anyone in Erie County has been investigated or tested. Hundreds of New Yorkers are being monitored for exposure across the state, but no one has tested positive.
As for suspected cases reported to the county health department, county staff will go to person's house and ask the person to sign a legal document agreeing to a voluntary quarantine or isolation, Burstein said. The individual is given a thermometer and asked to check for temperature twice a day, keep a log of temperatures and any symptoms, and check in daily with the health department.
The health department will also serve as an intermediary if the individual needs to go to a health care facility, requires transportation or needs food and clean clothes. The department will also provide information about patients to their employers, Burstein said.
In light of the CDC's announcement that it is realistic to expect local COVID-19 cases in the future, the health department is taking a closer look at implementing more mitigation plans associated with public health disasters, she said.
That would include sharply scaling back community gatherings, including in schools and workplaces, since no vaccine will be ready for roughly a year. There is no medication specifically designed to treat this virus post-infection so curbing social interaction to prevent the spread of the disease is the primary alternative, Burstein said.
"Enhanced social distancing" measures include discouraging large business meetings, large school gatherings and public celebrations. Businesses would encourage employees telecommute. School districts would close their buildings and offer virtual classes instead. And health care providers would perform more patient diagnoses by phone or video.
Burstein and Niagara County Public Health Director Daniel J. Stapleton stress the need to take common-sense precautions to prevent the spread of any contagious illnesses, such as the flu, which recently claimed the life of a child locally.
"I’m more concerned about the influenza season, with the tens of thousands of people who die every year," Stapleton said. "And this is an unusually bad season. Both young people and old are at higher risk."
Public health officials called for personal responsibility. Stay home and isolate yourself if feeling sick. Wash your hands often and stay away from people who are sick or appear sick. Keep a clean and disinfected environment at home.
Seek accurate information from local or state health departments, or from the CDC, which has detailed and updated information about the illness and its symptoms.
Local health officials say they have been frustrated by false information about the disease being spread on social media.
"We want to make sure there’s a partnership with the public," Stapleton said. "We can’t do it on our own."
Story topics: Covid-19