On Saturday, March 14, Montana finally joined the rest of the nation as the first reports were issued of people testing positive for COVID-19, the coronavirus that is sweeping through the United States at an alarming pace. That it would arrive here was inevitable, according to the scientists at the Centers for Disease Control (CDC). The big question is, “Are we prepared?”
Actively preparing for the arrival of such a highly contagious and rapidly spreading infection before it arrives, it turns out, is one of the best things a community can do. If you can’t prevent the influx of the infection, then you do what you can to mitigate the impacts when it does arrive.
It is something like nailing plywood sheets across the windows of your house in preparation for a hurricane. It feels a bit foolish to be boarding up your house on a bright, calm sunny day, but it is being done to prepare for the worst.
What’s coming is not exactly like a hurricane, but there is reason to be especially concerned with this “flu-like” virus because it is not a flu virus, it is a coronavirus. And a “novel” form of coronavirus at that, brand new to humans. Another novelty is the extremely high infection rate, high death rate and high rate of spread. The World Health Organization has recognized it as a pandemic.
The most lethal pandemic to hit the United States was the 1918 Spanish flu. The CDC estimates that about 500 million people or one-third of the world’s population became infected with that virus. The number of deaths was estimated to be at least 50 million worldwide with about 675,000 occurring in the United States.
The Institute for Disease Modeling at CDC calculated that the new coronavirus is roughly equally transmissible as the 1918 flu, and just slightly less clinically severe, and it is higher in both transmissibility and severity compared with all other flu viruses in the past century.
The CDC has also modelled a worst case scenario if no interventions and no acts of mediation at all are taken, that 160 million to 214 million people in the U.S. could be infected.
The projections suggest that 2.4 million to 21 million people in the U.S. could require hospitalization, potentially crushing the nation’s medical system, which has only about 925,000 staffed hospital beds, in an outbreak that could last months or even over a year.
But, according to Lauren Gardner, an associate professor at the Johns Hopkins Whiting School of Engineering who models epidemics, when people change their behavior those model parameters are no longer applicable, so short-term forecasts are likely to be more accurate.
“There is a lot of room for improvement if we act appropriately,” said Gardner.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, speaking at a congressional hearing last Thursday, said that what will determine the ultimate death count “will be how you respond to it with containment and mitigation.”
Some things that could serve to flatten the infection rate curve include increased testing, tracing contacts of infected people, and limiting social interactions by banning large gatherings and encouraging people to stay home and take simple precautions such as frequently washing your hands and not touching your face.
The funds needed to help local communities in the United States prepare for and endure this massive pandemic were freed up Friday when President Trump declared the outbreak to be a national emergency.
Dr. Fauci said that Mr. Trump’s declaration of a national emergency had cleared the way for a concerted, effective response to the virus. “Now it’s all systems go,” he said, adding that “as we get knowledge about new testing, we’ll alleviate the anxiety that we have in the world about, we don’t know what’s going on, but also it will give the individual physician and individual citizen the opportunity to know where they stand.”
All levels of government are trying to form a unified voice and unified approach to try and slow the outbreak down and try and keep medical facilities from being overwhelmed. The top orchestrator of the effort is the Centers for Disease Control and that is probably the best source for people to look for information on how the disease is progressing and what steps they can take to mitigate the impacts.
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://dphhs.mt.gov/publichealth/cdepi/diseases/coronavirusmt
Local efforts to address the coming crisis are concentrated in the Ravalli County Health Department. Public Health Nurse Karyn Johnston went to the County Commissioners last Wednesday to ask that the county’s emergency coordinator’s hours be increased from 20 to 40 hours per week. The coordinator will be handling information requests from the public and updating procedures and protocols to meet the demands of the situation. An incident command system is also being installed.
County health officials have been meeting with hospital staff at Marcus Daly Memorial Hospital and with school superintendents. They have been accepting samples from local health providers and running them to Missoula where a courier takes them to the state lab in Helena.
Johnston said that right now they are encouraging good hygiene as a way to personally protect yourself from the virus and reduce the spread. Good handwashing is important, she said, and coughing into your sleeve or into a Kleenex and then washing your hands. It’s also good not to be touching your face and to keep some “social distance” while out in public. If you do get sick it’s important to stay home and self-isolate.
Right now, there is a lot of influenza going around in the county, according to Johnson, a majority of cases being influenza A, but some influenza B is also occurring.
“Unfortunately, it is the same sort of symptoms as the coronavirus,” said Johnson, “fever, coughing, and achiness.”
In an announcement on social media, Corvallis School District School Superintendent Tim Johnson stated that a number of students and staff returning from the Cody, Wyoming field trip had reported flu like symptoms. According to the state health department, the timeline of the onset of symptoms is consistent with influenza.
“It is the recommendation of the state health department that students or staff exhibiting flu-like symptoms should stay home and contact their health care provider. As a reminder, students and staff should be free of fever (without medication) for 48 hours before returning to school or work.”
By Sunday evening, however, the decision had been made to close the school and at the recommendation of Ravalli County Health Department, Corvallis Public Schools #1 will be closed through Spring Break (April 5th) tentatively returning to school on April 6th.
This was quickly followed by an announcement from the Governor’s office that directed all Montana’s public K-12 schools to close starting March 16 until March 27. During this time, schools will engage in planning to provide arrangements to provide free meals to students who need them, pursuant to a waiver obtained from the United States Department of Agriculture, and to provide for all other matters and services that students need in the event of future or ongoing closure. Schools will continue to receive all state funding during this two-week closure.
“I recognize that our schools often serve as a lifeline for families and that this decision is going to have disruption on Montanans over the coming weeks. I’m committed to working with schools, communities and public health to minimize the impact. I encourage businesses to do everything they can to support families as well,” said Governor Bullock.
To address that, beginning Tuesday, March 17, lunch and breakfast will be delivered to students of Stevensville Schools. The kitchen staff will be preparing sack meals which will be delivered daily via morning bus routes at the usual prescribed pickup time. Students/families should plan to meet the bus to pick up sack meals. Meals will be delivered on both Friday and Monday even though students were not scheduled to attend. If you cannot meet the scheduled bus time or if students do not utilize bus services, the District will provide grab and go meals. These meals are available from 10 a.m. to 12 noon at the Burnt Fork Market parking lot and the bus stop at the corner of Illinois Bench and Airport Roads. The backpack food program will continue on Fridays. These packs will be prepared, labeled for recipients, and available to students on the morning bus routes and grab and go locations Fridays. Check school website, building Facebook pages and email for updates.
To mitigate the impact of school closures on families, Governor Bullock encourages all employers to be generous with their employee sick and paid leave policies during this time.
Governor Bullock is strongly recommending that the public limits all gatherings, especially those more than 50 people, in every community across the state. Governor Bullock is also recommending that individuals over the age of 60 or who are immunocompromised or with chronic health conditions do not participate in gatherings of more than 20 people. He also recommends that parents should avoid, if possible, placing children for childcare with grandparents or individuals over the age of 60 or immunocompromised persons.
Visitation in Montana’s nursing homes is suspended except for certain compassionate care situations. People who meet the exception for visitation will undergo a screening to determine whether they have traveled in the last two weeks, are residing where community spread is occurring, or if they have symptoms consistent with COVID-19.
Johnson said that all of her guidelines for response to the outbreak are coming through the state and the state is getting direction from the CDC.
Ravalli County is already beginning a voluntary shut down as public events are being cancelled, the libraries are regulating public access, retail business is dropping off, and many changes in the workplace are being made by businesses.
“Local school leaders are on the front lines of keeping their students safe while also ensuring that they receive education services,” Superintendent of Public Instruction Elsie Arntzen said Friday. “I commend local leaders for their tremendous responses to the rapidly changing and unique circumstances they are facing. The OPI is here to serve and partner with local communities as they respond to the COVID-19 outbreak and we will work to ensure that they continue to receive funding and support as decisions are made at either the state or local level to close schools.”
In addition to OPI specialists and district superintendents, the Montana Federation of Public Employees, School Administrators of Montana, and the Montana Quality Education Coalition are coordinating with OPI.
The OPI has also submitted a waiver request to the USDA to allow school nutrition flexibility so that children can still receive meals.
According to Dylan Klapmeier, Director of Communications & Federal Relations, OPI has applied for a waiver from USDA. The waiver will allow eligible Summer Food Service Program (SFSP) sponsors to provide grab and go meals rather than the normally required congregate meal service. “We have our SFSP applications ready to begin as soon as we get USDA approval and sponsors know about school closures. We can approve the sponsor applications quickly. The sponsors are responsible for their own food procurement, preparation and delivery,” he said.
In the event of extended school closures made through advice from local health departments, OPI will seek additional waivers and extensions for impacted federal programs. The U.S. Department of Education will consider case by case waivers and extensions to federal program requirements. Although campuses are not closed, the University of Montana has moved all of its classes to online-only.
John Bishop, CEO of Marcus Daly Memorial Hospital, stated in a letter to the community that, out of an abundance of caution and preparation, Marcus Daly Memorial Hospital initiated its Hospital Incident Command Structure (HICS) last week. This team is meeting regularly to manage communications, logistics, and planning efforts effectively. Marcus Daly Memorial Hospital has maintained an emergency preparedness plan for many years to align with Federal Regulatory Requirements and to ensure it can effectively respond to events, such as COVID-19.
The hospital has already begun controlling access to its facilities to ensure the safety of patients, visitors and staff. “At each access point, we have hand sanitizer, masks, and tissues available so that patients and visitors can perform respiratory etiquette, as appropriate. Patients with a fever, cough, or cold symptoms are asked to put on a mask when they show up for an appointment. We also ask that if you are ill, please do not visit our already vulnerable patients,” said Bishop.
“We are taking these steps to be proactive in protecting our staff, patients, and the community,” said Bishop. “As the situation with COVID-19 changes, our team will adjust accordingly. Your safety and the quality of care we provide are of the utmost importance to us. Controlling the spread of communicable diseases is a community effort; please do your part by washing your hands, covering your coughs, and staying home when you’re ill,” he said.
Montana Supreme Court Justice Mike McGrath issued a letter to District Court Judges and Clerks; Montana Water Court; and Montana Courts of Limited Jurisdiction emphasizing the importance of keeping the courts running.
“At a time like this, it is especially critical that we continue ahead with an organized society that is able to demonstrate that we can absorb this potential crisis and continue to function in an orderly manner. The courts are an essential part of that organization. Without the courts properly functioning society can begin to drift into disorder and chaos,” wrote McGrath, “It is for this reason that the Courts must remain open.”
He outlined some “common sense” procedures to “help flatten the curve of progress” of the outbreak. He sets forth some requirements for the courts. One is that Jurors who are defined by the Centers for Disease Control as at-risk if they contract the virus must be released from reporting for jury duty, if requested. The Court is encouraging attorneys and self-represented litigants to request a continuance or a bench trial. The Court will try to schedule jury pools in a way that large crowds can be avoided and have plenty of tissues and cleaning products with signs warning to wash hands in high-touch areas. Litigants and attorneys who report not feeling well will be asked to reschedule their appearance. Jurors who report they are feeling ill must be released. The Court is encouraging the use of video conferencing whenever possible instead of meeting and cancellation of all non-essential meetings and travel by staff.
“Finally, it is imperative your court be involved and engaged with your local disaster and public health planning committee. This will be critically important moving forward,” wrote McGrath.
CDC recommends that for the next eight weeks, organizers cancel or postpone in-person events that consist of 50 people or more throughout the U.S. Meanwhile, many groups and organizations are cancelling smaller meetings and events as well. As the Star gets notification of this, we post them on our facebook page and on our website. Many local businesses have curtailed their usual operating procedures as well.
As of Monday, six people in Montana had tested positive for coronavirus, two of them in Missoula County.
For more information on COVID-19, please visit the CDC website: https://www.cdc.gov/coronavirus/2019-ncov/index.html