Local health officials would be at the spear-tip of the response should the novel coronavirus (COVID-19) become widespread in the United States.
There had been more than 83,000 people confirmed with COVID infections as of Friday afternoon. Most have been found in China; however, more than 40 countries, including the United States, have reported cases of the disease.
There are now 62 cases of coronavirus infections confirmed in the United States. As of Friday, the disease had killed more than 2,800 worldwide. The United States on Saturday reported its first death from COVID-19 in Washington state.
Missouri health officials reported in the past few days they have monitored 60 people who have traveled to places where they could possibly have exposed themselves to the virus, but none have become ill.
Randall Williams, director of the Missouri Department of Health and Senior Services, said his office has been in daily contact with Washington, D.C., for a month concerning COVID-19.
"The United States has a robust health care system," Williams said. "And we have the best infectious diseases (prevention organization) in the world — the CDC (Centers for Disease Control and Prevention)."
The message from the top down has been containment, he added. If the situation can't entirely be contained, health officials will move to a mitigation phase.
It is important that federal and state organizations work with local health officials to prepare for any sort of health outbreak.
On the county level, health officials would have much of the responsibility for the response to a pandemic, Williams said.
Should anyone present to local health providers with concerns that they may have COVID-19, it will be a county health department decision to test people for the virus or to quarantine them, said Chezney Schulte, communicable disease coordinator for Cole County.
"I would be the one conducting that interview," Schulte said. "(Decisions) would be based on what the client is saying and the most recent, up-to-date guidelines."
Guidelines changed Thursday for the first time in two weeks. The CDC added the risk if the patient had traveled to one of five countries that has "community spread" — China, Iran, Italy, Japan and South Korea. Community spread means the virus is circulating within the local community and infecting people without an obvious source of infection, such as a person who is already ill with the virus.
The United States may have identified its first case of community spread Thursday. A woman in northern California who came down with the virus had not traveled outside the country and had no known contact with someone who had.
Schulte said several people in Cole County have called, concerned about whether they had the virus, but none have met enough of the criteria (such as having traveled to a place where the disease is active) to be tested.
"The general population in the United States is at a very low risk of being exposed to coronavirus," she said. "Right now, we're focused on travelers."
Data from China appear to confirm older people are at highest risk from the COVID-19 illness.
Within the United States, right now, a greater risk to older people is seasonal influenza, Schulte said. About 18,000 people in the country have died from the flu so far this season, CDC data show.
The Cole County Health Department isn't working alone to prepare for a possible COVID-19 outbreak.
St. Mary's Hospital and Capital Region Medical Center in Jefferson City are among a large group of community organizations meeting regularly to discuss and prepare for a possible pandemic, according to Jackie Glover, St. Mary's Hospital's infection preventionist.
In addition to the hospitals and county health officials, the group includes Cole County EMS, local police departments, sheriff's departments and emergency management officials, she said.
"We have discussed personal protective equipment, communication between the groups, transport of patients and other ways we can work together," Glover said in an email to the News Tribune. "We are well prepared with supplies at SSM Health St. Mary's Hospital, as well as within our SSM Health system."
The organizations work together to decrease the spread of diseases if possible and to heal and comfort those infected, she said.
CRMC has updated policies and procedures in preparation for the possibility COVID-19 reaches Jefferson City, Lindsay Huhman told the News Tribune in an email. Huhman, director of marketing at CRMC, said the hospital has implemented patient screenings.
"We are working closely with our local public health departments on monitoring, detecting, quarantining and coordinating medical care of community members, if needed," she said. "We are assessing our supply chain needs to assure we have adequate supplies on hand. We participate in the weekly situation updates offered by the CDC."
Cole County Emergency Management has also taken a number of steps to be certain it is prepared, should pandemic occur, according to Director Sierra Thomas.
Thomas has scheduled meetings with department heads, as well as the Jefferson City Fire Department, the Cole County Sheriff's Office and others.
"I've been in direct contact with the CDC to find out what specific equipment we may need," Thomas said. "We have a couple of (infectious disease protective) suits that we will put in ambulances and buses in case they come across anyone who is ill."
Her department continues to monitor COVID-19 responses.
"We're doing everything we can on this end. We have handed the reins to the county Department of Health," Thomas said.
The DHSS recognizes some counties don't have the capabilities or resources of their larger neighbors.
The state will step in to assist those counties if it is necessary, he said. State health officials will also help if school districts or other organizations need additional guidance about whether to close their doors or for other considerations.
The CDC has said it is likely the outbreak will soon be considered a pandemic.
That's not too surprising, Schulte said. The health organization has three criteria to identify a pandemic, she said.
"The virus causes an illness. Check — we have that. The virus goes from person to person. Check — we have that," she said. "The virus spreads through communities."
Well, in five countries, the virus has verified "community spread," she said. The case in California may indicate the United States could have the same spread.
If COVID-19 does come to the community and people have to make decisions about closing doors, they could reach out to the county for help.
"In the same way, we will work with the Department of Health and Senior Services — and employers or businesses, schools — things like that that might be considering having to close or make decisions about their operations," Schulte said. "The main groups we've been in touch with have been health care providers and Jefferson City Schools."
All of those facilities are staying in communication with the Cole County Health Department, she said.
Also, there are guidelines for businesses on the CDC website.
Guidelines are similar to those practices considered best for influenza outbreaks — such as encouraging people who are ill to stay home, promoting good hand hygiene, or telling employees to cover their mouths when they cough or sneeze.
The CDC recommends employers separate employees who appear to have acute respiratory illness (such as cough or shortness of breath) from other employees and send them home immediately.
The CDC also recommends businesses conduct routine environmental cleaning, especially for frequently touched surfaces like workstations and countertops.
Schulte said the CDC proposed — in a case-by-case basis — some employees may speak with their employers about working from home or educating from home and not placing a burden on their economic status.