Missouri's health department director came prepared Monday to demonstrate for state legislators how to properly wash their hands, one of the best measures he and other doctors said the public can use to defend against the COVID-19 disease caused by a new, spreading coronavirus.
Dr. Randall Williams, director of the Missouri Department of Health and Senior Services, was prepared to demonstrate proper hand-washing techniques before the House Special Committee on Disease Control and Prevention with a bowl of water at-the-ready.
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Williams did not have time to do that, but with the aid of a brief hand-washing video, advised that hand-washing should last 20 seconds — "sing 'Happy Birthday' twice" — should get under the fingernails and include the back of the hand, and while ideally it's with soap and water, hand sanitizer with a 60 percent alcohol content will do.
Along with the practice of good hand-washing, the other advice given Monday to the public before the House committee as what's most important to do at the moment in light of the spread of COVID-19 included to stay home if sick, and only seek medical care if cold-like symptoms include a fever of 100.4, shortness of breath, light-headedness or an inability to take food or water.
The government's response to COVID-19 has and could go far beyond hand-washing demonstrations, though, and Williams spoke to instill confidence and assure "we are very well-prepared" for the best and worst COVID-19 could bring.
Status of COVID-19 and other ways to prepare
The new coronavirus that causes the disease called COVID-19 — shorthand for "coronavirus disease 2019" — was first detected in Wuhan, a city in east-central China.
Coronaviruses are common in people and animal species including bats, camels, cattle and cats, according to the Centers for Disease Control and Prevention. Animal coronaviruses can rarely infect people and then spread between people.
Williams said he did not think pet dogs or cats will contract the virus that causes COVID-19.
COVID-19 is caused by a member of the coronavirus family that's a close cousin to the SARS and MERS viruses that have caused outbreaks in the past. COVID-19 is specifically caused by a virus named SARS-CoV-2, which like the SARS and MERS viruses originated in bats.
Many of the early COVID-19 patients in Wuhan were linked to a large seafood and live animal market, where another animal likely was the bridge of transmission between bats and humans, but person-to-person spread has now carried the virus that causes COVID-19 far beyond Wuhan and China — infecting approximately 90,000 people, and killing more than 3,000, according to media reports.
Most of those illnesses and deaths have been in China, but outbreaks continue to spread in Italy, Iran and South Korea, and cases have been confirmed in more than 65 countries — including the United States, where just Monday, the death toll in Washington state rose to six people.
Rep. Jon Patterson, R-Lee's Summit, who is the chairman of the House committee, said at the start of the hearing there had been 88 confirmed COVID-19 cases in the U.S., in 10 states, including Missouri's neighbor Illinois — though there have been no confirmed cases in Missouri.
Williams said about 100 people are self-monitoring in the state — including taking their temperature, wearing masks — but no tests have come back positive.
Most people who become infected only develop mild disease, if they show any symptoms at all, but some, especially people with other medical complications, develop more serious symptoms such as pneumonia that can be fatal.
Dr. Stevan Whitt, a University of Missouri specialist on infectious disease, gave the same advice as with dealing with flu season — do not go visit a frail loved one while sick.
The medical consensus Monday was also clear on another response to COVID-19 that's been seen; do not hoard face masks, as they do not protect the people who wear them from getting sick and better serve health care providers and people who are already sick.
Williams said masks offer a false sense of security, akin to thinking wearing a heavy coat will offer protection in a 70 mph car crash when the person wearing the coat is not also wearing a seatbelt.
Whitt said masks "don't really filter air," but trap airborne particles.
It's that trapping of airborne particles that can help reduce the spread of an illness via airborne droplets, which is why the masks are better-suited for people who are already coughing or sneezing — and the health care workers tending to them.
There is no proverbial seatbelt for COVID-19 — no vaccine. While a vaccine may eventually be developed, that will likely be months away.
State and health care systems' preparedness
Williams said tests for COVID-19 in Missouri can be turned around in six hours, there are daily meetings with medical professionals, almost daily briefings with Gov. Mike Parson, there's an itemized plan of how the state would distribute any federal financial aid it may receive, and the state's pandemic influenza emergency plans are adaptable to COVID-19.
Williams also touted a recent report by the Trust for America's Health that put Missouri among 25 states and the District of Columbia in being in a "High Tier" for level of preparedness for protecting public health during an emergency.
The Trust for America's Health describes itself as "a nonpartisan public health policy, research and advocacy organization that envisions a nation that values the health and well-being of all and where prevention and health equity are foundational to policymaking at all levels of society."
The report's findings included that 87 percent of Missouri hospitals participated in health care coalitions, as of 2017.
"Coalitions prepare members with critical tools, including medical equipment and supplies, real-time information, enhanced communication systems, and exercises and training for healthcare personnel," and foster coordination that can free hospitals "to focus on clinical care," according to the report.
Dr. Clay Dunagan, chief clinical officer for BJC HealthCare, said "we will depend mightily" on self-quarantine to get through an outbreak of COVID-19 without over-stressing the health care system.
Dunagan expected the mortality rate of COVID-19 to decrease to about 1 percent — which would still be several times more lethal than the seasonal flu, which kills thousands of people in the U.S. every year, but down from the current estimated 2-3 percent mortality rate — as more asymptomatic and mild cases are reported, but said it's important to take care of those asymptomatic and mild cases at home.
He said if someone were to test positive for COVID-19, they would be isolated and evaluated, and would be hospitalized if any pre-existing health conditions suggested that would be appropriate.
He added it's best to wait 10-14 days after symptoms abate before going back to one's normal routine — a recommendation which is being more cautious than with the flu.
For his part, Parson's office announced Monday the governor would be having a closed briefing today with Cabinet members, external stakeholders, the Missouri State Emergency Management Agency and Williams at SEMA's headquarters in Jefferson City about COVID-19, to be followed by a news conference.
The Associated Press contributed to this report.