The coronavirus cometh

State, local officials plan against an invisible enemy

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More hand washing and less hand wringing — that’s still the message from state and local health officials on how to cope with the coronavirus that is spreading around the world.

No cases of the new coronavirus that causes a respiratory illness called COVID-19 have yet been reported in Michigan. But a relentless drip of new cases in Italy, Iran, South Korea and the United States have left greater Lansing hanging between blithe business as usual and pit-of-the-gut dread.

With the activation last week of Michigan’s Emergency Operations Center, state and local officials are tightening communication among all levels of government, hospitals, police and private relief agencies. The state is dusting off scenarios that have already been rehearsed in the past decade, in the face of threats from Ebola and earlier flu outbreaks in the United States.

If there is a major COVID-19 outbreak in Michigan, the question of whether to impose school closings, quarantines or other “social distancing” measures will be primarily up to Ingham County’s top health officer, Linda Vail.

Vail said we’re not there — yet. For now, she said, the basic rules of hygiene, however boring and familiar, are still the most effective sandbags against a possible flood.

“As far as what people can do here — not a whole lot,” Vail said. “Those flu messages are critical. Wash your hands, cover your cough, stay home when you’re sick. It is remarkable how effective those measures are.”

Lansing Mayor Andy Schor said the city’s Emergency Management team is “preparing for the possibility of a pandemic outbreak, along with many of our local partners.”

“We have plans that are updated and ready to be put in place if they are needed,” Schor said. “I strongly encourage Lansing residents to take preventative measures, such as washing hands regularly, covering mouth and nose when coughing and staying home when sick.”

Avoiding any airborne virus is, first and foremost, a matter of keeping away from invisible droplets full of genetic pirates eager to board your body through your eyes, nose and mouth.

William Engelter, chief Lansing’s emergency management, said, “The most important information for people to know is to not panic about this outbreak.”

“This is very similar to other outbreaks we have had in the past,” Engelter said. “The keys to prevention are the same as other disease prevention — good hand washing, covering coughs and other good hygiene practices.”

Warning: Wash your hands as often as you will be told to in the course of this story, by a long series of public health officials, and your fingers will become prunes.

But there are worse fates. In 1918, a Spanish flu pandemic infected 500 million people, about a third of the world’s population. Worldwide, the virus killed about 50 million people, 675,000 in the United States.

For now, Michigan’s fate bobs in a vast sea of possibilities, from catastrophe to a brief brush with inconvenience. Local government, hospitals, MSU and other entities are getting ready for the unknown.

This is a test

The coronavirus numbers on Linda Vail’s computer dashboard at the Ingham County Health Department keep going up, but Vail said the story they tell is not entirely grim.

She considers it significant that, so far, the overwhelming majority of deaths from coronavirus have happened in Hubai Province, China, where the virus originated. She said that’s probably because public health officials there were caught in “reactive mode, not preparedness mode.”

“For me, it raises questions when I look at the fact that of about 2,800 deaths, 2,600 of them have happened in one place,” Vail said. (The worldwide death toll passed 3,000 since Vail spoke with City Pulse Friday.)

According to data from a large study in China, about 80 percent of coronavirus patients who sought medical help had mild infections, about 15 percent were severely ill and 5 percent were critical.

Like the flu, coronavirus is more dangerous for people who are over 65, have chronic illness or a compromised immune system. The average age of people who have died of the virus in the affected parts of northern Italy is over 80 years of age.

“We know there are other places where it has spread, and other cases, but the death numbers aren’t anywhere near as high as in Hubai Province,” Vail said. “They were behind in reacting because, unlike the rest of us, they didn’t see it coming and weren’t prepared.”

An early fruit of Michigan’s preparedness sits in a locked case in the state lab in south Lansing. A coronavirus test kit — the state’s only kit so far — arrived there Feb. 27.

“That’s the advantage of having advance warning,” Vail said. “We can sequence the entire virus and test for it and identify it.”

The lab successfully ran its first in-state test over the weekend. An Oakland County resident with coronavirus-like symptoms tested negative.

Five Michigan residents have been tested out-of-state, by the Centers for Disease Control, for the coronavirus and all of them were negative.

The test kit is a sophisticated genetic code breaker and a first line of defense in humankind’s battle with the new coronavirus.

Sandip Shah, State Public Health Laboratory director, said for now, one kit is enough. The kit can test 100 to 300 patients.

“The test detects the unique genetic pattern of the virus,” Shah said. “We can take a swab from your nose or throat, or we can take sputum, and we pull out the RNA, the genetic material. If we detect a positive, we call the provider right away.”

Another kit is on order from the CDC. Shah said more can be ordered if needed.

“There is more need in California and Texas, where they are monitoring tens of thousands of people,” Shah said. “They need them more than us. If we start seeing cases here, we’ll order again from the CDC. They’ve quite sensitive to it.”

Shah said his lab staff has meetings daily to monitor the spread of the virus.

“So far, there are none in Michigan, but it may arise,” he said. “The way these things are evolving, you never know.”

The state is monitoring medium-risk people who showed no symptoms at an airport checkpoint but traveled to areas hit by the coronavirus or came from a cruise ship that had a confirmed case.

The CDC flags these people at airport quarantining stations and notifies the state that they should be kept under observation. The state, in turn, notifies local health departments, who contact these people and ask them to self-isolate for about two weeks.

As of Saturday, the state had received 360 referrals, with 76 people still under watch. The rest have safely passed their 14-day window; people with the virus show symptoms within two to 12 days.

Local health departments check with these people every day, asking them if they’re experiencing fever, coughing, shortness of breath or other coronavirus symptoms.

Keep your distance

If the coronavirus causes a widespread health emergency in Ingham County, citizens could feel the full force of a rarely flexed muscle in the state’s police power.

Michigan law gives local health officers like Linda Vail sweeping powers to respond to health emergencies.

They can “prohibit the gathering of people for any purpose” by emergency order, secure court orders to quarantine or temporarily detain “carriers of disease” and inspect or investigate “any matter, thing, premises, place, person, record, vehicle, incident or event.”

Quarantining and “social distancing” are the biggest artillery pieces in this shadowy armory.

Social distancing means “not having a lot of bodies in one place, where a respiratory disease could spread easily,” Lynn Sutfin said. Sutfin is the spokeswoman for the state’s Department of Health and Human Services.
Social distancing can take many forms. In “red zones” of northern Italy where the coronavirus broke out in late February, the local Lombardy government closed down schools, theaters, universities and public gatherings from the opera to soccer matches.

“In the end, it’s matter of watching numbers,” Vail said. “If those numbers start to uptick really fast — but we’re not seeing that right now.”

Sutfin said several Michigan schools have closed in the past month alone, because of various illnesses that had nothing to do with the coronovirus, from neurovirus to influenza. As director of the Kalamazoo County Health Department, Vail closed schools there when the H1N1 virus broke out in 2009.

“Generally, we don’t make those decisions in a vacuum,” Vail said. “We consult with the state and the CDC. They’re situation-based decisions, and the situation isn’t here for me to make those decisions.”

But the spread of coronavirus, or any form of the flu, is so fluid and unpredictable that the assurances made yesterday can fly out the window tomorrow. Two weeks ago, Japan’s prime minister closed the schools in that nation for a month — one day after saying such a drastic measure would not be necessary.

Sutfin said it’s not too soon to “think about your own personal emergency plan.”

“If you have small children, how are you going to handle it if your school or daycare closes for two or three weeks?” Sutfin said. “Can you take off from work? Do you have a backup person? Talk to your boss and ask if you will have an opportunity to telecommute. Those are the kinds of things people can start doing now.”

Once an outbreak begins, there isn’t much time for Vail to vacillate. Social distancing works best immediately after the first cases are detected.

“They’re not effective if you wait too long to do them,” Vail said.

According to a widely cited 2007 study, a rapid two-day response to the 1918 Spanish flu outbreak in St. Louis made a big difference in mortality compared to Philadelphia, where the city waited two weeks to implement “social distancing” measures.

The first cases of the disease in St. Louis were reported Oct. 5. Within two days, the city closed schools and theaters, banned public gatherings and stopped streetcar service. In Philadelphia, authorities downplayed the outbreak when the first cases were reported Sept. 17. They waited until Oct. 3 to close schools and public gatherings and even went ahead with a citywide parade Sept. 28.

The difference in mortality between the cities was dramatic. The peak “excess pneumonia and influenza” death rate in Philadelphia during the study period was 257 out of 100,000. The peak rate in St. Louis was 31 out of 100,000.

There is one precaution, besides washing hands, that health officials from Vail up to the U.S. Surgeon General agree on: stop buying masks, unless you’re already sick or you are a health care worker.

“The thing is, the masks aren’t effective,” Vail said.

They keep virus-bearing droplets from spewing from the mouths of sick people, but once the tiny viruses are in the air, they sail right through common surgical masks. Even the N95 masks health care workers use for protection require special fitting and are close to useless for the general public.

A massive run on masks that won’t do any good for most people is putting health care workers, and people who need them for other health reasons, at risk, health officials say.

On Saturday the U.S. Surgeon General Jerome M. Adams tweeted, “Seriously people — STOP BUYING MASKS!”

‘There are only so many’

On Feb. 28, Gov. Gretchen Whitmer activated the state Emergency Operations Center, a nexus of state, local and federal agencies. Chief Medical Executive Dr. Joneigh Khaldun said people should — you guessed it —wash their hands frequently, cover their coughs and stay home if they feel sick.

The EOC, a James-Bond-ish bank of screens and consoles tucked into the basement of the Michigan State Police headquarters, is staffed with a cross–section of public and private organizations that need to coordinate a response to an outbreak, from the Red Cross to the Department of Education to the state police.

“We’ve used it in the past for hepatitis A, and natural disasters such as flooding and tornadoes,” Sutfin said. “If you were to have an outbreak of coronavirus, if there’s a request coming in for medical supplies, food, water, it all goes through one funnel point and everyone knows what’s going on.”

Local units on the front lines of a possible outbreak are also taking action, from hospitals to the Capital Region International Airport to MSU, with its large number of international students.

Monday, McLaren Greater Lansing announced that it has begun to screen potential patients for coronavirus. If a patient has the virus, the hospital notifies county and state health authorities and the CDC, and isolates the patient. Sick people are being urged not to visit the hospital.

Chris Farnum, director of infection prevention and control at McLaren Greater Lansing, said the staff is “having frequent daily meetings to prepare for a wide variety of scenarios.”

Hospitals are already stressed by flu season, but Farnum said McLaren has “ample space to accommodate additional cases of any kind in an emergency scenario and has updated plans for expanding our treatment areas if necessary.”

Farnum encouraged patients to contact their primary care physician if they have coronavirus symptoms, including fever, cough and shortness of breath.

Efforts to learn what preparations Sparrow Health System may be making were unsuccessful.

Sutfin said the state has a stockpile of supplies, including masks and ventilators that could be sent to hospitals if they run low.

“We’re attempting to get more supplies, particularly the protective equipment, those gowns, masks, gloves and things like that, but so is everybody else in the world,” Sutfin said. “There are only so many out there.”

Customs and Border Patrol officers are on site at the Capital Region International Airport, according to spokesman Spencer Flynn, mostly to screen travelers returning from Cancun or other Caribbean vacations. The airport is not one of the 11 airports in the United States that receives direct flights from China. Flynn said CDC screeners are concentrating their presence at those airports, including Detroit’s Metro.

“It’s still a generally low risk in the United States,” Flynn said. “The airlines are making some decisions to stop service to certain locations, but we’ll make sure everyone is informed.”

To keep up on travel bans or other development, Flynn recommended checking the airport’s Facebook page or airline web sites.

In January, Michigan State University formed a COVID-19 task force, cochaired by Elizabeth Alexander, an East Lansing pediatrician, and Chris Daniel, director of MSU’s Office of International Health and Safety.

The task force is drawing up plans to house some international students on or near campus this summer, in case they can’t return to their homes. They are also planning when and how to cancel classes if an outbreak happens.

The university called for students or faculty travelling in areas with a higher risk of an outbreak to return.

Study abroad trips to China, Singapore, South Korea and Hong Kong have been canceled through July. Travel to Italy, where over 80 people have died from the virus, is being looked at day to day.

MSU is encouraging all students, faculty and staff to practice self-monitoring and follow any instructions provided to them during their travel by federal and state health officials. 

Plane spotting

It is strange, but quite possible, that you are reading this story because somewhere in rural China, maybe a year ago, a bat bit a pangolin.

Health experts guess that the virus that causes COVID-19 may have made the fateful jump from animal to human at a seafood and meat market in Wuhan, China, where live animals and birds are sold. Bats, the starting point for SARS, are high on the suspect list. The bat most likely passed the virus on to a pangolin, a scaly little anteater with the misfortune of being the world’s most trafficked mammal.

The coronavirus might be good news, at least for pangolins. In January, Chinese authorities put a halt to the wild animal trade, including animals used for food in markets and restaurants. A permanent ban, now in the works, may help to stop future outbreaks, but it won’t stop COVID-19, now that the genie of human-to-human transmission is out of the bottle.

Learning more about the history of the new coronavirus is more than an academic exercise. As health officials try to figure out how widespread and virulent a COVID-19 outbreak to plan for, they compare and contrast it with past outbreaks.

So far, Vail is confident that this coronavirus “is acting much more similar to a typical influenza, although it’s a more serious influenza, than it is to some of its coronavirus sisters.”

Those “sisters” are known as SARS and MERS-CoV.

The 2003 outbreak of SARS (severe acute respiratory syndrome) originated in Asia, spreading to 29 countries, including eight confirmed cases in the U.S. The death rate was 10 percent, but closer to 50 percent in people over 60.

The deadly 2012 outbreak of MERS (Middle Eastern respiratory syndrome) primarily affected the Arabian Peninsula, with only two patients in the U.S. testing positive for the disease. Like the CORVID-19 virus, SARS and MERS are suspected to have come from some toothy encounter between bats and critters that ended up in East Asia’s live animal trade.

“The coronavirus looks like SARS and MERS, considering its place of origin, China,” Sutfin said. “Depending on community spread goes, it could look more like H1N1.”

H1N1 is a subtype of influenza that reached pandemic levels in 2019, with 60.8 million cases estimated in the United States from April 2009 to April 2010, resulting in 274,000 hospitalizations and 12,469 deaths.

The CDC declared the 2009 H1N1 pandemic over in mid-2010, but it’s still in seasonal circulation in the viral soup that surrounds us.

Scientists have learned a lot from earlier outbreaks, but trying to get a definitive profile of a new virus is like plane spotting when the craft is still a dot in the sky.

“This one’s potentially looking like it could take off,” Vail said of COVID-19. “But we need to hit the pause button until we get more information.”

However, there are indications local planners are girding for the sandbags to start sliding in the United States as more states report coronavirus cases.

Sutfin said Michigan’s emergency planning for coronavirus started out “using the Ebola plan,” which focused on monitoring travel and trying to prevent the disease from taking hold in the United States.

“Now everybody, including the CDC, has pivoted to their H1N1 plans, dealing with a respiratory disease that is highly communicable,” she said.

‘My country is sick’

The MSU campus was eerily empty last weekend, owing to the unintentional “social distancing” effect of spring break. Chuntao Ding, a visiting Ph.D. candidate in engineering from Beijing, was sitting in a café at Shaw Hall, monitoring a web site with statistics on the progress of the coronavirus.

Ding’s family lives in Zhengzhou, home of the world’s largest iPhone factory, close to the epicenter of the coronavirus outbreak in China. Nobody in his family has the virus.

“They are OK,” he said. “It’s the worst for older people.”

Ding expects to return to a normal city when his MSU visit ends in November, thanks to sweeping public health measures that have been taken in the city, including public sanitation, quarantine, and even special high-speed trains that are bringing people back to work.

“We can control it,” he said. There was pride in his voice. “The city is closed. It’s a city of 10 million people, and they’re protecting the city and the world.”

But hardly an hour goes by that he doesn’t check on things.

It’s his longest time by far he’s spent away from home. He sighed. “My country is sick, and I am concerned,” he said.

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