2019 Novel Coronavirus Disease COVID19 Update Rappahannock Area

2019 Novel Coronavirus Disease (COVID-19) Update Rappahannock Area Health District March 2, 2020

What is COVID-19? COVID-19 is a respiratory illness in humans caused by a new (novel) coronavirus Coronaviruses are a large family of viruses Symptoms of new virus can include: • Fever • Cough • Shortness of breath Most (80%) cases not severe Severe cases (20%) can cause pneumonia, respiratory failure, need for ICU care and death Symptoms may appear 2 -14 days after exposure to the virus

COVID-19 Cases in the United States 69 confirmed & presumptive cases among U. S. residents as of Feb 29, 2020 • • • 13 travel-related cases 9 person-to-person spread in U. S. 47 among individuals repatriated to the United States: • • 3 residents tested positive in Wuhan City 44 individuals aboard the Diamond Princess Cruise Ship tested positive • One PRESUMPTIVE death (not confirmed) from COVID-19 in United States • One death of a U. S. citizen in Wuhan, China • No cases of COVID-19 in Virginia

How is Coronavirus spread? Person-to-person spread thought to occur via respiratory droplets produced when a person coughs or sneezes • Droplets land on the mouth or nose of the person nearby or inhaled into the lungs • Currently unknown if a person can become infected by touching a surface or object that is contaminated with the virus – WHO feels risk is low • Research on when peak infectivity occurs is ongoing

• For 2019 novel coronavirus infection, please note this is a preliminary figure. Based on small number of patients in China. This could change in the future. • As of 2/27/2020, the confirmed case death rate is around 2. 3% • By comparison, CDC estimates that since 2010, seasonal influenza has resulted in 140, 000 – 810, 000 hospitalizations per year and 12, 000 – 61, 000 deaths per year

Public Health Response: Prevention and Treatment Currently no vaccine to prevent 2019 -n. Co. V infection No specific treatment for COVID -19 = supportive care Therefore, prevention is paramount. Standard infection control measures = wash hands, cover cough, stay home if ill, clean surfaces

Public Health Response: Non-pharmaceutical interventions (NPIs) Personal: • Personal protective measures you can take every day, and personal protective measures reserved for pandemics Community: • Social distancing measures designed to keep people who are sick away from others Environmental • Environmental cleaning measures

Non-pharmaceutical interventions (NPIs) Personal: • Stay home when you are sick (Stay home for at least 24 hours after being fever-free without the use of fever-reducing medications) – everyday use and pandemic measure • Respiratory etiquette = cover cough or sneeze – into a tissue or your sleeve. Wash hands or use hand sanitizer right after. An everyday use and pandemic measure • Hand hygiene = wash hands with soap and water frequently or use alcohol-based hand sanitizer. An everyday use and pandemic measure • Avoid touching your eyes, nose, or mouth – an everyday use or pandemic measure • Consider voluntary home quarantine of household members who have been exposed to someone they live with who is sick. This is a possible pandemic measure. Duration of quarantine would need to be determined. For pandemic influenza, would be one incubation period of virus. • Possible use of face masks (surgical mask) by ill persons. A possible pandemic measure • CDC does not generally recommend use of face masks by well people

Non-pharmaceutical interventions (NPIs) Community: • Preemptive coordinated school closures. Includes all types of schools = daycare, K-12 and colleges/universities. This is possible for more severe pandemic use. • Have a plan in place in the event of the need for school closures • Consider using internet-based teleschooling to continue education • Social distancing measures: Have a telework plan in place if physical workplace closure is advised. Businesses can replace in-person meetings with video or telephone conferences and increase teleworking options. • Communities may need to modify, postpone, or cancel mass gatherings. Another social distancing measure. • Healthcare providers may consider increasing telehealth services and delaying elective surgery in the event of sustained community transmission Environmental Cleaning: • Clean and disinfect frequently, particularly high touch items. An everyday use and pandemic measure.

Public Health Response: Coronavirus Screening/Testing Traveler screening at 11 airports: • • • John F. Kennedy, New York Chicago O’Hare, Illinois San Francisco, California Seattle - Tacoma, Washington Daniel K. Inouye, Hawaii Los Angeles, California Hartsfield – Jackson, Atlanta Washington - Dulles, Virginia Newark Liberty, New Jersey Dallas - Fort Worth, Texas Detroit, Michigan • Asking about symptoms of illness (fever, cough, shortness of breath), or exposure to person with COVID-19. Giving information about COVID-19

Public Health Response: Risk Assessment for Returning Travelers • Phone interview with local health department staff • Depending on risk assessment conclusions, VDH may advise: • Self-isolation = for symptomatic people • Self-quarantine = for ASYMPTOMATIC people • Monitor for symptoms on Daily Temperature Monitoring Log • Most returning travelers fall into asymptomatic, “medium risk” category: • • Returned from travel to mainland China (i. e. not Wuhan City) Have no symptoms of illness Require self-quarantine at home with public health supervision Must monitor their temp twice daily until end of the 14 day monitoring period

U. S. Public Health Response Summary • • Federal, state and local responses Entry screening at 11 U. S. airports CDC travel advisories issued for multiple countries (see https: //wwwnc. cdc. gov/travel/notices) Diagnostic test developed – Virginia state public health lab will do testing at some point in future Ongoing research on therapeutics Vaccine development underway Non-pharmaceutical Interventions (NPIs) Information and guidance • CDC website (www. cdc. gov/coronavirus) • VDH website (www. vdh. virginia. gov/coronavirus)

VDH and Rappahannock Area Health District Responses • VDH Coordinating with CDC and other states • RAHD coordinating with healthcare systems and providers for early case detection and infection control • Guidance from CDC, VDH, and state public health lab • RAHD: Person Under Investigation case management; contact tracing and monitoring • VDH and RAHD: Preparing for potential of further spread in U. S. • Working under Incident Command System (ICS) • VDH and RAHD: Education and information = press releases, letters, conference calls (www. vdh. virginia. gov/coronavirus) • VDH and RAHD targeted education • Healthcare providers – letters from Health Commissioner and RAHD • Educational institutions – VDH guidance on website • Local emergency managers - letter, conference call

Final Thoughts and Important Links to Information • Rapidly evolving situation • Case counts in U. S. will grow over the coming days and weeks • Public health guidance will change as more information learned • At this time, overall risk to U. S. general public considered low – may change • Vigilance, frequent communication, and coordination btw healthcare and public health are critical • More to learn about virus, transmission factors, risks for infection, and the disease itself • Promote flu and respiratory infection prevention • Updates will be communicated via: • Press releases, letters, etc. • www. vdh. virginia. gov/coronavirus • https: //www. cdc. gov/coronavirus/2019 -ncov/index. html • https: //www. who. int/health-topics/coronavirus

Thank You! Contact information for Rappahannock Area Health District staff: Brooke Rossheim, M. D. , M. P. H. District Director brooke. rossheim@vdh. virginia. gov Direct office: 540 -322 -5930 Nicole Sullivan District Epidemiologist nicole. sullivan@vdh. virginia. gov Cell: 540 -290 -2426 Wendi Lane Local Health Emergency Coordinator Office: 540 -322 -5940 Cell: 540 -940 -5486 wendi. lane@vdh. virginia. gov