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‘All Hands on Deck’: Health Workers Race to Track Thousands of Americans Amid Coronavirus ‘All Hands on Deck’: Health Workers Race to Track Thousands of Americans Amid Coronavirus
(2 months later)
After a long journey at sea on the Westerdam cruise ship, which was denied entry at ports across Asia over fears of the coronavirus, Holley Rauen finally returned home to Florida on Wednesday night. Moments later, she discovered that she had joined a cast of thousands who are being meticulously tracked by local health officials across the United States.After a long journey at sea on the Westerdam cruise ship, which was denied entry at ports across Asia over fears of the coronavirus, Holley Rauen finally returned home to Florida on Wednesday night. Moments later, she discovered that she had joined a cast of thousands who are being meticulously tracked by local health officials across the United States.
As Ms. Rauen’s plane from overseas touched down, one message was already waiting on her phone, from a nurse at the local public health department in her Florida county. Should she develop a fever or cough over the next 14 days, she should report it immediately, the nurse explained when Ms. Rauen called back.As Ms. Rauen’s plane from overseas touched down, one message was already waiting on her phone, from a nurse at the local public health department in her Florida county. Should she develop a fever or cough over the next 14 days, she should report it immediately, the nurse explained when Ms. Rauen called back.
“I was so impressed,” said Ms. Rauen, who is herself a retired public health nurse from the same health department in Lee County. “We are really truly in uncharted waters.”“I was so impressed,” said Ms. Rauen, who is herself a retired public health nurse from the same health department in Lee County. “We are really truly in uncharted waters.”
Preventing the spread of infectious disease is the essence of public health work, but the scale of efforts by state and local health departments across the country to contain the virus known as COVID-19, experts said, has rarely been seen. Since early February, thousands of people returning to the United States from mainland China, the center of the outbreak, have been asked to isolate themselves at home for 14 days.Preventing the spread of infectious disease is the essence of public health work, but the scale of efforts by state and local health departments across the country to contain the virus known as COVID-19, experts said, has rarely been seen. Since early February, thousands of people returning to the United States from mainland China, the center of the outbreak, have been asked to isolate themselves at home for 14 days.
Local health officials check in daily by email, phone or text. They arrange tests for people who come down with symptoms, and in some cases, groceries and isolated housing. There is no centralized tally in the United States of people being monitored or asked to remain in isolation, and they are scattered across the nation’s nearly 3,000 local health jurisdictions.Local health officials check in daily by email, phone or text. They arrange tests for people who come down with symptoms, and in some cases, groceries and isolated housing. There is no centralized tally in the United States of people being monitored or asked to remain in isolation, and they are scattered across the nation’s nearly 3,000 local health jurisdictions.
People arriving from mainland China are added each day, while those who have completed 14-day “self-quarantine” periods are released from oversight. In California alone, the department of public health has been monitoring more than 6,700 returning travelers from China, while health officials in Washington State have tracked about 800, and officials in Illinois more than 200.People arriving from mainland China are added each day, while those who have completed 14-day “self-quarantine” periods are released from oversight. In California alone, the department of public health has been monitoring more than 6,700 returning travelers from China, while health officials in Washington State have tracked about 800, and officials in Illinois more than 200.
The nationwide mobilization is taking a financial toll, health officials say. The cost to local health departments is unknown, but some experts say it has reached into the tens of millions. Even as the first of 34 confirmed coronavirus patients in the United States have recovered in recent days, health officials say they are preparing for what some fear could still be a much wider outbreak. Worldwide, the virus, which is known to be highly contagious, has infected 75,000 people and killed more than 2,000.The nationwide mobilization is taking a financial toll, health officials say. The cost to local health departments is unknown, but some experts say it has reached into the tens of millions. Even as the first of 34 confirmed coronavirus patients in the United States have recovered in recent days, health officials say they are preparing for what some fear could still be a much wider outbreak. Worldwide, the virus, which is known to be highly contagious, has infected 75,000 people and killed more than 2,000.
“All hands on deck are being pulled into this,’’ said Dr. Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials, a nonprofit organization that represents public health agencies across the country. “If it really blows up, at some point, it could overwhelm state and local health departments.”“All hands on deck are being pulled into this,’’ said Dr. Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials, a nonprofit organization that represents public health agencies across the country. “If it really blows up, at some point, it could overwhelm state and local health departments.”
So far, officials say, the containment effort in this country has been largely orderly. The only known transmission of the virus in the United States has involved people in the same household. But no matter how effective health workers are in monitoring their charges, “there will always be some leakage,’’ said Dr. John Wiesman, the Secretary of Health in Washington State.So far, officials say, the containment effort in this country has been largely orderly. The only known transmission of the virus in the United States has involved people in the same household. But no matter how effective health workers are in monitoring their charges, “there will always be some leakage,’’ said Dr. John Wiesman, the Secretary of Health in Washington State.
In Washington, where the first coronavirus patient in the United States was confirmed on Jan. 21, health officials tracked down and monitored 69 individuals with whom the man had come in contact, including work colleagues, health workers and other patients present in a clinic he visited when he first felt sick. Still, there have been issues. One person the man had been in contact with and who had developed symptoms of illness flew on a plane to Wisconsin during the 14-day period when she was supposed to be isolated at home.In Washington, where the first coronavirus patient in the United States was confirmed on Jan. 21, health officials tracked down and monitored 69 individuals with whom the man had come in contact, including work colleagues, health workers and other patients present in a clinic he visited when he first felt sick. Still, there have been issues. One person the man had been in contact with and who had developed symptoms of illness flew on a plane to Wisconsin during the 14-day period when she was supposed to be isolated at home.
“There is no way, with something this large, that you can make it seal-proof,’’ said Dr. Wiesman, who has started twice-weekly conference calls with the chief health officers in every state and territory to share tips and seek advice on how to manage the shifting challenges of the coronavirus response. While enforcing total compliance with isolation orders may not be possible, Dr. Wiesman said, “We have to try for 80 to 85 percent, and hopefully that will work.’’“There is no way, with something this large, that you can make it seal-proof,’’ said Dr. Wiesman, who has started twice-weekly conference calls with the chief health officers in every state and territory to share tips and seek advice on how to manage the shifting challenges of the coronavirus response. While enforcing total compliance with isolation orders may not be possible, Dr. Wiesman said, “We have to try for 80 to 85 percent, and hopefully that will work.’’
Federal authorities are in charge of setting guidelines to manage the danger, such as deciding how much risk a returning traveler poses and who should be tested for the coronavirus. But the day-to-day work putting those policies in place and tracking thousands of people falls to the vast, decentralized network of local health departments across the country. Travelers’ data, culled from federal customs officials, is passed on to state health agencies, who farm out lists of people returning from China to local health departments.Federal authorities are in charge of setting guidelines to manage the danger, such as deciding how much risk a returning traveler poses and who should be tested for the coronavirus. But the day-to-day work putting those policies in place and tracking thousands of people falls to the vast, decentralized network of local health departments across the country. Travelers’ data, culled from federal customs officials, is passed on to state health agencies, who farm out lists of people returning from China to local health departments.
In the Chicago area, public health officials are using an electronic monitoring system originally developed to track the measles to monitor more than 200 travelers. Each day, they receive a link asking their temperature and symptoms.In the Chicago area, public health officials are using an electronic monitoring system originally developed to track the measles to monitor more than 200 travelers. Each day, they receive a link asking their temperature and symptoms.
The costs associated with containing the virus have reached more than $150,000 a week for the Chicago public health department alone, according to its commissioner, Dr. Allison Arwady. Among the costs: $17,000 for a quarantine facility at an undisclosed location for people who can’t isolate themselves at home. So far, fewer than five people have used it, she said.The costs associated with containing the virus have reached more than $150,000 a week for the Chicago public health department alone, according to its commissioner, Dr. Allison Arwady. Among the costs: $17,000 for a quarantine facility at an undisclosed location for people who can’t isolate themselves at home. So far, fewer than five people have used it, she said.
“If you are quarantining them under a legal order, you have to think about food, their medications, their communication needs and their mental health,” she said.“If you are quarantining them under a legal order, you have to think about food, their medications, their communication needs and their mental health,” she said.
Some jurisdictions have negotiated with hotels to host people who may harbor the virus. Washington State has RV’s.Some jurisdictions have negotiated with hotels to host people who may harbor the virus. Washington State has RV’s.
Ruth Jones, public health commissioner in Quincy, Mass., a town of about 100,000 people south of Boston, says that her department has been receiving lists of between three and 10 people each day who are returning from China and are being asked to stay isolated from other people. Quincy’s two public health nurses and two translators have been working long hours to call them and make sure they understand how to monitor and report any symptoms.Ruth Jones, public health commissioner in Quincy, Mass., a town of about 100,000 people south of Boston, says that her department has been receiving lists of between three and 10 people each day who are returning from China and are being asked to stay isolated from other people. Quincy’s two public health nurses and two translators have been working long hours to call them and make sure they understand how to monitor and report any symptoms.
“It’s overtime for our nurses,’’ Ms. Jones said. “It’s been extremely busy,”“It’s overtime for our nurses,’’ Ms. Jones said. “It’s been extremely busy,”
Local officials in places that have had confirmed cases have been under particular strain. In Madison and Dane County, Wis., a local health staff of 160 has been forced to rearrange its operation to focus on monitoring anyone who may have been exposed to a resident who tested positive for the virus after falling ill and remains in self-isolation.Local officials in places that have had confirmed cases have been under particular strain. In Madison and Dane County, Wis., a local health staff of 160 has been forced to rearrange its operation to focus on monitoring anyone who may have been exposed to a resident who tested positive for the virus after falling ill and remains in self-isolation.
“We’re in this new normal, but it’s not normal,” said Janel Heinrich, the county’s director of public health.“We’re in this new normal, but it’s not normal,” said Janel Heinrich, the county’s director of public health.
Along with monitoring individuals who are seen as at risk of having been exposed to the virus, state and local health officials have been scrambling to prepare for worst case scenarios in the months ahead. State officials in Washington said they will hold a webinar next week to brief school superintendents on best practices for cleaning and planning for home schooling should schools need to shut down.Along with monitoring individuals who are seen as at risk of having been exposed to the virus, state and local health officials have been scrambling to prepare for worst case scenarios in the months ahead. State officials in Washington said they will hold a webinar next week to brief school superintendents on best practices for cleaning and planning for home schooling should schools need to shut down.
“People are doing contingency planning,’’ said Julie Sullivan-Springhetti, spokeswoman for the Multnomah County Health Department in Oregon, which has devoted resources to preparing a regional hospital system for a potential case. “Just like we plan for the Cascadia earthquake, which may or may not happen in our lifetime.”“People are doing contingency planning,’’ said Julie Sullivan-Springhetti, spokeswoman for the Multnomah County Health Department in Oregon, which has devoted resources to preparing a regional hospital system for a potential case. “Just like we plan for the Cascadia earthquake, which may or may not happen in our lifetime.”
Updated June 1, 2020
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.
As for the returning passengers from the Westerdam, the cruise ship, passengers at first thought they had no reason to worry about the coronavirus because no one on the ship had traveled through mainland China during the outbreak. But after passengers began leaving the ship to head home, an 83-year-old woman was reported to have tested positive on a layover in Malaysia, creating confusion and chaos.As for the returning passengers from the Westerdam, the cruise ship, passengers at first thought they had no reason to worry about the coronavirus because no one on the ship had traveled through mainland China during the outbreak. But after passengers began leaving the ship to head home, an 83-year-old woman was reported to have tested positive on a layover in Malaysia, creating confusion and chaos.
Erin Carney, 70, a retired nurse and midwife from Mendocino County, Calif., flew out on the same flight as the woman who was reported to have tested positive, though questions have been raised about that finding and the C.D.C. has since said that other passengers do not need to isolate themselves.Erin Carney, 70, a retired nurse and midwife from Mendocino County, Calif., flew out on the same flight as the woman who was reported to have tested positive, though questions have been raised about that finding and the C.D.C. has since said that other passengers do not need to isolate themselves.
Given the initial reports of a positive test, Ms. Carney called hospitals to figure out what she and her partner should do.Given the initial reports of a positive test, Ms. Carney called hospitals to figure out what she and her partner should do.
“The person that we spoke to read the C.D.C. guidelines and thought that everything seemed fine and we didn’t have to self-quarantine,” Ms. Carney said. “They said, ‘If you have symptoms, go see your doctor.’”“The person that we spoke to read the C.D.C. guidelines and thought that everything seemed fine and we didn’t have to self-quarantine,” Ms. Carney said. “They said, ‘If you have symptoms, go see your doctor.’”
But then a nurse from the Mendocino County Health and Human Services Department called Ms. Carney. She recommended that they quarantine themselves at home, and offered to supply groceries.But then a nurse from the Mendocino County Health and Human Services Department called Ms. Carney. She recommended that they quarantine themselves at home, and offered to supply groceries.
“We had kind of talked about doing that anyway,” Ms. Carney said. “They’ve called every day since.”“We had kind of talked about doing that anyway,” Ms. Carney said. “They’ve called every day since.”
Nicholas Bogel-Burroughs contributed reporting.Nicholas Bogel-Burroughs contributed reporting.