State, local health officials mobilize to fight spread of coronavirus
CDC: Coronavirus To Spread In U.S. Wochit
Pandemic plans being updated, adapted as situation evolves
FARMINGTON — As he compares the novel coronavirus epidemic that is spreading across the globe to the H1N1 influenza outbreak of 2009, state epidemiologist for the New Mexico Department of Health Dr. Michael Landen says he sees some similarities in how people have reacted.
"As is the case when any new virus emerges, we didn't know much about it, there were a lot of questions about it, people tried to predict what would happen and a lot of people weren't correct," he said. "And what will exactly happen, we do not exactly know."
Landen recalled the fear that accompanied the spread of the H1N1 virus a decade ago, and he sees the same thing happening today. But he watched that fear subside as physicians and scientists learned more about the H1N1 virus, eventually bringing its spread under control and limiting its impact.
Over the last 10 years, that pattern has continued with such illnesses as SARS, MERS and the Ebola virus.
It is often the unknown qualities of a disease, rather than its specific attributes, that contribute so much to that fear, Landen said.
"As time went on, it was not so much that we got used to the (H1N1) virus as it was to loss of an unknown," he said, describing the way New Mexico residents seemingly came to terms with the threat of that disease.
Immunologist Dr. Steven Bradfute, an assistant professor in the Center for Global Health in the Department of Internal Medicine at the University of New Mexico in Albuquerque, acknowledged the many unknowns that have accompanied the coronavirus, but he sees no reason for New Mexicans to be unduly worried.
"I always like to say, 'It's good to be concerned; it's never good to panic,'" he said. "We don't know what this is going to look like in the next few months, maybe even the next few years."
Penny Hill, the infection prevention and employee health manager at San Juan Regional Medical Center in Farmington, noted the rapidly changing nature of this situation and said that requires health care officials to remain constantly up to date.
"It's fast paced, and we need to make sure we're up to date every day instead of every few days," she said.
A growing sense of urgency
The rapid spread of the novel coronavirus from its apparent origin in China to six of the world's seven continents over the past several weeks has led to mushrooming concern, even alarm among some Americans. Officials at the U.S. Centers for Disease Control and Prevention still rate the disease's immediate health risk as low, but the agency states on its website that "current global circumstances suggest it is likely that this virus will cause a pandemic. In that case the risk assessment would be different."
The potential for the development of a pandemic was reflected in comments made during a Feb. 26 press briefing by Dr. Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases. She warned that agency officials expect to see community spread of the disease in the United States.
"It's not so much a question of if this will happen anymore, but rather more a question of exactly when this will happen and how many people in this country will have severe illness," she said.
Landen said the World Health Organization would be the institution responsible for declaring a pandemic, a step it likely would take once it sees widespread community transmission of the disease in most countries.
"They're not calling it a pandemic yet," he said. "This is increasing, but we don't have widespread community transmission in most countries."
That hasn't stopped various public health agencies around the country from crafting plans to address a coronavirus pandemic. Landen said the state Health Department has been monitoring New Mexico residents who have traveled to China and South Korea for 14 days after their return, since they are considered to be at the highest risk of having contracted the virus.
He also noted that New Mexico soon will have the capability to conduct its own tests for the novel coronavirus instead of having to send samples to the CDC in Atlanta for testing. He expects the testing to soon be available through a lab in Albuquerque.
The CDC offers a considerable amount of support, guidance, resources and tools when it comes to these kinds of disease outbreaks, Landen said, describing a close relationship between public officials at the federal and state levels.
"That partnership is really critical," he said. "We rely on collaboration with the federal government and Indian Health Services, tribal nations and municipalities. That partnership is really important for working on something like this."
But if a large-scale coronavirus outbreak occurs in New Mexico, the response would not be dominated by the federal government, he said.
"The state Health Department pretty much determines the approach to addressing the outbreak," he said.
Specifics remain elusive
UNM's Bradfute said the university is involved in the fight against the coronavirus in two ways — first through its hospital, which already has response plans in place for dealing with virus patients, and as a research institution, which is where he comes in. Speaking as a researcher, he said the challenge for public health officials is quickly identifying people who have become infected and intervening to make sure they don't pass it along to someone else.
But the process may not be that straightforward, he said.
"They may be able to pass it on before they know they're sick," he said, describing another of the unknown characteristics of coronavirus.
So far, Bradfute said, public health officials have done a very good job of stopping the person-to-person spread of the illness, noting that a relatively small number of cases have been reported from that scenario. That was not the case with some other rapidly spreading diseases in recent years, he said, citing the Ebola virus as an example.
The coronavirus differs from Ebola and other diseases that have surfaced in recent years in regard to its mortality rate, Bradfute said.
"The virus doesn't appear to be as dangerous in terms of the percentage of people it kills," he said, explaining that SARS had a mortality rate of approximately 10 percent, while the rate for MERS was approximately 30 percent. "(The coronavirus) is not as lethal as some of its cousins, but it spreads more rapidly."
Despite the seriousness of the situation and the uncertainty regarding the spread of the illness, Bradfute said he was surprised at how well the virus has been contained in China — and that could offer encouragement to the rest of the world.
"If the Chinese numbers are accurate, and they have 80,000 infections, percentage wise, that's a very, very low number for such a large country," he said.
If a pandemic develops and spreads to the United States, Bradfute said Americans could expect to see much more movement by public health officials to screen possible carriers and monitor the people around them.
Bradfute is hopeful that the coming of spring and the advance of warmer weather will help stem the tide of the disease, as it does with many respiratory illnesses. But he said there is no indication yet of whether that will be the case with the coronavirus.
"SARS puttered out around May, but it's hard to tell what will happen with this," he said.
Preparing for the worst
The advance of the disease has not caught local public health officials flat footed. Dr. Brad Greenberg of the San Juan Regional Medical Center said the hospital has been engaged in pandemic preparedness since the H1N1 pandemic in 2009.
"We've had a plan that encompasses the whole gamut of care for patients and employees," he said.
But during a Feb. 27 interview at the hospital, he, too, noted the rapidly changing nature of this situation and acknowledged that has made confronting it a challenge.
"The rate of change in the last 72 hours has been very high, and we're adapting to that," he said. "We've had to stand up our existing preparedness plan and adapt it."
Hospital officials began screening emergency room visitors for the illness a few weeks ago and have put signage and precautions in place designed to help slow or halt the spread of illness throughout the facility. They also are doing their best to coordinate with local public safety agencies, and state and county health officials, he said.
"But we also try to understand we have an important and unique role in our region," Greenberg said. "We would coordinate with other hospitals in our region. We are a huge resource in our region, and we have an obligation to care for the population. … We understand our responsibility to this region."
Hill said hospital officials take part in frequent conference calls with state officials as new information about the disease becomes available. It's just as important to keep health care providers safe as it is the patients themselves, she said.
Landen said state Health Department officials are examining some other approaches if widespread community transmission of the coronavirus begins to occur — and those changes would be conveyed quickly to the local level.
"We're focused on making sure New Mexicans know what to do," he said.
The agency would coordinate a statewide response by keeping track of the availability of hospital beds, something it does routinely during flu season, Landen said. It also tracks the inventory of personal protective equipment for health care providers at sites throughout the state to maintain a sense of what kind of supply exists.
The experience gained from the H1N1 outbreak more than 10 years ago has helped public health officials around the country be better prepared for the next viral outbreak, Landen said.
"Our influenza pandemic planning has been a major focus," he said. "We're taking a lot of what we learned from that pandemic and used it for the coronavirus."
But because this is a new virus, that planning is missing two important pieces, Landen said — vaccinations and antiviral medications. Neither of those elements is in place right now because they have not been developed.
"If the coronavirus becomes a seasonal event, then the vaccination would be very important," he said. "But for right now, vaccination is not available."
Greenberg cited the coordinated, federal-state-local nature of the response that would occur if a coronavirus pandemic reached New Mexico. But he said hospitals like his would have a unique role as the front line of defense — a responsibility he thinks his institution is ready to shoulder.
"We're rising to meet that challenge," he said.
Mike Easterling can be reached at 505-564-4610 or firstname.lastname@example.org. Support local journalism with a digital subscription: http://bit.ly/216TU0e