The spread of the coronavirus around the world has given leaders of U.S. cities and counties the unique opportunity to watch a response in real time and see what works and what doesn’t.  Now, they need to consider how to apply those lessons here.

Understand the threat. 

During flu season in the U.S., on average one of every one thousand people who contract it will die.  For every one thousand infected with coronavirus, it’s estimated that 20 will die.

While the coronavirus is more dangerous than the seasonal flu, 80 percent who contract it will have mild symptoms and won’t need hospitalization.  Most vulnerable are seniors as well as those with preexisting conditions like diabetes and heart disease.  While worldwide those under 18 make up only 2.4% of  reported cases of COVID-19, the disease caused by coronavirus, 38% of those hospitalized with it in the U.S. are between 20 and 54 years old.

The coronavirus began in China, but more cases have now been detected outside its borders where it has spread to more than 140 countries.  The initial cases of COVID-19 in the U.S. were travel-related, but now most don’t know how they were infected meaning there is increased community transmission.  Medical experts remain concerned that the coronavirus may be spread before an infected person has symptoms, which makes the disease harder to control.

Have a plan.

It has been more than a decade since most communities here dealt with a fast-spreading illness.  So experts like former FEMA Deputy Administrator and former Boston Public Health Commission Assistant Director Richard Serino advise elected officials to prepare.

“Take the opportunity now to start planning, to ask the questions of their emergency manager,” says Serino.  “Ask the questions of your fire chief, your police chief, your public health director, EMS chief. Ask them now, ‘What’s the plan?’ And tell ‘em you want to see the plan.”

He believes being hands on is important.  “You want to sit through a drill.  Be involved in the planning stages.  Develop a relationship with them and then trust what they have to say.  And if you don’t understand something, ask them again.”

Plans should include how to continue providing essential government services with a reduced staff.  Consider what could be provided virtually to minimize unnecessary contact and travel.  Make certain there is a continuity of government plan in case top level decision makers are infected or incapacitated.  Err on the side of caution by having at least one senior leader participate in meetings via phone to avoid a situation where all city or county leaders are exposed and forced to self-quarantine.  Have a strategy for crowd and traffic control at local medical facilities, since statistics show that during the spread of a highly contagious illness four times as many people seek treatment as are actually infected with the disease.

Consider what support your community can provide to low-wage workers and those in service jobs who will lose income if they stay home while sick with COVID-19.  Otherwise those without paid sick leave, roughly 25% of the U.S. workforce, may report to work while ill and spread the disease.  That could have serious consequences in nursing homes and assisted living facilities where residents are extremely vulnerable.

Make sure others have a plan.

As the potential health crisis looms, city and county leaders should contact their local health care coalition and make certain medical facilities in their community are coordinating with each other.

“While we understand that day to day they are competitors, when it comes to something like this or it comes to an emergency, they have to have a plan in place to communicate things like supply levels.  Are they all operating under the same protocol?  Are they all connecting with their local health departments?” explains Mary Laurel Castle, Deputy Director of the Northern Virginia Hospital Alliance.

“I would certainly advise people to check.  Because the last thing you want is to hear that the next jurisdiction over is tackling their screening or their response for a disease in a different way than your jurisdiction. That undermines the confidence people have in the response system.”

Mayors and county leaders should check with local utilities to make sure they’ve developed plans to continue providing essential services even if the virus impacted a large percentage of their staff.

“It’s a question they should always be asking us and it’s what we’re always prepared for,” says Potomac Electric Power Company Senior Vice President Melissa Lavinson.  “We’re a 24/7 business and we need to make sure that we have business continuity and that we’ve got the right folks in the right roles.  We have mutual assistance plans with other utilities in case we need resources, so we’re always prepared for that situation.”

Understand local laws.

Quarantine and isolation laws vary from state to state.  Elected officials need to know what laws apply in their area and who has the authority to quarantine or isolate individuals suspected of being exposed to or potentially infected with the coronavirus.  Frequently, a state public health officer has the power to make those decisions and the ability to execute them quickly to control an outbreak.  Most such orders are voluntary, but can be made mandatory to ensure compliance.

“So it’s good that elected officials don’t get blindsided by that, and think, well, you know, ‘Who’s that person?  What authority do they have to do that?’  They do have the authority.  It’s something the public health system has put into place so we can deal with situations like this,” explains Marcus Plescia, Chief Medical Officer of the Association of State and Territorial Health Officials.

“It’s very, very important that elected officials understand that and that they also support that.  Because when you start limiting people’s movements, it can have pretty significant ramifications.  And everybody needs to understand that it’s for the greater good and it’s important that everybody feels that they can support that.”

Establish a quarantine protocol.

Travel restrictions continue to ban foreign nationals who’ve traveled recently to China, Iran and one of 26 European countries from entering the U.S.  Still, non-citizens who’ve been to those areas and returned via other countries could arrive at one of 11 designated U.S. airports or a port and be picked up in health screening there.

“If somebody is identified in that process as needing to in some way be isolated, the local community in collaboration with the state are going to have to sort that out.  We’re having big problems right now that some communities don’t know where to house these people,” says Plescia.

He explains most hotels don’t want to fill that role and hospitalizing someone who isn’t sick isn’t appropriate.  So cities need to determine where they could house a traveler for 14 days, as well as how to provide transportation there from the airport.  Then there are “wrap around services” that local governments will have to supply.

“If you’re going to force somebody into quarantine, how do you provide food?  Is it something like grocery delivery?” Castle asks.  “Do you have an obligation to provide internet to somebody that’s under quarantine?  Do you have to provide a way for them to exercise?  Those are conversations to have ahead of time.”

Plescia encourages all city and county leaders to consider these issues now. “The other problem is – people may be saying, ‘Well, I don’t have one of those 11 airports in my community. I’m not going to worry about it.’ I would say this is a really good time to think that through.”

Monitoring is ongoing of thousands of Americans and permanent residents who returned from Iran, South Korea, Europe and parts of China outside of Hubei province.  Identified by travel data passed on by federal customs officials, local governments are responsible for reaching out and requesting they quarantine themselves at home for 14 days as well as report any symptoms.  However, with community transmission now outnumbering travel-related cases, cities need to determine whether the burden on local health departments and the cost of monitoring such self-quarantining is still justifiable.  Organizing volunteers from the local Medical Reserve Corps or university school of public health can help lighten the burden.

Contact tracing and monitoring could end if the coronavirus spread worsens significantly and communities switch to mitigation mode. “It’s not that we’re going to choose to stop.  It will get to be too many,” explains Plescia.  “It will get to be just impossible. You just won’t have the people to be able to do that.”

Communicate.

By now, elected officials should have had conversations with their local Chamber of Commerce, school superintendent and other stakeholders about how to proceed if cases of coronavirus are found in their area.  Preventive measures will be better accepted and adhered to if the community has a role in creating them.

While Wuhan imposed travel restrictions and temporarily shuttered all public places other than pharmacies and grocery stores, most other cities in China focused on finding and isolating cases and encouraging good hand hygiene and social distancing.  Consider what measures would be necessary or workable in your community, for how long and what steps could be taken to lessen their impact.

Castle believes communication can also prevent crowds from flooding hospitals the way they did in Wuhan. “Our first line of defense against that is the public information campaign, telling when people when they should care for themselves at home, when they should call a doctor and when it’s appropriate show up at a hospital,” she explains.  “So people understanding how to remain calm, what they can do to protect themselves, that they can contact their health department for questions.  They don’t have to show up at an ED (emergency department.)”

Information should be communicated frequently and clearly, since rumor and innuendo often quickly fill any void.

“You want to make sure you have many voices, one message.  The joint communications are crucial,” says Castle.

Communicate with your state and encourage it to make certain the coronavirus testing now beginning across the country is confidential.  Stan Mark, senior staff attorney for the Asian American Legal Defense and Education Fund, insists that is vital to prevent non-citizens fearing possible deportation from avoiding testing and then spreading coronavirus throughout a community.

“This is a really dangerous situation,” he warns.  “Really get ahead of it.  Not only demand free testing but full confidentiality – not reporting people to immigration or the Department of Homeland Security.”

If the coronavirus begins to spread in your area, suggest that residents delay elective procedures to avoid overloading the health care system and prevent exposure to infected patients.

Encourage anyone who sees instances of coronavirus-related price gouging to report them to your state attorney general.  Request that local merchants place purchase limits on products like hand sanitizer, disinfecting wipes and thermometers in order to prevent sell outs of needed items due to panic buying.

Tamp down stigma.

As U.S. COVID-19 deaths increase and tension grows over lockdowns of cities and entire states, officials need to do their part to discourage racism and xenophobia so it doesn’t spiral into violence.  Mark urges elected leaders to speak out and tamp down any fear-based racial stigma around the coronavirus.

“I think it would be better served to point out that this is a health problem and it affects all people not just Asians or Chinese.  You don’t have to be Chinese to be traveling to China.”

Closing thoughts.

A coronavirus vaccine is already in development and U.S. health experts predict human testing could begin by late April.  At least ten additional months of testing and manufacturing would be required before an approved vaccine was ready.  No one knows whether the virus will still be spreading then or if it will simply wind down on its own as the SARS virus did in 2003.

Regardless, experts say the coronavirus crisis is a powerful reminder that cities and counties need to know how to respond during a pandemic.

“Yes.  This outbreak is a wonderful reminder that this type of preparedness needs to have already happened,” says Chuck Johnson, President of the International Safety Equipment Association. “Doing this when it’s not an emergency is the key.”

Serino warns elected officials that public health isn’t the only thing that hangs in the balance.

“If they don’t have a good emergency manager, they don’t have a plan, they don’t have a relationship with them, it’ll cost them their job.  Plain and simply,” he says.  “If you don’t manage a disaster well, you will lose your job.”