Coronavirus Measures for U.S. Local Leaders to Consider
By Kathleen Koch
LeadersLink Founder & Executive Director
The spread of the coronavirus in China gives leaders of U.S. cities and counties the unique opportunity to watch a response in real time, see what works and doesn’t and consider what they would do if the virus began to spread here.
Understand the threat.
During flu season in the U.S., on average one of every one thousand people who contract it will die. In 2002 when the SARS virus started in Asia and spread to more than two dozen countries, one in ten patients died. With the coronavirus, one in fifty infected will die. So while the coronavirus is more dangerous than influenza, it is not as deadly as SARS.
Ninety-nine percent of coronavirus cases are in China. The patients diagnosed with coronavirus in the U.S. have been put in isolation. None have died and there is no evidence of spread of the disease here. Medical experts do remain concerned that unlike SARS and influenza the coronavirus may be spread before an infected person has symptoms, which makes the disease harder to control.
The coronavirus has been declared a public health emergency, but not a pandemic. The last pandemic declared in the U.S. was the H1N1 flu in 2009.
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. 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.
Make sure others have a plan.
When a 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.
“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.
Foreign nationals who’ve traveled to China recently have been banned from entering the U.S. But Americans, their immediate family members and permanent residents returning from China are allowed entry, with those who visited Hubei province facing a 14-day quarantine. The planeloads flown out of Wuhan by the U.S. government are being quarantined at U.S. military bases at the cost of the federal government.
While 73 airlines have cut flights to China, it is still possible that an individual traveler who has been there or exposed to others from the region could return through 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.”
Then, there is the monitoring of thousands of travelers to China who weren’t in Hubei province. Identified by travel data passed on by federal customs officials, local governments are responsible for reaching out and requesting they isolate themselves at home for 14 days as well as report any symptoms. The work load and cost of monitoring such self-quarantining could strain local health departments. Organizing volunteers from the local Medical Reserve Corps or university school of public health can help lighten the burden.
While the coronavirus remains under control in the U.S. is also the time for elected officials to have conversations with the local Chamber of Commerce, school superintendent and other stakeholders about how to proceed if things changed. Preventive measures will be better accepted and adhered to if the community has a role in creating them.
Parts of China imposed travel restrictions and temporarily shuttered all public places other than pharmacies and grocery stores. Consider whether such measures would be necessary or workable in your community, for how long and what steps could be taken to lessen their impact. Some health experts caution that broad quarantines don’t work and cause unnecessary hardship for those not infected.
Castle believes communication can also prevent crowds from swarming hospitals the way they have 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.
Tamp down stigma.
U.S. news outlets are already reporting that some ridesharing passengers of Asian descent are experiencing discrimination and difficulty getting transportation. Seattle media report a slowdown at businesses in the city’s Chinatown International District, with one restaurant shuttering its doors. In an editorial that pointed out a “worldwide increase in offensive anti-Asian rhetoric,” Georgetown University’s online news outlet, The Hoya, encouraged students to “be mindful about their humor and avoid furthering racism and xenophobia through coronavirus memes.”
The Asian American Legal Defense and Education Fund has not yet received any complaints, but Senior Staff Attorney Stan 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.”
A coronavirus vaccine is already in development and U.S. health experts predict human testing could begin by late April. At least nine 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 situation is a powerful reminder that cities and counties need to know how to respond if a pandemic were to occur.
“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.”