Seated at her desk in Lake City, Public Health Director Tara Hardy remains visibly calm as she swivels in her chair, pointing to a formidable stack of the day’s priorities. “I’ve barely scratched the surface,” she says with a sigh. Predictably, updates and meetings on the state’s increasing numbers of coronavirus cases took precedence during the workday on Monday, March 9, followed by an equally demanding schedule of coronavirus-related meetings in succeeding days this week. During the afternoon hours on Monday, Hardy and fellow public health staff members Kristen Hartje and Shawna Shidler were just back from a 1-1/2-hour meeting with Emergency Preparedness Response (EPR) coordinators on the topic of the day: the relentless spread of the respiratory virus COVID-19, commonly referred to as novel coronavirus, which as of this week has formally been designated as a ‘global pandemic’. In fast-breaking sequence, Colorado Governor Jared Polis was on the air Tuesday morning, March 10, announcing that new and suspected cases of the respiratory virus have prompted a State of Emergency declaration in Colorado. Simultaneous with the Governor’s announcement, Colorado Department Public Health & Environment reported two “presumptive positive” cases of COVID-19 in neighboring Gunnison County, the first a Denver woman in her 40s with Gunnison County connections who tested positive on March 10 and who has since returned to Denver. The second Gunnison County case, a woman in her 50s who is now isolated at home, was reported on Wednesday, March 11. This second positive case apparently occurred while the woman was traveling. While emphasizing the need for the requisite of practicing good hygiene, such as regularly washing your hands and the new etiquette of coughing into the crux of your elbow, Hardy states that in terms of emergency response to the pandemic, “We’re right on track; we’re fine tuning our plan of action and are making sure all entities are prepared.” “I’d encourage residents to continue to lead their regular, day-to-day lives,” says Hardy, “while also taking everyday preventative measures.” Hardy emphasizes that COVID-19 risk in Colorado, and closer to home here in Lake City, remains low. As of 10 a.m. Thursday, March 12, a total of 33 “presumptive positive” cases of coronavirus have been diagnosed in Colorado, up from just nine cases on Monday. In a majority of the instances, in-state cases of the virus have been tied to travelers from the state who were apparently infected on trips to China, Australia, or Italy, although other regional hot spots for the virus include South Korea, Iran, Japan, Singapore, Thailand, Taiwan, Hong Kong, and Vietnam. Asked for an update on Thursday, Public Health Director says she and her office continue to closely monitor the situation. “Triggering points” are under discussion, she says, for mandatory “social distancing”. In terms of triggering points, she adds, “We’re not there yet.” Asked for details on what might constitute a triggering point, Hardy responds that it is keyed to the occurrence of the first confirmed coronavirus case in our health district. Despite no mandatory restrictions, Hardy says Public Health is encouraging residents of the town and county to cancel or reschedule unnecessary gatherings or limit social activities. An example is Lake City DIRT which this week announced its “Celebrate Lake City!” awards evening has been rescheduled from April 21 to June 16. Also, the planned Friday, March 13, Senior Luncheon was cancelled out of an “overabundance of caution,” according to Public Health’s Jodi Linsey. As part of the Silver Thread Public Health District, both Lake City and Creede are guided in their emergency response by a Pandemic Plan with origins of the local emergency plan dating back to Jerry Gray and Ralph Grover in the early 2000s, which was later formalized around 2008 by former public health employee Carol Lynn Scheller. The plan is periodically reviewed and updated, the newest version of the Hinsdale County plan updated in 2018 and Mineral County’s plan reviewed and updated in 2019. “We got the plan down from the shelf,” Hardy recalls, “and dusted it off.” The good news, according to Hardy, is that “we’re right on track initiating the process and pulling in partners” based on what is called for in the Pandemic Plan. The current effort, such as Monday morning’s EPA coordinators’ meeting and a much larger Emergency Support Function-8 (ESF-8, the eight referring to its public health emergency support component) which was scheduled at Lake City Medical Center on Wednesday, afternoon, March 11, is a mustering of partners and lead agencies — in this case Silver Thread Public Health, Lake City Area Medical Center, and the Creede Medical Clinic. Hardy envisions this week’s meetings are just the start of a process which will entail weekly coordination meetings for the foreseeable future. Goals of the meetings will be periodic updates and a general consensus for unified messaging addressing education and outreach which is disseminated on a timely basis. In addition to public health and medical facilities in both Lake City and Creede, key partners in the response are Colorado Department Public Health & Environment, Colorado Division Homeland Security & Emergency Management, and — from both Mineral and Hinsdale counties — the sheriffs’ offices, school districts, county and municipal representatives, mental health and human services representatives, Hinsdale and Mineral county coroners, Emergency Managers from both counties, and Emergency Medical Services. Present at the initial EPR meeting on Monday this week were Tara Hardy, Shawna Shidler, and Kristen Hartje, the Lake City contingent of Silver Thread Public Health, and, from the Creede public health office, Joni Adelman. Also attending were Dr. Gina Carr, medical director of Lake City Medical Center; Hinsdale County Emergency Manager Phil Graham; and Jerry Gray, Susan Thompson, Jodi Stroh, Jim Loud, and Lyn Lampert who are board members of Silver Thread Public Health. Questioned on specific plans which are being put in place — “making sure all our roles are well- defined,” says Hardy — test kits for the COVID-19 virus will be available at Lake City Area Medical Center. The center will take samples from individuals who are suspected to have been exposed to the virus and the samples will be sent to Colorado Dept. Public Health & Environment for testing, results returned within 24 hours. Lake City Medical Center, according to Hardy, is also identifying the elderly population which, along with individuals with chronic, underlying health issues such as lung, heart and kidney disease, have been identified as most susceptible to the respiratory virus. Lake City Medical Center is also finalizing protocols in terms of isolating the sick and alleviating the spread of germs. One newly adopted measure is the suggestion of calling in to the clinic to describe flu-like symptoms rather than merely showing up at the clinic. Meetings are ongoing between Public Health, Lake City Community School, and Wee Care. Similar precautions are now in place in Gunnison, including Gunnison Valley Hospital and the local nursing home, Gunnison Valley Health Care Center, which as of this week has curtailed all public access to the center. Individuals feeling unwell are asked to phone screen through Gunnison County Health and not go directly to Gunnison Valley Hosital. Potential transmission of the COVID-19 virus is also being avidly discussed in Gunnison and Crested Butte in terms of the impending Spring Break visitors who will descend on both communities. The respiratory illness COVID-19, the novel coronavirus named for its unique corona (crown-like) shape, was first identified in December, 2019, at Wuhan, China, where, ultimately, upwards of 80,000 people fell ill and 2,700 of the infected died. Similar to SARS and MERS epidemics, coronavirus is thought to have an animal to human transmission originating where animals are housed in close quarters in open air markets in Africa and the Orient. The respiratory ailment SARS was confirmed to have originated from bats which transmitted the virus to civet cats and then people; for MERS, the transmission to humans was through camels. Studies continue on the transmission process for the novel coronavirus, although one widely discussed potential is the armadillo-like pangolin, the scales and meat of which is widely sold as a traditional medicine in China. The median age for the Wuhan, China, coronavirus patients was 59 years, approximately 80 percent of those infected ultimately recovering, and roughly 20 percent — primarily the elderly with underlying health problems — requiring more serious medical intervention. Symptoms of the virus typically occur five to six days after infection, sometimes as short as two days and as long as two weeks; 87.9 percent of those with symptoms report a fever over 100.4 F, 67.7 percent experience a dry cough, and a much smaller percentage, 18.6 percent, sustain difficulty breathing sometimes leading to pneumonia. For the vast majority infected with a moderate strain of the virus, recovery is auded by plenty of rest, liquids, cough drops and cough medications as needed, and pain/fever medications such as acetaminophen or ibuprofen. Mortality rates for the seasonal flu are 0.1 percent as a ten-year average, according to Hinsdale Public Health Nurse Shawna Shidler. Mortality statistics for the coronavirus are still being compiled and studied, Shidler says. A Chinese study of confirmed cases indicates a death rate of 2.3 percent. World Health Organization has come up with a higher mortality rate for coronaviurus at 3.4 percent, although this, too, is based only on confirmed cases and does not take into account a majority of the cases with mild/moderate symptoms who survived. Based on methodology of analyzing only confirmed cases, both the Chinese and WHO studies’ mortality rates may be “artifically high,” according to Shidler. The route of transmission is through droplets which are inadvertently inhaled after an infected person coughs or sneezes. A global effort to develop a vaccine for COVID-19 is simultaneously underway in multiple countries, although, realistically, according to Hinsdale Public Health’s Hardy, a mass-produced vaccine is multiple months and most likely over a year in the future. Good hygiene practices admonished by Hardy consist of the basics: frequent hand washing with hot water and soap with duration at least 20 seconds, avoiding sick people, and not touching your face, specifically eyes, mouth and nose. When coughing is unavoidable, the newly prescribed etiquette calls for coughing into the interior crux of a bent arm; handshakes and signs of affection such as hugs and kissing are also discouraged. As a precaution against further spread of COVID-19, Tara Hardy advises individual family plans and stocking up on key supplies to last a minimum of 72 hours, including such necessities as medications, infant formula, diapers, pet food, etc. In the pantry, it is advised households stock up on extra fluids and hydrating ddrinks, soups, broths, crackers, and honey, as well as household cleaners including bleach, alcohol, soaps. Nancy Chambers at Country Store says the local grocery continues to stock for routine service, although the store is entirely sold out of hand sanitizer, and rubbing alcohol is being limited to one container per household. Mass buying of particular items is not allowed, she adds, with a sufficient stock of toilet paper on hand at mid-week. With the virus’s inevitable spread to the U.S., the first U.S. fatality from COVID-19 occurred at a suburban Seattle, Washington, nursing home on February 29. Colorado’s first confirmed COVID-19 case occurred March 5 with confirmation that a male visitor to the state, in his 30s, had tested positive. The unnamed man, who is recovering in isolation in Denver, had traveled to Italy in mid-February and arrived in Colorado by airplane on February 29, after which he rented a car and drove for a skiing holiday at both Keystone and Vail Mountain Resort. He was asystematic at the time, although he did develop virus symptoms on March 3 and was subsequently treated at St. Anthony’s Summit Medical Center, at Frisco in Summit County, on March 4. “We are hopeful that the patient will have a swift recovery,” said Jill Hunsaker Ryan, Executive Director, Colorado Department of Public Health and Environment. “Like other states, we expected to begin seeing cases in Colorado, and that is why we have been preparing for the past couple of months, continued page 8 in conjunction with local public health agencies and healthcare partners. Our goals are to protect the public from the disease, get people the care they need, and minimize disruption to daily lives.” Since the initial positive diagnosis, a total of 32 additional positive diagnoses have occurred in the state through Thursday morning this week, including three new cases (Gunnison, Eagle and Arapahoe counties) announced Tuesday, March 10, by Colorado Dept. Public Health & Environment at 12:41 p.m. and an additional two “presumptive positive” cases” at 6:01 p.m. On Wednesday, March 11, ten new confirmations (Pitkin, Eagle, Gunnison, Denver, Jefferson, and Arapahoe counties) were reported at 1:14 p.m., followed by a group of six Pitkin County residents who were diagnosed positive in a press release at 3:12 p.m. The Pitkin residents are in a social group who had contact with an Australian woman who diagnosed positive. Statistics on the COVID-19 in Colorado are changing on an almost-hourly basis, although the six Pitkin County residents on Wednesday afternoon, March 11, brought the state’s total positive cases to 22; according to Colorado Dept. Public Health & Environment. The state lab had conducted a total of 300 tests between February 28 and March 11. New, ‘presumptive positive’ cases added to the list on Monday are a Eagle County woman in her 70s with no known contact with an infected person but with recent travel experience in the United States, and a female in her 30s from Denver County who likewise had not travelled recently and no known contact with an infected person; a third, “indeterminate” case was also reported by Colorado Dept. Public Health & Environment on Monday, a woman in her 70s from Denver who had no known contact with an infected person but who had travelled recently in the United States. Coronavirus testing in Colorado, like most states, was conducted by Center for Disease Control & Prevention until March 2 when testing began at the state lab in Denver by Colorado Dept. Public Health & Environment. The Denver lab has the capacity of testing 160 samples per day. Further updated information on the coronavirus pandemic is available at colorado.gov/cdphe/2019-novel-coronavirus or COHELP@RMPDC.org.