MOUNT VERNON – At the end of a 45-minute press conference Tuesday afternoon, sandwiched between two meetings, Knox County Health Commissioner Julie Miller was asked a simple question.
How are you doing?
“I’m tired,” she said.
As COVID-19 has spread across Ohio, with more cases confirmed each day, Miller and her staff have been busy. They’ve met with community partners on a daily basis, beginning at 7:30 a.m. and ending well after sundown, in an effort to plan for the inevitable.
“I envision that we will have a positive case in Knox County. I envision that there might be more than one,” Miller said. “I can’t envision how many.”
The goal, Miller said, is to reduce the rate of spread. By developing an organized local assessment system and encouraging residents to do their part, health officials hope to limit the impact of the virus in Knox County.
The systemic response
As of Wednesday, no confirmed cases had been reported in Knox County. But in a joint statement last Friday, officials from Knox Community Hospital and the Knox County Health Department said they “expect that status to change in the near future and are proceeding under the assumption that the virus is currently spreading locally.”
So, what if a local resident thinks they have COVID-19?
The health department and KCH have opened a call line, which will allow local residents to speak directly with healthcare professionals about their symptoms. After dialing 740-399-8014, residents will be asked about their symptoms, recent travel habits, age and more.
Those in the call center (located in the Knox County Emergency Management Agency’s training room) will assess and screen each patient before determining the appropriate next steps.
Miller said many callers will be told self-isolate at home and self-monitor symptoms. The health department will call back in three days and ask if symptoms have worsened.
Due to the nationwide shortage in testing kits (which contain nasal swabs and preservative solution, and are ultimately sent to the Ohio Department of Health or a private lab for results), only the most at-risk individuals will be tested locally.
Those include senior citizens, people who have been exposed to someone with COVID-19, people who have traveled abroad in recent months, or people who are reporting severe symptoms, such as coughing, a bad fever and shortness of breath.
If a patient checks those boxes, an additional assessment will be scheduled. Health officials will need to rule out other viruses – such as influenza, pneumonia, or mononucleosis – before testing for COVID-19. If a local patient tests positive for the coronavirus, health officials will evaluate the patient “to see if they need additional care,” KCH Marketing Director Jeff Scott said.
Those who are severely ill will be admitted into the hospital, while those with lesser complications will be sent home, where they will self-quarantine and communicate twice per day with the health department about their symptoms. If symptoms escalate, the patient may be hospitalized.
Around 80 percent of COVID-19 cases are mild, according to a World Health Organization report. Patients who are older, or who have underlying medical conditions, are more susceptible to severe symptoms.
Both Miller and Scott agreed that the goal is not to overwhelm the healthcare system.
“I spoke to KCH physicians this morning and I said, ‘This is all about us trying to wrap around you, and keep people out of the emergency room and the urgent care, so that they can get urgent and emergency care if they need it,’ ” Miller said.
By establishing a local response system that begins with the hotline, health officials hope to reduce the amount of walk-in visits that could result in infections.
“The whole idea is that we want to try to assess people who think they might have this infection remotely, before they go to a space where lots of other people are going to be for lots of other reasons,” Scott said. “We want to reduce the spread, especially in clinical places.”
Healthcare workers will be prioritized in the testing system, Miller added.
“If a healthcare worker becomes ill and really has to have moderate to severe symptoms, they’re gonna be tested,” she said. “Or if they have a long-term cough or fever, they’re gonna be tested because we need them. We need them on the front lines now.”
When the first confirmed cases are reported in Knox County, Miller said her team will work to identify those closest to the patients, so they can establish a line of communication and monitor symptoms. The individuals who recently had close contact with the patient will be asked to self-quarantine.
Miller defined “close contact” as having face-to-face interaction with the individual in close quarters (think a classroom, not a gym) for a substantial period of time (approximately two hours or longer).
This was how the health department and East Knox school administrators determined who would need to self-quarantine after it was confirmed Monday that a junior/senior high school teacher tested positive for COVID-19.
School and health officials were able to confirm 25 individuals – mostly students – had close contact with the teacher before he called off sick last Wednesday. Those individuals will self-quarantine for two weeks, until March 25, and will check in with the health department every day, Miller said.
By monitoring not only those who are infected, but also those who could be infected due to proximity, local health officials hope to control the spread of the virus.
“We can kind of keep the rate of exposure down, but we can’t keep the rate of illness down,” Miller said. “So if we can control the rate of exposure by quarantining, or closing bars and restaurants, and closing fitness centers – I hate saying that because I know what it does to people, but the more we can do that, we can reduce the rate.”
This is the first local plan, devised by KCH and the health department, to limit the spread of COVID-19. But officials know it might change, or need to be bolstered, as time goes on.
“In three days, everything could change again,” Scott said. “Everything is moving very rapidly.”
Still, local health officials believe this will lay the groundwork for an effective response system.
“I think we’re gonna have cases, and we’re prepared for that,” Miller said. “I feel very good about what we’re doing.”
Each resident's role
Health officials will manage the community’s systemic response to COVID-19. But Miller believes individual behavior will play an equally important role in containing the virus.
In following state and federal recommendations, Miller advises local residents to practice “social distancing,” or staying six feet away from the next-closest person. She encourages residents to wash their hands for 20 seconds, cover their cough or sneeze, and call the local hotline if they begin to feel symptoms.
Most of all, Miller urged residents Tuesday to respect the virus and its potential.
“I’m concerned, folks. This is the worst epidemic I’ve had in my 30 years in public health, and I tend to take us through it with no problems. But you need to be concerned,” she told those watching the press conference, which was live-streamed on the health department’s Facebook page.
“This thing is [more contagious] than measles, and the mortality rate is not pretty to hear either. You know, when one percent – and that’s a low average – one percent of those who get moderate to severe symptoms can die, we’re talking millions of people in the United States, let alone this county. Not millions, but hundreds. So that concerns me, as your health commissioner, and I want you all to take it seriously.”
As the weeks and months progress, Miller said her messaging will shift. It will become more community-oriented.
“I like to always preach about taking care of our health,” she said. “Now I need to start focusing on, let’s take care of our neighbors.”
Miller stressed the importance of caring for the local elderly population, which is highly susceptible to infection and might be afraid to get groceries. She lauded the efforts of local schools and nonprofit programs, which are feeding the community through volunteer efforts.
Lastly, she asked local residents to trust the local health officials who are working to contain the virus. Everyone must do their part, Miller explained.
“It’s scary when you can’t see what’s attacking you. And it’s new, we’re not used to it…” she said. “I want you to understand that I know how you feel… I get that people are scared, I get that they don’t know what they’re doing. We’re trying our best to answer those questions.
“We got this, and I’m asking you to trust us.”