Coughing, high fever, shortness of breath; Now what?

By CALLAN PUGH
City editor
While no positive tests in Wyandot County have been reported, Wyandot County health officials have said it should be assumed potential cases are in the county as the virus is showing signs of community spread, meaning it is spreading easily and sustainably in Ohio.
Wyandot County Health Commissioner Dr. Keri Harris said step one, if a person suspects they are exhibiting symptoms of COVID-19, is to call a primary care physician. A primary care physician will be able to determine if the symptoms are consistent with COVID-19 coronavirus. Symptoms are a high fever of above 100.4, a cough and shortness of breath.
If so, the patient will be asked to report to Wyandot Memorial Hospital, which is the county¹s temporary central assessment and testing location. The assessment and testing is conducted in an emergency preparedness tent in the parking lot of the emergency department and is a drive-thru, which allows people to stay in their cars to prevent additional exposure to health care workers and other individuals.
The station is open from 10 a.m. to 6 p.m. daily until further notice for patients who are triaged or referred by a medical provider.
Not everyone who is sent to the to the tent will be tested, at least for now. According to Harris, supplies are limited for testing and equipment to collect the tests is not yet at the hospitals or points of care, so only the patients deemed at the most risk will be tested.
³That¹s just the wrong thing to do, to test everyone at this point,² Harris said at the March Health Board meeting. ³We would love to, just being a public health person and being a doctor you want to know, Œdoes my patient have it or not, do they need to quarantine?¹ But we just don¹t have the supplies and the equipment. [If we say], ŒIf we test you, your grandfather might not be tested and they potentially could get more ill from this,¹ then I think people are more understanding. We just cannot at this time until we have more equipment available.²
While at the station, individuals remain in their vehicles, and hospital staff will provide them with the Ohio Department of Health form to complete with their health history, symptoms, and exposure and travel history. An insurance card also should be provided to hospital staff. The assessment and any subsequent testing will be billed to insurance providers. Due to the unique circumstances of the COVID-19 assessment and testing, the hospital is able to accept all insurances for these services, and no one will be turned away for inability to pay, according to a hospital notice.

Self-isolating

Those who do qualify for testing with moderate symptoms of COVID-19, will be asked to self-isolate at home until test results are returned. According to Wyandot County Health District Director of Nursing Darlene Steward, those who do not qualify for testing but who are showing mild symptoms of COVID-19 will be asked to self-isolate for 14 days and to self monitor symptoms. In these cases, a person is asked to disengage from others in their household by staying in separate rooms and using separate bathrooms if possible. She also suggested having a healthy member of the household prepare meals if food is shared between family members and as much as possible a sick person should not be in the kitchen with others in the household. Those who are sick also should be wearing a mask, Steward said, and practicing the other prevention techniques shared many times since the onset of the virus by the health officials, including regular hand washing for 20 seconds or using hand sanitizer, avoiding touching the face, covering coughs and sneezes with a sleeve or tissue and regularly disinfecting surfaces that are touched often.
Those who have direct close contact with a person suspected to have COVID-19 also will be asked to self-isolate Dr. Chevone Vent, a physician on the Wyandot County Board of Health and an infectious control representative from the Infection Prevention Committee said.

Worsening symptoms, hospitalization

For many, symptoms of COVID-19 coronavirus have been mild and are currently thought to be communicable for around 14 days. But, as the illness progresses, those who are sick but not hospitalized will be asked to self-monitor, keeping an eye on body temperature and worsening symptoms. Vent said worsening symptoms can include an increased shortness of breath, especially when conducting regular activities such as standing up to use the bathroom; a worsening fever; or increased confusion. Blue lips or face also can be a symptom that indicate a person should seek additional medical help, Vent said. In the case symptoms worsen, a person is asked to consult their primary care physician or the emergency department at the hospital by phone for next steps.
Those who are hospitalized could be there beyond 14-days, Harris said. She explained a patient would be hospitalized until they are able to safely go off oxygen and to go home and return daily living without help.
Steward said as of Wednesday, the thought is a patient can be deemed no longer contagious with COVID-19 after two negative swabs, 24 hours apart, to ensure they are negative. Harris said current thought also indicates a person who is asymptotic for 72 hours also could have samples collected to determine if they are negative for the virus, which could mean an earlier release. She said however most people have symptoms for a longer period of time.

Health Department involvement, contacts

Individuals with positive COVID-19 tests will be contacted by the health department, Steward said, as it is a ³Class A reportable² infectious disease. Public health nurses will follow up with the individual to collect required information that has to be reported to the state in addition to contact information, those who are living with the person with a positive case or who work in close proximity, for the positive case.
³Depending on the contact, it¹s not just Œhey, I passed someone in Walmart¹ type of thing ‹ the living together ‹ work in a close proximity, that would be considered a contact,² Steward said. ³That individual (contact) is going to be monitored for two weeks. So we are going to have to call them every day. They have to take their temps twice a day and then we¹re following up on any symptoms that he or she may have.²
The health department is taking similar measures with individuals who have traveled to level three areas, which include China, parts of Europe, Iran, Ireland, Malaysia, South Korea and parts of the United Kingdom. A complete list is available at cdc.gov/coronavirus/2019-ncov/travelers/.
Harris said local health departments also are being contacted if there is a positive on a plane or on a cruise ship. The health department will then contact the patient to self-quarantine. She said individuals who are contacted in these cases are those who were in close-proximity to an individual, and in the case of a plane, that would mean two rows in front, two rows in back and two seats on either side.
³That¹s what they¹ve done for years for measles, mumps, TB,² Harris said. ³But I think people are under the misconception that we have no idea.²

High risk individuals

In Wyandot County, the hospital is looking at patients 60 and older as high risk. Others at a high risk include those with ³bad² comorbidities (the simultaneous presence of two chronic diseases or conditions in a patient) Harris said, such as COPD, uncontrolled diabetes and immunosupression.

Why you¹re being asked to stay home

³Distancing is key at controlling,² Vent said.
Harris said the difference in the United States between a positive outcome in South Korea and the life and death decisions being made in Italy is how well the public handles the situation and follows the guidance of health professionals in terms of staying home and practicing social distancing.
³If the public continues to congregate, this is going to spread and its going to be bad,² Harris said. ³In Italy it¹s bad and they¹re having to make some really hard choices. We don¹t want to get there. We want to be South Korea. We want people to stay home, self-isolate, social distance and wash their hands.²
Harris said there is not a certain answer about how long droplets can last in the air or on surfaces, the CDC says hours to days on a variety of surfaces, but said good sanitation can help stop the spread.
With the virus being so new, it is unclear if a person can be a carrier and exhibit no symptoms, Harris, Vent and Steward agreed, but Vent said practicing good hygiene and covering coughs is important for everyone, because they are able to spread the virus 24 hours before showing symptoms.
³If you¹re wiping down surfaces, if you¹re covering your cough, that¹s the way it spreads,² Harris said.

Ways to stay as healthy as possible

Steward said there isn¹t one particular food or vitamin that will help keep a person healthy. Instead she recommends simply adhering to a healthy diet and staying hydrated with water and juice, rather than soda and alcohol.
Harris and Vent also suggest getting plenty of sleep and staying as active as possible. Harris said it is generally considered safe to go on walks or ride a bike in open outdoor areas, but she does suggest children avoiding park equipment and playing in close proximity to other children.

Ways to help neighbors

The health department, Steward said, suggests checking on elderly neighbors and offering to pick-up groceries.
³Don¹t be afraid to reach out to them, because some of what we¹re doing to offset the spread is keeping everyone at home, and so much of what the elderly do ‹ they have their little coffee [groups] and they go to breakfast, [it can affect] mental health. So if you¹re healthy, reach out to others, in your neighborhood, in your family and friends, especially if they¹re elderly.²
Steward said those who are well and who are visiting elderly neighbors who are well are safe to visit with each other, keeping in mind the social distancing guidelines of six feet and practicing good hygiene.

Why you don¹t need to hoard toilet paper

³It is not a G.I. (gastrointestinal) bug,² Harris said.

Where to look for more information

For more information about COVID-19, call ODH¹s call center at 1-833-4-ASK-ODH, visit coronavirus.ohio.gov, call Wyandot County Public Health at 419-294-3852 or call hospital administration at 419-294-4991 ext. 2267.