Coronavirus preparations begin in area

With seven confirmed and five presumptive positive cases of coronavirus in Maine and six presumptive cases in New Brunswick as of March 15, preparations for the coronavirus, or COVID‑19, have started in Washington County, with guidance from state and federal departments and agencies. On March 2 Governor Janet Mills convened a Coronavirus Response Team, led by Maine Center for Disease Control (MCDC) Director Nirav Shah, charged with coordinating the state government's response across departments and local agencies and health authorities to the potential spread of COVID‑19. Since then, progress has been made on the availability and number of test kits and the ability of the state lab in Augusta to process kits rather than having to send them to the national Centers for Disease Control (CDC) lab.

Those at greatest risk
Symptoms of the coronavirus are fever, cough and shortness of breath that can start two to 14 days after exposure. It appears to hold the greatest danger for the elderly or those with compromised immune systems. Shah notes his concern for the state's elderly population, especially those in nursing homes and assisted-living facilities. "We're working with them to make sure they have the latest CDC guidelines." He explains that the close contact of residents puts them at greater risk when visitors come who may be sick or are contagious but not yet exhibiting symptoms. He expects that, if the virus spreads, such facilities will likely implement restrictions on visitations. The best recourse is for family and friends to call the facility ahead of time to check to see if any recommendations or restrictions have been put in place.
The Veterans Affairs (VA) Maine Healthcare System has instituted additional steps as precautionary measures. It recommends that veterans coming in for a healthcare visit should call first or send a secure message through MyHealtheVet -- even if they have an appointment. They may be able to get diagnosed and receive care through telehealth without having to leave home. If they do visit, they should plan to get there earlier than usual to answer three simple screening questions about health symptoms, travel and contact with others. Veterans and their families should expect to encounter enhanced screening at single points of entry into VA Maine facilities. The VA recommends calling ahead to check on any additional changes that have been made according to the most recent updates from the CDC.

Personal and home health guidelines
Dr. Shah stresses that the situation is changing hour by hour, but the essentials of good personal hygiene are the best practice of keeping well. "I want to urge two things," he says. Stay healthy by exercising, eating a healthy diet, getting enough sleep and getting "your flu shot if you haven't yet." Along with those practices, follow the recommendation of washing hands frequently and resist touching eyes, nose and mouth. Cough and sneeze into elbows or disposable tissues. On top of those steps, Shah urges everyone to stay informed because of the rapidly changing nature of the situation. "I want people to make decisions based on facts." He points to the MCDC website, which has been overhauled to be more user‑friendly and has a page dedicated to coronavirus news and updates, as well as the national CDC website.
If someone is concerned that they might have the coronavirus, Shah stresses, "Call your physician first." Calling first allows the medical team to determine the level of concern and whether the patient should be met in a restricted space to prevent possible transmission to others. "The doctor's office is well aware of how to see patients" with infectious diseases. They will ask questions based on CDC guidelines about symptoms and travel. If it's determined that the person is at risk, the medical team will immediately contact the MCDC for guidance plus sample collection information. The samples will be sent by courier to the state lab for a total of a two‑day processing time. During those two days, the patient "should remain isolated at home. If there are others at home, try to separate themselves," he adds.
If a coronavirus test confirms infection, the patient should remain at home, self‑isolating, Shah explains. Family members may need to be tested. If symptoms are really bad, with difficulty breathing, Shah recommends the patient call either for EMT service -- "they know how to deal with this" -- or call a hospital emergency room or physician. "The same protocol would be followed," he adds, suggesting that the patient might be met in the parking lot in order for the medical team to make sure that steps are taken to ensure public health safety. "The degree and length of symptoms varies from person to person." It is usually for two weeks, but if after that period of time a patient is still not feeling well, they should contact their doctor.
Robert Long, communications director of MCDC, notes, "MCDC will not be billing for testing of individuals who meet the federal criteria for testing. Because insurance and medical plans differ, individuals should consult with their providers about potential costs that providers might incur." The state lab has the capacity to complete testing for 100 to 200 patients per day. As of March 10, that capacity far exceeds the demand for coronavirus testing in Maine, with samples being processed promptly. Long says, "The state lab has adequate supplies to conduct tests and has a plan in place to replenish supplies if the demand for testing increases."

Calais Regional Hospital (CRH) and Down East Community Hospital (DECH) have issued statements indicating that they are following CDC guidelines for establishing protocols. In February a work group was established at CRH to review processes and procedures to be instituted now and in the event of a local exposure. The work group consists of staff from nursing, lab, environmental services, infection control, quality management and more.
DECH states that education regarding the CDC's recommendations as to how to handle this viral disease has been provided to its staff. The clinical areas are equipped with the proper protective equipment, and the infection prevention department continues to monitor all communication coming from the CDC, the Maine Hospital Association and the Maine Health Alert Network to ensure staff are continually updated and prepared.
Schools, student and staff health and guidelines
The MCDC also is in contact with the Department of Education (DOE) and Maine's schools. "There is no simple equation of when to close schools," Shah says.
AOS 77 Superintendent Kenneth Johnson attended a webinar on March 5 held by MCDC and DOE and expects to discuss coronavirus planning with school boards over the next few weeks. "I will be asking school boards to authorize my ability to give overtime" for cleaning in schools, which would mean an increase in budget line items. He has already contacted AOS principals about the need for extra vigilance with cleaning and has heard back that many have already taken the extra precaution.
Johnson states, "The DOE emphasized that it's a local decision" to close schools, meaning that school boards and superintendents have the decision‑making authority to close schools if it becomes necessary. There are mandatory reporting protocols if 15% or more of the school population is sick, but even if there was less than that percentage, Johnson notes that it would be reported to the MCDC.
Johnson is most concerned with the possible repercussions of the April spring break. "Right now there are no cases, but the acid test will be right after April vacation. So we have a little time for people to know what the protocols will be." He adds, "Hopefully families will take measures. Hopefully it will be a quiet spring."
The worst‑case scenario would be closing the schools, he notes. Families would be notified by e-mail through the school notification system. "We already have arrangements with those who don't have e-mail with a simple phone call." The DOE is working with school systems to figure out how classes might be conducted remotely if a school closure is lengthy, which includes ensuring that students have electronic devices and resources at home. The DOE has determined that it would honor a school board's request to waive the length of the school year of the required 175 school days if CDC guidance indicates that a district should close a school and the closure exceeds the capacity of the district to provide continuity of education through remote school days.
In addition, many students qualify for and rely on receiving breakfast and lunch at school. Meeting their nutritional needs while at home is another challenge for school districts to figure out. Currently federal law requires that meals be served at school. However, the DOE is seeking guidance from the federal government for a waiver so that schools would not be penalized and lose meal subsidy funds. Johnson says, "There are times during the year when we send bag lunches home. So a 'to‑go' meal would be possible," but working out the delivery method would take some time.
Classroom teachers encourage common-sense measures for personal hygiene, such as washing hands often and not touching eyes, nose and mouth. "That's stuff we do," Johnson notes. However, he and educators are cautious about more specific measures, such as how to put on a mask, because "we don't want to instill fear."

University transitions to remote work
A statement released by University of Maine System (UMS) Chancellor Dannel Malloy and the presidents of Maine's public universities notes that a set of action steps has been developed for coronavirus preparations that has been shared with the university community and stakeholders. The first action item is an update to university continuity of instruction plans to provide academic accommodations to students who may be forced to cut short international study plans and travel due to the spread of the coronavirus.
Continuity of instruction planning will also include developing accommodations for continuing instruction, lab, internship or other experiential education and exam administration if a protracted pandemic event requires any university campus to close for any period of time.
The University of Maine System currently has 109 students and faculty members on university travel outside the country. Malloy states, "At our universities we are focused first on supporting our students and faculty who have been traveling abroad and making sure we keep everyone informed." He adds, "Longer term we are going to make sure Maine's universities can deliver credit hours and support students...[in] the unlikely event that a public health emergency impacts campus operations or traditional instructional delivery."
On March 11, Malloy announced that by March 23 all UMS campuses will transition all in‑class academic instruction to online or other pedagogically appropriate distance modalities that do not require in‑class presence for the remainder of the spring semester. Graduate, clinical and similarly‑situated students should be transitioned to remote work if possible. Individual universities, colleges and departments should provide all material assistance and accommodation possible through this transition. On‑campus residential students should make plans to depart campus by Sunday, March 22, with personal and educational belongings necessary to complete their semester requirements remotely.

Up‑to‑date resources
MCDC's Long says, "MCDC has been receiving strong support from other state agencies and strong leadership from the governor's office. This is a good reminder of the value of consistent funding for public health."
The MCDC website is <www.maine.gov/dhhs/mecdc/>, the national CDC website is <www.cdc.gov/>, the Maine DOE website is <www.maine.gov/doe/home>, and the Maine VA website is <www.maine.va.gov>.