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Alpine County Health Department, 75-B Diamond Valley Rd., Markleeville, CA 96120 Alpine County Board of Supervisors, Phone: (530) 694-2281 District 1: Donald M. Jardine, District 2: Ron Hames, District 3: Katherine Rakow, District 4: Terry Woodrow, District 5: David Griffith Monday January 27, 2020 Are You Worried About the 2019 Novel Coronavirus? Current Situation (as of Monday evening) in California and other states: Health officials have confirmed the first two cases of the new strain of coronavirus in Los Angeles and Orange counties, brought by travelers who came from the epicenter of the outbreak in Wuhan, China. Health authorities are following up with anyone who has had close contact with the patients, but they noted that casual contact with an infected person — such as visiting the same grocery store or movie theater — carries only “minimal risk of developing infection." Thus far, there have been 5 cases of the virus reported in the US, all associated with travel from Wuhan. There has not been a single case of spread to anyone else who has been in contact with them. Public Health Brief Richard O. Johnson, M.D., MPH Nichole Williamson Public Health Officer HHS Director Office: [PHONE REDACTED], Ext 249 Office: [PHONE REDACTED] e-mail: [EMAIL REDACTED] 24/7/365 Emergency Contact Numbers Dr. Johnson’s cell: (760) 914-0496 Dispatch: [PHONE REDACTED], Ext 330 ---PAGE BREAK--- Alpine County Health Department, 75-B Diamond Valley Rd., Markleeville, CA 96120 Alpine County Board of Supervisors, Phone: (530) 694-2281 District 1: Donald M. Jardine, District 2: Ron Hames, District 3: Katherine Rakow, District 4: Terry Woodrow, District 5: David Griffith China: China has this morning reported a total of 2,744 confirmed cases, with 461 (17%) classified as severe, 5,800 suspected cases under quarantine and investigation, and 80 deaths. That calculates to a fatality rate of 2.9%, which is undoubtedly artificially high. With most viruses there are many mild cases that never get reported. Most deaths have been among older men with chronic medical conditions, with a median age of 59 years (China’s median age is 37-38 years). The youngest patient I have heard of was 15 years of age. The original source has been reported as bats or snakes, although some believe the outbreak preceded the cluster associated with the Wuhan Seafood Market (which sells not only seafood, but many other wild meats). How contagious is the 2019 novel coronavirus? Many countries have recently also reported cases, and evidence is now mounting of self-sustaining human-to-human transmission. The R0 (R naught) is a mathematical term used to describe the average number of people infected from contact with one other person. For this virus, it is expected to be in the range of 2-3, much like seasonal flu infections which tend to have an R0 of around 2. (In contrast, measles has an R0 of 12-18!). The incubation period is 2-14 days. It is still not known if and for how long someone may be contagious during this incubation period before they begin to show It has come to light that some healthcare workers have also become ill after taking care of confirmed cases. A recent report states that a 36-year-old physician died from an infection with the 2019 novel coronavirus. Can the spread be stopped? Unlikely. Cases are now being reported in many countries around the world. With an R0 of around 2, the estimated doubling time is 6 days. Current modeling estimates that there are already 20,000 – 78,000 cases. The containment measures being undertaken by the Chinese government will only have a small impact on the spread and the total number of cases. This epidemic is forecast to peak by May, and then could possibly slowly disappear or continue with small numbers of cases into the future. To disappear, the R0 would need to be At present, there are no vaccines for prevention or recommended medications for treatment. The virus is spread by respiratory droplets and can live on dry surfaces for a few hours. ---PAGE BREAK--- Alpine County Health Department, 75-B Diamond Valley Rd., Markleeville, CA 96120 Alpine County Board of Supervisors, Phone: (530) 694-2281 District 1: Donald M. Jardine, District 2: Ron Hames, District 3: Katherine Rakow, District 4: Terry Woodrow, District 5: David Griffith What are we doing to protect the public? Risk depends on exposure. There have only been a handful of cases in the US, and NO spread in the community. While the available information suggests a low immediate health risk for the general public, we consider any new infectious disease a serious concern and we are taking precautions. Based on what has been learned from past outbreaks – including outbreaks of related coronaviruses – we know that finding cases quickly and responding to them effectively is key. That rapid response helps ensure that the ill person receives the care they need, and it lessens the chance of other people getting sick. Fortunately, California has a strong disease surveillance system in place that includes partnerships with hospital and clinic systems as well as local health departments. Early detection and isolation of suspected cases is key. Currently, 110 persons are being quarantined and monitored in 26 states for possible infection. Once notified, systems are in place so that we can obtain laboratory results within 24 hours. So far, over 24,000 persons have been screened at the 5 airports receiving passengers from Wuhan. Ill passengers are identified and enabled to receive a medical evaluation, and the remainder receive educational material. “Persons under investigation” are those who are sick with fever and cough and who have come from Wuhan, or those who are sick and have had close contact with a confirmed case. Travel to the Wuhan area is not advised. US citizens are being evacuated and are due to arrive in California soon. Screening protocols are subject to change as infections spread to other parts of the world. A key in reducing spread is early identification. Persons presenting to clinics, Urgent Care, Emergency Departments, or first responders should inform personnel if they have fever and cough and have either been in China during the last 14 days or have had close contact with confirmed cases. They should obtain a surgical mask and don it before checking in or sitting near other individuals. When possible, staff should usher them into a private area for further evaluation. Staff are instructed to wear gowns, goggles, gloves, and N95 respirators. Remember that Alpine County and the Eastern Sierra region with its tourist-based economy enjoys the benefits of travelers from many parts of the world all year round. That means we need to have an enhanced awareness of events going on in other parts of the world that may seem far removed from ours. We are less than 24 hours from anywhere! ---PAGE BREAK--- Alpine County Health Department, 75-B Diamond Valley Rd., Markleeville, CA 96120 Alpine County Board of Supervisors, Phone: (530) 694-2281 District 1: Donald M. Jardine, District 2: Ron Hames, District 3: Katherine Rakow, District 4: Terry Woodrow, District 5: David Griffith What should the public be doing? When a new disease is circulating, it’s natural for people to ask what they can do to protect themselves and their families. The best guidance at this point is to take the same precautions recommended for avoiding colds and flu: You should: - stay home when you are sick - cover your cough with your sleeve and elbow - wash your hands frequently - If you are planning a trip to China, keep an eye on the news and be aware of this evolving situation. Cancel all non-essential travel to Hubei Province and Wuhan. - If you have recently returned from a trip to China and are feeling sick, call your health care provider and let them know of your travel and before you walk in. The Bottom Line Liz Szabo in Kaiser Health News has put it well earlier today: “There’s a deadly virus spreading from state to state. It preys on the most vulnerable, striking the young, the sick, and the old without mercy.” This winter, it has caused >13,000,000 infections in the US, has caused 120,000 hospitalizations, and has killed more than 8,200 people in the US, including 149 in California. It’s called “the flu”. And yet, less than half of Americans get a flu shot, the single most important thing you can do to prevent an infection and its complications. Have you had your flu shot this year? It is not too late. So, what should you be doing: - Stay informed – We will keep you updated of any significant changes in advice as this story continues to unfold rapidly before our eyes. - Wash your hands! - Stay home if you are sick. - And for those of you still worried - Just Breathe! (Title used by Pearl Jam, Faith Hill, etc.) - Please contact us with any questions or concerns. - For the most recent updates, go to: (Note: This Alpine County Public Health Brief has been compiled from numerous sources over the course of the day. As this is a rapidly evolving situation, any numbers are already outdated. New scientific data may change some of the opinions, conclusions and predictions in the coming days, which are based upon my research and experience. As such, I take the sole responsibility, and do not speak for anyone else. References for the information are available on request. Please direct all questions to me. RJ)