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03/31/2020 12:00 AMAs the new coronavirus (COVID-19) spreads throughout Middlesex County, local health officials say a rise in the number of reported cases is inevitable.
“At this point, we’re really saying it’s pretty much in every town in the state of Connecticut,” said Scott Martinson, director of Connecticut River Area Health District (CRAHD), at the March 24 Deep River Board of Selectmen (BOS) meeting held by videoconference.
For residents, the news that the virus is in the community can be unsettling.
“The first case is usually the toughest,” said Martinson at a Chester BOS meeting on March 25, also held by videoconference. “It creates this, ‘Oh boy, it’s in my town’…but the protocol is going to be that I notify emergency management. We’re also notifying local law enforcement and [emergency medical technicians], so they are properly prepared to respond.”
Although there is standard protocol that his office follows in the reporting of cases, Martinson says the protocol on the handling of cases could differ depending on the circumstances of the infected individual.
“If we got a positive case in a high-risk area, a nursing home, we would definitely work with the community involved,” said Martinson on March 25.
Deep River’s first positive case of COVID-19 was reported on March 22.
“It’s one household right now,” said CRAHD nurse Sherry Carlson at the Deep River BOS meeting on March 24. “Even though we only have one positive test, the other family members who are also isolating in the home…All have similar symptoms, but without testing, and the physician is not recommending testing. Why take them out of the home when we already know that COVID is in the home?”
Carlson reported that she conducted a detailed contact history on each of the members in the household and asked them to notify their employers.
“They heeded all of the messaging for social distancing, putting themselves in self-isolation,” said Carlson.
Asked whether other residents could have been inadvertently exposed, at a grocery store, for example, Carlson said, “a true exposure is not considered passing by. It’s considered spending time in close proximity” to the infected individual.
The efforts of the local health department to conduct contact tracing is currently a valuable tool to limit the spread of the virus, but “there’s going to come a time when contact tracing may not be as important,” said Martinson on March 24.
Later in the conversation, he also added, “we’re lucky we have the staff and time [for contact tracing]. It’s probably only happening in 30 to 40 percent of the state now.”
One of the more challenging aspects in mitigating COVID-19 exposure to healthy individuals is the range in the severity of symptoms.
“The hard part about this virus is the symptoms may not be severe,” said Essex Health Director Lisa Fasulo in a March 25 interview with the Courier. “People might just have a mild fever. They may not even realize it, which is why the social distancing piece is so important. People may not know they are carrying this virus…They don’t want to inadvertently expose someone else who may not be able to fight off an infection as well.”
A fever, cough and shortness of breath are symptoms of COVID-19 that may appear 2- to 14 days after being exposed to the virus, according to the Centers for Disease Control and Prevention (CDC).
For individuals with mild symptoms, Fasulo, whose guidance is from the CDC, said, “If they are having a fever or cough or something like that, step one is suspect they might have this virus and manage their symptoms at home. Take fever-reducing, over-the-counter medicines…whatever they would take normally.”
She also recommends symptomatic individuals isolate themselves to an area of their home not shared with others and tracking their symptoms.
When experiencing mild symptoms, “the whole goal of this is to try to keep people at home, even if they don’t have this COVID-19. We don’t want to put them in a hospital waiting room where it increases their risk of catching the virus,” said Fasulo.
If an individual’s symptoms become more severe, Fasulo recommends calling a personal physician, a COVID-19 hotline at an area hospital, or, in a true emergency, calling 911.
Emergency warning signs for COVID-19 that require immediate medical attention include trouble breathing, persistent pain or pressure in the chest, new confusion or inability to arouse or bluish lips or face, according to the CDC.
The CDC also recommends that any other severe or concerning symptoms should be reported to an individual’s medical provider.
With limited testing kits available statewide, Carlson, in the March 25 Chester BOS meeting, said that “nobody can just roll up to one of the drive-throughs at Bristol or [Lawrence and Memorial Hospital] without first getting screened on telehealth and getting a prescription sent in electronically.”
She also adds that a consensus in the medical community is to prioritize the testing of the most severe cases.
Latest Projections
At the same meeting, Martinson outlined the potential timeline and impact of COVID-19 in Connecticut, as discussed in a conference call that he attended with State Epidemiologist Matthew Cartter.
“The latest projections from the state…anticipate this virus possibly affect[ing] 10 percent of Connecticut with the first wave,” said Martinson. “That is the wave we are in now.
“You do the math,” he continued. With a state population of “3.5 million, you’re looking at 400,000 people. So, bear in mind that doesn’t mean that is what is going to happen, however, our state [epidemiologist] is fairly confident that it will be within that range.”
As of March 27, there have been 85,381 cases of COVID-19 in the United States, with 1,271 deaths, according to data from the New York Times.
A Historical Perspective
No event in recent history offers a comparison to the COVID-19 pandemic, as these numbers increase daily, but some are looking back to the 1918 H1N1 flu pandemic to see how people acted and responded to a health threat.
“It’s not too far to make the conclusion that obviously the [1918] pandemic motivated people, almost scared them into saying we need the infrastructure to support our public health needs,” said Essex Historical Society Director Melissa Josefiak in a March 18 interview with the Courier.
“After the pandemic you see in the town reports…that the town invests in its public health. It shifts from private enterprise, going to the doctors when you are sick to in the early 1920s…the creation of a public health [program] and shortly thereafter the hiring of a school nurse who does checkups and recommendations,” she said.
Josefiak says the Town of Essex’s notable changes after the 1918 pandemic continue to influence the community’s reaction to today’s pandemic, including taking preventative measures such as social distancing.
“I think Essex shifted from crisis management into preventative care and I think that is what we are doing now, taking it seriously so we’re not dealing with crisis management,” said Josefiak. “Everyone is taking it seriously so that we can learn from the crisis of the past. We have this infrastructure to address it directly ourselves. We’re all working together to make this happen.”