The outbreak may pass without mass closures or quarantines, and for now local and national officials maintain the risk is low. But as they prepare for more infections, they say individuals should, too.
Prep kits with food and prescriptions are tangible things people can put together ahead of government orders, officials say. They can also wash their hands and take other steps to prevent infections generally, including the seasonal flu that is widespread now.
So far, the reaction in the United States to the coronavirus has included dumping stocks and hoarding masks, which likely do little to protect healthy people and contributes to shortages in medical offices, said Michael Runnels, associate professor of law and social responsibility at Loyola’s Sellinger School of Business.
He said this activity comes in the absence of a clear message from President Donald Trump and his administration. Runnels pointed to statements this week from the U.S. Centers for Disease Control and Prevention that COVID-19 is certain to spread, and statements from Trump that it’s largely contained and not certain to spread.
“It’s something of a corporate, a business response so far,” Runnels said. “But if infections come here, local government will step in if there is still a gap at the federal level. They will begin shutting things down. It’ll be like when Baltimore had that really big snowstorm.”
There could be shortages at the local pharmacy of medications for common ailments like high blood pressure and bacterial infections because many drug ingredients are produced in China and manufacturing has been curbed. The U.S. Food and Drug Administration reported there already is one COVID-19 related drug shortage, though it didn’t identify which one. Maryland Sens. Ben Cardin and Chris Van Hollen signed onto a letter Friday to the FDA questioning how the agency plans to address the issue.
When it comes to closures, it’s not yet clear who would make a final determination on which facilities and businesses would shutter and when. State Superintendent of Maryland Schools Karen B. Salmon said school decisions would be made between her and the state Health Secretary Robert R. Neall.
"We are really looking to the health department on this as the lead to this,” Salmon said.
The health department and governor’s office did not respond to request for comment about the process.
Dr. Nilesh Kalyanaraman, the health officer for Anne Arundel County, said the response to a case would depend on factors such as the health of the people exposed to the virus and where the infected person works.
“The details really matter,” Kalyanaraman said. “What we’re trying to do is convey that our response to any situation is dependent on the specifics.”
The state health department has said there has been considerable planning in Maryland for health effects, and Hogan plans next week to request $10 million in emergency funding based on that planning.
“The State’s preparedness builds on decades of planning, experience and expertise gained from previous public health events such as SARS, MERS, H1N1, Zika and Ebola,” said a statement from the health department about the virus.
State Senate President Bill Ferguson said the legislature is committed to working with the Hogan administration to amplify a coordinated message.
"The biggest concern we have right now is the panic,” Ferguson, a Baltimore Democrat, told senators Friday morning. “It is really important we are prepared, in case there is an issue with the virus, we are ready to handle it.”
“If infections come here, local government will step in if there is still a gap at the federal level. They will begin shutting things down. It’ll be like when Baltimore had that really big snowstorm.”
Michael Runnels, associate professor of law and social responsibility at Loyola’s Sellinger School of Business
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Public health experts say transparency and clarity will be key going forward to gain public trust if extreme measures are needed to stop virus spread.
Unlike during the last pandemic that heavily affected the United States, the 2009 H1N1 flu, there isn’t likely to be a vaccine ready to combat COVID-19 soon, said Dr. Wilbur Chen, an infectious disease doctor and scientist for the University of Maryland School of Medicine’s Center for Vaccine Development and Global Health in Baltimore.
He was a principal investigator on the vaccine trials for the H1N1 pandemic, also known as swine flu, and Chen said a vaccine was ready in months. Scientists prepare a new flu vaccine every year with new strains, and there is an established system.
A vaccine for the new coronavirus is in the works, in part through the work of University of Maryland researchers and based on an existing coronavirus vaccine. However, Chen said, it’s unlikely to be ready this year, partly because there is no established system or manufacturers at the ready.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said as much during a news conference with Trump last week. He said a vaccine could be used if there is an outbreak next year, though a treatment could be ready this year.
Chen said the state and federal governments will need to rely on other methods that some may find “draconian" if the outbreak becomes a pandemic.
“We need to be very transparent with the public and tell them why we are doing these things,” Chen said. “Some may interpret them as draconian, and others may say they sound reasonable. But there will be no public trust, or cooperation, without transparency that starts early on.”
He said that’s what the CDC intended with its comments, to ensure such measures don’t come as a shock.
Chen said there are several possible scenarios with the virus. One is that the virus is contained through measures such as travel bans and quarantines overseas before it’s widespread in the United States. A second is that it continues over weeks and months into a pandemic that is far harder to contain. And a third is that the infections abate in warmer weather, much like the flu, then return with a larger wave in the fall.
Those in Maryland are preparing for any scenario with a lot of local infections.
Hospitals are laying out plans to operate with fewer medical staff and send office staff home to telework, said Dr. David Marcozzi, who is in charge of COVID-19 preparedness for the University of Maryland Medical System.
Hospitals already were prepared to quarantine patients, but now there are protocols to care safely for COVID-19 patients, who could grow rapidly in number. They also are evaluating circumstances in which health professionals could forgo masks, gloves and other protective equipment so they can be stockpiled, as supplies are becoming low.
“We know this will be coming to Maryland. The question is how large of an impact will it have,” said Marcozzi, also associate chair of population health in the Maryland medical school’s department of emergency medicine and assistant chief medical officer for acute care at the University of Maryland Medical Center.
“Our plan not only speaks to care for our patients, but our facilities,” he said. “Everyone needs a plan: schools, businesses, community leaders, city and state leaders. Things like telework don’t happen overnight. You need to plan."
It’s the same story at local schools, where officials said they are coordinating with local health officials.
“We are very closely monitoring the development of the virus,” said Charlie Herndon, a spokesman for Baltimore County schools. “It’s a matter right now of getting as much information as we can.”
Filipa Gomes, supervisor of health services for the Carroll County schools, said officials are emphasizing precautionary measures similar to those used to prevent the spread of flu — such as washing hands with soap and water and coughing into a tissue.
The Baltimore City school system is following the direction of the state health department and has handed students a fact sheet in English and Spanish, said Gwendolyn Chambers, a schools spokeswoman.
The Howard County Public School System has developed an infectious-disease response plan to deal with flu that will be used, according to spokesman Brian Bassett. The response plan calls, for instance, for different levels of cleaning at schools with large numbers of cases of the flu.
Anne Arundel County Public Schools have been developing a plan to teach students via telecommunication since the H1N1 flu outbreak in 2009, spokesman Bob Mosier said. Students at every level have access to Microsoft OneDrive and Google Classroom, where they can receive documents, instruction and turn in assignments from home if schools were to shut down.
“Those conversations have cropped up in the last month about what we would do, not only with teleinstruction, but with students who didn’t have access to computers at home,” Mosier said. Educators are discussing options like lending students the Google Chromebooks they often use in the classroom.
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Officials from Harford County schools did not respond to requests for comment.
Some schools could close, as they did in 2009. Acting on recommendations from the CDC, then-Gov. Martin O’Malley closed several schools where students were suspected of being sick with H1N1.
The University System of Maryland also began preparations. Presidents of the 12 campuses were briefed last week by university experts, said Joann Boughman, the senior vice chancellor for academic and student affairs. The campuses have begun to explore ways to have classes go online if students need to stay home or if classes are canceled.
UM presidents have wide latitude to make decisions for their individual campuses, including when to close down their campus, said Mike Lurie, a spokesman for the system. “It is also clear that any decision to close a campus due to a health emergency would be made in coordination the governor’s office and relevant state authorities.”
Boughman said the best way forward is clear communication. “If the people in leadership feel they are prepared, then it brings down or helps reduce the fear and eliminates the sense of panic," she said. "I think continuous calm but substantial communication is one of the greatest assets we might have.”