The news of the novel coronavirus pandemic, like the pandemic itself, is moving fast.
On Saturday, Maryland Governor Larry Hogan announced that 66 residents at the Pleasant View Nursing Home in Mount Airy, in Carroll County, had tested positive for the novel coronavirus and that 11 had been hospitalized. Maryland cases now top 1,200, while Carroll County has 83 confirmed cases.
By noon Sunday, the novel coronavirus had resulted in some 2,200 deaths in the United States out of more than 125,000 people who have tested positive for the virus, according to Johns Hopkins University. Just three days earlier, there had only been 1,207 deaths in the U.S.
The Carroll County Health Department is on the front lines of the pandemic, just as it is with seasonal influenza or the rare occasion when a potential case of tuberculosis might appear.
And at the forefont of those public health and communication efforts has been Dr. Henry Taylor, deputy health officer for Carroll County. As busy as he has been, the Times recently caught up with Taylor via email to learn more about the novel coronavirus, Carroll County’s public health response and what people should do to best keep themselves and others safe.
Q: First of all, this is a public health crisis and as the health department is the public health institution here in Carroll County, can you explain to folks, broadly speaking, what your role is at this time?
A: Public Health agencies coordinate community response to infectious disease outbreaks like the COVID-19 pandemic. This means the state and local health departments take many different actions to support to their communities and coordinate the assistance of our many community partners. We provide current, coordinated messaging to the public and our partners; we track cases of the disease and inform people who are at risk of contracting it due to case contact; we assist our healthcare partners with personal protective equipment, staffing, and other operational support; we organize public health volunteers and coordinate funding to assist in staffing response activities; and more.
Most times outbreaks are limited to certain areas, like a mumps outbreak at a college or a measles outbreak in a community. We had an E coli outbreak a few years ago. But this COVID-19 situation is a pandemic — an outbreak everywhere — and so many people are needed to help our county get through this.
Q: There’s a lot of new terminology flying around right now that many people may be encountering for the first time, and might be used in different ways by different people. Can you help us break some of this down with some simple definitions? For starters, there’s several different ways people are referring to this virus and disease. Many newspapers, including this one, have adopted the style of “the novel coronavirus,” but you’ll also hear COVID-19 or SARS-coV-2. What’s in a name here?
A: nCoV = Novel Coronavirus (initial name, replaced by SARS-CoV-2).
SARS-COV-2 = the official name of the virus, stands for Severe Acute Respiratory Syndrome Coronavirus.
COVID-19 = the illness caused by SARS-COV-2, stands for COronaVIrus Disease from 2019
Other types of coronaviruses can cause mild illness, like colds, or other severe illnesses, like SARS and MERS (Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome).
Q: What about “social distancing,” and how does it differ from, say, “self-quarantine”?
A: Social distancing means that we as a “society” have chosen to deliberately create a certain “distance” between people. Scientists have determined that 6 feet is sufficient to stop the spread of this type of viral illness.
“Self-Quarantine” means that you voluntarily stay away from anyone else because you have been exposed to a disease. How long you stay away as determined by the amount of time it takes for an illness to appear once you’ve been exposed. I find it fascinating that the word “quarantine” originated in the Middle Ages when travelers were not allowed to leave ships ships from plague affected areas for 40 days.
Social distancing means increasing the physical space between people to avoid spreading illness. Staying at least six feet away from other people lessens your chances of catching COVID-19. So, this means cancelling events and closing spaces that draw large crowds and put people too close together; it means working from home instead of going to the office; it means Facetiming friends and relatives instead of visiting.
People who have been exposed to COVID-19 but don’t have symptoms are asked to self-quarantine for 14 days. This includes people exposed to a known case without wearing protective gear, and people who have traveled to an area where it COVID-19 is very actively spreading, like New York. Self-quarantine involves staying home, of course, but also staying at least 6 feet away from others in your house, standard handwashing and hygiene but also not sharing things like utensils and towels. After 14 days if the person doesn’t have symptoms they can return to their normal routine.
Self-isolation is when a person who is sick isolates themselves (ill = isolation — helps to remember which is which). People with mild illness can isolate at home following the guidelines, www.cdc.gov.
People with more severe illness may be isolated at a care facility.
Q: Health department staff are having to work hard through this emergency. How do you protect yourselves at work?
A: At the Health Department, many of us have been reassigned from our normal jobs. Some of us are working from home, while others go into the office but avoid any behavior that may allow the virus to spread. We don’t share keyboards, phones, or office equipment. We do all the things that we ask everyone else to do, and, did we mention frequently washing hands or using hand sanitizer?
Q: The World Health Organization declared the novel coronavirus a pandemic on March 11. What exactly does it mean for a virus to be a pandemic? Is the seasonal flu a pandemic?
A: Epidemic refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area. An outbreak is an epidemic in a more limited geographic area.
A pandemic is an epidemic that has spread over several countries or continents, usually affecting a large number of people. The World Health Organization defines a pandemic as an epidemic which has spread over at least two of its regions, which roughly correspond to the continents.
Q: The phrase “flatten the curve” has been used a lot. It’s even a social media hashtag. For those who haven’t heard and explanation of it that makes sense to them, what does it mean?
A: Flattening the curve means using all the social distancing and quarantine and isolation to slow the rate of COVID-19 infection so hospitals are not overwhelmed trying to care for too many people at the same time.
Q: There have been comments in the media and in government, even from the president himself, suggesting that social distancing could be going too far and hurting people economically. It is certainly true that many people here in Carroll County have had their livelihoods severely disrupted by some of Maryland’s actions in response to the pandemic, restaurant owners and the employees they have had to lay off for instance. Knowing that financial relief is not in your wheelhouse, what’s the public health case for continuing to isolate, even as it may severely disrupt life in other ways?
A: We are seeing the social disruption caused by social distancing! Our local, state, and federal officials continually balance the risks and benefits of any action taken in the public’s interest. Decisions about the health of the public must be based on the best available evidence and communicated transparently. This is why local boards of health were created to understand the technical details upon which to base political decisions.
Q: What about those people who say, “Well, I’m 20, I work out and I’ve heard coronavirus only hurts old people.” What’s the case for young people socially isolating?
A: We know this situation is hard on everyone. And if you are young and healthy, it’s hard to see how it directly affects you. But more younger people are getting sick and testing positive for COVID-19, so anyone can get it. And it is up to all of us to protect our community by following all of the executive orders and restrictions and social distancing recommendations. It’s hard to imagine, but staying home and playing with your kids or trying a new recipe or watching Netflix is going to save lives. The Health Department is sharing positive messaging, ideas for staying healthy while staying home, and thanking our community for their efforts to slow the spread of COVID-19 with our campaign “Carroll Cares.”
Q: Do you have a sense of what the end game may be here? A study from Imperial College recently suggested that the whole world may go through multiple periods of isolation where COVID-19 cases go down, followed by loosened restrictions where they go up and the cycle repeating, for perhaps 18 months or more, until a vaccine can be made available. That’s only one model, and no one may be able to say for certain, but should we be digging in for a longer haul than is often being discussed?
A: What you’re describing is the fundamental nature of epidemics. Complex biological systems cycle up and down based upon interactions between different factors. With infections, we pay particular attention to those things that will interrupt or accelerate their spread. For example, small children in daycare are “accelerators” or "super-spreaders” for influenza, as are the hot humid conditions of late summer for bacterial skin infections. The entire world is rapidly learning how to best “interrupt” transmission of this virus from person-to-person.
We must acknowledge that with this pandemic, a new virus has entered the human population. We will learn how to control it, treat it, and begin to live with it. Certain characteristics of smallpox allowed it to be eliminated, specifically that its unique and immediately recognizable rash developed just as the person became infectious. In the 1950s polio put many American children on ventilators (called iron lungs at the time) and we have controlled it with vaccination. However, despite a massive global effort over many years, it is still not eradicated.
Q: South Korea has reportedly done exceedingly well in flattening the curve, primarily through an aggressive testing campaign that included testing people without any symptoms. This has not been the case in the U.S. so far. Can you explain why we still have such limited testing criteria and if there is any chance that will change here in Carroll anytime soon?
A: We have many tools to help flatten the curve. It’s human nature to want a sledgehammer that will smash something in one blow. Though many people are focused on tests, this distracts us from the reason we need tests — to identify people who are infected. That allows us to “go downstream” to quarantine anyone they put at risk, and also “go upstream” to identify their sources of exposure. By following social distancing guidelines, we are able to slow the spread even from people who don’t have symptoms.
The type of test — reverse transcription polymerase chain reaction, or rRT-PCR — to detect SARS-CoV-2 is very complicated. In general the United States tends to set the bar very high when it comes to test reliability and reproducibility. That’s why we have regulatory agencies like the FDA. In this case, it’s possible that “the perfect was the enemy of the good.” There are an increasing number of reports elsewhere that people will have positive test one day and negative tests another; that does not necessarily mean that they have gotten COVID-19 a second time, but that the specimen was not collected, transported, or handled properly.
Q: Let’s review the symptoms, when they present, of COVID-19: Fever and a dry cough are primary among them, correct? When should people be worried and how can they tell COVID-19 apart from seasonal allergies, the flu or common cold, which have similar symptoms?
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A: Remember that many common colds are caused by viruses in this family.
Focus on your symptoms and how you are handling the infection rather than getting tested or what the lab results say. We know that older people and those with underlying medical conditions start to get worse during the second week of illness. Rather than getting better, they get extremely short of breath or have a very severe cough. There is some indication that this may be due to an exaggerated immune response against the virus. Focus your attention on taking care of yourself during the early stages of the illness, staying home so that you don’t infect others, drinking plenty of fluids, breathing moist air, and not getting run down. Just because we don’t have medicine, there are treatments and respiratory therapy that can help improve your breathing. The rest of us need to allow the hospital workers to provide that intensive care to those who needed the most.
Q: There have been reports that anosmia, a temporary loss of the sense of smell can be a leading indicator of COVID-19 infection, particularly in people who are otherwise asymptomatic. The New York Times has reported U.K. doctors have been asking people with this symptom to self-isolate. Is this something that has been considered here or is this an unsubstantiated or unactionable rumor at this point?
A: This is an area of active research. It would be wonderful to have an early warning sign that illness was starting. However, what is important is not the specific name of the illness, but how it affects you. Most people get better, just as they do with the common cold. It seems that during the second week the illness takes its toll on those people with underlying medical conditions or other risk factors such as being older.
Q: Recognizing that everything is moving fast right now, what’s the best public health advice you can give for people in Carroll County with regards to staying safe — and keeping others safe — from the novel coronavirus?
A: Stay home as much as you can, and when you need to go out for shopping or work, stay 6 feet away from others! If you have mild respiratory symptoms, let your health care provider know, isolate yourself from other household members, and take care of yourself. If you get worse, call your healthcare provider. If you have questions, call the Health Department’s call center at 410-876-4848, 8 a.m.-5 p.m. daily.
Learn to use technology creatively to stay in touch with others, virtually travel, and learn new things. Don’t spend too much time reading the news about COVID-19, and when you do, stick with reliable sources like the Centers for Disease Control and prevention, Maryland Department of Health, and Carroll County Health Department.