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As the outbreak of novel coronavirus disease 2019 (COVID-19) continues to expand around the globe, including more than 100 confirmed or suspected cases across the United States, many folks in the Big Horn Basin are concerned that it might eventually reach here. As of Tuesday, there are no Wyoming cases.

The Wyoming Department of Health's website suggests that the risk to Wyoming residents remains low, but "it is becoming increasingly likely that COVID-19 will spread to our state."

According to the World Health Organization (WHO), more than 90,000 people have been infected with COVID-19 in more than 70 countries worldwide. As of Tuesday, there have been more than 3,000 deaths. WHO data show that more than 90% of all cases and about 96% of all deaths have occurred in China, where the outbreak began late last year. Before health authorities in China realized something was wrong, people who had COVID-19 but with only mild symptoms were inadvertently spreading it among the population.

The Centers for Disease Control and Prevention (CDC) website says that COVID-19 symptoms are like those of many other acute respiratory infections – fever, cough and shortness of breath. In serious cases, COVID-19 develops into a severe pneumonia.

According to WHO, most COVID-19 deaths have occurred in older people and people who already have another serious illness. Around 80% of all cases have been classified as mild. About 14% have been severe, and 6% have been critical. The crude COVID-19 mortality rate in China is around 3.6%. Overall, in the rest of the world, it is around 1.4%, but this may vary by country. All nine US deaths were in the state of Washington. The Seattle Post-Intelligencer newspaper reports that five of these deaths occurred in a Seattle-area nursing home.

The United States government has taken strong measures to prevent COVID-19 from entering this country, but as it has spread to countries far beyond China in the past two months, many cases showing no symptoms or only mild ones have evidently slipped through. WHO data suggest that a patient may show no COVID-19 symptoms for as long as 14 days, though the average time without symptoms is five to six days.

Patients with only mild symptoms may spread the infection to family, friends and even strangers. The COVID-19 virus may remain infectious for a long time on doorknobs and other surfaces – probably at least a week, say the CDC. Because of this, the risk of infection with COVID-19 is no longer just from encountering someone who recently traveled in a high-risk country. There is some evidence that the disease is also now spreading in the community – it is suspected in several cases in California and Washington. This means that if an uninfected person touched a doorknob or other surface recently handled by someone with COVID-19, and did not immediately wash his or her hands, that person may become infected with it too.

LOCAL

PREPARATIONS

Given the chance that COVID-19 may eventually find its way to Wyoming, what preparations have local health systems made to prevent the spread of the disease and care for those who get sick? At Banner Health Washakie Medical Center, Chief Nursing Officer Lisa Van Brunt said that although no patients have yet been tested for COVID-19, the hospital will use a screening algorithm developed by Wyoming Department of Health, in partnership with the CDC, to decide whether any person should be tested.

Following these evidence-based guidelines, what will happen if hospital personnel suspect that someone may have been exposed to COVID-19, or even have the infection? "We establish them with a mask, and put them in a particular room for the protection of everyone who is caring for them. We provide care to that patient," Van Brunt said. She described how the subsequent stages of the algorithm would be operationalized. "We involve our infection prevention team right away. That support system in itself, with that expertise, then contacts Wyoming Department of Health, and CDC. We would determine, does this individual fall into this category? Do we need to go on with the testing? If we do, can we safely provide that testing, monitoring and care, or do they need to transfer to a higher level of care? We have each piece of that ready to go as a coordinated effort within Banner Health, utilizing our experts within our organization, local Public Health and the Wyoming Department of Health," Van Brunt concluded.

Van Brunt also pointed out that the hospital, Washakie County Public Health and the Wyoming Department of Health are in constant communication, and are sharing all relevant information.

On Tuesday afternoon, Wyoming Governor Mark Gordon held a press conference in which he stated that Wyoming will follow the state's existing Pandemic Influenza Response Plan as a framework for its response to COVID-19, as CDC recommends doing. He also mentioned that the Wyoming Department of Health is coordinating efforts with county Public Health officials; and that the US Department of Homeland Security is coordinating with county Homeland Security officials.

After the governor's remarks, State Superintendent of Public Instruction Jillian Balow described some of the ways that Wyoming school districts should be sure they are following the best practices. "For example, are desks and other surfaces disinfected according to best practice protocol? Do students have adequate time and facilities to wash hands before lunch? Should professional development time be devoted to training, or re-training staff? Strict adherence to the best practices our professionals know are the best measure for prevention."

In Worland schools, an open letter sent Monday from Washakie County School District No. 1 Superintendent David Nicholas described the district's preparations to minimize the potential for COVID-19 spreading in schools. All staff and students will be encouraged to wash hands frequently. Existing policy to send home kids with fever will be strictly enforced. School personnel will continue to disinfect "high-touch" surfaces. The school nurse and other school personnel will monitor the student body as well as all of the staff for potential COVID-19 symptoms.

The COVID-19 situation is evolving rapidly, both worldwide and within the US. All acute respiratory infections, including seasonal influenza, are especially risky for older people and anyone who is already in poor health.

In addition to washing hands frequently, here in Wyoming, it will be wise for folks to follow CDC's "everyday preventive actions":

•Avoid close contact with people who are sick.

•Avoid touching your eyes, nose, and mouth.

•Stay home when you are sick.

•Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

•Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.