Charleston — News outlets reported Friday that West Virginia was the only state without a "confirmed" case of COVID-19. The key word in that sentence is "confirmed."
Because the test kits the federal Centers for Disease Control and Prevention first developed were flawed, the entire United States has been slow to identify cases.
Dr. Clay Marsh, vice president and executive dean for health sciences at West Virginia University, said it is likely people in West Virginia already have the virus.
"They're just not sick, and we just haven't tested globally," he said, "and that doesn't mean West Virginia is overwhelmed with the virus. It means the virus is everywhere."
ProPublica reported in late February that rather than using World Health Organization test guidelines used in other countries, the CDC set out to develop a test of its own, losing valuable weeks in the process.
In West Virginia, the state Department of Health and Human Resources has said West Virginia became capable of testing in a state lab only about a week ago, and reported on its website Friday that private labs are now capable of testing. Just 31 tests had been performed in West Virginia as of Saturday.
Because of that lack of testing, Marsh noted that people are having to choose to self-quarantine just because they've internationally traveled, for instance. South Korea, meanwhile, arranged for drive-through testing.
"During the time we're not looking, the virus is still expanding and it's connecting to other people," Marsh said. "We just don't know it because we can't detect it yet."
So, Marsh is encouraging West Virginians to practice good hygiene measures like hand-washing, covering their coughs and keeping their distance from others at social gatherings, but not to stop the spread of coronavirus.
That's not going to happen, Marsh said, in an interview last week.
Instead, he said, we can only slow down the spread.
Practicing those habits, he noted, may also lessen the risk the virus is spread to particularly vulnerable populations, including older people with underlying conditions.
Marsh noted that humans have no immunity to the virus and that there is no treatment. He also noted that people who don't show symptoms yet can still be contagious and that it appears the virus can live on surfaces.
This virus is also more dangerous than previous global outbreaks, such as SARS, for example, because it can be contagious days before becoming symptomatic, he noted.
Marsh said ideally health providers could quarantine people who've been diagnosed. Since testing has been so limited, quarantines are occurring "en masse" instead, he said.
Officials closed state correctional facilities to visitors on Wednesday. West Virginia University and Marshall University have announced they'll transition students to online classes after spring break. Justice has requested that nursing homes restrict visitors.
"The virus does not recognize state lines, country lines, etc.," Marsh said. "It's a pandemic. It is everywhere, and it doesn't mean we're invaded with something that's going to kill all of us, because in fact most people are going to be fine, but it says that our strategies have to change from saying 'we've got to get rid of this' to saying 'we have to control as much of the side effects that we don't want to see as we possibly can.'
"And if the forest is all on fire, it's hard to get control of it," Marsh said. "But if it's just starting, and you can direct it to a place it's going to burn out, then you have a much better chance."
COVID-19 is a respiratory illness that originated in China late last year and has since spread to more than 100 countries. Globally, more than 130,000 people have been diagnosed, and nearly 5,000 have died, according to the World Health Organization.
According to the federal Centers for Disease Control and Prevention, as of Friday, 1,629 people had been diagnosed in the United States and 41 had died.
But along with testing being scarce, many people who've contracted it exhibit only mild symptoms and may not seek testing. Symptoms may include cough, fever and shortness of breath.
Some, particularly older people and those with other health problems, including smoking and obesity, may be more likely to experience lung injury and require life-sustaining care.
In an interview last week, Rocco Massey, CEO of Beckley ARH Hospital, said watching COVID-19 first hit Washington state, where at least 37 people have died, gave the Appalachian Regional Healthcare System time to prepare.
"Its not a question of is there going to be a case in West Virginia," he said. "There will be a case in West Virginia. It's a matter of when and where."
Beckley ARH has been screening patients for signs of COVID-19 and asking about international travel at points of entry to the hospital and affiliated providers. Nearly 1,000 patients a day receive that screening, he said.
They also have plans for quarantining patients, have provided employee education and have been surveilling employees to ensure proper cleanup and hand-washing.
Massey also said since they are a large health system, they have access to a large reserve of personal protective gear, including masks, gloves and gowns.
Even so, they don't have enough beds for a large influx of patients. Massey said they could handle about ten extra.
But they do have a "surge policy," he said, so they could set up temporary beds. And if they needed to increase staffing, they could pay current workers overtime as well as hire travel nurses, he added.
The intensive care unit runs pretty full, he noted.
But he added that they do have a progressive care unit, which he called a step-down from the ICU, that they could revamp, and he said telemedicine services are available.
Massey also noted that many patients will be able to stay home. He also recommended patients call their providers instead of just showing up.
Dr. Zonaira Gul, infectious disease specialist at the hospital, added that patients could even get worse by unnecessarily showing up. They should keep in contact with health providers, but not necessarily visit the hospital, she said.
Individuals with mild symptoms, who don't have shortness of breath, can be monitored at home, she said.
BARH can even evaluate people who stay in their cars, she said. They should call before they show up.
"We do not put them in our waiting areas because waiting areas many times are full," she said. "There are other sick individuals there who could be at risk of getting that infection."
By phone Friday, Courtney White, marketing coordinator for Raleigh General Hospital, said she didn't know how many vacant beds they had because it's an "ever-changing number." She said preparations were "certainly underway."
She also pointed to an online statement, which says the hospital is screening patients for COVID-19, it has hand hygiene products available throughout the facility, and staff are provided with personal protective gear. The CEO was unavailable for comment to answer more specific questions.
Marsh said that if West Virginians who aren't symptomatic practice those measures he described earlier – hand-washing, limiting contact with large groups – that in turn could help health care providers more adequately respond.
If the virus spreads more slowly, health care providers would see a steady stream of patients versus an influx.
"If the infection becomes faster moving between people in the population, that can create a surge, kind of a big wave like a tsunami wave, and it makes it very difficult for the medical care providers to be able to keep up with," he said, "and that's what we're seeing in Italy right now."
News outlets have reported that in Italy, some providers are having to choose who lives and who dies.
Marsh noted that health providers typically buy things like protective gear based on how much they usually need.
"From a financial standpoint, you don't want big inventories," he said.
He referenced a CNN interview with Michael Osterholm, an infectious disease expert at the University of Minnesota who has been warning for a decade and a half that the world would face a global pandemic of this scale.
In the article, Osterholm noted that hospitals lack protective gear, vacant space, ventilators and respirators.
"The truth is honestly, no health system is prepared for this," Marsh said.
Marsh noted that it isn't useful to "apply the same logic or patterns to this problem because this problem is really different."
Some have compared the illness to the flu, for instance.
"We want to communicate that this is something different, and we'll need to be flexible and thoughtful and creative to get through it together, but this is also not the end of the world," Marsh said.
"And we'll have to also understand that as this gets worse, and I think that we haven't seen the peak of it yet, that we're going to see some celebrities that will get sick with this and maybe die. We'll see some people that we know get sick with this and maybe die. So this is something that will be difficult for us to deal with, and we need to make sure that we are not panicking, and to make sure that we are still staying together."
He also said health care providers should build up reserves of protective supplies and work together instead of competing against one another, perhaps by loaning supplies or workers.
"It's like when 9/11 happened, you know how everybody rallied together? Or the Boston Marathon bombing? ... And I'm not saying this is like that, but it's the same principle that these kind of real challenges to us almost always bring out the best in our humanity and the best in our community.
"West Virginia has great community and great connectedness, and this is a strength that we need to leverage right now."
West Virginia's COVID-19 website can be found at www.coronavirus.wv.gov. The state has also set up a hotline: 1-800-887-4304.
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