Maine does not yet have any cases of novel coronavirus, but state and local public health officials are fine-tuning their plans in case it shows up in Maine. The protocols go into nitty-gritty details, such as what happens when someone walks into a local hospital or doctor’s office and has a suspected case of coronavirus.

The virus has spread rapidly in China and now Europe, and there have been 74 confirmed cases of novel coronavirus – also known as COVID-19 – in the United States, including 44 from the Diamond Princess cruise ship. Washington state had the nation’s first death from the virus on Saturday. With more than 88,000 confirmed worldwide cases and at least 3,000 deaths, public health experts have said an outbreak in the United States is expected, although it’s unclear how severe it would be.

Fears of a coronavirus outbreak are happening at the same time as the seasonal flu, which has infected an estimated 32 million in the United States, with 18,000 deaths. Maine has had 6,994 flu cases so far this season, through Feb. 25, according to the Maine Center for Disease Control and Prevention.

Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention Gregory Rec/Staff Photographer

All top state public health officials – including Dr. Nirav Shah, director of the Maine CDC – traveled to Washington, D.C., last week to meet with federal officials and lawmakers. Maine has so far had one suspected case of novel coronavirus, but test results came back negative.

Shah said the situation keeps changing, and so preparedness plans may also be altered quickly, depending on how the virus spreads and what scientists learn.

Dr. Dora Anne Mills, senior vice president of community health at MaineHealth, the parent company of Maine Medical Center and eight other hospitals, said the protocols begin with those doing intake of patients, either at hospitals or primary care offices. Patients will be asked a series of screening questions – such as does the patient have flu-like symptoms and have they recently traveled to China or other areas where novel coronavirus is prevalent. If the answers match a case of suspected COVID-19, a scripted response follows, Mills said.

“Wherever a patient presents at MaineHealth, we will be ready. The details about what to do will pop right up on the computer screen,” Mills said. “The patient will be given a mask and taken right away into a private room. A health care provider will visit right away, and they are going to be donning personal protective equipment, such as respirators, gloves and gown.”

If the patient’s symptoms are severe, nurses, doctors and any employee entering the room will wear full infectious diseases suits.

STATEWIDE RESPONSE

Similar protocols are being implemented at hospitals throughout the state.

“Maine CDC has been providing guidance to Maine hospitals on a regular basis,” said Robert Long, spokesman for the agency.

Troy Cutler, infection preventionist at MaineGeneral Health, the parent company of MaineGeneral Medical Center in Augusta, said they have been training for years for new virus outbreaks.

“We regularly prepare for these kinds of scenarios,” Cutler said. “(We have) developed policies and procedures to have us ready for any emerging disease transferred by airborne, droplet or contact vectors.”

Mills said in some cases, patients will be urged to recover at home with close consultation with doctors.

“If someone is having mild symptoms – and 80 percent of coronavirus patients have mild symptoms – it may be better to stay at home for 14 days,” Mills said. The 14-day recommendation is by the U.S. Centers for Disease Control and Prevention so that patients recover past the incubation period for the virus and are then no longer contagious. Patients who stay at home to recover are less likely to spread the disease.

Novel coronavirus symptoms include fever, cough and shortness of breath.

Shah said since COVID-19 is more deadly than influenza, the protocols at health care facilities will be more strict.

“Novel coronavirus is more transmissible and more lethal than the flu virus,” Shah said.

He said that means, for instance, that someone with mild influenza may not be placed in isolation at a health care facility, but someone with novel coronavirus could be, even if the person had mild symptoms.

Shah said another key part of preparing is for states to obtain the capability to conduct their own novel coronavirus tests, which should happen in Maine within the next few weeks. It can take a few days to get test results back when the sample has to be sent out of state for testing, compared to potentially less than 24 hours for in-state tests, Mills said.

Shah said a new testing machine that cost $58,000 in federal funds should be arriving soon in Maine, plus the U.S. CDC is sending Maine coronavirus testing kits. The U.S. CDC had to recall coronavirus testing kits sent to states because they did not work properly, but Alex Azar, secretary of the U.S. Department of Health and Human Services, told federal lawmakers on Friday that the issue has been fixed and new testing kits should be available to the states by next week.

“Being able to do our own testing is really important,” Shah said. “We have to be able to know what’s happening on the ground quickly.”

Since there is no cure for novel coronavirus, treatment for severe cases includes rest, fluids delivered intravenously, oxygen and other supportive care.

“Scientists are right now testing an anti-viral medication and hoping it gets good results for patients,” Mills said.

Also, the Greater Portland Council of Governments is planning a meeting at 7:30 a,m. on Wednesday in Portland to prepare local governments for an outbreak, according to Kristina Egan, executive director of the council.

WHAT’S NEXT FOR COVID-19

Shah said it’s impossible to tell how much more widespread COVID-19 will become, and there are conflicting signs.

“The rate of increase has started to slow in China, but the number of cases outside of China have really started to take off,” Shah said. The virus has recently spread to northern Italy – with 1,694 cases as of Sunday – and the streets of Milan were nearly empty last week.

Meanwhile, scientists from all over the world are scrambling to study the new virus.

Dr. Meghan May, an associate professor of microbiology and infectious disease at the University of New England, is part of that effort, conducting research on the gene sequencing of COVID-19. May said researchers have complete genome sequences of the virus from nearly 200 patients.  Sequencing is the process of determining the order of the basic genetic components and can be critical for guiding diagnosis and treatment.

May said they are putting the finishing touches on the research, and it will likely be published in the coming weeks in a scholarly journal.

She said so far it seems COVID-19 mutates slowly, which should be fairly good news for public health. May said COVID-19 is a “close cousin” of the SARS virus, which also emanated from China and caused an outbreak in 2003.

“It’s not evolving any more quickly than any other beta coronaviruses. It’s within the range you would expect,” May said.

She said in contrast, influenza can mutate quickly, which makes it difficult to make an effective vaccine, and vaccine effectiveness can vary year by year depending on the strains of influenza circulating.

“When the virus evolves slowly (like COVID-19), it’s much easier to make an effective vaccine against,” May said.

May said scientists developed a SARS vaccine, but it was never put into widespread manufacturing because the virus dissipated before the vaccine was invented. May said the SARS vaccine or a very similar vaccine could help stamp out COVID-19, once it’s proven effective and able to be manufactured.

But COVID-19 is being treated seriously by infectious disease experts because it is a lot more lethal than the flu – influenza kills about 0.1 percent of patients it infects, compared to 2 percent of novel coronavirus.

And many people may not even realize they have COVID-19, because sometimes the symptoms are merely a cough and sore throat, where influenza’s symptoms are typically worse.

“A mild case of coronavirus can be pretty mild, but a mild case of influenza can still feel really bad,” said Mills, of MaineHealth.

May said while flu season ends in May, no one knows how long COVID-19 would stick around or when it would peak.

“H1N1 peaked in May (in 2009),” May said. “We have no idea what the seasonal patterns to this disease might be.”

While Maine has not had any cases, the coronavirus threat has had some on-the-ground effects, including the cancellation of a Portland performance by a drum group from China, and Maine schools with international students have been closely monitoring the situation. Foxcroft Academy in Dover-Foxcroft canceled an international trip. Arnold Shorey, the academy’s head of school, would not specify the destination to the Press Herald, except to say the trip was not to China.

“Our (Foxcroft Academy) boarding students are not from the areas where the coronavirus originated. Students did not travel home during the February break to areas of the world that have been identified as a health risk. We will evaluate with the students from areas of concern and their families about the virus to see if it is prudent to allow travel during the April break,” Shorey wrote in a Facebook post on Thursday.

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