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Hospital urges simple measures

BMH official urges simple hygiene to slow the pace of the spread of novel coronavirus to keep from overwhelming the health system

To learn more, visit Brattleboro Memorial Hospital’s information on coronavirus at bmhvt.org/coronavirus.

BRATTLEBORO—Enough rumors and gossip have been swirling around the region regarding the ongoing novel coronavirus crisis that one town was compelled to issue a statement designed to knock down some of the chatter.

“I have been advised this morning that some rumors of significant COVID-19 impacts are circulating in Brattleboro,” wrote Town Manager Peter Elwell in response to the fast-spreading virus, which originated in China and affects vulnerable populations with unusual intensity.

“Examples include ‘hospital staff have been instructed not to report to work’ and ‘police officers are wearing masks whenever they are in public,’” he wrote. “These rumors are not true.”

Elwell said that the town is “in a state of heightened awareness and preparation to take emergency response action(s). We are not at this time in active response mode. Individually, the best action we can take is to continue to be vigilant about hand washing, sneeze and cough covering, surface cleaning, staying away from sick individuals (if possible), and staying home if we ourselves feel sick.”

Local officials are challenged by the mission to find a balance between avoiding panic and acknowledging the utter social and economic disruption of a worldwide pandemic whose cases are, by one estimate, doubling every six days.

By Tuesday, a number of colleges in New England, including Middlebury College in Vermont and Amherst and Smith colleges in Massachusetts, announced that they were suspending classes on campus.

Locally, events are being postponed or cancelled out of an abundance of caution, from church dinners to the Women’s Film Festival.

Preventing the spread of the virus

Dr. Kathleen McGraw, chief medical officer and chief information officer at Brattleboro Memorial Hospital, echoed Elwell’s sentiments in an interview with The Commons on March 10.

“One of the really important things is wash your hands, cover your cough with your elbow, and don’t touch your face. On one hand, I think people hear that and think, ‘Oh, but that’s really so simple, tell me the important stuff.’ But that is the really important stuff.”

McGraw said being diligent doing those simple things “will help us prevent the spread, and not only will it help prevent the spread [of the virus], but it will help slow the pace of the spread, and the pace of the spread will ensure the rest of us can get the proper medical attention to those who need it.”

As chief medical officer, McGraw oversees quality control and patient safety at BMH. According to her, one crucial effort of public health officials and emergency responders is to ensure that people receive accurate information.

If people want to research the virus and and statistics, such as the number of cases, they should go to the website of the Centers for Disease Control and Prevention or the Vermont Department of Health’s site, McGraw said.

Don’t go to Facebook, and don’t panic because of a social media post, she advised.

As of March 10, there was one identified COVID-19 case in Vermont, according to the state Department of Health, and 40 people tested negative for the virus.

Meanwhile, the state is monitoring another 226 people, and 56 Vermonters have completed their monitoring period.

BMH has tested a few community members who have tested negative.

Still, the virus’s spread is growing geometrically and rapidly.

Making plans

McGraw said BMH staff started preparing for the virus’s arrival in Vermont approximately six weeks ago.

“For us, it’s been preparation with a significant advanced notice,” she said.

When it first broke out, the virus caught public health officials in China by surprise, “and they had to scramble to get their feet under them,” she said.

As the coronavirus moved to other countries, officials in Vermont were able to watch and learn.

“That has allowed us to start our work early, which is an advantage that other countries in the world have not had,” McGraw said.

Like all hospitals in the state, BMH developed its emergency planning programs years ago. When the virus was identified in China, the organization went back to its pandemic preparedness procedures and updated them, she said.

“We looked at our supplies make sure that we have adequate supplies — and we do,” she said.

The hospital also examined its staffing levels and protocols to ensure the facility would have the right number of the right people to respond to a crisis, she added.

BMH also coordinates some of its preparedness planning with Cheshire Medical Center and Dartmouth-Hitchcock Medical Center in New Hampshire.

Fragile, but virulent

McGraw explained that outside the human body, COVID-19 is a fragile virus.

“This virus, fortunately, is destroyed with soap and water; you don’t need fancy anything to wash it away,” she said. “So while the stores have had their shelves emptied of all those hand sanitizers, soap and water is completely fine.”

Be sure to routinely clean “high touch” surfaces such as light switches, computer keyboards, and cell phones, she advised.

Also, the COVID-19 virus is related to the common cold, and for 80 percent of the people who contract it, their symptoms will be mild to moderate. Some might not even know they have COVID-19, she said.

Flu has a “wax and wane that is seasonal” as a virus, she said. “This particular version of this virus, we do not yet know what its course will be, but we do expect when there is less flu around, that will be helpful.”

McGraw said that the regular flu vaccine won’t prevent COVID-19, and it is possible for people to contract more than one virus at a time. Consequently, she recommends getting the flu vaccine, which can be effective against other strains.

Currently, there is no COVID-19 vaccine.

“It will take at least a year to a year-and-a-half to have a vaccine we can use,” National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony Fauci M.D. told U.S. Senators on March 3.

The COVID-19 flu follows the emergence of other viruses such as “swine flu” or “avian flu.” Yet public health officials have had a greater response to COVID-19.

McGraw said that’s in part because of how fast the virus initially spread.

“It broke so quickly and was so contagious in China,” she said. “Because it was a brand new novel virus, we didn’t know what its course was going to be like.”

The “novel” part of the virus means there is still a lot medical experts are learning.

“It is quite contagious, as we’re seeing, although we should note 80 percent of the people who contract it have few symptoms,” McGraw said.

“Some proportion of the remainder will be sicker, and it’s tough to say who will be those sicker folks,” she added.

According to the CDC, “Older people and people of all ages with severe underlying health conditions — like heart disease, lung disease and diabetes, for example — seem to be at higher risk of developing serious COVID-19 illness.”

That said, people should not run to the emergency department every time they have the sniffles, McGraw said. Mild cases of COVID-19 can be managed at home like most other colds or flu, she noted.

She advised to save the emergency department visits for severe and urgent cases, such as shortness of breath — one consequence of COVID-19 — or a non-COVID-19 issue like a heart attack.

“If you have a fever and a cough, that doesn’t necessitate an emergency room visit,” she added. “In a normal flu season, you wouldn’t take your fever and a cough to the emergency department, you’d call your primary care provider and that still is true.”

Feeling ill?

According to McGraw, just because someone contracts the flu, they don’t necessarily go to the doctor unless they have severe symptoms. Much of the same advice around treating the flu holds true for COVID-19.

“For us, it’s about trying to balance the importance of being able to provide people the appropriate level of medical care in the appropriate setting as well,” McGraw said.

If someone is concerned that they have COVID-19, then they should call their doctor. Anyone without a primary care physician can call BMH’s Central Scheduling at 802-251-8777 to be connected with a physician.

According to McGraw, to be tested for the virus, a person’s doctor must contact the Vermont Department of Health to get the test approved.

McGraw wanted to clarify the term “drive-thru testing” that has appeared in several media outlets. It is not an on-demand, impromptu service.

According to her, hospitals have developed a procedure for people to get tested when their doctor recommends it, but who also don’t require the acute care of an emergency room.

Such a test takes place in the patient’s vehicle, she said, and doing so is not only easier for the patient but also ensures that the virus doesn’t spread.

“That takes place in the car so it becomes a drive-up appointment for it, but that’s not the same as saying we’re like Taco Bell or Burger King,” McGraw said.

McGraw said that not everyone needs to be tested. A doctor and the Vermont Department of Health will determine if a person needs to be tested or does not need to, she said.

According to McGraw, there is a misconception that everyone exhibiting symptoms will be automatically tested.

“Those who need to be tested will be tested,” she said.

Still open for business

So far, the Vermont Department of Health has not called for cancelling any community events or gatherings.

McGraw said some other state governments have started cancelling events but noted that Vermont’s rural population does not have the same issue of scale as many urban centers.

In many cities, a sporting arena holds more people than the population of Brattleboro, she said.

One thing all Vermonters and business owners should investigate is their staffing plan, McGraw said. For example, what happens if staff members contract COVID-19 and miss a month of work? How will the business support its staff, and how will the business continue to operate without enough staff or key staff members?

“Right now, everything is operational, and functional, and safe,” she said.

BMH wants the community to know that it’s open for business as usual. That includes the emergency department and doctors’ appointments.

The hospital has plans in place should the amount of resources need to shift to caring for COVID-19 patients. Then, BMH would start to evaluate changes and inform the community at that time, McGraw said.

“People should stay tuned — check our website — this is a fluid situation,” she said. “We will continue to have updates and changes as they’re appropriate because we know that this disease is likely to have some changes from what we know it is now.”

While McGraw is cautious, she is also confident in BMH and the state’s ability to respond to the virus when it infects more of the community.

“We’re prepared to move forward with those changes — that’s what our planning and preparation has been for, so we can adapt as necessary,” she said. “This is public health, and this is what we’re here for. We will continue to care for our community through this event.”

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Originally published in The Commons issue #552 (Wednesday, March 11, 2020). This story appeared on page A1.

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