Triage

A triage tent awaits patients outside Mark Twain Medical Center in San Andreas. 

Updated 3/15/20:

As of Sunday, all Calaveras County public schools are closed, per the recommendation of Calaveras County Public Health, with classes scheduled to resume in mid-April. 

Original article:

With the confirmation of two COVID-19 cases in Copperopolis and Gov. Gavin Newsom’s moratorium on mass gatherings, Mother Lode residents have already felt the impact of a “rapidly evolving” global pandemic that was first detected in China late last year.

In the past week, the new coronavirus has made its way into the forefront of local news and social media posts, sparking a frenzy of event cancellations, resulting discourse and confusion.

In Valley Springs, one clothing store is offering a free roll of toilet paper with every $20 purchase. The cheeky Facebook post pokes fun at those who may be “hoarding” supplies in preparation for a shortage, yet Business Insider reported Thursday that Amazon, Target and Walmart are nearly sold out of toilet paper online. A quick scan of Amazon Prime shows most disinfectant wipes are also unavailable.

So how serious is this coronavirus situation? And how bad will it get?

According to experts, the worst is yet to come. If reports from towns like Bergamo, Italy, are any indication of what may happen globally in the weeks to follow, then even the Mother Lode may need to prepare for closed businesses, overflowing hospitals and the triaging of patients.

On Friday, the Centers for Disease Control and Prevention (CDC) reported 1,629 confirmed cases of COVID-19 resulting from exposure to the novel coronavirus and 41 deaths nationwide. California has been one of the most heavily affected states, with 224 cases and the confirmation of community spread.

Many have questioned why the coronavirus is garnering more concern than influenza, or the common flu, which has killed as many as 52,000 Americans since October, according to the CDC.

Experts say the simple answer is in the virus’ name: it is new, it spreads easily, and there is no vaccine currently available. Another concern is that COVID-19 has led to severe respiratory illness or death in many patients, particularly those who are older or have underlying health problems, according to the CDC.

“It’s likely that at some point, widespread transmission of COVID-19 in the United States will occur,” the CDC website reads. “Widespread transmission of COVID-19 would translate into large numbers of people needing medical care at the same time. Schools, childcare centers and workplaces may experience more absenteeism. Mass gatherings may be sparsely attended or postponed. Public health and healthcare systems may become overloaded with elevated rates of hospitalizations and deaths. Other critical infrastructure, such as law enforcement, emergency medical services and sectors of the transportation industry may also be affected. Healthcare providers and hospitals may be overwhelmed.”

The Chinese Center for Disease Control and Prevention has reported that the COVID-19 mortality rate becomes significantly higher – 3.6% – in individuals above 60 years old. In those above 80, it’s almost 15%. That is troubling data for communities like Calaveras County, where the U.S. Census Bureau estimated more than 27% of the population was 65 years or older in 2018.

And although the CDC reports that the majority of those infected with the coronavirus will develop only mild symptoms, the virus may be spread by individuals who do not know they are infected, endangering those who are at risk of severe illness.

As a nation braces for increased community spread of the coronavirus, local hospitals and county services are taking measures to fortify resources against a potential tidal wave of public health demands.

Preparing local hospitals

According to the Calaveras County Office of Emergency Services (OES), slowing the rate of transmission so as not to overwhelm the local healthcare system is a primary concern. For that reason, experts are recommending social distancing and, if possible, placing a call with a doctor before going into a healthcare facility if one is experiencing a cough, runny nose, sore throat or fever.

“The idea of everybody getting this is not exactly far-fetched,” Randy Smart, MD, CEO of the Mark Twain Health Care District (MTHCD), told the Enterprise Friday. “It’s really transmissible. You could use numbers that as many as 70% will get infected. Our hope is that they don’t all do it at the same time. … If I get it in June, and you get it in August, it’s less overwhelming for our infrastructure.”

Smart said that the Valley Springs Health and Wellness Center, operated by the MTHCD, and Mark Twain Medical Center, run by Dignity Health, have been preparing for the onset of the coronavirus for the past four to six weeks. Preparations have included securing supply chains for much-needed testing kits and protective gear, and developing plans for intake, communication, and protecting those who are most vulnerable.

“That said, we have an emergency disaster plan and do tabletop drills from time to time, related to Ebola, infectious diseases, etc.,” Smart said. “I don’t feel that we’re behind the curve at all. I think we’re as prepared as we can be.”

So far, there haven’t been any shortages of testing kits or supplies at local facilities due to constant communication with suppliers and educating staff on how to effectively ration protective gear, Smart said.

“We have enough supplies on hand to care for COVID-19 patients and since Adventist Health Sonora is part of the Adventist Health system, we have access to additional supplies, expertise and support should we need it,” Dr. Ramesh Nathan, an infectious disease specialist at Adventist Health Sonora, confirmed Friday.

However, most healthcare providers cannot perform in-house testing. Nasals swab samples from testing kits must be analyzed in either a private or state-run lab, a process which usually takes about 48 hours, Smart said.

According to the OES, testing availability has been expanded in Calaveras County, though the number of kits are “limited,” leading to prioritization of testing.

“Testing is more widely available to local providers, including emergency departments. Local providers can now collect specimens and send to labs,” Sgt. Greg Stark with the Calaveras County Sheriff’s Office, who is acting as the public information officer for OES, told the Enterprise Friday. “We are working with the State to continue to increase access to testing for Calaveras County.”

But as with regions that have been severely impacted by the coronavirus, it is possible that shortages in supplies and hospital beds could occur locally in the future.

“Capacity is a really hard question,” Smart said. “In order to answer that question, it’s a really complex formula. How many people (will need) hospitalization? Now many receive intensive care? How many show up at the same time? Those are numbers we just don’t know. … The chances of us being overwhelmed? I have no idea. It’s really hard to say.”

According to Stark, local medical facilities, OES and Public Health are coordinating with state and federal health organizations to prevent the spread of the coronavirus and protect those who are in danger of becoming seriously ill if exposed. 

Efforts have included setting up triage areas for testing at hospitals, providing remote services for some patients and isolating those who are elderly or have underlying health conditions.

OES announced on Thursday the activation of an Emergency Operations Center (EOC) to support Public Health and distribute accurate information to the public.

“Calaveras OES is diligently coordinating efforts with state, regional, and local agencies: Health Department, Ambulance Services, Fire Departments, Mark Twain Hospital, Law Enforcement and American Red Cross are some,” an OES news release reads.

“The EOC staff holds several conference calls throughout the day monitoring the status and challenges of the region and state,” Stark said.

Tapping into his background in microbiology, Dr. Smart says it’s too soon to say what a future with the coronavirus may look like.

“These are the kinds of infections that are really hard to predict,” Smart said.

He added that concern is warranted, but “panicking never accomplishes anything.”

Smart advises the public to not get overwhelmed by media coverage and to instead gather information from reputable sources like the CDC. He also recommends postponing routine medical appointments for a few months, if possible, to prevent exposure to the virus and to keep resources available for those most in need.

Nonetheless, Smart says he’s “confident” that health authorities will have a better understanding of the coronavirus by summertime.

“It’s fear of the unknown,” Smart said. “By looking at other outbreaks in the Middle East and in Europe, we’ll know more about this virus and how it behaves.”

School closures

With Copperopolis Elementary School shuttered until Tuesday under the direction of Calaveras County Public Health following the diagnosis of a student with COVID-19 on Tuesday, the local public school system has already been disrupted by the coronavirus.

What’s more, Calaveras County Superintendent of Schools Scott Nanik told the Enterprise Friday that fear and misinformation among parents has caused many to pull their children out of class, triggering a “substantial” drop in attendance countywide.

He says that a misunderstanding of how the coronavirus is transmitted and the implications of being tested for the virus are largely fueling those fears.

“We have a lot of people with just the cold or the flu that’s going around, and (they are) getting tested,” Nanik said. “Just because you’re being tested doesn’t mean you have the virus.”

As attendance is the primary source of funding for public schools, and because districts cannot apply for supplemented state funding unless schools are closed under the direction of Public Health, Nanik has concerns that fears surrounding the virus may lead to prolonged absenteeism and underfunded schools.

“Extracurriculars, athletics and electives will be the first to go,” Nanik said. “(The school system) can’t be shut down for months. This genie is not going back in the bottle. This virus is going to be with us in the world from now going forward. … We expect to see a spike again next winter. We need to work through this as humanity and find how to best protect our most at-risk population.”

Nanik added that shutting down schools for prolonged periods would also put a burden on many working parents who depend on schools for childcare.

In summary, Nanik’s advice to parents is to not succumb to fear at the detriment of their children’s education. He assured that county schools are “working diligently” to prevent the spread of the virus on campus, with some schools sanitizing as often as three times a day and deep cleaning at night.

“If students are sick, stay home. If they’re not sick, come to school,” said Nanik, who stressed that the coronavirus has been found to produce only minor symptoms in children and the majority of the population. “If you have the sniffles and maybe just a cough, come to school and let the school decide if you should be there or not.”

Event cancellations

Most public gatherings in the Mother Lode have been canceled in the past few days, from high school games and plays to popular events like Murphys Irish Day.

Following Gov. Gavin Newsom’s Wednesday declaration that gatherings of 250 people or more should be canceled, major sporting events, concerts and even film productions have been sent into a standstill statewide.

However, according to Calaveras County Fairgrounds CEO Laurie Giannini, the coronavirus won’t stop the largest annual mass gathering in the county, which is still scheduled for late May.

“The governor and the California Department of Public Health has wisely asked that folks limit their gatherings through the end of the month. We are confident that this strategy will be effective and the Fair in May will proceed as planned,” Giannini told the Enterprise Thursday. “In conclusion, we like to say, ‘keep calm and frog on.’”

Individual prevention

Calaveras County Public Health has recommended the following:

• Large gatherings that include 250 people or more should be postponed or canceled. (This includes gatherings such as concerts, conferences, and professional, college, and school sporting events.)

• Smaller gatherings held in venues that do not allow social distancing of six feet per person should be postponed or canceled. (This includes gatherings in crowded auditoriums, rooms or other venues. )

• Gatherings of individuals who are at higher risk for severe illness from COVID-19 should be limited to no more than 10 people. (This includes gatherings such as those at retirement facilities, assisted living facilities, developmental homes, and support groups for people with health conditions.)

• A “gathering” is any event or convening that brings together people in a single room or single space at the same time, such as an auditorium, stadium, arena, large conference room, meeting hall, cafeteria, or any other indoor or outdoor space.

For everyday practices:

• Avoid close contact with people who are sick.

• Stay home from work or school and limit contact with others if you are sick.

• Wash your hands often with soap and water for at least 20 seconds.

• Avoid touching your eyes, nose or mouth with unwashed hands.

• Clean surfaces that are touched often, like toys and doorknobs.

Older adults and people with serious medical conditions – like heart disease, lung disease, and diabetes – are urged to take extra steps to protect themselves from COVID-19.

For high-risk groups:

• Stay at home and avoid crowds as much as possible.

• Get food brought to your house by friends, family or neighbors.

• Have a plan if you get sick.

• Stay in touch with family, friends and neighbors.

• Have a back-up person if your caregiver gets sick.

For localized information, call the county’s COVID-19 hotline at (209) 754-6460.

3/13/20 Correction: A previous version of this article stated that Copperopolis Elementary School will remain closed until Monday. The closure has been extended to Tuesday, per the recommendation of Public Health. 

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Dakota graduated from Bret Harte in 2013 and went to Davidson College, NC where she earned a bachelor's degree in Arab studies. After spending time studying in the Middle East and Europe, she is happy to be home, writing about the community she loves.

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