NOVEL CORONAVIRUS (COVID-19)

UPDATE
Community Organizations Active in Disaster (COAD)
March 16, 2020

Jennifer Henn, PhD

Public Health Manager
CORONAVIRUSES: DEFINITION
& SYMPTOMS
 CORONAVIRUSES OF IMPORTANCE
MERS CoV in 2012 (ongoing)
• Arabian Peninsula
• WHO: 2,499 lab-confirmed cases
in 27 countries w/ 861 deaths
• Case-fatality rate ~34%
• In Saudi Arabia alone: 1831 cases
and 787 deaths
SARS CoV in 2002-2003
• Infected >8,000 people w/ 774 deaths
in 32 countries in 2002-2003
• Case fatality rate ~9-10%
• HCWs accounted for 20% of all cases
• “Many “SuperSpreading” events
 COVID 19-WHAT WE KNOW SO FAR
• Infectiousness: Similar to
SARS, more than influenza
• Incubation period: 2-14
days, average 7.5 days,
some studies suggest
longer in individual cases
• Severity: Less severe than
SARS or MERS, possibly
more virulent than
influenza
 DISEASE SEVERITY
BASED ON WHO REPORT FROM 2/20/2020 OF 55,924 LAB-CONFIRMED CASES

• 80% have mild disease and recover (includes pneumonia and non-
pneumonia cases)
• 13.8% have severe disease
• 6.1% are critical (respiratory failure, septic shock, multisystem organ
failure)
• Asymptomatic infection reported, but the majority went on to develop
disease

Report of WHO-China Joint Mission on Coronavirus Disease 2019:

https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf. Accessed 3/8/2020
 COVID-19 RECENT TIMELINE
• Commercial labs begin testing for COVID-19 – 3/9
• Multiple presentations and multimedia engagement -3/9 and ongoing
• WHO Declares Pandemic-3/11
• Governor and CDPH directive to cancel or postpone mass gatherings of
>250 and for at risk >10 – 3/12
• Declaration of local health emergency – 3/12
• EOC activation to Level 1 – 3/12
March 2020 • Declaration of local emergency – 3/13
• Health Officer Order to restrict nonessential visitation at residential care
facilities – 3/13
• CDPH guidance for theme parks, casinos and theaters -3/13
• Governor and CDPH directive to close bars, wineries, nightclubs and beer
pubs; have >65 self-isolate, house the homeless – 3/15
SITUATIONAL STATUS
3/16/2020 Cases Deaths Recovered More Info

Worldwide 185,067 7,330 80,236

US 4,661 69 12 49 states, D.C., Puerto Rico, Guam, and US Virgin

Islands
CA 583 7 6 30%Travel-Related
22%Person-to-Person
22%Community Transmission
12%Repatriation
14%Under Investigation
Napa County
3/17/2020 Cases PUIs Contacts Travelers Tests More Info
Under Investigation 0 14 0 11 29 1 positive test in
Diamond Princess
https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html
 RISK FACTORS
• Highest risk of severe disease and death
• Age > 60 years
• Underlying conditions: Hypertension, diabetes, cardiovascular
disease, chronic respiratory disease and cancer
• Highest risk among people over 80 y of age
• Higher among males vs females
• Children
• 2.4% of total reported cases reported among those less than 19 y
of age
• Small proportion of those cases developed severe (2.5%) or critical
(0.2%) disease

Report of WHO-China Joint Mission on Coronavirus Disease 2019:

https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf. Accessed 3/8/2020
 COVID 19 TOOLBOX
What we have:
• Containment measures - PHASE 1
• Preparedness for community spread - PHASE 2
• Mitigation measures – PHASE 3

What we don’t yet have:

• FDA approved medicine (only medicine for experimental
use in more severe cases)
• Vaccine effective against COVID-19
DISEASE CONTAINMENT STRATEGIES

Isolate Quarantine Reduce

the sick the exposed social
mixing
LAB TESTING ISSUES

Not enough test

Defective test kits
kits

Infection control
Not enough swabs
requirements
and viral transport
(mask, gloves,
tubes
gown, eyeshield)

Need for a single

isolation room
LAB TESTING
• Drive through specimen
collection
• Minimizes risk to healthcare
workers
Pool lab
testing • Preserves personal
resources protective equipment
Increase
testing and • Increases testing
improve • Enables pooling of lab
detection
testing resources
PREPAREDNESS
(Phase 2)
COMMUNITY PREPAREDNESS

Healthcare
Personal
Business
PERSONAL PREPAREDNESS
• Step up your hygiene game. Hand washing, covering coughs
with your elbow or a tissue, and staying home when sick are
the most important things you can do to protect yourself
and others.
• Try to keep a 30-day supply of essential medicines.
• Get a flu shot if you haven’t already. The flu is still circulating
and the symptoms are similar to COVID-19.
• If possible, have extra of essential household items (e.g.
diapers for small children, laundry detergent) and food
staples on hand.
• Have a support system in place for elderly family members.
WWW.COUNTYOFNAPA.ORG/CORONAVIRUS
 PHASE 3: COMMUNITY MITIGATION
Social
Distancing
• Prevention of exposure for
high risk groups
• Health Officer Order and
CDPH Directive - Visitor
limitations at residential care
facilities
• CDPH Directive: Avoid
gatherings of >10
• CDPH Directive: Persons >65
or with medical conditions
isolate at home
Cancellation of School
Large Events Dismissals
• Large events • School dismissals
• CDPH Directive: Avoid • Reactive dismissals (school
gatherings of >250 and self-closes)
keep social distancing
strategies (separation of 6
feet) for smaller sizes
• CDPH Directive: Social
distancing for theme
parks, theaters and
casinos
RATIONALE OF SOCIAL DISTANCING
“FLATTEN THE CURVE”
URE 1. Goals of community mitigation for pandemic influenza

Healthcare Capacity
COMMUNITY SUPPORTS NEEDED TO
“FLATTEN THE CURVE”
Social distancing is the key to flattening the curve in a pandemic
situation without effective treatment or vaccine
Communities can support the efforts of families and individuals to sustain themselves
during times when they need to shelter in place by:
 Coordinating emergency food distribution for children and adults
 Preventing evictions and water shut offs
 Providing extra support for those at highest risk of severe illness, allowing them to stay
inside their homes (e.g. shopping, transportation, etc)
 Ensuring adequate hygiene facilities and healthcare for those experiencing homelessness
 Providing referrals to mental health and other health and human services
CURRENT MESSAGING NEEDS

•Biggest need: helping people understand what

to do when sick and when to go to the
Emergency Department
The main symptoms of COVID-19 are fever, cough, shortness of breath and sore
throat.
If you would not normally visit your doctor for these symptoms, don’t go to the
doctor.
Call your doctor and ask for advice if you have concerns about your illness.
Do not go to the emergency department or your doctor’s office. You may infect
other people.
The ED does not have test kits for COVID-19, people should go only if they are
having a medical emergency