I just took a look at the Johns Hopkins COVID-19 interactive map (it’s late morning March 10, 2020) and it shows 116,152 confirmed cases of COVID-19 around the world, with 761 confirmed cases in the United States. To date, none have been confirmed in Maine, but the virus has made its way to all the other New England states, so as we keep hearing, it’s only a matter of time.

Your head may be spinning because of the torrent of information we are getting from multiple sources. Because the situation continues to evolve, there are still lots of unknowns, which unfortunately leads to misinformation and confusion. That’s why it’s critically important to share what is known and that the information comes from trusted sources

One of the sources I trust is Dr. Dora Anne Mills, who was the director of the Maine CDC and the State’s Health Officer for 14 years. She is currently the Chief Health Improvement Officer for MaineHealth.

Dr. Mills has been sharing information about COVID-19 on her Facebook page. Because not everyone is on Facebook or has access to the information, with her permission, I will be sharing her updates on the Catching Health blog. If you have specific questions or concerns or wish to comment, please do so in the comment section at the end of the post

Update from Dr. Mills

This is what Dr. Mills shared late last night (March 9, 2020)

As of late Monday, there are no confirmed cases in Maine. We are the only state in New England not to have someone test positive, so it seems it’s just a matter of time. Our health care professionals at MaineHealth have cared for several people who needed to be tested – some hospitalized and some well enough to stay at home in isolation. Most of those tests have come back negative, except for some pending ones.

One emerging and fascinating story on COVID is the number of cases who attended a Biogen conference at the Marriott Hotel in Boston on February 24 – 27. As of today, there are 32 in MA and several from other states (5 from NC, 2 from IN, 1 from TN, and 1 from DC) and countries who attended this conference and are positive for COVID-19. This may be an indicator of how easily this can be transmitted in the right conditions. It is also giving pause to a number of conference planners who have participants who are supposed to attend from around the country or globe. I’ve seen a large number of such conferences canceled or are planning to carry on virtually. Another place we’ve seen rapid spread has been Italy – from 9 cases only ~two weeks ago, to the entire country being shut down. Yet other countries have seemingly been spared so far. (See link below to WHO daily situation reports.)

Fortunately, Maine CDC finally received the testing materials from the US CDC after quite a delay from the federal government in distributing them to states. Maine CDC is now testing. Although US CDC liberalized their recommendations about who should get tested (see link below), currently, in Maine, with no evidence of community transmission, generally speaking, those who should be tested include: Individuals who exhibit symptoms (fever, cough, or shortness of breath) and have had close contact with a laboratory-confirmed COVID-19 patient or who have traveled from outside of the state within 14 days of the onset of symptoms, especially if was to an area with sustained transmission, and who do not have evidence of another respiratory illness (e.g. influenza). A lower threshold for testing is recommended for those patients who are in high-risk groups. It is also up to the clinician to use their judgment about whether to test. And guidelines are subject to change. I should mention that when someone is tested until the test result is available and is negative, they need to stay in isolation. Even with testing now available in Maine, that could be up to 2 – 3 days.

Monday, March 9, the US CDC issued Guidance for People at Risk for Serious Illness from COVID-19. (see link below). As I mentioned earlier, there is an increasing focus on assuring the health and safety of those at highest risk. CDC says If you are at high risk of getting very sick from COVID-19 (older adults or those with serious chronic medical conditions), you should:
• Stock up on supplies.
• Take everyday precautions to keep space between yourself and others.
• When you go out in public, keep away from others who are sick, limit close contact and wash your hands often.
• Avoid crowds as much as possible.
• Avoid cruise travel and non-essential air travel.
• During a COVID-19 outbreak in your community, stay home as much as possible to further reduce your risk of being exposed.

A companion piece to this guidance is the one on Cruise Ship Travel (see link below) that basically recommends anyone in a high-risk category defer any cruise ship travel.

Given the decimation of the nursing home in the Seattle area (accounting for 16 deaths out of 120 residents, due to COVID-19), today Maine CDC issued recommendations (see link below) that all long term care facilities (LTCF) screen everyone upon entry (staff, visitors, vendors, etc) to confirm that they:
• Have no signs or symptoms of respiratory infection such as fever, cough or sore throat
• Have not traveled within the last 14 days to restricted countries
• Have not had any contact with someone with known COVID-19 or a person under investigation for COVID-19.
If any visitor or staff meets any of the above criteria, LTCFs should restrict their entry to the facility. (There may be further restrictions when we have community transmission of COVID-19 detected in Maine.)

Today CDC also issued Environmental Cleaning and Disinfection Recommendations (see link below) that apply to a variety of settings. There is a focus on disinfectants that are bleach solutions or have at least 70% alcohol. That is not surprising, but good to know that those basic disinfectants appear to kill the virus.

CDC also issued guidance for colleges and universities (see link below) that reviews many prevention and mitigation strategies and also encourages these institutions to consider canceling international travel plans and recalling students currently in them. It also encourages them to develop ways to teach using distant technologies. Because boarding schools are especially challenging settings to mitigate disease transmission, a number of them in areas with outbreaks have temporarily closed or are taking extended spring breaks.

It was a busy couple of days with a number of new guidances and news about the spread of the infection and its ramifications. We’re fortunate to be spared right now in Maine. However, there is a lot of new information that the US CDC and Maine CDC have issued to assist in preparations, so this is a great time to review any that are relevant. It’s also important to use this time to practice vigilant hygiene and social distancing (greeting people with a wave instead of handshaking, heading to the grocery store in off-hours). These practices will help a great deal to get us through this, so we may as well use this time to make sure they’re fully integrated habits. As Ben Franklin said, “never leave that till tomorrow which you can do today”.

My writing is a bit crisp, as it’s been a long couple of days, but I’d like to end with some encouragement. I have a number of friends on the West Coast where there are outbreaks, who have been sharing that life is going on, they’re fully integrating all of these hygiene and social distancing habits, are grateful for the internet, and still feel close to friends and family, but in different ways. And, since I managed to miss the rush at the stores a couple of weeks ago to stock up, I went to my local grocery store on Sunday evening and found everything I needed. Yes, there was no hand sanitizer, but there was plenty of soap, and that works best anyway.

Dora Anne Mills, MD, MPH, FAAP

Resources from Dr. Mills

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If you have specific questions or concerns or wish to make a comment, please do so in the comment section at the end of the post. I will do my best to get answers for you.