‘It’s an evolving situation’

PCPH’s Reese says no one in Polk County is being monitored for coronavirus, acknowledges that there are no test kits currently available in Crookston

    Sitting down to discuss the coronavirus/COVID-19 with the Times in her Polk County Public Health office in Crookston the other day, PCPH Director Sarah Reese noted how often of late she's had to modify her message, her numbers and information and other relevant data on the virus, even by the minute, when she's communicating daily with PCPH's many partners.

    Sure enough, she noted via email only a few hours after the interview, Minnesota's first official case of coronavirus had been reported.

    “I’d hoped we wouldn’t need to reconnect quite so soon,” Reese stated in her email to the Times, in which she forwarded the Minnesota Department of Health’s notification on the state’s first confirmed case of COVID-19. That older man in Ramsey County was joined on Sunday by Minnesota’s second case involving a male in Carver County.

    But that rapidly changing and expanding situation is simply the way it's going to be for a while in Crookston, Polk County, Minnesota and the nation as coronavirus numbers no doubt ramp up rapidly, Reese noted, as more sick people are tested for the virus.

    With still only two official cases in Minnesota, Reese said it's all about implementing a "containment strategy" right now, and going forward, unless or until that strategy needs to be altered.

    "At this point it's about making sure our plans are in place and that we have good communication with our partners and the public," she said. "We're checking with our partners on how we would utilize our plans. We have an infectious disease out there, and our response plans are in place."

    PCPH is working with health care partners like RiverView Health and Altru Clinic in Crookston, and other health care providers in the county. Reese says PCPH is also working closely with Polk County Emergency Management.

    "There are plans specific to primary care, long-term care, school settings, the public's general health and safety; we want to minimize the potential for spread for COVID-19 as well as any respiratory illness," Reese said.

    It's been well documented by now how people can protect themselves by doing things like extensively and enthusiastically washing their hands and using copious amounts of soap, using hand sanitizer and cleaning surfaces they touch, steering clear of people who are coughing or appear ill, coughing into their elbows, avoid touching their face, and staying home if they're sick.

    "These are common things we should all be doing all the time in order to avoid infectious illnesses, especially respiratory illness," Reese explained.

    If someone feels sick and thinks there might be a chance they've somehow been exposed to coronavirus, Reese recommends that they contact their physician first. "Talk to someone about your symptoms before rushing right in," Reese advised. "A very important thing about containing respiratory illnesses that can travel quickly is reducing the strain on our health care systems."

    While working with local agencies and partners, Reese says PCPH is in daily contact with "incident command," the Minnesota Department of Health and Centers for Disease Control, under the guidance of the World Health Organization.

    "We want to be as prepared as possible while trying not to overreact," Reese said. "But we know there's a real fine line with that. ...This is obviously a very fluid situation, and we're all trying to drum to the same beat as we work our way through it.

    "In a situation like this, it's easy to get sidetracked by all the noise out there," she continued. "But this is about the basics of infection control, and constantly reviewing your plans to make sure they're the right plans for what you're dealing with."

    An epidemiologist in the region working specifically with Polk County is an especially valuable resource, she noted. "Together, if we don't have the answers, we go to the Department of Health to get them," she said, adding she's especially thankful for the MDH's laboratory, which, she said, is one of the most respected in the nation. The MDH would analyze coronavirus tests to either confirm the presence, or absence, of the virus. Reese acknowledged that coronavirus testing is not available in Crookston at this time. All test kits are currently available through the MDH lab. A specimen would be collected locally, if someone is determined to meet the testing criteria, and the specimen would be sent to MDH.

    “If you feel ill and possibly have certain symptoms, you come in, you meet with your provider, and the provider is required to consult with (MDH) to decide if testing should happen,” Reese explained. “That all happens right in the room involving very specific criteria required by the Centers for Disease Control. We want to make sure we’re not testing people who don’t need to be tested. That’s why there is the consultation.”

    If people in this area have been traveling around the world, the MDH is assessing their risk factor, Reese explained. If they meet certain criteria, they’re asked to self-quarantine for 14 days. From the first day, known as  “day zero,” the self-quarantined are in communication via email with MDH regarding any relevant symptoms they may be experiencing. “They try to keep it simple. It’s ‘if you come down with these symptoms, notify us.’ It’s as simple as that,” she said. If someone is deemed to have been in contact with a diagnosed person, they, too, are asked to self-quarantine for 14 days.

    No one is currently being officially “monitored” in Polk County, Reese added.

    That doesn’t mean a lot of people want answers to the “What about me?” and “What about my scenario?” questions, she continued. She’s making sure PCPH’s partners have the “Personal Protective Equipment” they need in order to carry out their work, and she’s making sure that questions get answered, no matter how far up the chain of incident command she has to go.

    “Infectious disease is in the public health wheelhouse when it comes to mitigation and reducing transmission,” she said. “We’re trying to be calm while we’re working through the plans we have. This right now is why we work so hard to put those plans in place.”

Brand new

    The coronavirus concerns medical experts because it’s so new, so there’s no specific history or precedent to base reactions and treatments on.

    “It’s a changing, evolving situation,” Reese said. “The difficulty with a new virus is we’re learning about its transmission, severity, incubation period, when people don’t feel sick but they could get sick. There are so many things we don’t know about it yet. So we have heightened awareness. There will be ebbs and flows and peaks and valleys we’re not aware of, which makes it different from influenza. But we’re using what we know about influenza to guide this work.”

    But, she added, it gets “tricky” with COVID-19. Like, while the elderly and those with other chronic health conditions are at the greatest risk to be the most affected by coronavirus, unlike influenza, the virus seems to be impacting children much less. “We’re hearing far more about nursing homes than schools, so that is something different,” Reese said.

    So will coronavirus reach Polk County and Crookston? Reese said she’d be “remiss” to not acknowledge the potential. Minneapolis-St. Paul International Airport is only a few short hours away, “And there are international travelers coming and going through there all day, every day,” she said. “I think I’d have my head in the sand if I said I didn’t think we’d see (coronavirus cases) be diagnosed closer to home.

    Reese keeps going back to trying to maintain a balance between being proactive and not triggering a public panic.

    “It’s really important that we don’t have a big public scare,” she said. “We’ve had calls. People are very anxious. They’re either insisting this is not happening, or that it’s everywhere. Especially people with chronic conditions. They are nervous.”

    She assures those people that plans are being followed and they’re being modified as needed, even moment to moment, if need be. “My approach is that this is what I know on this date and at this particular time,” Reese said. “That information is constantly being evaluated and re-evaluated.”

    Reese says it’s unavoidable that the number of cases of coronavirus are going to rise, likely by a significant factor, as more testing kits are made available to Americans. “If you have the ability to test more, you’re probably going to see more,” she said. “It’s important that people are prepared to see those numbers and react appropriately. That’s what we are ready to do, react appropriately and accordingly to this new, changing landscape.”