Kansas prepares coronavirus response amid worries over hospital supplies, test kits

Kansas health authorities, fearful they had potentially encountered one of the nation’s first coronavirus cases, in January quietly prepared a mass outreach campaign to warn more than 400 people who could have been exposed.

“We had a phone bank. We were ready to go,” said Lee Norman, the state’s top health officer.

A person who had recently traveled from Wuhan, China, the epicenter of the coronavirus outbreak, had turned up at a Lawrence hospital with symptoms of a respiratory illness.

Health officials decided to test him and began laying the groundwork for a worst-case scenario. They reconstructed his movements and quickly developed a list of hundreds of potential contacts. They readied the messages to be shared if he had the virus.

And then they waited.

“It did make us nervous just because it was five days into it before the test result came back,” said Norman, the leader of the Kansas Department of Health and Environment.

The student tested negative, and the calls were never made. But the episode served as a practice run, revealing the ways the virus could test the state’s health care system and how even a single case could touch the lives of hundreds of people.

What happened in Lawrence illustrates the complexity local health officials and their communities face as they prepare now for a global public health emergency that is a constantly moving target. No one can predict if Wichita, Kansas City or other cities and towns in the region will be hit. But if it does, there are already concerns:

▪ How big will an outbreak be and will local hospitals have enough supplies to keep both patients and workers safe?

▪ Will states have access to testing kits that deliver accurate results quickly, not in days.

▪ Will schools and universities have time to create infectious disease protocols they didn’t have before?

And what to do about a general public that seems more panicked every day.

The Centers for Disease Control and Prevention this past week described the coronavirus — called COVID-19 — as “a serious public health threat.” Like their counterparts around the world, local and state health departments in Kansas, hospitals, schools, first responders and scores of others are working with one another and the CDC — to prepare should the virus hit.

Ultimately, the burden of responding to infectious disease outbreaks — including tracing back who could be infected — falls to local and state health authorities, said Dennis Kriesel, director of the Kansas Association of Local Health Departments.

“I think some people get the impression that the CDC will come in, and the CDC is not equipped for that,” he said. “It looks good in the movie ‘Outbreak,’ but by and large that is a state and local responsibility.”

Health officials are reviewing lessons they learned while preparing for other recent outbreaks — including the 2009 H1N1 (swine flu) global pandemic — and say they are prepared to handle this new virus.

For now, local health officials say the virus is a low risk for Kansas.

On Thursday, the Department of Health and Human Services reported 60 confirmed cases of the coronavirus in the U.S., including the latest one in Northern California. A man in Washington state was the first in the U.S. to die of the virus, officials said Saturday.

In the Kansas City area this past week, health officials in Clay County announced they are monitoring three people who, based on recent travels, are at “medium risk,” according to CDC guidelines. The three have “self-isolated” at home, and county health officials are tracking their temperatures — fever is a symptom of the virus — and other symptoms for 14 days.

None of the three show signs they are sick, said Kelsey Neth, spokeswoman for Clay County’s health department. She said health officials are not testing anyone else for the virus.

One CDC official this past week warned Americans that “disruption to everyday life might be severe” should an outbreak happen, raising the specter of school closings, cancellation of large public gatherings and workplaces affected by sick employees.

“This is a serious situation that is evolving,” said Ginny Boos, director of infection prevention at Saint Luke’s Health System in Kansas City. “None of us make good decisions when we’re in a panic mode. So we need to think about what we know and where the gaps are, and I think being informed is probably” the best thing to do.

Lawrence test case

Kansas’s encounter with a potential coronavirus case began on Monday, Jan. 27, when a student who had come from Wuhan, China, in the past two weeks came to LMH Health (formerly Lawrence Memorial Hospital). The hospital placed the patient in isolation and alerted health officials, setting into motion a multifaceted response.

KDHE notified the Lawrence-Douglas County Health Department that evening the hospital had a possible case. The next morning, officials from the health department interviewed the patient.

“Who else might be exposed? Who else might need to be reached out to,” Dan Partridge, the department director, said of the purpose of the interview.

As word began to circulate in Lawrence of a potential case, the Kansas Department of Health and Environment publicly revealed the situation on Tuesday in a lengthy statement. Behind the scenes, KDHE began to coordinate their response with other agencies.

A conference call was held Wednesday to put together an initial “game plan,” Partridge said.

“You start working through that scenario of if it’s positive, what needs to happen,” he said.

Healthcare providers discussed whether they had the supplies and staff they would need to handle a surge of cases. At the same time, the health department mapped out how it would reach those who had potentially been exposed.

The University of Kansas was also looped into discussions. Thousands of students live and study on its Lawrence campus, sometimes in close quarters, creating conditions that could allow an infection to spread rapidly.

“If somebody’s a gamer that sits at home playing video games all day and then goes out and grabs a burger, that’s a short contact list,” Norman said. “If somebody goes into a lecture hall of 160 other students, has a car and goes to a sporting event or something, that’s a gamechanger right there.”

Because the individual was a student, officials knew there were a lot of potential contacts, Norman said. Still, officials were able to trace back his movements and compile a list of 403 potential contacts quickly, in part because of the time he spent in classrooms.

If the patient had tested positive, the hundreds of potential contacts would have received texts asking them to report any symptoms.

“Push one if you’re symptom free. Push two if you have symptoms,” Partridge said, describing the text.

Anyone with symptoms would have received a phone call with further instructions that would have likely included isolation. The others would have been asked again each day for at least two weeks.

Norman said the university as well as the Lawrence-Douglas County Health Department weighed how voluntary isolation would work. KU officials did not return a request for comment.

Public universities in Kansas have held discussions with KDHE and local health departments around identifying housing for students if they contract the virus, said Matt Keith, a spokesman for the Kansas Board of Regents, which governs the institutions.

On Saturday, Feb 1., KDHE announced the student had tested negative for the virus and had been released from the hospital.

Testing concerns

The one “vulnerability” exposed by the episode in Lawrence was the time coronavirus testing takes, according to Norman. He said that if testing hadn’t taken five days, the episode “would have been not even a speed bump” in terms of the health department’s KDHE’s day-to-day activities.

Testing the student for the virus required shipping a sample to a CDC lab., a process that takes days.

“The thing that we sat and did a lot of toe tapping and waiting for was the turnaround from the CDC in terms of the test,” Norman said. “And that still remains as a problem.”

Kansas and many other states don’t have the ability to test for coronavirus and must rely on the CDC. Norman, who was in Washington this past week, said he came away from a meeting with a CDC official without much reassurance that the agency can do more to push test kits out to states.

Randall Williams, director of Missouri’s Department of Health and Senior Services, said officials in Missouri had hoped to get test kits last week, but now it’s unclear when that will happen.

“The test isn’t technically where it needs to be. And you can imagine, in a public health campaign that involves surveillance and identification, they’re really important,” said Williams.

Norman said he is hopeful local testing will be available in a matter of weeks.

“As far as I’m concerned, that’s the next big hurdle is getting the ability to do testing locally for rapid turnaround,” Norman said.

‘Up to speed’

Until recently, the CDC’s emphasis has been global. Now the agency has shifted its focus to local communities to make sure they are prepared.

Norman, the Kansas state health officer, said he feels good about the communication KDHE has already had with other agencies.

“We had thousands of people on various webinars and telephone calls with the KDHE hosting and I think that we very quickly got up to speed on the issues at hand regarding coronavirus,” Norman said.

Wichita and Sedgwick County would work closely together and coordinate responses in the case of an emergency, according to Wichita Fire Department Division Chief Darrel Kohls. The city’s response would rely heavily on firefighters, the county health department, and the state.

Kohls said in a statement that the health department provides continuous surveillance of diseases that may pose a risk.

“The Health Department works with local and state partners to monitor any threats, including COVID-19, the strain of coronavirus disease-causing alarm throughout the world,” he said.

The Wichita City Council in September adopted the Kansas Homeland Security Mitigation Plan, which details how authorities would respond to outbreaks, including procedures for quarantines.

Byrne, the health department director, said the agency has for years had a regular conference call with schools, hospitals and emergency responders. The last two calls have been focused on coronavirus, she said.

At this point, because of past preparations, “hospitals are ready to isolate and to deal with anything that should arise,” Byrne said.

Wesley Medical Center in Wichita, a member of the Hospital Corporation of America network, has been bracing for a coronavirus outbreak for the last month - “when we first, just like the public, began hearing about a coronavirus spreading outside of China,” Chief Medical Officer Lowell Ebersole said.

“The concern is that this could cause a pandemic, and we definitely want to be prepared for that,” Ebersole said.

At the direction of the CDC, Ebersole said, Wesley began three weeks ago screening for all patients who had been to China. So far, no coronavirus has been detected in Wichita.

Wesley has put together a sort of rapid-response group of its infection prevention specialists and emergency preparedness team, Ebersole said.

There’s no vaccine for coronavirus and the likely response from hospitals like Wesley would be to quarantine patients with suspected coronavirus. A case is only confirmed after it’s sent off to the CDC for testing. The turnaround time on a test could be up to 10 days, Ebersole said.

“If we were to get into a situation where we have multiple cases that would present here, for Wesley that team is in place. And that is literally just a turn of a switch to get that stood up and then have access to all the resources that both people as well as supplies that we need to respond to a potential pandemic of that type,” Ebersole said.

Ebersole said Wesley has off-campus treatment sites that could be used to help contain the virus.

Are there enough supplies?

While local health officials are confident they have enough medical supplies for the moment, there is less certainty about what would happen in a large-scale outbreak.

Ebersole said Wesley is “very confident” in the amount of supplies it has available.

“We’re very confident about that, that we can protect our patients as well as our staff that are caring for these patients,” Ebersole said.

But Adrienne Byrne, director of the Sedgwick County Health Department, said she is hearing that there is a shortage of some gear. She emphasized that if they run out locally, her department can reach out to state authorities.

“Once something like this happens, everyone’s running out to buy it,” Byrne said.

Kriesel of the Kansas Association of Local Health Departments said some departments are ordering supplies, such as gloves and hand sanitizer. They’re also conducting inventory of their personal protective gear.

He said he was told by one department administrator that masks already appear scarce on the market.

“One of the things that ironically has come out of this is that many of the surgical supplies,” including masks, gloves and surgical gowns are manufactured in Wuhan, China, said Lowell Ebersole, chief medical officer of Wichita’s Wesley Medical Center.

“That has created some significant concern in the health care world as well as a bit for the general public.”

Panic setting in

As they make plans for taking care of the medical needs of sick people, health officials are also concerned about panic. Some people are reportedly started stockpiling food and other supplies.

Officials have a simple response to those who are worried.

“We’ve already given you that message: Monitor your symptoms, talk to your physicians, talk about your travel history,” said Partridge, the director of the Lawrence-Douglas County Health Department.

Several health officials have emphasized that the flu kills thousands of people each year even though it often receives less attention.

“Coronavirus is a serious disease. So is influenza,” Partridge said.

From day one, health officials have preached that the best line of defense against the coronavirus is the same as for fending off the flu: wash your hands; keep your hands away from your mouth, nose and eyes; and stay home if you’re sick.

And right now, when news about the virus is changing nearly every hour, the best information comes straight from the CDC, local health officials say.

That website is cdc.gov.

This story was originally published February 28, 2020 at 4:55 AM with the headline "Kansas prepares coronavirus response amid worries over hospital supplies, test kits."