Kansas health authorities, fearful they might have encountered one of the nation’s first coronavirus cases, in January quietly prepared a 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 student 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 person 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.

The incident 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.

Officials in Kansas and Missouri claim they are prepared if the virus hits locally. But they concede they have concerns:

▪ Not knowing the scope of an outbreak, will hospitals have enough supplies to keep patients and workers safe?

▪ Instead of having to wait days for results, as they do now, will the states gain access to testing kits that deliver accurate results quicker?

▪ Will schools 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, 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 an outbreak — 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 in both states 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 Missouri and Kansas.

As the number of confirmed cases in the U.S. surpassed 60 over the weekend, a patient in Washington state was the first in the U.S. to die from the virus. President Donald Trump on Saturday said the patient was “medically high-risk.”

Most of the cases could be explained by overseas travel or contact with someone who had been ill. This past week, though, four new cases, in California, Oregon and Washington, were the first in the U.S. where the cause was mysterious and unknown.

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 sign 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.

One CDC official 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.

Following that, county health departments in the metro urged residents to make plans.

“Although we don’t have any confirmed COVID-19 cases in the metro, we encourage families, faith communities, businesses and schools to start the discussion about how they would prepare for widespread illness and disruption to daily life,” health officials said in a joint statement.

“This is a serious situation that is evolving,” said Ginny Boos, director of infection prevention at Saint Luke’s Health System. “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.

Will there be enough masks?

Hospitals across Missouri are running drills to make sure staffs are up to speed on procedures for handling patients with infectious diseases.

The Missouri Hospital Association has asked members to review their infectious disease procedures, which involve everyone from the admissions people at the front door to the engineers who keep the buildings, including negative air flow rooms used to quarantine patients, running.

“There are elements of this that we do everyday,” said David Dillon, spokesman for the group in Jefferson City. “We don’t always see it with the potential for this scope, so you have to think a little bit differently.”

What hospitals do not know for certain is whether they will have enough supplies for a large-scale outbreak. Some sound more confident than others.

The Missouri hospital group has asked members to examine supplies of anything from masks to protective gear.

Most hospitals in Missouri, Dillon said, “have a fairly robust supply” of the protective gear needed not only for patients who might be infected, but for hospital staff who care for them.

At Saint Luke’s, “the suppliers we’re using right now are able to meet our needs,” said Boos. “We are in the midst of an influenza season, and every year we know that we’re going to need additional supplies.

“So right now we know that our supply chain has secured in our warehouse … more than a 45-day supply. And we have a weekly call set up with various suppliers in our distribution chain to stay on top of that. Right now, things are fine.”

Adrienne Byrne, director of the Sedgwick County Health Department, said she is hearing that there is a shortage of some gear. But 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.”

A case study in Lawrence

Kansas’ 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.

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

“Who else might be exposed? Who else might need to be reached out to?” the county department’s director, Dan Partridge, said.

As word got out, state health officials revealed the situation on Tuesday in a lengthy statement. Behind the scenes, they 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.

Health care providers discussed whether they had the supplies and staff to handle a surge of cases. At the same time, the health department mapped out how it would reach those who might have 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, so an infection could have 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 game changer right there.”

Officials were able to trace back the student’s movements and compile a list of 403 potential contacts quickly, in part because of the time he spent in class.

If the patient had tested positive, the people on the list would have received texts asking them to report any symptoms.

“Push ‘1’ if you’re symptom free. Push ‘2’ 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 county health department weighed how voluntary isolation would work. KU officials did not return a request for comment.

Public universities in Kansas have talked to state and local health departments about finding housing for students who get the virus, said Matt Keith, a spokesman for the Kansas Board of Regents, which governs the institutions.

On Saturday, Feb 1., state health officials 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, Norman said. 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 day-to-day activities.

Testing required shipping a sample to a CDC lab.

“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, Missouri and most other states can’t 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 in February, 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.

‘This is what we do’

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.

In Kansas City, health and emergency management officials are monitoring developments and reviewing the city’s emergency operations plan, already in place, city spokesman Chris Hernandez said in an email.

The fire department is using a set of questions, a procedure created during the Ebola scare, to screen people who call dispatch, he said.

“Asking these questions enables dispatchers to notify EMS crews when someone could potentially be infected, so that they can determine the appropriate level of personal protective equipment. Keep in mind that this is the same precaution taken when EMS crew encounters any other similar situation,” Hernandez said.

In late January, Williams of Missouri’s health department set up a team of infectious disease specialists, epidemiologists and other health experts who have met every day at noon to talk about the state’s plan for a possible outbreak.

Williams and Norman were in Washington along with other health officials from across the country, who met with acting White House chief of staff Mick Mulvaney, CDC officials and others.

“This is what we do in public health, whether it’s Zika or legionellosis (Legionnaire’s disease) or the flu, or in the past SARS or MERS,” said Williams. “We have the ability to prepare for emerging diseases in public health.”

Schools on watch

Kansas City Public Schools officials said the district is meeting with building leaders and nursing staff to discuss protocols for handling any outbreaks.

Kelly Wachel, district spokeswoman, said the district would have a plan and communications in the next few days but for now does not want to cause fear, a concern shared by many. (One Kansas City hospital doesn’t like using the word “quarantine” because of its negative connotation.)

KCPS will also be working with the CDC and the local health department. “They will be our guide,” Wachel said.

Officials at the University of Missouri in Columbia have been talking for weeks about how the virus affects students and faculty traveling abroad.

Like other colleges in the area, they already have a travel ban for China and are monitoring developments in other parts of the world where students and faculty have or are planning to travel, said spokesman Christian Basi.

As for local protocols, Basi said they met Wednesday to discuss procedures should an outbreak occur.

Officials at Missouri State are also meeting to draw up a “comprehensive plan, but we don’t have a completed plan at the moment,” Andrea Mostyn, communications director, said on Wednesday.

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 reportedly started stockpiling food and other supplies.

“Infectious disease is (something) that just intrinsically creases fear, and we know that. We know that from our experience, whether it’s Legionnaire’s disease or Zika or H1N1 flu,” said Williams.

“We believe the most important thing to do is be as transparent as we can and share with people what we know.”

COVID-19 is one of seven coronaviruses. The common cold is another. But COVID-19 is different because it has “about a 2 percent mortality rate that appears to have a predilection for older people and people who have chronic health conditions, and not so much children or pregnant women, like the flu would,” he said.

“The second fact is that at least 80 percent, if not more, of the cases are mild. Many of the cases, like other corona cold viruses, are benign. You get a cold.”

From day one, health officials have preached that the best line of defense 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.

Includes reporting by The Star’s Mará Rose Williams and The Eagle’s Chance Swaim.