Unified Command Chief explains how COVID-19 differs from other viruses

Lake County’s COVID-19 Unified Command Ops Chief Greg Gould has seen a lot of viruses in his 31 years of public health emergency management. He was in the fight against the Hantavirus, SARS, MERS, and Ebola pandemics, and now teaches Public Health Emergency Preparedness at Salish Kootenai College. But as dangerous as those viruses are, he says they have been able to be contained with effective application of epidemiology practices such as testing, quarantine, and health care.

The novel coronavirus, COVID-19, is different, Gould says. Though it is part of the infuenza “family”, it acts differently than we have learned to expect of other flu viruses, and its spread is unprecedented. Indeed, Dr. Anthony Fauci, Director of National Institute of Allergy and Infectious Diseases, testified to congress this week that the U.S. may soon see as many as 100,000 new confirmed cases per day. The U.S. Centers for Disease Control expect at least half of all Americans will catch the virus. The number of Lake County cases is currently increasing rapidly, with Lake County Public Health reporting at least 57 active cases as of Monday, July 14, with evidence of communal spread rather than from identifiable outside sources.

One particularly strange and troublesome feature of this disease is the high asymptomatic rate, says Gould. At least 40% of people infected with the virus never show any symptoms of being sick at all. This allows them to mingle in their communities, “spreading and shedding” the virus without ever knowing it or removing themselves from public life due to illness. As an example, Bighorn County went from nine cases to 72 as the result of one visitor from out of the area who did not know they were infected. Recent research shows potential damage to lungs and other organs even in many who never experienced symptoms.

Another “game changer,” Gould says, is the long incubation period. With typical flu viruses, a person starts to feel ill within two or three days of exposure. With COVID-19, your body is “cooking” it for up to two weeks before you feel symptoms, and you are able to infect many more people in that time.

“Typically, an aggressive virus would not sit dormant for two weeks, nor have such a high asymptomatic rate,” says Gould. “These two things make this a real head-scratcher for everybody.”

This virus is also extraordinary for its mortality rate. Gould accesses Montana and U.S. data through the montana.maps.arcgis.com website, using the data to calculate a current overall U.S. death rate of 5% of known infections. The death rate is 20% among the elderly and those with compromised immunity and other aggravating factors. In Montana, we have lost 2% of those known to be infected to date. Death rates vary based on the quality of health care available to patients throughout the world, with some rates higher than the U.S., and others lower.

Gould says the pace of medical research efforts to understand the virus’ behavior and search for treatments and vaccines is like never before. These efforts are finding even more disconcerting news. Tests show antibodies developed through exposure can decline over time, so a person can be re-infected within a few months after having the disease. Also, the long-term effects of the disease can be significant even among young survivors, including blood clots that cause stroke, and damage to the heart, lungs, and nervous system.

“You’ll hear people say it’s ‘just a flu,’” Gould says. “That’s not accurate. This is a doozy.”

Though this virus is different in many ways, the strategies and science of managing the pandemic are the same. Wearing masks, maintaining social distance, hand-washing, quarantining of infected individuals, and avoiding large gatherings where people are close together are all part of the entire spectrum of measures to protect people from infection and slow its spread, Gould says.

“It is always a balance between prevention measures and economics,” Gould says. Montana’s response was “early and aggressive,” and was effective at bringing our daily cases to zero. Montana recently joined other states in removing restrictions and allowing businesses to re-open.

Unfortunately, the virus does not respect the balance between economics and prevention — as restrictions have lifted, the disease has come roaring back. Montana’s daily numbers of infections surpassed the March 26 peak in late June, and are growing exponentially, with 936 active cases reported statewide for July 13. Nationally, there could be as many as a quarter million fatalities by the end of 2020, according to Dr. Irwin Redlener, Director of the National Center for Disaster Preparedness.

Lake County and CSKT have a robust health care system, and tests are available to anyone at local health care providers. Call ahead to arrange for testing. St. Luke’s reports, “Our Convenient Care and Emergency Department staff have been working incredibly hard – performing up to 100 tests per day.”