Concerns about the COVID-19 novel coronavirus spiked in New England this week after an employee at Dartmouth-Hitchcock Medical Center in New Hampshire who was suspected of having the virus ignored recommendations and attended a party rather than self-quarantining at home.
The employee and a person with whom he came in contact at the party have since both tested positive for coronavirus.
On Friday, officials from Dartmouth-Hitchcock Health sought to reassure the public that, so far, the virus has been contained and is under control.
However, over the weekend, the New Hampshire Department of Health and Human Services confirmed a third case in Grafton County, where Dartmouth-Hitchcock is located, due to direct contact with one of the other infected individuals. This person is not an employee, Dartmouth-Hitchcock said. There is also a fourth case in Rockingham County in the state, of an individual who recently returned from Italy, according to the Union Leader.
According to a report in The New York Times, the first case was of a hospital employee who had recently flown back to New Hampshire from Italy. The employee had reportedly been directed to self-quarantine and did not comply, instead attending an event with Dartmouth students, during which time another person was exposed to the virus.
"We understand this causes great concern," said Dartmouth-Hitchcock Health President and CEO Dr. Joanne Conroy on Friday, "and this concern is shared both inside and outside the organization."
Based on New Hampshire state law, Conroy was unable to provide further details on the employee, the exposed party or whether more people may have been infected. The state, she said, will release those details when it deems it appropriate.
"The most important point to understand is we followed all appropriate procedures, and we are confident no patients were put at risk," said Conroy. "Efforts have been taken to contain the situation. … We have anticipated this situation. It is evolving the way we have planned and prepared for."
Dr. Edward Merrens, the health system's Chief Clinical Officer, said Dartmouth-Hitchcock has tested people who were potentially put at risk. To date, they have not identified any new cases of COVID-19.
"We feel we have all the right mechanisms in place for care and coordination," Merrens said.
In response to the ongoing situation, the state set up a testing site at the airport to screen those who may have been traveling to areas in which the virus is present.
As the coronavirus has spread throughout the globe, concerns have been raised about supply-chain disruptions, largely because a lot of medical equipment and components are sourced from China.
"We have adequate supplies at Dartmouth-Hitchcock, but the supply chain cycle is not what it used to be," said Merrens. "A lot of ingredients and parts we use are made in China. The shipping and the timeline may be disrupted. We are actively looking at our supplies. We're OK right now, but we also want to make sure those at our network of hospitals are as well."
WHAT'S THE IMPACT?
On Thursday, Merrens joined Antonia Altomare, Dartmouth-Hitchcock's epidemiologist and head of infectious disease and international health, in an online video to clarify questions and concerns surrounding the coronavirus.
Notably, the health system formalized its definition of what constitutes "close contact."
"We have been able to work closely with our health department and come up with a definition, and this definition is actually being formalized by the Centers for Disease Control and Prevention," said Altomare. "When we say our first infected person had 'close contact,' the people we're talking about were within six feet of that person, either the day prior to when symptoms started or when they were symptomatic. We consider that close contact, and someone at risk for infection."
Altomare added that facemasks are not adequate protection against COVID-19.
Merrens also clarified the differences between quarantine and isolation. Isolation, he said, means remaining in the home apart from all other individuals, and is reserved for those who have been diagnosed. Quarantines occur when someone has had contact with a symptomatic person, but they themselves are not yet symptomatic, and in New Hampshire that's typically handled at the state level. Quarantines usually last 14 days because that's the timeframe in which symptoms are likely to occur.
On Friday, Merrens said the CDC has a limited number of testing kits; New Hampshire was only allotted 60, and Dartmouth-Hitchcock coordinates with the state before administering a test. The Food and Drug Administration has given the green light for hospitals to work on their own testing, which Dartmouth-Hitchcock is currently doing.
Merrens said the test only works on people who are symptomatic. Every test the health system orders is administered to someone who had exposure to a known case, or had been in a country in which there's a significant coronavirus presence, such as China, Japan, South Korea and Italy.
THE LARGER TREND
At the federal level, the House and Senate recently came to a deal on an $8.3 billion spending package to combat the coronavirus. The Department of Health and Human Services has also released its own emergency measures.
Through the CDC, HHS is awarding an initial $25 million in a cooperative agreement to states and local jurisdictions that have carried the brunt of response and preparedness activities. The funds are for immediate assistance for activities such as monitoring of travelers, data management, lab equipment, supplies, staffing, shipping, infection control and surge staffing.