When and how will West Virginia start transitioning to the next phase of coronavirus response?
“The net of the whole thing is just this simple: We have done amazingly well, but this next phase will be very tedious and very difficult,” Gov. Jim Justice said this week.
West Virginia leaders are starting to talk about how the state can move from stay-home orders for everyone to a cautious re-start for some, but officials have not yet provided a full roadmap to the public. It’s likely they’re still assessing.
Clay Marsh, the West Virginia’s coronavirus response coordinator, said during a Wednesday afternoon briefing that the state’s response so far has been like a “blunt object approach,” ordering shutdowns of all but essential businesses and telling citizens to stay home.
“As we come back out again,” Marsh said, “we need to become more like a scalpel than a hammer.”
Marsh has said several times recently that he would not advise a reopening of the state until West Virginia sees a consistent decline in new cases, which would be apparent over a period of at least two weeks.
Justice has said he would like nothing better than to reopen the state for business, school and the enjoyment of citizens.
But Justice has also consistently expressed caution about protecting the health of citizens.
“You’re going to hear more and more and more noise about back to work and getting the engine restarted,” the governor said Wednesday. “I absolutely want us back to work. I want us to go back to our lives and enjoying our lives as best we can.
“But,” he continued, “I would say this first and foremost: My job is to protect you. And until we get into a situation where I feel like you’re safe, I’m going to do my job.”
Justice expressed confidence in his team of experts to guide his decisions.
He acknowledged that striking a balance will be difficult.
“I caution just this: All would be forgotten very quickly if we moved into a stage quicker than we should and then we got into a situation to where we had people dying like flies — and that would be really bad.
“On the other hand, you know if you don’t restart the engine, people are going to die as well from drug overdoses to suicide to whatever it may be. That can be catastrophic on the other side. It’s tough, tough, tough balancing act to know what to do.”
What factors would determine reopening?
The Centers for Disease Control and the Federal Emergency Management Agency have been working on a plan to reopen America, according to reporting today by The Washington Post.
The strategy may wind up going state by state, depending on their circumstances.
The plan envisions three phases:
The first would be a national communication effort and community readiness assessment until May 1 to prepare the nation.
Second, through mid-May, would mean ramping up the manufacturing of testing kits and personal protective equipment while also increasing emergency funding.
After that, some reopenings could start, depending on local conditions.
First priority, according to the CDC response document, is to “reopen community settings where children are cared for, including K-12 schools, daycares, and locally attended summer camps, to allow the workforce to return to work. Other community settings will follow with careful monitoring for increased transmission that exceeds the public health and health care systems.”
Justice has expressed hope for reopening West Virginia’s K-12 school buildings, which have been ordered closed until at least the end of April.
But today he also expressed caution about sending students and teachers back into buildings.
“In regard to our schools, never, no way on this planet would I ever put our students and teachers back into a school setting until I’ve been advised by our experts that we’re good to go,” Justice said.
He later said,” “We don’t go back until it’s safe to go back.”
When can those kinds of decisions be clearer?
The CDC and FEMA document says any reopening should meet four conditions:
- Incidence of infection is “genuinely low.”
- A “well functioning” monitoring system capable of “promptly detecting any increase in incidence” of infection.
- A public health system that is “reacting robustly” to all cases of covid-19 and has surge capacity to react to an increase in cases.
- A health system that has enough inpatient beds and staffing to rapidly scale up and deal with a surge in cases.
Asked today about those standards, Marsh agreed with each of them as a concept West Virginia must measure.
“Those four steps are exactly what we’re talking about,” he said.
What is West Virginia’s current health situation?
A major factor in Justice’s view is West Virginia’s underlying health conditions.
West Virginia’s average age ranks it among the oldest states in the nation. West Virginia’s prevalence of diabetes, heart disease and lung disease leads the nation.
People over age 65 or who have those other chronic health issues are most at risk for severe illness from the coronavirus, according to the Centers for Disease Control and Prevention.
“We’ve got to realize West Virginia is the highest-risk state in the nation,” Justice said earlier this week and repeated many other times these past weeks.
By 5 p.m. Wednesday, West Virginia had 718 confirmed cases of coronavirus. State health experts have acknowledged that the true number of cases is likely much higher because many people aren’t experiencing symptoms or aren’t being diagnosed.
That is out of 17,821 tests.
The number of confirmed cases out of the total number tested provides a figure that state leaders have been watching closely.
That number has been between 3 and 4 percent since the end of March.
The past few days have been on the upper side of that range.
One of the factors was the identification of 66 coronavirus cases at a nursing home in Wayne County this week.
The most sombering statistic is the deaths that have been reported in West Virginia so far.
“You won’t be forgotten,” Justice said today as he acknowledged the state’s 10th death, a 62-year-old man in Marion County. “This is tough stuff.”
Within a few hours after Justice delivered his remarks, West Virginia registered three more deaths.
What is the outlook?
Prominent modeling by the Institute for Health Metrics and Evaluation at the University of Washington continues to update as new data comes in.
That model, which has been cited by state and federal officials, at one point showed West Virginia reaching the virus’s peak effects by early May and the possibility of 500 deaths.
But with subsequent updates, those projected numbers started coming down.
West Virginia officials were pleased at the end of last week to learn the model had updated to project an Easter Sunday peak for West Virginia with 74 coronavirus-related deaths.
Then, this week, the model changed again.
Instead of showing West Virginia past the peak, the model now shows the state approaching the peak effects of coronavirus by the end of this week.
It predicts 70 deaths, but there’s enough uncertainty that a broad range of fatalities is possible — up to 381.
The model assumes social distancing continuing through May.
Can West Virginia’s health system handle the projected coronavirus effects?
One of the main worries of the coronavirus pandemic is that a surge of cases will overwhelm the capacity of hospitals and ICU units, like what happened in Italy and New York.
West Virginia’s healthcare system is fragile, with the closures of two hospitals — in Fairmont and Williamson — during the coronavirus outbreak.
But the IMHE model provides some reassurance for West Virginia.
Of the 3,032 beds available in West Virginia, the model suggests 121 will be needed at peak.
Of the 196 intensive care unit beds available, it anticipates 29 ICU beds will be needed.
And it anticipates 26 ventilators will be needed in West Virginia without specifying how many are actually available.
Again, that model is based on the assumption that West Virginia and other states will practice social distancing through May.
West Virginia’s Department of Health and Human Resources, in a dashboard available on its coronavirus response website, shows that most coronavirus cases have been treated at home but 82 have required treatment in the hospital.
Of those, 46 have been treated in a regular floor unit — not the ICU.
Thirteen have required admission to the intensive care unit.
And another 23 have required treatment on a ventilator in the ICU.
What is West Virginia’s ability to detect an outbreak or resurgence?
National experts and state health leaders have acknowledged any kind of reopening will require an enormous build-up of testing capacity.
At the least, this would involve the testing of people with symptoms — as well as “contact tracing.” That means going back over anyone else who interacted with the patient and could be infected. Those who are sick and those they contacted would be asked to quarantine for 14 days.
“We need to very rapidly figure out those people and their contacts and isolate those people,” Marsh said today.
But some national experts envision much broader testing than that, regularly throughout the population, because so many people can have the coronavirus and spread it without actually displaying symptoms.
Any scenario involves faster and broader testing than West Virginia has managed so far.
“We know as we move forward over the next month ahead, the contact tracing and ability to test widely really are key to what we want to be able to do,” State Health Officer Cathy Slemp said this week.
Social distancing guidelines that have slowed the spread of the virus have bought time to get ready, she said. “It extends times for the testing capacity to grow, the technology to develop.”
Slemp did not yet provide specifics on what the state’s testing capacity is versus what it will need. Much of that depends on federal, as well as state, preparations.
She did acknowledge the need for more personnel to handle the contact tracing. That would involve reaching out to patients and then to those with whom they interacted — and providing guidance about what to do. Experts believe it will take time and trust to accomplish.
Slemp said help is coming from the West Virginia National Guard, and occupational medical students recently completed training to help. Again, there were no numbers provided for the currently available workforce versus an estimate of the number of people needed.
“There’s lots that’s underway and lots that we’ll be thinking about as a country in terms of how do we ramp up these and how do we have the capacity testing-wise and the newer technologies that might bypass some of the barriers we’ve had to date,” Slemp said.
Where does West Virginia stand then?
The state is still assessing and preparing to inch cautiously forward.
State leaders express an overriding philosophy, but they’re still filling in the details of what’s to come.
“Any decision will be informed by the health and safety of West Virginians,” Marsh said today.
Justice acknowledged that the situation is so difficult — with a pandemic that risks citizens’ health intertwined with an economic crisis — that no approach may be perfect.
“I want to be as close to being right as we can possibly be,” Justice said today.
But the governor continues to say he does not want to rush and risk making a bad situation worse.
“Trust me, we’ll get our people back to work very soon because of all the good stuff that’s going on right now,” Justice said this week. “Let’s stay the course so we don’t have a big time setback and then we can’t get them back to work.”