The lifting of stay-at-home orders caused by the coronavirus — whenever that happens — won’t signal that things are back to normal, a health expert says.
“The world’s going to look different even after the peak of this epidemic has passed,” said Dr. Garold Minns, an infectious disease specialist who serves as Sedgwick County’s health officer.
“There will probably still be a need for us to observe social distancing. We’ll still need to emphasize hand hygiene. And we will need to be very vigilant in our long-term care facilities, to make sure that they are properly staffed and continue practicing good hygiene. We know it’s a disaster when this (novel coronavirus) gets into a long-term care facility.”
County officials announced in April that a coronavirus cluster had been found at Clearwater Nursing and Rehabilitation Center in Clearwater, with 42 people testing positive and two deaths attributed to it.
They were among 250 confirmed cases and four deaths in Sedgwick County through April 20. About one-third of cases were people 60 and older, and those people were much more likely to become severely ill, Minns said. Butler County reported 12 cases and Harvey County five.
Minns said the area was fortunate to have experienced a lower rate of infection than many other places.
“We’re somewhat optimistic that, if things continue as they are now, we will be able to handle the number of cases at any one time in our hospitals,” he said. “We’re optimistic that we won’t have the huge surge that other cities have had.”
However, he added, “the consequence of avoiding the surge means you’re kind of having a slower progression rather than a sudden burst of cases.”
Minns compared the situation in places where the virus spread quickly to the days before the measles vaccine, when “almost all kids got exposed in elementary school.”
In contrast, the Wichita area will see “a lower level of transmission through the community, but it’s going to last longer” than many people probably expected.
‘Cases through the rest of the year’
“We’ll probably see cases through the rest of the year, if not longer, until we have a vaccine or effective treatment,” Minns said.
Kansas Gov. Laura Kelly extended her original stay-at-home order for the state from April 19 to May 3, superseding a similar county order that would have expired April 23.
When Kelly lifts her order, Minns said, “We hope we can start relaxing some of those restrictions so more people can get back to work. But which ones do we relax first?”
“We all acknowledge that the economic impact of this has not been good on our citizens and communities.”
Minns was hopeful that activities such as in-person church services will also resume, but he said people would likely be discouraged from shaking hands and sitting or standing too close to one another. Officials will need to “provide better care for prisoners and other places where people are congregated together.”
The Sedgwick County Jail, which is the largest in Kansas, reduced its inmate population by several hundred prisoners in response to the coronavirus. A jail deputy tested positive.
One thing hampering the local response was a shortage of test kits for coronavirus in Sedgwick County, meaning everybody who should have been tested was not. Instead, family members and other close contacts of people who tested positive were asked to quarantine themselves. As a state, Kansas had one of the lowest rates of testing in the nation.
“If we had more tests, we could constrain the spread of coronavirus more easily,” Minns said.
The lack of a vaccine or proven treatment for coronavirus also makes predictions difficult. A vaccine is not expected to be developed before 2021. Medical trials of possible treatments are underway, including one that Ascension Via Christi in Wichita will participate in, but so far “we don’t know whether any of that will be effective,” Minns said.
There are also tests being developed to identify people who have immunity to the virus, but so far experts “don’t know how accurate” they are, Minns said. Figuring out who is immune would be a big help in allowing people to return to jobs, he noted.
One final unknown is whether people who’ve recovered from coronavirus develop immunity, as happens with measles.
Get evaluated ‘immediately’
Minns urged older residents to get evaluated “immediately” if they show symptoms of coronavirus, which include fever, tiredness and a dried cough. People close to them “need to be vigilant, keep in contact with them daily.”
“Some colleagues have noted that some patients who are coming to the hospital seem to have put off coming,” Minns said. “Don’t proscratinate.”
Minns said it was “no big surprise” that a local nursing home was discovered to contain a cluster of cases, noting there have been several nursing home clusters across the state. In one instance, 33 cases and four deaths were reported at the Riverbend Post Acute Rehabilitation Center in Kansas City, Kan.
“Some people feel like some of our nursing homes struggle to keep their staffing where it should be,” Minns said. “Obviously, you have people congregated together closely, and people are coming to see them.”
On Medicare.gov, the U.S. government site for Medicare, the 69-bed Clearwater home was rated “much below average” overall and for health inspections, “average” for staffing levels and “below average” for quality measures. In an inspection conducted Oct. 22, the facility was cited for 28 health violations, more than three times the national average.
During a complaint inspection on Jan. 27, one resident told an inspector: “Things are terrible. Staffing is a huge problem. Baths were fine up until a month ago and now they’re given only if you beg for one.”
The facility changed ownership last year, according to Medicare.gov, and managerial and operational control is now held by Willie and Michelle Novotny of Manhattan, Kan., who also run Orchard Gardens nursing home in Wichita and several more in the state. Willie Novotny told the Wichita Eagle that the problems cited in the Clearwater inspections had been fixed and were not related to the coronavirus outbreak.
It was not known if residents of other nursing homes in the area have tested positive for coronavirus. Officials are not releasing where affected individuals lived unless there is a risk to the public. Across the state, 242 cases of coronavirus had been recorded in long-term care facilities, according to a Sedgwick County spokesperson.
One advocate for nursing home patients, Mitzi McFatrich of Kansas Advocates for Better Care, said testing of staff and residents in those facilities should be one of the state’s “highest priorities because of the congregate setting and level of risk, and yet I don’t think we have the infrastructure to make that happen in terms of test kits.”
“Based on what’s happened in other states, I think we’ll continue to see outbreaks in other care facilities,” McFatrich said. “Whether there’s a correlation between facilities that had (health inspection) deficiencies and outbreaks, I don’t know.”