War Rooms, Gloves and Beds: How U.S. Cities are Preparing for Coronavirus

(Bloomberg) -- Major cities around the U.S. didn’t wait for federal health officials to tell them to brace for an outbreak of the coronavirus -- some have been preparing for weeks.

In San Francisco, local officials have declared a state of emergency despite no confirmed cases. In Illinois, they’re checking stockpiles of gloves, gowns and masks. In Dallas, they’ve set up war rooms to monitor the spread of the disease worldwide, designated quarantine beds and assigned medical teams for potential patients.

“We’re as prepared as we can be,” said Dallas County Judge Clay Jenkins, who coordinated the city’s response to an outbreak of the Ebola virus in 2014.

Virus anxiety soared around the country on Tuesday when an official with the Centers for Disease Control and Prevention warned that the agency expects the disease, called Covid-19, to begin spreading among U.S. communities, and that businesses, schools and local governments should prepare for the possibility of major disruptions. On Wednesday, federal authorities said they've identified the first U.S. case with an unknown origin, suggesting a possible wider outbreak.

Earlier in the day, New York Governor Andrew Cuomo attempted to bring a calmer tone at a press conference to announce a $40 million initiative to hire additional staff and obtain extra resources to combat a potential outbreak. Of 27 possible virus cases examined in the state, 26 have come back negative and one test is pending, Cuomo said. And while the state is expecting to eventually see a confirmed case, there’s no reason for “undue fear,” he said.

Reassuring Residents

There have been 15 cases of the virus detected and diagnosed in the U.S., with another 45 among Americans repatriated from infection hotspots in Asia. Several cities are taking pains to assure residents that no one has been confirmed with the virus in their area yet. But concern will spike when independent transmission within communities takes hold, health experts say.

“It is not a matter of if, but a question of when, this will exactly happen,” said Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases.

Indeed, health authorities said late Wednesday they may have detected the U.S.'s first case of community transmission in northern California, in a patient with no known travel to China, or exposure to another case.  No details of the condition of that person, who made the 15th case, were provided.

At least four cities or counties in California have already declared a state of emergency -- mainly as a legal mechanism to authorize crisis planning and funding. Santa Clara County was first to call a local emergency on Feb. 10, after two travelers from China were confirmed with the coronavirus. San Diego followed after two people came down with the disease among 200 repatriated from China and quarantined at the nearby U.S. Marine Corps Air Station Miramar.

San Francisco declared a state of emergency Tuesday, even though it hasn’t identified any local cases yet. The city activated its emergency operations center on January 21 to focus on planning for a potential outbreak, according to a statement from the mayor’s office.  On Wednesday, Orange County declared an emergency despite no new cases since one local man recovered from the virus. Officials there are suing to stop federal and state agencies from implementing a proposal to use a state-owned facility in Costa Mesa as a quarantine site.

Around the country, city emergency officials are getting daily updates in calls with the CDC and coordinating their responses with nearby jurisdictions, including airports and shipping ports, which are seen as the most likely arrival point for the virus.

Harris County, which includes Houston, began monitoring the virus’s spread two months ago and has now moved into “preparedness” mode for a potential local outbreak, said Dr. Umair Shah, executive director for the Harris County Public Health department.

Unanswered Questions

It’s a monumental task, with the county’s 4.7 million people spread out over an area the size of Rhode Island. Shah is especially concerned about the large number of uninsured people in Texas -- 20% of Harris County, alone -- if the virus were to take hold. Questions they’re trying to answer include, “Where are people going to get their care? How are they going to get their care? How is it going to be paid for?”

Staffing is a rising problem in a number of cities. In Los Angeles, whose airport is one of the main sites for screening travelers from virus-stricken regions of the world, the county public health department is reassigning nurses and increasing overtime to handle outreach to more than 3,000 travelers under CDC guidelines, said Director Barbara Ferrer. She’s considering expanding their monitoring program to hand out information to travelers from newly hit areas, such as Italy, telling them how to self-monitor and when to seek help.

The agency is urging public venues to plan for possible postponement of big events if the area turns into a virus hotspot.

Another major worry is making sure local hospitals across the country know they need to build up enough supplies and safety gear to handle a major surge in patients -- an issue Shah intends to raise in a trip to Washington this week.

“Every hospital in our community should have the ability to isolate,” the doctor said. “They should be able to handle a novel Coronavirus confirmed case in their facility.”

In New York, Mayor Bill De Blasio reassured residents that while he sees arrival of the virus as “inevitable” in the city, officials are prepared, “so there's not a single reason for panic.”

New York’s hospitals have designated 1,200 beds for the treatment of virus patients, De Blasio said. And while they’ve obtained 1.5 million protective masks for healthcare workers, 300,000 more are needed.  Federal officials could help by ordering manufacturers to step up mask production, and by doing more to enable local testing for the virus, the mayor said at a press conference.

“I would argue it is a matter of them being a little more creative, a little more flexible and to help us do the most we can do,” he said.

In north Texas, Tarrant County officials established a war room in a downtown Fort Worth building a month ago. Dubbed “the Bridge,” it’s a place for officials and experts to gather for daily conference calls with federal, state and local health officials, and to hash out local actions to take.

“That’s what you do in an emergency operation, you plan as best you can,” said Richard Hill, a spokesman for the Tarrant County Public Health Department.

In neighboring Dallas, which was the U.S. epicenter of the 2014 Ebola outbreak, Judge Jenkins has been through this drill before. A 45-year-old-man visiting from Liberia died from the Ebola virus in a Dallas hospital after infecting two nurses who were caring for him.

The city learned a lot from that experience, so local officials are especially aware of the potential impact of a pandemic. Even so, “Every outbreak is different,” Jenkins cautioned.

No ‘Sugarcoating’

There are no cases in north Texas yet, he stressed. But emergency workers have spent recent weeks carefully mapping out procedures for everything from testing and isolating sick people, to communicating with the public -– a high-wire act requiring keeping the community informed without causing panic.

If a case is confirmed, that will be announced, and the public will be told where that person has been and who might have had contact with them, Jenkins said. What officials won’t be sharing: Every time a person gets tested for the virus, or the location and identity of quarantine facilities and medical staff.

“We won’t sugarcoat things, but we don’t want you to be unnecessarily alarmed,” he said.

Those suspected of the virus but not in need of immediate medical care will probably be asked to self-isolate in their homes until test results are back, Jenkins said. Health workers will monitor the person daily, and others in the home will be educated about how to stay safe. The address will be entered into a quarantine database for first responders, so if fire, police or an ambulance are called to the location, they’re aware of the situation, he said.

In Illinois, which became the first state this month to provide testing for Covid-19 at state labs, officials are assessing hospitals to determine capacity, and checking availability of gloves, gowns and masks for health care workers, according to a statement. The state’s health department is working on increasing testing capacity for quick results while coordinating with federal and local governments.

Chicago Mayor Lori Lightfoot expressed frustration that CDC and Trump administration officials were unnecessarily alarming people. “I want to make sure that people understand they should continue to go about their normal lives,” Lightfoot said, noting that the Chicago area has had two confirmed cases. “We have extremely well-thought out, well planned responses in the event that the virus appears again in anyone else in Chicago.”

Wash. Your. Hands.

Much of the public outreach cities are doing now is focused on preventing the spread of the disease. Chicago is screening travelers at O’Hare International Airport for signs of illness, and tracking suspected cases in the community, according to a statement. In the two confirmed cases, both people have already recovered and infected no one else, the city said.

Atlanta’s Mayor Keisha Lance Bottoms said the city is advising area residents on basic precautions they can take: wash their hands, cover their coughs or sneezes and avoid touching their faces.

While there are no confirmed cases in Georgia, “we are following CDC as well as state recommendations and guidelines,” Bottoms said in a statement. That includes telling families to be sure to have a supply of essential medications and to make child-care plans in case anyone in the household gets sick. “We are also encouraging private employers to review and update, if necessary, work continuity plans,” the mayor said.

Economic Impact

In a country on tenterhooks awaiting what’s been called the inevitable spread of a potentially deadly virus, some people are taking on a personal mission to increase awareness.

Christopher Muller, a professor at the Boston University School of Hospitality, is teaching his students about the devastating financial impact of the coronavirus on the cruise ship, airline and hotel industries. And he’s also imparting some pointed advice:

“I tell students, if they don’t feel well, don’t come to class. Send me an email, and I will thank them for not coming to class,” Muller said in an interview with Bloomberg Radio. “Second is, make sure you don’t sneeze in public, try to stay three to five feet away from people if you can. Wash your hands often and, if you can’t wash with hot soapy water, use a 60-percent alcohol base.”

--With assistance from Keshia Clukey, Tom Moroney, Matt Day, Kristen V Brown, Shruti Singh, Elise Young, Henry Goldman, Michelle Cortez and Christopher Palmeri.

To contact the editor responsible for this story: Flynn McRoberts at fmcroberts1@bloomberg.net, Timothy Annett

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