Coronavirus reaches Delaware

In the wake of four coronavirus COVID-19 cases announced in Delaware, officials are telling residents to practice social distancing and good hygiene in order to prevent the spread of the virus.

Social distancing – staying away from crowds or at least six feet away from people – has caught on as organizations and groups have canceled or rescheduled events across the state. One of the biggest cancellations was the DIAA state basketball tournament games that had been scheduled to play at the University of Delaware's Bob Carpenter Center. The Cape High girls' basketball team was slated to play in the semifinal round in Newark, but the university closed the center for championship games March 10 because of COVID-19 concerns. The Delaware General Assembly has postponed its return from break from March 17 to March 24 because of the virus. The World Health Organization labeled COVID-19 a pandemic on March 11, and on March 12, Gov. John Carney declared a state of emergency for Delaware.

In Lewes with its abundant population of older residents, the city's board of health met March 11 to talk about whether to cancel upcoming meetings where 200 or more people are expected. “We do have a population in the high 60s, so we have a large vulnerable population here, and we don't want to put people at risk,” said City Manager Ann Marie Townshend. The board discussed recommendations that include discouraging large groups from meeting and also discouraging sick people from attending events. They also talked about allowing liberal sick leave and vacation time for Lewes employees who get sick or have sick relatives.

In a town hall meeting March 11, Carney said the state is offering time for employees so they don't have to use their mandatory sick time. “They might not be sick enough not to come to work, but we don't want them to come to work because they might infect someone else in the workplace,” he said.

The Lewes board will meet again at 1 p.m., Wednesday, March 25.

Other municipalities are working on plans and making changes in light of a potential outbreak.

Dewey Beach Town Manager Scott Koenig said the Sussex County Association of Towns forwarded precautionary information from the state's Division of Public Health to supervisors so they can post it in work areas.

As of March 11, the commissioners meeting scheduled for Saturday, March 14, is still on, but Koenig said a town committee cancelled a meeting it planned to hold later this month.

“If an employee tested positive or was definitively exposed to the virus, we would obviously consult with healthcare and state officials for guidance on how to address coworkers,” Koenig said.

In Rehoboth Beach, one of the first actions taken was the postponement of a community expo related to the 2020 Comprehensive Development Plan scheduled for Saturday, March 21. The second action taken was to cancel events at the Rehoboth Beach Convention Center through April 30. 

Additionally, the staff is working closely with local partners to prepare and respond as necessary, said city spokesperson Krys Johnson. The city is encouraging community members to protect themselves as they would do during any cold and flu season, she said.

Johnson said all city divisions, managers, and associated agencies conduct aggressive preventative disinfection of all public facilities immediately and routinely. She said all employees have been asked to stay home when sick, avoid contact with people who may be sick and wash their hands often.

Johnson said division managers have been asked to follow the recommended guidelines from the Centers for Disease Control and Prevention. Soap and hand sanitizer are being provided at all high-touch surfaces and communal areas in city facilities, she said.

Milton Mayor Ted Kanakos said the town has been in communication with the state DPH for the latest information on the virus and will react accordingly. Town Manager Kristy Rogers said as the town gets updates from the state, they will be posted to the town website. Milton has not canceled any government meetings.

“That’s the most we can do for now,” Kanakos said.

Kanakos said the town has an emergency management program in place if COVID-19 cases begin popping up.

While Milton does not have the same volume of businesses as other Cape Region towns, area business owners are taking precautions.

In an email newsletter, Milton Theatre officials say performances will go on until further notice.

“These are challenging times, to be sure. But these times are collectively ours. If you need a piece of theatre to raise your hopes, lift your spirits and lighten your heart, or you just need a temporary distraction across all of this uncertainty, we’re here,” theater officials wrote.

To prepare, the theater has enhanced its cleaning procedures and will add sanitizer dispensers in the lobby and bar area.

Marie Mayor, co-owner of Lavender Fields on Cool Spring Road, said while the lavender farm will remain open, meetings and parties held indoors will be rescheduled. She said the gift shop, a more tightly confined space that sells hand sanitizers and soaps, will only be taking orders ahead of time, either by phone or by the farm’s website.

Mayor, who also serves as president of the board of the Milton Historical Society, said the Lydia Cannon Museum is planning to remain open until April. She said closing then is not due to coronavirus, but for the museum to remove the Walking Into Greatness: Bryan Stevenson exhibit, which will become a traveling display, and install a new exhibit.

Sussex County officials have not yet canceled any county council, planning and zoning commission or board of adjustment meetings. “There is no discussion, to my knowledge presently, as to postponing public meetings,” said Chip Guy, Sussex County communications director, adding he's not aware of any county-sponsored large events in the near future. Guy said if someone has concerns about being in a public space with others, the county provides livestreams at sussexcountyde.gov for the public to watch county council, planning and zoning, and board of adjustment meetings. Sussex County emergency planners and first-responders are continuing to monitor the situation and remain in close contact with state and federal partners, he said.

Delaware's first cases

On March 11, Delaware announced its first case of COVID-19 after a week of testing in which 41 have been tested. A New Castle County man over the age of 50, who is a faculty member at the University of Delaware, contracted the virus from a confirmed case in another state, officials said. The day after Delaware announced its first case, three more cases were announced. All three are under the age of 30 and had been in contact with the same out-of-state person as the first man. Two are graduate students and one is a postdoctural researcher. All four people are self-isolated at home and they are not severely ill, officials said.

The CDC will confirm test results of the four who tested positive. As of March 12, there were 10 tests pending and 30 have been negative. Thirty-five people are being monitored because they have come in contact with a confirmed case or they have traveled to countries at elevated risk for the virus. Those countries include China, Japan, Italy, Iran and South Korea.

“We understand that news of additional cases is concerning to students, staff, and families in the University of Delaware community,” said DPH Director Dr. Karyl Rattay. “However, DPH is working closely with the administration at the University of Delaware on their coronavirus disease response.” 

Lewes Board of Health Chairman James Marvel, a retired physician, said doctor offices and emergency care centers should be careful about sending too many patients to the hospital unless they need immediate care.

“Number one, it's going to overwhelm the emergency system, and they're not going to be able to test that many people because right now, Delaware only has 300 test kits available,” Marvel said.

Marcy B. Jack, chief quality and safety officer for Beebe Healthcare, said the state expects to get more kits, but the state should be [prudent] with its resources. “We need to not use up things just because maybe we're afraid because we don't have information,” she said. “The CDC does recommend staying home unless medical care is needed.”

Symptoms include fever, cough and shortness of breath. People who have those symptoms can be tested, said Rattay. Testing is also available for people who have traveled to a country of concern in the past 14 days. The DPH lab in Smyrna has conducted testing for a week, and private company LabCorp can now do testing in Delaware. Quest Diagnostics is also working on offering tests in the state, and officials said they should be available within a week. Gov. Carney said he has requested more kits from the CDC and expects them to arrive.

Christina Deidesheimer, director of marketing communications for Beebe Healthcare, could not say at what point the hospital would be overwhelmed with patients.

“That's impossible to answer because it depends on the acuity of the cases coming in,” she said. “I can't give you a number.”

On March 12, Beebe Healthcare announced only two visitors per patient would be allowed at the hospital and all outpatient sites. Visitors must be screened before entering any of Beebe's sites, officials said.

At the main hospital in Lewes, no one 16 or younger is allowed to visit. The two approved visitors are the only visitors allowed during a patient's stay, officials said. No one else is permitted to enter the Margaret H. Rollins Lewes Campus or wait in any area of the facility including waiting rooms, cafeterias or hallways, officials said.

Risk factors

Age is the biggest risk factor in contracting COVID-19. People most at risk for the virus are over the age of 60, said Secretary Kara Odom Walker of the Department of Health and Social Services.

Also at risk are people who are on immunosuppressants or who have a chronic condition such as asthma, chronic obstructive pulmonary disease, diabetes or heart disease, she said.

“If you are sick, don't go out in public. Stay at home,” she said.

Marvel said it appears that juveniles are protected from COVID-19. The youngest person he has seen tested so far is 24, he said.

Dr. Uday Jani, a general practitioner in Lewes, said he has heard of only two children worldwide dying from the virus. He said kids are often asymptomatic and if tested may take a few times to test positive. Even if a child seems healthy and normal, he said, they can be carrying the virus. “They can be affecting other people in the family,” he said.

While older residents and those with compromised immune systems are more at risk, Jani said, an average person would end up with a flu-like sickness at the worst.

“It's not as infectious as you think it is,” he said. “It's not that contagious until you're in constant contact.”

With an estimated incubation period of 14 days, Jani said, if a person shows no symptoms after 11 days it probably means they are scot-free.

Staying home when one is sick is the best option, he said.

“Someone asked me if I get sick should I go to the hospital, and I said that's the last place you should go,” he said.

Dr. William Chasanov, an infectious disease physician with Beebe, said people should stay home with their symptoms, but if they need medical care or experience a health emergency call 911.

“The CDC and state of Delaware are recommending to stay home, rest and avoid others if you are sick and not requiring medical care,” he said.

Pandemic preparation

Cheryl Hopple, a member of the Lewes Board of Health and the emergency management coordinator with Beebe Healthcare, said Beebe has an infectious disease plan, and they have been working on a COVID-19 plan for several weeks.

Beebe's Marcy Jack said Beebe Healthcare prepares for potential pandemics with regular drills throughout the year.

“Emergency preparedness is something that Beebe Healthcare practices frequently, not just at the time an event occurs or when there is heightened awareness of a potential threat. Infection prevention professionals consisting of nurses and infectious disease physicians are currently working closely with the state of Delaware,” she said.

The hospital has infection protocols in place for sick patients who come to the facility, Jack said. “As COVID-19 continues to evolve in our community, necessary protocols will be updated to ensure our community, colleagues and patients are safe,” she said.

Jack said she is confident it has the necessary protective equipment to keep team members safe if there is an outbreak. And, he said, the hospital is prepared if there is a surge of patients.

“Beebe has protocols that existed prior to the outbreak of COVID-19 in how to manage a sudden surge of patients who present to the hospital,” she said. “We have performed simulations and drills for these types of events to ensure we are prepared.”

EMT response

Glenn Marshall, spokesman for the Lewes Fire Department and an infection control officer for Lewes, said they have not yet been inundated with calls over COVID-19. Emergency responders have regular training on how to handle sick patients, whether it is coronavirus or the flu, he said.

“We do have a plan in place,” he said. “That would not change our operations. It may minimize actual personnel on a unit, but we have a fluid plan that allows us to transfer a unit from one area to another to make sure calls are covered.”

Marshall said responders ask patients about their symptoms and if they are exhibiting fever, cough and other symptoms, responders have form-fitted masks that they can wear to protect themselves. They also have masks to put on the patient to limit the spread of germs, he said.

Once a patient is transported, he said, everything is wiped down and an exhaust system in the ambulance helps ventilate the vehicle. At the station, Marshall said, there are clean uniforms for responders to change into after a sick call, and washing machines and dryers to clean the dirty uniforms.

“We will escalate things as we need to, but at this time it has not reached our region and we are being proactive in what we do,” Marshall said.

Rehoboth Beach Volunteer Fire Company spokesman Warren Jones said the department is following the state's direction. Offices are being disinfected and EMS staff are making sure to wear gloves during calls, he said, adding that all of the company’s ambulances have isolation equipment if needed.

As of March 11, Jones said the company has been dealing with calls about the flu, but they are constantly monitoring the situation. Jones said he doesn’t expect the spread of the virus to cause the fire company to get too busy, but things could change as more people travel to the Cape Region for the summer season.

“We are prepared to handle that,” said Jones.

No cure yet

Health officials say anyone with symptoms should contact their doctor or call the DPH call center at 1-866-408-1899.

“Many people recover by resting, drinking water, and taking pain and fever medication,” DPH's Rattay said.

Officials remind citizens that practicing good hygiene such as washing hands with soap and water, using hand sanitizer, covering coughs and sneezes, and not touching one’s face are key to preventing the spread of germs.

During a presentation at the Lewes Public Library March 11, Dr. Jani remained optimistic with a slideshow that included a photo of Chinese nurses celebrating at their hospital because COVID-19 patients had been discharged.

Because there is no cure, Jani said building a strong immune system is important. Herbs and vitamins such as vitamin C, vitamin D3, zinc, garlic, echinacea and astragalus can help boost immunities needed to fight viruses, he said. Mushrooms such as reishi and cordyceps, and elderberry are also considered immunity boosters, he said.

But he stressed none of the supplements has been shown to cure COVID-19.

“All I'm showing you are things that can boost up your immune system so you can take care of the coronavirus even better,” he said. “Your immunity is the only thing that fights the virus.”

Ron MacArthur, Ryan Mavity, Ellen Driscoll and Chris Flood contributed to this article.

The story has been updated to reflect an expanded county opinion