If – or perhaps when – the coronavirus disrupting travel and markets as it circles the globe reaches Missouri, the preparations to test potential patients, isolate those infected and prevent new cases will be crucial to controlling its effect.


County health departments are monitoring reports from the Centers for Disease Control and the state Department of Health and Senior Services, obtaining or stockpiling supplies of respirators for health care workers and funneling information to schools and other agencies.


The public should be alert but careful about changing habits or making expensive purchases out of fear, health officials said.


An example, said Sandra Hewlett, Audrain County public health administrator, is the N-95 respirator, which provides a tight seal and filters out small particulate matter. In some places, stocks of the respirators have disappeared from shelves.


"We have ample supply of N-95 respirator masks if that should become necessary, but right now the public should not go out and wear a mask unless they are ill, because it would just create a further medical shortage for first responders," Hewlett said.


Since the coronavirus, named COVID-19 by the World Health Organization, appeared last year, it has infected 85,000 people, with 2,900 deaths, worldwide. That is a death rate of about 3.4 percent.


Most of those cases and deaths are in China, where the disease first appeared, with the second- and third-largest outbreaks in South Korea and Italy, respectively. There have been 62 confirmed cases in the United States.


In comparison, the 1918 flu pandemic infected 500 million people, about one-third of the world’s population, and caused an estimated 50 million deaths, including 675,000 in the U.S.


Missouri has a widespread flu outbreak this year, with 69,382 confirmed cases through Feb. 22, according to the most recent report of the state health department. There have been 40 deaths attributed to the flu and 971 pneumonia and flu-related deaths.


While the numbers are relatively small outside China, the disruptions to travel, trade and financial markets has been large. The CDC issued a Level 3 travel warning to avoid unnecessary travel to South Korea and the University of Missouri on Friday canceled university-sponsored travel to that country.


MU has traditionally close ties to South Korea, which has the largest number of alumni overseas.


France has banned indoor gatherings of more than 5,000 people and is recommending that people no longer greet each other with kisses.


Major financial indexes lost more than 10 percent of their value last week as fear gripped the markets, with the closely watched Dow-Jones Industrial Average losing 12 percent. The Dow-Jones average was at a record high on Feb. 13.


Missouri has evaluated more than 60 people as potential COVID-19 cases because of their travel or exposure history or symptoms, with a "much smaller number" meeting CDC guidelines as "persons under investigation" for testing. None have tested positive and no tests are pending, the state health department stated in a news release Thursday.


The department isn’t releasing specifics about those individuals, spokeswoman Lisa Cox wrote in an email.


"Missouri is not releasing information about specific PUIs, as they are not confirmed COVID-19 cases," she wrote. "If a case is confirmed in Missouri, the public will be notified about the case and any necessary steps to protect the health of their families and communities."


The state health lab was certified Thursday to provide COVID-19 testing, and local health agencies are coordinating collecting samples with health providers, Lucio Bitoy, spokesman for the Columbia-Boone County Public Health and Human Services Department, wrote in an email.


"If a resident meets the criteria for testing, they would be directed to a designated health care facility for specimen collection that would be sent to the State Public Health Laboratory for analysis," Bitoy wrote.


The same guidelines to prevent the spread of flu and other diseases are those that will help prevent the spread of coronavirus, and that’s how Columbia Public Schools is handling education about the epidemic, spokeswoman Michelle Baumstark wrote in an email.


"We are continuing to encourage the same practices with regard to illness as we always have during flu season – and really as general health and wellness best practices any time," she wrote.


Those practices include instructions to staff and students to stay home when they are sick and teaching students to cover their coughs and sneezes, she wrote. Other steps are to encourage good hand-washing, providing alcohol-based hand sanitizer and encouraging staff and students to be vaccinated for the flu.


The district has a plan for epidemic illness worked out with health providers and emergency response agencies, and would take direction from health agencies, Baumstark wrote.


The main work for health agencies is preparation and coordination with other local agencies, Sharon Whisenand, administrator of the Randolph County Health Department, wrote in an email.


"We have a team that works in planning and monitoring events in our county," she wrote. "Plus, we are meeting with local emergency management staff and our hospital to discuss and plan."


University of Missouri Health Care is ready with a supply of N-95 masks for providers and is looking to the state health department for leadership if a possibly infected person seeks treatment, spokesman Eric Maze wrote in an email.


"If a decision is made to test, we would collect the samples and send it to the state lab which can test the samples directly and send the results to the CDC," Maze wrote.


Once a case is confirmed, the patient would be isolated until they are not infectious and people who came into contact would be tested, Cox wrote.


"This will be determined by DHSS and local public health, in consultation with the Centers for Disease Control and Prevention, on a case-by-case basis," she wrote.


The preparations may not prevent COVID-19 from reaching the state but they are intended to mitigate it, Hewlett said.


"We're just not going to wait until we have a case," she said.


Charles Dunlap of the Mexico Ledger, Erik Cliburn of the Moberly Monitor-Index and the Associated Press contributed to this report.


rkeller@columbiatribune.com


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