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West Virginia officials continue to try to stave off the effects of an outbreak of the novel coronavirus in the state — despite no confirmed cases being announced by health officers. As the potential for a diagnosis appears inevitable, those involved in the response to the pandemic are hoping to mitigate its spread and prevent stresses on the state’s health care system.
Is our health care system equipped to handle what lies ahead? How can West Virginia prevent stresses that have occured in other countries?
West Virginia University Health Sciences Vice President and Executive Dean Clay Marsh is one of those involved with planning the state’s response to the COVID-19 pandemic.
Editor's Note: The following has been edited for clarity and length.
Clay Marsh: My role, specifically — but, really, our role as a university and as a health care delivery system WVU medicine — is to try to make sure that we are both giving our communities and community member the best advice on how to avoid becoming infected with the novel coronavirus or COVID-19 as it's called. But, also, to try to reduce the surge, the stress, on our health care system. So that if people do become ill, that we will have enough health care workers to be able to treat them and will have enough health care resources to be able to handle, perhaps, the increased volume of very sick people that we could see related to this pandemic virus.
Dave Mistich: You mentioned having enough health care workers. West Virginia’s rural hospitals have been closing at an alarming rate. Do you see issues between the rural — and it's not necessarily urban in West Virginia — but the more equipped cities and towns in the state for something like this?
Marsh: I think that this is a really unusual time. And let me just explain very briefly why this is different than anything that we've ever seen — at least in all of our lifetimes. So this is a virus that has jumped from an animal source to a human source. This is a bat-borne virus that is related to regular cold viruses. There are coronaviruses that are regular cold viruses and the regular coronaviruses we respond to, and they make us sick a little bit, but then we'll get over it.
This novel coronavirus, the one that jumped from bats to us is really more like the SARS virus that we saw a few years ago. But this one is different in that we have no native immunity to it. And it turns out that when we get infected with it we don't know we’re infected with it, but we can transmit the virus. So, the problem then becomes that some people that may not even feel very many symptoms, they may be able to spread the virus to other people.
What's happened is — and this is really now Italy's experience if you look around the world — Italy didn't do as, perhaps, an aggressive an approach in trying to reduce person-to-person contact and these public health measures of asking people to self-quarantine if they may have come from an area where the coronavirus is more prevalent.
But Italy now has gotten to the point where they've closed their borders. They have basically told people to stay in their homes. At their health care system, they basically have critically ill people in the hallways of their hospitals — and they're making some triage decisions about whether to apply the critical care equipment like ventilators and support devices to people because they don't have enough of them. Their health care workers have also gotten sick — some of them — which further stresses their system.
So, this surge effect on their health care system has created an almost collapse of that system. And the mortality rate right now in Italy is six percent. If you look at influenza virus, it's 0.5 percent. And this has been a pretty significant influenza year. Still influenza kills more people than this novel coronavirus. Across the world, about two percent of people it's estimated or maybe less will die from the novel coronavirus. Usually people that are older — 70s and 80 year olds. But when you look at the pandemic of 1918, which was another novel virus, that time the H1N1 virus, the mortality rate and that was 2.5 percent — across the world 50 to 100 million people during the pandemic of 1918.
Mistich: So, all that being said, West Virginia’s rural hospitals are closing at an alarming rate... is Morgantown better equipped than Fairmont Regional (a hospital that recently announced it was closing) — the region of Fairmont — or Wheeling?
Marsh: Of course. So what we're really doing and this is the leadership of the state and, and our state health officer, Cathy Slemp, is doing a wonderful job and Secretary Bill Crouch and certainly the governor and the governor's office and the local health department's with the academic centers, the medical schools, the hospital systems — we're all working together.
So the thought would be that — although, we do have more capabilities and Morgantown than say you would in Fairmont right now — we all want to pull together and we're all part of a single state. We believe our role here is to help anybody in this state, whether that's helping an individual citizen or helping another health system, a smaller hospital system or set of clinics that need our help. And we're trying to do that in a way we're all pulling in the same direction and working in series versus parallel.
Mistich: How's West Virginia doing as far as testing? What’s our capabilities? What's the criteria? Because, the way I understand it — if I feel sick — I just can't walk into the hospital and say, ‘Test me for coronavirus,’ right?
Marsh: It's getting more like that today. And obviously we want to have a doctor or a health care workers order or asking for that kind of test. When the novel coronavirus first came here to the United States, we had a limit and how we could test so it really got centralized that the Centers for Disease Control in Atlanta.
It's recently been liberalized and we have many more tests that we're capable of running to the state level — and we believe very soon we'll have those at the local level. So there are private companies like Labcorp and Quest Diagnostics that can run these tests.
The test is a relatively straightforward test to run — that is done all the time. And what you're looking for is the RNA, the genetic material from this virus that's very unique. And you're trying to amplify that. And that tells you that somebody has been exposed and has been infected with a virus. And if it's negative, it means you haven't been exposed or haven't been infected with a virus and trying to bring that down to the local levels.
South Korea, as a country, they tested very broadly. And part of the way that they started to control the infection is — instead of just asking everybody to self-quarantine, if you've had any potential exposure — they started to test a ton of their population. So they actually knew who was infected and who wasn't. And, optimally, you find that out and you quarantine the people that are infected. You don't quarantine the people who aren't. So that's really a step that we're moving toward, which will allow us, I think, to be much smarter about how we're approaching this from a public health protection standpoint.