Pennsylvania’s hospitals, clinics, first responders and public health officials are preparing for a potential spread of coronavirus to the region as concerns mount globally.

While there have been no announced cases of the COVID-19 virus in the state, infectious disease experts say it’s only a matter of time.

“What’s to say one isn’t here now that is mild and doesn’t meet testing criteria?” said Dr. Amesh Adalja, a Pittsburgh-based infectious disease and critical care physician.

Dr. Kristen J. Mertz, an Allegheny County Health Department medical epidemiologist, said the county is working with the Pennsylvania Department of Health, the Centers for Disease Control and Prevention, and area health care providers to make sure everyone is prepared in the event that an abundance of coronavirus cases show up here. One of her main concerns has to do with the unanswered questions related to the disease.

“I think that right now the estimation is about 15% of the cases are severe, but that might be an overestimate,” Mertz said. “We’ll know a lot more when testing is more widespread and they develop a serologic test to see who has antibodies to the disease. So, there’s a lot of work that needs to go into figuring out what the fatality rate is.”

Allegheny Health Network infectious disease physician Dr. Tom Walsh said the latest statistics are showing the fatality rate for coronavirus is higher than the seasonal flu.

“In terms of how many patients are going to be infected and how transmissible it is really depends on how well we have our public health measures and our infection prevention measures at the hospital side,” Walsh said.

Mertz said the more people know about the disease, the less anxiety they will have. For many, it’s a mild disease.

“It does seem to be less deadly than SARS even though it’s more transmittable,” Mertz said. “I think the concern is mainly older people and people with underlying conditions, because those are the ones who are having the most severe and sometimes fatal outcomes.”

AP Medical staff wear protective suits Sunday outside a hospital in Daegu, South Korea.  

UPMC hospitals are screening employees as well as patients who have been in China, South Korea, Japan, Italy or Iran in the past two weeks, spokesman Paul Wood said. Signs alerting patients to the travel risks are posted at nearly every waiting room desk, along with a stack of face masks.

“And we have directed staff to avoid nonessential travel to any of those countries,” Wood said. “We have not yet implemented an outright travel ban. That may happen. Who knows?”

UPMC is urging employees to avoid unnecessary travel to China and four other countries.

A similar memo went out to Allegheny Health Network employees, said Dr. Thomas Campbell, AHN’s chairman of emergency medicine.

Together, UPMC and AHN health care systems employ more than 120,000 people statewide.

Both issued employees the notices after the CDC called for more urgency and preparation for the highly contagious virus.

‘Nothing to panic about yet’

Officials said it’s almost certain to spread more widely in the U.S. at some point, as Europe and Asia scramble to contain new outbreaks of the illness.

“It’s concerning, but it’s nothing to panic about yet,” Campbell said. “But we need to be prepared and take precautions.

“The good news in this is we’ve been through a similar event,” he said, citing the H1N1 outbreak. “And because it’s starting in another part of the world, we have time to prepare.”

Hospital executives are taking calls several times a day to check in with epidemiologists, infectious disease specialists, nurse leaders and others to keep everyone informed of the latest developments, in addition to daily updates from public health departments and the CDC.

Planning for the worst

UPMC’s preparation spans equipment, training and communication, said Leslie Davis, chief operating officer of UPMC Health Services Division.

“So if this is just sort of another H1N1(-type outbreak), it’ll be one set of things that we do,” Davis said. “And if it is a true pandemic, we’ll have another.”

Should the virus continue to spread more rapidly, response options could include pop-up centers and using existing hospitals and outpatient facilities to screen and treat patients, Davis said.

Kathleen Rosatti, Excela Health director of medical outcomes, patient safety and infection control, said CDC guidelines for health care workers dealing with coronavirus are very similar to the precautions used to treat patients with tuberculosis and other contagious respiratory illnesses.

“For the coronavirus, individuals would be placed in respiratory (airborne) precautions and care workers would don specific PPE (personal protective equipment) items including gowns, gloves, eye protection and purified air masks or hoods,” Rosatti said. “Health care organizations had to implement similar planning processes with the emergence of SARS (2000) and MERS (2012).”

Health officials urge anyone who believes they may have symptoms caused by coronavirus to stay home.

“There really is not a lot of treatment,” Davis said, “so the best thing is really to stay home and stay isolated and not to expose people if someone suspects that they have this.”

But how do medical experts ascertain that it’s coronavirus and not some other virus?

“We currently screen patients upon entry to any of our facilities,” Rosatti said. “If the patient has a positive screen, indicating that they have had recent travel to the areas that have the heaviest impact, or that they have been exposed to someone that may have been exposed to the virus, we triage the patient per the directives of the CDC and reach out to the Department of Health to confirm if we need to work with them to perform the specific testing required for the coronavirus.”

First responders, police preparing

Public safety efforts have ramped up in recent days and weeks.

First responders throughout the city of Pittsburgh are being trained to recognize coronavirus symptoms and being equipped with kits that include masks, sanitizer, gloves and protective eyewear.

Pittsburgh Public Safety Director Wendell Hissrich said he has been meeting regularly with other officials since early January to discuss coronavirus concerns.

The city adopted a formal pandemic plan in 2014.

“While we are pleased that no cases have appeared in this area yet, we will be ready if any cases do appear here,” Hissrich said in a statement. “We prepare for any and all types of threats, whether it be flooding concerns, large snowfalls, extreme heat, large gatherings in the city or presidential and dignitary visits.”

The virus can cause fever, coughing, wheezing and pneumonia. Health officials think it spreads mainly from droplets when an infected person coughs or sneezes, similar to how the flu spreads.

“The main thing at this point is to use the usual protective measures against respiratory diseases like thorough hand-washing frequently. If you cough or sneeze, cough into your elbow not into your hand, and stay home when you’re sick so you don’t cough and sneeze on other people,” Mertz said. “Also, it’s still a good time to get a flu shot. We still have flu going around, and you don’t want to get flu and then think you have coronavirus.”

Officials are working to develop a vaccine, including at a laboratory at the University of Pittsburgh, but Walsh doesn’t see it happening right away.

“In reality, once they would have a candidate vaccine and it would start to go into trials, we’re not looking at a remarkably quick turnaround,” Walsh said. “The estimates are probably into 2021 before there would be a vaccine that would be widely available for the public.”

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