Wyoming’s pandemic response plan for the COVID-19 outbreak gives the state health officer sweeping powers but leaves important decisions regarding closures, rationing of expected shortages and patient triage to local governments and institutions.
The 80-page Pandemic Influenza Response Plan will guide reaction to the worldwide outbreak, Wyoming’s State Health Officer Dr. Alexia Harrist said at a press conference Thursday. Despite its official title as an influenza plan, parts of it will serve as a framework for response to the novel coronavirus pandemic, she confirmed.
The plan gives Harrist broad powers, including the ability to enforce isolation and quarantine and to close public buildings and cancel events. Under the plan Harrist has the authority to require vaccinations or, in the case of refusal, to quarantine a person.
Vaccines and prophylactics aren’t yet available, Harrist said, making that part of the plan irrelevant for now. Otherwise there are “many similar aspects” between influenza and COVID-19, including that both are respiratory viruses spread by similar means.
District courts will handle appeals of quarantine orders. It also is Harrist’s duty “to regulate the disposal, transportation, interment, and disinterment of the dead,” the plan says.
Last updated on June, 30, 2019, the plan also relies on local governments and institutions to make many decisions. While Harrist has closure authority, “it is likely the decision whether to close schools, pre-schools, and child caring facilities will be largely made by local school officials, public health officials, and parents,” the plan says.
School closures might come “if there were multiple cases or a case in a school,” Harrist said, or if there was “transmission in the community where it was clear if we closed a school we could limit that.”
School boards would consult with Cheyenne
Officials believe school districts would only act after consulting with Harrist and their local health departments, Jillien Balow, superintendent of public instruction said at the briefing in Cheyenne.
Such decisions depend on the local extent of illness, parents’ willingness to send children to schools, facilities’ contingency plans and the effects on communities, the plan says.
“For these closures to be effective they must be implemented early in a pandemic (before widespread transmission) and be maintained throughout the entire time the pandemic virus is circulating in a community,” the plan says. “This will likely be 1-2 months at a time for each pandemic wave, and possibly for 2 or 3 separate waves.”
Like all plans, the state framework will be “adjusted based on current situations and actual conditions,” Department of Health Spokeswoman Kim Deti wrote WyoFile in an email. The state will set up a unified command center, Gov. Mark Gordon said, which includes representatives from the Department of Homeland Security, health office and other relevant officials.
Meantime, local jurisdictions should seriously consider cancelling events that draw more than 250 people, Gordon said.
The University of Wyoming on Thursday extended by one week its spring break, which begins March 16 and was originally scheduled to last only one week. The extension will allow instructors to prepare for possible online teaching.
No cases have been detected at the Laramie campus and the only confirmed case in the state has been in Sheridan County.
Other institutions are cancelling gatherings, including the Jackson Hole Mountain Resort, which was scheduled to host Grateful Dead musician Bob Weir and Wolf Bros at Teton Village March 28 with other end-of season music shows. Weir and Wolf Bros cancelled their tour. The state high school basketball championship has been cancelled as well as the World Championship Snowmobile Hill Climb that was scheduled in Jackson for March 19-22.
Tourist destinations are on the hook during an outbreak, according to the state plan. “Local government agencies will be primarily responsible for providing all necessities associated with isolation and quarantine of travelers (e.g. food, clothing and medical care),” the plan reads.
Worst case scenario?
Wyoming has the ability to test hundreds of people, officials said Thursday. As of Thursday, 16 people have been tested via state systems and one by the federal Centers for Disease Control. More tests will be run today.
“We’re not concerned about the number of tests we’re able to conduct at this point,” Harrist said. They are complex, require work in a lab and “are not tests that can be run in a doctor’s office,” she said.
Gordon urged calmness. “This is not necessarily a time for panic,” he said. the state, he said, is “in charge of information” and the risk in Wyoming is low.
Having two weeks of supplies at home “does not mean you need to stock two years supply of toilet paper,” he said.
The state plan, with caution and caveats, says “the most severe scenario” of an outbreak on the order of the 1918 influenza event could lead to 4,301 deaths, 18,813 hospitalizations and 87,077 outpatient cases in Wyoming. “There is great uncertainty associated with any estimate of a pandemic influenza impact,” the plan cautions.
The estimates assumed a “1918-type scenario” using “rates of influenza-related morbidity and mortality” from that outbreak. The estimates were based on CDC software and a Wyoming population during the 2010 census. It assumed a gross attack rate, or infection of 35% of the population.
“It does give you kind of good ideas of things to plan for,” Clay Van Houten, infectious disease epidemiology manager with the Department of Health told WyoFile Friday. “That’s what those models are — they’re good estimates. They’re a pretty good way to plan for the worst.”
Around the world there’s a large disagreement over the key case-fatality rate of CORVID-19, the rate at which infected people die. Some officials put the rate higher than that of the 1918 influenza outbreak while others believe the rate is as low as the seasonal flu.
Flu causes between 291,000 and 646,000 deaths worldwide, and 12,000 to 61,000 deaths in the U.S. per year, according to Johns Hopkins Medicine.
“Since this disease is caused by a new virus, people do not have immunity to it, and a vaccine may be many months away,” the respected health institution states on its website. “Doctors and scientists are working on estimating the mortality rate of COVID-19, but at present, it is thought to be higher than that of most strains of the flu.”
Equipment shortages
During a widespread outbreak, there will be significant increased demand for ventilators and other critical care needs “likely beyond the usual capacity of healthcare facilities,” the Wyoming plan reads.
Triage, the process of prioritizing who gets what treatments, will be the responsibility of the local healthcare system, the plan states. Healthcare personnel will be affected too and there will be “high absenteeism rates” among those workers until a vaccine is developed, the plan states.
The state plan downplays the benefit of wearing masks or respirators by those who are not ill, saying no advantage for using them has been established. Further, improper use may increase the transmission of illnesses.
There are exceptions, including when there’s evidence of considerable community spread and a person must enter a crowded setting.
It’s reasonable for families who must be in close contact with an ill person to stockpile face masks and respirators. “Government supplies of masks and respirators will NOT be available to meet these needs,” the plan reads.
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The state health department will be the clearinghouse for testing surveillance and epidemiological responses through its existing statewide network of specialists, according to the plan. It will inform local jurisdictions, ensuring their plans and capabilities to handle a surge of cases are up to date.
The health department also will coordinate with neighboring states.
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