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LIVINGSTON — Dr. Laurel Desnick knows the public wants guidance on how to adapt to life in a global coronavirus pandemic. Desnick, the health officer for Park County, home to 17,000 people just north of Yellowstone National Park, has been receiving calls from health officials, school officials, businesses, and sick residents. She, too, is scrambling for guidance.
When it first became clear early this year that the COVID-19 coronavirus would begin to spread to the U.S., Desnick received updates from the Centers for Disease Control and the Montana Department of Public Health and Human Services. Desnick, an academic physician who retired last year after decades of work at the University of Washington and as a clinical physician at Livingston HealthCare, also began poring over the academic literature.
She says CDC media calls became one of her best sources of information in the rapidly evolving environment. She couldn’t ask questions, but she could at least get the latest news. As the disease spread and news began moving faster, she said, the CDC calls slowed. Health Alert Network updates from the Montana Department of Public Health and Human Services became her best source of information, arriving every few days via email.
But with the situation now changing hour by hour, Desnick is constantly learning. She gets her news via phone calls from state officials and local health organizations. She scours online and television news updates. She refreshes the CDC and DPPHS websites and checks her email for official updates.
So when Park County residents, emergency officials, and community partners gathered on Thursday afternoon, March 12, at a public meeting to discuss the outbreak, Desnick was combining all those perspectives to inform her advice.
“The vast majority of the information we get from CDC is just a recommendation. We use our best judgment and community perspectives to add to the recommendations.”—Park County Health Officer Laurel Desnick
“This is not a public information meeting where you will receive the golden word and go forth,” said Greg Coleman, director of Emergency Services for Park County, who with Desnick coordinates the county’s response.
About 40 people attended the meeting, representing the community’s breadth of feeling and preparedness about COVID-19, which in the previous 24 hours had led to a spiraling stock market, an international travel ban, and the postponement of the NBA season.
Montana would confirm its first four presumptively positive coronavirus cases the next evening. None are in Park County. One is in neighboring Gallatin County.
Becky Bird, the executive director of the Park County Senior Center, said the center had closed the public gathering place, which typically serves meals every day. Don Viegut, superintendent of the Livingston School District, said he was trying to decide whether to keep open the schools, where half the students rely on free and reduced-cost lunches, and whether to host a statewide wrestling meet. Lt. Tom Totland, of the Park County Sheriff’s Office, said the department wasn’t doing anything differently than it had been doing three weeks earlier.
“The National Forest is open if you want to get away from people,” one U.S. Forest Service official joked.
Four million people visit nearby Yellowstone National Park each year. Millions more drive through Livingston on Interstate 90. Livingston’s economy relies on visitors. Local health care infrastructure would be challenged by even a dozen serious COVID-19 cases, officials said.
Like rural public health officials across Montana, the information on which Desnick bases her decisions comes from Montana Department of Public Health and Human Services Health Alert Network emails. The county had received a six-page information sheet at 2:54 p.m. on Wednesday, March 11, which compiled DPPHS, World Health Organization, and Centers for Disease Control recommendations.
“The vast majority of the information we get from CDC is just a recommendation,” Desnick said. “We use our best judgment and community perspectives to add to the recommendations.”
Following the meeting, Desnick walked down the hall to her office in the basement of the City-County Complex. She had a simple press release typed up in a Word document on her laptop with the basics: no current cases; high-risk individuals should stay home; no plans for school closure or event cancellation, though preparation for potential closures is underway; call your clinic if you have a fever or cold-like symptoms; if anything changes, we’ll update you; and tips for preventing illness.
“We are all trying so hard to do the right thing for the community, but it’s impossible to know what that is,” Desnick said.
As Desnick edited the release, Coleman, the county’s director of emergency services, came into her office. Desnick turned the laptop around, and Coleman suggested that the release should mention the Montana woman who tested positive in Maryland, but hasn’t been in Montana since November. Julie Anderson, director of the Park County Health Department, came in and sat on the carpeted floor with her back against the wall. Desnick handed her the laptop and she read the release.
The day had been a constant stream of meetings, texts, emails, and phone calls. Residents concerned about fevers or cold-like symptoms wanted to know what to do (call the clinic — don’t just show up). Parents wondered if their children could come home from the colleges that are moving classes online (yes, but they may have to self-quarantine). Local organizations wondered if they should hold scheduled events (they can, but vulnerable populations should avoid them). First responders wondered if the health department has enough face masks and equipment for an outbreak (they don’t).
Later, Anderson sent the press release to public information officers at Livingston HealthCare, the Community Health Partners clinic, the city government, the county government, the school district, the library, and several local nonprofits. The combined reach of those email lists, she hoped, would be far-reaching enough to get the message out and quell the calls.
Anderson has had to monitor three people so far. If someone is returning home to Park County from a high-risk area, the state department of public health calls Anderson, tells her they’re coming, and makes sure she knows how to contact them. Those potential patients check in with her daily, reporting any symptoms and checking their own temperature. She gives each of them her cell phone number so they can call in the middle of the night if they wake up with a fever. That’s safer than having them call 911 and be taken to the hospital in an ambulance, which would have to be disinfected. As of Thursday, the county had tested five people. All came back negative.
Because Livingston is a small, connected town, Anderson had several people inform her that a local couple would be returning from Italy Thursday night. She was waiting for the call from DPPHS to alert her.
“For small towns and rural communities, it’s easy to pick up the phone. It’s easy for us to help out. I don’t think that’s the case in a place like Seattle.”—Julie Anderson, director of the Park County Health Department
She knows that if a local person breaks their self-quarantine, she will get a call about it from a concerned neighbor.
Livingston HealthCare has two isolation rooms. If COVID-19 arrives in Park County, the very sick will stay at the hospital, but those well enough to go home will self-monitor, Anderson said. The county has plans to set up temporary hospital beds in other community facilities if the need arises. She’s also trying to figure out how to deliver basics like toilet paper and medication to affected individuals.
There are benefits to being a smaller community, Anderson said.
“With a small community, it’s grassroots,” Anderson said. “We know to call Michael [McCormick, executive director of the Food Resource Center], he can help us out. We know the owners of the Frontier nursing home, we can call them. For small towns and rural communities, it’s easy to pick up the phone. It’s easy for us to help out. I don’t think that’s the case in a place like Seattle.”
Desnick entered the office after a phone call. She had been talking with a local resident who had just returned from out of country about whether they should self-quarantine. She decided to call DPHHS for guidance. It turns out that a resident of a neighboring county had recently returned from the same country, and had the same question.
“It’s the same situation. I’m saying no risk. [The other county’s official] put her on 14 days quarantine. I’m not saying they’re wrong. Everyone is doing their own thing,” Desnick said.
Desnick called a state official for guidance. The official interpreted a CDC release one way; Desnick interpreted it another.
“We want to have consistent management,” Desnick said.
She referred again to a CDC document, noting that the CDC defines social distancing as one meter. She has also heard two meters.
“They have got to get that together,” Desnick said, scrolling through the document. “It’s very vague.”
Eventually Desnick’s laptop battery died. She decided to let her don’t-quarantine decision stand.
The state official had said it was up to her.