Austintown Elementary School Kindergarten teacher Michelle Bilas wipes down a table in her room with a Clorox wipe. The Ohio Department of Health is recommending people wipe down "high touch" surfaces like counters, door nobs, and tables daily to help stop the spread of viruses. Bilas said teachers keep Clorox wipes in their rooms year-round to wipe down desks and iPads.

With COVID-19 cases on the rise in the United States, health departments in the Mahoning Valley are gearing up for a potential pandemic-level outbreak.

As of Saturday, more than 400 illnesses and 19 deaths had been linked to the disease in 23 states, according to the Centers for Disease Control. Five schools in eastern Pennsylvania closed after the state reported two “presumptive positive” cases of the disease.

Though no cases of COVID-19 — novel coronavirus — have been confirmed in Ohio and the state is still considered “low risk,” health agencies in Mahoning and Trumbull counties have already laid groundwork to deal with an outbreak.

Mahoning County has an “all hazards” emergency response plan of four phases: preparedness, mitigation, response and recovery, said Susan Kovach, deputy director of Community Health at the health agency.

Kovach said in the event of a pandemic, the plan covers case investigation and surveillance, “social distancing” or non-pharmaceutical measures once the virus has spread, and, if needed, mass distribution of a vaccine.

The Trumbull County Combined Health District has crisis plans in place that align with national standards, explained health Commissioner Frank Migliozzi. Speaking recently to the Trumbull County Federated Democratic Women’s Club, he held up a thick binder to show the extent of those plans.

“There are a lot of plans in place. We’ve been preparing to deal with a potential pandemic for years,” said Migliozzi.

MASS CLINIC

Mahoning County has a “mass clinic” plan with guidelines for a public point of dispensing. Kovach said COVID-19 vaccine distribution would depend on the situation at the time the vaccine is developed.

“It is difficult to say for sure how the vaccine would be distributed: Our most recent experience was with Influenza A H1N1 in 2009,” she said. “The vaccine was provided to us by the CDC and was provided without cost to the public. At first, the vaccine was distributed to those at the highest risk of developing severe illness from the disease.”

Mahoning County Public Health works with community partners on emergency preparedness — it has since before 9/11, Kovach said.

“The Mahoning County Healthcare Coalition meets regularly. This group consists of local hospitals, emergency management, long term care centers, schools, universities, Red Cross, etc.,” Kovach said. “This group has already met and will continue to meet so MCPH can provide the most up-to-date guidance and information to these agencies.”

AWARENESS

Migliozzi said the Trumbull health district has “situational awareness” and is monitoring the population for spread of the disease through processes put in place by the Ohio Department of Health and the CDC.

If COVID-19 begins to spread in Trumbull County, a “Phase II” pandemic response of social distancing would shut down gathering places such as schools and athletic events. “This is an effective way of stopping the spread,” said Migliozzi.

Migliozzi said the health district is in contact with local schools superintendents and Kent State University at Trumbull. If a lengthy school shutdown happens, teachers likely would have provisions to give students assignments at home.

“Phase III” would involve a mass inoculation of the community. There is currently no vaccine for COVID-19; though one is under development, it may take about a year to reach mass production.

Migliozzi said if COVID-19 is spreading through the community when a vaccine becomes available, the entire Trumbull County population is expected to be vaccinated within 48 hours, per state goals. “That’s nearly impossible,” he said.

For that reason, the health district has agreements with “anybody that has the ability to do a vaccine” — such as fire departments with EMTs and smaller nursing facilities — to set up vaccination stations across the county.

In pandemic events, vaccines come from the Strategic National Stockpile and are administered for free. The large quantities of supplies, including items such as needles and gloves as well as the vaccine itself, will be transported on pallets in large vehicles — in Trumbull County, those vehicles will be provided by the Trumbull County Engineer’s office.

Supplies will be taken to KSU Trumbull, which would serve as a central distribution center and a space for the Trumbull County Combined Health District to operate throughout the immunization process. Migliozzi said there are also plans in place to get vaccines to people with functional needs who may not be able to get to distribution areas.

Any confirmed cases in Ohio must be reported immediately to the local health district.

HOSPITALS

Hospitals are also gearing up for the possibility of a pandemic.

A statement from Mercy Health — which operates St. Elizabeth Boardman and Youngstown hospitals and St. Joseph Warren Hospital — reads: “Our clinical leaders have implemented protocols that are consistent with CDC guidelines, and we’re closely monitoring the situation across our ministry.”

The hospital is directing all virus questions to the Trumbull and Mahoning county health departments.

The Ohio Department of Health recommends anyone who thinks they may have the virus to call before visiting her or his doctor.

Most hospitals are now using a question-based screening for those who believe they have COVID-19 — questions focus on symptoms and the possibility of exposure, including if a person has traveled to or through an affected area.

A respiratory panel test is given to “persons of interest” who have traveled to COVID-19 hotspots in the last two weeks or have had contact with confirmed cases. As of Friday, two people were under investigation in Ohio, while eight people who had been investigated tested negative for the virus, according to ODH.

WHAT IS COVID-19?

COVID-19, or the novel coronavirus, was first identified in the Chinese city of Wuhan. It is a new and still unpredictable strain of coronavirus, but “coronavirus” is broadly a type of upper respiratory illnesses.

“Anybody in clinical medicine at all learned about coronavirus,” said Dr. Brad Lucas, chief medical officer of Columbus-based Buckeye Health Plan. He said coronavirus falls into the same family as the common cold — what makes COVID-19, named for its origin in 2019, different is that it seems to be more severe than the common cold.

“We don’t think of the common cold killing someone,” Lucas said.

He said COVID-19 has been affecting the elderly, especially those with chronic lung problems — “It seems to affect them more than we’ve ever seen.”

Additionally, the virus can be in the human body for a comparatively long time without symptoms showing, which allows the virus spread to sometimes go undetected.

Methods recommended to the general public to help prevent COVID-19 are the same as those recommended to combat the common cold: get adequate sleep, stay at home when sick and wash hands often — washing for 20 seconds or more.

ODH recommends cleaning all “high touch” surfaces — countertops, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards and tablets — every day.

The U.S. Environmental Protection Agency has released a list of bacterial-killing products for use against COVID-19. Many Clorox and Lysol brand disinfecting products as well as Purell brand professional surface disinfectant wipes and others are included on the list, which can be found on the EPA’s website.

Lucas said people will have to adopt a different mentality, avoiding touching their faces and standing eight to 10 feet away from people who appear to have a cold — practices medical professionals have been recommending for years.

IMPACT

Lucas said the real concerns with COVID-19 stem from the unanticipated ways the virus could affect the community.

“It’s coming to Ohio and you’re going to see more people staying home, more businesses not being open, more workers not wanting to work if they’re going to be around people,” said Lucas. “And then you’re going to realize all the things about your daily life have changed.”

For example, he said while getting breakfast at a hotel recently, he began to think about all the items he had to touch, such as the coffee pot, silverware and croissant.

“Did somebody sneeze on the croissant?” he wondered.

Kent State University has issued a notice to students canceling planned spring break trips to Italy, which is listed as a CDC level 3 travel warning; and Vietnam, which had a flight passing through South Korea, also listed as a level 3 warning.

CDC recommends avoiding all non-essential travel to Level 3 destinations due to a “high risk” to travelers and no precautions available to protect against the identified risk. China, Iran, South Korea and Italy were listed as level 3 risks, and Japan was listed as level 2. An interactive travel risk map is available on the CDC’s website.

“In addition, university-sponsored faculty and staff travel to level 3 travel warning countries for any purpose including, but not limited to conferences, grant work and consulting are prohibited. If or when additional countries are assigned a level 3 travel warning by the CDC, the university will cancel trips to, or through, those countries up to the day of departure,” KSU’s statement said.

A January message from Youngstown State University President Jim Tressel stated there are no YSU-sponsored trips or research activities in the affected areas. Later communications to students urged them to avoid non-essential travel to China and to be aware of possible impacts to international spring break travel.

“Anyone traveling internationally should consider the very real possibility of additional travel warnings, new entry and exit control measures, and even quarantines implemented with very little notice during the coming weeks. These actions could severely impact your timely return to campus,” reads the March 2 YSU notice.

Lucas predicted there may be one other unintended consequence of COVID-19: instances of the common cold and the flu may be reduced as people take extreme measures to avoid getting sick.

“There’s nothing wrong with really staying aware of things, but we don’t want to be too fearful,” Lucas said. “If we become too scared and fearful then we affect all of our lives. The results are going to be really bad for our jobs, for the economy, for our businesses.”