The Teton County COVID-19 Response Team met remotely on March 18, connecting via online meeting software to share information about how different public and private entities are responding to the pandemic of viral illness.
Teton County Health Department Director Melissa Moyer moderated the meeting, which included participants from Teton County Disaster and Emergency Services and Emergency Medical Services, the Health Department, Benefis Teton Medical Center, Sheriff Keith VanSetten, the county Superintendent of Public Schools and other school officials, the mayors of Choteau and Fairfield, County Sanitarian Austin Moyer, the county commissioners and USFS Rocky Mountain District Ranger Mike Munoz.
Moyer said this standing group will meet by online meeting software every Thursday at 9 a.m. until the crisis abates. She suggested citizens who want more information can go online to the U.S. Centers for Disease Control and Prevention, the Teton County Health Department or the state of Montana websites.
Moyer said she will work with Benefis Teton Medical Center and other Teton County providers to make sure that people in the county who need testing receive it and that, if or when cases are diagnosed here, their social contacts are informed so they can voluntarily self-isolate for 14 days.
In the meantime, she said, everyone in the county has been advised to exercise social distancing to help “flatten the curve” — to prevent a huge spike in cases that would overwhelm the state’s hospitals and leave people without access to oxygen, IVs for hydration and ventilators for pulmonary support.
COVID-19 is the illness caused by a virus named SARS-CoV-2, which first appeared in late 2019 in Wuhan, China, and has since spread across the world and has been declared a pandemic by the World Health Organization.
Symptoms of COVID-19 can include fever, cough and breathing trouble. Most develop only mild symptoms, but some people, including older people and those with other medical complications, develop more severe symptoms, including pneumonia, which can be fatal.
Moyer said social distancing is also necessary to protect high-risk individuals, including those 60 and older and anyone who has chronic health conditions such as lung and heart disease, diabetes or a compromised immune system.
“We live in an area of the state and the nation with a lot of people who do fit into that high risk category,” Moyer said, adding that everyone wants to keep the vulnerable population as healthy and safe as possible.
Social distancing can also protect individuals and families throughout a community, she said.
Moyer said the Teton County Board of Health met on March 16 and agreed that the board would support social distancing and would encourage businesses to use strategies to minimize the risk of exposure to patrons.
At that time, the Board of Health did not move to impose any business closures, but on March 19, Montana Gov. Steve Bullock, who had already closed all public schools, took the next step of closing all places where people congregate, including restaurants, coffee houses, bars, breweries, gym, theaters, bowling alleys and more, starting at 8 p.m. on March 20 and lasting through midnight on March 27, with the knowledge that the closure could be extended.
The governor’s order does allow restaurants to continue to serve to-go meals, available for pickup at the business, and to deliver to-go meals.
Moyer updated the group on testing capacity in Montana, saying that it has increased. Three weeks ago, the state had only 200 test kits. Now the state is well beyond that, but the capacity still does not allow health departments to do comprehensive testing. Instead, she said, tests will be given based on criteria including, a fever of 100.4 degrees or higher, respiratory symptoms, dry cough, travel to an infected area, known contact with a positive case, having high-risk factors or showing symptoms consistent with COVID-19.
Anyone who thinks they may have COVID-19 and are having trouble breathing should call 9-1-1 or go to the emergency room, she said. Those experiencing more mild symptoms should call their healthcare provider or the Teton County Health Department (466-2562) and seek advice on whether they need to see a medical provider and whether they need to be tested.
Teton County EMS/DES Coordinator Deb Coverdell said the county ambulance service has been in contact with Great Falls Emergency Services to review that company’s contingency plan. She has also talked to Teton County emergency dispatchers, asking them to get as much information as possible from anyone calling for an ambulance with COVID-19 symptoms. If COVID-19 is suspected, she said, one responder would go in to do the initial evaluation.
She said the county ambulance service’s medical director was set to meet with the ambulance crews on March 19 about protocols to protect EMS volunteers from being exposed to the coronavirus.
Also, she said, BTMC has asked that the EMS providers call the hospital in advance if they are bringing in a potentially contagious patient.
Wearing her DES hat, Coverdell said she is tracking impact to communities in Teton County through school closures, public event cancellations and business impacts. She said anyone with impacts should email her so that she can keep track of their information.
BTMC medical director Judy Borland, a Fairfield physician, and disaster coordinator Amanda Copenhaver said they have set up a room adjacent to the emergency room, where COVID-19 patients can be isolated and evaluated. This room can be disinfected after each patient, Borland said, adding that the hospital wants anyone with a respiratory illness to call in advance. “That would be a huge help,” she said.
Borland agreed with Moyer that the general population will not be tested for minor illness, but added that healthcare providers who become ill will be tested. For those who are tested, she said, they will first be tested for influenza, then another virus panel. If those tests are all negative, then the patient may be a candidate for COVID-19 testing.
She said BTMC would prefer not to have any COVID-19 positive patients hospitalized here because of the risk that creates for the 19 extended care facility residents in the 25-bed Critical Access Hospital. But, she said, BTMC may need to do that if Benefis Health System in Great Falls is overwhelmed. If that does occur, she said, the hospital will likely create one wing for infectious patients and take all steps to prevent the spread of COVID-19 to the long-term care residents.
Copenhaver said at BTMC presently all potential patients and outpatients are checking in at the front desk, where they are asked about symptoms, travel, etc., and have their temperatures taken. Members of the staff are also undergoing daily screening and temperature checks.
Dr. Borland said in the BTMC community clinic, the staff has designated rooms for “sick” visits and for “well” visits and are talking about possibly using telemedicine for well patients who do not want to come to the facility.
BTMC Chief Operating Officer Susan Murphy said the hospital is still offering all essential services though some outreach services (including cardiology and mammography) have been postponed for the month. “We are not closed,” she said, but added that the hospital and long-term care wing are closed to visitors.
Borland said the hospital is also serving long-term care residents their meals in their rooms. “We are trying to keep them as safe as we can,” she said.
Borland also noted that Choteau dentist Luke Allen, following the recommendation of the American Dental Association, is now closed to all but dental emergencies.
Moyer said that Frontier Family Practice in Fairfield is now seeing well people in the morning and sick people in the afternoon to minimize the risk of infection.
Moyer said long-term care facilities and group homes are all closed to outside visitors and most are serving meals to residents in their rooms and screening staff for fevers and any sign of illness. The senior citizens centers in Choteau, Power, Dutton and Fairfield have stopped serving communal meals but are still providing to-go meals and delivering meals to shut-ins.
Eyglo Nelson with the Skyline Lodge retirement apartment complex in Choteau said meals are being delivered to residents’ apartments and there are signs on the front door asking people who feel ill not to visit.
Moyer said Choteau Activities, which provides services to intellectually disabled adults, has an excellent prevention plan and has put it into effect.
Munoz said the USFS several weeks ago paused all traveling for staff so they don’t bring illness back to the communities in which they work. The USFS is also having as many employees as possible work from home though the USDA Service Center in Choteau remains open and employees are still doing mission-critical work for customers.
He also said that under the federal Robert T. Stafford Disaster Relief and Emergency Assistance Act, the USFS can provide help in Choteau and Augusta with food deliveries or other logistical or operational needs.
County Sanitarian Austin Moyer said he has received guidance from the state Department of Public Health and Human Services and the CDC for how businesses can respond to the COVID-19 outbreak for public safety and for the safety of their employees, and he is in contact with county businesses in that regard.
The county is planning a table top exercise on April 7 at 1:30 p.m. to talk through different COVID-19 scenarios.
Editor’s note: This story was written on March 23. Changes in the present coronavirus situation may have occurred by the time this story is published and distributed on March 25.