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As the COVID-19 outbreak spreads across the United States – with Colorado reporting 11 cases Monday – residents, businesses and government agencies are taking precautions and making preparations for what could be a deadly fight.

In Montezuma County, law enforcement officials are wiping down squad cars, and Southwest Health System has prepared for diagnosing and isolating patients.

In Durango, grocery stores are running low on hand sanitizer and disinfectant wipes, health workers are brushing up on emergency management plans and government officials are discussing response efforts should an outbreak occur here.

Public libraries are stepping up efforts to clean surfaces and even books.

They’re not alone. While the threat of a COVID-19 outbreak remains low in Southwest Colorado, the flu-like virus has people on high alert. One of the clearest signs of the community’s concerns are the barren shelves usually stocked with hand sanitizer at Walmart, City Market and Albertsons. Employees at the businesses report they were empty last week.

Customers at north City Market have bought up most of the store’s disinfectant wipes and household cleaners. Walmart is out of masks and is running low on supplements, rubbing alcohol and antibacterial soap.

Colorado’s first confirmed cases

The Colorado Department of Public Health and Environment announced Thursday that the state had its first confirmed cases of COVID-19. Friday, the state announced that eight people had diagnosed with COVID-19, all on the Front Range.

The first was a man in his 30s visiting from out-of-state who had contact with a known case of COVID-19 outside of Colorado, according to a news release. The state said it was proceeding as if the case was officially confirmed, but the results would still be sent to the Centers for Disease Control and Prevention for confirmation.

The man was recovering in isolation in the Denver metro area until cleared by public health officials, and the state health department is working with local public health officials to identify anyone who might have been exposed while the person was infectious, the news release said.

Denver Public Health & Environment warned that the number of people testing positive is expected to rise since the Centers for Disease Control is now allowing providers to test patients on their own without help from county health departments.

There were zero confirmed cases in Archuleta, Montezuma and La Plata counties as of Friday afternoon, according to San Juan Basin and Montezuma County public health departments.

Montezuma County has a planSouthwest Memorial Hospital and the Montezuma County Health Department have protocols in place for preventing and responding to COVID-19, officials said.

“This is a rapidly evolving situation,” said Marc Meyer, director of Pharmacy Services and Infection Control for Southwest Health System. We want people to be aware that SHS continues to work to provide the care our community needs in the event we start seeing cases in our area.”

The hospital works with the Centers for Disease Control and state and county health departments on suspected cases of COVID-19. If a case is suspected, a specimen would be sent to the Colorado Department of Health and Environment to be tested.

If confirmed as COVID-19, SHS will coordinate with the health department on quarantine measures for the patient, Meyer said. The health department will conduct further investigations on who else may have been potentially exposed and take appropriate action.

If a patient shows symptoms of respiratory illness, SHS can test to rule out the flu. Other factors for a suspected coronavirus case include whether a patient has a travel history from an area where there are a lot of cases.

SHS asks that you call ahead if you have a fever, cough, and shortness of breath, so your health care provider can prepare for your arrival. Special areas will be set up to isolate the patient.

Health officials warn that once the corona virus is detected in a community, numbers can increase quickly.

Updates are regularly posted on the SHS Facebook page and website. The SHS email is contact@swhealth.org.

The city of Cortez is preparing to possibly take action, but will let the county Public Health Department take the lead, said City Manager John Dougherty. Staff are collaborating with Southwest Memorial Hospital, posting the hospital’s public service announcement online, and the council will hear a presentation by the Public Health Department at their March 10 meeting.

Dougherty said that for now he’s postponing a conversation with council about how the outbreak should be handled if it worsens – for example, if all non-essential personnel would be asked to stay home and if city facilities would need to be closed.

“Mostly wash your hands and don’t panic,” he said.

Jails are on alert

Montezuma County Sheriff Steve Nowlin said precautions are also being taken regarding the threat of COVID-19 in the county jail.

If an inmate is suspected for the virus, jail officials will coordinate with the county health department for appropriate action including transport to Southwest Memorial for further testing, Nowlin said.

Also, patrol cars are being regularly wiped down with sanitizer. Law enforcement, jail staff and inmates have been informed of the potential threat and procedures.

The close quarters at the La Plata County Jail are ripe for disease to spread, said Capt. Ed Aber, the jail’s top administrator with the La Plata County Sheriff’s Office.

“Anytime somebody has a common cold in the jail, there’s a lot of people who get the common cold,” he said. “If somebody gets the flu, there’s a great potential of that spreading to employees and inmates.”

First steps of avoiding an outbreak in the jail are to identify where people have been before they’re booked, Aber said. If anyone is sick when they’re booked in the jail, that individual will be put into isolation to avoid contact with others.

Schools, libraries take precautionsLocal schools are also reminding families to take proper precautions. On March 3, the Montezuma-Cortez School District Re-1 posted on social media that staff were in communication with the Colorado Department of Public Health and Environment and the local health department.

“The district will continue with our school health plan and prevention practices including sending students home who are not feeling well, reminding students and staff to wash their hands often and cover their mouth if they sneeze or cough, and regularly disinfecting schools during and after school hours,” the post says.

The district also asks that students remain at home when sick. They cited guidelines from Children’s Hospital Colorado for when children should be kept home. Children exhibiting mild respiratory or cold symptoms (like a stuffy nose or mild cough) can go to school, but students with high fever or who are vomiting or exhibiting “flu-like” symptoms should stay home.

What we don’t knowCarol Huser, a medical doctor and forensic pathologist of more than 30 years, was already thinking about returning to Durango from Florida. If COVID-19 spreads farther through the United States, she might return sooner, she said.

“I think the smaller the population, the better,” Huser said.

Proximity to other people is the biggest factor in the spread of a virus, she said.

“The farther you distance yourself from other people ... the fewer people you’re around, the better,” she said. “If you never get within 10 feet of another person, you’re not going to catch a virus at all.”

Experts still do not know as much as they would like about COVID-19.

Virus behavior depends on the virus, Huser said. Experts are still learning about rates of infection, rates of lethality, likelihood of spreading the virus before showing symptoms and the effectiveness of antiviral drugs.

They do not yet know how far the virus travels after a sneeze or cough, or if the virus would interact differently in a high-altitude, semi-arid climate versus other climates.

Some viruses’ ability to infect people seems to be affected by heat and humidity, but no one knows if that’s true yet for the new coronavirus, named SARS-CoV-2.

Overall, Huser urged people not to panic. But people of all ages should take it seriously and stay home if they are sick.

“If you do get it and you’re young and healthy and get over it, great,” Huser said. “But you still could affect your parents, grandparents ... that might not be as strong as you.”

The CDC said coronaviruses, a name that simply refers to the shape of the virus, have poor survivability on surfaces and there is likely a low risk of spread from products or packaging.

After numerous people who attended a Buddhist temple in Hong Kong fell ill, samples from restroom faucets and other surfaces tested positive for coronavirus, according to a New York Times article.

Other coronaviruses remained on metal, glass and plastic for two hours to nine days, according to a German study published in February.

Surface disinfectants effectively inactivated the coronaviruses, the study said.

“Please respect other people, and either don’t come in sick or wear a mask,” Vining said.

Health agencies review emergency planWhile there have been zero confirmed cases of the virus in Southwest Colorado, San Juan Basin Public Health continues to evaluate the risk of an outbreak with its emergency management plan for La Plata County, said Claire Ninde, SJBPH’s director of communications.

“The purpose of our plan is to promote a system to save lives, protect public health and environment, alleviate damage and hardship, and reduce future vulnerability within Archuleta and La Plata counties,” Ninde said in an email to The Durango Herald.

SJBPH’s emergency plan involves different levels of activation, depending on the emergency. As of Thursday afternoon, the health department had activated its emergency plan at a Level 2 for enhanced response, Ninde said.

This level involves opening a Department Operations Center and implementing its Incident Command System to increase coordinated response efforts in the community.

“Basically, this allows us to secure the resources we need and utilize the full breadth of subject matter expertise that we have across our workforce to prepare,” Ninde said.

While the health department is responsible for handling much of the community response coordination, Mercy Regional Medical Center handles the testing for COVID-19. Similar to a flu test, a COVID-19 test is obtained by a swab of the patient’s nasal canal and then transported from the Mercy lab to the Colorado Department of Public Health and Environment, said Dr. Jennifer Rupp, infectious disease physician with Four Corners Infectious Disease and Internal Medicine at Mercy.

If someone in the community tested positive for COVID-19, San Juan Basin Public Health has a series of protocols in place, Ninde said. The health department would first notify regional medical providers, release the information to the media and continue to share the news via social media, its website, radio and television.

Ninde added encouraged concerned residents to check the website SJBPH established for COVID-19 updates.

Journal reporters Jim Mimiaga and Erika Alvero and Herald reporters Liz Weber, Shannon Mullane and Bret Hauff contributed to this story.