‘Unprecedented’: Ohio makes sweeping changes to slow coronavirus spread

Following evidence that the coronavirus outbreak is spreading among people in Ohio communities, Gov. Mike DeWine ordered restrictions on visits to nursing homes and assisted living centers and announced a forthcoming order that will impact mass gatherings, including NCAA basketball tournament games in Dayton and Cleveland.

Fans will not be allowed to attend NCAA March Madness games scheduled to be played in Dayton and Cleveland, the governor said, just before the NCAA determined no tournament games in the U.S. would be played in front of large crowds.

Restricting mass gatherings is recommended to slow the spread of coronavirus so that Ohio’s health care system is not overwhelmed with a spike in cases, said Ohio Department of Health Director Dr. Amy Acton.

“We’re going to be able to take care of people better and we’ll be able to handle this better and ultimately save lives,” said Gov. Mike DeWine.

Acton is expected to sign the public health order on mass gatherings in the coming days.

“We know when we take these actions, they make a difference,” said Acton.

Community spread

A fourth Ohio confirmed case announced Wednesday involves a 53-year-old man in Stark County who first fell ill Feb. 25 and is now hospitalized. He had no history of international travel or known contact with someone with the virus — which indicates that the virus is spreading in Ohio communities.

“Community spread is a game changer,” Acton said.

She noted that up to 40% of Ohioans may end up getting infected. The fatality rate with coronavirus disease increases with age and can be as high as 15% for people in their 80s, Acton said.

With that in mind, Acton will issue an order restricting visitors to nursing homes and assisted living centers to one per day per resident. Visitors and vendors will be screened and logged when they enter those centers.

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Community spread requires different types of prevention measures to keep Ohioans healthy. Public health workers and elected officials also emphasized that while the measures being taken are disruptive, they are not a reason to panic, but rather a sign of health officials taking the right measures to manage the situation.

Local officials expect to see cases at some point in the Miami Valley.

“We’re not panicking,” Dayton Mayor Nan Whaley said. “We’re just being really thoughtful about public events and social distancing … I know Dayton will do this well, we’ll be able to save lives and keep our health system intact.”

The city of Dayton, Montgomery County and Public Health - Dayton & Montgomery County said at a press conference that they are working together and have plans and tools in place to respond. They urged people to have a family emergency plan such as having food and any regular prescription medications in case they need to stay home a few days.

“We want to reassure the public and ask that you remain calm,” said Montgomery County Commissioner Judy Dodge. “Much like the spread of the flu, the best thing you can do to help our community is to practice good hygiene that will prevent the spread of germs.”

The Winter Guard International championships in April were cancelled for this year in Dayton because of the outbreak. Dayton Convention and Visitors Bureau President Jacquelyn Powell said the Winter Guard International competition will be back in Dayton in 2021.

WGI championships bring 60,000 visitors and almost $20 million in revenue over the two weekends.“These are unprecedented times for all of us. We fully support our state and local officials, making these decisions for the health of our community and visitors,” Powell said.

Public Health Commissioner Jeff Cooper said there will be disruptions or changes to people’s normal way of life, but all measures being taken are about protecting population health.

“I believe that by working together, we will continue to meet this unprecedented, emerging infectious disease public health challenge in our community,” Cooper said.

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The governor did not take action regarding K-12 schools, which are attended by 1.74 million students. But he noted that discussion is underway about waiving state requirements, such as standardized tests, if closures become necessary.

It marked the third day in row in which DeWine announced aggressive moves designed to slow the spread of the coronavirus to protect vulnerable people and guard against cases overloading Ohio’s health care system.

On Monday, he announced three Ohioans in Cuyahoga County had tested positive and he declared a state of emergency. On Tuesday, he asked indoor sporting events to voluntarily bar spectators, stopped visits for 48,000 inmates in Ohio’s 27 prisons and three youth detention centers and asked public and private colleges and universities, which have 635,000 students, to move to online learning.

“It’s almost takes your breath away how fast things are changing,” DeWine said after visiting the Ohio Department of Health where 25 workers are taking calls from the public on coronavirus. Life as we know it will change for a period of time, he said.

DeWine urged Ohioans to make responsible choices to keep themselves, family members and community members healthy. If they can avoid a trip, social gathering or crowds, they should do so, he said.

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“This is the time to come together. Maybe not physically together, but emotionally. Do what you can to protect your neighbor and protect yourself and your family. It is a time to look forward and accept what the reality is and accept what the experts are telling us,” DeWine said.

Why the strong response?

In an outbreak, cases climb until they reach a peak and then case counts go down.

If an outbreak happens along a natural course with no efforts to control its spread, then the speed of new cases and number of cases quickly climbs beyond what hospitals and health care can handle (which is what Italy is experiencing with the coronavirus outbreak). Eventually, cases reach a peak and circulation starts to slow.

The public health goal is to lower that peak, delay that peak, and slow the number of new cases.

When good prevention measures are in place, the number of new cases rises slower. The peak number of cases in the outbreak comes later, giving health systems time to prepare and learn about the disease. There are fewer severe cases at a time, which keeps the number of extremely sick people low enough where hospitals can effectively treat all their patients.

In order to not go the same route as Italy and other places that have been overwhelmed, health care experts guiding DeWine administration have recommended precautions like keeping social distance, not having large close gatherings of people like indoor sporting events, and limiting visits to loved ones in nursing homes.

The reason for their aggressive recommendations — even though the confirmed case numbers in the U.S. remains low — is because the time when the dangerous first scenario can be prevented is while case counts are lower. Prevention measures don’t make the same difference if implemented after a virus is already widespread.

Influenza remains a public health concern, with flu still widespread in Ohio and more than 8,500 Ohioans have stayed in a hospital so far this season for flu-related reasons. Health officials have said flu shots are recommended not only for the standard prevention reasons, but also because it can help keep people from having symptoms confused for the coronavirus and can keep capacity free at local health care systems in case there are people with COVID-19 who need to be cared for.

Hospitals prepared

“If we don’t do things in Ohio to both decrease the pace of this infection as well as the intensity of this infection in the community, some of our communities will end up being overwhelmed by this. Not every hospital in Ohio has the capacity with the types of rooms that you need and the equipment that you need to manage these patients so many of our larger hospitals will be relied upon regionally to take these patients,” said Dr. Any Thomas, chief clinical officer at Ohio State University Wexner Medical Center.

Greater Dayton Area Hospital Association president and CEO Sarah Hackenbracht said the board of trustees activated a regional task force for COVID-19. It includes the executive leadership of all of the hospitals in the region and their designated clinical leaders.

“This is something that they are escalating to the highest level of each of their organizations,” she said.

The hospitals have activated their incident command systems and that involves leadership on multiple levels and disciplines reviewing plans already established and in place for different emergency scenarios and figuring out what needs to be retooled or redeployed.

“In this particular instance, we’re looking heavily at plans that were developed for Ebola, for H1N1, for seasonal flu,” she said.

NCAA makes decision

NCAA President Mark Emmert said Wednesday that he made the decision to conduct both the men’s and women’s tournaments, which begin next week, with only essential staff and limited family in attendance. The decision comes after the NCAA’s COVID-19 advisory panel of medical experts recommended against playing sporting events open to the general public.

Emmert told The Associated Press that canceling the tournament was considered.

“The decision was based on a combination of the information provided by national and state officials, by the advisory team that we put together of medical experts from across the country, and looking at what was going to be in the best interest of our student-athletes, of course,” Emmert told the AP in an phone interview. “But also the public health implications of all of this. We recognize our tournaments bring people from all around the country together. They’re not just regional events. They’re big national events. It’s a very, very hard decision for all the obvious reasons.”

Emmert said the NCAA also was looking into moving the men’s Final Four from Atlanta’s Mercedes-Benz Stadium to a smaller arena. The NCAA will consider using smaller venues for regional sites currently scheduled to be played at the Toyota Center in Houston; Madison Square Garden in New York; Staples Center in Los Angeles and Lucas Oil Stadium in Indianapolis.

The decision applies to more than just men’s and women’s basketball. All NCAA-sponsored championships including hockey’s Frozen Four will be affected.

The Associated Press contributed to this story.