The coronavirus that has infected more than 100,000 people around the world landed in Nevada last week.
It was diagnosed at both ends of the state in patients who have since been quarantined. The total of known cases in Nevada now stands at four. Two people in Washoe County and two people in Clark County.
Public health experts say that despite this milestone, the risk to any individual remains low, particularly if preventive measures are employed like washing your hands and disinfecting hard surfaces.
Christina Madison is a pharmacy professor at Roseman University and the former president of the Nevada Public Health Association.
She said when the virus first started to spread testing was limited to just people who had traveled to or been exposed to people who traveled to China, but that has changed.
"Now we know that we're seeing sustained human-to-human transmission within a community," she said, "That community spread is how we're handling the virus differently now."
Madison said there is now a broader net for people who might have the virus and who might need to be tested.
She said that people with a high fever, dry cough and shortness of breath should be tested; however, she recommended that people who are just concerned about their exposure should not flood emergency rooms or clinics with the "worried well."
Instead, she and other health professionals recommend calling a primary care doctor first and discuss their symptoms.
Because there is a limited number of test kits and the test kits are not rapid kits, health officials want only the people at the most risk or people who are sickest to get tested.
Madison also said that testing should not cost more than a person's insurance co-pay and people should not avoid going to the doctor over fears of not having the money to pay for testing and treatment.
"We don't want people to not get tested or at least not seek medical attention because of fears of having a surprise bill or not being able to afford it," she said, "We're in the middle of a public health crisis at this point. We don't want people to not seek medical because of fear of not being able to pay."
One of the big questions that remains about the virus is the mortality rate. Overall, it's believed that COVID-19 is more serious than the flu, but Mark Pandori, the director of Nevada State Public Health Laboratory, said health professionals really don't know.
"The data that we do have you'll see the number of deaths or fatalities divide that by what we know is the number of cases," he said, "If you do that, you'll get a number somewhere in the neighborhood of two percent - may be higher."
He said just looking at those numbers then it could be said that coronavirus would be a very dangerous infection to get; however, he said that health officials are still not sure of the number of people who have actually had the disease, making it difficult to know just how deadly it really is.
"When surveillance testing gets online, what we'll have is much more widespread testing going on and find the true number of people who are infected," he said, "When we know the true number - or at least get close to that... when we have a better idea of the total number of people that are actually infected and then divide the fatalities by that, it is possible that that number will come down."
Pandori said that we know the mortality rate of the seasonal flu because there is a surveillance network already established to look for flu cases and deaths.
The four cases that have been diagnosed have been in Nevada's two population centers but there are people living between Reno and Las Vegas.
Joan Hall is the president of the Nevada Rural Hospital Partners. She told KNPR's State of Nevada four patients have presented with symptoms at rural hospitals. She said one of those cases was tested and two others were transferred to other hospitals before they could be tested.
Hall said the state is overseeing the response to the virus in rural counties and she said the state division of health has been "fantastic" in helping rural hospitals prepare.
"Some of our biggest concerns are resources," she said, "We are obviously small and so we have limited number of medical providers and nurses and protecting them and our housekeeping staff is paramount, as well as, protecting our communities."
Hall said another concern is the distance that needs to be traveled to get test kits to labs in Las Vegas and Reno. She agreed with Madison that people who are concerned about their health should first contact their health care provider by phone or over an internet connection instead of going into a doctor's office.
Listeners called in to talk experts about other specific questions. Here are a few of their questions and answers:
Should someone who is returning from a cruise self-quarantine?
Madison: The key here is if they are asymptomatic and they haven't been around anyone who is sick or ill, their risk is most likely low. Unless they are saying that they were around someone who was sick or if someone who was on their cruise ship turns out to have been sick then I don't think there is anything you need to worry about right now.
Can you get the virus from a package sent from China?
Madison: It is spread through respiratory droplets. The main way that you get this is through contact with another human. It is not from a package. You could potentially get it from touching a surface that has been recently exposed to one of those respiratory droplets - either a sneeze or a cough but it doesn't live on surfaces for long periods of time.
Should people who think they have the virus stay home?
Hall: Unless it gets to the point that you have shortness of breath or very difficulty breathing and then you should seek medical assistance but actually staying home and away from the germs is probably one of the best things that you can do for yourself.
Southern Nevada Health District - Coronavirus - 702-759-INFO
Centers for Disease Control and Prevention - Coronavirus
Nevada Department of Health and Human Services - Coronavirus
Christina Madison, professor, Roseman University; Mark Pandori, director, Nevada State Public Health Laboratory; Joan Hall, president, Nevada Rural Hospital Partners
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