March 31, 2020

MARSHALL NEWS MESSENGER
https://www.marshallnewsmessenger.com/news/commissioners-to-consider-extending-declaration-of-local-disaster/article_e49c5bb2-72d5-11ea-81ab-4b82ec866d2f.html?utm_medium=social&utm_source=email&utm_campaign=user-share

Northeast Texas COVID-19 case count
Updated 16 hrs ago
The total of cases in Northeast Texas is now at least 56 in 14 counties. Here’s a look at totals reported late Sunday and early Monday, and changes from Sunday’s report:

Angelina: 3
Bowie: 9 (+5)
Camp: 1 (+1)
Cass: 2
Cherokee: 1
Gregg: 5 (+1)
Harrison: 1
Hopkins: 2 (+1)
Morris: 1
Nacogdoches: 2 (+1)
Rusk: 3 (+1)
Shelby: 2 (+1)
Smith: 32 (+1), 1 death
Upshur: 2 (+1)
Van Zandt: 1 (+1), 1 death

MESSAGE FROM DR. HERMAN FELTON OF WILEY:
Marshall News Messenger] Leading with Faith during a global crisis
https://www.marshallnewsmessenger.com/opinion/leading-with-faith-during-a-global-crisis/article_1591373e-7145-11ea-b870-d3bae7275e1b.html?utm_medium=social&utm_source=email&utm_campaign=user-share

NEW ENGLAND JOURNAL OF MEDICINE RE CERTAIN BP PILLS:
KEEP TAKING THEM
https://www.nejm.org/doi/full/10.1056/NEJMsr2005760?query=RP
Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19

SUMMARY: Given the common use of ACE inhibitors and ARBs worldwide, guidance on the use of these drugs in patients with Covid-19 is urgently needed. Here, we highlight that the data in humans are too limited to support or refute these hypotheses and concerns. Specifically, we discuss the uncertain effects of RAAS blockers on ACE2 levels and activity in humans, and we propose an alternative hypothesis that ACE2 may be beneficial rather than harmful in patients with lung injury. We also explicitly raise the concern that withdrawal of RAAS inhibitors may be harmful in certain high-risk patients with known or suspected Covid-19.
Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19
https://www.nejm.org/doi/full/10.1056/NEJMsr2005760?query=RP

NAMES OF THIS TYPE OF MEDICINE: KEEP TAKING THEM UNLESS YOUR DOCTOR TELLS YOU TO STOP.

candesartan Atacand
eprosartan
irbesartan Avapro #
losartan Cozaar #
olmesartan Benicar
telmisartan Micardis
valsartan Diovan #
benazepril Lotensin

captopril Capoten
enalapril Vasotec #
enalapril solution Epaned
fosinopril
lisinopril Prinivil #
lisinopril Zestril #
lisinopril solution Qbrelis
moexipril
perindopril
quinapril Accupril #
ramipril Altace #
trandolapril

Covid-19 — Navigating the Uncharted (A NEJM editorial by DR. FAUCI—the little NIH doctor on the TV updates)
List of authors.
Anthony S. Fauci, M.D., H. Clifford Lane, M.D., and Robert R. Redfield, M.D.

https://www.nejm.org/doi/full/10.1056/NEJMe2002387?query=recirc_mostViewed_railB_article

This editorial is somewhat reassuring about the severity or mortality rate of the C-19 virus, but it points out it will take time to clear out. Easy to read. Based only on China, which means the cases are several months old. That’s why I also read the MNM and the NYT.  J. Harris, MD

ANOTHER NEJM SHORT ARTICLE WORTH READING:
Feeding Low-Income Children during the Covid-19 Pandemic
nejm.org/doi/full/10.1056/NEJMp2005638?query=RP

HERE’S HOW TO FIGHT CORONAVIRUS MISINFORMATION
Send this to the person in your life who needs to read it.

Consider the source and consider the source’s source.

Be patient, kind, deliberate, and fact-based. More people will listen.

We’re in this together. It’s our civic duty to ensure we’re all making the smartest decisions and not allowing rumors or conspiracy theories to take seed. We all have a role to play. You don’t have to become an epidemiology expert—the medical professionals and journalists will do their jobs. You do have to make an effort to not spread rumors or falsehoods, or anything else that could make a public-health response harder for those around you.

Lives depend on it.

JOHNS HOPKINS DAILY MESSAGE:
(Multiple helpful stories)
https://mail.google.com/mail/u/0/#inbox/FMfcgxwHMZPhtTChBCPJRvQLmhKXbDNv

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[Marshall, Texas, March 31, 2020]

Harrison County and City of Marshall Issue Mandatory Shelter in Place Orders

First Amended Declaration of Local Disaster and Public Health Emergency Related to Communicable Disease

[Harrison County and Marshall, Texas] Harrison County Judge Chad Sims and City of Marshall Mayor Terri Brown confirm a second and third positive case of the coronavirus (COVID-19) in Harrison County. In each case, the cause of COVID-19 exposure was travel-related. County and City leadership believe it to be in the best interest to be proactive and take measures to further safeguard our citizens and prevent community spread. In response, Judge Sims and Mayor Brown are both issuing Mandatory Shelter in Place orders effective at 11:59 p.m. on March 31, 2020.

                Under this Order, citizens of Harrison County and the City of Marshall are still permitted to perform essential activities for their families; including obtaining medical supplies, visiting a health care provider, obtaining supplies they need to work from home, grocery shopping, engaging in outdoor activities while maintaining social distancing, and to perform work defined as an essential service. Citizens at a high risk of illness from COVID-19 and people who are sick are urged to remain in their residence except to receive medical care.

                Essential services are defined as all first responders, emergency management personnel, individual performing government functions, healthcare operations, essential infrastructure, grocery stores, farmers’ market, food banks, pet stores, farming, livestock, fishing, social services, media, gas stations, auto supply/repair, banks, hardware, mailing services, plumbers, electricians, exterminators, laundromats, dry cleaners, restaurants, office supplies, airlines, private transportation, home-based services or shelters for seniors, adults or children, professional services (legal, accounting, insurance, real estate, appraisal, survey, and title), childcare, utilities, telecommunications, janitorial, maintenance, healthcare operations, funerals, defense industry, and educational services operating online. A full list of all essential services may be found in the Ordinance at www.marshalltexas.net.

Non-essential businesses shall shut down except for maintaining Minimum Basic Operations.  Essential Businesses exempted from shut-down are encouraged to determine staff who are essential to operations and to send non- essential staff home.

For the purposes of this Order, “Essential Travel” includes travel for any of the following purposes:

•             Any   travel   related   to   the provision of or access to Essential Activities, Essential Governmental Functions, Essential Businesses, or Minimum Basic Operations;

•             Travel to care for the elderly, minors, dependents, persons with disabilities, or other vulnerable persons;

•             Travel to or from educational institutions for purposes of receiving materials for distance learning, for receiving meals, and any other related services;

•             Travel to return to a place of residence from outside the jurisdiction;

•             Travel required by law enforcement or court order; or

•             Travel required for non-residents to return to their place of residence outside the City. Individuals are strongly encouraged to verify that their transportation out of the City remains available and functional prior to commencing such travel.

When citizens need to leave their places of residence, whether to obtain or perform vital services or to otherwise facilitate authorized activities necessary for continuity of social and commercial life, they should at all times comply with the Social Distancing Requirement.

Failure to comply with any of the provisions of this Order constitutes an imminent threat to public health. In accordance with Texas Government Code §418.173, a person who knowingly or intentionally violates this Order commits an offense punishable by a fine up to $1,000.00 and/or confinement in jail for a term that does not exceed 180 days, and each day or portion of a day that such a violation continues shall constitute a separate offense.

                The Emergency Management Team will continue to meet with leaders from Harrison County, Marshall – Harrison County Health District, CHRISTUS Good Shepherd Health System – Marshall, and City of Marshall monitoring the situation on an ongoing basis and providing notices to citizens as needed.

Harrison County and the City of Marshall are following the Centers for Disease Control’s (CDC) guidelines and recommendations on the steps our community can take to help prevent catching or spreading the coronavirus (COVID-19). This is a situation that continues to evolve and we will do our best to keep our citizens informed of the latest information.

Harrison County and the City of Marshall urge our community to practice healthy habits including:

1.        Restrict physical contact and publicly used areas.

2.        Maintain Social Distancing with a safe distance of six (6’) feet between individuals.

3.       Every person in Texas shall avoid social gatherings in groups of 10 or more per Executive Order of Governor Abbott.

4.         Residents should not visit nursing homes, retirement, or long-term care facilities unless to provide critical assistance.

5.        In accordance with the CDC, people shall avoid eating or drinking at bars, restaurants, and food courts, or visiting gyms or massage parlors. Residents may still utilize drive-thru, pickup, or delivery options through the Executive Order.

6.        Regularly wash hands with warm soap and water for at least 20 seconds.

7.        Avoid touching eyes, nose, or mouth.

8.        If soap is not available, use at least a 60% alcohol-based hand sanitizer.

9.        Avoid close contact with people who are sick. All persons should remain in the home if one person in the home exhibits symptoms

If you are experiencing fever, cough or difficulty breathing, been exposed to a sick traveler or been exposed to a person with COVID-19 in the last 14 days, please contact your healthcare provider immediately. Inform your physician or emergency department of your symptoms to prevent any potential spread.

The City of Marshall will hold City Commission meetings utilizing a video and audio conferencing tool, as well as, a standard conference call.  Instructions and direct links to view meetings or speak during Citizen Comment can be found at http://www.marshalltexas.net.

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March 30, 2020

Monday Longview Paper: Northeast Texas COVID-19 case count
Updated 50 min ago
The total of cases in Northeast Texas is now at least 56 in 14 counties. Here’s a look at totals reported Sunday, and changes from Saturday’s report:

Angelina: 3 (+2)
Bowie: 3
Cass: 2
Cherokee: 1
Gregg: 5 (+1)
Harrison: 1
Hopkins: 1
Morris: 1
Nacogdoches: 2 (+1)
Rusk: 3
Shelby: 1
Smith: 31 (+4), 1 death
Upshur: 1
Van Zandt: 1, 1 death
Sources: Texas Department of State Health Services, Northeast Texas Public Health District, local officials

TRENDS CHART: https://aatishb.com/covidtrends/?fbclid=IwAR3CtUglbwrC6HfhCJ9SoJTE5pAn0qeDyRizWLazaKb_Uk9lz9vI5A-cyK8.

LINEAR/LOG SCALE PROJECTION OF CVID
https://aatishb.com/covidtrends/?fbclid=IwAR3CtUglbwrC6HfhCJ9SoJTE5pAn0qeDyRizWLazaKb_Uk9lz9vI5A-cyK8

Sent to me by Dr. John Vasser who got it from a colleagues son who is PhD astrophysicists at Princeton’s Advanced Institute in NJ  (Einstein founding member)  Henry Lin

https://www.npr.org/sections/goatsandsoda/2020/03/27/822407626/mystery-in-wuhan-recovered-coronavirus-patients-test-negative-then-positive

THIS IS A COUPLE OF DAYS OLD. PROBABLY SOME CHINESE NUMBERS NEED TO BE EVALUATED CAREFULLY. A GOOD DOCTOR I KNOW IN HOUSTON SAYS THAT THEY ONLY LIE IF THEY MUST.

Last Thursday, Wuhan reported for the first time since the outbreak began that it had no new cases of the virus from the day before — a milestone in China’s virus containment efforts. The city reported a zero rise in new cases for the following four days.

Assessing asymptomatic carriers

But Caixin, an independent Chinese news outlet, reported earlier this week that Wuhan hospitals were continuing to see new cases of asymptomatic virus carriers, citing a health official who said he had seen up to a dozen such cases a day.

Responding to inquiries about how the city was counting asymptomatic cases, Wuhan’s health commission said Monday that it is quarantining new asymptomatic patients in specialized wards for 14 days. Such patients would be included in new daily case counts if they develop symptoms during that time, authorities said.

… Research suggests that the spread can be caused by asymptomatic carriers. Studies of patients from Wuhan and other Chinese cities who were diagnosed early in the outbreak suggest that asymptomatic carriers of the virus can infect those they have close contact with, such as family members.

https://vimeo.com/399733860

This long video features a New York ICU doctor who is very well informed. He’s a working doctor who’s  right in the middle of the epidemic.  It could stand some editing. It was sent to me by Dr. Al McClurg, who grew up in Marshall and lives in Austin. I don’t agree with a couple of minor things, but this doctor has been working daily in the midst of the epidemic. It runs over 30 min. but he answers many, many simple but pertinent questions. It is worth the time.

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March 28, 2020

1. NYT CASE MAP—CONSTANTLY UPDATED
Coronavirus in the U.S.: Latest Map and Case Count
https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

2. OXYGEN DELIVERY DEVICEs:

A. OXYGEN (O2) MASKS ALONE WITHOUT PRESSURE:
These may be tubes in the nostrils, a small mask over the nose and throat, or a shield over the face and perhaps the head — even a scuba mask. These simple systems are generally available and flow O2 without pressure for the patient to inhale. The patient must be able to breathe on his own. These O2 lines and be divided and can supply many patients at the same time without risk. In virtually all American hospitals, O2 is piped into each hospital room and service area. O2 can be delivered and used at home out of big green pressurized bottles.

B. O2 DELIVERY SYSTEMS with PRESSURIZED FLOW DIRECTLY INTO THE LUNGS WITH OR WITHOUT A TUBE INTO THE TRACHEA/LUNGS
These are the VENTILATORS that are in short supply. Oxygen is delivered even into stiff, sick lungs in the computerized and observed exact amounts needed for each individual patient based on their size, lung volumes, and needs. More basic ventilators without all the bells and whistles can be mass-produced without much trouble. The management of these devices requires training and experience and semi-sterile techniques. Ventilators force air with increased amounts of oxygen into the patient’s lungs. (From NYT: …a Medtronic ventilator has about 1,500 parts, supplied by 14 separate countries. More machines might, at best, be manufactured by the hundreds a month — but not by the thousands, as is needed right now).

3. COVID-19 Screening Tool
This tool can help you understand what to do next about COVID-19.
https://www.apple.com/covid19

4. NEW COVID-19 TEST LATE NEXT WEEK WITH RESULTS IN ONLY A FEW HOURS. No details available at present.

5. FOLLOW THE MARSHALL NEWS MESSENGER FOR AREA REPORTS SUCH AS:
[Marsews Messenger] Smith County issues two-week stay at home order
https://www.marshallnewsmessenger.com/news/smith-county-issues-two-week-stay-at-home-order/article_a9644763-c3ae-57da-b9be-b5a69d807f9f.html?utm_medium=social&utm_source=email&utm_campaign=user-share

][Marshall News Messenger Wiley College employee tested positive for COVID-19, the school says
https://www.marshallnewsmessenger.com/wiley-college-employee-tested-positive-for-covid–school-says/article_07247cb6-7086-11ea-8abb-c394c7e9ccdd.html?utm_medium=social&utm_source=email&utm_campaign=user-share
Christus COVID-19 hotline at 1-800-458-4559 to evaluate symptoms and get instructions on testing, if appropriate, and instructions on self-isolation.

6. COVID-19 cases in Northeast Texas by county*

Smith: 27 cases, 1 death   |   Gregg: 4 |    Angelina: 1   | Bowie: 1   |   Cass: 1   |   Cherokee: 1   |   Harrison: 1   |   Hopkins: 1   |   Morris: 1 |  Nacogdoches: 1   |   Rusk: 2 | Shelby: 1 | Upshur: 1 | Van Zandt: 1
As of afternoon on Friday, March 27, 2020.
From the Longview paper.

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March 27, 2020

1. MARSHALL: [Marshall News Messenger] Harrison County issues declaration of local disaster, following positive COVID-19 case
https://www.marshallnewsmessenger.com/news/harrison-county-issues-declaration-of-local-disaster-following-positive-covid/article_f750110c-6fc1-11ea-96bc-f387f9e6abe6.html?utm_medium=social&utm_source=email&utm_campaign=user-share
(MNM story contains Christus Hot Line for testing—800 458 4559)

2. ATLANTIC ARTICLE WITH POSSIBILITIES FOR DURATION OR C-19
The Four Possible Timelines for Life Returning to Normal
The coronavirus outbreak may last for a year or two, but some elements of pre-pandemic life will likely be won back in the meantime.

JOE PINSKER
MARCH 26, 2020
https://www.theatlantic.com/health/archive/2020/03/how-will-coronavirus-end/608719/
(My best guess is #2 J.Harris)

3. Provocative fairly long summary of recent scientific matters relating to the Pandemic. I don’t know anything about the publication, but the article seems well researched and well written. Take your time.
The road not traveled: How Big Science skipped clinical trials after past coronavirus outbreaks
‘There was no economic incentive for pharmaceutical companies … and governmental attention’ drifted elsewhere, former HHS boss laments.

4. Lancet’s Guide for Parenting:
For WHO’s information on parenting in the time of COVID 19  see https://www.who.int/emergencies/diseases/novelcoronavirus-2019/advice-forpublic/healthy-parenting
For UNICEF’s tips for parenting during the COVID-19 outbreak see https://www.unicef.org/coronavirus/covid-19-parentingtips
For Parenting for Lifelong Health’s COVID-19 resources see https://www.covid19parenting.com/
For CDC’s guidance for schools see https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/guidance-for-schools.html

5. HOPKINS:
Cloth masks and mask sterilisation as options in case of shortage of surgical masks and respirators (ECDC) This document aims to provide advice on the use of cloth face masks and sterilisation of respirators and surgical masks as an alternative in healthcare settings with suspected or confirmed COVID-19 cases if there is a shortage of specialised surgical masks and respirators.

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March 26, 2020

Positive case of Coronavirus found in Harrison County

1. MARSHALL NEWS MESSENGER: THERE ARE SEVERAL IMPORTANT ARTICLES IN TODAYS LOCAL PAPER https://www.marshallnewsmessenger.com/eedition/page-a/page_b8e5f95f-a4ea-5d97-9ede-7b0796715ebc.html#utm_source=marshallnewsmessenger.com&utm_campaign=%2Fnewsletters%2Flists%2Feedition%2F%3F-dc%3D1585216802&utm_medium=email&utm_content=image

2. Protecting health care workers is essential, and despite increases in production, we cannot avoid the reality that demand for N95 respirator masks and other personal protective equipment (PPE) will continue to exceed supply for the near future. We must conserve masks and other protective equipment now, so that clinicians can be protected later.
https://www.nejm.org/doi/full/10.1056/NEJMp2005118?query=TOC

3. Can people become immune? It’s one of the most pressing questions: Do people who recover from Covid-19 develop immunity to the virus? So far, evidence points to a qualified yes. But a lot is still unknown. For instance: Do the antibodies give lifelong immunity — as with polio or measles — or is the protection narrow and likely to fade, as with antibodies for colds and the flu?   (My best guess is some imperfect immunity will be conved to the infected, most of whom are without symptoms or apparent illness—especially children). JHarrisMD

4. FYI Madrid is converting an ice rink into a makeshift morgue, as Spain’s case count nears 48,000. The country has recorded more than 3,400 deaths linked to the coronavirus, second most in the world after Italy. In NY City they are using refrigerated trucks.

5. A Verizon Web Site said to help local business: https://www.verizon.com/pay-it-forward-live/?sourceID=SmartLink&cmp=EMC_SLNON_IN_APP_COVID-19_PAYINGFORWARD_20200325&medium=SMS&campaignName=COVID-19+-+Paying+Forward+-+SMS+-+20200325&campaignGroup=General&campaignSource=CRM&extSystemTransactionId=SL-D4135836-2A5E-4958-BB6A-6D53AB433D6F

6. A ventilator rationing article/video from WSJ sent by R. Anderson: video will play without a subscription to the paper.
https://www.wsj.com/articles/lacking-ventilators-hospitals-seek-out-alternative-device-11585154579

7. This appears to be a good article on treatment and vaccines in development. I don’t know anything about the web site, but I believe it to be reliable. https://medium.com/@indica/the-latest-coronavirus-drugs-and-vaccines-748d367313ae The Latest Coronavirus Drugs and VaccinesIn two infographics

8. From Time Magazine: https://time.com/5805368/will-coronavirus-go-away-world-health-organization/   Will the Coronavirus Ever Go Away? Here’s What One of the WHO’s Top Experts Thinks:  
would your message be for young people around the world? This is one of the most serious diseases you will face in your lifetime, and recognize that and respect it. It is dangerous to you as an individual. It is dangerous to your parents, to your grandparents and the elderly in particular and it is dangerous to your society in general. You are not an island in this, you are part of a broader community, you are part of transmission chains. If you get infected you are making this much more complicated and you are putting people in danger, not just yourself.

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[Marshall, Texas, March 26, 2020]

On March 26, 2020, at 11:30 a.m., City of Marshall Mayor Terri Brown issued a Declaration of Local Disaster and Public Health Emergency Related to Communicable Disease in conjunction with Harrison County Judge Chad Sims as a positive test of the coronavirus (COVID-19) has been reported in Harrison County, Texas. Additional information and data are being collected at this time. The City of Marshall Emergency Management Team composed of representatives from the City of Marshall, Harrison County, CHRISTUS Good Shepherd Health System – Marshall and the Marshall – Harrison County Health District continue to meet on a regular basis to review developments and make appropriate responses to safeguard our community.

Declaration of Local Disaster and Public Health Emergency Related to Communicable Disease

WHEREAS, the disease Covid-19 currently poses a significant health risk to the residents of the City of Marshall and has been declared a World, National and State Health Emergency; and,

WHEREAS, the Covid-19 disease was confirmed to exist in Harrison County as of March 26, 2020; and,

WHEREAS, as City of Marshall Mayor, I have concerns regarding finite accommodations for an influx of local Covid-19 patients, personal protective equipment shortages for emergency response personnel and the potential for the escalating spread of the disease in pandemic form; and,

WHEREAS, it is necessary to preserve and protect the public health of the residents of the City of Marshall with the disease already present in the County; and,

WHEREAS, on the date of this declaration, the Harrison County Judge has also issued a declaration of a public health emergency.

NOW, THEREFORE, BE IT PROCLAIMED BY TERRI BROWN, MAYOR OF THE CITY OF MARSHALL, TEXAS:

l.          That a local state of disaster and public health emergency is hereby declared in the City of Marshall pursuant to §418. l08(a) of the Texas Government Code.

2.         Pursuant to §418.108(b) of the Texas Government Code, the local state of disaster and public health emergency shall continue for a period of not more than seven (7) days from the date of this declaration unless continued or renewed by the Marshall City Commission.

3.         Pursuant to §418.108(c) of the Texas Government Code, this declaration of a local state of disaster and public health emergency shall be given prompt and general publicity and shall be filed promptly with the City Secretary.

4.         Pursuant to §418.108(d) of the Texas Government Code, this declaration of a local state of disaster and public health emergency activates the Marshall Emergency Management Plan.

5.         Pursuant to §418.108(g) of the Texas Government Code, this declaration of a local state of disaster authorizes the Mayor to control ingress to and egress from the City of Marshall and to control the movement of persons and the occupancy of premises within the City of Marshall.

6.         All officers and employees of the City of Marshall, including without limitation all law enforcement officers employed by the City of Marshall and all emergency medical personnel employed by the City of Marshall, are hereby authorized and directed to cooperate to the fullest extent allowed by law with the health authority designated by the City of Marshall pursuant to Chapter 121 of the Texas Health and Safety Code to enforce any and all communicable disease control measure by said health authority pursuant to Chapter 81 of the Texas Health and Safety Code or other applicable law.

This declaration shall take effect immediately from and after its issuance. ORDERED and DECLARED this 26th day of March 2020.

Terri Brown
Mayor, City of Marshall

 
Citizens are urged to follow following the Centers for Disease Control’s (CDC) national guidelines and the Executive Order GA-08 by Governor Greg Abbott.
It has been expressed that our community practice Social Distancing which includes:
1.         Restrict physical contact and publicly used areas.
2.         Maintain a safe distance of six (6’) feet between individuals.
3.         Every person in Texas shall avoid social gatherings in groups of 10 or more per Executive Order of Governor Abbott.
4.         Residents should not visit nursing homes, retirement, or long-term care facilities unless to provide critical assistance.
5.        In accordance with the CDC, people shall avoid eating or drinking at bars, restaurants, and food courts, or visiting gyms or massage parlors. Residents may still utilize drive-thru, pickup, or             delivery options through the Executive Order.
6.         Regularly wash hands with warm soap and water for at least 20 seconds.
7.         Avoid touching eyes, nose, or mouth.
8.         If soap is not available, use at least a 60% alcohol-based hand sanitizer.
9.         Avoid close contact with people who are sick. All persons should remain in the home if one person in the home exhibits symptoms.

If you are experiencing fever, cough or difficulty breathing, been exposed to a sick traveler or been exposed to a person with COVID-19 in the last 14 days, contact your healthcare provider immediately. Be sure to call before going to your doctor or an emergency department to prevent any potential spread.

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