Behind every confirmed case of the novel coronavirus in eastern Idaho is a team of public health investigators looking to contain it.
Epidemiologist Mike Taylor called his job being a "disease detective." He and the small team of other infectious disease experts at Eastern Idaho Public Health work with the coronavirus cases in eight counties, trying to determine how each person was exposed to the virus and who they might have passed it along to.
The overall message, whether it's someone with a likely case of the virus or a small chance of exposure? Play it safe and stay home.
"It's sort of the American way to power through a lot of illness. 'I have a lot of work to do, people are relying on me.' We really don't want people doing that for this," Taylor said.
Local public health officials have been keeping an eye on the coronavirus long before it entered Idaho, or anywhere else in the United States. The virus first came on the radar for Eastern Idaho Public Health back when it still seemed isolated to the area around Wuhan, China, as it was standard practice for officials to watch out for any new global diseases that could begin to spread
Taylor and the rest of the staff began running drills and reaching out to hospitals in December, laying down early plans for how to handle a potential outbreak. The drills based response on a worst-case scenario for a similar virus: the 1918 Spanish Flu, which infected around a third of the world population and killed around 3 percent of those who contracted it. The Spanish flu claimed the lives of somewhere between 50 and 100 million people, according to the Smithsonian.
The Idaho Department of Health and Welfare and Gov. Brad Little's task force are working on a model for the outbreak in Idaho, though so far the pandemic is less widespread and has a lower fatality rate. Health and Welfare spokeswoman Niki Forbing-Orr said they were hoping to complete the model by the end of the week.
"I've had several conversations with people who hear about community spread and think the patient has been out there spreading disease in the region. It's actually the reverse, they got it from somewhere else in the community," Eastern Idaho Public Health Director Geri Rackow said.
In community-spread cases, the researchers need to work to determine both how the patient first got infected and who they might have exposed since then. The first two cases of community transmission in Bonneville County were announced by EIPH on Thursday afternoon among two women under the age of 50.
The average coronavirus patient will have come into contact with at least 10 people since they were infected, all of whom need to be tracked and checked in on daily by the public health department in case they're also infected. Those with suspected cases are asked to fully self-isolate for at least seven days if no symptoms, or three days after symptoms go away.
"Overall we see a high amount of compliance with (isolation requests), which makes our job easier and keeps the public safe," Taylor said.
Early evidence from Washington and California shows that measures such as social distancing, travel restrictions and nonessential business closures have slowed the spread of the virus, keeping their peak case numbers far below what has happened in New York.
While social distancing helps slow the spread of the virus, it also poses some issues to the people trying to track how it spreads. Schools are a major resource for epidemiologists during the flu season, as they can look at absence rates and talk to school nurses to get a sense of which strains of the virus are being circulated.
"That tool is gone right now. We don't know what cases are in the school settings because there isn't a school setting," Taylor said.
On the other extreme, anxiety about the virus has begun to cause consequences for patients with other problems. Rackow spoke to hospitals across the region that reported that while fewer patients are making trips to the emergency rooms, the ones that do come through have more acute risks and are in worse stages.
"That bad information is something that we have been battling from Day One. People need to look to reliable sources, and I think we are the most reliable source of information in our eight-county health department," Rackow said.
Eastern Idaho Public Health does not do its own testing for the virus, contrary to some rumors. It can only recommend that people who reach out seek a test from their doctor and send other samples to the state lab, which they did on Thursday morning.
Testing also is not free or widely available. Many insurance packages and the Medicare and Medicaid programs will cover the cost of testing, but Rackow said nothing is in place to support people without insurance or those who want testing without being referred by a doctor.
Even more than the lack of testing, the shortage that most concerns Eastern Idaho Public Health is the lack of personal protective equipment. The masks and gloves that are needed by hospital staff to care for patients who have the virus are also needed by the places testing for the virus.
The Strategic National Stockpile run by the federal government has been nearly emptied, and the regional cache kept by the health district is being rolled out. The agency is also working on a request to FEMA to access some of its emergency equipment for natural disasters.
"That's just a drop in the bucket when we talk about the amount that we really need," Taylor said.