Dr. Brian Holmes

Dr. Brian Holmes, chief medical officer for Dickinson County, updates the current COVID-19 situation.

Back on March 12, Dr. Brian Holmes was looking forward to a typical spring — watching the Big 12 and NCAA basketball tournaments, seeing his daughter compete in spring sports at Abilene High School — and then everything changed.

By the next afternoon, Holmes — as Dickinson County’s health officer — issued the county’s first order intended to limit the spread of COVID-19.

“I feel we got a little bit ahead of the situation by being proactive. We’ve been ahead of the curve so far,” Holmes said.

Other county orders soon followed, but now the state of Kansas’ stay-at-home order supersedes them all.

Since the middle of March, Holmes — along with the Dickinson County Health Department, health care providers and other officials — has been monitoring the spread of COVID-19.

As of Wednesday afternoon, no one in Dickinson County has tested positive, but Holmes said he thinks it’s quite likely some Dickinson County residents have the virus.

“I think there’s a lot of presumptive people we think may have it, but we can’t test them because they don’t fit the guidelines for testing, which is frustrating,” Holmes said.

Current guidelines limit testing to certain groups —people like first responders or health care workers — because so few tests are available, but providers can also test if they feel a person could make a group of people sick.

“For instance, if a nursing home patient is sick we might test them so they don’t infect a whole facility,” Holmes explained.

False negatives?

Holmes believes there’s a chance some people who have been tested for COVID-19 may have received a false negative.

“I suspect that’s a possibility, but we’ll probably never know unless we do serum patterns where you look at the antibodies’ response to the virus. We’ve not done those at this point,” he said.

Holmes doesn’t know how accurate the current COVID-19 test is, but said he does know other health providers who believe some people have received negative results when their doctor is sure the person has it.

“It would be nice to have a quick test like the flu test, but that’s not even 100 percent (accurate),” he said.

Symptoms vary

Symptoms of COVID-19 are “all across the board,” Holmes said, because everyone is different.

“Everybody’s immune system is different. You can’t chalk it up to ‘everybody is going to have X, Y and Z’ because that’s just not reality,” he said. “Most folks are going to have shortness of breath. Not everybody is going to have a fever. We’ve heard of people being tested as positive and they’ve never run a fever.”

Also, as the disease progresses, Holmes feels it will no longer be important to determine where people have visited.

“As this becomes more community-wide it’s not going to matter if you were in Colorado, Louisiana or New York or wherever. It’s just here,” he explained.

Even though symptoms vary, Holmes said anyone with shortness of breath needs to be concerned.

“Eighty percent do fine. They got it. They’ll get sick, but they don’t require hospitalization. Seventeen to 20 percent may require hospitalization and then we’ve got 3½ percent maybe that will die,” Holmes said.

“In Abilene with around 6,700 population, 3½ percent would be 18 people. It doesn’t sound like a big number, but for Abilene it would be a huge number,” he added.

Hospitalization

If 20 percent of the population needed hospitalization that would be around 250 people, Holmes said.

“We only have 26 beds in our hospital so where are you going to put the rest? Of that number if five percent are critical they would need to be on a ventilator and we’ve only got one or two ventilators we can use,” he explained.

All hospitals are still dealing with limited supplies of protective equipment, including masks. “It’s pretty scary to think you may have to start treating patients without the standard equipment you need,” he said.

Like the county response, Memorial Hospital has been proactive, but there’s only so much a small hospital can do.

“No place is completely prepared. I don’t care where you’re at in the United States,” Holmes said. “I think we’ve got a good leadership team at (Memorial) hospital. Our people are working tirelessly, trying to stay up to date on conference calls, emails.”

Facility wise, Holmes said Memorial has two OR circuits, one of which must remain open in case an emergency C-section is needed.

“The other one we would use if we needed rooms now for negative pressure isolation to deal with this (COVID-19),” he said.

A tent has been erected by Memorial’s emergency room to serve as a triage area if it becomes necessary to screen a number of people at once.

Memorial has not seen large groups of people showing up with symptoms so far. In fact, total emergency room traffic has been down in recent weeks, Holmes said.

“That’s region wide,” he explained. “People are not coming in for every little thing. In reality, most of the time they can work through it and stay home.”

Worst yet to come?

State health officials on Tuesday were predicting the COVID crisis in Kansas might peak in about a month. They feel it will hit the urban centers first before moving to the rural areas.

“Right now, it all depends on travel. We still had people travel. We still had people who went on spring break or cruises. Not everybody listened to the quarantine order to stay home,” Holmes said.

“It not only put them at risk, but other folks in the community, especially our more vulnerable or older people,” he added. “People don’t take it seriously yet because it hasn’t hit here. Nobody probably knows anyone who’s died or been infected.

“I think that once that happens — God forbid — people will pay attention.”

Stay home

Holmes advised people to take the COVID-19 threat seriously, stay home and isolate as much as possible.

“Stay away from group activities. You can do stuff with your family, but don’t let your kids play with the neighbor kids. Don’t let your kid hang out with his or her girlfriend/boyfriend. We need to give this more time and see if we can get past this without any major catastrophes,” he said.

Also, take simple precautions. Cover your cough, wear a mask if you’re sick, make sure you’re washing your hands.

“I think now more than ever people are more vigilant and thinking ‘I touched this door handle, I wonder how many other people did?’” Holmes said. “I believe that’s the major way this thing spreads, but there’s been other people who got it other ways.

“We don’t really understand how aerosolized it gets. In a year, maybe six months, we’ll have more information and there will be more studies out,” he said. “That’s the scary thing about this.”

Light at end of

tunnel?

Some coronaviruses seem to be more “sunlight and UV sensitive” which might mean the situation could improve in the summer. However, Holmes said he does not know if that will be the case.

As far as a vaccine, that will take at least a year, barring an unforeseen miracle, he said.

“Everybody is learning on the fly. We don’t know whether the symptoms change. Some of the information we’re getting has come from China, but how much of that is reliable? We’re trying to learn from European countries now based on what they’ve gone through,” Holmes said.

“Hopefully, we don’t have a crisis like they are experiencing in Italy and we can learn from what they did and didn’t do right.”

Contact Kathy Hageman at reporter@abilene-rc.com.

Contact Tim Horan at editor@abilene-rc.com.

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