A good Saturday at the office for Sarah Schram means there’s only a few people around and she’s there for four or five hours, but she hasn’t had a day off since the end of February.
Schram is the health director of the Sarpy/Cass Health Department, the local public health agency whose services and guidance are in great demand as the novel coronavirus shuts down normal daily life.
Between daily meetings and conference calls with state and federal health officials, tracking and monitoring people who may have been exposed to positive cases or educating the public about proper preventative measures, Schram said she’s in the office early and on a good day out the door by 6:30 p.m.
“On a not good day it’s a lot later than that,” she said.
In anticipation of the coronavirus’s arrival in its jurisdiction, the health department set up its internal structure to deal with public health emergencies or disasters on Jan. 27, six days after the first confirmed case in the U.S.
Over the next few weeks, coronavirus news came to Nebraska, just not in positive cases. On Feb. 7, 57 Americans arrived from Wuhan, China, where the outbreak originated, to spend a 14-day quarantine at the National Guard’s Camp Ashland. On Feb. 17, and additional 13 Americans arrived and were taken to the University of Nebraska Medical Center campus.
Nebraska’s first confirmed case came on March 6, but Schram said the long days started the week before with daily conference calls. There are 19 cases in the department’s jurisdiction as of Tuesday, five of which are community spread cases.
The health department has 14 employees, Schram said. Four are part-time peer counselors helping mothers with breast feeding who are helping through text messaging and phone calls. Of the other 10, two are part-time, and with the limited manpower “it’s all hands on deck.”
“It is not business as usual here,” she said. “It is longer days, it’s seven days a week, and the staff that we have here at the department understand that and are dedicated to keeping the residents as safe and healthy as possible.”
Each positive test initiates a contact investigation of when the person began to experience symptoms, where they contracted the virus and people who may have been exposed to them. Department staff then give health recommendations to those individuals.
The department’s community liaisons are tracking down information to answer questions from the public and the emergency response coordinator is working with state and local partners to ensure they have emergency plans in place and possess adequate protective equipment.
Initially, a public health department had to approve a test for coronavirus, but now, primary care doctors and commercial labs can conduct tests, so department staff also spend a lot of time working with healthcare providers on whether or not a test is appropriate.
One nurse is managing other disease investigations and helping with COVID-19 when able.
“Even though we’re focusing a lot of our efforts on COVID-19, there still are other things that are happening from a disease investigation perspective,” Schram said.
Conference calls and meetings take up a lot of Schram’s time, she said.
Many of those calls are with state, county and local health and elected officials, law enforcement or first responders and are aimed at providing up-to-date information.
One of the most difficult parts of managing the response, Schram said, is the rapidly evolving situation.
“Things are changing so quickly that to constantly be updating and making sure that residents are aware of the situation we have in our community, sometimes can be difficult because the things that we knew yesterday are slightly different today,” she said.
Community health education is a paramount function of the department, Schram said, so the department regularly communicates messages to the public about ways to flatten the curve of cases, like social distancing and frequent hand washing, even if it feels like its repeating itself.
“When you continue to beat that drum it sometimes can be difficult to find new ways to say the same thing you’ve been saying for a while,” she said.
Overall, Schram said she believes the community has embraced those messages.
“People understand what needs to happen and I think people are trying their best to adhere to those recommendations,” she said.
Schram said she wishes she had a “crystal ball” to predict how much longer or drastic the spread of the coronavirus will be, and it will be difficult to gauge the full extent of the spread until testing ramps up.
“We know that the virus is out there, we know that it is in our community, and we also know all the things we can do and the practices we can put in place to keep ourselves and others as healthy as possible,” she said.