The coronavirus is not yet confirmed in any single individual in Flagler County, but the pandemic’s effects are already rippling through the ranks of local law enforcement, first responders and emergency medical personnel.
“This job is dangerous to begin with, and now we have an invisible enemy that they have to deal with also,” Flagler County Sheriff Rick Staly said late this afternoon as he described a situation that developed during the day and that now affects two of his deputies.
Staly is maintaining close phone contact with two deputies now in self-isolation following their exposure to potentially coronavirus-related conditions during a death investigation in the Hammock. The investigation involved the death of an elderly man who developed flu-like symptoms Wednesday, after contact with people from South Florida. His spouse has refused medical attention and is remaining at home. The two deputies will be tested in 48 hours, and meanwhile are working from home to the extent that they can, taking reports and the like. They only found out that the household required to be entered with protective measures after they responded to the call, even though the dispatch center had asked the screening questions.
Separately, EMPros, the Volusia County-based company that manages emergency departments in several cities in Volusia and Flagler, including at AdventHealth Palm Coast, said several of its employees and AdventHealth Palm Coast employees are in self-quarantine.
“As you know,” the EMPros Board of Director told local and regional AdventHealth leadership in an email late this afternoon, “recently an asymptomatic EMPros advanced practice clinician at AdventHealth Daytona Beach was quarantined and this morning an asymptomatic EMPros physician and Assistant EMS Medical Director for all EMS agencies in Flagler County was placed under quarantine as were multiple AdventHealth Palm Coast employees. An ad hoc meeting of the EMPros Board of Directors was held  today and we have identified several areas of opportunity to prevent further similar events as well as [Emergency Department] efforts that can be undertaken to mitigate risk to our patients, staff, hospitals and communities.”
Staly said the hospital has instructed his deputies not to bring Covid-19 patients to the hospital unless they are suffering from other serious medical conditions.
EMPros has requested that AdventHealth institutes a series of “pandemic management” measures.” Those include “No visitors apart from one parent for a pediatric patient, one advocate if there is a special needs patient, or one visitor if there is a patient death,” according to the Board of Director’s email. ” If placed under quarantine, asymptomatic EMPros physicians and advanced practice clinicians will be tested for Co-SARS-2 at 5 days (average time from exposure to symptom onset) and return to work if negative. Masks will be worn by these previously monitored individuals at all times upon return. Should these individuals become symptomatic, they will self-report and be re-quarantined.” (Co-SARS-2 is severe acute respiratory syndrome coronavirus.)
Protocols for directing patients to tents away from the Emergency Department are under development, and “All EMPros physicians and advanced practice clinicians will be placed on mandatory standby due to the current state of emergency and prohibited from traveling outside of the local community to ensure availability,” the email states.
The death investigation in the Hammock was an example of in-the-trenches challenges for deputies well before an individual would get to a health care facility. But it, too, illustrates how responders are adapting to uncharted situations.
“We responded to a death investigation in the Hammock Community,” Staly said. “A deputy and a corporal entered the home, and during the investigation, concerns were developed that the individual who is now deceased and his wife had flu-like symptoms. Before the deputies were dispatched, we have protocols we’ve implemented in the communications center to ask certain questions. But it requires the honesty and forthcoming of the caller in answering those questions accurately.”
In this particular case, the caller was not as forthcoming as necessary, so deputies entered the home without protective gear, as they would have otherwise. “After the caller answered no to the first question, the protocol said you stop there and start providing life-saving information. which is what our 911 operator did.” As deputies at the scene started asking questions, “The wife gave information that gave us concerns for the well-being of my deputies.”
A physician does not believe that the deceased man or the wife had Covid-19, the sheriff said. The deceased had not exhibited any fever, for example, one of the more common signs of Covid-19. But the concern was the connection with visitors from South Florida in the days before the illness presented. “In an abundance of caution for my team and for individual employees, we have asked them to self-quarantine and to work from home, so they can handle calls that we send to them where they can take reports over the phone, if you will,” Staly said. “There is a 48-hour incubation period, so no testing can be done right now. The earliest that can be done is Tuesday midday. The results will supposedly come back pretty quick, and we will know whether they were exposed or not.” Meanwhile, Staly told the two deputies to skip the chain of command and get in contact with him whenever necessary.
The medical examiner took the body of the deceased man to St. Augustine.
Flagler County still has not produced a positive case of Covid-19 even as cases have been multiplying elsewhere in the state, reaching 100 overnight.
Asked of any developments today, Bob Snyder, who heads the Flagler County Health Department, said he was “not able to say much about it or confirm one way or the other. Pretty strict protocol, wherever the case is, wherever it’s coming from, it needs to be confirmed by the epidemiology team at the Department of Health” in Tallahassee, he said. “We’re under strict rules.” He was aware of the medical response today in the Hammock, but did not elaborate.
Asked about Volusia County Sheriff Mike Chitwood’s decision to disclose the number of people under observation, by town–not just the number of people who have tested positive for the virus–Snyder said: “It’s that balance between the public’s right to know versus the privacy and confidentiality of potential clients and patients and I disagree with his approach, because approaches like that can lead to unnecessary panic and dread, and we need to be strong at times like this. There are professionals who know what they need to do.”
“It’s any time now that we can expect a patient from Flagler who is confirmed” positive for coronavirus, Snyder said. When that happens, the epidemiology team at the department will get in gear and trace the likely origin of the infection, the goal being to limit widespread infections. “The city and the county and all organizations that I have heard about, many are doing the right thing in canceling and postponing events,” Snyder said. “That social distance aspect of public health is what’s going to end this sooner rather than later.”
The Palm Coast Fire Department starting Monday will no longer be joining Flagler County Fire Rescue in most medical calls that don’t involve life-threatening situations. The aim is to limit the exposure of firefighter-paramedics and limit the number of quarantines or sicknesses that may develop, and keep personnel on the line.
Staly has the same concerns for his ranks. He said that he’s expanded Covid-19 guidelines to all calls coming in to the 911 center, whether medical or law enforcement related. He said that may sound draconian to callers, but the questions must be answered for the safety of all involved.
The Department of Health has agreed to let the 911 center know, when those cases are confirmed, where the confirmed cases are in order that personnel dispatched to the scene are appropriately prepared. That does not include the self-quarantined. “We’d love to have that information, but without that information is why we’re asking those questions in our communication centers after getting a call,” Staly said. (The agency will release a video public service announcement detailing the new approach on Monday.) “This is uncharted territory, and we are trying to protect the first responders and the community. We need the community to be honest with this and understand why we are asking those questions,” the sheriff said.
There are other challenges: the sheriff’s office has 600 masks on hand, but none of the masks are of the standard required in this particular emergency. The office is awaiting a shipment. Protocols have changed at the detention facility as well, with medical screening stepped up to include coronavirus issues.
But the sheriff is limited in that regard: with AdventHealth declining to take covid-19 patients, “should we get an inmate with Covid-19 and they do not have a medical emergency, the only choice we have is put them in isolation in the jail, and we only have three isolation cells.” It’s unclear what the facility will do should there be more cases than it can handle.