Preparing for the COVID-19 surge: It’s going to be war

Few people are alive today who had first-hand experience of the 1918-1919 Spanish flu. At best, some octogenarians may remember their parents talking about their concerns during that time. In my family, I knew that it was so devastating that my grandparents and parents never openly discussed it.

The past may hold clues as to what’s ahead for us as we traverse this unfamiliar situation.

Reviewing the Spanish flu and its three surges

A review of the CDC’s website reveals both similarities and differences between our current COVID-19 pandemic and the 1918-1919 H1N1 Spanish flu.

Similarities include that the 1918 influenza was a worldwide pandemic, spread in part due to World War I when millions of soldiers came together to fight in Europe and both sides were housed in very cramped and unsanitary quarters. The first vestiges of the flu occurred throughout Europe in late-1917, believed to be of avian origin initially spread from birds to humans, then transmitted by close contact from person to person.

This flu had three waves or surges worldwide:

• The first wave in 1917 was somewhat limited in the United States because we had not yet fully entered the war; large numbers of American troops were first sent overseas in 1918.
• The second wave of the virus occurred worldwide after the 1918 Armistice, as troops having contact with this flu returned home.
• The third wave occurred in 1919 and again started in military encampments, both in the United States and Europe, subsequently spreading to the general public.

In the absence of more modern sanitary systems, vaccinations and pharmaceutical treatments, quarantine and limited person-to-person contact was the only way to stem the pandemic.

In the end, it is estimated that over 500 million people died worldwide, with approximately 675,000 deaths in the United States, from this three-year pandemic.

Slowing the COVID-19 surges

Today’s COVID-19 has traveled more rapidly across the globe than any other pandemic. From its origins in Wuhan, China, late last year, it reached every continent in weeks due to the ease of worldwide travel. This quick rate of spread has increased the demand for otherwise readily available medical supplies, equipment and resources; shortened the time needed for the development of a vaccine and pharmaceutical treatments; and will shortly put a huge strain on our finite prehospital and hospital response capabilities, including those services provided by us in fire and EMS.

Epidemiologists predict that we will see a similar surge (or surges) as those from 1917 to 1919. The trouble is we cannot accurately predict where, when and for how long this will occur.

Our current approach to the virus – frequent handwashing and personal hygiene, social distancing, limited contact with others, self-quarantine when symptoms are present, the use of disinfectants, and very limited public gatherings – is important for two reasons.

First, we must flatten the curve of the surge, not necessarily eliminate it, but rather to reduce stress on our prehospital and hospital capacity. Probably the least popular of these actions already taken are those associated with closing schools, churches, businesses and athletic events where more than 50 or 100 people congregate. But the reasoning is simple: The model shows that in such gatherings, even a single asymptomatic person with the virus can infect up to seven other individuals in close proximity. Those seven each infect seven more, and by the third level of contact nearly 2,500 people are now infected.

Second, this extended time might bring us closer to the development and testing of both a vaccine or proven pharmaceutical treatments to combat the spread and lessen the mortality rate of the virus. Combatting this virus had been compared by some to an all-out war, and I agree.

From my experience as a former Air Force officer, I know that it takes coordination to have a successful outcome in combat. Unlike what we see in Hollywood movies or TV, it’s a lot more than just a pilot pulling a trigger to launch an air-to-air missile or drop a set of bombs. It entails both the planning and coordination of forward air controllers to paint a laser on a given target; mid-air refueling tankers, fighter escorts for combat patrol; others to suppress both anti-aircraft and surface-to-air missile sites; and an airborne command and control aircraft to oversee the operation; plus hundreds of others in support with much-needed supplies, such as fuel, maintenance and ammunition, all staged at the right place in the right time.

The same will be true with the war on COVID-19.

Three priorities for battling COVID-19

Since the fire service provides nearly 80% of the prehospital emergency medical care in the United States, we should be prepared for this increase in our service demand. We will squarely be on the frontline of this battle. Every firefighter and EMT must have a working knowledge of both our department and community’s strategic and tactical priorities, and how we fit into the plan. These should include:

1. Focus on keeping personnel safe and healthy so they are available for response
2. Community Action Plan (CAP)
3. Dissemination of accurate public information on the local level

Let’s review what each of these priorities entails:

1. Personnel health and safety: In order to protect the health and safety of our personnel, we must do the following:

• Close the stations and administration to the public to avoid inadvertent contact with the virus.
• Suspend community risk reduction programs, such as residential smoke detector installations, CPR or fall prevention programs (but also see a further discussion of alternatives under the Information section below).
• Screen all personnel for symptoms, most easily by taking temperatures at the start of each shift and at least once at mid-shift; send home anyone with a temperature above a level set by your medical director or infectious disease officer.
• Ensure that personnel have the best medical PPE available as well as clear, concise SOPs on when they are to be used.
• Limit the number of personnel making direct contact with a suspected virus patient.
• Frequently remind both officers and firefighters to look out for the mental wellbeing of themselves, their family and their crews during this difficult time. Advise seeking help from the department’s Employee Assistance Program or trusted counselors as needed.
• Stop scheduled training or meetings that involve multiple stations to avoid any cross-infection.
• Separate command staff (8 to 5 personnel) from on-shift personnel except on emergency calls.
• Use online platforms for daily conferencing to keep all stations and personnel informed of the latest virus numbers and trends.
• Have a flexible, alternative staffing plan(s) available in the event the virus affects the number of firefighters/paramedics available for duty.

2. Community Action Plan: Follow these steps to address your CAP:

• Keep the public informed and confident of the department’s ability to handle their emergency needs, primarily at-risk patients.
• Instruct otherwise healthy but symptomatic to contact their personal physician, not 911, for advice and medications.
• Work with your medical director and local public health authority to create a “Treat and Release”/Non-Transport form that allows the department to have otherwise healthy individuals acknowledge the department’s right to refuse transport to a hospital for those patients who can ride out their symptoms at home.
• Address language barriers within your community. Work with interpreters or faith-based groups that can contact non-English-speaking groups to explain how the local medical system works, how to access help, and what to expect from your department’s response.
• Work with your local Chamber of Commerce or business association to contact their members with how to screen their workers for symptoms of the virus, especially in the food service, grocery and essential businesses supporting the medical supply chain.

3. Dissemination of accurate information: Only disseminate information that is from a trusted source, such as the CDC, or your state and local health departments.

While we routinely see briefings by public officials at the federal and state levels, our local citizens, especially those confined to their homes, deserve accurate, updated information on the local level. This can be via your department’s website, social media or your local radio, TV and cable providers.

Some social media ideas:

• Post pictures of firefighter at the station holding signs that indicate they are practicing social distancing, exercising for good health, eating right and taking other precautions to keep themselves healthy and ready to respond to their emergency needs.
• Post links to fire safety or science-focused websites that parents can share with their children, not only to occupy their time but also to help them learn. Two great examples include the NFPA’s sparky.org for preschool through third grade and Underwriters Laboratory’s Middle School STEM programs at ulxplorlabs.org.

Providing this information not only shows that your department remains available to respond to their critical needs – fire, medical, rescue etc. – but also that it cares enough to keep them informed.

When to expect the surge

The million-dollar question for all of us is when can we expect the surge. Truthfully, none of the “experts” really knows for sure. Some epidemiologists predict that the states currently most impacted, such as New York and California, will see the surge by mid- to late-April. Others suggest if the social distancing methods work as hoped, a much smaller surge might take place in July.

Like in any war, we never really know when or where an enemy may strike, but we have to diligently prepare and follow the developmental phases of this disease over time to anticipate the where and when it will surge.

Stay safe!