What We Know and Don't Know
What We Know…
• Five Camden residents -- two women and three men -- tested presumptive positive for the COVID-19 novel coronavirus. The two women, one of who is said to be in her 80s, have been hospitalized and isolated. One of the men, described as elderly, was briefly admitted, but then released to self-isolate at home. That man and the second woman had face-to-face contact with the first woman. The other man --whose case is not related to the first three -- was not hospitalized and is also self-isolated at home. The third man had direct contact with one of the other patients, was not hospitalized and is self-isolated at home.
• None of the Camden patients were in a nursing home or other group care environment. It does not appear that any of them traveled outside the country or to other parts of the country where the coronavirus is present.
• The first Camden woman was evaluated and initially treated at KershawHealth and then transferred to Prisma Health Richland Hospital.
• Two other people -- a Charleston woman in her 30s and a man of unknown age in Spartanburg -- are both known to have traveled, separately, to Italy, and are self-monitoring/isolated at home.
• As part of their internship at KershawHealth, two high school students from Camden and North Central were present in the emergency department on March 3 when the first Camden woman was admitted to the hospital. They had no contact with the woman, but have been asked to self-isolate along with any siblings at home this week.
What We Don’t Know…
• Due to privacy laws, the names, exact ages or specific addresses for any of the patients or of the two high school students who have been asked to self-isolate with their siblings.
• The current condition of the two Camden women who have been hospitalized.
• Whether or not any of the patients actually have COVID-19. The U.S. Centers for Disease Control and Prevention (CDC) has to confirm the presumptive positive results. It takes 24 to 48 hours to do confirm such tests, and the CDC had not announced any results by press time Monday.
• If the first woman did contract COVID-19, how she did so.
• Where the second woman and the three men from Camden were evaluated and treated.
• Whether any healthcare workers have been quarantined due to their exposure to any or all of the Camden patients.
UPDATE (4:20 p.m., Tuesday): The S.C. Department of Health and Environmental Control (DHEC) announced that it is investigating two new possible cases of the COVID-19 novel coronavirus in Camden. The new cases are "household contacts" who tested presumptive positive for COVID-19 and are currently hospitalized. DHEC said it is working with the healthcare facility where the two people are being treated and taking measures to prevent possible spread. This bring the total number of presumptive positive case involving people from Camden to seven.
DHEC has confirmed for the Chronicle-Independent via email that U.S. Centers for Disease Control and Prevention (CDC) has confirmed that the first Camden patient -- a woman in her 80s -- did test positive for the coronavirus. DHEC also said the CDC confirmed the same to be true of a Charleston woman in her 30s who had recently returned from Italy, but is now no longer experiencing symptoms and is self-monitoring at home. The Camden woman is still hospitalized.
The remainder of DHEC's press release reads as follows:
“Presumptive positive” means samples from these individuals tested positive for COVID-19 at DHEC’s Public Health Laboratory, however, these results are required to be confirmed by the Centers of Disease Control and Prevention (CDC). It takes typically 24-48 hours for the CDC to confirm samples after they’re received. DHEC treats all presumptive positives as cases of COVID-19.
“Our coordinated response efforts continue to identify new cases,” said Dr. Linda Bell, State Epidemiologist. “We are working with the CDC and state and local officials to limit community spread while continuing with our protocol for identifying travel-related cases in the state.”
In line with CDC guidance, the department does not recommend closing schools or canceling public events at this time. DHEC will monitor absentee rates in schools and businesses as well as reports of illness in the community to determine if or when closures may be recommended. DHEC also is providing updated recommendations to schools and day care facilities, colleges and universities, and organizers of large events. That updated information is publicly available at scdhec.gov/COVID19. DHEC continues to be in communication with state agencies and community partners.
As of this afternoon, DHEC has tested a total of 41 individuals for COVID-19, which includes seven presumptive positive cases and two confirmed cases. The remaining 32 tests are negative. DHEC will update the public as soon as the confirmatory test results from the CDC or other reference laboratories that are now testing are available, and as other new information is known.
“We understand residents will have concerns about this indication of community spread, however, I urge the public to remain calm and follow recommendations to prevent the spread of illness. Public health events like this one are not new to South Carolina,” Bell said. “We have trained, prepared, and put systems in place to ensure that we are prepared and ready to respond to this and other events.”
At this time, precautions are recommended to maintain daily routines of protecting against illness by practicing good hygiene, washing your hands, covering your cough. Individuals with signs of illness are asked to take seriously the recommendation to stay home from school and work and not attend public gatherings.
Residents who are showing symptoms such as fever, cough or shortness of breath should call their personal doctor or healthcare provider. If an individual doesn’t have a primary care physician, MUSC Health is providing free telehealth screening to all South Carolinians. Anyone experiencing symptoms can visit MUSC.care and use the promo code COVID19 and be screened without having to leave your home.
The DHEC Care Line is available to provide general information about COVID-19 by calling 1-855-472-3432 from 8 a.m.-6 p.m. seven days a week. Because call volume has been high, callers are urged to be patient if they receive a busy signal and try their call at a later time. For general questions about COVID-19, visit the DHEC website at scdhec.gov/COVID19 or the CDC website here.
A total of five people from Camden may have contracted the COVID-19 novel coronavirus. All five have tested presumptive positive for the virus, meaning local testing showed they have the virus, but that those results have to be confirmed by the U.S Centers for Disease Control and Prevention (CDC).
Just before deadline Monday, the S.C. Department of Health and Environmental Control (DHEC) announced that the fifth Camden resident, a man, tested presumptive positive late on Sunday. He was evaluated, was not hospitalized and is currently isolated at home. DHEC said the man had direct -- close face-to-face -- exposure to one of the other four Camden residents who tested presumptive positive.
In addition, two Kershaw County School District (KCSD) high school students have been asked to self-quarantine because they interned in an emergency department when the first of those patients was brought to the hospital where she was treated.
The S.C. Department of Health and Environmental Control (DHEC) identified the first patient on Friday as a Camden woman in her 80s who was initially evaluated and treated at a Kershaw County healthcare facility before being transferred to another facility in the Midlands. KershawHealth later confirmed it was the initial facility where that woman was evaluated. Prisma Health Richland Hospital then confirmed it was the facility which took over the woman’s care.
(Editor’s note: As the C-I reported Friday, Prisma Health is in the process of acquiring KershawHealth from LifePoint as part of a deal that would also transfer control of Providence and Providence Northeast hospitals to Prisma.)
Sunday, DHEC announced in a press release that three more Camden residents had tested presumptive positive for COVID-19. Two of those had “direct … close face-to-face contact” with the first patient. One of those two people, DHEC said, is a woman who was hospitalized for reasons unrelated to COVID-19 and is now being treated under isolation after testing presumptive positive for the coronavirus. DHEC described the second person with face-to-face contact with the first woman as an elderly man who was temporarily admitted to a healthcare facility, discharged and is now self-isolated at home.
Sunday’s third new Camden presumptive positive case is another man who, DHEC said, has no known connection to the other three patients. DHEC said he was evaluated at a healthcare facility, did not require hospitalization, and is also self-isolated at home.
DHEC also announced that a man in Spartanburg has tested presumptive positive for COVID-19. He also has no known connection to either the Camden group of patients or a Charleston woman in her 30s identified on Friday as presumptive positive for the coronavirus.
In its update Sunday, DHEC said the Charleston woman is now symptom free, but continues to self-monitor her condition.
As of press time Monday, the C-I was still trying to learn whether the new presumptive positive patients were diagnosed and/or treated at KershawHealth or elsewhere, and what their general ages are as the woman in her 80s was described.
Isolation v. Quarantine
Isolation separates sick people with a contagious disease from people who are not sick.
Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.
In effect, those who are self-isolating at home are actually under self-quarantine. Isolation is usually voluntary, but officials have to authority to isolate those who are sick. Quarantine can also be voluntary, but officials have the authority to quarantine people who have been exposed to infectious disease.
First Camden patient
In its initial press release Friday, DHEC said the presumptive positive cases involving the first Camden and Charleston women were not linked. When Prisma Health Richland Hospital confirmed it had accepted the first Camden woman as a patient, officials there said she was being kept in a “special isolation room that helps keep our team members and the community safe.”
Monday morning, DHEC added a note to its website stating that its initial description of when KershawHealth first encountered the woman was incorrect. DHEC State Epidemiologist Dr. Linda Bell stated during a press conference Saturday that the woman was admitted “in February” and was tested for various conditions during the course of “several days.” Monday, DHEC stated that the woman was first admitted one week ago today, on March 3, and did not initially meet the CDC’s COVID-19 screening criteria. DHEC officials said KershawHealth placed the woman in isolation the next day, March 4, and tested for the coronavirus Thursday. That test came back presumptive positive Friday and sent on to the CDC.
During Saturday’s press conference, Bell said the first Camden woman had “no known exposure” at that time, meaning they did not know how she may have contracted the coronavirus.
“The possible source of her infection is still being investigated,” Bell said.
She said the woman was transferred to Prisma Richland in order to provide her with the “appropriate level of care.” Bell added that DHEC is working to identify people with whom the woman had close contact in an effort to determine -- if the CDC confirms her diagnosis -- how she contracted the coronavirus.
Bell said the first Camden woman was not in a nursing home or other group care environment prior to being admitted to KershawHealth. She said if anyone with whom she had contact -- including healthcare workers -- developed symptoms, they would be placed under quarantine for 14 days for treatment while making sure they could not expose the coronavirus to other people.
She said both the Camden and Charleston women were tested Thursday, and the results came back presumptive positive Friday. Those samples were then sent to the CDC for confirmation. Bell said it can take 24 to 48 hours to confirm if they contracted COVID-19. That should have meant results were available Sunday, but as of press time Monday afternoon, no CDC results had been made public.
When DHEC issued its second press release on Sunday with the information on the additional three cases and the one in Spartanburg, it stated that the Charleston woman no longer had symptoms and was self-monitoring her progress. However, at Saturday’s press conference, Bell declined to address the first Camden woman’s condition, and DHEC did not mention her condition in Sunday’s press release.
“The Kershaw County patient had a more prolonged course of illness and was admitted to the hospital for an unknown illness,” Bell said of the first Camden woman during Saturday’s press conference. “Other diagnostic tests were performed to find what was the cause of her illness.”
Bell said when those tests came back negative, healthcare workers began considering the possibility of COVID-19.
“She had no history of travel outside the U.S; community spread is one possibility if her source (of contamination) had a history of travel, and we’re continuing to investigate if she had contact with someone who did, potentially, travel elsewhere. That would make this case a travel-associated case, and we’re still working to investigate all those details,” Bell said Saturday.
She said even without knowing exactly how the first Camden woman contracted COVID-19 -- assuming the CDC confirms that diagnosis -- Bell did not recommend that the public take any additional measures other than those to deal with a flu outbreak:
• Wash hands frequently with soap and water.
• Cover coughs and sneezes.
• Stay home when sick.
• Appropriately dispose of tissues and other items you’ve sneezed or coughed into.
As for obtaining verification from the CDC, Bell explained that the federal health agency had issued new COVID-19 test kits recently. She said when a new test kit starts being used and/or a new laboratory begins testing, the CDC has to validate those results.
Around noon Saturday, the Kershaw County School District (KCSD) issued a press release stating it was taking extra measures to clean all school facilities during the weekend in response to learning -- at that time -- of the initial COVID-19 case in Camden.
“Similar to how our district works during cold and flu season, we are ensuring our custodial staff is cleaning thoroughly,” KCSD officials said. “We decided to bring in our custodial team this weekend to go through our buildings hitting door handles, desks, water fountains, bathrooms, etc. for good measure. We will be using Lysol, Clorox, and other alcohol mixtures, all approved by the CDC as products that will kill COVID-19. If your child is ill, please keep him/her home. Likewise, we will be communicating the same to our employees. We know we have a hardworking and dedicated staff; however, now is not the time to “work through it,” as some would say.
Officials said the worst-case scenario would be if a significant community outbreak occurred, the district has the authority to enact eLearning days so students could continue to study at home while schools were closed.
A little more than 24 hours later, on Sunday afternoon, the district sent a message to parents and guardians that officials had learned that two students -- one each from Camden and North Central high schools -- were interning in KershawHealth’s emergency department when the first Camden woman was admitted to the hospital.
“The students did not have direct contact with the patient,” KCSD Executive Director for Community Relations Mary Anne Byrd said in the message. “We have also been advised that these students would not be able to transmit the disease for several days. Only close contact or touching surfaces that the patient may have touched would be significant. However, we have asked the families to self-isolate just as a precaution (this) week.”
Byrd said this is in line with KershawHealth’s standard operating procedures for its employees. Byrd also said that the cleaning procedure mentioned in Saturday’s announcement had been completed at all schools.
Monday morning, Byrd confirmed the students have been interning at KershawHealth and said they were doing so on March 3 when the first Camden woman was admitted to the hospital. She also said the self-isolation request included any of the students’ siblings, asking them to stay home as well.
Monday afternoon, Byrd said 20 others students who have internships in healthcare settings have had those internships suspended as a precaution. She said the district is also taking some extra measures in school cafeterias.
“Secondary (high school) students can self-serve themselves certain side items, and we have suspended that practice,” Byrd said. “Also, students usually enter their own meal codes on pinpads. Right now, we’re having them tell those codes to staff to eliminate another touch point.”
S.C. Gov. Henry McMaster spoke during Saturday’s press conference, and said he wanted to assure the public there was no cause for alarm.
“This is exactly what we’ve been planning for … with all hands on deck and following all standard operating procedures,” McMaster said. “We’d ask you to go about your daily lives with the understanding that there is a new virus out there and there are ways to protect yourselves.”
DHEC Director Rick Toomey said the agency has been taking proactive steps, including informing healthcare providers of recommendations for testing, the availability of testing and the appropriate precautions for the public.
“Late (Friday) afternoon, we had two presumptive positive tests for the coronavirus. Our decision was to release this information in a quick fashion, so that has led us to now start the process of the investigation for those two possible coronaviruses. Those specimens have been sent to the CDC’s lab for confirmation testing. Based on what we see and know so far, the risk for the public remains low,” Toomey said Saturday.
He said this is not the first time South Carolina has responded to the flu or flu-like illnesses.
“We are still learning about the coronavirus and are committed to keeping the public informed,” Toomey said.
He and Bell said the Charleston County woman had recently returned from a trip to France and Italy. In Sunday’s press release, DHEC said the Spartanburg man had recently returned from Italy as well. Bell said the Charleston woman had a mild illness that did not require medical treatment. Meanwhile, Toomey said, DHEC is working to identify anyone with whom the Charleston woman came into close contact with as she returned to South Carolina to determine who else may have been exposed.
MUSC President Dr. David Cole also appeared at the press conference. He referred to the Charleston woman as a “member of the MUSC family” who is “doing the right thing by following protocol (and) making the right decisions.”
Cole said the Charleston woman had flown back to the U.S. more than a week prior to Friday’s presumptive positive test.
“We are working on her flight schedule, and communicating with the CDC so it can implement its protocols in identifying at-risk individuals,” Cole said.
Bell said that woman’s onset of symptoms appeared to be around Feb. 28 and that she sought care on March 2.
Bell also said that DHEC is confident that all the facilities where presumptive positive cases have been evaluated and treated have followed protocols and taken precautions, including KershawHealth.
“They have all been using protective equipment and observing isolation management,” she said. “There is no reason for these hospitals to change their admission procedures.”
In regards to KershawHealth and Prisma Richland, specifically, Bell said both facilities began taking precautions even before the first Camden woman tested presumptive positive.
“The healthcare facilities took measures to place her in isolation and made sure that the healthcare workers were observing appropriate measures and to protect themselves with personal, protective equipment. We will be investigating all the individuals involved for potential signs of illness,” Bell said on Saturday.