As COVID-19 Reaches the Mid-Ohio Valley, the FDA Hampers What States Can Do

As the coronavirus spreads, its presence in the Mid-Ohio Valley feels increasingly real. With the second confirmed case in Wood County, West Virginia last Friday, this part of Appalachia is preparing for bigger problems.

Washington County, Ohio, across the river from Wood County, has three confirmed cases, as noted by the Marietta Times. Athens County, Ohio also has three cases (and one death), and Pleasants County, West Virginia has one case. Jackson County, West Virginia has eight cases. The largest confirmed outbreak in Appalachia is centered on Pittsburgh, where Allegheny County has 290 confirmed cases and two deaths, according to the Appalachian Regional Commission, which is tracking cases for the region. In total, the region has about 2,000 cases.

Given the lack of widespread testing, however, only the most obvious cases have been confirmed. Health care workers expect a rise in cases in the near future. The key to weathering the storm could be in telehealth and remote testing, which would require the Food and Drug Administration to break from its bureaucratic ways.

“The general feeling is a mix between calm and anxious,” said Missa Culver, a physician assistant at Camden Clark Medical Center in Parkersburg, West Virginia, before the coronavirus was confirmed in Wood County. “Calm for a few reasons. We have not seen the surge of patients come through yet as compared to some of the bigger city hospital systems.”

After coronavirus was confirmed, though, that sense of calm gave way. “There is much more panic because the patient came in contact with several people who were without proper protective gear,” Culver said. “Several people are now quarantined due to this and I can only see more of this happening, which is very scary. Our hospital and leaders are doing the very best with the limited resources we have. I just worry for how this trend will continue if we do not have proper precautions for all of us working in the health care field.”

What’s important in the Ohio Valley is to “flatten the curve,” or spread out the infection over time, to make sure hospitals aren’t overwhelmed. Limited resources can be replaced after some time, but not if they’re needed all at once. Avoiding a shortage of protective equipment and beds might be difficult, however. The 10 Ohio counties and 10 West Virginia counties surrounding Washington and Wood Counties only have 95 intensive care unit beds, according to the Marietta Times. Of those, 29 are in Washington and Wood Counties.

To set up testing sites and coordinate a state-level response, Ohio relies on its county health departments. If health centers and care providers need masks, gloves, and other supplies, their requests to the state are funneled through health departments. Health departments also have extra cots and plan to set up medical tents if the need for beds grows, Crystal Earley, regional public health emergency preparedness coordinator of the Washington County Health Department, told the Marietta Times.

Ideally, testing the public off-site can prevent its spread in hospitals.

Private providers are also setting up testing locations. On March 24, MedExpress, which has several locations in the Ohio Valley from Pittsburgh to Parkersburg, announced that it will screen for the coronavirus in Wheeling.

Local- and state-level responses, however, have been hampered by the federal government. The FDA has been slow to approve new solutions to problems caused by the coronavirus. When the Battelle Memorial Institute, a Columbus-based nonprofit focused on science and technological innovation, figured out a way to sterilize surgical masks, the FDA imposed a 10,000-mask daily limit—even though Battelle has the capacity to sterilize 160,000 masks per day.

At a press conference on Sunday, Ohio Governor Mike DeWine called the decision “nothing short of reckless” and said he was “stunned that the FDA would decline to do all it can to protect this country’s frontline workers in this serious time of need.”

The FDA also limits the sterilization to Battelle’s Columbus headquarters, so Battelle cannot send a machine to New York to help with the mask shortage there. [Update: Since then, the FDA has now given full approval to Battelle to “to ramp up their systems to full capacity and send devices to parts of the country hardest-hit by the coronavirus outbreak.”]

The FDA put a stop to at-home coronavirus tests as well, though some at-home tests have been approved after breaking through the agency’s red tape. Without more at-home tests, it becomes harder for doctors to test people. Potentially infected residents will have to go to a testing site instead of sending in a sample, another restriction on telehealth. When residents come in for a test, this also requires more gloves, masks, and protective equipment to be used, making the shortage worse.

Telehealth isn’t a cure-all, but in an area like the Mid-Ohio Valley, it could be expanded to check on at-risk residents who are social distancing. Some doctors are testing telehealth to be used in place of in-person regular appointments, but FDA rules could make its use irrelevant.

At a time when small-town and rural health providers have limited supplies and could be overwhelmed if the coronavirus hits hard, the federal response could mean more infections and deaths that were avoidable. Nationally, the FDA and the Centers for Disease Control and Prevention made it harder to test for the coronavirus.

“Clearly the virus has maneuvered its way into even the more rural locations,” Culver said. “There will be a lot to take in over the next few weeks, I imagine.”

Places like the Mid-Ohio Valley have a leg up for the moment. It does not have a large outbreak like New York City or Seattle—yet. Social distancing is easier in rural areas and small towns. But those areas do not have as strong of a medical infrastructure as large cities do. The situation could take a turn for the worse if time is squandered. What matters now is testing as many people as possible for the coronavirus, then isolating those who are infected. So far, testing sites have only been set up in Athens, Ohio, and Parkersburg and Vienna, West Virginia.

Expanding testing capability is crucial. If at-home tests and telehealth aren’t used as much as possible, rural areas in Appalachia could be caught flat on their feet as more and more people fall ill.

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Anthony Hennen is co-founder and managing editor of expatalachians and managing editor at the James G. Martin Center for Academic Renewal in Raleigh, North Carolina.