Dr. Alan Michels, Ponderosa Family Care, and Luke Wohlford, a third-year medical student at the University of Arizona College of Medicine — Phoenix and inaugural participant in the Payson Longitudinal Integrated Clerkship, recently discussed COVID-19 in Gila County.

Michels is chief of staff for Banner Payson Medical Center and was very involved with BPMC’s preparations for COVID-19. He volunteered for the mass testing, which the MHA Foundation helped bring to the community.

As of Thursday, Sept. 3, according to a report from the Gila County Health & Emergency Management Department, Payson has had 352 confirmed cases of COVID-19.

Of these, 312 have recovered and nine are still active.

Overall, Gila County has had 654 confirmed, non-tribal cases, with 598 recovered.

There have been 41 COVID-19 related deaths among non-tribal residents, and 30 of those were in Payson. There have been eight deaths among tribal residents.

COVID-19 Timeline

• Dec. 31, 2019 – First cluster of unknown pneumonia identified in China, a week later it was found to be a new coronavirus, identified as COVID-19.

• Jan. 11, 2020 – First known death from COVID-19 in Wuhan, China.

• Jan. 21, 2020 – First known U.S. COVID-19 case in Washington.

• Jan. 31, 2020 – World Health Organization declares global health emergency due to COVID-19.

• Feb. 3, 2020 – U.S. declares Public Health Emergency.

• Feb. 9, 2020 – COVID-19 death toll surpasses that of SARS.

• Feb. 14, 2020 – First case in Africa confirmed in Egypt.

• Feb. 26, 2020 – First case in South America confirmed in Brazil.

• Feb. 29, 2020 – First COVID-19 death in the United States in Washington.

• March 11, 2020 – WHO declares COVID-19 as a pandemic.

• March 13, 2020 – President Trump declared COVID-19 a National Emergency.

• March 19, 2020 – California becomes first state to issue stay-at-home order.

• March 27, 2020 – U.S. government passes CARES Act.

How COVID-19 became a pandemic

• Variable time to symptom onset — this could be up to two weeks after exposure, which made it really difficult to track down.

• Asymptomatic cases — people can be asymptomatic and yet can be spreading the virus.

• Respiratory nature of virus makes it easily spread in crowds — crowds in enclosed spaces is the worst thing to spread the virus.

• No proven antiviral treatment.

In Gila County, the first documented case of COVID-19 was reported March 28, 2020. There was a slow rise in cases until mid June when the county started seeing 10 cases daily — the number of confirmed cases went from one a day to 10 cases a day overnight. The first documented COVID-19 death in Gila County was reported May 8, 2020. The most recent report has the death toll at 47, with most of these in the Payson area.

Specific concern for nursing homes

Michels is also the medical director of Rim Country Health & Rehabilitation in Payson. This long-term care facility was especially hard hit by the virus. The enclosed and vulnerable populations in nursing homes has proven a large challenge in the pandemic, this was evident by the outbreak at Rim Country Health.

Overall, long-term care facilities have had 125 cases and 27 deaths, according to the Sept. 4 county report.

To address the problem, RCH and other long-term care facilities in Payson closed to public and family visitors and instituted regular temperature testing, COVID-19 tests for everyone periodically, and other precautions, including isolating confirmed cases from other residents.

“Person zero was a staff member (at RCH), someone who traveled outside of the area. Unfortunately the onset of symptoms is insidious. This happened in New York City in nursing homes,” Michels said.

COVID-19 symptoms

The “Big 12”

• Fever

• Chills

• Cough

• Shortness of breath or difficulty breathing

• Fatigue

• Muscle or body aches

• Headache

• New loss of taste or smell

• Sore throat

• Congestion or runny nose

• Nausea or vomiting

• Diarrhea

Two symptoms really stand out: muscle or body aches and loss of taste or smell (as in no sense of smell) Allergy symptoms may be confounding factors, but the others are distinctive for the flu or COVID-19 and some have no symptoms at all.

COVID-19 infection timeline

Infection day — symptoms may not appear for two to 14 days; the average time to symptom onset is four to five days.

Day 1 of symptoms — most commonly fever, cough or loss of taste or smell.

Days 2-10 of symptoms — symptoms worsen, with fatigue and muscle pains becoming prominent.

Days 10-12 of symptoms — this is typically when ICU admission and respiratory failure occurs, but can range between eight and 15 days.

Days 10-14 of symptoms — this is usually when milder cases begin to subside.

Long-term COVID-19 consequences

• Subsequent pneumonia (damaged lungs are more susceptible to pneumonia)

• Heart problems from the virus

• Long-term symptoms — up to several months —include cough, shortness of breath and fatigue

• Hypertension

• Blood clots

• Kidney failure

These are the known long-term consequences, the full range will not be known until the virus is controlled.

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