Mesa County Public Health Response and Recommendations related to Gastrointestinal Illness Outbreak Affecting Mesa County

With a significant number of people in our community experiencing illness, many have asked about what Mesa County Public Health (MCPH) is doing to ensure the health and safety of our community.  

Public Health agencies across the country and at the national level keep our communities safe by controlling disease outbreaks, helping people avoid leading causes of death and injury, making sure food and water are safe, and much more. Disease and illness investigation is one of the main components of Public Health; we have an entire team of Epidemiologists or “disease detectives” here at MCPH dedicated to this type of work.

Our role in this outbreak is to help our local school districts stop the spread of illness as well as work to determine the cause of illness, if possible. 

How common is this?

We understand the community’s concern over a large number of students impacted, this illness is spreading quickly and has some very undesirable symptoms.  These types of illnesses (usually viral and gastrointestinal) are very common. In Mesa County, in 2018, there were 45 total outbreaks, 17 were gastrointestinal illnesses (GI), six of those were confirmed as norovirus. Of those GI illness outbreaks, nine were in long term care or assisted living facilities, six were in child care centers, one was a retail food establishment.

Mesa County Public Health monitors absenteeism at D51 schools as a proactive measure to learn about illness trends that may impact large groups of people, such as students. Looking at data from 2019, from January 1 through November 1 there were 23 reports of increased absenteeism (when at least 10% of students are absent due to illness).  The illness at Palisade High School was the first report of elevated absences due to illness in D51 for the 2019-2020 school year. That is in line with what we typically see as this is the time of year when illnesses begin to spread.  

Since the initial report at Palisade High School, 12 other schools and two preschools have reported an increase in absences due to illness. There was additional illness reported mid-week prompting the district-wide closure.

How many people are impacted?

Mesa County Public Health is not able to track each individual case, as each student’s absence due to illness is not something that is reportable to public health. We are not given the names of students who are sick, just the number, or sometimes a percentage, of students and staff absent due to illness at each building. We are closely monitoring the situation and we’re concerned about the further spread in our community.

Has this ever happened before?

Outbreaks and illnesses happen often. School District 51 has guidelines and procedures as to when schools might need to close, which has occurred in the past in individual schools. District 51 has never before closed due to illness. According to D51 Nursing Coordinator Tanya Marvin, “We are taking this highly unusual action because this virus is extremely contagious and spreading quickly across our schools…”

This illness is unique in its rapid onset of symptoms, and person-to-person spread. We’re hearing reports that a person might  feel just fine, and in less than an hour’s time have a vomiting episode, sometimes in public places. That’s causing the further spread of the illness and making it more concerning than a typical gastrointestinal virus, much like norovirus.

We are responding appropriately, and treating the outbreak as a norovirus outbreak, even without lab confirmation.  

What is Mesa County Public Health doing?

We are closely monitoring the situation and we’re concerned about the further spread in our community. To help stop the spread of this illness we’re providing education, information, and support to many community partners.  This includes first responders, caregivers, child cares, retail food establishments, the business community, local libraries, shopping centers, and more. 

We are and will continue to be in constant contact with our partners at District 51 and have ensured they’re utilizing cleaning products and practices that will be most effective in stopping the spread of this illness.  

We’ve created resources so people are informed about the ways these types of illnesses can be spread. One focus of these efforts is in clean-up and disinfecting procedures. We know viruses like these are very contagious and spread rapidly from person-to-person.  A large number of people can be infected if there is a public incident of vomiting. When that occurs, tiny particles, are released and can travel in the air for up to 25 feet, these particles can enter the nose and mouth of a non-infected person and get them sick.  This resource, created by the Colorado Department of Public Health and Environment (CDPHE) for use in retail food establishments outlines the potential for spread this way:

  • One gram of diarrhea (equal to ¼ teaspoon of water or the weight of a dime) from someone with norovirus can have five billion viruses.  You can become infected by coming in contact with as few as 20 of those viruses – an amount smaller than what would fit on a pinhead as a visual reference.

In addition, viruses like this can live on surfaces for months, so if waste (either vomit or feces) from an infected person is not cleaned up properly, it can re-infect folks.  There is a limited amount of immunity patients experience once they’ve been sick, but viruses like this are highly contagious and notorious for re-surfacing.

Our Environmental Health Team has consulted on cleaning procedures with individual cleaning companies, the District 51 janitorial staff, and members of the public.

Our Epidemiology Team has been fielding questions from the public and interviewing those who have contacted us and are impacted by the illness.  We continue to monitor the illness, symptoms, and outcomes of patients. We have not been made aware of any symptoms other than vomiting, diarrhea, and in some cases, fever associated with this illness.

Why don’t we know what it is?

A lot of people are wondering why the exact illness remains unknown. We know based on the symptoms is that it’s acting like a virus. A virus typically comes on quickly – patients report a very short amount of time between not feeling well and their first instance of vomiting – and lasts a relatively short period of time. Patients in this outbreak report feeling better within 12-24 hours.  The main symptom is vomiting and diarrhea and some have reported a fever.

Determining an exact diagnosis for these types of illnesses requires laboratory tests, which can be invasive, costly and not all that helpful in remedying a patient’s outcome.  Additionally, not all illnesses are reportable to public health.  Norovirus is so common that labs and doctors’ offices aren’t required to report these illnesses to the local public health agency. This illness specifically seems to be hitting quickly, and patients are also recovering quickly, so many have not gone to a medical provider to be seen or tested.

MCPH has is actively seeking samples that would provide an exact diagnosis and has asked medical providers in the community to collect stool samples from patients. If we are able to obtain samples, MCPH has offered to pay for the testing on a limited number of samples.  Testing to confirm an initial suspicion that the illness is a virus, much like norovirus, takes about a week, but if that testing is inconclusive, further testing might be needed that could take longer if it’s required.

What can I do?

It may seem trivial, but proper handwashing techniques are vital in order to stop the spread of this illness in our community.  

  • Soap and water is best, but hand sanitizers are better than no washing at all.
  • Wash your hands routinely throughout the day and especially after using the restroom, before handling food, and after contact with ‘high touch’ surfaces (doorknobs, keyboards, light switches, handrails).

If you are sick, or show any signs of illness STAY HOME and do not congregate in public spaces until you are symptom-free for at least 24 hours.

If someone in your family has been sick, and you’ve cleaned up vomit or feces as a result of their illness, know that you’re at an increased risk to get sick.  

Be sure the clean up for that incident involved a cleaner that is effective against norovirus (it will specifically say that on the label). If you are unsure if the cleaning product you are using is approved, you can:

  • Review a list of EPA-approved cleaners can be found here.
  • Mix one cup of bleach with one gallon of water. This concentration will kill the virus, most bleach-based cleaners that come from the store are not at this concentration.  

Norovirus can live on surfaces for months, so proper cleaning is essential to stop the spread of this outbreak, and prevent future exposure to the virus.

MCPH_D51_stopspread

This is just impacting schools so my business can function without interruption, right?

This illness is showing very strong person-to-person transmission. We are closely monitoring the situation and we’re concerned about the further spread. It is very possible employers, care facilities, and other groups will be impacted.  Gatherings with large amounts of people, or even a few people in close contact can create opportunities for further spread.

Things to consider:

If your business has a gathering or meeting in the near future, consider options that can reduce person-to-person contact; for example, changing an in-person meeting to a phone or video conference.

Talk with your custodial provider or staff about the types of cleaner and sanitizer they are using to clean your facility. To kill viruses like this a bleach or alcohol-based cleaner is required. The typical ‘bleach wipes’ don’t have a high enough bleach concentration to kill the virus. Check the label, and use a product that says it’s effective against norovirus. To make your own, use a concentration of one cup bleach to one-gallon water.

If members of your staff have experienced illness, or there was a public instance of vomiting, ensure the waste was properly cleaned up.

Check out this infographic created my MCPH as a resource to guide those cleanup efforts, and recognize that there’s a strong possibility anyone within 25 feet of that occurrence, will get sick. 

Stomach Flu vs. Influenza

This virus is a gastrointestinal illness, not influenza. Viruses like this typically come on quickly – in this outbreak patients have reported a very short amount of time between not feeling well and their first instance of vomiting – and lasts a relatively short period of time. Patients in this outbreak report feeling better within 12-24 hours.

Influenza is a respiratory illness with symptoms of fever, body aches, cough, and possibly sore throat. The onset can also be very quick, but influenza typically takes much longer to recover from. Getting an annual flu shot is your best protection against influenza.

Public Health Recommendations to prevent the spread of illness

  • Wash your hands often with soap and water or an alcohol-based hand rub when soap and water are not readily available.
  • Know the signs and symptoms of illness such as fever, cough, sore throat, body aches, headache, vomiting, or diarrhea.
  • If you or any of your family members have been sick with this illness, stay home and remain home for at least 24 hours after symptoms have subsided. If you think you’ve been exposed to the virus through clean up or contact, consider limiting interaction with others for at least 24 hours.
  • Consider getting a flu shot.

MCPH encourages you to remain at home for at least 24 hours after symptoms have subsided. 

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