If you get elbowed while visiting the Wrentham public health nurses' office, it's not because anyone is being pushy or rude.

With the flu season in full swing, and now with the novel coronavirus, COVID-19, putting everyone on guard, it's one way of offering a greeting these days.

On Monday, senor public health nurse Lauren Hewitt, R.N., and public health nurse Jeanine Murphy welcomed a visitor cheerfully, but stopped short of extending their hands. Grinning, Murphy instead offered an elbow bump.

"We're not shaking hands right now," explained Hewitt, smiling as she gave a light fist bump in place of the standard American, palm-to-palm greeting.

It's all part of a heightened focus on precaution -- a usual practice when the seasonal flu is making its rounds -- as COVID-19 has continued to spread globally from its origination point in Wuhan, China.

While stressing that the chances of contracting COVID-19 remain low, Wrentham's public health nurses join other public health officials around the area and at the state level in acknowledging that it is an evolving situation and they are monitoring it closely.

"This is a new disease caused by a novel (or new) coronavirus that has not previously been seen in humans," noted Murphy.

There is no telling whether it will "fizzle out" like the Influenza A virus subtype H1N1 and SARS coronavirus outbreaks did a decade and more ago, or if it will continue to evolve. As of Friday, Massachusetts had seven confirmed cases of COVID-19, three of them in Norfolk County.

"No one is sure in what direction this virus may move or how quickly," Murphy indicated. "But decreasing the spread of the virus is our main concern. Virus symptoms include fever, coughing, shortness of breath and may lead to pneumonia."

The public health nurses (PHNs) and public health departments in local towns are all receiving regular updates from the Centers for Disease Control and the World Health Organization. The Massachusetts Association of Public Health Nurses is also sending out statements "to keep all health care clinicians current on this rapidly evolving situation," the Wrentham nurses noted. 

"We, as your PHNs, in turn, make every attempt to get this information out to the public," they said.

Part of that effort includes making fact sheets available online and in public places. Wrentham's nurses have taken the addiional step of creating wellness stations in the town hall, while local schools are increasing efforts to sanitize surfaces, stores are offering cart wipes, and many businesses are putting out bottles of hand sanitizer.

"At Wrentham Town Hall, we have stations at both main floor entrances with Purell, gloves, masks and alcohol wipes but we ask, if you are sick, please stay home," Murphy said. "We have updated the Public Health Nurses page on the town website with links and fact sheets on coronavirus."

Franklin Director of Public Health Cathleen Liberty, MPH, also reassured the public that local health departments are keeping watch and "receiving information from the DPH regarding the coronavirus," and will inform the public if any additional steps must be taken.

"The CDC has an excellent website providing us with information as well," Liberty said via email.

Echoing Hewitt's and Murphy's caution against panicking over COVID-19, she noted, "the DPH is stating that there is a low risk of Massachusetts residents contracting the virus."

"The DPH also states that people should take normal precautions against any infection, including the flu, by washing hands, covering coughs, and staying home when you are sick," she said. "They are encouraging people to live their lives normally and go about their normal activities."

According to the CDC, at least 80 percent of those infected with COVID-19 are experiencing "mild" symptoms and are recovering on their own.

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Franklin Town Administrator Jamie Hellen noted that the town -- like other towns -- has set up a special portal on its website through the health board with information for residents.

"As you can see, much of it is information driven by the state, with tips, but nonetheless is important to set up to make sure residents have the most up to date information," he said.

Local school officials are keeping close tabs on developments as well.

"We are maintaining communication with our local health director and school nurse leader," said Franklin Superintendent Dr. Sara Ahern. "We are following updated guidance from agencies such as the MA DPH, DESE, and CDC. Our facilities department is actively cleaning our schools, as recommended. We are also educating families about preventative measures that we can all take to stay healthy."

Local school districts from Franklin to North Attleborough have released a similarly-worded statement to families concerning COVID-19.

"As with seasonal cold and flu infections, we are being advised to reinforce general precautions we all should take to remain healthy," the statement reads.

These precautions, also issued by public health departments, include:

? Practice good hand hygiene. Wash your hands often and thoroughly with soap and water for at least 20 seconds. Avoid touching your eyes, nose, and mouth with unwashed hands. Use Alcohol-based hand sanitizer when soap and water are not available.
? When coughing and sneezing, cover your mouth and nose with a tissue. You can also cough or sneeze into your sleeve. Throw used tissues in the trash and immediately wash your hands with soap and water for at least 20 seconds.
? Avoid sharing drinking glasses, cups, eating utensils, dishes, towels or other items. Wash these items thoroughly with soap and water after use.
? Avoid close contact with people who are sick whenever possible.
? Practice other good health habits: Clean and disinfect frequently touched surfaces at home, work or school, especially when someone is ill. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

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Hellen said Franklin has engaged the services of an independent vendor to sanitize the town's public buildings over this weekend as a precaution. While there have been no cases of the virus in local towns, officials want to ensure that residents feel confident when they need to stop in at town buildings.

"It feels like a step to take when you can say we have a new baseline," Hellen said.

Officials say anyone anyone with symptoms of illness should stay home. These include a temperature greater than 100, coughing, vomiting, diarrhea, any rash not yet diagnosed by a physician, red or pink itchy eye, and/or drainage from eye, and any contagious illness such as chicken pox, strep throat or flu.

At the schools level, the districts note, "nursing staff are monitoring illness within the student body and are prepared to react appropriately, according to MA DPH guidance." 

In Franklin, facilities staff members spent extra time over February break deeply cleaning the schools, "as we typically do during the cold and flu season. They will continue to be vigilant about cleaning frequently touched surfaces," said Ahern.

The scenario is the same in other area schools.

At this time, public health officials are not recommending the use of masks or gloves in public settings. Also, federal health authorities are not recommending that schools cancel classes.

"Should school closure or dismissal become necessary, we would follow the same procedures for our cancellation practices due to
inclement weather," Ahern noted.

While there is no treatment for COVID-19 at this time, supportive non-pharmacological interventions include: Fluids, Tylenol, rest "and good, common sense hygiene to prevent spreading of the virus," the Wrentham nurses said. 

Anyone who has symptoms and has traveled in Asia within 14 days or has been in contact with a known coronavirus case should call their doctor and report it but NOT go to their doctor's office. The doctor will arrange for the patient to have testing done (oropharynx and nasopharynx swabs, similar to a strep test) and will contact the CDC for potential quarantining and medical support at predetermined locations.

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