A ‘fire of infections’ could sweep California evacuation centers. Here’s the plan to stop it

The town of Paradise and the surrounding communities had burned to the ground. The victims, many of them poor and with nowhere to go, barely escaped. They were exhausted and scared.

Then the norovirus hit as they crammed together in churches and a local fairground. They shared restrooms and slept shoulder-to-shoulder on cots.

At the East Ave Church in Chico, some 300 Camp Fire evacuees had it better than some others in Butte County. Only about 10 evacuees at the church got sick, said Ron Zimmer, one of the church’s pastors.

But it was still plenty miserable.

“Anybody who got it, had it coming out both ends,” Zimmer said. “Some weren’t able to make it to the bathroom.”

Now, with the new coronavirus pandemic sweeping through the U.S., public health experts are worried again about the spread of disease in crowded evacuation centers. They say the norovirus outbreak in Butte County should serve as a stark warning to disaster relief organizations and government officials planning for the next wildfire season.

In recent years, the fire season has extended well into November when the first major rains fall. Federal health officials warn of a “second wave” of COVID-19 cases that could happen around then.

In November 2018, by the time the norovirus was contained, Butte County officials said at least 270 evacuees in four Camp Fire evacuation shelters became ill from the highly contagious virus that attacks the digestive system.

Even in the mildest of fire seasons, thousands of Californians are forced to flee their homes, and hundreds, if not thousands, end up in temporary shelters in churches, gymnasiums and community centers around the state.

If just one person infected with the coronavirus gets inside a tightly packed shelter, the odds are high that COVID-19 spreads quickly through the entire group, said Dr. Jake Scott, an infectious disease specialist at Stanford University.

“It’s like a raging wildfire that starts with just one match or one downed electric wire,” Scott said. “In a disaster shelter, all it takes is one person who could definitely spark a huge, huge fire — a fire of infections.”

California to use more hotels and trailers

California officials and aid relief organizations such as the American Red Cross are working on plans that include relying more on motels and the state’s surplus of trailers to house evacuees instead of at traditional evacuation sites.

But how many will be available in a fire is far from certain.

In a typical fire, evacuees and disaster workers quickly book every room in communities surrounding a fire. There may be even fewer available this year. Gov. Gavin Newsom has been working with motels to house the state’s homeless population in the COVID-19 crisis. Earlier this month, he said the Motel 6 chain may open 5,000 additional rooms across the state for homeless residents.

Arenas, school gymnasiums and churches will still need to be used in the biggest fires or in a major earthquake, said Brian Ferguson, a spokesman for Newsom’s Office of Emergency Services.

Ferguson said that it’s likely officials will have to open more of them scattered in cities and towns farther from the disaster, so evacuees can maintain at least six feet of social distancing in each one. Health officials will also calculate the prevalence of COVID-19 in a particular area when making those decisions.

“If you’re in a county with a relatively low-risk factor based on the number of cases, you may have greater flexibility,” he said.

Protective equipment will play into it as well. By the time the worst part of fire season hits in late summer and fall, officials hope to have built up enough of a supply of personal protective equipment such as masks to give to aid workers and the evacuees under their care.

“We’re going to (need to) have some supplies in caches that we don’t necessarily have for routine disaster relief,” said Debra McQuillen, the chief operations executive of Scripps Mercy Hospital San Diego. McQuillen, a nurse, was leader of the Scripps Medical Response Team that helped provide medical care at shelters during the Camp Fire.

Officials also are hoping that the state’s COVID-19 testing rapid capacity also will expand. Those who test positive during an initial screening could then be moved to a separate area from the rest of the evacuees, Ferguson said.

Handwashing stations and areas walled off and segregated for people who test positive or show symptoms will be critical to prevent the spread of the disease, said Irva Hertz-Picciotto, professor of epidemiology and the director of the Environmental Health Sciences Center at UC Davis.

“I think you really want to have a good way to divide off the space for people who are testing positive or coming in with symptoms,” she said.

Other states plan COVID-19 evacuations

The profound risk of the coronavirus at disaster shelters has prompted some other states to rethink their emergency evacuation models.

Florida is considering offering hurricane evacuees hotel and gas vouchers instead of housing them in shelters.

To avoid crowding people into evacuation buses, the state also is weighing the use of Uber and Lyft drivers to give rides to those without cars. Florida officials may tell people living in homes built after 1996 not to leave in the event of smaller, Category 1 and 2 storms, since newer buildings are more likely to survive.

But in America’s tornado country, officials are still relying on traditional shelters to protect people whose homes are unable to withstand the storms, which can pop up quickly and with little warning, not unlike California’s wildfires or earthquakes.

“Do not let the virus prevent you from seeking refuge from a tornado,” the American Meteorological Society said in a statement on April 9. “If a public tornado shelter is your best available refuge from severe weather, take steps to ensure you follow CDC guidelines for physical distancing and disease prevention.”

Experts like Hertz-Picciotto and Scott, the Stanford physician, said past norovirus outbreaks in evacuation shelters provide a good analogy of how quickly a highly contagious infectious agent like coronavirus can spread through an evacuation shelter.

Norovirus is one of the most contagious viruses known to science. Spread through feces and vomit, the virus also can be inhaled through airborne particles after someone vomits. It only takes a few particles to make someone severely sick, Scott said.

The new coronavirus may be slightly less contagious, Scott said, but it has shown itself to be virulent.

The coronavirus has spread across the world in two months, and it’s shown similar infection rates to norovirus in places where people are packed indoors for long periods such as at nursing homes, on cruise ships and in prisons and jails — facilities that also tend to have large outbreaks of norovirus

Norovirus has swept through disaster shelters after several major disasters in recent decades.

One of the largest outbreaks came in September 2005 following Hurricane Katrina.

Nearly 24,000 evacuees were sheltered at Houston’s Reliant Park, a sports and convention complex. Of them, 6,500 — more than one in three people — began vomiting or had diarrhea, symptoms of what doctors call acute gastroenteritis, according to the Centers for Disease Control and Prevention.

The outbreak lasted more than a week and only slowed after relief workers put out hand sanitizer and a bank of portable sinks at a temporary medical clinic. Relief workers also hung posters and handed out fliers encouraging aggressive handwashing to slow the virus.

Deep cleanings and screenings

After that incident and others, local officials created infectious disease protocols as part of their routine shelter planning.

For instance, Butte County officials have created an emergency shelter infection control binder that contains documents and educational posters for infection control for digestive diseases like norovirus as well as for respiratory illnesses like influenza.

“This toolkit will be used in future emergency sheltering events,” Lisa Almaguer, a spokeswoman for Butte County Public Health, said in an email. “With that said and in light of COVID, additional prevention and screening tools may be implemented with future shelters.”

The Red Cross will work with county health officials to screen patients coming into any shelters that need to open if there aren’t enough hotels or dormitories to house evacuees, said Stephen Walsh, a spokesman for the disaster aid organization’s Gold Country Region in California.

He said the Red Cross also will work with local health departments to provide masks for evacuees and workers will use “enhanced cleaning and disinfecting practices” to scrub down surfaces. Cities across the state have begun doing similar deep cleanings at homeless shelters.

At the East Ave Church in Chico, that sort of aggressive cleaning — as well as a dedicated team of local hospital nurses — helped get the norovirus under control, said Zimmer, the pastor.

The church’s door handles still show the effects of all that cleaning, nearly two years later.

“All the handles around every door in my church is bleached because of all the cleaners,” he said, chuckling. “But that kept us safe.”

This story was originally published April 29, 2020 at 10:31 AM with the headline "A ‘fire of infections’ could sweep California evacuation centers. Here’s the plan to stop it."