In rural upstate New York, it takes up to two weeks to find out test results for the novel coronavirus. Personal protective equipment is sparse. And there's no medical facility with an intensive care unit.
This is what officials in Seneca County are trying to remedy as their first COVID-19 case was diagnosed on Monday.
"A lot of our customers are wearing masks, wearing gloves, taking the safety precautions seriously, observing social distancing -- and employees are doing the same," said Sue Cirencione, the owner of Ovid Big M, a market in Seneca County. "The customers are watching the news feeling good that the [local] numbers are so low."
After Seneca County's Health Department announced the area's first case on Monday, four more residents tested positive for COVID-19 within 72 hours.
The Finger Lakes region as of Tuesday had more than 420 confirmed coronavirus patients, Public Health Director Vickie Swinehart told ABC News.
"We have anticipated and planned for our first positive case of COVID-19. This was not unexpected as every other county across the state has reported positive cases to date," said Swinehart in a press release issued on Monday about the first case in Seneca County, which has been following all statewide guidance regarding school and business closures.
Instead of releasing any identifiable data about the positive cases, Swinehart said the agency was able to notify those who may have been exposed and ordered them to be quarantined and monitored for symptoms. Seneca County's population is about 35,000.
"The residents are handling it well, they are being cautious," said Carl Martin, the manager of Glenwood Foods in Seneca Falls. "There's a lot of talk, people are concerned of getting it, but they aren't panicking."
Martin, 47, said once COVID-19 cases started appearing in the area, personnel from the county's health department hung up posters in his store and across the region to promote social distancing and the Centers for Disease Control and Prevention's other guidelines.
Twenty-four people in Seneca County are under COVID-19 symptom supervision as of Thursday morning, the county's health department said.
While 105 tests have been administered in Seneca County to date, health officials are concerned that the number of coronavirus cases is underreported because there aren't enough tests and PPE supplies are limited.
"Because there aren’t many people being tested in Seneca County, we have no idea how many people are actually positive," said Office of Emergency Management Director Melissa Taylor.
"I have been telling our first responders to assume everyone is positive in order to protect themselves," Taylor said. "Because we were the last county with a positive case, there are concerns about PPE supplies drying up when we need them most. We hope that won’t be the case."
Because there isn't a hospital in the county, Taylor said she has ordered more testing supplies to set up a drive-thru testing site.
"In this area, it can take 10 to 14 days to get results. By the time we know someone is positive, they should be ending their isolation period," Taylor told ABC News on Thursday.
"It's a small county which is adjacent to Ontario County, about 10 miles, a 20-minute drive, away," said Regina, who runs a flower stand along Route NY-89 and declined to give her last name. "We have walk-in clinics that refer us to go hospitals that are about an hour away -- Strong Hospital in Rochester or Thompson Hospital in Canandaigua."
If overcrowding becomes a problem, the Public Health Department has reached out to the Microtel and the Hampton Inn in Seneca County and they are willing to house quarantined patients if needed.
Swinehart told ABC News that Seneca County's five COVID-19 patients are not "sick enough for hospitalization, are able to remain in isolation in their own homes, and are monitored twice daily by staff of the Seneca County Health Department."
She also said those residents who live alone and are under quarantine while they await their test results can take advantage of county resources that can assist with meal, grocery and medication delivery. "We also can arrange for a mental health professional to contact them if they need some assistance with mental health issues," she said.
For patients living alone who experience a mild progression of symptoms, it's recommended that they use a telehealth platform or visit an urgent care center, said Dr. Tanvir M. Dara, chief medical officer of WellNow Urgent Care, which has a location in the area.
For residents who are closer to medical facilities like Geneva General Hospital in Geneva, Schuyler Hospital in Montour Falls, or Cayuga Medical Center in Ithaca, an emergency room health care professional can determine what services the patient will need, Dara said.
"This includes ICU admission and -- if needed -- where to transfer them if an ICU bed is not available," said Dara. "Unfortunately, we are seeing people delay urgent care due to fear of exposure to COVID-19 and, accordingly, fewer people are coming in for treatment. This is concerning as certain conditions can escalate to become more serious if left untreated."
"In the event symptoms become life-threatening, patients should alert a friend or loved one of their symptoms and visit their nearest emergency room, or call 911 immediately," he said.
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