Appalachian Trail Privy - Rice Field Shelter, Virginia
With businesses and schools closing during the pandemic, and isolation orders being issued in many cities and some states, many people are taking this opportunity to get away to the outdoors. This has lead to record crowds at the more popular trailheads and parking lots and vistas and trail shelters along the Appalachian Trail.
Campsites and parks all over the country are seeing record visitation, as media reports have shown.
Concerns are being raised about infection spread risk. All over the country, at national parks, and state parks. California is conducting a ‘soft closing’ by closing parking lots at state parks to limit use and occupancy.
The Appalachian Trail Conference has issued an appeal for visitors to avoid the 2,000 mile plus trail system at this time. The crowds are so large that social distancing may not be possible, especially at the more popular summits and shelters. From the ATC, (23 March):
“The ATC does not want to do too little, too late. We cannot close the Trail. We cannot physically bar access to trailheads or connecting trails. We can and do, however, urge everyone to please stay away from the Appalachian Trail until further notice.
There is an unfortunate truth about this virus: unless everyone is safe, no one is safe. So, take a walk around the block. Spend time with your loved ones. And, please, stay home.”
From a public health standpoint, this situation poses a special risk. And it’s more than infection with Covid-19. A potential combination of risks may be present. Covid-19 and norovirus.
For years now, the Appalachian Trail (AT) has had a problem with hikers contracting norovirus. Outbreaks have occurred, especially along the busy sections in Georgia, Virginia, and the North Carolina/Tennessee sections including the segment though the Great Smoky Mountains. Perhaps other segments; these are sections I’m aware of that had noro in the past.
Spewmageddon: Illness on the AT appalachiantrailhistory.org/...
Compounding the risk, we are having record rains, and unusual, sometimes record temperatures this winter and this week.
Norovirus outbreaks, also associated with cruise ships, long term care homes, and dormitories, spread infection at the trail shelters, springs and water sources, and of course, the privies. And with shared trail mix, and personal contact, like with Covid. These peak in spring and fall, like the flu. These are also the peak visitation times on the AT. New studies have found Covid RNA, viability uncertain, on cruise ships 17 days after the occupants disembarked. 23 March
CDC says coronavirus RNA found in Princess Cruise ship cabins up to 17 days after passengers left www.cnbc.com/...
These visiting hordes of people, like the Spring Breakers, will be widely dispersed, so contact tracing, which the US isn’t even doing, according to the NYT, won’t connect positive cases with the many passing strangers potentially exposed. Who knows the day hiker passing by, or who last touched the handrail, or just left the privy. Hikers famously go by trail names, too.
The Epic Failure of Coronavirus Testing in America www.nytimes.com/...
“Contact tracing — the practice of identifying and testing every person that an infected person came into contact with after they themselves contracted the virus — has not been prioritized.”
Noro will confuse the diagnosis. With the new medical reports confirming that diarrhea presents in about 50% of cases, as recently covered in another diary here—www.dailykos.com/… how will doctors discern if it’s noro or Covid, or both? Clear chest (asymptomatic stage), but confirming for noro, and the patient goes happily along, (after the diarrhea bout) only to begin the Covid symptoms at about five days or more, to then seriously worsen at nine days. Will they be aware or be advised they may have asymptomatic Covid? They may stay asymptomatic, and be a ‘spreader’... At nine days, things can get life threatening, fast. Or not ‘present symptoms’ at all, just be an unaware threat to others—we know the message by now, but many still seem to not care.
If Covid only—and you tell local doctors you were on the AT, they may assume noro, if presenting with GI tract symptoms. May even confirm it, or not, and not test for Covid, if in fact these supposedly available tests are in fact offered. Again, the patient is set up for a life threatening situation. If not them, then those they may infect. Some can be expected to get sick or seriously sick on the trail or in the woods—more on that below.
The recent medical reports that alert us that GI tract disturbances can be a first presentation of Covid have gotten some attention. Seems the life threatening progression is still not being able to breath, without supplemental oxygen, or when the patient reaches critical status, mechanical ventilation.
Study from American Journal of Gastroenterology Reveals Diarrhea is a Prominent Symptom of COVID-19
globalbiodefense.com/...
Since first publication of this science paper, the authors have amended it to show that Covid cases presenting as GI tract disturbances have the same mortality as those presenting with respiratory distress, not higher, if that’s good news.
The American Journal of Gastroenterology Pan L, et al., Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study,
We know those ventilators will be scarce soon, at the biggest and best hospitals. This raises another concern—access to rural health care.
Access to health care at all levels is limited in rural areas, but especially in Appalachia. Five counties touch on the southern terminus of the AT, Springer Mountain. There, increasing 911 calls are a problem for county responders.
There isn’t any federal dispatch for the handful of federal (USFS) officers. There are only five dedicated officers at this time, for round the clock coverage of a million acres. That’s more per square mile than out west, but these are busy areas, with urban interface and millions of people in less than a hundred mile radius of the Southern forests. More ‘prescribed burns’ funding, a hot topic for the USFS, less each year for law enforcement and maintenance of campsites and day use areas.
The state ‘game wardens’, here, Georgia’s Wildlife Resource Division force, is at half the level of ten years ago. Forest use and population have more than doubled here in that same time.
Response to these 911 calls falls on the county, usually the Sheriff’s office or fire department. Often these are poor counties, doing what they can. Of the five counties here at the southern end of the trail, two have had their hospitals close (no state expansion of Medicaid), one has no hospital, and the other two local hospitals are a few dozen beds, so a handful of patients, and there are no ventilators, unless the patient gets to a metro area. Atlanta is close enough, and other metros, to flood the woods with all wheel drive vehicles, drivers behaving like they are in an off-road commercial, but the metro doesn’t have to respond to calls here.
The counties get nuisance calls frequently, from the lost, or from family that haven’t heard from a hiker, or folks who think they are having heatstroke, etc.
In February, a hiker started at the approach trail to Springer, at Amicalola Falls State Park, Georgia’s most popular park. Saturday he called family, and Sunday after another call, he spoke to family, and then called 911 for rescue, in distress. He wasn’t found that day, though just a few miles from the start of the approach trail. Monday, the search resumed, a clear weather day, and some of his gear was found, near the occupied hike-in lodge off the official approach “blue blaze” trail. Despite a drone being sued, he wasn’t located. Tuesday was another rainy day, then heavy rains. His body was found on Wednesday. February 19, 2020:
Missing hiker found dead just 1 mile away from trail www.cbs46.com/...
And before this incident, last year a call came in to 911 reporting a rol-over wreck off Nimblewill Gap Road, a gravel Forest Service road, used as an AT terminus approach. The response time was six hours—the deputy thought “it was a set up”…
Accident victim waits six hours for help to arrive from Dawson County Sheriff’s Office dawson.fetchyournews.com/...
Any sickened through hikers, or segment hikers, or folks encamped for this isolation period, should not assume the ambulance and rescue will reach them in this area. The 911 centers at the county hope your call is another counties responsibility—they often don’t have resources to respond. “Be adapt at self rescue” the white water crowd trains for. That isn’t reality if you have shortness of breath and need oxygen or the rare machine to breath for you, while infused with a paralytic, requiring a lot of medical personnel, placing them at risk, taking up a bed that maybe could have been available for others if you had not gone hiking with the crowds.
Back to the main points: Please stay off the trail, don’t put yourselves and the unsuspecting thru-hikers at risk. Be aware many people, like the airline travelers and Spring Break crowd, may not be able to alert others they’ve placed them at grave risk, and they may be misdiagnosed with norovirus, and noro may hide their Covid infection.
Let’s show our concern for others, and keep some distance, or better, stay home. And as I shared in my first diary here, just as Covid-infected people may be shedding long after “recovery”, there is emerging data about virus shedding that raises more concerns about feces as a source of infection and spread with Covid, aka Sars-2. Feces and sewage was proven to have caused infection with SARS 1, just as it does with other viruses we know, noro- roto- and others. How certain and for how long, and whether immunity even develops—these are questions waiting for more “evidence”. Avoid be part of that medical research “cohort”.
Thanks for reading. Pass these concerns along, not the virus.
