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TOPEKA — Kansas Gov. Laura Kelly announced Saturday the signing of a temporary statewide stay-at-home directive excluding essential activities and taking effect 12:01 a.m. Monday in response to escalation of coronavirus cases in Kansas.

Kelly said the executive order to suspend activities recognized the capacity of COVID-19 infection to escalate and a key role the public could play in restraining it by limiting interaction among people. She said the caseload in Kansas could surge from the current level of at least 267 to as many as 900 within a week. Kansas also recorded its sixth death from the virus, with new fatalities in Shawnee and Johnson counties.

"Positive cases are appearing everywhere at this point," she said. "I know this has been hard. I know we have tough days ahead."

The order will remain in place until April 19 and won’t be lifted until consistent evidence of a declining infection rate is in hand, she said. It does permit exceptions that include leaving the home for reasons of personal health or safety, to secure supplies or services and for outdoor activities.

More than half the state’s population already was under a stay-at-home order issued by county health officials. The governor said she left the decision up to counties for as long as possible.

"The reality is a patchwork approach is a recipe for confusion in our statewide fight to slow the spread of coronavirus," Kelly said. "Statewide uniformity will ensure we're all playing by the same rules, and it will help prevent an influx of new cases."

Under the statewide order, Kansans must remain at home unless going to work to perform an essential function, obtaining food or medicine, seeking medical care, providing care for children, pets, family or someone who is vulnerable, or exercising outdoors while adhering to social distancing guidelines.

"You can still go outside," the governor said. "You are not under house arrest."

All individuals performing essential functions must work from home to the extent possible. No individual leaving their home is required to carry or present any letter, ID card or other paper proving they are allowed to leave home.

Twenty-two other states have adopted comparable statewide directives, Kelly said.

The Kansas Chamber responded positively to the Democratic governor’s order.

"As the number of Kansas counties issuing stay-at-home orders grew, a patchwork of what were considered ’essential’ businesses was beginning to develop. This made it challenging for companies to operate, especially those with multiple locations in our state," said Alan Cobb, president of the statewide business organization.

Kansas House and Senate leaders on the Legislative Coordinating Council would review the governor’s statewide order in consultation with the attorney general and emergency management officials. A measure adopted by the 2020 Legislature granted the LCC the responsibility for analyzing Kelly’s emergency orders.

"While I appreciate the governor’s very difficult task, I am concerned about a one-size-fits-all solution," said Senate President Susan Wagle, R-Wichita. "We are not like coastal states and our efforts must be specific to the needs of Kansans."

Emotional test

Registered nurse Ashleigh Adams witnessed the dodged-a-bullet relief of people informed their coronavirus test was negative and the despair of those who had their fear confirmed.

Adams, who works for University of Kansas Health System in Kansas City, Kan., said she initially was assigned to care for KU hospital patients awaiting test results. As the virus infiltrated deeper into Kansas’ population, her assignment shifted to a wing dedicated to people fighting COVID-19.

"When we would come in and tell them, ’Hey, we got your test back. It’s negative.’ You could just see their face — whew. Right now, we’re dealing with the positives. You’re not seeing that. They’re not getting that relief," she said.

The Kansas Department of Health and Environment said more than 260 confirmed cases of coronavirus had been detected in Kansas. It’s evidence the state was traveling upward on a Nike swoosh infection curve. Five people have died, including three in Wyandotte County. Cases have cropped up in more than 30 counties in Kansas.

Officials at KDHE believe the infection peak in Kansas could occur in mid-April. The first known case in Kansas was identified on March 7.

Ventilator rationing

Tessa Goupil, 49, of Topeka, has muscular dystrophy and uses a ventilator. Reliance on the breathing apparatus to care for the most critically ill coronavirus patients led KDHE to issue a protocol to assist health professionals with decisions about prioritizing life-saving treatment.

She said the state’s approach could have a significant impact on people with disabilities.

"The message is that my life is not important. My role as a mother, and as a person, is less valuable to the state because I have muscular dystrophy," Goupil said. "It is so devalued that if I need help, my ventilator would be taken away from me by the very medical professionals I would be turning to for help."

On Friday, Goupil joined with the Disability Rights Center of Kansas and Topeka Independent Living Center in filing a complaint about the ventilator protocol with the civil rights office at the U.S. Department of Health and Human Services.

The complaint alleges KDHE’s policy discriminates against people with disabilities because hospitals responding to the pandemic would be able to remove ventilators from patients with "advanced untreatable neuromuscular disease," "advanced or irreversible immunocompromise" and some forms of cancer.

"Unless it is significantly changed, Kansas’ ventilator rationing policy will relegate members of the Kansas disability community to die," said Rocky Nichols, executive director of the Disability Rights Center.

During Saturday’s news conference, Kelly said she questions whether disabled Kansans are losing access to ventilators.

"I think that might be a proactive act on behalf of the disability rights community," Kelly said. "I have not heard of any of that happening."

In harm’s way

Lee Norman, who deployed to the Middle East in 2018 as a National Guard officer, sees nurses and doctors serving in harm’s way on the front line in the war against a blitzing pathogen.

The KDHE secretary also spent 42 years in hospitals before joining the Kelly administration, and this isn’t the first time an infectious disease has threatened populations. Norman recalled "going through this" with the Ebola virus in 2014 and H1N1 in 2009.

"You know, when we had Ebola patients we thought came in, we had no shortage of volunteers," Norman said, "but it was because they were armed with knowledge and equipment to do the work."

Health care workers, Norman said, are altruistically driven. As long as there is some measure of safety for them, they will show up and do great work.

"One, we have to arm them with information — what's this about?" Norman said. "Second, we have to provide the necessary protective equipment. In this case, we've been strained on that. We have to prioritize."

Norman said KDHE is deploying novel solutions for overcoming a shortage of supplies needed in the trenches with the novel coronavirus. The ideas include making gowns from surgical-grade clothing and using ultraviolet light to sterilize and reuse masks.

The agency also requested dentists and others who do routine medical work to cut back so they use less protective equipment.

"We need to ship that to the people that are front lines," Norman said. "Traumas are still coming in the door and babies are still being delivered. We need to have the right equipment."

Kelly said she was mindful of families at home with school-age children and parents out of work. The governor said her administration is doing everything it can to make a difficult situation less difficult.

For now, she said, officials are trying to "buy the time we all need to get through this virus and get life back to normal."

"I appreciate what Kansans are doing right now," Kelly said. "We'll continue to work hard on their behalf, and I'll continue to hope this is all over soon. If we just stick together, we will get through this. We've been through hard times before."

Door-knob factor

Physician Steve Stites said the most significant contribution that could be made by Kansans from a public health perspective would be to stay at home.

And, he said, channel fear of coronavirus into vigilant adherence to social distancing principles. That includes washing hands and staying 6 feet from people.

The virus is spread by person-to-person respiratory droplets during close contact. Symptoms include a cough, fever and difficulty breathing. However, some carriers of the virus show no symptoms.

"I call it the door-knob principle," said Stites, chief of staff at the KU Health System. "If you go out, you don’t know how many people have touched that darn door knob. When you’re at home, you have control over your environment."

He said people could effectively isolate themselves in the home.

"Coronavirus doesn’t jump across time and space," the doctor said. "It doesn’t crawl across the carpeting. It has to have some form of direct contact from one person to another."

Feeling good

It is OK to be anxious during this unprecedented time, said Greg Nawalanic, clinical psychologist at The University of Kansas Health System.

Maybe you could learn to play guitar.

Nawalanic offered some advice for coping with the stress of staying at home. We are in uncharted territory, he said, but know that if we make sacrifices now, we will get through this sooner.

"No one’s going to war," Nawalanic said. "We’re asked to sit at home and couch surf."

Except, don’t do that. It is important to get outside for some time every day, he said. You will feel better if you go for a walk.

Another idea: Take advantage of the three months of free lessons being offered by Fender, the guitar maker.

Make it a goal to get restful sleep at night.

"The best advice we can give is turn off all the screens — the phones, the iPads, the laptops, the email, the news, any of it — an hour before your intended actual bedtime," Nawalanic said. "You say, 'Oh, what do I do in that last hour before bed?' You can try reading a book. That worked for years for people. You can also talk to one another. If you've got kids, spend time with them."

Stephen Lassen, a pediatric psychologist with the KU Health System, encouraged parents to focus on maintaining routines, which provide comfort to children.

School being out takes away structure, Lassen said, so be sure to stick with morning and bedtime routines. Parents should create a new schedule to maintain.

"We're really in uncharted territory for kids and adults and parents — parents working from home, kids not going to school — and so we're on this collision course, if we're not careful, of things really becoming very stressful, very difficult at home," Lassen said.

Parents can expect more behavior issues from children. They should remember, Lassen said, that outbursts are usually caused by stress. He suggested parents have conversations about the source of stress: I’m frustrated I can’t go into work, and what is it like to not see your friends?

"For sure, there's going to be a learning curve here for everyone," Lassen said. "Kids are actually pretty resilient. If we get those things in place, they will respond accordingly and do quite well. But there's going to be a period of transition here where everyone's getting used to the new routine."