Although Jefferson County has yet to confirm a single case of the COVID-19 coronavirus as of Monday morning, that could be due as much to the lack of ability to test locally as residents’ resistance to the highly contagious and sometimes deadly pandemic that has killed almost 13,000 worldwide including just over 200 in the U.S.

It could also be a geographical benefit and/or validation that the measures being implemented locally — vigilant hand washing and sanitation, social distancing and isolation and the temporary closure of places where residents are most at risk to spread COVID-19 — are working.

Meanwhile, Gov. Eric Holcomb carried social distancing and isolation a step further by ordering Hoosiers to remain in their homes except when they are at work or for permitted activities, such as taking care of others, obtaining necessary supplies, and for health and safety. The order is in effect from March 25 to April 7.

“The next two weeks are critical if we are to slow the spread of COVID-19, and we must slow the spread. You must be part of the solution, not the problem,” Holcomb said.

With four confirmed cases in Clark County and one each in Ripley, Jennings and Scott counties — including one of Indiana’s six deaths in Scott — Jefferson County is now nearly surrounded by communities with positive cases of COVID-19. Switzerland County, located to the east, is the lone county bordering Jefferson that is also with no confirmed cases.

Jefferson County Health Officer Dr. John Hossler issued a news release Sunday confirming the county has been “hampered by lack of testing availability” but that the lack of confirmed cases should in no way lead the community to let its guard down and break from the precautions that have proven most effective in limiting exposure to the virus in other regions.

“We’ve got a handful — not many — people we are following as what we call people of interest,” Hossler said Monday morning. “There’s no way we do not have it here. We continue to advise people who show symptoms to assume you’ve got it and self-quarantine ... it’s not overwhelming numbers, but there’s a handful and there’s probably others who just aren’t showing the symptoms.”

Hossler said health officials in Jefferson County are in contact and working with officials in surrounding counties that have experienced their first cases of COVID-19 to track details on the virus and where those who are testing positive have been.

“We fully expect to have positive cases in Jefferson County. Please do not let the fact that we have zero cases at this time let you become non-compliant with social distancing and isolation. Let us reassure you that we do not have any positive cases yet in our county and when we do get a positive case, we will let the constituents of Jefferson County know,” Hossler said in Sunday’s statement.

One of the trends Hossler and other health care professionals are seeing with the spread of COVID-19 in Indiana is that rural counties — more isolated already due to their location — are reporting lower numbers of positive cases.

“In situations like this there are some advantages to living in a rural county. We’ve always said there are no roads that lead to Jefferson County and that’s a good thing at times like this,” Hossler said. “You look at the cases in Indiana and you can track a lot of them right along the I-65 corridor. There’s a lot of people who pass through those communities along the interstate so at least we’ve got that to our advantage.”

The counter side of that is that rural Jefferson County, and King’s Daughters’ Health, have been unable to get the test kits needed to confirm whether people of interest are actually positive cases. Hossler has been unable to get an answer as to why, despite talking to state medical officials and state legislators.

“We have been hampered by lack of testing availability and have tried leverage from several different approaches without any success. We have no explanation why there is a shortage but we must move forward as if COVID-19 is now among us,” he said. “We suspect that testing capabilities will become more readily available in the next week or so but it is still unknown if and when drive-up testing will become available to everyone.”

The Jefferson County Health Department continues to monitor the county’s COVID-19 status and work closely with community leaders. The Indiana State Department of Health is trying to source additional test capability but for now certain criteria must be met in order to be tested anywhere and even more so in Jefferson County.

Hossler reiterated that Jefferson County residents who experience any symptoms of COVID-19 — fever, shortness of breath or a dry cough — should “self-quarantine” immediately and continue to do so until fever free for 72 hours (three days without fever reducing medication) and other symptoms have improved, and at least seven days have passed since symptoms first appeared.

He also urged residents “please do not seek medical attention unless you are experiencing life threatening symptoms such as shortness of breath, difficulty breathing, persistent pain or pressure in the chest, new confusion or inability to arouse, bluish lips or face, fever greater than 102 degrees. Those contacting or going to the Emergency Department without life threatening symptoms are overloading our local health care systems, prohibiting those experiencing life-threating illness from receiving prompt service.”

He noted that a lot of people who contract COVID-19 will be asymptomatic or experienced only mild symptoms that, depending on their age and health, will do fine without any intervention and by self-quarantining they can reduce the spread of the virus and avoid putting pressure on those who are more susceptible and the health care resources. However, older individuals — those age 65 and older — and patients with comorbidities — pre-existing conditions like COPD, coronary artery disease/congestive heart failure, and diabetes — are considered high-risk groups that should seek medical evaluation.

Hossler said the health department and local officials are working with and urging local businesses to not require work excuses from health care providers in order to stay home from work if you are experiencing symptoms of COVID-19.

Holcomb said the state will be proactive by allowing as much personnel as possible to work from home over a two week span beginning today.

“I’m setting the example by sending state government personnel home to work to the maximum extent possible and closing our facilities to public interaction beginning Tuesday, for at least the next two weeks,” said Gov. Holcomb.

Beginning Tuesday, all state government offices will be closed to in-person public activity until at least April 7. This includes the Government Center complex in Indianapolis and other offices throughout the state, including Bureau of Motor Vehicle branches. State employees will work remotely whenever possible and continue to provide core functions online and by phone. All public safety functions will continue.

In conjunction with the closures, Gov. Holcomb ordered an automatic extension of all state-issued licenses and will advise law enforcement to refrain from issuing citations for a driver’s license or registration that expires during this emergency.

The state, in conjunction with the city and all hospital systems in Marion County, has activated a comprehensive emergency operations center to maximize hospital capacity and provide joint coordination. The center is charged with tracking the inventory of all hospital beds, supplies and personnel as the number of COVID-19 patients grows.

“I am proud of our hospital systems that are participating in the initial phase of this process, Eskenazi Health, IU Health, Franciscan Health, Community Health Network, and Ascension,” said Gov. Holcomb. “Marion County is where we’ve seen the most community spread to date, but we will expand this model to other parts of the state.”