When the floodwaters came, people in mid-Michigan had little time to think about the virus that had kept them in their homes for the previous two months, avoiding public places and large gatherings.


They had to escape with their lives, not knowing when or if the Tittabawassee River's surge would force the Edenville and Sanford dams to give way.


Ultimately, both did. And many trudged through muck as rising water swirled at their feet, thick with debris and potentially deadly pathogens.


They didn't think about where they put their masks or how they would social distance in this next disaster. They gathered their loved ones, a few essential belongings, and fled.


Some managed to escape to the homes of friends and family outside the flood zone. Some parked their cars on higher ground and slept in their vehicles.


About 260 people stayed in Midland County's five emergency shelters Tuesday to wait out the cresting water, said Fred Yanoski, the director of the county health department.


It was a crisis layered on top of another crisis.


Public health officials, volunteers and the Red Cross did all they could, Yanoski said, to mitigate the possibility of COVID-19 spreading inside the shelters set up at Midland, Coleman and Bullock Creek high schools and a pair of community centers.


Every person who entered a shelter was screened for coronavirus symptoms, he said. Each had a temperature check, too.


"The shelter teams did a tremendous job being mindful of all the health and safety issues of the residents," Yanoski said. "They implemented social distancing. ... The cots and whatnot were spaced appropriately and the cleaning and environmental hygiene procedures were ramped up. You do the best you can, understanding this is not a perfect scenario and there would be challenges."


Anyone who arrived without a mask, he said, was given one at the door.


So far, COVID-19 hasn't ravaged Midland County as ferociously as it has the southeastern corner of the state. On Saturday, the county reported 79 people have had confirmed cases of the virus since the pandemic began. There have been 46 probable cases and eight confirmed deaths.


Using public health contact tracing and with the help of the Red Cross, Yanoski said anyone with a known coronavirus infection who needed to evacuate was steered to isolated housing, away from the community shelters.


But it's the people who did not know they were infectious, the asymptomatic or pre-symptomatic people who might have stayed at the homes of friends and relatives, who might have slept at the community shelters, that concern Dr. Joel Fishbain, medical director of infection prevention and epidemiology at Beaumont Hospital, Grosse Pointe.


"How many of them might not have symptoms of COVID but could potentially spread it?" he asked.


Assuming at least a couple people who were forced out of their homes by the flood were carriers of the virus, Fishbain said, "we have a potential disaster experiment that we can follow.


"I think in seven to 10 days we're going to know if the social distancing and the masking works. There could be a big bump in cases from the gymnasiums or wherever they were housing the unfortunately displaced individuals. ... But if there's no bump in cases, then maybe we should be hopeful that this whole social distancing and masking works."


Another source of potential COVID-19 infection is the floodwater itself.


It likely contained "feces, soil, saliva, all sorts of other possible contaminants that may pose a health risk," Yanoski acknowledged.


The U.S. Centers for Disease Control and Prevention reports that the coronavirus has been found in the feces of people who have COVID-19, but "it is unclear" whether the feces can spread the infection.


Fishbain said scientists are studying whether the virus can be spread through aerosolized particles when a person with COVID-19 flushes a toilet, or when an infected person doesn't wash their hands after using the bathroom, and touches a surface that is then touched by someone else. In that scenario, the virus particles would hitch a ride into the body of that uninfected person when he rubs his eyes or nose or puts his hands in his mouth.


"One of the questions I think that has to be addressed is if you can detect the virus in stool, and we saw a lot of patients with diarrheal illness, is the mode of spread fecal-oral contamination?" Fishbain said. "Or is the mode of spread still respiratory with a virus that happens to have a gastrointestinal manifestation? I actually don't know the answer to that.


"In theory, if the water was contaminated with COVID, then you would have to either have mucosal membrane exposure, accidental ingestion or ... aerosolized from splashing (to contract it). I don't know if if we have enough information to be able to give a good, solid answer."


Yanoski said he believes the risk that the virus was spread through exposure to floodwater is low, but the threat is still there.


"It's hard to gauge how high of a risk it is," he said. "As an example, take hepatitis A. There's a risk from contaminated water. But we know there's a low prevalence of hepatitis A in our community. So we would say that your risk of contracting hepatitis A from the water would be a low risk.


"I would deem COVID in the same regard as a low risk from being in contact with floodwater. However, low does not equal zero. It is very difficult in public health to say you have zero risk. So that's why we would urge people to take precautions and be very mindful of coming in contact with floodwater practicing good hygiene afterward to limit the risk from any disease."


Coronavirus isn't the only thing people who've survived the flooding need to consider when it comes to their health.


Anyone who had an open wound that was submerged in the murky floodwater should watch for signs of infection and seek medical treatment if it becomes red, swollen, pussy or they develop fever.


Anyone who might have accidentally swallowed some of the water should be concerned about diarrheal illness, and seek medical help if it's severe.


If you're returning to a home or business that's been damaged by the flooding, Yanoski said it's vital to ensure the electricity and gas have been shut off before you go inside.


The health department also warns that anyone who lives in the flood zone and has well water or a cistern should not drink or use that water for cooking, bathing, toothbrushing, washing dishes or clothes unless it's been boiled at least 10 minutes or treated with chlorine.


And when it comes to trying to salvage what's left of flood-battered property, he said residents can go to Midland County's website for tips about how to safely clean up: bit.ly/36onLcS.


Though much was lost, and it's still unclear whether COVID-19 managed to spread among the people in mid-Michigan as the Tittabawassee tore through their towns, Yanoski said he's especially grateful for one thing.


"We were very fortunate that, at this point, there were no deaths or injuries associated with the flood," he said.


All there is to do now is wait, and hope it stays that way.