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The experts from the U.S. Centers for Disease Control and Prevention huddled in a room with Bela Matyas, health officer of Solano County, California. They had a raft of questions about a milestone case in the spread of the coronavirus: the first U.S. victim with no known connection to travel in Asia.

“Did she go to the spa?” they wanted to know late last week. “Did she go to church? Did she go to a playground?”

Now, the CDC is sending another team to Washington state, where the first U.S. virus death was reported Saturday after a potential outbreak at a King County health facility that cares for the elderly. The county reported a second death late Sunday, and there were at least two other confirmed cases in Washington, two in Florida, three in California and the first in New York and Rhode Island.

With new cases emerging every day across the country, the virus may soon outpace the efforts of medical detective work as it becomes harder to track and contain.

Health authorities have been paying closest attention to patients with connections to Chinese travel. Now, they’re trying to track down anyone who came into contact with confirmed cases. There could be hundreds or thousands of unreported carriers, some with multiple degrees of separation from those that have been confirmed.

Most people infected will likely suffer mild, flu-like symptoms from the virus, which has an estimated mortality rate of 2 percent. The worldwide death toll passed 3,000 on Sunday, and the infection has proven most dangerous for elderly people or those with underlying illnesses.

At the same time, “there are people without symptoms who carry the virus,” Matyas said. At “San Francisco airport, tens of thousands of people have returned and been allowed back in the community — it could be a lot of people. It could be hundreds of people who have it,” he said of the Bay Area alone.

‘Substantial outbreak’

The same is true in Washington.

With data from the Washington State Department of Health, the Seattle Flu Study conducted genomic sequencing on the virus of an adolescent sufferer with no known connection to affected areas. The test “strongly suggests” untracked, undetected transmission in the state for six weeks, according to a tweet from Trevor Bedford, a scientist who studies viruses at the Fred Hutchinson Cancer Research Center and the University of Washington.

“I believe we’re facing an already substantial outbreak in Washington state that was not detected until now due to narrow case definition requiring direct travel to China,” he wrote, saying the best estimate is a few hundred infections in the state.

Scott Gottlieb, a former head of the U.S. Food and Drug Administration (FDA), echoed that Sunday. There may be “hundreds or low thousands” of coronavirus cases in the U.S. that haven’t been reported, he said on the “Face the Nation” TV political talk show and posited that “community spread” is under way in at least two and possibly four states.

As of Saturday, 263 people in Washington who recently traveled to China or were “close contacts of laboratory confirmed cases” were under supervision, according to the Washington State Department of Health, which said that number is expected to rise. Throughout California, 8,400 people who recently returned from Asia are being monitored for the virus.

In the Solano County case, the 95 hospital and ambulance workers who came into contact with the woman have been quarantined. About 11 have shown signs of the virus and are in isolation, Matyas said, along with two of the woman’s relatives. Two people who came into contact with the woman’s son have also been quarantined.

Robert Redfield, director of the U.S. Centers for Disease Control and Prevention, listens during a hearing of the House Energy and Commerce Subcommittee on Health in Washington on Wednesday. | BLOOMBERG
Robert Redfield, director of the U.S. Centers for Disease Control and Prevention, listens during a hearing of the House Energy and Commerce Subcommittee on Health in Washington on Wednesday. | BLOOMBERG

Precautions vary

Precautions for the public are no different from those during a regular flu season: Wash your hands, cover your cough and stay home from work if you’re sick.

Advice to health workers is stricter: Treat anyone who comes into the hospital or doctor’s office with a respiratory illness as if they have the coronavirus. That means “droplet precaution,” which includes face masks, eye protection, gloves and gowns. It’s not the full hazardous material suit, Matyas said, but just a step down.

The precautions are meant to prevent what happened at the NorthBay VacaValley Hospital, which was short 93 health care workers for a time because they weren’t wearing proper protection when the woman with the virus first came in.

“What they’re trying to do is keep people calm, and that’s why they’re presenting it as just a really bad flu,” said Steven Taylor, a University of British Columbia clinical psychologist who has written about the response to pandemics. “On the other hand, if cases do come in they need to protect hospital workers because they’re at increased risk of infection.”

The spread of community-transmission cases has been exacerbated by a shortage of tests for the virus. California initially had only 200 kits in a state of almost 40 million people whose airports are a major entry point for travelers from Asia, where the disease originated. After Gov. Gavin Newsom complained, the CDC on Friday sent enough new kits to test as many as 1,200 people.

Jeff Duchin, health officer for Seattle and King County, said authorities there have faced the same problem.

“If we had the ability to test earlier, I’m sure we would have identified more patients,” Duchin said on a call with reporters Saturday about the outbreak at the elder care facility in Kirkland.

Test kits

The FDA said Saturday it would authorize American labs to develop their own tests. Matyas said Solano County, along with Napa, Marin and Yolo counties, expect to receive more next week. But Matyas said he doesn’t expect to get more than a dozen.

In the meantime, Americans are just beginning to come to grips with what could be an immunological siege.

In Rhode Island, 26 immediate family members and contacts of a man in his 40s with the virus, are in self-quarantine.

In Washington, some students are getting a long weekend. Henry M. Jackson High School in Mill Creek, north of Seattle, will be closed Monday for the third of three days of “deep disinfecting” after a student was found to have coronavirus, according to the school district website. The high school has rescheduled an SAT exam planned for Wednesday and delayed the start of the spring athletic season from Monday to Tuesday.

Matyas said Solano County will close schools and advise people to stay inside only if it gets to the point of “out-of-control spread.”

On Friday afternoon in Vacaville, California, a Panera Bread in a strip mall filled up around noon for lunch, and shoppers picked up groceries from a Walmart about a kilometer from where the Solano County woman was first treated.

At a closer look, the Walmart was out of face masks and hand sanitizer, and shopper John Bailey, 64, had Lysol wipes on the handle of his shopping cart. Bailey wasn’t wearing a face mask but had some in his car, he said. He’s already stocked up on canned goods and 50 kilograms of dog food.

His biggest concern?

“Dying.”

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