The state that saw the first confirmed novel coronavirus infection in the country now has become the site of its first death.
A man in King County has died of COVID-19, an illness caused by the new coronavirus SARS-CoV-2, and two more cases at a long-term care facility in Kirkland were identified Saturday, prompting the governor to declare a state of emergency to try to contain a virus that has killed more than 2,900 people globally. Officials additionally identified two new cases on Sunday, bringing the total in King County to six.
The man, in his 50s, was a patient at EvergreenHealth hospital in Kirkland. He had an underlying chronic health condition but no history of recent travel to a country affected by the outbreak or contact with an infected person. He died Friday, according to EvergreenHealth.
More than 85,000 cases have been detected in 57 countries, including more than 60 in the United States. King County has monitored more than 500 people for signs of the illness, and 41 people have been tested in Washington state.
All local cases announced Saturday were acquired through “community transmission” in the Seattle area, said Dr. Jeffrey Duchin, health officer for Public Health – Seattle & King County. That means none of the patients had traveled recently overseas.
Officials attributed reports of the new cases to increased capacity for testing, meaning more low-level cases were likely already being transmitted in the community.
“I think, like anything, what we’re seeing is the tip of the iceberg,” EvergreenHealth’s Dr. Francis Riedo said at a news conference in downtown Seattle. “We’re seeing the most critically ill individuals. Usually that means there is a significant percentage of individuals with less severe illness floating around out there.”
The Centers for Disease Control and Prevention (CDC) changed its testing guidance Friday for healthcare providers. Rather than only test people who had traveled to China or who had come in close contact with someone diagnosed with novel coronavirus, the new CDC guidance allows clinicians to test patients they suspect of having COVID-19, even if they don’t have a history of travel.
“That’s how we have covered the local cases, by dropping the travel criteria and testing patients who had an illness that was serious,” Riedo said.
The reason health officials call it “novel” is because the virus is new, emphasized Riedo, the hospital’s medical director of infection control. In other words, people don’t have a built-up immunity, nor are there medicines and vaccines for it, he said.
News of the death and additional cases arrived after health officials announced Friday night that a Snohomish County high school student who also had not traveled to any country affected by the outbreak had tested positive. Health officials Friday night reported him as doing well.
Two other people from the longterm–care facility Life Care Center in Kirkland also have tested positive at a state lab and have been hospitalized. A resident in her 70s is in serious condition, and a health employee in her 40s is stable condition. Life Care has 108 residents and 180 employees, according to the CDC.
Twenty-seven residents and 25 employees at Life Care Center have symptoms, according to the CDC. All are being tested for COVID-19, and “additional positive cases are expected,” according to public health officials.
The Lake Washington Institute of Technology in Kirkland, which had about 16 nursing students visit the Life Care Center, will disinfect its campus. Two police officers and 25 firefighters from Kirkland, as well as seven Redmond firefighters who responded to the Life Care facility within the last week are under quarantine either at home or at a fire station.
Officials declined to share information about the deceased man’s underlying health condition, citing patient privacy.
The five cases announced Saturday and Sunday brought the total of presumptive positive cases – meaning they had tested positive in a state lab but hadn’t yet been confirmed by the CDC – to six in King County, including a woman in her 50s who had recently traveled to South Korea, and one in Snohomish County.
The two cases announced Sunday were men in their 60s with underlying health conditions, officials said.
A 35-year-old Snohomish County man who was the United States’ first patient confirmed to have the virus is now considered fully recovered. He became ill after visited Wuhan, China, where the global outbreak began in December.
Government responds
Gov. Jay Inslee declared the state of emergency Saturday afternoon. The proclamation allows state agencies to “use all resources necessary to prepare for and respond to the outbreak.”
“It is a sad day in our state as we learn that a Washingtonian has died from COVID-19,” Inslee said in a statement. “Our hearts go out to their family and friends. We will continue to work toward a day where no one dies from this virus.”
At a White House news conference Saturday, the Trump administration responded with an announcement of new travel restrictions. Vice President Mike Pence detailed the expansion of an existing Iran travel ban to include “any foreign national who has visited Iran in the last 14 days.” Pence also said the administration was advising citizens not to travel to specific areas in Italy and South Korea “most affected by the coronavirus.”
Pence additionally announced that the president had directed the State Department to coordinate medical screenings in Italy and South Korea of any people coming to the U.S.
Recent weeks have brought dramatic examples of actions in other nations to try to stop the virus’ spread, including isolating entire cities or regions.
Local health officials have said they do not yet feel more extreme measures – such as shutting down schools — are required.
In Washington state, a local health officer, “at his or her sole discretion” can issue an emergency detention for “a person or group of persons” to be held for up to 10 days for isolation or quarantine, according to state Board of Health rules.
That power can be exercised only after reasonable efforts are made to obtain voluntary compliance with requests for medical examination, testing and treatment, and the health officer must issue a written order detailing why the action is necessary.
Dr. Kathy Lofy, state health officer, said if there are more events in Washington, officials might consider measures such as canceling large public gatherings, but do not yet feel that is necessary.
On Friday, Washington state’s public health lab started testing samples from patients, significantly reducing the wait time for results. A team from the CDC was set to arrive in King County by Saturday night to help with investigating the paths of the new cases.
King County, which activated its Emergency Operations Center on Saturday, is also exploring options for people who are homeless to rest and recover from COVID-19 away from shelter situations, including identifying potential county-owned properties for this purpose. Healthcare for the Homeless Network has scheduled four trainings across the county for human services providers to review and answer questions.
“We are rapidly shifting our operations here to be focused solely, primarily on dealing with this crisis,” said King County Executive Dow Constantine.
With 400,000 daily passengers, transit buses are the county service that brings the most people together, sometimes 80 or more in a single vehicle.
Bus schedules and even rider volumes have been normal, and county officials will discuss virus-related options Sunday. Constantine urged people with cold and flu symptoms to stay off the buses.
Quarantined students
At Henry M. Jackson High School in Mill Creek, where one of the patients goes to school, district officials have shut down the campus for “deep disinfecting” through Monday.
In a statement released through the Snohomish Health District, the family of the high school patient said he became ill with flu-like symptoms on Monday morning and stayed home through Thursday. The student returned to school without symptoms Friday, but remained there for only about five minutes until the family learned about COVID-19 testing and the student returned home.
“We are taking this situation very seriously,” the family’s statement read, and asked the larger community and the media to respect the family’s privacy. “Please know that we have been following all guidance and instructions from both the healthcare providers that treated our son, as well the Snohomish Health District.”
Kathy Reeves, a spokeswoman for Everett Public Schools, said Saturday that the maintenance crew is disinfecting and sanitizing “every touchable surface,” at Jackson, including those in the gym, locker rooms, classrooms and cafeteria.
The eight-person crew is implementing “standard cleaning practices” and disinfectants they use “all the time,” said Jennifer Goodhart, another Everett Public Schools spokeswoman.
Snohomish County health officials confirmed the teenager was in close contact with a handful of other students, who are all being quarantined at home for 14 days. Because the Snohomish Health District is handling patient cases, Reeves said, the school district doesn’t have any information yet about who the infected student is or how many students have been quarantined.
On Monday, the Jackson High School nurse will be in contact with all families whose students are quarantined to organize academic support while they’re out of school, Reeves said.
The high school is scheduled to reopen on Tuesday, unless “something unforeseen happens,” Reeves said.
Other school districts in the area also have plans in place for protecting against the virus. Bothell High School recently canceled two days of class out of an abundance of caution, after hearing one of its staff members had a family member who was showing symptoms of the virus. The family member has since tested negative for COVID-19, and the school will reopen Monday.
Public schools in Seattle, Bellevue and Snohomish are all reminding families and students to practice good hygiene, but aren’t discussing school closures at this time. The Washington Office of Superintendent of Public Instruction encouraged all schools in the state to create contingency plans, including implementing online learning and canceling class if necessary, but emphasized that they should follow recommendations from local health agencies.
Flight cutbacks
Several airlines have announced cutbacks on flights between Seattle and affected countries.
In the past week, Delta said it would reduce weekly flights to South Korea from seven to five. The two other carriers offering service to South Korea – Asiana and Korean Air – have yet to yet to announce any flight reductions, said Port of Seattle spokesperson Perry Cooper.
Cathay Pacific announced it will reduce its Seattle-Hong Kong service from five a week to three or four per week in March and April, Cooper said.
The reductions follow the suspension of flights between Seattle and China last month by Delta and Hainan. Since the suspension, 73 flights to mainland China have been canceled, Cooper said.
Airport employees have stepped up cleaning and sanitizing of “high touch” areas, such as handrails, escalators, elevator buttons and restroom doors, “with an emphasis on where international travelers arrive,” and making hand sanitizer available, according to a port statement.
Cooper said the port has received no new guidance from the CDC for ships arriving at the port’s Seattle and Tacoma cargo facilities.
Hospitals’ advice
The message from hospitals is clear: If you suspect you might be infected, call your healthcare provider before you show up. That could be a primary care physician, an online health clinic, an urgent care center or another source. If fewer patients come to hospitals, doctors can focus on the most serious cases.
“We really want people to call if they fit any of the criteria, if they’re confused if they have the flu, coronavirus, or something else,” said Susan Gregg, spokeswoman for UW Medicine.
A provider could do a triage over the phone or online, and some patients might be able to stay home. Hospitals in the UW system are deploying doctors to assess patients in their homes, Gregg said.
Hospital officials are discouraging people from visiting EvergreenHealth hospital in Kirkland, the site of the first COVID-19 death. Certain entrances remain open though, including the emergency room.
“To ensure the health and safety of our patients, staff and community, we are discouraging visitors to EvergreenHealth Kirkland campus,” a tweet from the hospital read.
What individuals can do
Health experts believe novel coronavirus to be spread between people in close contact with one another by droplets emitted when an infected person coughs or sneezes. Illnesses can range from something resembling a common cold to a chest infection that requires hospitalization.
Symptoms among people who have been diagnosed with novel coronavirus have been reported between two days and two weeks after exposure.
People at higher risk of serious infection are those over 60, pregnant women, people with weakened immune systems and those with chronic health conditions such as cardiac disease, lung disease and diabetes.
But in a media briefing on Friday, Duchin said much is still unknown about the illness. It appears highly transmissible, Duchin said, though officials did not have precise numbers on transmissibility – and Duchin acknowledged that this would vary from community to community.
There’s less clarity on how severe the illness is, Duchin said. The fatality rate from Hubei province in China, for example, may have been portrayed as higher than it actually was because there may have been more total cases than reported, Duchin said.
Eighty percent of cases of the infection are mild, according to Duchin.
“Patients frequently don’t even need to see healthcare,” Duchin said. “However, as these recent cases demonstrate, it can be severe, and we want people to understand that there are things that they can do to protect themselves from getting this infection.”
Those actions include washing hands with soap and water and avoiding touching the face, social distancing and staying home from work or school when sick.
Health officials are also emphasized that people of Chinese ancestry are not at greater risk of contracting the infection than anyone else.
Seattle Times staff reporters Hal Bernton, Mike Reicher, Paul Roberts, Daniel Beekman, Elise Takahama, Asia Fields, Mary Hudetz, Scott Greenstone, Joseph O’Sullivan and Nina Shapiro contributed to this report.