Thursday, February 27, 2020

California undertakes massive effort to trace contacts of woman with coronavirus

 
 
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Despite reassuring messaging, U.S. not fully prepared for coronavirus outbreak
VACAVILLE, Calif. — California officials outlined a far-reaching effort Thursday to trace anyone who came into contact with a new coronavirus patient and urged federal officials to move quickly to improve their faulty testing process so the state can protect residents.
Gov. Gavin C. Newsom (D) and state health officials declined to reveal how many people may have crossed paths with the Solano County woman, who is the first person in the United States to develop the new covid-19 disease without traveling to a virus hotspot or having close contact with someone who did.
But they acknowledged the woman was living and working in the community and showing symptoms of the disease before she was admitted to a local hospital here Feb. 15. That is a worrisome prospect because the virus is highly transmissible, especially when someone with the disease has symptoms. They did not share any details about the woman’s family, work and social contacts, citing patient privacy.
Newsom said the federal Centers for Disease Control and Prevention was sending 10 staffers to aid state and local personnel in tracing the woman’s contacts.
Mark Ghaly, secretary of the state’s Health and Human Services Agency, described a “robust and first-class reaching out to ... many, many individuals in all walks of this person’s life.” That includes the people who cared for her at NorthBay VacaValley Hospital, some of whom have been put on paid leave and are now isolated at home monitoring themselves for symptoms, according to hospital official .
Projecting an air of calm during a moment of roiling anxiety over the fast-changing situation, Newsom repeatedly told reporters that the tracing methods employed in northern California have been honed in response to other public health crises, including outbreaks of tuberculosis and the H1N1, also known as swine flu.
“This is not our first great challenge as it relates to public health,” Newsom said. “Quite the contrary. These protocols have been perfected.”
At the same time, he called repeatedly for the CDC to expand guidelines that govern who should be tested and dramatically upgrade state and local capacity to test for the virus.
“It can’t happen soon enough,” Newsom said. “Testing protocols have a been frustration for many of us.”
The woman’s case is considered the first sign that coronavirus, which has killed more than 2,800 people around the world, may be spreading in a U.S. community. 
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The woman wasn’t tested for the disease for four days, despite an immediate request to the CDC, because she didn’t meet the strict criteria for the test, according UC Davis Medical Center, where she is being treated. The CDC has not responded to that charge. But federal health officials have said clinicians always have discretion to order the test for people who do not meet the criteria.
The state of California is calling the case, first reported by The Washington Post, its first instance of community transmission.
The patient is a Solano County woman who brought herself to NorthBay VacaValley Hospital, a 50-bed community hospital in Vacaville, Calif., with flulike symptoms on Feb. 15, according to a person briefed on the situation who spoke on the condition of anonymity.
Staff at the hospital questioned the woman about travel and contacts under CDC guidelines, but she did not meet the criteria for someone who should be tested for the virus, since she had not recently traveled to China or had contact with someone who is a confirmed case, according to Aimee Brewer, president of NorthBay Healthcare, which owns the hospital.
The hospital is “meticulously tracing” anyone who may have come into contact with the woman there, and monitoring scores of dozens of staff members who may have been exposed, Brewer said in a statement. She added that any staff who had direct contact with the patient have been tested for the virus and are now on paid leave, tracking their health at home. So far, there have been no positive tests, she said.
Asked about the risk to other patients at the hospital, Brewer noted in an interview that the woman had a private room, and “we believe strongly that our patients are protected.”
“We are going the records and security footage to make sure we know every person who has been in contact with the patient to determine if they are a low, medium or high risk,” she said. “We did that last night and are finishing it up today.”
Staff at NorthBay inserted a tube in the woman’s lungs to help her breathe, a procedure experts say increases risk of exposure to the virus because it can aerosolize respiratory droplets, according to the person briefed on the case
When the woman’s health continued to decline, Brewer said, she was transferred to UC Davis Medical Center in Sacramento, which has more capacity and expertise with pulmonary patient. UC Davis officials said she arrived there on Feb. 19.
Community spread would represent a significant turn for the worse in the battle against the virus. To date, the United States has 60 known cases of the infection, with 59 among people who traveled to Asia or were close contacts of people who went there. The vast majority, 42, picked up the virus while quarantined on the Diamond Princess cruise ship off Japan.
How the woman acquired the respiratory disease covid-19 is unknown.
“It’s possible this could be an instance of community spread of covid-19, which would be the first time this has happened in the United States,” the CDC said in a statement Wednesday night, referring to the disease caused by the coronavirus. The health agency left open the possibility “that the patient may have been exposed to a returned traveler who was infected.”
Two UC Davis officials sent an email to employees Wednesday that said the patient arrived at the medical center Feb. 19 but was not tested until Sunday because they did not meet the criteria for testing. That includes recent travel to China or close contact with a confirmed case.
The patient arrived from another hospital in Northern California, according to the email sent to UC Davis Medical Center employees from David Lubarsky, vice chancellor of human health sciences, and Brad Simmons, interim chief executive.
“When the patient arrived, the patient had already been intubated, was on a ventilator, and given droplet protection orders because of an undiagnosed and suspected viral condition,” they wrote. “Since the patient arrived with a suspected viral infection, our care teams have been taking the proper infection prevention (contact droplet) precautions during the patient’s stay.”
UC Davis asked the CDC to conduct a test for the virus because local and state labs were not doing so. “Since the patient did not fit the existing CDC criteria for covid-19, a test was not immediately administered. UC Davis Health does not control the testing process,” they wrote.
The CDC ordered a test Sunday and additional precautions were taken, they wrote. The agency confirmed the positive test Wednesday.
Kris Concepcion, fire chief and acting public information officer in Vacaville, Calif. , said county officials had issued a directive not to transport any new patients to two local hospitals — NorthBay VacaValley Hospital in Vacaville and NorthBay Medical Center in nearby Fairfield. Concepcion declined to say why those orders had been given.
Steve Huddleston, vice president of public affairs at NorthBay Healthcare, declined to comment. He said the hospital was directing all inquiries to the California Department of Public Health.
The person briefed on the situation said the ban on new patients lasted only through Wednesday night.
Vacaville City Mangager Jeremy Craig said he was told by the Solano County Public Health Department not to send patients to NorthBay VacaValley hospital Wednesday but was not given any reason. The city is anxious to know whether there is a coronavirus case in the community.
“We are telling our residents to just take the normal flu precautions,” he said. “We don’t have any news at this point.”
Reached by telephone, Erin Hannigan, chairwoman of the Solano County Board of Supervisors, indicated that the CDC was handling the situation. Asked whether the local government was taking any steps in response to the reported case, she said, “It’s one person, so we have to keep it in perspective” and then hung up.
The two hospitals are in Solano County, home to Travis Air Force Base, where hundreds of Americans repatriated from China and others brought home from the Diamond Princess cruise ship have been kept in quarantine. Many of them have been released.
The health department said it has already begun tracing people who may have come in contact with the coronavirus-infected individual.
“We have been anticipating the potential for such a case in the U.S., and given our close familial, social and business relationships with China, it is not unexpected that the first case in the U.S. would be in California,” said Sonia Angell, director of the California Department of Public Health and state public health officer.
The virus, which originated in Wuhan, China, has killed 2,801 people and sickened more than 82,000 as it has spread around the globe, reaching every continent except Antarctica. The CDC on Tuesday warned Americans that community spread is almost certain to occur, and to prepare for significant disruption in their daily lives.
geoffrey.fowler@washpost.com
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