Why coronavirus could have slipped into U.S. long before screenings, travel restrictions
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As public health investigators try to track down how a Solano County woman ended up getting a case of new coronavirus, two epidemiologists told The Sacramento Bee that the illness could have arrived in the United States days or even weeks before screenings and travel suspensions began.
Researchers have run models of the evolution of this virus, and they say it’s more likely that it first emerged in early to mid-November, said Catherine Troisi, a professor at the University of Texas Health Science Center at Houston. That means the virus was floating around the Wuhan area for as many as 11 weeks before the U.S. Centers for Disease Control and Prevention confirmed the first U.S. case on Jan. 21.
Put that together with the fact that thousands of people travel through Wuhan’s airport daily, heading to foreign destinations, Troisi said, and it’s likely that the highly transmissible COVID-19 pathogen caught a flight to the United States before the outbreak caught the world’s attention.
In January, when officials with the U.S. Centers for Disease Control and Prevention finally began their testing, they limited it:
▪ To travelers who had returned from traveling in China within a 14-day period and showed respiratory distress.
▪ Or to people who had close contact with such a traveler and showed symptoms.
The policy meant that no one could say whether the new coronavirus had already surfaced in individuals who were hospitalized with pneumonia.
“You only have the opportunity to be counted as a case if you’ve been tested,” Troisi said, “as of a couple days ago, there had been only 426 tests done in all of the United States.”
By Thursday, the CDC website said there had been just 445 tests performed.
Epidemiologist Christine Kreuder Johnson said: “We know that oftentimes diseases are recognized only at the tip of the iceberg where the more severe cases get the health care facilities and testing is initiated, so ... there could be other cases that we don’t know about. This news from (Wednesday) is our first indication that’s possible.”
Johnson and her colleagues at the University of California, Davis, have been leading a global investigation into coronaviruses and other pathogens that can be transmitted to humans. Right now, Johnson said, they are supporting colleagues around the globe who are being asked to do case detection for the first time in their country. UCD researchers are supporting them with test interpretation.
In early January in Nepal, a UC Davis partner used testing protocols they had developed to diagnose a case of the new coronavirus, Johnson said.
CDC expands testing
She predicted early Thursday that the CDC would expand testing now that they have discovered a case of unknown origin in Solano County, and later that day, CDC Director Robert Redfield told congressional leaders that his agency had changed the criteria for testing and now planned to test people hospitalized with unexplained cases of pneumonia.
Troisi said she felt that “the reason testing is not being done is not because nobody wants to test. It’s because nobody has the testing kits, and once those become available, which they will — and hopefully very soon — more testing will be done.
Until there is broader testing, Johnson said, it will be difficult to know whether prior testing efforts were sufficient.
At a news conference Thursday, Gov. Gavin Newsom said that California would rapidly and “exponentially” expand its ability to test for COVID-19. Newsom vowed that “we will meet this moment,” saying that CDC officials spoke with him about boosting California’s testing capability.
“The CDC is assuring us that testing protocols will be enhanced with urgency. The CDC is moving expeditiously on this,” Newsom said, adding that “there is nothing more important than point-of-contact testing.”
In the case of the UC Davis patient, doctors had requested a coronavirus test shortly after the patient arrived Feb. 19 from another hospital in Northern California., according to a statement from UCD Health Chief Executive Officer David Lubarsky and UCD Interim CEO Brad Simmons. The medical team at the prior hospital said she had a virus, so they transferred her with orders that all personnel use personal protective gear to guard against droplets, Simmons and Lubarsky said.
It was four days before the CDC sent someone to take samples and run the test, according to the UCD statement. During that time, medical personnel used protective equipment when with the patient, Simmons and Lubarsky said, but still, out of an abundance of caution, they had asked the team to take time off at home and monitor themselves for symptoms.
UC Davis Health patients and their relatives told The Bee that they worried about the possibility of exposure at the hospital because it was a week before anyone knew the patient had coronavirus.
Medical center leaders posted a Q&A online at the UCD Health website on Thursday, explaining how the organization puts patient safety first.
“Patients and visitors should know that we have the right people, with the right training, facilities and processes to ensure a healthy and safe environment for everyone at all times,” officials noted in the Q&A. “UC Davis Medical Center in Sacramento is open and serving patients. Taking care of individuals with complex illnesses such as an infectious disease, like novel coronavirus (COVID-19), is nothing new for our care teams – we do it every single day. “
‘The very best at what they do’
The Bee asked union leaders whether their members were concerned about the possibility of infection.
AFSCME 3299, which represents thousands of patient care workers at the medical center, sent a statement that, in part, read: “Together with UC doctors, nurses and other technicians, AFSCME 3299-represented ... workers are the very best at what they do.”
“We are working closely with UC and other medical center stakeholders to follow all CDC guidelines with respect to detection, treatment and prevention of coronavirus — and in many cases, to exceed them. The public should be confident in the quality of care and safety precautions being undertaken by our members.”
The UCD case brought home the potential risks in only testing people who had traveled to China. Public health officials say they have people on the ground in Solano County tracking down close contacts of the woman, and they have quarantined and isolated an unspecified number of hospital employees who came into contact with the patient at NorthBay VacaValley Hospital.
Johnson said it’s crucial that the front-line medical team are protected: “Based on what we know today, we need more diagnostic testing. There are various diagnostic tests that can support each other in the confirmation of a positive or a negative, not just one test. We need multiple tests, and we need them ready at the hands of doctors at the minute they suspect.”
As for the public health investigation into the Solano case, Johnson said, no one knows what will be found. It could be that the individual unknowingly or unwittingly came into contact with a traveler who had been to China or came into contact with a surface that such a traveler touched. Contact tracing will be very difficult in this instance, she said.
The New York Times reported Thursday that a government whistleblower filed a complaint with the Office of the Special Counsel, alleging that federal employees were not given any protective gear or training when they had been sent to help process U.S. evacuees from Wuhan, China, at Travis Air Force Base and other military installations. Travis is located in Solano County, where the UCD patient lived.
What people should know, Troisi said, is that those who have coronavirus can transmit it before symptoms show up and, in fact, the person shedding the virus may never experience symptoms.
Don’t panic. Prepare, experts say
Despite this and other challenges, neither Troisi nor Johnson expressed fear or anxieties about living in a world where they could encounter someone with coronavirus. Johnson said people should prepare, not panic.
“I understand outbreak epidemiology enough to know we can minimize community spread through actions,” Johnson said. “We can take action. We are not hopeless. I think people get very worried when they feel they don’t have any control over a situation, but there is a lot we can do to minimize community spread of a virus here in the U.S.”
What does preparation look like? Johnson suggested individuals go to the CDC site and learn about the ways to prevent the virus: hand-washing, staying at home when you’re sick, and covering your mouth with your elbow or tissue when sneezing or coughing.
Schools and businesses can prepare by making decisions on what procedures they will implement if there’s widespread transmission and communicating that to parents and workers respectively. What would they consider in terms of allowing work outside the office or school?
At UC Davis, Johnson said, the faculty and staff are “looking at sharing best practices in minimizing infectious disease transmission, and for respiratory diseases, we are sharing best practices in workplace preparedness so that everyone has all the information they need and nobody feels worried because of lack of information.”
Does this mean they’re also stocking up on those N95 respirator masks that are hard to find around the region?
“No, we’re not,” she said. “The masks have only been recommended for people who are actually sick with COVID-19.”
This story was originally published February 28, 2020 at 7:31 AM with the headline "Why coronavirus could have slipped into U.S. long before screenings, travel restrictions."
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