Bay Area rushes to stem disease
With 4 local cases, efforts grow to keep virus in check
Federal and local public health authorities are expanding efforts to contain the new coronavirus that has blown up across China in the hopes of preventing it from getting a foothold in the United States.
There are now 11 cases of the new coronavirus in the U.S., including four people being treated in the Bay Area: two patients in Santa Clara County and a husband and wife from San Benito County who were moved to UCSF for treatment on Monday.
The number of cases worldwide has skyrocketed from just a few dozen at the start of the year to more than 20,000, including 427 deaths, and it’s now more widespread than SARS. But the virus is not yet passing freely from person to person in the United States — in the Bay Area or elsewhere — and the goal is to keep that from happening, infectious disease experts said.
The next week or two will be key in that effort. Authorities have increased airport screenings, will likely order more mandatory quarantines and are rapidly tracking down anyone who may have been exposed through contact with known cases. Individuals already infected have been isolated and interviewed about anyone they may have been in contact with.
“This is an unprecedented situation, and we have taken aggressive measures,” said Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, in a news conference Monday. “We have the opportunity to slow it down before it gets into the United States.”
Bay Area medical facilities are taking extra steps to identify possible coronavirus cases and make sure that patients at risk of having the virus are kept away from others, either by asking that they stay at home or keeping them in isolation rooms in emergency departments or other parts of hospitals.
So far, no Northern California cases have turned up unexpectedly in medical centers — everyone who has tested positive was already isolated at home and being monitored by public health authorities. Local and state public health officials will not say how many people have been tested for coronavirus in the Bay Area. Nationwide, 260 people have been tested, 167 have come up negative and results are pending on 82, according to the CDC.
Six people have tested positive for the new coronavirus in California — two in Southern California and the four people now in the Bay Area. The San Benito County patients, who are both 57, were at home until early Monday, when they were taken by ambulance to UCSF after their symptoms suddenly worsened. They are being cared for in isolation at the hospital.
In a statement, UCSF said that it “specializes in the care of patients with complex illnesses, including infectious diseases like the novel coronavirus.” Doctors there “also treated patients during past epidemics, such as SARS in 2003.”
Five of the six California patients were almost certainly infected in China before returning to the United States. The sixth patient is the San Benito County woman, who was infected by her husband. Other than the San Benito couple, only one other U.S. case of coronavirus passed from one person to another.
Public health officials’ foremost concern is preventing sustained human transmission of the virus from person to person outside immediate, close contacts like people who live in the same household. That hasn’t yet happened in the United States, but the virus clearly is capable of widespread transmission based on what’s been reported in China.
“Once you actually do start seeing sustained transmission, it becomes very difficult to stop the outbreak,” said Dr. Charles Chiu, an infectious disease expert at UCSF. “The next couple of weeks are going to be pivotal in the U.S. We’re going to find out whether there’s evidence of sustained transmission, or if the cases are going to be restricted to travelers returning from Wuhan, China, and maybe a spouse or family member.”
The next two weeks are critical because the incubation period of the new virus is thought to be up to 14 days. China began restricting travel outside the most impacted regions on Jan. 21, but people were still leaving the country until Jan. 24. Some passengers continued to arrive via other countries last week.
On Sunday, U.S. authorities began much more extensive screening of people arriving in the United States from China. All travelers are being diverted to one of 11 airports, including San Francisco International Airport. Foreign travelers who have been anywhere in China in the previous 14 days will be denied entry to the country.
U.S. citizens who have been to Hubei province in China — the epicenter of the outbreak — will be quarantined for 14 days, regardless of whether they have symptoms of the illness including fever, cough and difficulty breathing. People who are sick may be isolated in a nearby medical center. Those who are not symptomatic will be held at quarantine locations nearby. Americans returning from other parts of China may also be subject to quarantine depending on their risk of illness.
In the Bay Area, Travis Air Force Base in Fairfield has been designated a quarantine facility, with space for up to 250 people. In Southern California, 195 Americans who were evacuated from China last week are currently quarantined on an air base in Riverside County.
People who entered the country from China before the new restrictions took effect are being asked to isolate themselves at home for two weeks, and to contact their doctor or local public health department if they feel ill. So far, both people who tested positive in Santa Clara County, plus the husband and wife in San Benito County, isolated themselves at home before they became sick.
“This couple selfisolated. They had no contact with the outside world” after the husband returned from Wuhan, China, on Jan. 24, said Sam Perez, a spokeswoman for the San Benito County Department of Public Health. “Our county health officer continues to stress that San Benito County residents are at low risk.”
CDC officials said the coronavirus cases in the United States have ranged from mild to serious, and some patients have needed help breathing while hospitalized. The two patients in Santa Clara County have had mild illness and have not required hospitalization.
Hospitals are typically equipped with negative pressure rooms, which have a separate aircirculation system from the rest of the hospital and suck out contaminated air using an exhaust system. This is where patients with any infectious disease, such as measles, tuberculosis or, now, coronavirus, are taken so that they don’t contaminate others.
Health care workers are taking extra precautions when treating patients suspected of having coronavirus by wearing gloves, gowns and goggles. The CDC set this guideline because it’s not yet clear how the new coronavirus spreads, said Cheryl Flesner, infection prevention director at Dignity Health Sequoia Hospital in Redwood City.
Bay Area hospitals are doing everything they can to screen patients for potential exposure before they arrive at a clinic or hospital. At Kaiser Permanente, patients who go directly to a clinic or hospital without having first gone through a phone screening will be given a surgical mask upon arrival. If needed, they’ll be taken to an isolation room.
All Kaiser patients who book appointments online are asked if they’ve traveled to China recently, and if so, they’re directed to call a primary care doctor who will ask whether the patient has a fever or shortness of breath. Patients who call to make appointments go through a similar screening process.
“It’s a pretty good filter,” said Dr. David Witt, lead epidemiologist at Kaiser Permanente Northern California.