Woman waited 11 days for test results

Only 200 test kits available in California; CDC sending more kits, will broaden who is eligible for testing

A Solano County woman now critically ill with coronavirus was hospitalized for 11 days before her infection was detected, raising the prospect of broader, uncontrolled community exposure to the dangerous respiratory disease.

The failure to test the woman, whose risk factors did not fit the narrow federal criteria, immediately put those who came into contact with her at risk. Also late Thursday, officials announced that three students at UC Davis were in isolation with one showing symptoms of the illness. It is not clear how the symptomatic student, whose tests are pending, was exposed; the other two students are the first student’s roommates.

The Solano County woman’s case prompted federal health officials on Thursday to revise guidelines that will increase the number of people who should be tested, adding criteria that would have caught this mysterious case. The earlier guidelines focused only on patients who had trav

eled to China or had been in contact with anyone with the illness. It is not known how she became infected.

Also on Thursday, Gov. Gavin Newsom vowed to boost the number of tests and testing locations to more quickly detect any new cases of the virus in California. Earlier efforts to expedite local detection fell short due to problems with the test.

“This case marks a turning point,” said Dr. Sonia Y. Angell, director of the California Department of Public Health, at the Thursday briefing. “We are expanding surveillance activity, increasing lab capacity and planning for increased demand on medical systems.”

Health officials throughout the state are monitoring as many as 8,400 people who recently have returned from China or are in close contact with someone who has.

California currently has only 200 test kits, and all samples must be shipped back to the Atlanta-based Centers for Disease Control and Prevention for processing and confirmation, a time-consuming process that could allow some cases to go undetected for too long, Newsom said at a

Sacramento news briefing.

“This is simply inadequate to do the type of testing that is required to address this issue head on,” he said.

California was among a handful of states that received the CDC screening kits and were authorized to use them, but many were faulty and produced inaccurate results. Health and Human Services Secretary Alex Azar on Thursday told the House Ways & Means Committee that a new and improved CDC test will be sent to 93 public health labs around the country as soon as Monday. He did not specify which labs will receive the test. A privately manufactured test based on the new CDC test also will soon be sent to labs, pending approval from the Food and Drug Administration, he said.

The Solano County patient was suffering from f lu- like symptoms when she brought herself to the emergency department at the 50-bed North Bay Vaca-Valley Hospital in Vacaville on Feb. 15.

She was not tested at that facility because she was not severely ill, had not traveled to China and had no connections with travelers to China or anyone quarantined at Fairfield’s Travis Air Force Base, said Dr. Bela Matyas of the Solano County Department of Health, referring to CDC guidelines for ordering tests for coronavirus.

After the woman’s condition worsened, she was transferred to UC Davis’ medical center in Sacramento for advanced care four days later, on Feb. 19.

Suspecting coronavirus, UC Davis requested a test upon her arrival and took immediate precautions to protect their health care workers. But the CDC stuck to its guidelines and waited four days — until Feb. 23 — to conduct the test. Results were not returned until Wednesday, according to a UC Davis statement, a full week after she was admitted.

“Upon admission, our team asked public health officials if this case could be COVID-19,” the name of the respiratory disease, according to a statement written by David Lubarsky, vice chancellor of human health services, and Brad Simmons, interim CEO of UC Davis Medical Center. “We requested COVID-19 testing by the CDC.

“Since the patient did not fit the existing CDC criteria for COVID-19, a test was not immediately administered,” they said in the statement. “UC Davis Health does not control the testing process,” they added.

The sick woman is the nation’s first known case of coronavirus infection from an unknown source.

Although such a scenario was not wholly unexpected, the situation offered a jolt for health officials who had put strict measures in place to stay on top of the outbreak.

The new CDC guidelines make room for clinical judgment — testing anyone who is hospitalized, has no known source of exposure and whose illness cannot be explained by other pathogens, such as flu. It also expands the geography of higher-risk traveling to include the nations of Iran, Italy, Japan and South Korea.

The federal government has been reluctant to test everyone with a severe respiratory illness, given the limited availability of coronavirus kits and vast number of routine ailments. An estimated 45 million Americans get sick with the flu every year — with symptoms that are nearly identical to the new coronavirus.

But the launch of what federal health officials are calling an expanded “surveillance” system — planned for public health labs in San Francisco, Los Angeles, Seattle, Chicago and New York City — also has been delayed due to problems with a chemical in the test. The revised test corrects that, but the plan does not yet include Solano County, the home of the sick patient and hundreds of quarantined people at Travis Air Force Base, or in Sacramento and the Bay Area outside of San Francisco.

Also on Thursday, an asymptomatic person quarantined at Travis was transported to a hospital in Marin County for monitoring after testing positive for the virus, according to health officials.

In the meantime, UC Davis and the Vacaville hospital that first treated the Solano County woman are monitoring the health of scores of staff members who may have come in contact with her. Most are tracking their own health, but staff who had direct contact with her have been tested for the virus.

Because of precautions we have had in place since this patient’s arrival, we believe there has been minimal potential for exposure here at UC Davis Medical Center,” the statement added.

Information on the woman’s family, work and social contacts was not immediately available. State and federal health officials are tracking down contacts of the patient, as well as investigating whether she was unknowingly exposed by a returned traveler who was infected.

Such community transmission is worrisome because a virus is much harder to control once it spreads in offices, schools, medical offices and other public sites.