Inside the Race to Contain America’s First Coronavirus Case
The
health emergency is global, but in the United States, it is local
public health officials who isolate the sick, trace “close contacts’’
and deliver thermometers.
A recently built coronavirus testing facility in Lynnwood, Wash.Credit...Chona Kasinger for The New York Times
EVERETT,
Wash. — It started with a stubborn cough. A visit to an urgent care
facility. A test being sent off to the Centers for Disease Control and
Prevention. And then a 35-year-old resident of Snohomish County, Wash.,
being named the first confirmed case of the coronavirus in the United
States.
Hollianne Bruce, the lone
epidemiologist assigned to the control of communicable diseases in the
county’s public health office, jumped into action. Declining to wait for
a C.D.C. team to arrive from Atlanta, she dialed up the patient, who
had been taken to an isolation unit at a hospital.
Seeking
to establish a rapport, Ms. Bruce told him she knew he was not feeling
well. She apologized for the disturbance. But she impressed on him how
he might help save lives by sharing where he had been in recent days and
with whom he had come into contact.
“We don’t know a lot about this virus,” she told him. “We’d like to ask you some questions.”
The
man, who had been taken to the hospital the night before in a covered
gurney intended for Ebola patients, agreed to help. It would be the
first of several conversations he would have with Ms. Bruce, some by
phone, others over a walkie-talkie as she stood outside his sealed room.
Once, at his request, she bought him lunch at a nearby Panda Express.
In
their conversations, she took him back six days, when he had returned
from visiting family in Wuhan, China, the epicenter of the outbreak.
Could he tell her the dates of his travel? His flight number? His seat number?
How
had he returned home from the airport? When did his symptoms start?
Where did he work? Did he stop anywhere on the way to work? Did he stop
on the way home? Had he gone out for any meals?
For
Ms. Bruce, it was a relief to learn that the patient lived alone, that
he took the stairs rather than the elevator to his office, and that he
did not work in an open cubicle.
But
he had attended a group lunch the day he developed a cough, and all
eight of his lunch partners would be tracked down. Once he developed a
cough, he had walked into a crowded health clinic. Thirty-eight other
people who were in the clinic that day would need to be monitored.
The
coronavirus, which has killed hundreds of people in China and sickened
more than 20,000 in countries across the world, has been declared a
global health emergency. To slow its spread, the Trump administration
has invoked a rarely used constitutional power to impose a quarantine on
Americans returning from the area around Wuhan.
But within the United States, containing the virus is a local responsibility. Across the country, where at least 10 more cases
have since been confirmed, it is health officials at the county and
municipal level who are scrambling to isolate the sick, learn where they
have been and monitor those who have come into contact with them.
Health workers are also debunking rumors, calming fears and bracing for
the expected emergence of new cases.
The Coronavirus Outbreak
How Is the U.S. Being Affected?
Updated Feb. 4, 2020
Eleven cases
of the coronavirus have been confirmed in the United States, including a
35-year-old man in Washington State, a couple in their 60s in Chicago
and six people in California. If you live in California, here’s what this means for you.
American citizens
and permanent residents who fly to the U.S from China are now subject to
a two-week quarantine.
A high school exchange student may have been among the last Americans to arrive home in time to avoid the mandated quarantine.
Mask hoarders may increase the risk of an outbreak in the U.S. Health care workers risk infection if they cannot get the protective gear.
Most experts agree: To protect yourself wash your hands and avoid touching your face.
Affected by travel? Or do you know someone who is? Please contact us at coronavirus@nytimes.com if you are willing to be contacted by a reporter or have your comments used for a coming story.
At the
Snohomish Health District, the staff of 113 has poured 1,000 hours into
coronavirus control since the patient’s test was sent to the C.D.C. over
the Martin Luther King’s Birthday weekend. Food inspectors, human
resource managers and opioid outreach specialists have pitched in.
Image
Carrie
Parker, the outreach and preparedness supervisor for the Snohomish
Health District, has taken on the role of coronavirus “incident
commander” for the district.Credit...Chona Kasinger for The New York Times
Image
Snohomish Health District employees met late last week in Everett, Wash., to discuss the county’s efforts to contain the virus.Credit...Chona Kasinger for The New York Times
“All
responses are local,” said Dr. Satish Pillai, an infectious disease
specialist who headed an eight-person team that was dispatched from
C.D.C. headquarters in Atlanta to monitor the case. “What happened in
Snohomish is emblematic of what we need to evolve and improve our
ability to respond to a virus we are seeing for the very first time in
the United States.”
An account of the
last two weeks at the Snohomish Health District — whose offices are
festooned with messages like “Immunizations: They’re your best defense!”
and “Save A Life: Give Your Blood” — offers a look at what may be in
store for more of the nation’s 3,000 local health jurisdictions in the
weeks to come.
Delivering a Thermometer
The
Wuhan coronavirus still seemed far away on the evening of Jan. 19 when
Dr. Chris Spitters, the district’s interim health officer, was alerted
that a local clinic had sent specimens to the C.D.C. from a resident who
had recently returned from Wuhan.
“In the first moments you kind of want to deny that this is happening,” Dr. Spitters recalled.
Dr.
Spitters, who was out of town for the holiday weekend, asked Katie
Curtis, the district’s assistant director of prevention services, to
check on the man, who had agreed to remain isolated at home until the
test results came back.
His
symptoms were relatively mild. But health officials wanted to monitor
him for fever and to make sure he had any supplies he might need so he
did not need to leave his house.
He had plenty of food, the man told Ms. Curtis on the phone, but no thermometer.
When
Ms. Curtis knocked on his door the next morning after picking up a
thermometer at a pharmacy, he answered wearing a face mask. He promised
to text her his temperature every few hours.
His first text came a few minutes later.
It was no cause for alarm.
But
before the next one, Ms. Curtis called him with Dr. Spitters on the
line. By then, a team of nurses and emergency medical technicians had
been assembled. The simulation they had performed earlier in January on
how to transport and quarantine a highly infectious patient was suddenly
becoming reality. An isolation unit at Providence Regional Medical
Center, meant for Ebola patients and never before used, was in the
process of being erected.
“We have your test results,” Ms. Curtis told the patient.
Image
Gov. Jay Inslee of Washington addressed the response to the first confirmed case of coronavirus last week.Credit...Grant Hindsley for The New York Times
‘Can I Cure It With a Lime?’
The
reactions among the dozens of people potentially exposed to the patient
ranged from anxiety to irritation. Some expressed gratitude to Ms.
Bruce and the other health workers who reached out to them. There were
several jokes about Corona beer.
“Can I cure it with a lime?” one wanted to know.
Only one person earned the notation “resistant to public health intervention.”
Everyone
on Ms. Bruce’s “close contact” list received two phone calls from a
public health worker to impress upon them the seriousness of the
situation. They were required to take their temperatures twice a day and
report any fevers or coughs. After that, they could opt to receive a
text message, carefully worded so as not to raise alarm should another
person see it.
“This
is the Health District with your daily symptom check for your
household,” it read. “Please reply with 1 if you have no symptoms, reply
with 2 if someone in your household is ill.”
Across
the county line, Ms. Bruce’s counterparts in King County were
performing the same task with dozens of others who worked with the
patient, were on his flight or rode with him from the airport. At least
nine people who were exposed to the patient have developed symptoms that
fell within the C.D.C.’s criteria for testing. Results for three of
them are still pending; the others were negative.
A ‘Person Under Investigation’ Breaks Quarantine
In
many ways, the coronavirus response was familiar ground for the local
health workers, who routinely labor to prevent and control outbreaks of
gastroenteritis, measles, tuberculosis and H.I.V.
The
novel nature of the coronavirus added urgency — and a disquieting
uncertainty — to the work. Who is most at risk? How soon do symptoms
arise in people who are infected? How, exactly, is the virus
transmitted?
During a season when
nearly everyone has a sore throat, it was hard to know who among the
contacts they were tracing needed to be tested and given the “PUI”
designation, for “person under investigation.”
Those
who were ordered to stay in their homes were taken care of. The
groceries that the Seattle and King County public health department
delivered to one prospective patient included hair conditioner,
blueberries and 2 percent milk.
Still,
when Ms. Bruce could not reach one of the people she was monitoring
over the weekend of Jan. 25, she grew alarmed. After leaving a message
with the woman’s emergency contact, she received a call at home that
night. The woman explained that she had been in the process of moving to
Wisconsin, and that she had taken her flight as planned.
“You did what?” Ms. Bruce asked. The woman has subsequently tested negative.
Image
The Snohomish Health District offices in Everett.Credit...Chona Kasinger for The New York Times
Accusations of a cover-up
The people of Snohomish County had questions.
Why had local health officials not released the name of the clinic where the patient had received care?
Was
this all a government scheme to sell vaccines? Was it safe to take
children to the airport? Was the rumor at a local high school that a
student had tested positive for the virus true?
There
was no reason to believe, health officials told residents, that the
patient had posed a risk to people with whom he had not been in
reasonably close contact. To disclose the clinic location could create a
false sense of panic, officials said.
There
was no government scheme, officials made clear. They had tested no
minors for the coronavirus, they said of the school rumors. And as for
the airport, they said parents should encourage their children to wash
their hands.
But it was hard for officials to keep up with the anxiety.
“This is an evolving situation,” reads a post on the health office’s Facebook page.
Seeking a Normal Life Again
Carrie
Parker, the outreach and preparedness supervisor for the Snohomish
Health District, took on the role of “incident commander” over the last
two weeks. On Tuesday, she told her 30-person team that they might soon
be returning to their day jobs.
The
Snohomish County patient has been discharged from the hospital with
instructions from Dr. Spitters to remain in isolation at home for now.
Snohomish health officials declined to release his name, and his
identity could not be determined.
In a
statement, the man said he was continuing to get better and he thanked
those who had cared for him. He expressed a desire to return to his
normal life and “not to be in the public eye.”
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