Five states report more COVID-19 cases; silent Washington spread suspected

March 2, 2020

Four states have reported more COVID-19 cases, including two more in Washington state, where a new gene finding is fueling concerns that the virus may have been circulating in the community for as long as six weeks.

Also, Rhode Island reported its first case, California's Santa Clara County reported another case and Illinois' Cook County reported a presumed positive, raising the number of cases detected by the nation's public health system to 27.

In addition, the Florida Department of Health (Department) has announced there are two presumptive positive cases of 2019 coronavirus disease (COVID-19) in Florida. One patient had no recent travel to countries reporting confirmed cases, while the other patient recently traveled to Italy. Both patients are in isolation and being closely monitored.

Public health experts expect U.S. cases of the novel coronavirus to increase quickly in the days and weeks ahead, now that state public health labs are able to test for the virus and with the U.S. Centers for Disease Control and Prevention (CDC) sending out more test kits.

A lengthy delay with the CDC-developed test kit had hobbled state testing for the virus until late last week, which, along with a narrow case definition, tied public health's hands for casting a wider net for the virus, which is known to spread easily in the community.

Also, Food and Drug Administration (FDA) Commissioner Stephen Hahn, MD, announced on Twitter that the FDA has granted an emergency use authorization to COVID-19 virus diagnostic tests developed by two public health laboratories in New York City.

On Face the Nation, former FDA Commissioner Scott Gottlieb, MD, said in two weeks, the U.S. will able to test nearly 20,000 samples a day.

Meanwhile, the gene sequence from a Snohomish County, Washington, high school boy whose illness was announced on February 28 as a community spread case has already been uploaded to a public database, and an early analysis hints that it is related to a Snohomish County case reported in January, suggesting that transmission has been underway in Washington state for the last six weeks.

The earlier case was a man in his 30s, the first to be detected in the United States. The Snohomish County man had traveled to Wuhan at a time when there were only 300 cases in China. He was seen at a clinic, where his specimens were collected and sent to the CDC. After his COVID-19 infection was confirmed, he was taken to Providence Regional Medical Center for treatment.

Trevor Bedford, PhD, in Twitter comments from the open-source pathogen genome analysis project Nextstrain, said the sequence from the new case descends on a branch from the earlier Snohomish County sequence, strongly suggesting transmission in the area over the past six weeks, which could have resulted in a few hundred cases. Bedford is a computational biologist at Fred Hutchinson Cancer Research Center in Seattle.

He said the two sequences could also reflect separate introductions, though highly unlikely. "I believe we're facing an already substantial outbreak in Washington State that was not detected until now due to narrow case definition requiring direct travel to China."

In addition, Public Health–Seattle & King County reported two more cases, based on state lab testing. One of the patients is a man in his 60s who is hospitalized at Valley Medical Center in Renton. He has underlying health conditions and is in critical but stable condition.

The second patient is also a man in his 60s with chronic health conditions. He is hospitalized at Virginia Mason Medical Center, where he is listed in critical condition.

Also, the health department addressed a report of an infected U.S. Postal Service worker, noting that the patient is one of four cases reported recently. Media reports said the postal employee worked at a package handling facility in Seattle.

In related news, the Rhode Island Department of Health (RIDH) said their case of an infected patient is a person in his or her 40s who had traveled to Italy in the middle of February. It added that the patient had traveled little since returning from Italy and had not returned to work. Nicole Alexander-Scott, MD, MPH, said at a media briefing that the patient had also been in France and Spain.

The person is isolated in the hospital, and family members are in home quarantine. Health officials are in the process of identifying other contacts.

California's Santa Clara County also reported another case, an adult woman who is a household contact of a community-spread case it announced on February 28. The newly reported patient is not hospitalized or sick.

Also, the Illinois Department of Public Health (IDPH) and Cook County announced a presumed positive, but had no other details about the patient, pending CDC final confirmation. Public health officials are tracing contacts and have asked the CDC to deploy a team to help with the efforts.

The case is the third to be detected in Illinois; the earlier two involved a woman who got sick after a Wuhan trip and her husband, who didn't travel but contracted the virus from his wife.

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