At least two people who died in early and mid-February had contracted the novel coronavirus, health officials in California said Tuesday, signaling that the virus may have spread — and claimed lives — in the United States weeks earlier than previously thought.
Tissue samples taken during autopsies of two individuals who died at their homes in Santa Clara County, California, tested positive for the virus, local health officials said in a statement. The victims died on Feb. 6 and Feb. 17, respectively.
Initially, the nation’s earliest coronavirus fatality was believed to have occurred on Feb. 29, in Kirkland, Washington, a suburb of Seattle that rapidly became a hot spot. In March, health officials there linked two Feb. 26 deaths to COVID-19, the disease caused by the new virus.
The Santa Clara County fatalities push the earliest coronavirus-related fatality back by weeks, with the new findings potentially altering the timeline of the U.S. outbreak.
“The fact that there were deaths related to COVID back in early February is very significant because it means the virus was around for a lot longer than was initially realized,” Jeff Smith, a physician and the county executive in Santa Clara, told The Washington Post. “It’s been around for a while and it’s probably been spreading in the community for quite some time.”
It is not yet known exactly how the two people became infected, but Sara Cody, the county’s public health officer, told The Post that the cases are believed to be community transmissions.
“From what I understand, we don’t know of any travel history,” said Cody, who is also a doctor. “More investigation will be done to try and confirm that that’s the case.”
The connection between the February deaths and coronavirus did not become apparent until now due to strict limitations on testing at the time, Cody said.
Both of the Santa Clara County deaths occurred as the Centers for Disease Control and Prevention had tightly restricted tests to those who displayed respiratory symptoms and recently traveled to China or had close contact with an infected person. Cody said local officials often had to call the CDC and discuss the specifics of individual cases before the agency would grant permission for testing.
“We did have a very uncomfortable feeling that we were missing cases because we didn’t have the tests to be able to confirm,” Cody said. “This tells us that yes, we were definitely missing cases.”
Eric Topol, a geneticist and researcher who directs the Scripps Research Translational Institute, told The Post that the early deaths could mean that many COVID-19 patients may have been misdiagnosed very early this year.
“How many of those were presumed to be flu or pneumonia when they were actually COVID-19?” he said.
Cody said she credits the discovery of the infections to the county’s “thoughtful, astute medical examiner,” who sent tissue samples from the two people to the CDC. The positive test results were confirmed Tuesday.
These two fatalities, along with a third on March 6, also indicate that the coronavirus was likely spreading earlier and further in the San Francisco Bay Area than local officials initially believed. So far, Santa Clara County has tallied 88 coronavirus-related deaths, including five new deaths reported Tuesday. The county now has 1,946 confirmed cases.
As Cody explained it, each severe COVID-19 case or death “represent tips of icebergs of unknown size.”
“Every time when I see someone in the ICU or someone who dies, what that says to me is that represents many more infections,” she said.
Santa Clara County’s first locally transmitted case of the virus was reported on Feb. 28, in 68-year old Azar Ahrabi, who later became the region’s first known death on March 9.
But the three new deaths show that the coronavirus had in fact killed others in the county, which includes the city of San Jose as well as Silicon Valley, days if not weeks before Ahrabi died — a sign that the virus may have been introduced to the region as early as late January, said Jay Bhattacharya, a professor of medicine at Stanford University.
Modeling for epidemics rely heavily on the start date of an outbreak, Bhattacharya told The Post. If that date gets pushed back, models must be redone and reviewed, increasing the number of people believed to be infected right now, he said.
An outbreak in the Bay Area was first detected at the beginning of March, as reported cases reached the double-digits and the virus believed to be mostly concentrated on the West Coast. On March 16, Santa Clara County became one of the first counties in the country to order residents to stay at home, The Post’s Scott Wilson reported, a move that was considered among the strictest steps taken nationally to enforce social distancing and reduce people’s exposure to the virus.
In light of Tuesday’s news, Cody said the county’s shelter-in-place directive was “definitely the right call.”
“It’s a very blunt tool, but it’s an effective way of slowing the spread and if you already have significant levels of circulation of the virus that’s really your best and only tool,” she said.
Smith, the county executive, echoed Cody’s sentiments, stressing that the deaths from February and March should be a clear message that such orders must remain in place. Recently, more governors, largely fueled by encouragement from President Trump, have begun working toward reopening their states, with Georgia Gov. Brian Kemp (R) announcing Monday a controversial plan to lift restrictions on a large number of businesses there on Friday.
“I hope sincerely and deeply that the message gets across very clearly that we cannot relax shelter-in-place at this point because we don’t have enough testing to know with any type of certainty which areas of the community and which people have the virus,” Smith said.
Elsewhere in the U.S., other signs have surfaced in recent months hinting at the possibility that infections may have been occurring earlier than previously believed.
In March, a genetic analysis of virus samples found that the virus may have spread undetected for weeks in Washington state, which reported the country’s first two deaths, The Post reported. Similarly, research from the Mount Sinai Health System in New York concluded that the virus was also spreading there for many weeks before the state’s shutdown order on March 22.
Ethan Weiss, a professor at the University of California at San Francisco, said that he expects to see additional deaths like the ones in February, or even earlier.
“It would be shocking, given what I know about travel between Wuhan and the Bay Area, if there weren’t cases here in mid-January,” Weiss told The Post.
On Tuesday, officials in Santa Clara County concurred with Weiss, noting that they also anticipate the number of coronavirus-related fatalities in the area to increase as the medical examiner continues to investigate deaths.
“In retrospect, even though we were detecting relatively little, we had quite a bit,” Cody said. “This confirms that we had a lot more than we recognized.”