Feeling fine and showing no outward symptoms is no guarantee of being virus-free, according to health-department experts. Also, those who received notifications from the hospital won’t have to pay for testing.

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One month after leaders of Puyallup’s Good Samaritan Hospital announced an outbreak of hepatitis C and sent notices to roughly 2,761 patients who might have been exposed, they’re facing a different kind of problem: stragglers.

As of May 30, 1,207 people who received the notices had not sought testing, according to Marcelene Edwards, spokeswoman for the MultiCare Health System, which runs the hospital.

Waiting or ignoring the notice is a bad idea, said Edie Jeffers, spokeswoman for the Tacoma-Pierce County Health Department. “Whenever you get a letter from a health-care provider or from the health department stating you should be tested for possible exposure to a communicable disease, you need to take it seriously,” Jeffers said. “People may have the disease and not know it. If you received a letter, you need to get tested. ”

The health department, in collaboration with the federal Centers for Disease Control and Prevention (CDC), is investigating the outbreak, initially tied to a nurse who longer works at the hospital and has denied infecting patients.

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Hospital and health-department leaders identified two patients who contracted the virus from the same genetic source. They’ve been working ever since to identify additional cases, updating the investigation data every week online at www.tpchd.org/hepcstats. The latest figures show 11 additional confirmed hepatitis C cases labeled as “probable,” suggesting a likely link to the same genetic strain. The numbers show eight more cases listed as “under investigation” and 41 confirmed hepatitis C diagnoses believed to be unrelated to the Good Samaritan outbreak.

Hepatitis C is a bloodborne virus that attacks the liver. Typically, it spreads through shared needles. Left untreated, it can lead to cirrhosis and liver cancer.

Hepatitis C cases are rising in Pierce County, driven in part by the opioid epidemic. The health department normally tracks cases, but the Good Samaritan outbreak requires deeper investigation. Health-department leaders expect to receive new test results shortly from the CDC that are expected to be more definitive.

Feeling fine and showing no outward symptoms is no guarantee of being virus-free, according to health-department experts. It’s possible to contract and carry it without knowing. People born between 1945 and 1965 are five times more likely to have the virus.

Those who received notifications from the hospital won’t have to pay for testing. MultiCare sends letters twice a week notifying patients of negative results. Positive results are delivered via phone calls.

A positive diagnosis isn’t necessarily dire. The disease is “curable in almost everyone,” according to Kim Desmarais, the health department’s viral hepatitis coordinator.