Health officials’ message Wednesday as the state’s novel coronavirus crisis grows: Work from home if possible, postpone or cancel large events and — for people over 60 or with underlying health conditions — avoid groups and close contact with others.
Worried people have been turned away from health clinics and a state coronavirus hotline has been overwhelmed with callers.
Confirmed cases of the disease in Washington state have grown to 70 Thursday as health officials ramp up testing, including at a University of Washington lab that was given emergency approval to test specimens provided by physicians and health care centers. The state’s 10th death from COVID-19 was announced on Wednesday, as well as the nation’s first death outside of Washington, in California.
Gov. Jay Inslee said on Wednesday he was ready to use his legal authority to cancel large events, if medical evidence showed it could prevent the virus’ spread. Vice President Mike Pence announced he would visit Inslee in Washington amid criticism of the Trump Administration’s response.
And major local employers, like Microsoft and the Fred Hutchinson Cancer Research Center, are telling their employees to stay home.
As Washingtonians take steps to reduce contact with one another, researchers look to the Chinese city of Wuhan, the starkest example of social distancing amid outbreak, to better understand the virus and how to stymie it. China has managed to slow the virus’ spread, but only after draconian quarantine measures that halted travel there.
A Fred Hutchinson infectious-disease expert on Monday compared Seattle’s outbreak at this juncture to Wuhan in early January, about three weeks before the country took drastic measures with thousands sick.
While the U.S. struggles to contain the outbreak, there are lessons to glean from China’s infection data, but also questions about how to manage the virus’ spread without trampling on civil liberties, how to avoid unintended consequences of society-shifting measures and concerns that China’s lockdown is but a short-term remedy.
“What happened in Wuhan is not something you can actually do in Seattle,” said Michael Osterholm, who directs the Center for Infectious Disease Research and Policy at the University of Minnesota, saying China’s measures were authoritarian and extreme. “What they were able to do to limit movement of people was unlike what can be done in almost any other location.”
Lessons from Wuhan
The World Health Organization (WHO) last month sent a team to Wuhan for a two-week visit to better understand the outbreak and containment measures.
A report published Feb. 28 provided data on virus symptoms, its spread and how China sought to contain it.
The WHO data says the virus was transmitted during close contact, typically in households or in places that foster close contact like long-term living facilities, hospitals or jails. Of nearly 56,000 lab-confirmed cases, 88% of patients developed fevers, nearly 68% had a dry cough and 38% had fatigue.
Signs and symptoms developed, on average, 5-6 days after infection. People over 60 with risks like hypertension, diabetes, cardiovascular or respiratory diseases and cancer were most at risk to die. Researchers also suspect other health risks, like smoking, contributed.
Only a small percentage of the cases — about 2.4% — were among children, and few kids’ conditions became critical.
The epidemic grew until China implemented a “cordon sanitaire” unprecedented in size, by essentially locking down a city of 11 million people.
The WHO report praised that measure.
“China’s bold approach to contain the rapid spread of this new respiratory pathogen has changed the course of a rapidly escalating and deadly epidemic,” the report said. Locking down Wuhan “effectively prevented further exportation of infected individuals to the rest of the country.”
But extreme measures should not be required anywhere else in the world, said Bruce Aylward, the lead WHO researcher of the China visit.
“Wuhan was the exception,” Aylward said. “They were weeks behind the eight ball in a big, densely populated city.”
Fred Hutchinson and University of Washington researcher Trevor Bedford on Monday shared an early analysis comparing his estimates of the virus’ spread in Seattle with how the disease advanced in Wuhan.
Bedford estimated some 570 Washington infections and wrote Seattle was “at a critical juncture” comparable to the beginning of January in Wuhan. He advocated for social-distancing measures, like limiting large events.
“Now would be the time to start these interventions rather than waiting three weeks,” Bedford told STAT, a science news service.
Aylward said health officials here should focus on investigating cases and isolating patients, identifying close contacts of those infected and eliminating barriers to testing and treatment.
“Everything is about speed,” Aylward said, adding that focusing on long-term care facilities or other places where vulnerable people congregate is paramount.
“You want your population to become your surveillance system,” he said. “You want your population to know what to look for: It’s not a runny nose. It’s you have a fever or a dry cough.”
If health officials have difficulty bringing transmission under control, Aylward said canceling events and public gatherings, “amplifiers of transmission,” is the next step.
Health experts say public calls for mandatory shutdowns of schools and event cancellations are not uncommon when disease is feared, but halting everyday life can do harm.
Jennifer Nuzzo, epidemiologist with the Johns Hopkins Bloomberg School of Public Health’s Center for Health Security, said she was troubled by some messages in the WHO report.
“It’s possible the aggressive, heavy-handed measures China took possibly slowed down transmission of the virus, but any effect of those measures is temporary,” Nuzzo said, and when the economy starts up again, “it’s going to surge.”
Nuzzo said overall impacts of a lockdown must be considered, like people’s access to medical treatment when facing conditions like cancer or HIV.
“If we do things like close schools or shut down public transportation, that makes it harder for health care workers to show up to work,” Nuzzo said.
Unlike influenza, data from China and other parts of the world suggest that children are not as vulnerable to severe sickness from the virus, though it’s not yet clear what role kids play in transmission.
“We’ve always thought of kids and infants as perhaps being some of the most vulnerable,” said Jason Kindrachuk, an assistant professor of viral pathogenesis at the University of Manitoba. “That’s not holding up here.”
Kindrachuk, Nuzzo and Osterholm said closing schools might not be in the public’s best interest, though political pressure from parents has often forced the issue.
Parents would have to scramble for child care, some families rely on school-provided meals and closures can dismantle children’s well-worn routines and social connections, Nuzzo said.
“It’s disruptive. Maybe it makes people feel better. I don’t believe in placebo public health,” Nuzzo said. But “sometimes the politics become too much.”
Low-income families, Osterholm said, are often hit the hardest.
“They have to take time off. They might not be reimbursed or paid,” he said.
Nuzzo said asking people to work from home and discouraging attendance at large events was a reasonable measure for now in a tech-focused economy.
The measures China took in Wuhan are politically and ethically fraught, too, said David Bachman, the Henry M. Jackson Professor of International Studies at the University of Washington, who focuses on Chinese politics.
“First, the WHO report, to put it mildly, glosses over the fact that the Chinese government covered up the outbreak of the coronavirus from early December to almost Jan. 20,” he said, adding that consequences would have been less severe.
When the truth emerged, Bachman said China overreacted with drastic measures that could not be replicated in the U.S.
Bachman said the Chinese government is uniquely positioned to enforce a lockdown. The country has high levels of surveillance and the central government’s influence reaches into neighborhoods, Bachman said.
“People are suffering economically, to say nothing of the virus,” Bachman said, adding that China’s response prompted dissidence and anger. “The political situation in China is arguably, fairly tenuous.”
As the number of cases rises and pressure mounts on elected officials and health officials, experts say they face a difficult balance to prevent the virus from spreading without unnecessary disruptions to life.
What options remain?
“They could make all these things mandatory. They could shut down public transportation. They could shut schools, potentially for a very long time, many measures up to what we saw in China, which is full-scale lockdown,” Nuzzo said. “There’s strong recognition those measures could do more harm than good.”
Local health officers, under Washington’s administrative code, can issue emergency detentions for up to 10 days for the purposes of isolation or quarantine.
The power can only be exercised after efforts to obtain voluntary compliance and the officials must issue a written order explaining why the action is needed. People who have been subject to a quarantine have a right to petition a Superior Court for release.
Inslee on Saturday declared a state of emergency, giving him wide authority to take measures to protect life and health under Washington law.
A spokesman for the governor said his staffers, the state health department and the attorney general’s office examined options under the law Wednesday and believe he has the authority to impose travel restrictions or a cordon sanitaire.
Inslee said on Wednesday he would cancel large events if medical evidence shows that could prevent or slow the spread of the novel coronavirus.
“If we reach the point where the medical evidence … suggests that this is necessary to incur whatever disruption would be required, we’ll make that decision,” Inslee said.
“It’s a weighty decision.”
Seattle Times staff reporters Joseph O’Sullivan and Hal Bernton contributed to this report.