Why Washington State? How Did It Start? Questions Answered on the U.S. Coronavirus Outbreak


SEATTLE — Officials are recommending that residents of Seattle and surrounding communities who are 60 or older or have underlying health conditions remain in their homes and that community groups cancel events that would bring together more than 10 people and could possibly further spread the coronavirus.

“We are dealing with the most serious outbreak of Covid-19 anywhere in the nation,” said Dow Constantine, the King County executive. “Our actions are forming the model that will be followed in other parts of the country.”

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The measures — including recommendations that employers urge their workers to telecommute and that pregnant women stay home — were aimed at containing the rapid spread of the virus. The regional health care system is “under incredible stress right now,” said Patty Hayes, director for public health for Seattle and King County. “We need to slow the spread of disease to the point where our health care system can continue to handle the load.”

After the county released its recommendations, Microsoft, one of the region’s largest employers, told employees in Puget Sound and the San Francisco Bay Area to work from home until at least March 25.

With Washington State the focal point of the virus in the United States, some of the measures unveiled here may presage what is to come in other parts of the country. Here is a closer look at what is unfolding in Washington State and why.

Why are there so many cases of coronavirus in Washington State?

There are three main explanations for why more cases of coronavirus may have been detected in Washington State than any other state in the nation.

One is that many of the cases are related to a case at a long-term care facility in the Seattle suburb of Kirkland. The coronavirus is more severe in older people with underlying health conditions. That means the coronavirus could be circulating in other communities — in Washington or elsewhere — but causing mild enough symptoms that those who are contracting it do not seek or require medical care, therefore unintentionally passing it on.

In another scenario, someone who had become infected in China, where the virus originated, might have returned to Washington weeks ago with a mild infection and passed it on, undetected, until many more people became affected. The longer a virus is circulating in a community, the more likely transmission is to happen.

Lastly, Washington State may be performing more tests than other states, relative to its population. It’s not clear whether that is the case, but it’s important to remember that tests were not widely available until last week. That is the reason so many states have announced new cases in recent days. And states are applying their own criteria to determine whom to test.

Didn’t the coronavirus outbreak in the United States first emerge in Washington?

Sort of. The first individual in the United States to be confirmed as positive for the new coronavirus by the Centers for Disease Control was indeed a resident of Snohomish County, Wash. That was on Jan. 20.

But Washington State did not report any other cases until last week. In the meantime, Illinois, California, Arizona, Massachusetts and Wisconsin all announced cases of the new coronavirus, related to travel in China.

How is that first patient doing?

He has fully recovered, according to Snohomish County health officials.

Do we know whether he infected others?

The cases identified last week occurred well after the first patient was no longer expected to be contagious.

And local health officials traced and monitored more than 60 contacts of the first case, none of whom tested positive.

But an analysis of the viral genome from a 17-year-old patient in Snohomish County seems to suggest this new case descended from the first case.

Those two patients are not known to have had contact with one another. A third genome sequenced on Wednesday was also found to be in the same genetic grouping. Both of the latter two patients were picked up through testing of nasal swab samples taken as a part of surveillance for flu in Seattle.

Trevor Bedford, an associate professor at the Fred Hutchinson Cancer Research Center at the University of Washington who helped conduct the analysis, said it was possible that the cases could be unrelated and had been introduced separately into the United States. He said that was less likely, however, because in all three cases the virus contained a genetic variation that appears to be rare. That variation was found in only two of the 59 samples whose sequences have been shared from China, where the virus originated.

Federal, county and state health officials said that Dr. Bedford’s analysis was plausible, though it was based on limited data, and that with so few samples sequenced from China, it is unknown how rare the variant truly is. More samples from the state are being analyzed by the C.D.C. “Seeing how they all relate to each other will be the real answer to the question of, has it been circulating,” said Dr. Scott Lindquist, the state epidemiologist for communicable diseases with the Washington State Department of Health.

So how many people are infected in Washington State?

If the virus has been spreading undetected in Washington since mid-January, that could mean that anywhere from 150 to 1,500 people may have had or contracted it as of the beginning of this week, with about 300 to 500 people the most likely range, estimated Dr. Mike Famulare, a principal research scientist at the Institute for Disease Modeling in Bellevue, Wash. These people “have either been infected and recovered, or currently are infected now,” he said.

Dr. Famulare’s estimate was based on a simulation using what scientists have learned about the incubation period and transmissibility of the virus. He called his figures a “best guess, with broad uncertainty.”

Another method, based on the size of the local population, the number of tests performed and the proportion of those that were positive, produced similar estimates of how widely the virus might have spread in the community.

If the analysis is correct, that could mean that Washington is in the position that Wuhan was in January, after the virus was detected but had already been spreading in the community. This would add urgency to the need to step up measures to avoid a skyrocketing infection rate in the state.

What is being done in Washington State to isolate those with the virus?

A wide variety of efforts are underway to try to keep the number of cases from rising.

With the aim of isolating those who become infected but are not sick enough to be hospitalized, King County, which includes Seattle, placed modular units in a neighborhood southwest of downtown and identified two additional locations in the city where additional units could be located.

The county also finalized the $4 million purchase of an Econo Lodge in the south end of the county, which could be operational within days. The county is seeking funds for improvements to the property, as well as hiring 11 current motel employees.

How many cases are there in the state?

As of Wednesday evening, 45 people have been diagnosed with the novel coronavirus infection across Washington State. Ten of them have died.

Some of those people, including several passengers from a cruise ship, were brought to the state for treatment.

The nursing care facility in Kirkland has been the focus of the state’s cases. Eight of the people who died were residents of Life Care Center. Eighteen others with ties to the center have been diagnosed with coronavirus, including one person who visited the facility but was diagnosed after returning home to North Carolina.

What’s happening at the nursing facility now?

Dozens of residents of the nursing facility remain inside the low-slung building; families and other visitors have been told they may not enter. Many families have expressed anguish at the prospect of leaving their loved one inside, even as new deaths are announced.

Dr. Jeff Duchin, the health officer for public health for Seattle and King County, apologized for a breakdown of communication with families, who said they had not heard from officials. He said there was an effort underway to test every resident for the virus.

Two epidemiologists were deployed to the facility on Wednesday, and a disaster medical assistance team from the federal government was scheduled to arrive on Thursday.

“We know this disease is not able to be put back in the box,” Dr. Duchin said. “Most people will do fine, some people will get sick.”

Why weren’t people in the state tested sooner?

Many Washington State residents have expressed frustration about not being able to get tested for the virus sooner.

“There are lots of people in our state who are sick and they want to know if they have Covid-19,” said Dr. Kathy Lofy of the Washington State Department of Health. She said that testing in the state had been hampered by limited lab capacity and by criteria set earlier by the C.D.C.

Officials expected the crunch to ease in the coming days. The state’s lab has quadrupled its staff and purchased new equipment, she said. The virology lab at the University of Washington announced that it had developed a new diagnostic test, under an expedited F.D.A. protocol, and can run about 1,000 samples a day.

What does life feel like in Washington State?

Around Seattle, small changes were visible. School attendance was down a modest 4 percent, but officials were putting plans in place for more disruption. Yoga studios announced that use of some often-touched items — like pads and blocks — would be reduced for now. At a Safeway store, which was quiet, a clerk apologized for a wet area near the register.

“Disinfectant,” she said, wiping the spot down with a paper towel.

In Kirkland, Ron and Pat Knight skipped going to their gym on Wednesday morning, opting instead for a walk. Ms. Knight, 75, a retired occupational therapist, said she was concerned about the virus, though not really frightened.

“It’s the unknown that’s the big thing,” said her husband, Dr. Knight, who is a retired cardiac surgeon. “No one knows what’s going to happen.”

Restaurants and coffee shops in Kirkland were busy, though downtown was quieter than usual, residents said. Claire Robson, who lives about a mile from the nursing home, said she has noticed new parental etiquette for play dates.

“My friends are asking me, ‘Are you comfortable having my son come over to play?’” she said. “I’m like, ‘Yeah, of course.’ I’m not too worried about it, though I am having the kids wash their hands.”

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