The coronavirus outbreak in the Seattle area is at a critical juncture and could see explosive growth in cases much like Wuhan, China, if public officials don’t take immediate, forceful measures, according to a new analysis of genetic data.
The author of the analysis, a computational biologist named Trevor Bedford, said there are likely already at least 500 to 600 cases of Covid-19 in the greater Seattle area. He urged health authorities and the public to immediately begin adopting non-pharmaceutical interventions — imposing “social distancing” measures, telling the sick to isolate themselves, and limiting attendance at large gatherings.
“Now would be the time to act,” Bedford, who is at the Fred Hutchinson Cancer Research Center in Seattle, told STAT.
Support STAT: If you value our coronavirus coverage, please consider making a one-time contribution to support our journalism. You can help us continue to produce authoritative pieces from the frontiers of health and medicine.
The genetic sequences of patients in the Seattle-King County region suggest the virus has been circulating there since about mid-January, when the first U.S. patient — a man who returned from Wuhan — was diagnosed, Bedford wrote in the analysis, published online.
The spread of the virus has gone undetected in part because many infected people experience only mild infections that could be confused for a cold or the flu, and in part because of stumbles in the Centers for Disease Control and Prevention’s effort to develop test kits for state and local public health laboratories, which has meant very little testing has been done in the country until the past few days.
On Capitol Hill, Washington Sen. Patty Murray (D) expressed deep frustration with the situation.“The failure to develop and distribute working test kits to public health agencies has really cost us valuable time. I am hearing from people personally across our state who are frustrated,” Murray said.
“They believe they have been exposed, they are sick, they want to get tested, they have nowhere to go,” she added. “People want to be safe and protected, they do not want to spread this, they want to take care of themselves but we don’t have the capability right now to do it with the policies we have in place.”
Bedford said Seattle faces a stark choice — take aggressive actions to slow down the spread of the new coronavirus now or face the type of outbreak that engulfed Wuhan’s health facilities and led to a lockdown of the city that remains in place six weeks later.
Seattle is effectively in the position that Wuhan was on Jan. 1, when it first recognized it had an outbreak of a new virus, but did not realize the scale of the problem or the speed at which the virus was spreading, Bedford said.
Three weeks later, on Jan. 21, China imposed the most draconian quarantine measures ever deployed in modern times, both in that city and in others to which the virus had spread but where transmission was only just beginning.
“January 1 in Wuhan was March 1 in Seattle,” Bedford told STAT. “Now would be the time to start these interventions rather than waiting three weeks.”
Samuel Scarpino, an assistant professor at Northeastern University’s Network Science Institute, agreed time is of the essence.
“I think it’s unequivocal that there is widespread community transmission in Seattle and they have to take decisive action now,” said Scarpino, who uses mathematical and computational models of infectious diseases transmission to inform public health policy.
Washington State health authorities announced late Friday that they have found a case of Covid-19 in a teenager from Snohomish County, north of Seattle. The teen had not traveled outside the country and had no known contact with a confirmed Covid-19 patient, meaning this was likely a case of community transmission of the virus. This was the first such case for Washington State and one of the first four or five detected in the country.
The case was actually found by the Seattle Flu Study. Bedford, a co-investigator, normally works on influenza but has been one of the key players trying to assess what is happening with the new virus by studying genetic sequences from around the world.
Frustrated by the lack of testing resulting from the problem with the CDC-developed kit, the Seattle Flu Study began using an in-house developed test to look for Covid-19 in samples from people who had flu-like symptoms but who had tested negative for flu. That work — permissible because it was research — uncovered the Snohomish County teenager.
Analysis of the genetic sequence of the virus from the teenager showed it was so closely related to that of Washington State’s first case that Bedford believes the teen was infected as part of a chain of transmission that started with the first case. That would mean the virus has been circulating in the northern part of the state for about six weeks.
The pattern seen in other locations that are fighting the new virus is that it takes a while for enough people to be infected for severe cases to start showing up in hospitals for care. The Seattle area is soon going to be there, Bedford said.
“So we’re going to expect a large uptick in just the number of people presenting to hospitals,” he said.
As of Tuesday, the state was reporting 27 cases and nine deaths. That is up from 18 cases and six deaths on Monday.
The stringent actions China took drove down new infections in Hubei province — where Wuhan is located — to low levels, though transmission continues there. Other cities in the country that started to see cases were able, with the same measures, to avoid the explosive transmission Wuhan had experienced. Flattening the epidemic curve, as that phenomenon is called, helps health care systems continue to function. An eruption of cases overtaxes hospitals, leading to deaths that otherwise could have been avoided.
“China saw not much of an epidemic outside of Hubei because they acted early,” Bedford said.
Some question Bedford’s analysis. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, said it is possible that another traveler who came from Wuhan later started the chain that infected the Snohomish County teen.
While Scarpino agreed that is a possibility, he insisted that from a public health point of view, it makes little difference.
The window of opportunity “may be already shut. But we have to assume we’ve got some time left,” Scarpino said. “But that means, like yesterday, we have to start seriously testing, putting infection control policies in place, ensuring we have plans for what we’re going to do with homeless or marginalized populations.”
Scarpino urged hospitals in the Seattle area to assume anyone coming in with acute respiratory infections is infected with Covid-19 and isolate them to protect other patients and health workers.
Andrew Joseph and Nicholas Florko contributed reporting.
An earlier version of this story misstated which research group had discovered Washington State’s first community spread case.
About the Author Reprints
In response to other comments, much of the discussion that I have read is very trivial in comparison to the seriousness of the situation. This is a time to think through some serious questions. Do you think there is a purpose behind all of this? If so, what might it be? Is this just humankind’s doing, or might there be a Higher Power behind it, and if so, why? If you believe in God, is God trying to tell us something? Do you have a hope that transcends human existence?
Maya, you are sorely incorrect. One, humans are *not* biological omnivores, and two, we do *not* have any biological requirement for animal proteins. Please educate yourself. All plants have protein, and all protein originates in plants. Plant protein is not only sufficient, it is the optimal diet for humans, and Kevin is correct; a vegan/plant-based diet is beneficial for one’s immunity. (he’s also correct by listing some of the many diseases obtained from eating animals) Regarding “lane”, what you mean is, “Don’t call out my ignorance and resistance to change, and don’t remind me of the horrible things I pay others to do to animals unnecessarily – and to the planet.”
God bless us? Isn’t he the one who gave it to us?
Kevin, one doesn’t have to be a vegan or vegetarian (please…). Humans are omnivores and require animal proteins. I will stay in my lane, but you need to stay in your lane.
All Washington State casinos should be closed for 2 weeks. That is what they did in Macau, China, and the casinos support it! Not only will it reduce the spread of the virus, it will keep people from wasting their money, at least for a little while. Time for the Native American tribes to step up and help here.
This is how we Europeans wiped out native Americans hundreds of years ago by introducing infectious diseases. now is a payback time babes! Karma is a…. what’s the word?
Turn vegetarian or vegan. We will all be good. This is what happens when you get animals – bird flu, swine flu, mad cow disease and now this one with bats
Impose immediate martial law or we can call it draconian quarantine so it’s not so imposing(Only a communist country could enforce this so easily, ironic the upside of communism). Failure will ensure the health system to become overwhelmed. Its how China stopped it in its tracks but only after spread like wildfire. Let’s pray Trump has the insight into how China turned the tide.
I would much prefer the type of response Democratic South Korea has taken vs the Communist China approach. I believe it’s just as effective and better yet, more transparent. There is no upside to Communism since the dictatorship can easily hide embarrassing situations.
I stand corrected, South Korea has 0.6% mortality vs China’s 3.7% mortality. South Korea’s approach is much more effective. Of course, there are many variables involved but I don’t accept they fully account for the big difference. Also, China can much more easily hide deaths as compared to South Korea. So, I think Korea’s approach is superior to China’s and America’s for that matter. For example, in South Korea, they are giving around 10,000 tests per day and you can even go through a drive up to get a test. Here, we are still debating who’s going to pay for the tests which further complicates matters. The administration needs to step up and say all necessary tests are free. This is not socialism.
You do realize in South Korea their health system is overcome and the death rate will skyrocket if they don’t overturn what has happened(they are converting every space they have free to hospital beds in government buildings to churches). WHO has in place the same strategy from China in Italy and Iran, it’s basically what this news article is about above from Helen. The death rate will go through the roof if health services collapse. My choice will always be the preservation of life before anything else.
The coronovirus has mutated – there are now 2 strains L and S. With different death rates and spread rates. And it spreads not only by droplets but also via faeces and urine. This from the South China Morning Post today March 4, 2020. Already, Washington state is in trouble, not enough test kits (thanks to the failed US government), 9 people dead (of 27 counted = yesterday March 3), airport employees sent home without testing. We are all in an intense situation of Do-It-Yourself. Don’t go to gatherings, don’t travel, and do everything possible to stay healthy and out of harms way. Good luck all.
You obviously mean a failure to provide working tests in a timely manner and NOT a failed government
IM REALLY SCARED!!
Covid-19 will be ubitquitous, we cannot stop it, merely slow it down. Panic would remove all opportunity to control spread. By undereporting cases, order is maintained, and panic remains at bay.
Its a fine line between civic order and operation of systems that involve social trust like retail, transport and banking. If we stop all operations and quarantine everyone we achieve reduction in transmission of virus, but lose social structures capable of supporting society, which leads to breakdowns in basic needs distribution, like food and water. which leads to social chaos, which leads to widespread disease transmission and no way to treat it.
its a fine line that must be balanced daily by those charged with managing an unmanageable disease. there is no perfection in this situation and all decision making will be critiqued in retrospect with perfect hindsight, that will do little to create wisdom and much to create even more schism between factions in our society.
this is not a test, or a tv show, its life, its imperfect and we all die in the end.
lets do our best and work together, for surely it is our only hope of the best possible outcome. wisdom is the antidote for chaos and there is precious little left in the world, don’t be reactionary or a prisoner of your emotions.
don’t let fear put you in danger or do or say stupid things.
this situation is in no ones control, it will unwind as it will. be brave, be strong and be smart.
Samuel, the scales are currently tilted far too heavily in favor of the financial economy and far too little towards keeping the rate of infections within the treatment capacity of the healthcare system.
Once the treatment capacity is exceeded, the death toll becomes catastrophic and will cause far more panic than any preventive measures.
I believe people have a higher capacity for organized resistance to this disease than the government gives them credit for. China and Singapore are great examples. Iran not so much. But the US is not Iran.