Response To 1st Coronavirus Case In Washington State Draws On Lessons From Measles

When the first U.S. case of a new coronavirus spreading throughout China was confirmed last week in Washington state, public health workers were well prepared to respond, building on lessons learned during the outbreak of measles that sickened 87 people in the state in 2019.

As of Monday, the Centers for Disease Control and Prevention had confirmed five cases of infection from the new coronavirus in the U.S., including two in California, one in Illinois and one in Arizona. All have been linked to people who traveled to the Wuhan region in China. More than a hundred people are under investigation for the new coronavirus in 26 states, according to the CDC.

The first U.S. patient, an unidentified man in his 30s, had traveled to the Wuhan area at the end of last year. He fell ill shortly after flying back to the U.S., where he lives north of Seattle.

In Washington state, health agencies have identified more than 60 people who came in close contact with the infected man before he was hospitalized in Everett, a city in Snohomish County outside Seattle.

The case quickly grabbed headlines, but it didn't rattle local health clinic workers who had recently geared up to handle another infectious disease.

"The measles really kind of enlightened everybody about 'Wow, there are a lot of things out there that can be really contagious and can get you really sick, really fast,' " says Tove Skaftun, the chief nursing officer for the Community Health Center of Snohomish County.

Skaftun says she's glad that last year's outbreak forced them to improve how they approach these situations.

"We've recently grown our infection-control program so it's kind of at the forefront of a lot of what we do," says Skaftun.

She says that effort focused on educating staff about the correct precautions to take when faced with different kinds of infectious diseases — including wearing protective air-purifying respirators when in contact with patients who may be infected.

Measles is one of the most contagious viruses and can stay in the airspace of a room for up to two hours. In contrast, public health experts believe the new coronavirus requires close contact to spread between humans.

"Coronaviruses are generally transmitted through sneezing, coughing and close contact with individuals, so those are the types of criteria we use to identify people at risk," says Dr. Kathy Lofy, state health officer for Washington.

She says previous outbreaks and most recently the measles outbreak led to "a lot of preparation by our health care system partners around how to appropriately ... protect themselves from highly infectious pathogens."

In Washington, public health workers are daily calling people who have come in contact with the confirmed case and asking about symptoms such as a fever or cough. Those being monitored are not required to be isolated unless they develop symptoms.

The patient in Seattle first went to a local health clinic when he started showing symptoms. Once it became clear he was at risk for coronavirus, he was transported to Providence Regional Medical Center in Everett, a hospital north of Seattle, where he was treated in isolation. He remains in "satisfactory" condition, according to the Washington State Department of Health.

Dr. Amy Compton-Phillips, the chief clinical officer at Providence St. Joseph Health, which runs that hospital, says it was set up to handle high-level infectious pathogens during the Ebola scare of 2014.

"All types of infrastructure had been put in place to ensure that when something came around we'd be ready," says Compton-Phillips.

Those include specialized gurneys to keep patients isolated while they're wheeled around the hospital, robots that can listen to patients' lungs and take blood pressure, and rooms with negative-pressure air flow so germs aren't circulated throughout the rest of the hospital.

In Snohomish County, health workers are on alert for signs that any patients could be at risk of carrying the new virus.

At the Community Health Center of Snohomish County, signs posted in the waiting room tell patients to notify staff if there's any indication they could have been exposed.

"We do have patients that are calling in, and we do have patients that are talking about it with their provider staff," says head nurse Skaftun.

Skaftun says it's natural that some patients have been asking questions, but like other health providers in the area, she's not too concerned that the first U.S case happened to arrive in her county.

In fact, her clinics had all the right protocols and infection-control gear at the ready when they first heard the news.

She says staff have practiced getting ready for an infectious outbreak pretty recently. Last year, Clark County, Wash., which is part of suburban Portland, Ore., had an alarming outbreak of 71 cases of measles, mostly among unvaccinated children.

In the Seattle area, which includes Snohomish County, there was a smaller outbreak. No one died and Snohomish County had only one case of measles, but Skaftun says it was a wake-up call for clinics like hers, which can be the first stop for patients worried they may be at risk.

The Wuhan coronavirus appears much less contagious than measles, and the flu has sickened and killed far more Americans already this year.

The public health message from public health leaders remains clear: The risk of the new coronavirus spreading from human to human in the U.S. remains low.

"At this time in the U.S., this virus is not spreading in the community," said Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, at a news conference.

Still, the CDC has been advising health care workers to take "airborne precautions" and wear protective gear if they are near a patient who is under investigation.

The Washington patient was diagnosed after samples were sent to CDC headquarters in Atlanta. The CDC has developed a test to diagnose the new coronavirus.

"We are refining the use of this test so we can provide optimal guidance to states and laboratoriums on how to use it," said Messonnier.

The agency plans to distribute those to public health labs around the country "as fast as possible" in the coming weeks.

"There are a lot of unknowns," says Janet Baseman, professor of epidemiology at the University of Washington. "The best thing public health can do now is assume that it will be similar to other coronavirus outbreaks we have seen in recent years until proven otherwise."

"Being overprepared is the name of the game," she says.

With only one case of the coronavirus from China confirmed so far in Washington, Baseman says it's much easier for public health workers to do contact tracing than last year when faced with the measles outbreak, which included multiple cases.

"It was a really different situation because there were also a lot more exposed people," says Baseman.

This story is part of a partnership between NPR and Kaiser Health News. [Copyright 2020 NPR]