SUNDAY, March. 1, 2020 (HealthDay News) -- Following the first U.S. coronavirus death, the Trump administration on Saturday placed travel restrictions on three countries that are battling COVID-19 outbreaks.
A complete travel ban was issued for Iran, while the highest-level travel advisory was issued for parts of Italy and South Korea. The travel advisory urges Americans to avoid all nonessential travel to affected areas of those two countries.
On Friday, three new U.S. coronavirus cases of unknown origin, confirmed in California, Oregon and Washington state fueled fears of "community spread" of COVID-19 among Americans.
And on Sunday, Washington state health officials announced they are investigating a potential outbreak of coronavirus at the Life Care Center nursing home in Kirkland, after two patients tested positive for infection. More than 50 staff and patients are showing symptoms, CNN reported.
On Saturday, Washington state confirmed the first coronavirus death in this country.
According to the New York Times, a spokesman for Evergreen Health said the 50-year-old man was a patient at Evergreen's hospital in Kirkland, Wash. He had underlying health conditions and was not a resident at the nursing home experiencing the possible new outbreak, CNN noted.
During a media briefing Saturday, President Donald Trump said there are a number of patients in the United States with coronavirus, and "one passed away last night." He added that, "four others are very ill."
Dr. Robert Redfield, who directs the U.S. Centers for Disease Control and Prevention, said there was no indication that the deceased man had contracted COVID-19 from travel or from contact with someone already known to have the virus.
The U.S. developments came after the World Health Organization on Friday raised its risk assessment of the new coronavirus' spread to "very high," with cases of infection now spotted in 59 countries and on every continent except Antarctica.
Also on Friday, Nigeria announced the first case of coronavirus in sub-Saharan Africa, identified in an Italian contractor who fell ill upon returning to his workplace north of Lagos.
"We are on the highest level of alert or highest level of risk assessment in terms of spread and in terms of impact," Dr. Mike Ryan, executive director of WHO's health emergencies program, said during a media briefing in Geneva on Friday. "This is a reality check for every government on the planet: Wake up. Get ready. This virus may be on its way and you need to be ready. You have a duty to your citizens, you have a duty to the world to be ready."
Besides the two cases at the Washington nursing home, the three other new cases of unknown origin in the United States include an older woman living in northern California, a high school student in Everett, Wash., and a worker at a Portland, Ore. area elementary school, according to the Associated Press.
None of those three have had any known contact with someone who had recently traveled abroad or was already diagnosed with COVID-19, authorities said.
The California case occurred in Santa Clara County. The affected woman is being treated in a hospital and had no known contact with an infected woman from nearby Solano County, who was diagnosed as the first U.S. coronavirus case of unknown origin on Wednesday, state health officials said.
Preparing for a domestic outbreak
Speaking with the AP, Dr. Sara Cody, director of the County of Santa Clara Public Health Department, said the new case there "represents some degree of community spread, some degree of circulation."
After the Oregon case was identified, the Lake Oswego School District sent a robocall to parents announcing that the school where the employee worked would be closed and deep-cleaned by maintenance workers, state health officials said.
Meanwhile, two new cases in Washington state were reported by state health officials: a student at Jackson High School in Everett whose infection had no known connection to travel abroad or contact with an infected person; and a 50-year-old woman who had recently returned from the city of Daegu in South Korea, the epicenter of a large outbreak of COVID-19 in that country.
As of Sunday, WHO has reported more than 87,000 cases of coronavirus worldwide, including 2,977 deaths, the vast majority of which have occurred in China, where the outbreak began.
In the United States, efforts are underway to prepare for what most experts say is an inevitable large-scale domestic outbreak of coronavirus. On Friday, Health and Human Service Secretary Alex Azar said President Trump might invoke a 1950 Korean War-era law, the Defense Production Act, to ramp up production of medical supplies needed in an outbreak, the Times reported. Those supplies would include more than 300 million high-tech N95 face masks for use by health care personnel.
Just how prepared the United States is to quell an outbreak of coronavirus on American soil came into question on Thursday, as federal officials broadened guidelines for testing and a whistleblower complaint was filed by a high-ranking U.S. health official.
The complaint claimed some federal health workers had been allowed to interact with quarantined Americans without proper training or protective gear.
Better testing, improved guidelines
Another issue emerged after the first U.S. case of coronavirus of an unknown origin surfaced in northern California on Wednesday. State officials there scrambled to track down anyone who might have come into contact with the woman, who arrived at UC Davis Medical Center on Feb. 19 from another hospital on ventilator support.
State and federal officials disagree on how long it took to get approval to test the woman, the AP reported. But one hospital memo claims that hospital officials couldn't get approval to test the woman for four days because she didn't meet strict testing criteria. Those criteria included travel to China or exposure to someone who had traveled to China.
"This was a clear gap in our preparedness, and the virus went right through the gap," Dr. Ali Khan, dean of the University of Nebraska College of Public Health, told the AP.
So, late Thursday, the U.S. Centers of Disease Control and Prevention moved to close that "preparedness gap" by broadening its testing criteria. Adding to the problem, state and local health officials say they don't have enough testing kits, as the first batch the CDC sent out to state and local health departments were flawed, and new ones are still being manufactured.
"As I said before, this has not gone as smoothly as we would have liked," Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, said during a Friday media briefing.
"Right now, labs can start testing with existing CDC test kits. States that were able to validate their kits should continue to test in this manner," she said. "States that were able to validate only two components specific to the novel coronavirus can test using only those two, using revised instructions. We've established that the third component, which was the cause of the inconclusive result, can be excluded from testing without affecting accuracy."
"This will increase the testing capacity of state and local health departments. All positive test results will continue to be confirmed by [the] CDC for some time," Messonnier added. "Additionally, [the] CDC has manufactured brand new test kits that will only include the two components that are specific to the novel coronavirus."
In Thursday's whistleblower complaint, a top official at the Department of Health and Human Services said workers from the agency were not tested after being exposed to quarantined evacuees without full protective gear. Some of those workers flew back home on commercial airlines, the complaint noted.
Meanwhile, schools across America are canceling trips abroad and preparing online courses as they brace for the possibility that coronavirus could spread into their communities, the AP reported. Many are also preparing for possible school closures that could stretch for weeks or longer.
On Wednesday, President Trump tapped Vice President Mike Pence to lead the U.S. response to a potential coronavirus pandemic.
Including the two cases identified at the Washington nursing home on Sunday, there have now been 71 confirmed cases of coronavirus in the United States. Many were contracted abroad through travel, and all have been placed under quarantine.
Further international spread
Internationally, hopes of containing the coronavirus are fading fast, as stock markets around the world plummeted on Thursday and a run on face masks threatened to trigger a shortage.
South Korea and Iran are each battling major outbreaks of COVID-19. In Europe, a similar fight is raging in Italy, even as new cases were recorded in other European countries, the Times reported. In Japan, a state of emergency was declared Friday in a northern province because of the growing number of coronavirus cases there, the AP reported. Japan has also taken the unusual step of closing all school for the month of March to protect children.
On Wednesday, Brazil announced that it had identified the first case of COVID-19 in Latin America, and on Friday Mexico announced it had its first two cases of COVID-19.
In Wednesday's press conference in which Trump appointed Pence to head the U.S. response to coronavirus Dr. Anne Schuchat, principal deputy director of the CDC, reminded Americans that the best way to protect themselves and others is to take the same sort of precautions as they would during cold and flu season.
"It's spread through coughs and sneezes, and so those everyday sensible measures we tell people to do every year with the flu are important here -- covering your cough, staying home when you're sick and washing your hands," Schuchat said. "Tried and true, not very exciting measures, but really important ways you can prevent the spread of respiratory viruses."
More information
The U.S. Centers for Disease Control and Prevention has more on the new coronavirus.