SAN FRANCISCO (AP) — Two people with the coronavirus died in California as many as three weeks before the U.S. reported its first death from the disease in late February — a gap that a top health official said Wednesday may have led to delays in imposing stay-at-home restrictions in the nation’s most populous state.
Dr. Sara Cody, health director in Northern California’s Santa Clara County, said the deaths were missed because of a scarcity of testing and the federal government’s limited guidance on who should be tested.
“If we had had widespread testing earlier and we were able to document the level of transmission in the county, if we had understood then people were already dying, yes, we probably would have acted earlier than we did,” she said.
The infections in the two patients were confirmed by way of post-mortem tissue samples that were sent to the U.S. Centers for Disease Control and Prevention for analysis.
The deaths in early and mid-February show that the virus was spreading in California well before officials realized it and that outbreaks were underway in at least two parts of the country at about the same time.
“It shifts everything weeks earlier, extends geographic involvement, (and) further shows how our inability to test let this outbreak loose,” said Dr. Eric Topol, head of the Scripps Research Translational Institute in San Diego, in an email.
County officials that the two people died at home Feb. 6 and Feb. 17 and that neither had traveled out of the country to coronavirus outbreak areas. The epidemic emerged in China in late December.
Because it can take one or two weeks between the time people get infected and when they grow sick enough to die, the Feb. 6 death suggests the virus was circulating in Northern California in late January, if not earlier. Previously, the first infection reported anywhere in the U.S. was in the Seattle area on Jan. 21.
The first known death from the virus in the U.S. was reported on Feb. 29 in Kirkland, Washington. Officials later attributed two Feb. 26 deaths to the virus.
“What these deaths tell us is that we had community transmission probably to a significant degree far earlier than we had known,” Cody said. “And that indicates that the virus was probably introduced and circulating in our community, again, far earlier than we had known.
Thousands of travelers from China and other affected regions entered the U.S. before travel bans and airport screenings were put in place by the Trump administration in mid- and late January. Lack of widespread testing meant the country was flying blind to the true number of infections.
Dr. Charles Chiu, a researcher at the University of California at San Francisco, has been looking at genetic information from virus samples from patients in Santa Clara County and elsewhere. He said that it appears the virus was most likely introduced into the U.S. by travelers from China and that it turned up independently in Santa Clara County and Washington state.
“It now appears most likely that there were multiple seeding events that introduced the virus to the United States,” he wrote.
It’s not unusual, as an epidemic is first unfolding, for infections to go unrecognized, said Stephen Morse, a Columbia University expert on the spread of diseases.
“When you’re not expecting it, you don’t look for it,” he said.
That’s why tissues from autopsies can be important in later understanding an outbreak, he added.
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Associated Press writers John Antczak in Los Angeles, Adam Beam in Sacramento, Carla K. Johnson in Seattle, Marilynn Marchione in Milwaukee and Malcolm Ritter in New York contributed to this report. Stobbe reported from New York.
