Editor’s note: The original version of this article said that the 1 percent mortality rate of this novel coronavirus was lower than that of influenza. Influenza’s mortality rate averages 0.1 percent according to experts. The spread of COVID-19 is ever-evolving and note that stories originally posted weeks ago could contain information that is no longer accurate.
Concern over a potential case of novel coronavirus caused a public health scare and a controversy in San Juan County. In mid-February, an island resident was tested for the illness, and the results came back negative.
The daughter of a 63-year-old Orcas Island resident revealed on Feb. 15 that her father was the patient under investigation. He had recently visited Vietnam.
“The only ‘symptom’ of the virus he has is that he’s an Asian man that had traveled back from Vietnam,” Mai-Lien Tran wrote in a public post on Facebook.
She said her father — whose first name she has requested not be published — was hospitalized at Island Hospital in Anacortes for six days, not treated for what he went to the emergency room for and was not provided a translator for his limited English abilities. Mai-Lien Tran added that her father had already tested negative for novel coronavirus before the specimen was sent to the Centers for Disease Control and Prevention.
According to the World Health Organization, coronaviruses cause illnesses ranging from the common cold to Severe Acute Respiratory Syndrome.
“Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties,” said the WHO website. “In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.”
Globally a total of 76,798 cases of novel coronavirus have been reported as of Feb. 21, according to Johns Hopkins University, which is tracking the illness — 75,476 of those who have been in mainland China. The first case was reported on Dec. 31, 2019, in Wuhan, China, and has triggered numerous travel bans to and from the country. On Jan. 30, WHO designated the novel coronavirus as a global health emergency.
“It’s novel, it’s new, there’s a lot to be understood,” said San Juan County Community Health Manager Ellen Wilcox at a Feb. 19 board of health meeting. “There’s a lot of information flowing very, very quickly on many, many fronts.”
As of Feb. 24, 53 cases have been confirmed in seven states, including two cases of people returning from travel and spreading the virus to someone else. In Washington state, Wilcox added, 746 people were being monitored at the time of the board of health meeting.
A Seattle Times story reported that the elder Tran was diagnosed with cirrhosis of the liver at a hospital in Ho Chi Minh City in Vietnam and that his medical records noted he was hospitalized for 15 days. Mai-Lien Tran told the Times reporter that though her father visited a clinic in Vietnam, he was never hospitalized. On his return flight to the United States, the Times reported, he caught a connecting flight in Taipei, Taiwan.
An interactive map created by Johns Hopkins University, which can be viewed at https://systems.jhu.edu/research/public-health/ncov/, tracks the spread of novel coronavirus. There have been 16 confirmed cases in Vietnam, three of which were in Ho Chi Minh City. Twenty-eight cases have been confirmed in Taiwan as of Feb. 23.
When the elder Tran’s medication ran out a week after he returned to the United States, his stomach began to swell, causing breathing difficulties, the Times story explained. That’s when he went to the Island Hospital emergency room. He was given diuretics to control the swelling Mai-Lien Tran told the Seattle Times. His symptoms were only managed but not treated while he was a patient, Mai-Lien said.
The physicians caring for the elder Tran — whose name has not been confirmed by the health organizations because of the Health Insurance Portability and Accountability Act — said his symptoms were consistent with those of novel coronavirus, Wilcox explained. Travel history and symptoms are enough to warrant testing, she said.
“We work closely with [the Washington] Department of Health and CDC and our health officer … to determine whether that warrants testing for novel coronavirus,” Wilcox said.
According to Wilcox, the county received a phone call at approximately 10:30 p.m. on Feb. 10 from the Washington DOH regarding a patient who had checked themselves into the emergency room Island Hospital in Anacortes.
The patient had recently returned from travel and had spent “significant time” in the healthcare setting in a country with confirmed cases of novel coronavirus, Wilcox said. The state department of health and CDC determined that the clinical symptoms and exposure risk while in a country with confirmed cases were significant enough to warrant testing, she added. The decision was made by San Juan County Health Officer Dr. Frank James, the state department of health and the CDC, “Out of concern for the patient and also concern for public safety.”
Specimens were collected on Tuesday, Feb. 11 and shipped to the CDC, according to Wilcox. The involved health authorities were informed results would return in three to seven days.
“Throughout the week, the patient continued to receive care in the hospital,” Wilcox said. “County public health officials recommended the patient remain in voluntary isolation for as long as the patient was in need of medical care in the hospital setting.”
Mail-Lien told the Journal that her father was never told that his isolation was voluntary. She said her father was put into quarantine and his coworker — who had taken Tran to the hospital — was told he could live while he had to stay.
“We are amazed at how the health departments involved are now saying that the quarantine was voluntary. That was never told to my father or us when we arrived Tuesday, and nowhere was this stated in his medical records that it was voluntary,” Mai-Lien Tran told the Journal. “In fact, what it does state is that he will remain in isolation until the [Washington Department of Health] contacts the hospital back. My father asked every day when he could leave. It was always ‘no’ or ‘not until we get the health department’s approval.’”
According to Wilcox, Island Hospital worked with the local health department to prepare contingency plans for voluntary isolation outside of the hospital in case the patient “became medically stable enough for discharge.”
“We did not invoke legal authority to quarantine this patient, so this was all voluntary,” Wilcox said.
On the afternoon of Saturday, Feb. 15, the test results returned negative. The elder Tran left the hospital that same day. The county published a press release both during the investigation and upon the return of the results.
“I think you did an outstanding job in considering all the options and then thinking about the impact of this on a small rural community, where word of mouth is very, very common. I think you did an excellent job in considering it,” Board of Health Chairman Dale Heisinger said. “I thank you that that information did go public early, before the test results and that you notified the public shortly after we got the test results. I think [they were] appropriate moves on your behalf.”
Wilcox said the decisions involved were very complex, especially since the patient had not traveled to China.
“We know this virus is spreading all over and this person had significant exposure in a healthcare setting in a country where there were cases confirmed,” Wilcox said. “Those decision points are complex but I think were made very solidly. … Hopefully we won’t have to go to the point where we’re invoking a mandatory quarantine order.”
The county has been fielding a lot of phone calls regarding its decision to test the patient, Wilcox said.
“Our primary duty is to protect the privacy and confidentiality of patients and citizens and we know that in a small community, the word gets out quickly, we also know that we need to send some information out there or people are going to make up the information in the void,” Wilcox said. “Our job is to make sure we’re putting out timely and very accurate information that’s protecting the privacy and confidentiality of our residents and citizens here.”
One decision that needed to be made when novel coronavirus was suspected was whether contact tracing needed to begin. Contact tracing is identifying who and what places may have been exposed to the virus by the patient.
“We decided not to do that [before receiving the test results back] because of the concern of stigma, public fear, but that’s a tough one,” Wilcox said. “There are consequences either way.”
Because the immediate risk remains low, Wilcox explained, she is expecting revised guidance from the CDC and state department of health on what the county’s future role is in relation to novel coronavirus. The state is awaiting testing kits for local testing, right now they all go to the CDC because the field tests have been known to show false negatives, Wilcox said. Additional medical staffing from Island, Skagit and Whatcom counties are on standby if needed, she added.
“I think we’re in this for the long haul and I think we can expect potential persons under investigation who potentially meet testing criteria at any moment,” Wilcox said.
Wilcox said that flight travel itineraries are sent to local governments by the airports to monitor returning travelers who visited affected areas or who have come in close contact with a confirmed case.
“As of [Feb. 18], in San Juan County, we have four people who have completed monitoring, that includes one person [who was] under investigation,” Wilcox said.
The travelers are monitored daily for 14 days after their return to the United States, Wilcox explained. When the first case of novel coronavirus was reported in Washington state on Jan. 20 — the first case in the nation — San Juan County established an incident command for the illness, Wilcox said. The county’s primary focus is getting information out to providers and the public.
“It’s better to start early than too late, especially with this information that’s just been flooding through since day one,” Wilcox said. “[CDC] guidance is changing very quickly and so making sure we’ve got current guidelines sent out is a big part of that work.”
The mortality rate for coronavirus is about 1 percent, according to James. He encouraged the public to wash their hands regularly and to use hand sanitizer to mitigate the spread of infection.
“That’s the thing we’re trying to work into almost all of our messages is that we should be talking just as much about flu. But people don’t want to talk about that,” Wilcox said. “Making sure people are getting their flu shots because when people present with symptoms of novel coronavirus, it looks very much like the flu. We know we can do something about that.”
Get updates and learn about what San Juan County is doing to prepare for a possible outbreak by visiting https://www.sanjuanco.com/1668/2019-Novel-Coronavirus.