With 19 people in the United States — 18 of whom were in Washington state — having died from COVID-19, the disease caused by the coronavirus, concern over it is spreading quickly.

“There is a very real chance of this being worse than a bad flu season,” San Juan County public health officials said in a press release. “That doesn’t mean it is a sure thing — it just means there’s a real chance and that we all need to be preparing for that, while also hoping for the best.”

The 19 recorded deaths were as of March 8. As of March 5, there were still no cases reported in San Juan County, according to health officials.

According to the CDC, common signs of COVID-19 include “respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.”

The county compiled several questions and answers into a press release that can be read at https://www.sanjuanco.com/DocumentCenter/View/19925/200305-Guest-Column-2-COVID-19-FAQ.

Gov. Jay Inslee proclaimed a state of emergency for the entirety of Washington state on Feb. 29. Washington was both the first state to have a confirmed case of COVID-19 in the nation as well as the first to have someone die from the disease.

As of March 8, there are 79 confirmed cases of COVID-19 in Washington state, according to the state health department. The affected counties are Grant, King and Snohomish. A total of 231 people were under public health supervision for displaying symptoms.

According to reports from the Snohomish and King county health departments, the deaths occurred in people who were elderly or had underlying health conditions — a group Department of Health Secretary John Wiesman said is the most vulnerable population.

Washington State Legislature quickly rushed through a request for $125 million for outbreak response from the state’s emergency “rainy day fund.” The decision was unanimous.

“These funds are for state, local and tribal entities to help carry out the directives of my emergency declaration,” Inslee said in a March 5 press conference. “We’re also excepting an infusion of billions of federal funds from Congress.”

The federal government approved an $8.3 billion emergency spending package to tackle the spreading epidemic on March 5.

According to Vice President Mike Pence, who met with Inslee and state health officials on March 5, the approved funding includes not only money for federal agencies but also resources for state and local efforts to fight the outbreak. He said the bill will provide research funding to develop therapeutic drugs for those infected as well as an eventual vaccine, which he estimated could take more than a year and a half before being tested and approved.

Wiesman said this is a “very dynamic situation, moving very quickly,” and right now the focus is on slowing the spread of the virus so the already strained health care systems can keep up. Wiesman told a Washington Newspaper Publishers Association reporter on March 2 that the state has the capacity to test about 100 people a day using the kits, but expects up to five million tests to be available nationwide in the coming weeks.

According to Sen. Karen Keiser, D-Des Moines, each testing kit currently costs $2,500. However, on March 5, Washington Insurance Commissioner Mike Kreidler issued an order to Washington health insurers requiring them to waive copays and deductibles for anyone requiring coronavirus testing. The order also requires insurers to allow a one-time early refill for prescription medications and suspend any prior authorization requirement that may be related to the treatment or testing of COVID-19.

Additionally, if there are insufficient in-network medical providers to provide testing or treatment, Kreidler said the insurance company must allow the patient to be treated by another provider within a reasonable distance at no additional cost to the patient. Testing would also be free for those who are uninsured, Inslee said in the press conference.

The order is in effect until May 4 and affects all state-regulated health insurance plans as well as short-term limited duration plans. Kreidler’s order can be extended by 30 days if Gov. Inslee’s emergency proclamation is in effect.

“Consumers are rightly concerned about prevention, testing and possible treatment,” Kreidler said. “My emergency order provides guidance to health insurers and should help reassure the public that we will take all necessary steps to protect them.”

Residents who fear they are experiencing symptoms of the coronavirus have turned to social media to express their frustrations with the lack of available testing in the state.

“Testing kits are limited still so health professionals have established a criteria themselves about who is eligible for testing,” Inslee said on March 5.

He said the priority for testing is for elderly people or those with underlying health conditions who are displaying symptoms.

Wiesman said the University of Washington School of Medicine now has the testing capacity for 750 to 1,000 people a day. He said local health departments are on the front lines of the issue and localities are covering the cost with the expectation of being reimbursed in the future. According to Wiesman, about $3.5 million has been spent in response to the viral outbreak so far.

Jaime Bodden, managing director at Washington State Association of Local Public Health Officials, said the state’s response will have to be coordinated between local, tribal, state and federal agencies and health departments. According to Inslee, previous federal rules prohibited the testing of people with relatively mild symptoms who had not been hospitalized. On March 4, he announced the federal government overturned the previous restrictions.

Wiesman said data is still being collected and studied by health experts to understand how the disease spreads, but he said the coronavirus has on average a five-day incubation period between when the virus is contracted and when symptoms appear.

Wiesman said the elderly, extremely young and those with underlying health issues will be the most adversely affected populations, similar to influenza.

He also said the virus can live on surfaces, and with perfect temperature and humidity conditions, could live on a surface for a few days. This raises the risk of port workers contracting the virus from an item or surface shipped from overseas.

Inslee said that based on advice he has received from medical experts, the vast majority of people who contract the virus will only experience mild symptoms if none at all, but the concern is that individuals who are infected may unknowingly pass the virus to someone who is vulnerable.

Inslee reiterated that the best defense against contracting COVID-19 is to wash your hands and stay home when you’re sick.

“It’s too risky at this point for everyone — your coworkers and your loved ones and the community at large,” Inslee said. “I understand that is harder for some people than others. Both because of their jobs and because of their financial circumstances.”

Washington’s sick leave policies adopted in 2018 help many, if not all, employees within the state, Inslee said.

He said the state has also been working toward securing compensation, as well as payment for any associated medical expenses, for health care workers and emergency responders who may miss work due to being isolated following an interaction with an infected person.

The Office of the Superintendent of Public Instruction reported at least 14 schools that are temporarily closed due to outbreak concerns.

Inslee also explained during his March 4 press conference why there aren’t more schools closed to inhibit the spread of the illness. He noted the ramifications to families and businesses should schools be closed for extended periods of time, and he commended the districts that have been planning for alternatives should the time come.

“Those things are things we’re considering very carefully on a daily basis to try to make the best decision we can for the health and safety and education of our children,” Inslee said.

Watch the March 5 press conference at https://www.tvw.org/watch/?clientID=9375922947&eventID=2020031009.