Two San Francisco residents with no history of recent travel have been diagnosed with the new coronavirus, Mayor London Breed announced at a news briefing Thursday, March 5.
The same afternoon, San Francisco Unified School District officials announced the temporary closure of Lowell High School because a relative of a student is being treated for COVID-19, the respiratory disease caused by the virus.
With the virus now spreading within communities, Governor Gavin Newsom on March 4 declared a state of emergency. This adds to the local state of emergency Breed announced February 25.
"We want everyone to remain calm and continue taking precautions to keep themselves and their families healthy," Breed said. "We have been increasing resources and staffing to prepare for the community spread of this virus, and we will do everything we can to protect public health. The city is in regular contact with all hospitals and health facilities in San Francisco, and our health system is prepared to deliver care to everyone in need and provide a coordinated response as additional cases of the novel coronavirus are confirmed."
Two unrelated patients tested by the San Francisco Department of Public Health laboratory were found to be positive this week. They do not have a history of travel to locations with confirmed cases of COVID-19, the respiratory disease caused by the virus, and they have had no known contact with people with confirmed cases.
The patients are in isolation and receiving care at separate hospitals. One, a man in his 90s with underlying health conditions, is in serious condition. The other, a woman in her 40s, is in fair condition. To protect patient privacy, Breed said the city would not be releasing further patient information or identifying the hospitals.
"Confirming cases of COVID-19 in San Francisco residents unfortunately does not come as a surprise. Given the patterns of the virus in the Bay Area, California, and the country, San Francisco has been preparing for the appearance of COVID-19 in the community for many weeks," said San Francisco Director of Health Dr. Grant Colfax, a gay man Breed named to the post a year ago. "The people who are sick are getting care by health care professionals. We do not know at this point how they were exposed to the virus, which suggests it is spreading in the community. We expected that to happen and are further investigating the circumstances of these patients' exposure."
California emergency
Newsom's announcement came after the first coronavirus death in California, a 71-year-old man in Placer County. As of Thursday morning, 60 people have tested positive for the virus, and more than 9,400 people are self-monitoring after returning to the state from affected areas.
"The state of California is deploying every level of government to help identify cases and slow the spread of this coronavirus," the governor said in a statement. "This emergency proclamation will help the state further prepare our communities and our health care system in the event it spreads more broadly."
Newsom said that the proclamation would combat price gouging on emergency and medical supplies and waive the usual licensing requirements for out-of-state health care personnel to work in the state.
The Placer County man is thought to have contracted the virus on the Grand Princess cruise ship, which sailed from San Francisco to Mexico in mid-February.
Upon its return to San Francisco February 21, thousands of people disembarked while others boarded, Newsom said at a news briefing. The ship then went to Hawaii, and on its return voyage, 21 people reported flu-like symptoms. This ship is now being held off the San Francisco coast while helicopters ferry patient samples to the mainland for testing.
Update: On Friday, it was reported that of 46 people aboard the Grand Princess tested so far, 21 people tested positive for coronavirus, 19 of them crew members and two passengers. Twenty-four people tested negative. One test was inconclusive.end of update
"The [Centers for Disease Control and Prevention] and the state will determine the most appropriate location for the ship to berth to provide for the safety of the surrounding community as well as the passengers and crew," Breed's office said in a statement. "The CDC and the state are fully engaged in determining a location that can most appropriately address the health of those passengers that may have COVID-19 and the safety of those passengers not impacted, as well as the surrounding community."
Also on Thursday afternoon, the state health department announced that more than 24 million Californians are now eligible for free coronavirus tests. Newsom directed all commercial and Medi-Cal health plans regulated by the department to reduce cost-sharing to zero for medically necessary screening and testing. The California Department of Insurance issued similar direction.
"Californians shouldn't have to fear a big medical bill just because they took a test for COVID-19," said Newsom. "This action means that Californians who fit the testing requirements can receive the test at no cost."
However, California Health and Human Services Secretary Dr. Mark Ghaly emphasized, "This doesn't mean every Californians should be seeking a test. If you are experiencing symptoms of COVID-19 and may have had contact with a person with COVID-19 or recently traveled to countries with apparent community spread, call your health care provider or local public health department first before seeking medical care."
In addition, the California Employment Development Department announced support for people affected by COVID-19. Individuals who are unable to work because they have contracted or been exposed to the coronavirus can file a disability insurance claim, while those caring for an ill or quarantined family member with COVID-19 can file a paid family leave claim. Employers experiencing a business slowdown can apply for the UI Work Sharing Program, which helps them avoid layoffs by providing partial unemployment benefits to compensate for cuts in hours and wages.
Vulnerable populations
Newsom said that public health officials are particularly concerned about preventing the spread of the coronavirus in nursing homes and other residential care facilities, such as the outbreak that led to several recent deaths this week in Seattle.
In San Francisco and Los Angeles, health officials and advocates are particularly worried about the fate of homeless people, who often lack access to soap and running water and may have other health concerns that increase their risk.
Elderly people, individuals with underlying health conditions, and people with compromised immune systems have a higher likelihood of developing severe COVID-19 illness.
While a majority of people infected with the coronavirus — officially known as SARS-CoV-2 — are expected to have mild symptoms, around 20% develop more serious illness, including pneumonia. The most severe cases require intensive care and mechanical ventilation.
The mortality rate for COVID-19 is thought to be in the range of around 2% to 3%. This is substantially higher than the typical seasonal flu (around 0.1%), but much lower than SARS coronavirus (around 10%). However, the true mortality rate is not yet known because it is unclear how many people have contracted the virus. If a large number of people have no, or mild, symptoms and never seek medical attention, the infected population could be much larger and the death rate could be lower.
According to a recent study of more than 45,000 confirmed cases by the Chinese Center for Disease Control and Prevention, people with coexisting conditions had higher death rates, including 6% for those with cancer, high blood pressure, or chronic respiratory disease, 7% for those with diabetes, and nearly 11% for those with cardiovascular disease. The greatest risk was seen among people age 80 or older, at about 15%.
People living with HIV, patients receiving cancer chemotherapy and organ transplant recipients typically have weaker immune systems.
Although people with HIV or AIDS were not included in the Chinese study, based on experience with other respiratory viruses, their risk is "all based on level of immune suppression," Dr. Steve Pergam of the Vaccine and Infectious Disease Division at Fred Hutchinson Cancer Research Center told the Bay Area Reporter.
"For an HIV patient who is on stable antiretroviral therapy and has a normal CD4 count, their risk may be slightly increased," he said. "HIV is a different disease than it was years ago. For people who have a reconstituted immune system because of treatment, I think the risk is not going to be tremendously different."
Unfortunately, some people with HIV are not receiving consistent antiretroviral treatment and do not have an undetectable viral load, which takes a toll on CD4 T cell counts. Just 33% of HIV-positive homeless people in San Francisco have full viral suppression, according to the latest DPH HIV epidemiology report.
Precautions evolving
Health officials currently are not recommending stringent "social distancing" to reduce the spread of the virus in public places, but the situation is rapidly evolving. Several Bay Area companies have asked their employees to work from home if possible, and a number of large conferences planned for the region have been canceled.
On Thursday afternoon, Lowell High School announced it is closing the school and canceling all events and gatherings "for the time being" after learning that a relative of a student is being treated for COVID-19. The school will be closed Friday and students and staff were advised to wait for updates about future plans.
As the virus spreads within the community, health officials advise following guidelines already familiar for prevention of seasonal flu. These include avoiding close contact with people who are ill, washing hands with soap and water frequently and thoroughly, using alcohol-based hand sanitizer if soap and water are unavailable, and not touching the face, nose, or eyes.
People who are ill should stay home from work or school and avoid contact with others. Those who develop COVID-19 symptoms — typically fever, a dry cough, and shortness of breath — should contact a health care provider promptly, officials said, but call ahead before showing up at a clinic or hospital so staff can take appropriate precautions.
Health officials do not recommend that the public routinely wear facemasks, but masks can stop the spread of droplets that carry the virus when worn by someone who is coughing or sneezing. Finally, experts advise getting the flu vaccine, both to reduce the strain on health care resources and to lower the risk of more serious illness if a person is infected with both influenza and SARS-CoV-2.