Two weeks ago, the director of the Centers for Disease Control and Prevention predicted we might soon see the beginnings of community spread of COVID-19 caused by the SARS-2 Coronavirus (SARS CoV2). Now, our nation’s first serious outbreak is underway in Kirkland, Wash., and first impressions indicate our initial experiences with SARS CoV2 resemble several aspects of the epidemic in Central China.
The spread of this virus on the West Coast highlights several key vulnerabilities, and these must be urgently addressed:
Skilled nursing facilities
Reports from China in January and February found that the SARS CoV2 disproportionately kills individuals over the age of 60, with those greater than 80 years of age suffering mortality rates as high as 15 percent. Tragically, the emergence of this virus in Washington has confirmed this finding. So far, at least three deaths – all individuals over the age of 70 – from the SARS CoV2 have been reported from a single skilled nursing and rehabilitation facility.
We’ve seen how this virus similarly struck older individuals in nursing homes in Wuhan. The clusters of deaths among the elderly is a wake-up call that our skilled nursing facilities with older populations are highly vulnerable to a swath of death and destruction from this virus.
Therefore, in the coming weeks, a top priority for federal, state and local health departments will be to prioritize infection control in these facilities. This might include restricting visitors and establishing intensive and regular virus diagnostic testing and monitoring among residents and staff. We urgently need federal guidance from the CDC on how to best design and implement infection control practices for these facilities and prevent the spread of SARS CoV2 – a tragic and scary “angel of death” among our senior citizens.
Hospitals and clinics
Healthcare providers represent a second highly vulnerable population. In Wuhan, the SARS CoV2 virus spread rapidly in hospitals and we have reasons to believe the same could happen here. According to a study just published in JAMA more than 1,700 healthcare personnel in China have been infected with SARS CoV2 (with more than 1,000 in Wuhan), including 14.8 percent with severe respiratory illness, with some in critical condition.
We have already seen how two healthcare workers in the Bay area just tested positive for SARS CoV2, and we might expect many more to become infected in the coming weeks. The worry here is that COVID-19 could deplete infected hospital staff who self-quarantine at home, or even worse, that the virus sickens hospital staff to a point where they are cared for in ICUs by their colleagues. We saw how this scenario created an unstable situation at the Dallas hospital, where two ICU nurses acquired Ebola virus infection, and we should anticipate that it could have a similar impact with SARS CoV2.
Fixing guidelines and diagnostics
Beyond these two significant vulnerabilities, others have pointed out how we must urgently expand national capacity for clinical diagnostic testing. Now, the Trump administration has enlisted private and academic laboratories, with the hope that more than one million people would be tested in the coming days or weeks.
In parallel, we’ll need to revise CDC clinical testing criteria. Currently, only those with fever and cough who have contact with a known COVID-19 patient or someone with travel to a known affected country qualifies, although last week the CDC opened this up to patients with severe respiratory illness not caused by flu or other known causes. However, now with community spread of COVID-19 in the U.S., such criteria will miss many, if not most, of the infected individuals. Hopefully, with expanded testing capabilities, criteria will also be loosened.
As we enter this next phase of the COVID-19 epidemic in the U.S., we will continue to learn more about the SARS CoV2 virus.