Two people with the coronavirus died in California as much 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 issuing stay-at-home orders 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.
The infections in the two patients were confirmed by way of autopsy tissue samples that were sent to the Centers for Disease Control and Prevention for analysis. The county coroner’s office received the results on Tuesday, officials said.
“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, which would have meant more time at home,” Cody said.
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In the wake of the disclosure, Gov. Gavin Newsom said he has directed coroners throughout the state to take another look at deaths as far back as December to help establish more clearly when the epidemic took hold in California.
He declined to say whether the two newly recognized deaths would have changed his decisions about when to order a shutdown. He imposed a statewide one in late March.
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Officials said the two Santa Clara County patients died at home — a 57-year-old woman on Feb. 6 and a 69-year-old man on Feb. 17 — and that neither had traveled out of the country to a coronavirus outbreak area. The epidemic emerged in the Chinese city of Wuhan in late December.
Family members identified the woman as Patricia Dowd of San Jose, a manager at a semiconductor company who became sick in late January with flu-like symptoms.
She appeared to recover and was working from home the day she died. Her daughter found her, the Los Angeles Times reported.
Dowd traveled to various countries several times a year and had planned to visit China later in the year, her brother-in-law, Jeff Macias, told the paper.
The first known death from the virus in the U.S. was reported on Feb. 29 in Kirkland, Washington, a Seattle suburb. Officials later attributed two Feb. 26 deaths to the virus.
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Coronavirus outbreak: U.S. continues to procure ‘millions’ of swabs needed for COVID-19 testing, says Trump
The two newly reported deaths 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.
Because it can take one or two weeks between the time people get infected and when they get sick enough to die, the Feb. 6 death suggests the virus was circulating in 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.
On March 17, authorities across the San Francisco Bay Area, Santa Clara County included, confined nearly 7 million people to their homes for all but essential tasks and exercise in what was at the time the most aggressive measure taken against the outbreak in the U.S. Three days later, California put all 40 million of its residents under a near-lockdown.
What the newly reported deaths show “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.
County officials said the tissue samples from the two patients were sent to the CDC in mid-March. CDC officials did not immediately respond to questions about why it took a month to come back with the findings.
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Dr. Charles Chiu, a researcher at the University of California at San Francisco who has been looking at genetic information from virus samples from patients, said it appears that the coronavirus 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.
Cody said the two deaths in California may have been written off as the flu because there were significant numbers of influenza cases at the time: “It had been extraordinarily difficult to pick out what was influenza and what was COVID.”
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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 understanding an outbreak, he added.
A test for the coronavirus was not available in the early weeks of the crisis. It was not until Jan. 11 that the world had the genetic makeup of the virus, which is necessary to design a test for it.
Cody said officials will now go back to determine how the patients became infected and what contacts with others they may have had.
Los Angeles County Public Health Director Barbara Ferrer was asked Wednesday to estimate the earliest case her county may have had, given the finding in Santa Clara.
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Coronavirus outbreak: U.S. health official addresses testing strategies, protections
She said that back in January heath officials worried that a small number of coronavirus illnesses might be occurring but were mistaken for flu and missed. “In hindsight we should have probably looked more carefully, particularly at deaths,” she said.
“I think everybody in public health would say that we anticipate that there were many more early deaths across the country that weren’t captured,” Ferrer said.
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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.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
