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.
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.
“Where did this come from if it wasn’t her traveling?” Macias said. “Patricia may not be the first. It’s just the earliest we have found so far.”
“Let’s keep looking so we know the extent of it,” he said of the virus. “That’s the greater good, for everyone else and my family included.”
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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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.”
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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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.
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.
© 2020 The Canadian Press
2,000 COVID-19 cases missing from Toronto's map of hot spots – CBC.ca
More than 2,000 confirmed COVID-19 cases are missing from the map the City of Toronto released last week that shows infections by neighbourhood, CBC News has found.
The detailed geographic information about the spread of the novel coronavirus was released last week by Toronto Public Health, marking the first time such data has been made available in Ontario during the pandemic. It shows infections based on where patients live.
But in a review of published data, CBC News found the count on the map comes up short.
On Thursday morning, the map showed 9,623 positive COVID-19 cases distributed over 140 neighbourhoods. That’s 2,029 cases short of the official 11,652 total count for that day.
That means roughly one out of every five cases is missing in the city’s own geographic analysis. Similar proportions of missing data were found in the map and case counts from previous days.
The data gap was not mentioned in any of the local health authority’s statistics or on its webpage until CBC pointed it out.
An extra row identified as “Missing addresses/postal code,” totalling 2,029 cases, has been added to the city’s downloadable spreadsheet showing the number of cases assigned to each neighbourhood.
Toronto Public Health blames the missing data on reports sent by testing labs. The public health authority says some forms only have a name and an address, while others don’t have a patient’s postal code or phone number, leaving health authorities scrambling to fill in gaps.
“Sometimes, they are not putting enough contact details, and in the legislation it doesn’t specify that you must include XYZ details of the individual,” said Dr. Vinita Dubey, Toronto’s associate medical officer of health, referring to the provincial law that requires medical labs to report positive results of certain tests to local health authorities.
“It just requires that it be reported, so that’s where some of the missing information and gaps occur.”
Dubey said it’s “very unlikely” that the missing data had an impact on contact tracing, but that there could have been delays as her staff had to retrieve missing contact information before they could connect with a patient who tested positive.
Toronto Public Health said that so far, it has been able to complete contact tracing for a patient within 24 hours in 88 per cent of cases.
The issue of information transfer between laboratories and public health units was raised last Friday in a report to city council and the Toronto Board of Health by Toronto Medical Officer of Health Dr. Eileen de Villa.
“Laboratories’ reports are received all together in one large fax, sometimes containing hundreds of individual lab results, which must be taken apart for further processing,” de Villa wrote.
She called for changes in laboratory procedures and the provincial law.
Missing hot spots
Beyond potential delays in contact tracing, the missing geographic data might have another impact.
Toronto’s current map distribution suggests that some of the city’s poorest and most diverse neighbourhoods — predominantly in the northwest and northeast areas — have had the highest number of cases so far and might be most vulnerable to the novel coronavirus.
As Ontario is ramping up testing, resources like mobile testing clinics, staff and personal protection equipment will be focused on those hardest-hit areas of the city.
But with 2,000 cases missing, one researcher familiar with Toronto’s map data said health authorities could be missing out on other vulnerable communities.
Kate H. Choi, an associate professor in the department of sociology at Western University in London, Ont., said Toronto has been ahead of the curve in terms of COVID-19 data collection, so she was “really, really surprised” when she was told how many of the city’s confirmed cases were missing from its map.
She said part of the issue might also be that some populations are less likely to be able to provide a precise address or a postal code, including homeless people, migrant workers or nursing home residents.
“We may be missing COVID-19 hot spots or certain vulnerable populations may be missing from the narrative about COVID-19 in Toronto.”
Alternatively, some Torontonians might feel a false sense of security after assuming their neighbourhood is low-risk based on the map, said Choi. It’s also possible that resources and staff could fail to be deployed to hospitals in unknown hot spots, which could lead to more transmission of the virus.
“Those 2,029 individuals are someone’s loved one,” said Choi. “They are also 2,029 people who could be your neighbours. They could be residents in an area where there are a lot of asymptomatic carriers and unfortunately, that may mean they could bring COVID-19 to your doorsteps.”
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Choi stressed that more research on the age, gender and other characteristics of the missing 2,029 cases is needed to fully understand the impact and risks of this data gap.
Toronto Public Health has also repeatedly said that the map shows where patients infected with COVID-19 live and not where they acquired the infection.
Gap won’t be fixed for weeks
Toronto Public Health said it does not have the resources to go looking for the 2,029 missing postal codes at the moment.
“Some of them were early on in our outbreak and so it would require going back to some of these cases in February and March. That work won’t be done until we either have less cases or have reached the end of the first wave,” said Dubey.
This is the second data gap uncovered by CBC in less than a week. On Monday, it was revealed that Ontario hospitals had failed to flag 700 positive COVID-19 tests to public health officials because of a mixup.
In a statement to CBC, Ontario Health has said the impact of the error “may not be fully understood for some time.”
Safety officers heading to Manitoba beaches amid COVID-19, no new cases reported Thursday – Globalnews.ca
Health officials say safety officers are being deployed to three popular Manitoba beaches to make sure beach-goers are staying safe while enjoying the sun amid the coronavirus outbreak.
The safety officers will be patrolling the beaches in Birds Hill, Winnipeg Beach, and Grand Beach Provincial Parks starting Thursday, the province said in a release.
The news comes as health officials reported no new cases of COVID-19 in Manitoba Thursday, leaving the province’s total number of lab-confirmed positive and probable cases at 298.
While provincial parks and beaches are open to the public, health officials are warning those heading into the great outdoors physical distancing rules remain in place, and beach-goers should keep at least four metres of separation between each group’s towels and blanket on the beach.
They also recommend bringing your own life jackets and personal flotation devices as the province’s life-jacket loaner program has been suspended to help stop the spread of COVID-19.
The province says there are currently seven active cases of COVID-19 in Manitoba and no one is in hospital or intensive care because of the virus.
To date 284 people have recovered from COVID-19, the province says.
There have been 46,701 tests for the virus completed across the province since early February, health officials say, with 899 done on Wednesday.
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Questions about COVID-19? Here are some things you need to know:
Symptoms can include fever, cough and difficulty breathing — very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.
To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out. In situations where you can’t keep a safe distance from others, public health officials recommend the use of a non-medical face mask or covering to prevent spreading the respiratory droplets that can carry the virus.
For full COVID-19 coverage from Global News, click here.
© 2020 Global News, a division of Corus Entertainment Inc.
COVID-19 study linking hydroxychloroquine, death risk retracted from medical journal – Global News
Three of the authors of an influential article that found hydroxychloroquine increased the risk of death in COVID-19 patients retracted the study on Thursday, citing concerns about the quality of the data behind it.
The anti-malarial drug has been controversial in part due to support from U.S. President Donald Trump, as well as implications of the study published in British medical journal the Lancet last month.
The three authors said Surgisphere, the company that provided the data, would not transfer the full dataset for an independent review and that they “can no longer vouch for the veracity of the primary data sources.”
The fourth author of the study, Dr. Sapan Desai, the CEO of Surgisphere, declined to comment on the retraction.
The observational study published in the Lancet on May 22 looked at 96,000 hospitalized COVID-19 patients, some treated with the decades-old malaria drug. It claimed that those treated with hydroxychloroquine or the related chloroquine had higher risk of death and heart rhythm problems than patients who were not given the medicines.
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Several clinical trials were put on hold after the study was published. The World Health Organization, which paused hydroxychloroquine trials after The Lancet study was released, said on Wednesday it was ready to resume trials.
Many scientists voiced concern about the study. Nearly 150 doctors signed an open letter to the Lancet last week calling the article’s conclusions into question and asking to make public the peer review comments that preceded publication.
“I did not do enough to ensure that the data source was appropriate for this use,” the study’s lead author, Harvard Medical School Professor Mandeep Mehra, said in a statement. “For that, and for all the disruptions – both directly and indirectly – I am truly sorry.”
Surgisphere was not immediately available for comment.
The Lancet in a statement said, “there are many outstanding questions about Surgisphere and the data that were allegedly included in this study.”
© 2020 Reuters
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