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Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020 Early Release / March 18, 2020 / 69 CDC COVID-19 Response Team CDC COVID-19 Response Team Stephanie Bialek, CDC; Ellen Boundy, CDC; Virginia Bowen, CDC; Nancy Chow, CDC; Amanda Cohn, CDC; Nicole Dowling, CDC; Sascha Ellington, CDC; Ryan Gierke, CDC; Aron Hall, CDC; Jessica MacNeil, CDC; Priti Patel, CDC; Georgina Peacock, CDC; Tamara Pilishvili, CDC; Hilda Razzaghi, CDC; Nia Reed, CDC; Matthew Ritchey, CDC; Erin Sauber-Schatz, CDC. Top Corresponding author: Hilda Razzaghi for the CDC COVID-19 Response Team, [email protected], 770-488-6518. Top All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

References CDC. Evaluating and testing persons for coronavirus disease 2019 (COVID-19). Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html CDC. Interim guidelines for collecting, handling, and testing clinical specimens from persons for coronavirus disease 2019 (COVID-19). Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html CDC. Real-time RT-qPCR panel for detection: 2019-novel coronavirus. Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://www.cdc.gov/coronavirus/2019-ncov/downloads/rt-pcr-panel-for-detection-instructions.pdfpdf icon CDC. 2019-novel coronavirus (2019-nCoV) real-time rRT-PCR panel primers and probes. Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://www.cdc.gov/coronavirus/2019-ncov/downloads/rt-pcr-panel-primer-probes.pdfpdf icon CDC. Coronavirus disease 2019 (COVID-19): information for laboratories. Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://www.cdc.gov/coronavirus/2019-ncov/lab/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fguidance-laboratories.html Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–81. CrossRefexternal icon PubMedexternal icon CDC. Infection control: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): interim infection prevention and control recommendations for patients with suspected or confirmed coronavirus disease 2019 (COVID-19) in healthcare settings. Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html Washington Office of the Governor. Proclamations. Olympia, WA: Washington Office of the Governor; 2020. https://www.governor.wa.gov/office-governor/official-actions/proclamationsexternal icon Washington State Department of Health. Healthcare provider resources and recommendations. Tumwater, WA: Washington State Department of Health; 2020. https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020/HealthcareProvidersexternal icon Public Health – Seattle & King County. Local health officials announce new recommendations to reduce risk of spread of COVID-19. King County, WA: Public Health – Seattle & King County; 2020. https://kingcounty.gov/depts/health/news/2020/March/4-covid-recommendations.aspxexternal icon

TABLE. Characteristics of patients with COVID-19 epidemiologically linked to facility A among residents of King and Snohomish counties — Washington, February 27–March 9, 2020 Characteristics No. (%) Resident (n = 81) Health care personnel (n = 34) Visitor (n = 14) Total (n = 129) Median age, yrs (range) 81 (54–100) 42.5 (22–79) 62.5 (52–88) 71 (22–100) Sex Men 28 (34.6) 7 (20.6) 10 (71.4) 45 (27.1) Women 53 (65.4) 27 (79.4) 4 (28.6) 84 (65.1) Hospitalized Yes 46 (56.8) 2 (5.9) 5 (35.7) 53 (41.0) No 3 (3.7) 30 (88.2) 9 (64.3) 42 (32.6) Unknown 32 (39.5) 2 (5.9) 0 34 (26.4) Died Yes 22 (27.2) 0 1 (7.1) 23 (17.8) No 59 (72.8) 34 (100.0) 13 (92.9) 106 (82.2) Chronic underlying conditions*,† Hypertension§ 56 (69.1) 0 2 (14.3) 58 (44.6) Cardiac disease 46 (56.8) 3 (8.8) 2 (14.3) 51 (39.2) Renal disease 35 (43.2) 0 1 (7.1) 36 (27.7) Diabetes mellitus 30 (37.0) 3 (8.8) 1 (7.1) 34 (26.2) Obesity 27 (33.3) 0 3 (21.4) 30 (23.1) Pulmonary disease 26 (32.1) 2 (5.9) 2 (14.3) 30 (23.1) Malignancy 11 (13.6) 0 0 11 (8.5) Immunocompromised 8 (9.9) 0 0 8 (6.2) Liver disease 5 (6.2) 0 0 5 (3.8) * Percentages represent the number with information on the comorbidity, irrespective of missing data. † Data on chronic underlying conditions were missing for four health care personnel and two visitors with COVID-19. § Hypertension was the only reported chronic underlying condition for 6 residents and 1 visitor with COVID-19.

Discussion These findings demonstrate that outbreaks of COVID-19 in long-term care facilities can have a critical impact on vulnerable older adults. In Washington, local and state authorities implemented comprehensive prevention measures for long-term care facilities (7–9) that included 1) implementation of symptom screening and restriction policies for visitors and nonessential personnel; 2) active screening of health care personnel, including measurement and documentation of body temperature and ascertainment of respiratory symptoms to identify and exclude symptomatic workers; 3) symptom monitoring of residents; 4) social distancing, including restricting resident movement and group activities; 5) staff training on infection control and PPE use; and 6) establishment of plans to address local PPE shortages, including county and state coordination of supply chains and stockpile releases to meet needs. These strategies require coordination and support from public health authorities, partnering health care systems, regulatory agencies, and their respective governing bodies (8–10). The findings in this report suggest that once COVID-19 has been introduced into a long-term care facility, it has the potential to result in high attack rates among residents, staff members, and visitors. In the context of rapidly escalating COVID-19 outbreaks in much of the United States, it is critical that long-term care facilities implement active measures to prevent introduction of COVID-19. Measures to consider include identifying and excluding symptomatic staff members, restricting visitation except in compassionate care situations, and strengthening infection prevention and control guidance and adherence (7,9,10).¶ Substantial morbidity and mortality might be averted if all long-term care facilities take steps now to prevent exposure of their residents to COVID-19. The underlying health conditions and advanced age of many long-term care facility residents and the shared location of patients in one facility places these persons at risk for severe morbidity and death. Rapid and sustained public health interventions focusing on surveillance, infection control, and mitigation efforts are resource-intensive but are critical to curtailing COVID-19 transmission and decreasing the impact on vulnerable populations, such as residents of long-term care facilities, and the community at large. As this pandemic expands, continued implementation of public health measures targeting vulnerable populations such as residents of long-term care facilities (8) and health care personnel will be critical. As public health measures are continually implemented, public information needs will only grow. To provide information for patients and families as well as communicate more broadly to all stakeholders, public officials and other community leaders need to work together to encourage everyone to understand and adhere to recommended guidelines to manage this outbreak. * The facility provides inpatient and outpatient rehabilitation and short-term and long-term care. Services include physical therapy, occupational therapy, and speech therapy. The facility, which has a medical director, also provides medication management and post-surgical care. † https://emergency.cdc.gov/han/2020/han00428.asp. § Some examples of specific PPE challenges included initial lack of access to eye protection, frequent changing of PPE types as supply chains were disrupted and PPE was provided via various donations or supplies, and a need for ongoing auditing of PPE use to ensure consistent and safe use of PPE by staff members (e.g., not touching or adjusting face protection, primarily facemasks, during extended use). ¶ https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/RecommendationsForLTC-COVID19.pdfpdf iconexternal icon.

On February 28, 2020, a case of coronavirus disease (COVID-19) was identified in a woman resident of a long-term care skilled nursing facility (facility A) in King County, Washington.* Epidemiologic investigation of facility A identified 129 cases of COVID-19 associated with facility A, including 81 of the residents, 34 staff members, and 14 visitors; 23 persons died. Limitations in effective infection control and prevention and staff members working in multiple facilities contributed to intra- and interfacility spread. COVID-19 can spread rapidly in long-term residential care facilities, and persons with chronic underlying medical conditions are at greater risk for COVID-19–associated severe disease and death. Long-term care facilities should take proactive steps to protect the health of residents and preserve the health care workforce by identifying and excluding potentially infected staff members and visitors, ensuring early recognition of potentially infected patients, and implementing appropriate infection control measures. On February 27, Public Health – Seattle and King County (PHSKC) was notified by a local health care provider of a patient whose symptom history and clinical presentation met the revised testing criteria† for COVID-19, which included testing of persons with severe respiratory illness of unknown etiology (1). The patient was a woman aged 73 years with a history of coronary artery disease, insulin-dependent type II diabetes mellitus, obesity, chronic kidney disease, hypertension, and congestive heart failure, who resided in facility A along with approximately 130 residents who were cared for by 170 health care personnel. Beginning in mid-February, the facility had experienced a cluster of febrile respiratory illnesses. Rapid influenza test results were obtained from several residents; all were negative. The patient had cough, fever, and shortness of breath requiring oxygen for 5 days at facility A. She reported no travel or known contact with anyone with COVID-19. On February 24, she was transported to a local hospital because of worsening respiratory symptoms and hypoxemia. Upon hospital admission, the patient was febrile to 103.3°F (39.6°C), tachycardic, and was found to have hypoxemic respiratory failure. On February 25, she required intubation and mechanical ventilation. Computed tomography scan showed diffuse bilateral infiltrates; however, multiplex viral respiratory panel and bacterial cultures of sputum and bronchoalveolar lavage fluid were negative. Four days after hospital admission, nasopharyngeal and oropharyngeal swabs and sputum specimens were collected to test for SARS-CoV-2; results were reported positive for all specimens on February 28. The patient died on March 2. Following notification of the index case of COVID-19, PHSKC and CDC immediately began investigating the cluster of respiratory illness in facility A to collect information on symptoms, severity, comorbidities, travel history, and close contacts to known COVID-19 cases by interviewing patients or a proxy for cases in which the patient could not be interviewed. Diagnostic testing by real-time reverse transcription–polymerase chain reaction (RT-PCR) (2–5) was performed for patients and staff members meeting clinical case criteria for COVID-19 (1). As of March 9, a total of 129 COVID-19 cases were confirmed among facility residents (81 of approximately 130), staff members, including health care personnel (34), and visitors (14). Health care personnel with confirmed COVID-19 included the following occupations: physical therapist, occupational therapist assistant, environmental care worker, nurse, certified nursing assistant, health information officer, physician, and case manager. Overall, 111 (86%) cases occurred among residents of King County (81 facility A residents, 17 staff members, and 13 visitors) and 18 (14%) among residents of Snohomish County (directly north of King County) (17 staff members and one visitor). Reported symptom onset dates for facility residents and staff members ranged from February 16 to March 5. The median patient age was 81 years (range = 54–100 years) among facility residents, 42.5 years (range = 22–79 years) among staff members, and 62.5 years (range = 52–88 years) among visitors; 84 (65.1%) patients were women (Table). Overall, 56.8% of facility A residents, 35.7% of visitors, and 5.9% of staff members with COVID-19 were hospitalized. Preliminary case fatality rates among residents and visitors as of March 9 were 27.2% and 7.1%, respectively; no deaths occurred among staff members. The most common chronic underlying conditions among facility residents were hypertension (69.1%), cardiac disease (56.8%), renal disease (43.2%), diabetes (37.0%), obesity (33.3%), and pulmonary disease (32.1%). Six residents and one visitor had hypertension as their only chronic underlying condition. As part of the response effort, approximately 100 long-term care facilities in King County were contacted through an emailed survey using REDCap (6), and information was requested about residents or staff members known to have COVID-19 or clusters of respiratory illness among residents and staff members. In addition, countywide databases of emergency medical service transfers from long-term care facilities to acute care facilities were reviewed daily for evidence of cases or clusters of serious respiratory illness. Routine active surveillance reports to PHSKC for influenza-like illness clusters from long-term care facilities were employed to identify clusters of illness consistent with COVID-19. All long-term care facilities with evidence of a cluster of respiratory illness were contacted by telephone for additional information, including infection control strategies in place and availability of personal protective equipment (PPE). Based on this information, the long-term care facilities were prioritized by risk for COVID-19 introduction and spread, and highest priority facilities were visited by response personnel for provision of emergency on-site testing and infection control assessment, support, and training. As of March 9, at least eight other King County skilled nursing and assisted living facilities had reported one or more confirmed COVID-19 cases. Information received from the survey and on-site visits identified factors that likely contributed to the vulnerability of these facilities, including 1) staff members who worked while symptomatic; 2) staff members who worked in more than one facility; 3) inadequate familiarity and adherence to standard, droplet, and contact precautions and eye protection recommendations; 4) challenges to implementing infection control practices including inadequate supplies of PPE and other items (e.g., alcohol-based hand sanitizer) §; 5) delayed recognition of cases because of low index of suspicion, limited testing availability, and difficulty identifying persons with COVID-19 based on signs and symptoms alone.

Summary What is already known about this topic? Coronavirus disease (COVID-19) can cause severe illness and death, particularly among older adults with chronic health conditions. What is added by this report? Introduction of COVID-19 into a long-term residential care facility in Washington resulted in cases among 81 residents, 34 staff members, and 14 visitors; 23 persons died. Limitations in effective infection control and prevention and staff members working in multiple facilities contributed to intra- and interfacility spread. What are the implications for public health practice? Long-term care facilities should take proactive steps to protect the health of residents and preserve the health care workforce by identifying and excluding potentially infected staff members, restricting visitation except in compassionate care situations, ensuring early recognition of potentially infected patients, and implementing appropriate infection control measures.

COVID-19 in a Long-Term Care Facility — King County, Washington, February 27–March 9, 2020 Early Release / March 18, 2020 / 69 Temet M. McMichael, PhD1,2,3; Shauna Clark1; Sargis Pogosjans, MPH1; Meagan Kay, DVM1; James Lewis, MD1; Atar Baer, PhD1; Vance Kawakami, DVM1; Margaret D. Lukoff, MD1; Jessica Ferro, MPH1; Claire Brostrom-Smith, MSN1; Francis X. Riedo, MD4; Denny Russell5; Brian Hiatt5; Patricia Montgomery, MPH6; Agam K. Rao, MD3; Dustin W. Currie, PhD2,3; Eric J. Chow, MD2,3; Farrell Tobolowsky, DO2,3; Ana C. Bardossy, MD2,3; Lisa P. Oakley, PhD2,3; Jesica R. Jacobs, PhD3,7; Noah G. Schwartz, MD2,3; Nimalie Stone, MD3; Sujan C. Reddy, MD3; John A. Jernigan, MD3; Margaret A. Honein, PhD3; Thomas A. Clark, MD3; Jeffrey S. Duchin, MD1; Public Health – Seattle & King County, EvergreenHealth, and CDC COVID-19 Investigation Team 1Public Health – Seattle & King County; 2Epidemic Intelligence Service, CDC; 3CDC COVID-19 Emergency Response; 4Evergreen Health, Kirkland, Washington; 5Washington State Public Health Laboratory; 6Washington State Department of Health; 7Laboratory Leadership Service, CDC. Top All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed. Public Health – Seattle & King County, EvergreenHealth, and CDC COVID-19 Investigation Team Meaghan S. Fagalde; Jennifer L. Lenahan; Emily B. Maier; Kaitlyn J. Sykes; Grace Hatt; Holly Whitney; Melinda Huntington-Frazier; Elysia Gonzales; Laura A. Mummert; Hal Garcia Smith; Steve Stearns; Eileen Benoliel; Shelly McKeirnan; Jennifer L. Morgan; Daniel Smith; Michaela Hope; Noel Hatley; Leslie M. Barnard; Leilani Schwarcz, Seattle & King County; Nicole Yarid, King County Medical Examiner’s Office; Eric Yim; Sandra Kreider; Dawn Barr; Nancy Wilde; Courtney Dorman; Airin Lam; Jeanette Harris, EvergreenHealth; Hollianne Bruce; Christopher Spitters; Snohomish Health District; Rachael Zacks; Jonathan Dyal; Michael Hughes; Christina Carlson; Barbara Cooper; Michelle Banks; Heather McLaughlin; Arun Balajee; Christine Olson; Suzanne Zane; Hammad Ali; Jessica Healy; Kristine Schmit; Kevin Spicer; Zeshan Chisty; Sukarma Tanwar; Joanne Taylor; Leisha Nolen; Jeneita Bell; Kelly Hatfield; Melissa Arons; Anne Kimball; Allison James; Mark Methner; Joshua Harney, CDC.

Rep. Ben McAdams, D-Utah, has tested positive for COVID-19, the disease caused by the novel coronavirus, he said in a statement released Wednesday evening. The congressman had mild cold-like symptoms when returned home from Washington D.C. on Saturday evening, the statement explained. McAdams met with his doctor on Sunday and isolated himself at home. His symptoms worsened and he developed a fever, dry cough and shortness of breath while he remained self-quarantined. On Tuesday, his doctor referred him for a COVID-19 test and he learned he tested positive on Wednesday. “I am still working for Utahns and pursuing efforts to get Utahns the resources they need as I continue doing my job from home until I know it is safe to end my self-quarantine,” McAdams said in a statement. “I’m doing my part as all Americans are doing to contain the spread of the virus and mitigate the coronavirus outbreak.” This is developing news. We’re working on gathering more information and will be updating this story shortly.

Rep. Ben McAdams, a freshman Democrat from Utah, has tested positive for the coronavirus, his office announced on Wednesday night. McAdams is the second member of Congress to have announced a positive test after Rep. Mario Diaz-Balart became the first to reveal his diagnosis on Wednesday evening. https://www.ksl.com/article/46731954/utah-rep-ben-mcadams-tests-positive-for-covid-19

Status Update as of March 18, 2020, 7:34pm Confirmed Cases of COVID-19 in Arkansas 37 Arkansas Department of Health Lab positive test results 30 Commercial lab positive test results 7 Persons Under Investigation (PUI) 112 Persons being monitored by ADH with daily check-in and guidance because of an identified risk 423 Past PUIs with negative test results 284 Arkansas Department of Health Lab negative test results 197 Commercial Lab negative test results 87 Confirmed Cases of COVID-19 by County Current as of 3/18/2020, 7:34pm. Negative COVID-19 Test Results from the ADH Public Health Lab Current as of 3/18/2020, 9:30am. ADH has activated a call center to answer questions from health care providers and the public about the novel coronavirus. During normal business hours (8:00am – 4:30pm), urgent and non-urgent calls, please call 1-800-803-7847 or email [email protected]. After normal business hours, urgent calls needing immediate response, please call 501-661-2136. https://www.healthy.arkansas.gov/https://www.healthy.arkansas.gov/programs-services/topics/novel-coronavirus

Coronavirus Disease 2019 (COVID-19) in Alabama Updated: March 18, 2020 4:10 p.m. (CT) County of Residence Cases Baldwin 1 Calhoun 1 Elmore 4 Lee 8 Jefferson 25 Limestone 1 Madison 1 Montgomery 2 Shelby 4 St. Clair 1 Tuscaloosa 3 Total 51 Deaths: 0 Note: We are updating case counts in the table above twice a day. Cases confirmed after 4 p.m. will be added the next day. You can find updated numbers on persons under investigation and confirmed COVID-19 cases in the U.S. from the Centers for Disease Control and Prevention (CDC). For more information on testing in Alabama, visit COVID-19 Testing. http://alabamapublichealth.gov/infectiousdiseases/2019-coronavirus.html

Current as of March 18, 2020 at 5 p.m. Eastern time Kentucky Coronavirus MonitoringNumber Tested: 489Positive: 35 Note: Data include both confirmed and presumptive cases of COVID-19 reported to KDPH at 5 p.m. Eastern time daily. https://govstatus.egov.com/kycovid19

Mississippi positive cases: 34 as of March 18, 2020 Individuals tested by the MSDH Public Health Laboratory: 513 as of March 18, 2020 https://msdh.ms.gov/msdhsite/_static/14,0,420.html

Test Results Number of People as of 3/18/2020 Negative 1577 Positive 106 More labs across the country are able to test for COVID-19. And now, Wisconsin clinicians can order tests without public health approval. Since tests are widely available, we will no longer report the number of people under investigation. Number of Positive Results by County Wisconsin County Total Cases as of 3/18/2020 Brown 1 Dane* 23 Fond du Lac 12 Kenosha* 4 La Crosse 1 Milwaukee* 47 Outagamie 1 Pierce 1 Racine 1 Sheboygan 4 Washington 2 Waukesha 5 Winnebago 3 Wood 1 Total 106 https://www.dhs.wisconsin.gov/outbreaks/index.htm * An asterisk indicates community spread has been identified.

Last Update: 03/18/2020 05:39 PM Reported Cases in Iowa by County County Reported Cases Adair 1 Allamakee 2 Black Hawk 1 Carroll 1 Dallas 5 Harrison 1 Johnson 21 Polk 3 Pottawattamie 1 Washington 1 Winneshiek 1 Total 38 https://idph.iowa.gov/Emerging-Health-Issues/Novel-Coronavirus?utm_medium=email&utm_source=govdelivery

Indiana COVID-19 Data as of March 17th, 11:59PM Dashboard updated daily at 10AM Cases and Deaths by County of Residence Esri, HERE, NPS | Esri, HERE, NPS +Zoom In −Zoom Out Total Positive Cases 39 Positive tests reflect results from ISDH and results submitted by private laboratories Total Deaths 2 Total Tested by ISDH 1 https://www.in.gov/coronavirus/

Florida Republican becomes first lawmaker to test positive for coronavirus BY RAFAEL BERNAL - 03/18/20 06:54 PM EDT 319 Florida Rep. Mario Diaz-Balart (R) announced Wednesday he tested positive for COVID-19 after developing symptoms Saturday. He is the first member of Congress to test positive for the novel coronavirus. Diaz-Balart has been in self-quarantine in his Washington, D.C., apartment since Friday. https://thehill.com/homenews/house/488354-florida-congressman-tests-positive-for-covid-19

Our knowledge of COVID-19 is still rapidly evolving. The risk assessment will be updated as needed. 2019 Novel Coronavirus (COVID-19) in Washington Updated on March 18, 2020 at 3:25 p.m. County Positive/Confirmed Cases Deaths Chelan 2 0 Clark 4 3 Columbia 1 0 Franklin 1 0 Grant 8 1 Grays Harbor 1 0 Island 16 0 Jefferson 4 0 King 562 56 Kitsap 9 0 Kittitas 4 0 Klickitat 1 0 Lewis 1 0 Lincoln 1 0 Mason 1 0 Pierce 56 0 Skagit 14 0 Snohomish 310 6 Spokane 4 0 Thurston 6 0 Whatcom 7 0 Yakima 7 0 Unassigned 167 0 Total 1187 66 Confirmed Cases by Age 0 to 19 years 2% 20 to 29 years 8% 30 to 39 years 12% 40 to 49 years 14% 50 to 59 years 17% 60 to 69 years 15% 70 to 79 years 16% 80+ years 16% Confirmed Cases by Sex Female 51% Male 46% Unknown 3% Number of Individuals Tested Positive 1187 Negative 15918 Note on the county and unassigned data: This data changes rapidly as labs conduct tests and discover new cases. Labs assign those cases to a county. Counties or the Department of Health then determine the appropriate county of jurisdiction. Those don’t always match initially. We’re working to reduce the “unassigned” number to 0. Contact the local health department for county specific information. Note on the deaths: Some deaths may be reported by health care providers, medical examiners/coroners, local health departments, or others before they are included in the statewide count. It takes longer for the state to announce deaths because they are often reported first to the local health department and then to us. Note on the number of infections: Public health experts agree that the true number of people who have been infected with COVID-19 in Washington greatly exceeds the number of COVID-19 infections that have been laboratory-confirmed. It is very difficult to know exactly how many people in Washington have been infected to date since most people with COVID-19 experience mild illness and the ability to get tested is still not widely available. https://www.doh.wa.gov/Emergencies/Coronavirus

Mar 17 Italy Daily deaths - 368, 349, 345 NYC to 1374 Washington 1012 w/ 52 deaths New Rochelle - Index orf8 lineage with European markers Spread from Italy to US (east coast) Pennsylvania to 96 Montgomery County - map and ages for 34 cases (most in 30/s and 40's) - 2 over 70, average age 45 Fox Chapel High School in Allegheny county Gross under count US close to Italy http://mediaarchives.gsradio.net/rense/special/rense_031720_hr3.mp3

03/18/2020 Governor Lamont Statement on the First Coronavirus Death in Connecticut (HARTFORD, CT) – Governor Ned Lamont today released the following statement regarding the first death in Connecticut due to severe complications from coronavirus (COVID-19): “It is with sadness today that we are confirming the first death of a person in Connecticut due to severe complications from COVID-19. The patient, a man in his 80s, had recently been admitted to Danbury Hospital, where he was receiving treatment. He had been a resident of an assisted living facility in Ridgefield. I want to thank all of the doctors, nurses, and medical professionals at the hospital who did everything in their power to save his life. I also want to acknowledge the dedicated professionals from hospitals and medical centers throughout our state who continue to work on the front lines and treat patients, in addition to all of the support staff who are providing critical assistance through this trying time. “We know that people of an advanced age and in certain conditions are among the most at risk of this disease, however I urge everyone in Connecticut – regardless of age or condition – to take an active role in doing their part to reduce the spread of this virus throughout our communities so we can protect one another.” Twitter: @GovNedLamont Facebook: Office of Governor Ned Lamont

The patient, a man in his 80s, had recently been admitted to Danbury Hospital, where he was receiving treatment. He had been a resident of an assisted living facility in Ridgefield. https://portal.ct.gov/Office-of-the-Governor/News/Press-Releases/2020/03-2020/Governor-Lamont-Statement-on-the-First-Coronavirus-Death-in-Connecticut

Latest COVID-19 Testing Data in Connecticut Updated 4:30 p.m. on Wednesday, March 18, 2020 Total patients who tested positive (including presumptive positive): 96 Fairfield County: 69 Hartford County: 11 Litchfield County: 5 Middlesex County: 1 New Haven County: 10 https://portal.ct.gov/Coronavirus

Pennsylvania’s 1st COVID-19 Death Reported in Northampton County Gov. Tom Wolf announced the first COVID-19-related death in Pennsylvania on Wednesday, an adult from Northampton County. What to Know Gov. Tom Wolf announced the first COVID-19-related death in Pennsylvania on Wednesday, an adult in Northampton County. Cases of the new coronavirus have been reported in Philadelphia, Bucks, Montgomery, Delaware, Chester, Lehigh and Northampton counties in Pennsylvania; Atlantic, Burlington, Camden, Cape May, Ocean and Mercer counties in New Jersey; and New Castle, Sussex and Kent counties in Delaware The cases have led to massive closures throughout Pennsylvania, including the closing of in-person dining in bars and restaurants Gov. Tom Wolf announced the first COVID-19-related death in Pennsylvania on Wednesday, an adult from Northampton County. Officials have not revealed the person's age but said he or she had been hospitalized at the time of death. Pennsylvania also reported at least 133 new cases of the novel coronavirus in the state Wednesday afternoon. However, while the state health department reported 17 cases in Philadelphia, the city itself reported 34, meaning the state's official figures could rise. Two more Temple University students also contracted the virus. Pennsylvania health officials said 1,187 people tested negative for the virus. They did not have a total number of pending tests. The new results come as hospitals across the Philadelphia region opened temporary testing sites — including drive-thru facilities — to rapidly test potentially-infected citizens. Dr. Thomas Farley, Philadelphia's Health Commissioner, said some of the newest cases in the city cannot be traced back to a person who traveled abroad. New Jersey continues to see a spike in new cases of the novel coronavirus with about 160 more reported Wednesday, bringing the state total to 427. Five people, all older people with preexisting factors, have died. On Wednesday, we learned of the first three cases of sickened people in Atlantic County and the first in Cape May County. Here are all the cases in our area in which people have tested positive for the new coronavirus. Northampton County Gov. Tom Wolf announced Pennsylvania's first COVID-19-related death on Wednesday, an adult in Northampton County. Officials have not revealed additional details about the person but said he or she had been hospitalized at the time of death.

Gov. Tom Wolf announced the first COVID-19-related death in Pennsylvania on Wednesday, an adult from Northampton County. Officials have not revealed the person's age but said he or she had been hospitalized at the time of death. https://www.nbcphiladelphia.com/news/coronavirus/where-coronavirus-cases-have-been-reported-in-the-philly-area/2318340/