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The person was brought to Seattle’s Harborview Medical Center on Feb. 24 and died two days later, on Wednesday, before a crisis in the state began unfolding over the weekend. Susan Gregg, a spokeswoman for the hospital, said on Tuesday that test samples from the person, who was a resident of the same nursing home that has had a number of coronavirus cases and deaths, have tested positive for the virus. “In coordination with Public Health, we have determined that some staff may have been exposed while working in an intensive care unit where the patient had been treated,” Ms. Gregg said. The confirmation of another death adds to an escalating emergency in a region that has rapidly emerged as a focal point for the virus in the United States. All of the U.S. deaths so far have been in the Seattle area. The other deaths, all announced over the last few days, included residents of a nursing care facility in Kirkland, a Seattle suburb. Four other people who have tested positive for the virus in the area were in critical condition, officials said. Officials in Washington State were rushing to take steps to contain the spread. Health officials were asking the State Legislature for an additional $100 million in funding to help respond to the virus. Some leaders were weighing more widespread closings of events, and around Seattle, immediate steps were being taken. In King County, officials were in the process of purchasing a motel in the region that could house people needing isolation. They were also working to repurpose modular homes that had been originally meant to be used by homeless people.

An earlier death in Washington State is tied to the virus. A person who died last week in a Seattle hospital had the coronavirus, tests have shown, marking the earliest known fatality from the infection in the United States, and raising the death toll in the country to seven. https://www.nytimes.com/2020/03/03/world/coronavirus-news.html

Mar 2 Community spread Snohomish county sequences show match between index case (35M in mid Jan) and community spread case (17M in late Feb) King Co Long Term Care Facility 5 deaths Health Care Workers in Solano/Santa Clara/Placer Cos Lack of testing Recent explosion of cases More testing needed http://mediaarchives.gsradio.net/rense/special/rense_030220_hr3.mp3

References Coronavirus disease. 2019 (COVID-19): situation report – 36. Geneva, Switzerland: World Health Organization; 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200225-sitrep-36-covid-19.pdf?sfvrsn=2791b4e0_2pdf iconexternal icon Patel A, Jernigan DB; 2019-nCoV CDC Response Team. Initial public health response and interim clinical guidance for the 2019 novel coronavirus outbreak—United States, December 31, 2019–February 4, 2020. MMWR Morb Mortal Wkly Rep 2020;69:140–6. CrossRefexternal icon PubMedexternal icon

Acknowledgments Maricopa County Department of Public Health; Arizona Department of Health Services; Lynn Mello, Mary White, Cynthia Marttila, Patricia Mottu-Monteon, Anthony Aguiar, Anita Alvarez, Veronica Guerra, San Benito County Public Health Services; Sara Cody, George Han, Shanon Smith, Elsa Villarino, Santa Clara County Public Health Department; Scott Lindquist, Washington State Department of Health; Hollianne Bruce, Snohomish Health District, Everett, Washington; Jeff Duchin, Vance Kawakami, Shauna Clark, Public Health Seattle-King County; Boston Public Health Commission; Sharon Balter; Dawn Terashita, Prabhu Gounder, Zach Rubin, Rebecca Fisher, Chelsea Foo, Meredith Haddix, Elizabeth Traub, Rebecca Lee, Kelsey Oyong, Christina Eclarino, Keith Gurtzweiler, Jennifer Kilburn, Jan King, Lucille Rayford, Ashley Griffin, Los Angeles County Department of Public Health; Howard Chiou, Los Angeles County of Public Health and COVID-19 Response Team, CDC; Olivia Almendares, Miwako Kobayashi, Olivia McGovern, Heather Reese, Anna Yousaf, Vaughn Barry, Karlyn Beer, Erin Conners, Connor Hoff, Alison Miller, Isaac Benowitz, Nora Chea, Cheri Grigg, Jennifer Hunter, Shannon Novosad, Amy Valderrama, Matthew Westercamp, Katie Wilson, Matthew Biggerstaff, Leora Feldstein, Pamela Kennedy, Archana Kumar, Holly Biggs, Jordan Cates, Victoria Chu, Nakia Clemmons, Brandi Freeman, Amber Haynes, Anita Kambhampati, Hannah Kirking, Stephen Lindstrom, Ruth Link-Gelles, Joana Lively, Mariel Marlow, Claire Mattison, Nancy McClung, Manisha Patel, Brian Rha, Janell Routh, Megan Wallace, John Watson, Kevin Chatham-Stephens, Max Cohen, Vishal Dasari, Matthew Donahue, Max Jacobs, Heather Rhodes, Varun Shetty, Amy Xie, Patrick Dawson, Jonathan Dyal, Mary Evans, Marc Fischer, Grace Vahey, Marie Killerby, Jennifer Verani, Kristen Pettrone, Satish Pillai, Sarah Elizabeth Smith-Jeffcoat, Bryan Stierman, Rebecca Sunenshine, Florence Whitehill, Jonathan Wortham, COVID-19 Response Team, CDC. Corresponding author: Rachel M. Burke, [email protected], 404-718-1016. Top 1COVID-19 Response Team, CDC; 2Orange County Health Care Agency, California; 3San Benito County Public Health Services, Arizona 4Wisconsin Department of Health Services; 5Washington Department of Health; 6Epidemic Intelligence Service, CDC; 7Illinois Department of Public Health; 8Los Angeles County Department of Public Health, California; 9Boston Public Health Commission, Massachusetts; 10Chicago Department of Public Health, Illinois; 11Santa Clara County Public Health Department, California; 12Maricopa County Department of Public Health, Arizona. 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. Top * https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html. † Close contact was defined by the state and local health jurisdictions with reference to the following online guidance: https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html. § https://emergency.cdc.gov/han/2020/han00428.asp. ¶ https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html. ** For these investigations, exposure of community members within a health care setting was defined as either at least 10 minutes spent within 6 feet of the patient with confirmed COVID-19 (e.g., in a waiting room) or having spent time in the same airspace (e.g., the same examination room) for 0–2 hours after the confirmed COVID-19 patient. The duration of time in the same airspace after the patient with confirmed COVID-19 was applied differently by health jurisdictions. However, no contacts were enumerated among those who were in the same airspace >2 hours after the patient with confirmed COVID-19. †† Health care personnel were defined as volunteers or paid persons who serve in a health care setting who might come into direct or indirect contact with patients or infectious materials. Examples of close contact with a patient or with infectious material could include spending prolonged time within 6 feet of the patient, conducting or being present during an aerosol-generating procedure, or direct contact with the patient’s secretions or excretions. Interim guidance for assessing the exposure risk and for symptoms that should prompt further evaluation among health care personnel is available at https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html. §§ At the time of the investigations, persons with close contact to a confirmed COVID-19 patient could be considered PUIs if they developed fever or signs or symptoms of lower respiratory tract illness. This threshold might be lower for contacts who are health care workers. At this time, symptomatic close contacts of a patient with confirmed COVID-19 should be further evaluated in consultation with public health authorities to review signs or symptoms and possible exposure on a case-by-case basis. Further information is available at https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html. ¶¶ The 95% confidence interval around the binomial proportion was calculated using the Wilson score interval. *** https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-prevent-spread.html; https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html.

In December 2019, an outbreak of coronavirus disease 2019 (COVID-19), caused by the virus SARS-CoV-2, began in Wuhan, China (1). The disease spread widely in China, and, as of February 26, 2020, COVID-19 cases had been identified in 36 other countries and territories, including the United States. Person-to-person transmission has been widely documented, and a limited number of countries have reported sustained person-to-person spread.* On January 20, state and local health departments in the United States, in collaboration with teams deployed from CDC, began identifying and monitoring all persons considered to have had close contact† with patients with confirmed COVID-19 (2). The aims of these efforts were to ensure rapid evaluation and care of patients, limit further transmission, and better understand risk factors for transmission. As of February 26, 12 travel-related COVID-19 cases had been diagnosed in the United States, in addition to three COVID-19 cases in patients with no travel history (including two cases in close household contacts) and 46 cases reported among repatriated U.S. citizens.§ Following confirmed diagnosis, the 12 patients with travel-related COVID-19 were isolated in the hospital if medically necessary, or at home once home care was deemed clinically sufficient.¶ Among the first 10 patients with travel-related confirmed COVID-19 reported in the United States, a total of 445 persons (range = 1–201 persons per case) who had close contact with one of the 10 patients on or after the date of the patient’s symptom onset were identified. Nineteen (4%) of the 445 contacts were members of a patient’s household, and five of these 19 contacts continued to have household exposure to the patient with confirmed COVID-19 during the patient’s isolation period; 104 (23%) were community members who spent at least 10 minutes within 6 feet of a patient with confirmed disease; 100 (22%) were community members who were exposed** to a patient in a health care setting; and 222 (50%) were health care personnel.†† Active symptom monitoring of the 445 close contacts, consisting of daily telephone, text, or in-person inquiries about fever or other symptoms for 14 days following the last known exposure to a person with confirmed COVID-19, was conducted by local health jurisdictions. During the 14 days of active symptom monitoring, 54 (12%) close contacts developed new or worsening symptoms deemed by local public health authorities to be concerning for COVID-19 and were thus considered persons under investigation (PUIs)§§ and subsequently were tested for SARS-CoV-2. Two persons who were household members of patients with confirmed COVID-19 tested positive for SARS-CoV-2. This yielded a symptomatic secondary attack rate of 0.45% (95% confidence interval [CI] = 0.12%–1.6%) among all close contacts,¶¶ and a symptomatic secondary attack rate of 10.5% (95% CI = 2.9%–31.4%) among household members. Both persons with confirmed secondary transmission had close contact with the respective source patient before COVID-19 was confirmed and were isolated from the source patient after the patient’s COVID-19 diagnosis. No other close contacts who were tested for SARS-CoV-2 had a positive test, including the five household members who were continuously exposed during the period of isolation of their household member with confirmed COVID-19. An additional 146 persons exposed to the two patients with secondary COVID-19 transmission underwent 14 days of active monitoring. Among these, 18 (12%) developed symptoms compatible with COVID-19 and were considered PUIs. All tested negative, and no further symptomatic COVID-19 cases (representing tertiary transmission) have been identified. In the United States, two instances of person-to-person transmission of SARS-CoV-2 have been documented from persons with travel-related COVID-19 to their household contacts. Since February 28, an increasing number of newly diagnosed confirmed and presumptive COVID-19 cases have been in patients with neither a relevant travel history nor clear epidemiologic links to other confirmed COVID-19 patients. However, despite intensive follow-up, no sustained person-to-person transmission of symptomatic SARS-CoV-2 was observed in the United States among the close contacts of the first 10 persons with diagnosed travel-related COVID-19. Analyses of timing of exposure during each patient’s illness as well as the type and duration of exposures will provide information on potential risk factors for transmission. Infection control and prevention efforts by patients with COVID-19, their household members, and their health care providers,*** in combination with contact tracing activities, are important to mitigate community spread of the disease.

Investigation of test kits Do you know what problem is? Washington contact tracing? Moving forward on test kits Washington finding interesting Still in hypothesis stage

Testing numbers Will aggregate national numbers Reporting might have slight delay because updates are once a day

Test kits Contaminant? One possibility - still under investigation Looking at going forward

PPE pipeline CDC's role is making sure PPEs for those at highest risk

CDC kits Van test 75,000 people FDA role on commercial kits

MMWR 0.45% in all contacts 10.4% in close contacts Good news? Early cases had limited spreading,but is just a limited number Looking at data from other countries

CDC's role in testing? Goal is getting results quickly and accurately Local tests are presumptive, but actionable FDA oversees commercial kits Working at getting kits out

California test? Need to check with California More kits available CDC open on questions

Limited criteria for testing? Need to look at where we are today

Older and in areas of spread Need medications for chronic conditions (like high blood pressure and diabetes) Need to take measures to reduce exposure

Diamond Cruise Many do not feel particularly bad However, maintaining 14 day quarantine is important

Most are mild 16% serious (based on China data) risk doubled for those with underlying disease

60 cases in US (excluding repatriated) 11 Travel 27 under investigation for community spread LTCF in Washington

Active Monitoring of Persons Exposed to Patients with Confirmed COVID-19 — United States, January–February 2020 Early Release / March 3, 2020 / 69 Rachel M. Burke, PhD1; Claire M. Midgley, PhD1; Alissa Dratch, MPH2; Marty Fenstersheib, MD3; Thomas Haupt, MS4; Michelle Holshue, MPH5,6; Isaac Ghinai, MBBS6,7; M. Claire Jarashow, PhD8; Jennifer Lo, MD9; Tristan D. McPherson, MD6,10; Sara Rudman, MD11; Sarah Scott, MD6,12; Aron J. Hall, DVM1; Alicia M. Fry, MD1; Melissa A. Rolfes, PhD1 (View author affiliations) https://www.cdc.gov/mmwr/volumes/69/wr/mm6909e1.htm?s_cid=mm6909e1_w

In December 2019, an outbreak of coronavirus disease 2019 (COVID-19), caused by the virus SARS-CoV-2, began in Wuhan, China (1). The disease spread widely in China, and, as of February 26, 2020, COVID-19 cases had been identified in 36 other countries and territories, including the United States. Person-to-person transmission has been widely documented, and a limited number of countries have reported sustained person-to-person spread.* On January 20, state and local health departments in the United States, in collaboration with teams deployed from CDC, began identifying and monitoring all persons considered to have had close contact† with patients with confirmed COVID-19 (2). The aims of these efforts were to ensure rapid evaluation and care of patients, limit further transmission, and better understand risk factors for transmission. As of February 26, 12 travel-related COVID-19 cases had been diagnosed in the United States, in addition to three COVID-19 cases in patients with no travel history (including two cases in close household contacts) and 46 cases reported among repatriated U.S. citizens.§ Following confirmed diagnosis, the 12 patients with travel-related COVID-19 were isolated in the hospital if medically necessary, or at home once home care was deemed clinically sufficient.¶ Among the first 10 patients with travel-related confirmed COVID-19 reported in the United States, a total of 445 persons (range = 1–201 persons per case) who had close contact with one of the 10 patients on or after the date of the patient’s symptom onset were identified. Nineteen (4%) of the 445 contacts were members of a patient’s household, and five of these 19 contacts continued to have household exposure to the patient with confirmed COVID-19 during the patient’s isolation period; 104 (23%) were community members who spent at least 10 minutes within 6 feet of a patient with confirmed disease; 100 (22%) were community members who were exposed** to a patient in a health care setting; and 222 (50%) were health care personnel.†† Active symptom monitoring of the 445 close contacts, consisting of daily telephone, text, or in-person inquiries about fever or other symptoms for 14 days following the last known exposure to a person with confirmed COVID-19, was conducted by local health jurisdictions. During the 14 days of active symptom monitoring, 54 (12%) close contacts developed new or worsening symptoms deemed by local public health authorities to be concerning for COVID-19 and were thus considered persons under investigation (PUIs)§§ and subsequently were tested for SARS-CoV-2. Two persons who were household members of patients with confirmed COVID-19 tested positive for SARS-CoV-2. This yielded a symptomatic secondary attack rate of 0.45% (95% confidence interval [CI] = 0.12%–1.6%) among all close contacts,¶¶ and a symptomatic secondary attack rate of 10.5% (95% CI = 2.9%–31.4%) among household members. Both persons with confirmed secondary transmission had close contact with the respective source patient before COVID-19 was confirmed and were isolated from the source patient after the patient’s COVID-19 diagnosis. No other close contacts who were tested for SARS-CoV-2 had a positive test, including the five household members who were continuously exposed during the period of isolation of their household member with confirmed COVID-19. An additional 146 persons exposed to the two patients with secondary COVID-19 transmission underwent 14 days of active monitoring. Among these, 18 (12%) developed symptoms compatible with COVID-19 and were considered PUIs. All tested negative, and no further symptomatic COVID-19 cases (representing tertiary transmission) have been identified. In the United States, two instances of person-to-person transmission of SARS-CoV-2 have been documented from persons with travel-related COVID-19 to their household contacts. Since February 28, an increasing number of newly diagnosed confirmed and presumptive COVID-19 cases have been in patients with neither a relevant travel history nor clear epidemiologic links to other confirmed COVID-19 patients. However, despite intensive follow-up, no sustained person-to-person transmission of symptomatic SARS-CoV-2 was observed in the United States among the close contacts of the first 10 persons with diagnosed travel-related COVID-19. Analyses of timing of exposure during each patient’s illness as well as the type and duration of exposures will provide information on potential risk factors for transmission. Infection control and prevention efforts by patients with COVID-19, their household members, and their health care providers,*** in combination with contact tracing activities, are important to mitigate community spread of the disease.

Active Monitoring of Persons Exposed to Patients with Confirmed COVID-19 — United States, January–February 2020 Rachel M. Burke, PhD1; Claire M. Midgley, PhD1; Alissa Dratch, MPH2; Marty Fenstersheib, MD3; Thomas Haupt, MS4; Michelle Holshue, MPH5,6; Isaac Ghinai, MBBS6,7; M. Claire Jarashow, PhD8; Jennifer Lo, MD9; Tristan D. McPherson, MD6,10; Sara Rudman, MD11; Sarah Scott, MD6,12; Aron J. Hall, DVM1; Alicia M. Fry, MD1; Melissa A. Rolfes, PhD1

Media Advisory For Immediate Release Tuesday, March 3, 2020 Contact: CDC Media Relations (404) 639-3286 CDC Media Telebriefing: Update onCOVID-19 What The Centers for Disease Control and Prevention (CDC) will provide an update to media on the COVID-19 response. Who Nancy Messonnier, M.D., Director, National Center for Immunization and Respiratory Diseases When 1:00 p.m. ET Tuesday, March 3, 2020 Dial-In Media: 800-857-9756 International: 1-212-287-1647 PASSCODE: CDC MEDIA Non-Media: 888-795-0855 International: 1-517-308-9127 PASSCODE: 4603973 Important Instructions Due to anticipated high volume, please plan to dial in to the telebriefing 15 minutes before the start time. Media: If you would like to ask a question during the call, press *1 on your touchtone phone. Press *2 to withdraw your question. You may queue up at any time. You will hear a tone to indicate your question is pending. TRANSCRIPT A transcript will be available following the briefing at CDC’s web site:www.cdc.gov/media.

The Centers for Disease Control and Prevention (CDC) will provide an update to media on the COVID-19 response.