Gov. Ralph Northam is “taking every precaution to ensure the safety of Virginians” amidst a global outbreak of novel coronavirus, press secretary Alena Yarmosky wrote in an email on Friday.
In reality, that translates to watching and waiting as experts learn more about the disease, recently named COVID-19 by the World Health Organization. The Virginia Department of Health has set up a command center to track the virus and meets daily to discuss the situation, state epidemiologist Dr. Lilian Peake said in an interview on Friday. But there’s still a wide degree of uncertainty surrounding the disease, even as Virginia and surrounding states remain free of confirmed cases.
“The risk right now is very, very low,” added Dr. Laurie Forlano, the department’s deputy commissioner for population health. “But it’s a dynamic outbreak and it’s changing daily, so we are taking it very seriously.”
In coordination with the Centers for Disease Control and Prevention, the state is identifying residents who have returned from travel in China and assessing their risk level for the disease. Those with higher risk are asked to stay home and limit public contact for 14 days since their possible exposure, which usually means the last day they were in the country, Peake said.
Right now, the state is monitoring 179 people. Eight people have been tested for the virus, and six tests returned negative results. Two are still pending from the CDC.
But Dr. Gonzalo Bearman, chair of the division for infectious diseases at Virginia Commonwealth University Health System, said Virginians should be more worried about seasonal influenza, which kills an estimated 50,000 to 60,000 Americans every year, than contracting the coronavirus. There have been no confirmed cases of COVID-19 in Virginia, Maryland, or Washington, D.C., and most cases in the United States have been linked to people traveling abroad or those that have come in contact with them.
On Friday evening, officials confirmed a second case of coronavirus that appeared to come from “community spread” — meaning the patient had not traveled to areas with confirmed cases of the virus or come in contact with someone who was already infected. The agency sent out revised testing guidelines in response, but state experts, including Bearman and Peake, are still more concerned about travelers coming from China or other countries with high rates of infection.
“Right now, the risk is low because we’re not seeing cases in Virginia or proximate states,” Bearman said. “But this is definitely an epidemic with looming pandemic potential, and it’s far from peaked.”
Globally, health experts have differed on how to characterize the disease, often driving more uncertainty. While the World Health Organization has declined to label COVID-19 as a pandemic, a top official at the Centers for Disease Control and Prevention recently warned that the virus could cause “severe” disruptions to daily life.
Virginia State Health Commissioner Dr. M. Norman Oliver listed COVID-19 as a “communicable disease of public health threat” in a Feb. 27 letter to clinicians.
In a Friday webinar for health journalists, Dr. Michael Mina — an assistant professor of epidemiology at the Harvard School of Public Health — said many epidemiologists considered the outbreak to be “the very definition of a pandemic.” But the severity also appears to vary depending on the age and health of a patient.
Young children seem less vulnerable to COVID-19, which is unusual for a respiratory disease. There’s a roughly 15 percent fatality rate among patients older than 80, which drops dramatically — to 0.2 percent or lower — among patients between 10 and 39 years of age, according the Mina’s presentation.
Virginia’s preparations come amid growing concerns over the virus, both globally and across the United States. While the official case count hovers around 84,000 across at least 57 countries, Mina said the number is likely a “low estimate” given delays in testing and shifting criteria for how the disease is identified.
Health experts are already concerned about the United States’ capacity to effectively test and monitor the disease. The CDC chose to design its own test for coronavirus despite existing guidelines from the WHO, losing weeks that could have been dedicated to tracking its potential spread, according to an investigation by ProPublica. When the tests were finally delivered, they malfunctioned in most states, limiting the ability of local health departments to launch surveillance testing in areas mostly likely to see an outbreak of the disease.
“The U.S. is really lagging behind in the ability to observe where these cases are occurring,” Mina said. Currently, the CDC is limiting the number of labs cleared to perform the test, forcing most state and local health departments, including Virginia, to send swabs to the agency’s headquarters in Atlanta. Forlano and Peake said it takes anywhere from three to seven days for the agency to come back with test results.
Forlano said patients in Virginia were asked to stay home while awaiting the results of their tests. But Mina worries that a delay in testing could clog valuable space in hospitals and limit states’ ability to respond nimbly if cases in the U.S. begin to rise.
“There is very low testing capacity in the U.S., which is becoming increasingly problematic,” he said Friday.