POST 6. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””

“Confronting a viral epidemic with a scant supply of protective equipment, more than 1,700 Chinese medical workers have already been infected, and six have died.

In the hospital where Yu Yajie works, nurses, doctors and other medical professionals fighting the new coronavirus have also been fighting dire shortages. They have used tape to patch up battered protective masks, repeatedly reused goggles meant for one-time use, and wrapped their shoes in plastic bags for lack of specialized coverings.

Ms. Yu is now lying at home, feverish and fearful that she has been infected with the virus. She and other employees at the hospital said a lack of protective wear had left medical workers like her vulnerable in Wuhan, the central Chinese city at the heart of the epidemic that has engulfed this region.

“There are risks — there simply aren’t enough resources,” Ms. Yu, an administrator at Wuhan Central Hospital, said in a brief telephone interview, adding that she was too weak to speak at length.

Chinese medical workers at the forefront of the fight against the coronavirus epidemic are often becoming its victims, partly because of government missteps and logistical hurdles.

After the virus emerged in Wuhan late last year, city leaders played down its risks, so doctors didn’t take precautions…

On Friday, the Chinese government for the first time disclosed the toll the outbreak was taking on hospital employees: 1,716 medical workers had contracted the virus, including 1,502 in Wuhan, and six had died.” (A)

“Officials are also looking to see whether the medical workers were exposed to the virus unknowingly within a clinical environment and whether they were wearing protective equipment at the time, Ryan said. “There are a whole lot of factors we need to look at, and we will be doing that with Chinese authorities.”…

Dr. Sylvie Briand, head of WHO’s Global Infectious Hazard Preparedness division, told reporters that the health workers may have been fatigued at the time they were infected and weren’t taking proper protective measures because they were too tired. China has sent medical professionals from several regions to support those workers, she said….

WHO is asking suppliers of protective gear to prioritize sending the equipment to regions most affected by the virus.

Last week, WHO said it sent medical supplies such as masks, gloves, gowns and diagnostic tests around the world. It is discouraging stockpiling of protective gear, saying the limited number of items need to be saved for regions most affected by the virus. The price of protective gear has increased, while availability has decreased, WHO officials said…

On Thursday, world health officials said they were scrambling to determine just how widespread the new coronavirus is as Chinese authorities reported a surge in new cases after changing how they count confirmed infections.

“How big is the iceberg?” Ryan said. “We do know, and we all accept, that there is transmission occurring at some level in communities. We’ve all seen those clusters, we’ve all seen those super spreading events.”  (B)

“A sudden spike in new coronavirus cases in China this week shocked researchers. But the huge bump in numbers isn’t a sign that the epidemic is worsening, say researchers, it is instead the result of authorities changing how cases are confirmed.

On 12 February, Hubei province reported nearly 15,000 new cases of COVID-19, the disease caused by the coronavirus, representing a 33% jump in total infections worldwide in a single day. Total infections in China now number around 64,000, with more than 1,300 deaths.

But most of the Hubei cases — about 13,000 — are the result of a new policy in the province that means physicians can diagnose suspected cases of COVID-19 on the basis of chest images, rather than having to wait for genetic tests to confirm the presence of the virus, which can take days.

The policy is in response to pleas from clinicians who are overwhelmed by patients with respiratory diseases, and don’t have time to wait for lab results, says Wu Zunyou, chief epidemiologist at the Chinese Center for Disease Control and Prevention, who helped design and implementing the new policy. “The clinicians in Hubei made a very strong request to modify the criteria because of their heavy work load,” he says. Now they can care for people more quickly and ensure they are properly isolated to protect others, says Wu. “We need to save lives.”

The policy makes sense from a medical point of view, says Michael Mina, an infectious-disease immunologist and epidemiologist at the Harvard T. H. Chan School of Public Health in Boston, Massachusetts. “Triaging based on symptomatic evaluation and physical exam is the bed rock of hospital-based and clinical triage,” he says.” (C)

“Hospitals in Wuhan, China — the largest city in Hubei Province and the center of the epidemic — have struggled to diagnose infections with scarce and complicated tests that detect the virus’s genetic signature directly. Other countries, too, have had such issues.

Instead, officials in Hubei now seem to be including infections diagnosed by using lung scans of symptomatic patients. This shortcut will help get more patients into needed care, provincial officials said. Adding them to the count could make it easier for the authorities to decide how to allocate resources and assess treatment options.

But the change also shows the enormous number of people in Hubei who are sick and have not been counted in the outbreak’s official tally. It also raises the question whether the province, already struggling, is equipped to deal with the new patients.

The few experts to learn of the new numbers on Wednesday night were startled. Lung scans are an imperfect means to diagnose patients. Even patients with ordinary seasonal flu may develop pneumonia visible on a lung scan.” (D)

“Even before today’s news, experts complained that epidemiological information from China has been incomplete, threatening containment efforts.

The new coronavirus is highly transmissible and will be difficult to squelch. A single infected “super-spreader” can infect dozens of others. Outbreaks can seem to recede, only to rebound in short order, as the weather or conditions change.

Recent clusters of coronavirus cases suggest the new coronavirus not only spreads quickly, but also in ways that are not entirely understood.

In Hong Kong, people living 10 floors apart were infected, and an unsealed pipe was blamed. A British citizen apparently infected 10 people, including some at a ski chalet, before he even knew he was sick.

In Tianjin, China, at least 33 of 102 confirmed patients had a connection of some sort with a large department store.

“This outbreak could still go in any direction,” Dr. Tedros Adhanom Ghebreyesus, director general of the World Health Organization, said on Wednesday.

A change in diagnosis may make it still harder to track the virus, said Dr. Peter Rabinowitz, co-director of the University of Washington MetaCenter for Pandemic Preparedness and Global Health Security.” (E)

“The head of the U.S. Centers for Disease Control and Prevention said the new coronavirus, which has killed nearly 1,400 people and is still spreading in China, could be around for at least another year. The outbreak has affected almost 50,000 people worldwide. There are 15 confirmed cases in the U.S. but none are said to be suffering serious symptoms.

The agency is setting up five labs around the U.S. where people with flu-like symptoms can be tested for coronavirus if their flu results are negative. The virus, dubbed COVID-19, has spread to more than two dozen countries.

The CDC is ramping up its own response to the epidemic by setting up five labs around the U.S. where people with flu-like symptoms can now be tested for coronavirus if their flu results are negative. This comes as scientists around the world race to develop a vaccine.” (F)

“Another U.S. case of infection with the novel coronavirus was confirmed Thursday, bringing the total number of domestic cases to 15. Around the world, cases have reached nearly 60,000 to date.

But if something changes and large numbers of people get infected in the U.S., is the country’s health system prepared to cope with a surge of patients with this virus, or any future pathogen?

“Surge capacity in the health care system is something that we think a lot about and prepare for in the U.S., and not specifically to coronavirus per se, but for a whole host of events that could occur in the United States,” says Jonathan Greene, director of emergency management and medical operations at the Department of Health and Human Services…

“No one is ready for a worst case-scenario for a really bad, lethal, fast-moving pandemic,” says bioterrorism and biosafety expert Dr. Tara O’Toole, former undersecretary for science and technology at the Department of Homeland Security and now at In-Q-Tel, a nonprofit strategic investment firm that supports U.S. national security.

For instance, O’Toole thinks that hospitals would have a very hard time handling a lot of critically ill patients who need to be in isolation. “That’s why we want to make sure that the people we’re putting in hospitals and keeping isolated are really the ones who need that kind of care,” she says…

What’s needed is a strategic approach to rapidly deal with an epidemic, says O’Toole, but “we don’t have a strategy and we haven’t built the infrastructure” to do so….

On the other hand, HHS official Greene argues that the nation’s health care system is better prepared than it has been in the past. “We’ve gone through outbreaks of other diseases, other coronaviruses, SARS and MERS,” he says. And each one of those experiences has helped the system develop “tactics, capabilities, training and education to be able to deal with whatever comes down the road. This is just one more in a long history of disease outbreaks that we’re being asked to tackle.”

The strategic national stockpile, says Greene, holds “millions of face masks, and supplies of respirators, gloves and surgical gowns that could potentially be deployed if state and local supplies are diminished during this current outbreak.” Greene says that HHS is working with the health care sector and the supply chain to ensure that any disruptions that may occur or shortages are “short-lived and that the right amount of material can be provided” as soon as possible.” (G)

“Dr. Craig Spencer was the first patient in New York diagnosed with Ebola in 2014. After that experience, he wrote, “When we look back on this epidemic, I hope we’ll recognize that fear caused our initial hesitance to respond — and caused us to respond poorly when we finally did.” In terms of New York, what has changed since then?

Our overall preparedness in maintaining our readiness — that’s a key phrase we use — has exponentially increased since 2014 because we’re constantly collaborating, coordinating, and communicating at all levels — local, state, national, and even international. We’ve been given funding on a national scale to prepare for Ebola and special pathogens. It wasn’t just specifically for viral hemorrhagic fevers like Ebola; it gave us funding to prepare for coronavirus disease, for MERS, for SARS, the full gamut. From that funding we were able to do more drills, exercises, collaborative public health. The unfortunate part is that funding was only for five years, and it actually expires in a matter of months — in 2020. So this entire infrastructure that we’ve built across the nation is going to get dismantled in a couple of months, which is mind-boggling knowing we’re in a potential pandemic situation and we’re letting our guard down.

The other thing we’ve also done is, we want to make sure we’re giving patients the opportunity to tell us what they have. Before, it was you come in, come to the front desk, and they ask, “What are you here for.” By that time it’s basically too late. Because you’ve come in through the door, there are probably 50 people waiting in the waiting area, if you’re coming in with something respiratory and you’re coughing and sneezing, you’ve probably infected a number of folks around there. One of the strategies we’ve implemented is something very basic: respiratory stations, which basically have simple masks, hand sanitizer, a tissue, and a sign that says, “Do you have a fever? Do you have a cough? Do you have a rash? Yes? Please take a mask. If a mask is not there use a tissue and sanitize your hands.” And it tells you, “If you have travel history let us know immediately.” So now we’re letting patients self-identify. It helps expedite that triage process. Before this outbreak and the Ebola outbreak in 2014, we only had those stands during seasonal flu time, and once seasonal flu was done we would take out that stand. Now we know these infectious diseases are all around us, so it’s all season long…

What are you most concerned about right now sitting here? What’s going to keep you up tonight?

Based on everything that we’ve been seeing, reading, looking at what’s happening in China, it doesn’t seem like this virus is containable. It’s not the fault of the government itself or China itself, it’s the nature of the virus. You just can’t stop a respiratory virus, especially a respiratory one in nature where it’s the sheer form of breathing and having droplets develop — you just can’t control it. It’s one of those things we know we can’t contain, so we need to continue to prepare very aggressively for it. And that’s exactly what we’re doing. What’s keeping me up at night is knowing that these cases are going to continue to occur, and that’s what the CDC has stated, that we’re going to see an increased number of cases. We need to make sure that we’re able to identify every single one. It just takes one person coming into one of our facilities to start an outbreak.” (H)

““On December 27, Syra Madad published an op-ed in the Washington Post co-written with Ronald A. Klain. The piece warned lawmakers that vital funding needed to prepare hospitals for infectious-disease outbreaks would expire in May. “We do not know when the next dangerous pathogen will arrive in our country,” it read, “but we do know that it will happen — sooner or later.” Four days after the article was published, on December 31, the government in Wuhan, China, reported to the World Health Organization that it was treating dozens of patients for pneumonia of unknown cause.

That was the beginning of a busy January for Madad. As the senior director for the systemwide special-pathogens program for NYC Health and Hospitals, it was her job to prepare the city’s 11 hospitals for an outbreak. Madad also happened to be the star of Pandemic, a six part docuseries that premiered on Netflix on January 22 — a week after she gave birth to her third child…

We want more time to continue our trainings, so we can continue to prepare our front lines for the inevitable surge of cases that we may potentially see. We may not get a whole lot of cases or we may get a number of cases, but either way it’s best for us to prepare for the worst-case scenario. If we have a surge of cases present, we’re looking at it from a 4S standpoint or the emergency-management approach: staffing, stuff, space, and system. Based on those four high-level domains, we’re looking at how we can bulk up staffing. Because the No. 1 asset in the health-care system is our people, and without our people we can’t take care of patients. Do we get volunteers involved? Do we look at our memorandum of agreements with other agencies to bulk up our staffing? Things like that. (I)

“Doctors in five U.S. cities will begin testing patients with flu-like symptoms for the new coronavirus, the Centers for Disease Control and Prevention said Friday.

The coronavirus test will only be given to patients who test negative for the flu. So far, the testing protocol will be implemented in Chicago, Los Angeles, New York, San Francisco and Seattle, though more cities will be added.

It’s a sign that the U.S. is broadening its surveillance of the illness.

This is just the starting point,” Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, said during a press briefing Friday. “We plan to expand to more sites in the coming weeks.”

Messonnier said the increased testing is part of an effort to determine whether the virus is spreading in communities across the U.S. “The results would be an early warning signal to trigger a change in our response strategy,” she said.” (J)

“As an outbreak of a novel coronavirus has swept through Hubei province, China, the US Centers for Disease Control and Prevention has been preparing for its worst case scenario — a widespread outbreak of illnesses in the United States.

“Right now we’re in an aggressive containment mode,” CDC Director Dr. Robert Redfield told CNN’s Chief Medical Correspondent Dr. Sanjay Gupta in an interview on Thursday.

“We don’t know a lot about this virus,” he said. “This virus is probably with us beyond this season, beyond this year, and I think eventually the virus will find a foothold and we will get community-based transmission.”

As of Thursday, there have been 15 cases of the novel coronavirus confirmed in seven states: eight in California; two in Illinois; and one in Arizona, Washington, Massachusetts, Wisconsin and Texas.

While more research is needed to fully understand the virus, Redfield told Gupta that the CDC has focused on surveillance to track cases and containment strategies to slow possible progression of the virus in the United States. Slowing progression gives more time for researchers to work on developing and testing a vaccine and antiviral drugs for this novel coronavirus. Currently, there is no known cure for the virus.

“The containment phase is really to give us more time. This virus will become a community virus at some point in time, this year or next year,” Redfield said. “We don’t have any evidence that this coronavirus is really embedded in the community at this time, but with that said, we want to intensify our surveillance so that we’re basing those conclusions based on data.”

The containment strategy refers to efforts to prevent widespread transmission of the coronavirus in the United States, including having people with confirmed cases stay in isolation and placing restrictions on travel between affected areas in the world. Such containment measures were used widely during the SARS global outbreak of 2003, during which 8,098 people worldwide became sick and of those, 774 died, according to the CDC…

“What I’ve learned in the last two weeks is that the spectrum of this illness is much broader than was originally presented. There’s much more asymptomatic illness,” Redfield said. “A number of the confirmed cases that we confirmed actually just presented with a little sore throat.””  (K)

“When 195 Americans, including diplomats, were evacuated from Wuhan, China, last month, they were tested for the coronavirus on arrival at a California military base. Health officials swabbed the throats and noses of everyone in the group — the first to be evacuated from Wuhan — and they were relieved when all of their tests came back negative.

But as more government-arranged flights evacuated Americans from China in the days that followed, the federal health authorities adopted a new protocol: Only people who showed symptoms of illness during a 14-day quarantine period would be tested. For some among the more than 600 people who are still waiting to be cleared to go home from military bases in three states, the new rule has left them worried — and angry. Some are pleading with the Centers for Disease Control and Prevention to test them for the coronavirus.

“We are not asking for skateboards or toys,” said Jacob Wilson, 33, one of more than 30 people in quarantine on a base in San Diego who signed a petition this week calling for tests. “We are asking to get tested and make sure we are not passing anything to other people.” (L)

The concerns come as three people in quarantine on bases in San Diego and San Antonio, Texas, tested positive for the virus, which has killed more than a thousand people in China but so far has been found to have infected only 15 people in the United States.

In San Diego, where 232 people are waiting out a government-mandated two-week quarantine, some evacuees said they worried that they and their children had spent days mingling with people — in an eating area, on a playground and in a laundry room — and would like to know for sure whether or not they have the virus.

Fifteen cases of the coronavirus have been confirmed in the United States, including a 35-year-old man in Washington State, a couple in their 60s in Chicago and eight people in California.

One of the people evacuated from Wuhan last week to San Diego had coronavirus but was discharged because of a labeling error.

Some evacuees are wondering why they aren’t being tested on bases…

“We believe testing everyone at the facility would help identify potential suspects as early as possible, so the appropriate treatment could be put in place,” the evacuees wrote in the petition, which they called a “suggestion letter” and shared with one another over WeChat, a Chinese instant-messaging app.

The C.D.C., however, has declined to test every evacuee. Officials said that such tests are less accurate before people show symptoms, so a negative early result could be misleading rather than helpful. The agency tested everyone on the first evacuation flight, the officials said, because they were learning about the virus and because doing so allowed them to collect more data about it. Since then, they said, they have determined that swabbing hundreds of seemingly healthy people is not useful.

“Every test has a limit of detection,” said Dr. Joseph Bresee, a deputy incident manager for the C.D.C.’s response to the coronavirus. “Early on, the test may or may not be able to pick it up.”

Almost everyone who gets sick from the virus will show symptoms within 14 days of exposure, often early within that window, Dr. Bresee said. Evacuees on military bases are having their temperature checked at least twice a day and are asked to alert health officials if they feel sick or if their temperature rises.

Dr. Bresee said that he empathized with evacuees who want definitive answers about whether they are healthy.

“They’re concerned, they’re nervous, and they want to be assured of their safety,” he said, adding that the cost of testing was not a factor in the decision not to test everyone. “We don’t think testing would be helpful, and if we did, we would test them.””  ..

“At the San Diego base, Marine Corps Air Station Miramar, Mr. Wilson and others said that people had to leave their rooms to get breakfast, lunch and dinner from a small room, which is also where their temperatures were taken. People rummaged through boxes of fruit and snacks with their bare hands, he said, and they stood shoulder to shoulder in line waiting to check their temperatures despite being told to stay six feet away from one another.

After the petition was circulated, health officials agreed as of Thursday to deliver meals and take temperatures at the room doors of evacuees who preferred it that way.

“The reality is, it’s impossible for us to keep any distace from each other,” said Mr. Wilson, a tech entrepreneur in Wuhan. He and others also said officials had not required evacuees to wear masks.

Earlier in the week, a labeling error led the authorities to return an ill woman to the base from a San Diego hospital, though a test later showed that she had the coronavirus. The mistake raised new worries among some evacuees. The C.D.C. had erroneously informed the hospital that the woman had tested negative for the virus when, in fact, her samples had not been tested. Health officials have tried to calm concerns, saying the woman had been isolated from other evacuees before returning to the hospital.

Dr. Bresee said that health officials were learning more about the virus each day, but that there were no plans to change testing procedures for the hundreds in quarantine.

“As we learn more, we may pivot,” he said. “It doesn’t mean we were wrong once and are right now, it just means we’re learning.”” (M)

“To combat the spread of the coronavirus, Chinese officials are using a combination of technology and policing to track movements of citizens who may have visited Hubei Province.

Mobile phone owners in China get their service from one of three state-run telecommunications firms, which this week introduced a feature for subscribers to send text messages to a hotline that generates a list of provinces they have recently visited.

That has created a new way for the authorities to see where citizens have traveled.

At a high-speed rail station in the eastern city of Yiwu on Tuesday, officials in hazmat suits demanded that passengers send the text messages and then show their location information to the authorities before being permitted to leave the station. Those who had passed through Hubei were unlikely to be allowed entry.

Other cities were taking similar measures.

Companies in China generally shy away from sharing location data with the local authorities, over fears it could be leaked or sold. And there were some signs that the companies were uncomfortable with the new rule.

China Mobile cautioned that the data should be used cautiously, because it indicates where the phone has been, not its owner. It also doesn’t differentiate between people who briefly passed through a province and those who spent significant time there. (N)

“Coronavirus Test Kits Sent to States Are Flawed, C.D.C. Says

Some tests distributed by the agency deliver “inconclusive” readings. The C.D.C. will need to ship new ingredients, further delaying results.

Some of the coronavirus testing kits sent to state laboratories around the country have flaws and do not work properly, the Centers for Disease Control and Prevention said on Wednesday.

The kits were meant to enable states to conduct their own testing and have results faster than they would by shipping samples to the C.D.C. in Atlanta. But the failure of the kits means that states that encountered problems with the test should not use it, and would still have to depend on the C.D.C.’s central lab, which could cause several days’ delay in getting results.

“Obviously, a state wouldn’t want to be doing this test and using it to make clinical decisions if it isn’t working as well, as perfectly, at the state as it is at C.D.C.,” Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, said at a news conference on Wednesday.

The C.D.C. recommends testing for some people who have symptoms like fever, cough or shortness of breath, and who, within the past 14 days, have traveled to China or have been in close contact with a patient known to be infected with the coronavirus. Doctors with patients in that category are supposed to consult their state health department about whether the patients should be tested for the virus…

Dr. Jeanne Marrazzo, director of the infectious diseases division at the University of Alabama at Birmingham, said accurate diagnostic tests were invaluable.

“The test is the only way you can definitely know you have the infection,” Dr. Marrazzo said. “You absolutely need it for case counting. It allows you to know who’s infected. You can treat those people, if a treatment is available, and you can isolate them.”..

The C.D.C. does not recommend testing for people who may have been exposed to the virus but have no symptoms. Even if they are infected, if they are still in the incubation period there may not be enough virus in their bodies for the test to detect.

The inability to detect very early infections is one reason for keeping planeloads of people from Wuhan in quarantine instead of just testing them and letting them go if the results are negative. A person could test negative and still be infected.

For the same reason, health authorities say there is no benefit to testing symptom-free people on cruise ships.

Because there is an unknown window of time between when a person becomes infected and when the test can find the virus, health officials have determined that a quarantine of two weeks — believed to be the incubation period of the illness — is the best way to make sure that people who may be infected do not transmit the virus to others.

Tests for other infectious diseases can also fail to detect some cases. A panel of tests used to screen for respiratory viruses when pneumonia is suspected can give negative results even if a patient is infected, Dr. Marrazzo said. So can rapid tests for flu and strep throat. Blood tests for H.I.V. can miss the diagnosis in people who were recently infected.”

“There is no perfect test for pretty much any infectious disease I can think of,” Dr. Marrazzo said. (O)

“The Diamond Princess cruise ship docked at Yokohama, Japan, on Friday. More than 200 coronavirus cases have been confirmed on the ship since it was quarantined last week.

The Diamond Princess cruise ship docked at Yokohama, Japan, on Friday. More than 200 coronavirus cases have been confirmed on the ship since it was quarantined last week.Credit…Jae C. Hong/Associated Press

The United States will evacuate Americans from the cruise ship that has been quarantined for more than a week in Japan because of coronavirus infections on board, the United States Embassy in Tokyo told Americans aboard the ship on Saturday.

American passengers and crew members were told in an email from the embassy that a chartered flight would arrive on Sunday for those who wanted to return to the United States.

The ship, the Diamond Princess, was placed under quarantine at the city of Yokohama early last week with about 3,700 passengers and crew members aboard, after a man who had disembarked in Hong Kong tested positive for the coronavirus. Since then, at least 218 cases have been confirmed aboard the ship.

There are about 400 Americans aboard, and at least 40 who were infected with the virus have been taken off the ship for treatment.

Americans will be subject to a 14-day federal quarantine and will be housed at two existing quarantine sites, in California and Texas, the Centers for Disease Control and Prevention said in a statement on Saturday.” (P)

“Errors by a hospital in San Diego and the US Centers for Disease Control and Prevention led to a woman with the novel coronavirus being sent back to Marine Corps Air Station Miramar instead of isolation at the hospital, according to a health official familiar with the situation.

The woman was among Americans in federal quarantine at the base, and is the first US evacuee from China known to be infected with the novel coronavirus.

She flew to the base on February 5 on a US Department of State flight evacuating Americans from Wuhan, China. The next day, she started experiencing symptoms of the novel coronavirus and was taken to UC San Diego Health. Three other people exhibiting symptoms were also transported to the hospital.

The hospital sent their specimens to a CDC lab in Atlanta for testing. According to the source, three of the four specimens were incorrectly labeled upon arrival and so they were not tested. The CDC lab did not realize the specimens were from the Miramar patients.

When no results were reported back, CDC staffers mistakenly gave UC San Diego Health the results of other patients who tested negative. That mistake led to the Miramar patients being transferred back to the base Sunday afternoon.

After they arrived back at the base, the mistake was discovered and the tests were run on the three Miramar patients.

The results for the woman came back positive, and she was transported back to UC San Diego Health on Monday morning, where she remains in isolation. The woman has had a very mild illness, according to the source, with no fever and a slight cough…

In a response Tuesday, the CDC said: “At all times, appropriate infection control precautions were taken around all of the persons quarantined at Miramar, including these three patients. From now on, a CDC laboratory staff member will form part of CDC quarantine field teams to ensure that specimens are correctly labeled/CLIA compliant to avoid delays in testing.””

During a press conference on Tuesday, Dr. Anne Schuchat, principal deputy director of the CDC, said “there was a little bit of a mix-up there” around the testing for the Miramar patient, but would not elaborate.” (Q)

“San Diego leaders declared a local emergency and public health emergency for seven days over the novel coronavirus, giving officials access to resources to address the virus.

CDC and county health officials cautioned that the declarations did not mean residents faced an increased risk of the virus.

Under the declarations, the county will be able to seek mutual aid, potentially be reimbursed for their response, and ensure resources to first responders and hospitals, stock pile medical supplies and gain access to hospital beds, and state and federal emergency funds if necessary.

“This action does not signify an increase in the risk to the residents in San Diego County to coronavirus,” Supervisor Nathan Fletcher told the media. “This is a step that positions us best to confront the challenges of this virus, this action best equips us to be in the strongest position to coordinate efforts, ensure access to available supplies, and best protect public health.”…

So far, San Diego has two confirmed cases of coronavirus. Those patients are under isolation at UC San Diego Medical Center.

According to Eric McDonald, medical director of the County’s Epidemiology and Immunization Branch, San Diego cases include:

Seven people are under investigation. Five of them have tested negative and two have tested positive;

Four non-San Diego residents who traveled to the region (but not Wuhan, China) monitored: Two tested negative and two have results still pending; Monitored 171 people returning from China with no symptoms: 48 have been cleared after self quarantine, 123 people are still being monitored. None are under investigation;

Thirteen San Diegans were on flights next to people confirmed for coronavirus. Eight people have been cleared after two weeks, four people are still self-quarantined, and one person was a person under investigation who has since tested negative.

MCAS Miramar has hosted two flights of passengers being evacuated from the coronavirus zone in Wuhan, China. Those passengers have been staying at the base under a 14-day quarantine. Once that quarantine ends next week, low to medium risk individuals will be asked to self-quarantine at home.” (R)

“Hundreds left a cruise ship in Cambodia. Then one tested positive for the coronavirus.

An American woman who disembarked from a cruise ship in Cambodia last week has tested positive twice for the coronavirus since flying on to Malaysia, officials in that country said on Sunday.

Cambodia allowed the ship, the Westerdam, to dock after five other ports  turned it away over concerns about the coronavirus.

Officials said more than 140  passengers from the ship had flown from Cambodia to Kuala Lumpur, Malaysia’s capital. All but the American woman and her husband had been allowed to continue to their destinations, including airports in the United States, the Netherlands and Australia. (S)

“A man who visited Hawaii was confirmed to have coronavirus when he returned home to Japan, Hawaii officials said Friday.

Health officials were tracking down details about his travel in the Aloha State, including his flight information and people with whom he had close contact.

The U.S. Centers for Disease Control and Prevention notified Hawaii about the man having the illness known as COVID-19 on Friday morning, Hawaii Health Director Bruce Anderson said.

The man was in Hawaii Jan. 28 to Feb. 7. He first visited the island of Maui, where he had no symptoms, Anderson said. He was on Oahu, the state’s most populated island, Feb. 3-7. While on Oahu, he had cold-like symptoms, but no fever, Anderson said.

He developed more serious symptoms when he returned to Japan, where he was tested and found to be positive for the illness, Anderson. He did not seek medical care in Hawaii, Anderson said.

Because of when his symptoms began, officials believe he became infected in Japan or while in transit to Hawaii, said state epidemiologist Dr. Sarah Park.” (T)

“The cruise ship had been shunned at port after port for fear it might carry the coronavirus, but when the Westerdam arrived in Cambodia on Thursday, the prime minister greeted its passengers with flowers.

Amid assurances that the ship was disease free, hundreds of elated passengers disembarked. Some went sightseeing, visiting beaches and restaurants and getting massages. Others traveled on to destinations around the world.

One, however, did not make it much farther than the thermal scanners at the Kuala Lumpur airport in Malaysia. The passenger, an American, was stopped on Saturday, and later tested positive for the coronavirus.

On Sunday, with passengers already headed for destinations on at least three continents, health officials were scrambling to determine how a big a problem they now have — and how to stop it from getting bigger.

“We anticipated glitches, but I have to tell you I didn’t anticipate one of this magnitude,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center.

With more than a thousand passengers from the Westerdam headed for home, Dr. Schaffner said, it may be harder than ever to keep the coronavirus outbreak contained to China.

“This could be a turning point,” he said.

It is unclear how well the passengers were screened before they were allowed off the ship. But the best approach to containing a broader spread of the virus from the Westerdam would be to track down all of the passengers and quarantine them for two weeks, experts said…

More than 140 passengers from the ship flew to Malaysia, and all but the American woman who tested positive and her husband were eventually allowed to continue on to their destinations, including the United States, the Netherlands and Australia, officials said. Over 1,000 other passengers took charter flights to Phnom Penh, the capital of Cambodia, and were in various stages of transit home, the cruise line said….

The global fight against the coronavirus is complicated by the fact that different countries may have different levels of disease surveillance and prevention measures. While the World Health Organization provides guidance, it is up to each country to enforce these standards, including whether to quarantine people who may have been exposed or to stop them from traveling.” (U)

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