PART 9. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”

 “A person in California who was not exposed to anyone infected with the coronavirus, and had not traveled to countries in which the virus is circulating, has tested positive for the infection in what may be the first case of community spread here in the United States, the Centers for Disease Control and Prevention said on Wednesday.

“At this point, the patient’s exposure is unknown,” the C.D.C. statement said. “The case was detected through the U.S. public health system and picked up by astute clinicians.”

The case was announced shortly after President Trump concluded a news briefing in which he said that aggressive public health containment measures and travel entry restrictions had successfully limited the spread of coronavirus in the United States.

It brings the number of cases in the country to 60, including the 45 cases among Americans who were repatriated from Wuhan, China — the epicenter of the outbreak — and the Diamond Princess cruise ship, which was overwhelmed by the virus after it docked in Japan.

Until now, public health officials have been able to trace all of the infections in the country to a recent trip abroad or a known patient.

This new case appears to be one of community spread — one in which the source of infection is unknown. It is possible the patient may have been exposed to a returning traveler who was infected, the C.D.C. said.” (A)

“The first suspected U.S. case of a patient getting the new coronavirus through “community spread” – with no history of travel to affected areas or exposure to someone known to have the COVID-19 illness — was left undiagnosed for days because a request for testing wasn’t initially granted, according to officials at UC Davis Medical Center in Sacramento, Calif.

The patient in Northern California is now the 60th confirmed case of the new coronavirus in the United States. The Centers for Disease Control and Prevention disclosed the latest case Wednesday evening, as President Trump assigned Vice President Pence to lead the administration’s response to the disease.

“This case was detected through the U.S. public health system — picked up by astute clinicians,” the CDC said in a brief statement about the new patient.

UC Davis included more details about the case in its own statement, drawing on an email sent to staff at its medical center. It said the CDC initially ruled out a test for the coronavirus because the patient’s case didn’t match its criteria.” (S)

“An American soldier in South Korea has tested positive for the new coronavirus, the U.S. military said on Wednesday.

The patient, a 23-year-old man, is based in Camp Carroll in Waegwan, only 12 miles from Daegu, the South Korean city at the center of  an outbreak in the country.

The soldier, the first U.S. service member to become infected, has been quarantined in his off-base residence, the military said.

The soldier visited Camp Walker, a military base in Daegu, on Monday and visited Camp Carroll from Friday to Tuesday.

South Korean and American “health professionals are actively conducting contact tracing to determine whether any others may have been exposed,” the military said.

The military added that it was “implementing all appropriate control measures to help control the spread of Covid-19 and remains at risk level ‘high’” for all its 28,500 soldiers stationed in South Korea “as a prudent measure to protect the force.” “(B)

“Why this looks like the beginning of a pandemic

These outbreaks outside of China, along with the latest science on Covid-19, suggest we may soon see a rapid rise in infections in more countries around the world. Here’s why.

1) The virus is very contagious, and some people seem to be able to infect others before they know they’re sick: Researchers currently believe one infected person generally infects two to three others, which would make the new coronavirus more contagious than other coronaviruses, like SARS and MERS…

2) Countries are still mostly looking for the disease in people who’ve traveled from China: The main method of screening in many countries is still testing passengers coming from China or from Hubei province only. But as we’ve seen, spread is happening beyond those people. And other cases may be undetected…

3) With flu season ongoing, it can take time to identify cases and outbreaks: “The challenge with this illness is that the clinical symptoms resemble other viral illnesses, like flu,” said Inglesby. So people with the flu, and doctors examining them, may not even be thinking of Covid-19 yet, especially in people who haven’t traveled to China.

4) China’s case toll is falling — but it may see another surge soon as travel restrictions are gradually lifted: The country has taken extraordinarily draconian measures to stop this virus, quarantining millions, and shutting down transit and travel. But the business community is growing increasingly frustrated with the restrictions and is pressuring government officials to ease some of them…

5) Many countries are only now getting testing up and running: Even the US, with one of the most highly resourced health systems in the world, doesn’t have adequate diagnostic capacity right now..

6) Some people may have abdominal pain before respiratory symptoms — and that’s not something health officials are screening for: This coronavirus is still very new, and we don’t know its entire spectrum of illness yet, but we’re learning the disease may sometimes surface in surprising ways. Though it’s a respiratory infection, a recent JAMA article found some have abdominal symptoms such as discomfort first. This means “we may not be detecting cases that do not present in the classic way with fever and respiratory symptoms,” said William Schaffner, an infectious disease expert at Vanderbilt University…”  (D)

“Outside China, there are now 2,790 cases in 37 countries, and 44 deaths,” WHO Director-General Tedros Adhanom Ghebreyesus said at a briefing in Geneva…

Tedros is urging the international community to have “hope, courage and confidence” that the new respiratory virus can be contained, citing 14 countries that haven’t reported a new case in more than a week.

Worldwide, there are currently 81,191 cases of the novel coronavirus, according to a dashboard created by the Johns Hopkins Whiting School of Engineering. That number includes 30,281 cases in which people recovered from COVID-19.

But Tedros also warned that the situation could get worse, saying, “At the same time, all countries, whether they have cases or not, must prepare for a potential pandemic.”..

On a broader scale, the WHO’s Tedros says every country should make it a top priority to protect workers who are dealing with the health crisis. And he says agencies should work with communities whose members are most at risk, “particularly the elderly and people with underlying health conditions.”

Despite the worrying rise of cases at the international level, Tedros again rejected calls Wednesday for the WHO to declare a pandemic, saying it’s not an accurate label for a virus he still views as containable. He has also recently noted that the virus’s fatality rate outside of Hubei province is less than 1%.

The WHO declared the coronavirus outbreak a global health emergency in January, as cases surged in China. The organization now says it believes the epidemic peaked and plateaued in China between the end of January and the early February.” (E)

“The World Health Organization (WHO) still avoided using the word “pandemic” to describe the burgeoning crisis today, instead talking about “epidemics in different parts of the world.” But many scientists say that regardless of what it’s called, the window for containment is now almost certainly shut. “It looks to me like this virus really has escaped from China and is being transmitted quite widely,” says Christopher Dye, an epidemiologist at the University of Oxford. “I’m now feeling much more pessimistic that it can be controlled.” In the United States, “disruption to everyday life might be severe,” Nancy Messonnier, who leads the coronavirus response for the U.S. Centers for Disease Control and Prevention, warned on 25 February. “We are asking the American public to work with us to prepare for the expectation that this is going to be bad.”

Dye and others say it’s time to rethink the public health response. So far, efforts have focused on containment: slowing the spread of the virus within China, keeping it from being exported to other countries, and, when patients do cross borders, aggressively tracing anyone they were in contact with and quarantining those people for 2 weeks. But if the virus, named SARS-CoV-2, has gone global, travel restrictions may become less effective than measures to limit outbreaks and reduce their impact, wherever they are—for instance, by closing schools, preparing hospitals, or even imposing the kind of draconian quarantine imposed on huge cities in China.” …

To prepare for what’s coming, hospitals can stockpile respiratory equipment and add beds. More intensive use of the vaccines against influenza and pneumococcal infections could help reduce the burden of those respiratory diseases on the health care system and make it easier to identify COVID-19 cases, which produce similar symptoms. Governments can issue messages about the importance of handwashing and staying home if you’re ill.

Whatever the rest of the world does, it’s essential that it take action soon, Aylward says, and he hopes other countries will learn from China. “The single biggest lesson is: Speed is everything,” he says. “And you know what worries me most? Has the rest of the world learned the lesson of speed?” (F)

“White House National Economic Council Director Larry Kudlow said Tuesday that the U.S. has “contained” the threat of a domestic coronavirus outbreak, breaking with the warnings of officials from the Centers for Disease Control and Prevention.

“We have contained this, I won’t say airtight but pretty close to airtight,” Kudlow told CNBC’s Kelly Evans on Tuesday afternoon…

Some of his comments stood in contrast to public pronouncements from CDC officials Tuesday that painted the coronavirus’ health threat to the U.S. as the most serious it‘s been.

Nancy Messonnier, who heads the National Center for Immunization and Respiratory Diseases, warned that American communities need to prepare now for the possibilities of remote work, teleschooling and other provisional measures when the disease starts spreading domestically.” (G)

“The Centers for Disease Control and Prevention on Tuesday warned that it expects the novel coronavirus that has sparked outbreaks around the world to begin spreading at a community level in the United States, as a top official said that disruptions to daily life could be “severe.”

“As we’ve seen from recent countries with community spread, when it has hit those countries, it has moved quite rapidly. We want to make sure the American public is prepared,” Nancy Messonnier, director of CDC’s National Center for Immunization and Respiratory Diseases, told reporters.

“As more and more countries experience community spread, successful containment at our borders becomes harder and harder,” she said.

There have been 14 cases of the virus diagnosed in the U.S., all in people who traveled recently to China or their close contacts. Another 39 U.S. residents have been infected in other parts of the world before being repatriated and quarantined. But CDC officials say the country could soon see more cases as the virus starts to spread through communities in areas outside China, including Iran, South Korea, and Italy.

The CDC urged American businesses and families to start preparing for the possibility of a bigger outbreak. Messonnier said that parents should ask their children’s schools about plans for closures. Businesses should consider whether they can offer telecommuting options to their employees, while hospitals might need to look into expanding telehealth services, she said.

“Disruption to everyday life might be severe,” Messonnier said, adding that she talked to her children about the issue Tuesday morning. “While I didn’t think they were at risk right now, we as a family ought to be preparing for significant disruption to our lives.”

The CDC’s messaging seemed to be at odds with the position of the World Health Organization, which reiterated Tuesday that countries could stop transmission chains if they acted swiftly and aggressively…

Messonnier said the CDC is evaluating data on measures that could be used to stem the spread of the virus, including school closures and other social distancing strategies, voluntary home quarantines, and surface cleaning methods. The CDC is using data from past flu outbreaks to study those strategies, but will tailor its recommendations for the new virus.

In a press briefing Tuesday afternoon, other top health officials pushed back on the perception that the public needs to take direct action now to prepare for community spread of the virus. They also doubled down on the message that the U.S. has successfully contained the spread of the virus thus far…

Messonnier said the CDC is also in conversation about whether to change the case definition that triggers a sick patient to be tested for the virus. Currently, health officials recommend testing only for people who have respiratory symptoms and have recently traveled to China, or those who have been in close contact with someone who was infected. But as community spread picks up in other countries, the case definition could change.” (H)

“President Donald Trump on Wednesday tried to ease growing fears over the spreading coronavirus, saying at the White House that his administration has the situation under control and is “ready to adapt” if the virus spreads.

“Because of all we’ve done, the risk to the American people remains very low,” Trump said. “We’re ready to adapt and ready to do whatever we have to as the disease spreads, if it spreads.

“We’re very, very ready for this,” Trump said, adding that only 15 people had contracted the virus in the U.S. and that all were expected to recover.

Trump, speaking from the Brady Briefing Room, said he was putting Vice President Mike Pence in charge of his administration’s response to the potential pandemic. Trump, however, rejected that he had made Pence a “czar” for the response to the virus.

Pence, speaking after Trump, reiterated that the “threat to the American public remains low” and said, “We will continue to bring the full resources of the federal government … to see to the health and well-being and to the effective response to the coronavirus in the United States of America.”

Trump — who this week announced a $2.5 billion plan to help combat the illness — said at the briefing, “We’re going to spend whatever is appropriate.”

Following the remarks of Trump and Pence, several senior officials from the National Institutes of Health and the Centers for Disease Control and Prevention spoke — and many didn’t paint quite as rosy a picture. One NIH official said a potential coronavirus vaccine was still at least a year away.

The president’s address came amid a tumbling stock market and grave criticism from Democrats who say his handling of the outbreak has been inadequate. It also came just a day after the CDC warned that it was only a matter of time before the illness, known as COVID-19, will spread across communities in the United States…

Measures to contain the virus in the U.S. so far have involved restricting travel to and from China — the center of the outbreak — and isolating identified cases.

Trump on Wednesday called those efforts “some very good early decisions” and indicated that he would consider restricting travel to South Korea and other countries “at the right time.”…

Federal health officials added Tuesday that they are preparing for a potential pandemic. CDC officials said the virus could disrupt daily lives, including closing schools, forcing people to work from home and delaying elective medical procedures.

Trump, asked Wednesday whether schools should prepare for a spread of the virus, replied that “every aspect of our society” should be prepared. He added that he doesn’t think it would come to that but that people should be prepared “just in case.”

But he also vacillated at various points during his news conference between agreeing with and rejecting the stark warnings of a broader potential outbreak issued by government public health experts.

Responding to a question about the likelihood of a U.S. outbreak, he said, “I don’t think it’s inevitable.

“It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”

At another point, Trump said, “Nothing is inevitable.” “ (I)

“Mike Ryan, head of the WHO’s health emergencies program, suggested countries need to be working full bore to be ready to deal with the virus.

“It is time to prepare. It is time to do everything you would do in preparing for a pandemic,” he insisted…

Mike Ryan, head of the WHO’s health emergencies program, suggested countries need to be working full bore to be ready to deal with the virus.

“It is time to prepare. It is time to do everything you would do in preparing for a pandemic,” he insisted.

Continuing to focus on trying to contain the virus — a goal many infectious diseases experts are skeptical can be met — buys time, Ryan said, noting if the illness can be prevented from spreading in Europe until flu season ends, hospitals won’t face a double blow.

“Even slowing down the virus by a month or six weeks has a massive positive benefit to the system,’’ he said.

But people need to be realistic about the limits of containment. “We cannot shut down the world,” Ryan said. “That’s not going to work.”

Countries should be working on trying to reduce the risk of imported cases, reduce the risk of spread from cases that get in, and increase the chance that people who get sick survive the infection. “But I think we have to be very, very careful in trying to suggest that we could absolutely stop the virus from spreading from one country to the next,” he said. “I don’t think that’s possible.”” (J)

“A federal health official warned Tuesday that the deadly coronavirus could cause “severe” disruptions in the USA as global experts struggled to fend off the outbreak and avoid a pandemic.

Is it too late?

“Disruption to everyday life may be severe,” Nancy Messonnier, director of the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, warned at a news conference Tuesday. Schools could be closed, mass public gatherings suspended and businesses forced to have employees work remotely, she said.

Messonnier said the coronavirus has caused sickness and death and sustained person-to-person transmission. That’s two of the three factors for a pandemic, she said.

“As community spread is detected in more and more countries, the world moves closer to meeting the third criteria – worldwide spread of the new virus,” Messonnier said.

Although the World Health Organization determined Monday that the term pandemic “did not fit the facts,” experts said it very soon could…..

Melissa Nolan, a medical doctor and professor of epidemiology at the University of South Carolina’s Arnold School of Public Health, cited new clusters in Iran, which faces at least 95 cases and has had 16 deaths, and Italy, which is dealing with 322 cases.

“If we continue to see focalized local transmission in areas outside of China, the WHO will need to reconvene,” Nolan told USA TODAY on Tuesday. “We are very close to seeing this virus becoming a pandemic.”

Nolan said responses to the outbreaks in Iran and Italy could help health officials in other countries prepare their own medical and quarantine policies before an outbreak. That is crucial, said Robert Glatter, an emergency physician at New York’s Lenox Hill Hospital who fears the world is on the “cusp” of a pandemic.

“Trying to contain a disease which spreads like influenza, in this case COVID-19, is almost impossible,” he said. “We are talking about rapid-fire and sustained transmission.”…

Ogbonnaya Omenka, an assistant professor and public health specialist at Butler University’s College of Pharmacy and Health Sciences, said he understands the concerns. The main implication of declaring a pandemic is requiring, or at least further urging, national governments to prepare facilities and health workers to treat a lot of patients, Omenka told USA TODAY.

“Not only is this costly, it may also trigger panic,” he warned. “Countries may as well put in place these plans without the official announcement.”

Tedros stressed that a pandemic declaration would not eliminate the need for health authorities to continue testing, limiting contact with the sick and encouraging frequent hand washing – the front-line defense….

Messonnier acknowledged the CDC struck a more urgent tone in warnings about the virus in the USA. The proliferation of coronavirus in countries outside China raised the agency’s expectations the virus will spread here.

“People are concerned about this situation –  I would say rightfully so,” Messonnier said. “But we are putting our concerns to work preparing. Now is the time for businesses, hospitals, communities, schools and everyday people to begin preparing as well.”

“It’s not so much a question of if this will happen anymore but rather more a question of exactly when,” an official said.” (K)

“When you start to see sustained transmission in other countries throughout the world, it’s inevitable that it will come to the United States,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told NBC News.

In the U.S., 57 people have been diagnosed with COVID-19, the illness caused by the new coronavirus. The majority are among repatriated residents who were passengers of the Diamond Princess cruise ship, docked in Japan.

The CDC said Americans should prepare for the possibility of disruptions to their daily lives if the virus were to start spreading in the U.S. That could include closing schools, working from home and delaying elective medical procedures.

“We should all be dusting off our pandemic preparedness plans and rehearse them very quickly,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University. “The core concept is social distancing.”

Business leaders, Schaffner said, should start considering which employees could work from home. Perhaps the time will come, he and other experts said, to observe religious practices and ceremonies at home, rather than attend larger community gatherings at places of worship. And families should start asking themselves how they would handle a week or two at home, without traveling even short distances for food, medicine or entertainment.”  (L)

“Gown, gloves, goggles, mask — deposit in biohazard container and wash hands for 20 seconds. That’s how to take it off safely. 

It’s a drill that’s becoming muscle memory for health care workers these days as hospitals and medical facilities prepare for the anticipated spread of the new coronavirus from China. Blanchard wants it to feel as routine for the Teaneck hospital’s staff as tying their shoes or fastening a seat belt.

Practice in donning and doffing personal protective equipment — or PPE, as it is called — has gained new urgency as the United States braces for a possible surge in infections. Health care workers are on the front lines…  

There has been no community transmission in the United States, Messonnier said. New Jersey has no cases.   

But the near certainty that the virus will arrive — whether in small, localized outbreaks or as a widespread epidemic — has state and local health officials and hospital leaders on the alert and concerned. 

In New Jersey, a governor’s task force meets weekly and has updated a preparedness plan. Hospital infection-control practitioners, chief medical officers and executives met with state health officials earlier this month. A conference call with 250 hospital executives — the second since the COVID epidemic began in China — is planned for later this week.

At individual hospitals, staff members are scanning for updates and new information on the virus, taking inventory of supplies, drawing up plans and reviewing infection-control procedures. One large system — RWJBarnabas Health — has a daily meeting of its emergency response team and a secure communication line systemwide.

“We don’t know who we may encounter in the Emergency Department,” said Jesson Yeh, an emergency physician at Holy Name who was part of that hospital’s training this week. “We need to be prepared for any possible situation, which may include people with viruses like the coronavirus, flu — Ebola, even.”

“Sometimes we do need a brush-up on how to prepare,” said Jennifer Temple, an Emergency Department nurse taking Blanchard’s review program. “Not that we forget. But it’s an emergency room; we want to work so fast. This is a great way to remind us.” 

Health care workers are the front lines of defense against the coronavirus’s spread as they diagnose and treat the sick. Their close proximity, exposure to the spray of coughs and sneezes and high touch contact as they do everything from take temperatures to insert breathing tubes vastly increases their risk of infection… 

For hospitals, that means two things, said Dr. Adam Jarrett, Holy Name’s chief medical officer: “The first thing we’re doing is reinforcing the training our staff has.” Then, “we’re making sure we have appropriate supplies.” 

Previous exercises involving government agencies across the nation “did show us that if we had a pandemic, there were going to be supply issues,” said Messonnier, of the CDC. “We are now thinking through and working on those supply issues,” to ensure there’s protection for health care workers. 

“There’s absolutely a shortage of masks and gowns,” said Jarrett, of Holy Name. “There hasn’t been a problem because there haven’t been any patients yet,” he said. “If there’s a significant outbreak in the tri-state area, I think there could be.”

CDC guidelines call for workers to wear N95 masks, which are also used in some construction or industrial settings. They form hard domes over the mouth and nose, with material like a HEPA filter filtering all air in and out. Hospitals are carefully controlling their use. Washable gowns might be used and thrown away, Jarrett said, if there aren’t enough disposable gowns. 

Another concern, depending on how the spread of the virus evolves, could be high rates of absentees among health care workers and other essential workers. New Jersey’s earlier pandemic flu preparedness plan, drafted in the wake of the 2009 swine flu epidemic, told hospitals to prepare for absences of 30% to 50%. 

CDC guidelines say health care institutions should err on the side of caution when workers may have been exposed to COVID-19 and show symptoms of fever or illness. They should stay home from work and self-quarantine, the agency suggested. 

Hospitals could manage those shortages by shifting the workers to concentrate on critical needs, employing temporary agency nurses, or canceling elective procedures, a spokeswoman for the state Health Department said. 

During Superstorm Sandy, for example, hard-hit facilities were able to waive standard credentialing procedures to make it faster to bring in personnel from other areas or out of state. “ (M)

“In New Jersey, Gov. Phil Murphy said preparations are ramping up. He noted that there are currently no confirmed cases in the state, but said it was prudent to anticipate that there would be.

“It’s pretty clear from financial markets the past couple of days, it’s pretty clear when you look at South Korea, Iran, Italy, that this is not going away anytime soon,” he said.

“We had a whole-of-government meeting this morning in Newark, just going over, once again, protocols, pre-emptive action — what do we do if X or Y happens,” he said, during remarks Wednesday at an unrelated news event at William Paterson University. “We’re doing everything to get out ahead of this and also be prepared as possible if something hits us.”

Murphy also said Health Commissioner Judith Persichilli on Wednesday was to convene a conference call with all hospitals in the state about preparations, noting that the state’s designated center for handling cases, University Hospital in Newark, “has a capacity of only so much.”.. (N)

“Against a backdrop of educated guesses — the state epidemiologist predicted it could be like a bad flu season with 500 deaths, but with no vaccine — Connecticut hospital officials said they have been drilling for weeks, got practice from the Ebola scare in 2014 and with the flu in 2009 and this year, and are ready for a coronoavirus outbreak if it comes to that.

In anticipation, as the virus spread in China, Hartford Hospital activated its emergency preparedness plan in early January, involving more than 300 units of the hospital, Dr. Ajay Kumor, chief medical officer, said at a news briefing Wednesday afternoon.

Gov. Ned Lamont outlines steps Connecticut has taken to prepare for coronavirus, urges residents to follow CDC guidelines to prevent spread of the disease »

For Dr. Mike Ivy of Yale-New Haven Hospital, the process is worn smooth on his lips: You have flu-like symptoms. You come into the emergency room. At the registration desk, you’ll be asked if you’ve traveled abroad to an area with there has been transmission of the virus — China, Iran, South Korea, Japan, northern Italy.

If the answer is yes, you’d be taken to an isolation room with negative air pressure, evaluated by a doctor and nurse and tested for coronavirus. You’ll be admitted if you’re sick enough, sent home if you’re not.

“People can isolate themselves at home so they do not infect anyone else,” said Ivy, deputy chief medical officer.

If you stay at the hospital, your treatment team will be wearing gowns, gloves and masks when they come in.

“And then, hopefully, you get better,” Ivy said, “as the majority of the patients do.”…  (N)

“Health organizations in Rhode Island said Tuesday that they are taking their coronavirus preparedness efforts to a higher level.

The United States said officials are warning Americans to prepare for the spread of coronavirus in communities across the country.

Doctors with Lifespan said they have created an emergency task force, so each facility can work together to combat the virus should it spread into Rhode Island…

The Rhode Island Department of Health said they’ve been having frequent talks with schools here, too.

A spokesperson for the University of Rhode Island said they have 50 students and one faculty member in Italy.

“The University remains in frequent contact with its study-abroad host partners, who have been communicating regularly with the students about the COVID-19 situation in Italy,” said the spokesperson.

Rhode Island Hospital Disaster Medicine and Emergency Preparedness Director, Dr. Selim Suner, said a concern is how exactly it’s spreading.

“We don’t know if it’s airborne yet because those studies have not been done,” said Suner…

The best preparation he said we know well.

“Hand-washing and keeping a distance from ill people is the best prevention,” said Suner.” (P)

“Reacting to concerns about the quickening spread of coronavirus, Gov. Andrew M. Cuomo said on Wednesday that the state would set aside some $40 million to fight the virus, as well as plan for possible quarantines at homes, hotels and hospitals.

In a briefing in the Capitol, the governor and his health commissioner, Dr. Howard Zucker, stressed that New York still had no confirmed cases of the virus, but warned that its spread to the state was inevitable.

The scope of the virus’s spread and the importance of New York as a center of global commerce and transportation led Mr. Cuomo, a third-term Democrat, to ask for additional funding for fighting the disease.

“It is highly probable that we will have people in New York State who test positive,” said Mr. Cuomo, noting that New York City is “the front door internationally” for many travelers. “No one should be surprised when we have positive cases.”

In addition to the $40 million from the Legislature, Mr. Cuomo said he would ask federal authorities permission to test patient samples in a laboratory in New York, rather than waiting several days for results from the C.D.C. in Atlanta….

State officials have already been taking precautions against the disease, asking some 700 recent visitors to China to voluntarily quarantine themselves, even as Customs and Border Protection agents continue to screen passengers at area airports. Individuals who have visited mainland China are judged to be of “medium risk,” according to the State Health Department, though it said none of those self-isolating individuals had exhibited symptoms of coronavirus.

In New York City, where officials say seven potential patients have been tested and cleared, Mayor Bill de Blasio has expressed confidence that the city is prepared, citing previous scares involving even more deadly diseases like Ebola in 2014…

 “We are in a state of high vigilance, high readiness, all elements of the city government, to address this crisis,” he said at a news conference on Wednesday. “We have the greatest public health capacity of anywhere in this country.”

The city has made 1,200 hospital beds available for anyone suspected of having coronavirus and has distributed 1.5 million face masks to health care workers.

But the mayor warned that the city needed help from the federal government in obtaining more protective gear — at least 300,000 more masks, he said — and stressed the importance of giving local health departments the ability to test for the virus on their own.

Other major cities were also taking precautions, including San Francisco, which declared a local state of emergency on Tuesday, despite no confirmed cases, saying “the global picture is changing rapidly.”

On Wednesday, officials at the Metropolitan Transportation Authority said they were working with state and federal health officials to assess potential contingency plans.

Those measures could include limiting or staggering public transit ridership, according to a document prepared by City Hall and the New York City’s Emergency Management Department in 2014 that focused on how the city might respond to a flu pandemic…

Similarly, state health officials were regularly consulting with the C.D.C. as well as county officials, and studying federal recommendations for mitigation in case of a large outbreak, including basic precautions such as covering one’s face when sneezing or coughing, to more expansive measures such as school closures and cancellation of public events.

“If you prepare correctly, you’ll have less of an issue when a situation develops into something that is more problematic,” Mr. Cuomo said. “The threat you don’t take seriously is the one that becomes serious.” (Q)

“A man in Miami went to the hospital to receive a test for the coronavirus after developing flu-like symptoms, only to receive the news that he didn’t have it — and a $3,270 medical bill, the Miami Herald reports.

Why it matters: The man had just returned from a work trip to China, so took his symptoms more seriously than normal, which is exactly what public health experts want people to do.

Our thought bubble: The episode would be a great parody of the health care system, if it wasn’t real.

The man has a short-term health insurance plan, which usually have skimpy benefits in exchange for lower premiums, and don’t have to cover pre-existing conditions. The Trump administration has expanded them.

The hospital told the Herald that the patient is only on the hook for $1,400 based on his insurance, but his insurer told him that first, he must provide three years of medical records to prove that his flu didn’t relate to pre-existing conditions.

And more bills are probably coming.” (R)