This article was updated March 2, 2020 at 3:30 pm. 

There are at least 5 confirmed deaths in the United States due to the novel coronavirus (COVID-19), all in the State of Washington.1 King County Executive Dow Constantine activated an Emergency Operations Center to coordinate responses across the region.2 

"We have moved to a new stage in the fight to contain, mitigate, and manage this outbreak," said King County Executive Dow Constantine in a press briefing on Monday.2

In a press conference Monday, Jeffrey Duchin, MD, health officer in Seattle and King Counties, said the number of deaths in King County has increased from 2 to 4, in addition to a previously-reported patient who died. There has also been 1 death in Snohomish County, Washington, bringing the total number of deaths to 6 in the state.2

According to the CDC, on Monday morning the US had 91 confirmed cases of COVID-19, including 48 people that were repatriated from either Wuhan, China, or the Diamond Princess cruise ship. There are currently 17 patients hospitalized in 10 states with confirmed cases.3

A long-term care facility in Washington has been of particular concern having at least 2 patients with COVID-19, including a health care worker. Other residents that have not yet been tested for COVID-19 are showing respiratory symptoms or have been hospitalized with pneumonia of unknown cause. The first reported death, a man aged in his 50s, was being treated at the same hospital but was not a resident of the long-term care facility.4

“The health of the residents, staff, and community of this skilled nursing facility are a top priority,” said Nancy Messonnier, MD, director of the National Center for Immunization and Respiratory Diseases, in a media briefing.4

Concerns in the State of Washington follow reports of possible community spread in Oregon and California. Although the CDC has only confirmed that these reports are “possible,” a press release said the preliminary information raises the level of concern about the immediate threat facing some communities in the US.4

The greatest risk is still to people who have been in close contact with COVID-19 patients, according to the CDC.4

Internationally, 5 new countries (Azerbaijan, Ecuador, Ireland, Monaco, and Qatar) have reported COVID-19 cases in the 24 hours ending 10am on Monday. There are now 87,137 confirmed cases globally, and 2977 deaths.5

The World Health Organization (WHO) has urged clinicians to focus on the clinical presentation, natural history, and treatment interventions for the virus.5

The majority of patients are adults, with only 2.1% of 44,672 patients in China under the age of 20 years. The most common symptoms include fever, a dry cough, and shortness of breath. Most patients (80%) still experience a mild illness, while 14% experience severe disease, and 5% are critically ill.5 Early reports suggest that illness severity is associated with patients over age 60 years and with comorbid disease. Mortality in those with critical illness has been reported at over 50%.5

Oxygen therapy is the major treatment intervention for patients with COVID-19, and all countries should optimize the availability of pulse oximeters and medical oxygen systems, according to the WHO.5

There is still no known effective antiviral therapy,5 though there are multiple ongoing ethics-approved clinical trials evaluating various therapeutic interventions.

Ensuring the availability of effective diagnostic tests has also been a major concern following earlier CDC reports that their diagnostics were inaccurate. As of February 28, 2020, the CDC said qualified labs can begin testing with existing CDC test kits. A third component of the test was determined to be the cause of inconclusive results, and the CDC said in press briefing that it can be excluded from testing without affecting accuracy.6

States that were able to validate their kits should continue with regular testing, while states that were able to validate only the 2 functional components can test using only those 2 components with revised instructions developed by the CDC.6

“While we’re working to amend the existing [emergency use authorization], we have discretionary authority from FDA to proceed in this manner,” Messonnier said in a press briefing on Friday. “This will increase testing capacity at state and local health departments. All positive test results will continue to be confirmed by the CDC for some time.”6

The FDA issued a policy update on Saturday, with the goal of expediting the availability of the diagnostic tests.7 The new policy allows for certain laboratories to use validated COVID-19 diagnostics before the FDA has completed review of the emergency use authorization requests.7

“Rapid detection of COVID-19 cases in the US requires wide availability of diagnostic testing to control the emergence of a rapidly spreading, severe illness,” said a statement from the FDA.7

The CDC is also developing a new serology test to determine how much of the US population has been exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. The test will look for the presence of antibodies, which would indicate whether the person had an immune response so SARS-CoV-2, regardless of whether the patient developed symptoms or remained asymptomatic.8


REFERENCES
  1. Washington State Department of Health, 2019 Novel Coronavirus Outbreak (COVID-19). https://www.doh.wa.gov/Emergencies/Coronavirus. Updated March 1, 2020. 
  2. Washington state officials hold briefing amid coronavirus outbreak [news briefing]. Streamed by CNBC Television, March 2, 2020. https://www.youtube.com/watch?v=o5DrRtXZh1k. Accessed March 2, 2020.
  3. Coronavirus Disease 2019 (COVID-19) in the US. Centers for Disease Control and Prevention; updated March 2, 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html. Accessed March 2, 2020.
  4. CDC, Washington State Report First COVID-19 Death [news release]. CDC website; February 29, 2020. https://www.cdc.gov/media/releases/2020/s0229-COVID-19-first-death.html. Accessed March 2, 2020.
  5. Coronavirus Disease 2019 (COVID-19) Situation Report 41. World Health Organization; March 1, 2020. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200301-sitrep-41-covid-19.pdf?sfvrsn=6768306d_2. Accessed March 2, 2020.
  6. Transcript for the CDC Telebriefing Update on COVID-19. Centers for Disease Control and Prevention; February 28, 2020. https://www.cdc.gov/media/releases/2020/t0228-COVID-19-update.html. Accessed March 2, 2020.
  7. Coronavirus (COVID-19) Update: FDA Issues New Policy to Help Expedite Availability of Diagnostics [news release]. FDA website; February 29, 2020. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-issues-new-policy-help-expedite-availability-diagnostics?utm_campaign=022820_PR_FDA%20Issues%20New%20Policy%20to%20Help%20to%20Expedite%20Availability%20of%20Diagnostics&utm_medium=email&utm_source=Eloqua. Accessed March 2, 2020.
  8. CDC Tests for COVID-19. Centers for Disease Control and Prevention; Reviewed February 25, 2020. https://www.cdc.gov/coronavirus/2019-ncov/about/testing.html. Accessed March 2, 2020.