EVERETT, Wash. — It started with a stubborn cough. A visit to an urgent care facility. A test being sent off to the Centers for Disease Control and Prevention. And then a 35-year-old resident of Snohomish County, Wash., being named the first confirmed case of the coronavirus in the United States.
Hollianne Bruce, the lone epidemiologist assigned to the control of communicable diseases in the county’s public health office, jumped into action. Declining to wait for a C.D.C. team to arrive from Atlanta, she dialed up the patient, who had been taken to an isolation unit at a hospital.
Seeking to establish a rapport, Ms. Bruce told him she knew he was not feeling well. She apologized for the disturbance. But she impressed on him how he might help save lives by sharing where he had been in recent days and with whom he had come into contact.
“We don’t know a lot about this virus,” she told him. “We’d like to ask you some questions.”
The man, who had been taken to the hospital the night before in a covered gurney intended for Ebola patients, agreed to help. It would be the first of several conversations he would have with Ms. Bruce, some by phone, others over a walkie-talkie as she stood outside his sealed room. Once, at his request, she bought him lunch at a nearby Panda Express.
In their conversations, she took him back six days, when he had returned from visiting family in Wuhan, China, the epicenter of the outbreak.
Could he tell her the dates of his travel? His flight number? His seat number?
How had he returned home from the airport? When did his symptoms start? Where did he work? Did he stop anywhere on the way to work? Did he stop on the way home? Had he gone out for any meals?
For Ms. Bruce, it was a relief to learn that the patient lived alone, that he took the stairs rather than the elevator to his office, and that he did not work in an open cubicle.
But he had attended a group lunch the day he developed a cough, and all eight of his lunch partners would be tracked down. Once he developed a cough, he had walked into a crowded health clinic. Thirty-eight other people who were in the clinic that day would need to be monitored.
The coronavirus, which has killed hundreds of people in China and sickened more than 20,000 in countries across the world, has been declared a global health emergency. To slow its spread, the Trump administration has invoked a rarely used constitutional power to impose a quarantine on Americans returning from the area around Wuhan.
But within the United States, containing the virus is a local responsibility. Across the country, where at least 11 more cases have since been confirmed, it is health officials at the county and municipal level who are scrambling to isolate the sick, learn where they have been and monitor those who have come into contact with them. Health workers are also debunking rumors, calming fears and bracing for the expected emergence of new cases.
At the Snohomish Health District, the staff of 113 has poured 1,000 hours into coronavirus control since the patient’s test was sent to the C.D.C. over the Martin Luther King’s Birthday weekend. Food inspectors, human resource managers and opioid outreach specialists have pitched in.
“All responses are local,” said Dr. Satish Pillai, an infectious disease specialist who headed an eight-person team that was dispatched from C.D.C. headquarters in Atlanta to monitor the case. “What happened in Snohomish is emblematic of what we need to evolve and improve our ability to respond to a virus we are seeing for the very first time in the United States.”
An account of the last two weeks at the Snohomish Health District — whose offices are festooned with messages like “Immunizations: They’re your best defense!” and “Save A Life: Give Your Blood” — offers a look at what may be in store for more of the nation’s 3,000 local health jurisdictions in the weeks to come.
Delivering a Thermometer
The Wuhan coronavirus still seemed far away on the evening of Jan. 19 when Dr. Chris Spitters, the district’s interim health officer, was alerted that a local clinic had sent specimens to the C.D.C. from a resident who had recently returned from Wuhan.
“In the first moments you kind of want to deny that this is happening,” Dr. Spitters recalled.
Dr. Spitters, who was out of town for the holiday weekend, asked Katie Curtis, the district’s assistant director of prevention services, to check on the man, who had agreed to remain isolated at home until the test results came back.
His symptoms were relatively mild. But health officials wanted to monitor him for fever and to make sure he had any supplies he might need so he did not need to leave his house.
He had plenty of food, the man told Ms. Curtis on the phone, but no thermometer.
When Ms. Curtis knocked on his door the next morning after picking up a thermometer at a pharmacy, he answered wearing a face mask. He promised to text her his temperature every few hours.
His first text came a few minutes later.
It was no cause for alarm.
But before the next one, Ms. Curtis called him with Dr. Spitters on the line. By then, a team of nurses and emergency medical technicians had been assembled. The simulation they had performed earlier in January on how to transport and quarantine a highly infectious patient was suddenly becoming reality. An isolation unit at Providence Regional Medical Center, meant for Ebola patients and never before used, was in the process of being erected.
“We have your test results,” Ms. Curtis told the patient.
‘Can I Cure It With a Lime?’
The reactions among the dozens of people potentially exposed to the patient ranged from anxiety to irritation. Some expressed gratitude to Ms. Bruce and the other health workers who reached out to them. There were several jokes about Corona beer.
“Can I cure it with a lime?” one wanted to know.
Only one person earned the notation “resistant to public health intervention.”
Everyone on Ms. Bruce’s “close contact” list received two phone calls from a public health worker to impress upon them the seriousness of the situation. They were required to take their temperatures twice a day and report any fevers or coughs. After that, they could opt to receive a text message, carefully worded so as not to raise alarm should another person see it.
“This is the Health District with your daily symptom check for your household,” it read. “Please reply with 1 if you have no symptoms, reply with 2 if someone in your household is ill.”
Across the county line, Ms. Bruce’s counterparts in King County were performing the same task with dozens of others who worked with the patient, were on his flight or rode with him from the airport. At least nine people who were exposed to the patient have developed symptoms that fell within the C.D.C.’s criteria for testing. Results for three of them are still pending; the others were negative.
A ‘Person Under Investigation’ Breaks Quarantine
In many ways, the coronavirus response was familiar ground for the local health workers, who routinely labor to prevent and control outbreaks of gastroenteritis, measles, tuberculosis and H.I.V.
The novel nature of the coronavirus added urgency — and a disquieting uncertainty — to the work. Who is most at risk? How soon do symptoms arise in people who are infected? How, exactly, is the virus transmitted?
During a season when nearly everyone has a sore throat, it was hard to know who among the contacts they were tracing needed to be tested and given the “PUI” designation, for “person under investigation.”
Those who were ordered to stay in their homes were taken care of. The groceries that the Seattle and King County public health department delivered to one prospective patient included hair conditioner, blueberries and 2 percent milk.
Still, when Ms. Bruce could not reach one of the people she was monitoring over the weekend of Jan. 25, she grew alarmed. After leaving a message with the woman’s emergency contact, she received a call at home that night. The woman explained that she had been in the process of moving to Wisconsin, and that she had taken her flight as planned.
“You did what?” Ms. Bruce asked. The woman has subsequently tested negative.
Accusations of a Cover-up
The people of Snohomish County had questions.
Why had local health officials not released the name of the clinic where the patient had received care?
Was this all a government scheme to sell vaccines? Was it safe to take children to the airport? Was the rumor at a local high school that a student had tested positive for the virus true?
There was no reason to believe, health officials told residents, that the patient had posed a risk to people with whom he had not been in reasonably close contact. To disclose the clinic location could create a false sense of panic, officials said.
There was no government scheme, officials made clear. They had tested no minors for the coronavirus, they said of the school rumors. And as for the airport, they said parents should encourage their children to wash their hands.
But it was hard for officials to keep up with the anxiety.
“This is an evolving situation,” reads a post on the health office’s Facebook page.
Seeking a Normal Life Again
Carrie Parker, the outreach and preparedness supervisor for the Snohomish Health District, took on the role of “incident commander” over the last two weeks. On Tuesday, she told her 30-person team that they might soon be returning to their day jobs.
The Snohomish County patient has been discharged from the hospital with instructions from Dr. Spitters to remain in isolation at home for now. Snohomish health officials declined to release his name, and his identity could not be determined.
In a statement, the man said he was continuing to get better and he thanked those who had cared for him. He expressed a desire to return to his normal life and “not to be in the public eye.”
