The first case of Coronavirus Disease 2019 (COVID-19) as a result of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed in New York City by Governor Andrew M Cuomo, on Sunday March 1, 2020.1

The patient, a woman aged 39 years, was a healthcare worker and is believed to have contracted the infection while traveling in Iran. She returned from Iran a week before diagnosis with COVID-19 and began experiencing respiratory symptoms. The patient presented to an undisclosed hospital in New York City during which she was evaluated and provided a sputum sample, which was tested in a laboratory in Albany, NY. Although this test confirmed that the patient had SARS-CoV-2, the results will be reviewed by the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. 

Likely due to her experience as a healthcare worker, the patient took several precautions upon returning from Iran, including not using mass transit. New York City’s Health Commissioner, Oxiris Barbot, MD, reported that all “close contacts of the patient” have been identified and measures are being taken to ensure that further transmission of the virus is minimal.1

As the outbreak of COVID-19 continues, reports indicate that community infections are likely to increase, but officials have stressed that this is not a cause for undue concern.1 The CDC has highlighted the importance of hand-hygiene, and cough/sneeze precautions (doing so into the crook of your elbow).2,3

As of March 2, 2020, there have been 88 confirmed cases of COVID-19 in the United States, including 45 cases as a result of the outbreak aboard the Diamond Princess cruise ship, and 3 cases from Wuhan, China, all of whom were repatriated to the United States.4 However, these numbers are increasing daily.

Further, reports from Washington state have confirmed the first US deaths related to the infection. Officials from Washington reported the death of a man aged in his fifth decade with underlying medical conditions on February 29, 2020. On the same day a second individual died, aged in his seventh decade, who also had underlying medical conditions. Of note, both individuals were patients at a long-term nursing home facility in the Seattle area, though only one was a resident at the facility.5,6 As of March 2, 2020, 6 residents at this facility, including the 2 aforementioned individuals, have died.7

The 2 deaths related to the infection have raised a secondary issue: community transmission of the virus. The facility in Seattle where these 2 patients received care has reported 4 additional cases of COVID-19.5,6,7,8 Three of these cases are of individuals aged >70 years, all of whom have underlying medical conditions and are in a critical condition; the fourth individual is a healthcare worker at the facility. Moreover, researchers conducted genetic sequencing of 2 virus samples; one from the first confirmed case of SARS-CoV-2 in the United States (Snohomish County, Seattle, Washington), and the other was from a recently confirmed case of the infection in a teenager from the same county, who had no history of travel or exposure to individuals with known infection. 

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Analysis of the samples demonstrated that the strains were nearly identical; scientists stated that it would be statistically unlikely for such genetic similarity, including a rare genetic variation, to be the result of 2 distinct viral infections.8,9,10 This discovery highlights the fact that SARS-CoV-2 may have been circulating undetected in Washington for roughly 6 weeks. Researchers estimated this may have resulted in 150 to 1500 COVID-19 infections, and that these cases are expected to be in various states of infectiousness to full recovery, based on current knowledge regarding incubation periods and the general transmissibility of the virus.9,10

The CDC widened criteria for its recommendations on how to evaluate individuals who are suspected of having COVID-19 on February 27, 2020.10 Subsequently, health officials anticipate that the number of cases in the United States may continue to significantly increase. However, given the previous criteria and the possibility of as many people as cited above exposed to the infection, the spokeswoman for the Snohomish Health District, Heather Thomas, stated, “It is definitely possible that COVID-19 has been circulating, with people experiencing mild symptoms just like the flu.”10

Similarly, New York City Mayor de Blasio stated the city’s health officials had “been in a state of high alert for weeks, and are fully prepared to respond.”1

References

  1. Goldstein J, McKinley J. Coronavirus in NY: Manhattan woman is first confirmed case in state. The New York Times. March 1, 2020.. Published March 2, 2020. Accessed March 2, 2020. https://www.nytimes.com/2020/03/01/nyregion/new-york-coronvirus-confirmed.html
  2. Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19): prevention & treatment. Updated February 15, 2020. Accessed March 2, 2020. https://www.cdc.gov/coronavirus/2019-ncov/about/prevention-treatment.html
  3. New York State Department of Health. Novel coronavirus (COVID-19) . Updated March 2020. Accessed March 2, 2020. https://www.health.ny.gov/diseases/communicable/coronavirus/
  4. Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19) in the U.S. Updated March 2, 2020. Accessed March 2, 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html
  5. Centers for Disease Control and Prevention: Washington state report first COVID-19 death.. Updated February 29, 2020. Accessed March 2, 2020. https://www.cdc.gov/media/releases/2020/s0229-COVID-19-first-death.html
  6. Washington State Department of Health. 2019 Novel Coronavirus Outbreak (COVID 19). Updated March 1, 2020. Accessed March 2, 2020. https://www.doh.wa.gov/Emergencies/Coronavirus
  7. Baker M. Three more deaths in washington state nursing care center, site of coronavirus outbreak. The New York Times. Published March 2, 2020. Accessed March 2, 2020.
  8. Achenbach J, Mettler K, Sun LH, Guarino B. Coronavirus may have spread undetected for weeks in Washington state, which reported first two deaths in U.S. Washington Post. Published March 1, 2020.. Accessed March 2, 2020. https://www.washingtonpost.com/health/coronavirus-may-have-spread-undetected-for-weeks-in-washington-state/2020/03/01/0f292336-5bcc-11ea-9055-5fa12981bbbf_story.html
  9. Silverman H, Yan H. 6 people have died from novel coronavirus in the US as cases nationwide surge. CNN. PublishedMarch 2, 2020. Accessed March 2, 2020. https://www.cnn.com/2020/03/02/health/us-coronavirus-cases-monday/index.html
  10. Fink S, Baker M. Coronavirus may have spread in U.S. for weeks, gene sequencing suggests. The New York Times. Published March 1, 2020.. Accessed March 2, 2020. https://www.nytimes.com/2020/03/01/health/coronavirus-washington-spread.html
  11. Centers for Disease Control and Prevention. Evaluating and reporting persons under investigation (PUI).. Updated February 28, 2020. Accessed March 2, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html