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A Coronavirus Death in Early February Was ‘Probably the Tip of an Iceberg’ A Coronavirus Death in Early February Was ‘Probably the Tip of an Iceberg’
(about 16 hours later)
SAN FRANCISCO — Weeks before there was evidence that the coronavirus was spreading in U.S. communities, Patricia Dowd, a 57-year-old auditor at a Silicon Valley semiconductor manufacturer, developed flulike symptoms and abruptly died in her San Jose kitchen, triggering a search for what had killed her. Flu tests were negative. The coroner was baffled. It appeared that she had suffered a massive heart attack.SAN FRANCISCO — Weeks before there was evidence that the coronavirus was spreading in U.S. communities, Patricia Dowd, a 57-year-old auditor at a Silicon Valley semiconductor manufacturer, developed flulike symptoms and abruptly died in her San Jose kitchen, triggering a search for what had killed her. Flu tests were negative. The coroner was baffled. It appeared that she had suffered a massive heart attack.
But tissue samples from Ms. Dowd, who died on Feb. 6, have now shown that she was infected with the coronavirus — a startling discovery that has rewritten the timeline of the virus’s early spread in the United States and suggests that the optimistic assumptions that drove federal policies over the early weeks of the outbreak were misplaced.But tissue samples from Ms. Dowd, who died on Feb. 6, have now shown that she was infected with the coronavirus — a startling discovery that has rewritten the timeline of the virus’s early spread in the United States and suggests that the optimistic assumptions that drove federal policies over the early weeks of the outbreak were misplaced.
The unexpected new finding makes clear that the virus was circulating in the Bay Area of California as early as January, even before the federal government began restricting travel from China on Feb. 2. It also raises new questions about where else the virus might have been spreading undetected.The unexpected new finding makes clear that the virus was circulating in the Bay Area of California as early as January, even before the federal government began restricting travel from China on Feb. 2. It also raises new questions about where else the virus might have been spreading undetected.
With little local testing throughout February — in part because of botched testing kits from the Centers for Disease Control and Prevention, along with strict guidelines that limited who could get tested — officials were not aware of the virus transmitting locally in the country until Feb. 26, in Solano County, Calif.With little local testing throughout February — in part because of botched testing kits from the Centers for Disease Control and Prevention, along with strict guidelines that limited who could get tested — officials were not aware of the virus transmitting locally in the country until Feb. 26, in Solano County, Calif.
Previous cases had involved people who had traveled to China, where the outbreak began, or who had been exposed to someone who was sick. But the Feb. 26 case in Solano County was of unexplained origin. Similar cases of community transmission were quickly identified in nearby Santa Clara County, which includes San Jose, as well as in Washington State and Oregon.Previous cases had involved people who had traveled to China, where the outbreak began, or who had been exposed to someone who was sick. But the Feb. 26 case in Solano County was of unexplained origin. Similar cases of community transmission were quickly identified in nearby Santa Clara County, which includes San Jose, as well as in Washington State and Oregon.
The new test results made public late Tuesday show that even this timeline failed to reveal how long the virus had been circulating. Ms. Dowd had not recently traveled outside the country, the authorities said, and yet she died a full 20 days before the earliest recorded case of community transmission. Another previously unconnected death in Santa Clara County, on Feb. 17, has also now been linked to the coronavirus.The new test results made public late Tuesday show that even this timeline failed to reveal how long the virus had been circulating. Ms. Dowd had not recently traveled outside the country, the authorities said, and yet she died a full 20 days before the earliest recorded case of community transmission. Another previously unconnected death in Santa Clara County, on Feb. 17, has also now been linked to the coronavirus.
“Each one of those deaths is probably the tip of an iceberg of unknown size,” Dr. Sara Cody, Santa Clara County’s medical officer, said in an interview.“Each one of those deaths is probably the tip of an iceberg of unknown size,” Dr. Sara Cody, Santa Clara County’s medical officer, said in an interview.
Gov. Gavin Newsom of California said on Wednesday that there could be “subsequent announcements” as investigations across the state further examine the early origins of the virus. He said investigators are looking at coroner and autopsy reports going back to December in some counties.Gov. Gavin Newsom of California said on Wednesday that there could be “subsequent announcements” as investigations across the state further examine the early origins of the virus. He said investigators are looking at coroner and autopsy reports going back to December in some counties.
Ms. Dowd, whose case was confirmed this week, worked at a company that had offices around the world, including in Wuhan, China, the city where the outbreak began, family and friends said.Ms. Dowd, whose case was confirmed this week, worked at a company that had offices around the world, including in Wuhan, China, the city where the outbreak began, family and friends said.
Public health authorities did not identify her, but her husband, Dean Dowd, a Santa Clara County correctional deputy, said he had been notified by public health authorities on Wednesday morning that the C.D.C. had confirmed the presence of the coronavirus.Public health authorities did not identify her, but her husband, Dean Dowd, a Santa Clara County correctional deputy, said he had been notified by public health authorities on Wednesday morning that the C.D.C. had confirmed the presence of the coronavirus.
Wednesday would have been their 25th anniversary, he said.Wednesday would have been their 25th anniversary, he said.
A longtime friend said that on Feb. 2, Ms. Dowd had complained of flulike symptoms. Four days later, he said, she was working from home, still feeling under the weather. Her daughter came home and found her collapsed at the breakfast bar in her kitchen, according to the friend, who asked not to be identified.A longtime friend said that on Feb. 2, Ms. Dowd had complained of flulike symptoms. Four days later, he said, she was working from home, still feeling under the weather. Her daughter came home and found her collapsed at the breakfast bar in her kitchen, according to the friend, who asked not to be identified.
Family members said they initially had wondered if Ms. Dowd had been suffering from Covid-19, the disease caused by the coronavirus. Her work as a company auditor for her firm, they said, brought her into contact with employees from all over the world and involved frequent travel.Family members said they initially had wondered if Ms. Dowd had been suffering from Covid-19, the disease caused by the coronavirus. Her work as a company auditor for her firm, they said, brought her into contact with employees from all over the world and involved frequent travel.
“She traveled all over for her job. Germany. Austria,” said her brother-in-law, Jeff Macias, who said she had also traveled at times to China.“She traveled all over for her job. Germany. Austria,” said her brother-in-law, Jeff Macias, who said she had also traveled at times to China.
She had gone to Beijing in November, according to the longtime friend.She had gone to Beijing in November, according to the longtime friend.
Across the country, doctors and public health officials have reported earlier cases of serious illnesses and deaths that preceded official diagnoses of the coronavirus. Only now are some of them being examined, and the new findings in Santa Clara County — suggesting that these suspicious earlier cases were instances of community transmission — shed light on the understated public health response to the widening outbreak.Across the country, doctors and public health officials have reported earlier cases of serious illnesses and deaths that preceded official diagnoses of the coronavirus. Only now are some of them being examined, and the new findings in Santa Clara County — suggesting that these suspicious earlier cases were instances of community transmission — shed light on the understated public health response to the widening outbreak.
Had there been earlier proof that the virus had already found a foothold in the United States, experts said, public health officials would have had more urgency to ramp up testing, prepare hospitals and assemble protective gear that might have prevented infections among health care workers and others.Had there been earlier proof that the virus had already found a foothold in the United States, experts said, public health officials would have had more urgency to ramp up testing, prepare hospitals and assemble protective gear that might have prevented infections among health care workers and others.
Instead, the focus in February was on quarantining thousands of travelers who were returning from China in the hope that infections could be identified, isolated and contained.Instead, the focus in February was on quarantining thousands of travelers who were returning from China in the hope that infections could be identified, isolated and contained.
“What in the end was that really going to accomplish if it was already here?” said Dr. Amesh Adalja, an infectious disease specialist and senior scholar at Johns Hopkins Center for Health Security.“What in the end was that really going to accomplish if it was already here?” said Dr. Amesh Adalja, an infectious disease specialist and senior scholar at Johns Hopkins Center for Health Security.
Officials in Santa Clara County said on Wednesday that the new cases were among more than a dozen deaths in the county that the medical examiner had suspicions about and ordered investigated.Officials in Santa Clara County said on Wednesday that the new cases were among more than a dozen deaths in the county that the medical examiner had suspicions about and ordered investigated.
Dr. Michelle Jorden, the Santa Clara County medical examiner-coroner, said Ms. Dowd’s case had piqued her curiosity, leading the county to examine it further. “It was when we were looking at the microscopic tissues and we decided — whoa! — this still looks infectious, and we are going to send the tissue to the C.D.C.,” she said.Dr. Michelle Jorden, the Santa Clara County medical examiner-coroner, said Ms. Dowd’s case had piqued her curiosity, leading the county to examine it further. “It was when we were looking at the microscopic tissues and we decided — whoa! — this still looks infectious, and we are going to send the tissue to the C.D.C.,” she said.
Tissue samples were sent to Atlanta for testing in mid-March, but the results confirming the coronavirus did not come back until Tuesday.Tissue samples were sent to Atlanta for testing in mid-March, but the results confirming the coronavirus did not come back until Tuesday.
It is unclear how the virus reached the people in these earliest deaths. In January, health officials identified a series of people who had traveled from China and then tested positive for the virus, but those cases were largely contained. At the time, President Trump said he did not think the virus would become a pandemic and declared that public health authorities “have it totally under control.”It is unclear how the virus reached the people in these earliest deaths. In January, health officials identified a series of people who had traveled from China and then tested positive for the virus, but those cases were largely contained. At the time, President Trump said he did not think the virus would become a pandemic and declared that public health authorities “have it totally under control.”
Federal health officials initially limited testing largely to those who had traveled from Wuhan, then expanded it to people coming from mainland China. Mr. Trump ordered travel restrictions, including health screenings for U.S. residents returning from mainland China, that began on Feb. 2.Federal health officials initially limited testing largely to those who had traveled from Wuhan, then expanded it to people coming from mainland China. Mr. Trump ordered travel restrictions, including health screenings for U.S. residents returning from mainland China, that began on Feb. 2.
By Feb. 26, Mr. Trump claimed that the limited number of cases in the country “within a couple of days is going to be down to close to zero. That’s a pretty good job we’ve done.”By Feb. 26, Mr. Trump claimed that the limited number of cases in the country “within a couple of days is going to be down to close to zero. That’s a pretty good job we’ve done.”
That was the same day community transmission began to emerge, first in California, then in the Portland, Ore., area, and near Seattle.
Dr. Cody led the effort to issue the nation’s first stay-at-home orders on March 16. But she said she would have issued them even earlier had she known about the February deaths.
“I think if we had had widespread testing earlier and if we had been able to document the level of transmission in the county, if we had understood then that people were already dying, we probably would have acted earlier than we did,” Dr. Cody said. She said officials had been hearing about a lot of people who were ill but did not meet the criteria for testing.
“It was just sort of this understanding that the testing capacity at the C.D.C. was very, very, very limited,” she said. When doctors would call them with suspicious cases, she said, county health authorities would have to explain that the cases did not qualify for testing.
“It got increasingly uncomfortable, right?” she said. “It didn’t make any sense. How are you going to detect community transmission if you’re only testing people with a travel history? Well you’re not.”
Updated June 22, 2020Updated June 22, 2020
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
That was the same day community transmission began to emerge, first in California, then in the Portland, Ore., area, and near Seattle.
Dr. Cody led the effort to issue the nation’s first stay-at-home orders on March 16. But she said she would have issued them even earlier had she known about the February deaths.
“I think if we had had widespread testing earlier and if we had been able to document the level of transmission in the county, if we had understood then that people were already dying, we probably would have acted earlier than we did,” Dr. Cody said. She said officials had been hearing about a lot of people who were ill but did not meet the criteria for testing.
“It was just sort of this understanding that the testing capacity at the C.D.C. was very, very, very limited,” she said. When doctors would call them with suspicious cases, she said, county health authorities would have to explain that the cases did not qualify for testing.
“It got increasingly uncomfortable, right?” she said. “It didn’t make any sense. How are you going to detect community transmission if you’re only testing people with a travel history? Well you’re not.”
There have been signs that the virus established itself long before community transmission was recognized.There have been signs that the virus established itself long before community transmission was recognized.
Researchers believe that cases in New York probably began circulating in mid-February. Trevor Bedford, a scientist at the Fred Hutchinson Cancer Research Center who studies the spread and evolution of viruses, has estimated that an outbreak in the Seattle area likely has roots back to about Feb. 1, or perhaps could be linked to the first reported case in the United States — a man who flew from China to the Seattle area on Jan. 15 and later tested positive.Researchers believe that cases in New York probably began circulating in mid-February. Trevor Bedford, a scientist at the Fred Hutchinson Cancer Research Center who studies the spread and evolution of viruses, has estimated that an outbreak in the Seattle area likely has roots back to about Feb. 1, or perhaps could be linked to the first reported case in the United States — a man who flew from China to the Seattle area on Jan. 15 and later tested positive.
But, until now, the first known deaths from the coronavirus were recorded in the Seattle area on Feb. 26.But, until now, the first known deaths from the coronavirus were recorded in the Seattle area on Feb. 26.
Whether and how the early cases might be related to later cases remains unclear. C.D.C. scientists are attempting to discern the genetic sequences of the virus from the three cases, which can be challenging when tissues are obtained after death.Whether and how the early cases might be related to later cases remains unclear. C.D.C. scientists are attempting to discern the genetic sequences of the virus from the three cases, which can be challenging when tissues are obtained after death.
So far, only relatively short pieces of genetic material have been obtained, said Kristen Nordlund, a spokeswoman for the agency. That was enough to confirm the diagnosis, but not large enough to detect the specific virus’s subtype, which could help identify potential links to other cases.So far, only relatively short pieces of genetic material have been obtained, said Kristen Nordlund, a spokeswoman for the agency. That was enough to confirm the diagnosis, but not large enough to detect the specific virus’s subtype, which could help identify potential links to other cases.
Dr. Charles Chiu, who has been examining the genetic signatures of the viruses circulating in the Bay Area, had previous suspicions about the Santa Clara cases. While many of the viruses landing in the United States have several mutations compared with the original strain in Wuhan, one of the cases examined at the end of February in Santa Clara had only one mutation.Dr. Charles Chiu, who has been examining the genetic signatures of the viruses circulating in the Bay Area, had previous suspicions about the Santa Clara cases. While many of the viruses landing in the United States have several mutations compared with the original strain in Wuhan, one of the cases examined at the end of February in Santa Clara had only one mutation.
That indicated that the cases there had a strong link to the original Wuhan strain.That indicated that the cases there had a strong link to the original Wuhan strain.
“It suggested that it was an early introduction,” Dr. Chiu said. Even still, he was surprised that a virus-related death occurred as early as it did in February. He is interested in seeing the genomic sequence of the new cases, although he suspects they are likely to be connected to the larger cluster in Santa Clara linked by the same signature mutation.“It suggested that it was an early introduction,” Dr. Chiu said. Even still, he was surprised that a virus-related death occurred as early as it did in February. He is interested in seeing the genomic sequence of the new cases, although he suspects they are likely to be connected to the larger cluster in Santa Clara linked by the same signature mutation.
The virus has an incubation period of up to 14 days, and people can be infectious before symptoms begin. Because Ms. Dowd had been ill for several days before dying on Feb. 6, it is possible that she could have transmitted the infection to others as early as January.The virus has an incubation period of up to 14 days, and people can be infectious before symptoms begin. Because Ms. Dowd had been ill for several days before dying on Feb. 6, it is possible that she could have transmitted the infection to others as early as January.
“This offers evidence of what many of us in the field had been saying,” said Dr. Adalja, the infectious disease specialist. “That restricting testing was going to miss cases that could have a chain of transmission that ended up with somebody dying.”“This offers evidence of what many of us in the field had been saying,” said Dr. Adalja, the infectious disease specialist. “That restricting testing was going to miss cases that could have a chain of transmission that ended up with somebody dying.”
Thomas Fuller reported from San Francisco, Mike Baker from Seattle, Shawn Hubler from Sacramento and Sheri Fink from New York. Katey Rusch contributed reporting from San Jose, Calif., and Tim Arango and Jill Cowan from Los Angeles.Thomas Fuller reported from San Francisco, Mike Baker from Seattle, Shawn Hubler from Sacramento and Sheri Fink from New York. Katey Rusch contributed reporting from San Jose, Calif., and Tim Arango and Jill Cowan from Los Angeles.