A number of developments occurred over the weekend and I have covered these in (more or less) real time on our Twitter account (@santa_care). For a more distilled and, hopefully, informative summary, please keep reading.

Most concerning and illustrative of the challenges ahead was the emergence over the weekend of #COVID-19 at the Life Care Center of Kirkland, Washington. At this writing, coronavirus infection in this community has led to one death (a male with chronic health conditions in his 70s, the second coronavirus death in Washington State) and four others hospitalized, with three in critical condition. A health care worker in her 40s also remained in satisfactory condition.

Further, of the nursing home’s 108 residents and 180 staff members, more than 50 have shown signs of possible COVID-19 infections. Visits from families, volunteers and vendors have been halted and new admissions placed on hold. To put this in perspective, 2.2 million Americans live in long-term care settings and may be at heightened risk of COVID-19 because of age and underlying health conditions.

The American Health Care Association issued updated guidelines Saturday, in response to the Washington outbreak. Although the guidelines are geared to a healthcare facility, it is useful to read them as they reiterate preventive steps that can be taken, primarily frequent hand sanitation. These guidelines can be found at: https://www.ahcancal.org/Survey-Regulatory-Legal/Emergency-Preparedness/Pages/default.aspx

Additionally concerning, community transmission of the virus has now been detected in California, Oregon and Washington. A fascinating genomic analysis of the virus performed by researchers at Seattle’s Fred Hutchinson Cancer Research Center showed that community based transmission in Washington State has likely been ongoing for the past 6 weeks. While the details of genomic phylogeny are beyond the scope of this post, Trevor Bedford, a computational biologist who is tracking the virus, estimated there could be “a few hundred” infections in the state.

After a significant flaw (likely due to contamination in the Atlanta lab making COVID-19 test kits), the CDC has now developed a new laboratory test kit for use in testing patients for the virus that causes COVID-19. The test kits will be shipped to qualified international laboratories, such as the World Health Organization (WHO) Global Influenza Surveillance Response System (GISRS). The test will NOT be available in U.S. hospitals or other primary care settings. Yes you read that last sentence correctly.

After being criticized for an overly narrow case definition, the CDC will now begin testing patients for COVID-19 if they have recent travel history to China, or Iran, Italy, South Korea, or Japan, as well as fever and signs of respiratory illness. Patients with signs of severe lower respiratory infections without alternative diagnosis (such as influenza) will also be tested.

In South Korea, concerned individuals can be tested at ‘drive through’ testing facilities. Demand for checks has soared there and the entire roadside testing procedure taking less than 10 minutes.

There are now 87 reported cases in the United States with 2 deaths (both in King County, Washington). A total of 7 individuals have recovered although details of their successful treatment have yet to be published in the medical literature. There are, undoubtedly, many more infections and widespread testing will reveal the extent of COVID-19 spread in the United States. Until then, the following advice continues to hold: