Here is a clear sign of how much things have changed over the last week when it comes to the global story of the 2019 novel coronavirus outbreak: On Monday, China imposed travel restrictions on flights coming in from South Korea, Italy, Iran, and Japan. With over 12,000 cases now outside China, and over 20 times as many cases reported outside China on Monday as were reported in China, it has reached the point where China is more concerned about cases coming in than going out.
What had looked like an epidemic that was leveling off is now a pandemic still on the rise. And in the United States, confirmed cases are at 111, with nine deaths. But one of those deaths is an odd one, because it’s not a new death—it’s one that happened last month, and as much relief as it may be to think that no one else has died, that’s not exactly good news.
This particular case is another in Washington state, someone who died in Seattle Harborview Medical Center on Feb. 26 after being in the hospital for just two days. But that was before the cluster of cases in King County made it clear that northwest Washington had COVID-19 circulating within the population. This person was a resident at the same Kirkland long-term care facility that has been the center of the local cluster, but the data pushes things back a couple of days and makes it even clearer that coronavirus had been circulating in the area for some time. It’s just that in a nursing home filled with elderly people who have other medical conditions, the novel coronavirus found a “sweet spot” for generating visible symptoms and bad outcomes.
Think of the Kirkland Life Center as a smoke alarm that went off at the edge of a growing cloud—it responded to COVID-19 because all the elements were there to generate a response. But how big or even how intense the fire may be is still unclear. The nursing facility is probably not the source of the disease; the people there weren’t exactly making jaunts to Italy or China. It’s not even as if the virus grew more efficiently in the facility than it did elsewhere. It was just more noticeable.
All of this just points out again how badly the United States needs to engage in more widespread testing for COVID-19. How bad is the testing status, three months after novel coronavirus first reached the attention of people outside Wuhan? It’s this bad: so bad that a woman who works in the healthcare industry, in the area of the greatest number of known infections, displaying symptoms that fit COVID-19, who knows she has cared for dozens of patients over the last few days, is still told that she doesn’t fit the profile for testing. Is still told that tests are only for those who have been outside the country or exposed to known cases.
This is a recipe for never getting ahead of an outbreak. And that’s not just been the case in the United States. Again and again, in country after country, there have been stories almost identical to the story above. It’s an aspect of that assumption that I wrote about on Monday, that there are evil red areas on the epidemic map, and nice safe white areas, when the truth is that, probably for some time now, everywhere is at least a little pink.
To be effective, nations have to stop assuming that there are imaginary firewalls out there that the infection cannot cross and begin widespread programs of testing based on both symptoms and exposure. Unfortunately, in nation after nation, that conclusion has been reached only after the “red zone/white zone” scheme has broken down. South Korea is now testing thousands of people a day, but it began doing so only after it was clear that attempts at regional isolation had completely failed. Ditto Italy. But not ditto everyone: France tested over 7,000 people even before the case numbers exploded in Italy. The U.K. tested 9,000. That was a month ago.
As of yesterday, the United States has still tested … well, we really don’t know. The number was below 500, but on Monday the CDC removed the number of people tested from the information it provides on its website.
Oh, and there’s this.
The number of recoveries has continued to increase, but look at the top of the orange section: The reason that it has stopped sloping downward and has resumed an upward climb is that the number of new cases outside of China has reached the point where it is overwhelming the number of recoveries that come from all those Chinese cases back in early- to mid-February. From this point on, expect the number of active cases to continue trending upward with the total case number until the total global pandemic values begin to ease. When that will happen is anyone’s guess, but it’s likely to climb steeply over the next two months at least.
I’ve been threatening to get rid of this pseudo-3D chart with its nearly impossible-to-read quantities and an overall layout that would make Edward Tufte belt me one for some days. At this point, it’s told about all it has to tell: The world has developed multiple regional epicenters. Those epicenters are generating challenges for neighboring countries, making international travel of all sorts an increasingly volatile crap shoot. The United States has actually been exceedingly lucky in this series of events. Neither Mexico nor Canada has exploded as a regional source. Despite a handful of cases in Central American nations over the last few days, there is no evidence that any cases of coronavirus have crossed into the United States without taking an airplane. If there is any risk, it’s that the United States, which now has by far the highest number of cases in the hemisphere, will become a regional epicenter that threatens to export infection to its neighbors.
In any case, say goodbye for now to the time sequence chart. If it has anything new to reveal, I may revive it at some future date.
Again, the map does not reflect locations where people who were identified as being infected outside the United States, such as passengers on the Diamond Princess cruise ship, are currently quarantined. So some states that are indicated on other maps are not highlighted here.
The most interesting case on Tuesday has to be that in Wake County, North Carolina. While that case does involve a traveler, that traveler had not just returned from Italy or China or Iran. That traveler had, in fact, just returned from Kirkland, Washington, where they visited that nursing home. Assuming this is someone who traveled across the country to visit an elderly relative in that facility, that’s pretty laudable behavior—which only makes it suck even more that the result of that trip was a coast-to-cast case of community transmission. And it shows once again how difficult it is to draw a line dividing areas that are safe and not safe.
I’m not going to quote that line spoken by Jeff Goldblum’s character in Jurassic Park—because I hate that line, and the whole way that Goldblum’s character is used to obfuscate chaos theory into something that’s painted over plain old bad plotting—but constraining a virus within a prescribed area is really difficult. It takes a government willing to act in a way that discounts political consequences and concerns over minimizing disruption. And it takes testing that gets out ahead of the spread of disease. We don’t have either of those things.
After days in which I’ve complained that numbers from Iran were barely worth posting, because they clearly underestimated the scale of the local outbreak, there is another potential epicenter where that is also true. Unfortunately, most of us are living in it.
So we will have more orange states on that map.