Nancy Messonier
Nancy Messonier: ‘Historic public challenge’

A skilled nursing facility in the state of Washington became the first U.S. site of a coronavirus outbreak, officials announced Saturday. 

By Sunday, there were reports of one dead resident and four others hospitalized due to the virus, which has sent ripples through national economies globally.

More than one-sixth of the nearly 300 residents and workers at the Kirkland, WA, facility had been reported as symptomatic Saturday, healthcare officials said during a Centers for Disease Control and Prevention teleconference call.

Two people from the nursing facility, Life Care Centers of Kirkland, had been tested positive for COVID-19 as of Saturday. One was a health worker in her 40s, who was listed in satisfactory condition, while the other was described as a resident in her 70s who was in “serious” condition and already suffered from significant chronic health problems. Officials said that approximately 27 of 108 residents and 25 of the 180 staff members had displayed symptoms.

Life Care Centers issued a statement early Sunday afternoon that said the first two infected individuals were at a local hospital, and that many others exhibiting what could be flu or pneumonia symptoms were being assessed. No visitors or new admissions were being allowed at the facility. 

A recent report in JAMA noted that the coronavirus in China has had a 1% to 2% fatality rate — but that soars to 8% to 15% in the elderly population.

“We are very concerned about an outbreak in a setting where there are many older people, as we would be wherever people who are susceptible might be gathering,” said Jeff Duchin, health officer for public health for Seattle and King County. 

A local medical authority said he did not believe there was a connection between the nursing home cases and the first U.S. fatality attributed to COVID-19, a man in his 50s who died at a hospital that is also located in Kirkland, a Seattle suburb.

“I think … what we’re seeing is the tip of the iceberg,” said Frank Riedo, the medical director of infection control at EvergreenHealth Hospital, where the death occurred. “We’re seeing the most critically ill individuals. Usually that means there’s a significant percentage of individuals with less severe illness floating around out there. So in all likelihood there is ongoing low level transmission.”

On Sunday, health officials said that the virus might have been circulating in Washington for six weeks before the Kirkland cases became known.

While acknowledging there had been several community outbreaks but not a national spread of COVID-19 yet, Nancy Messonier, director of the National Center for Immunization and Respiratory Diseases, on Saturday called the situation “an historic public health challenge.”

On Friday, the Society for Post-Acute and Long-Term Care Medicine issued guidelines for responding to the coronavirus threat. The American Health Care Association also issued updated guidelines over the weekend.