<![CDATA[Coronavirus: US officials overruled expert advice on listing places visited by Patient 1]>
Washington state health officials overruled expert advice calling for the public naming of locations visited by the first coronavirus patient in the United States before he tested positive on January 20, raising fresh questions about how US authorities responded to the outbreak during the crucial early days before it spiralled into a national emergency.
Washington state Secretary of Health John Wiesman made the decision not to reveal the locations despite the recommendations of a senior epidemiologist at the state health department, emails obtained by the South China Morning Post through a public records request reveal.
The internal discord in one of the worst-hit US states at the onset of the outbreak comes as federal authorities struggle to manage a rapidly escalating number of coronavirus cases nationwide amid partisan fighting over stimulus measures and looming shortages of intensive care beds and ventilators.
A health care worker wears a face mask as she leaves a nursing home at the centre of the outbreak in Washington state. Photo: AP alt=A health care worker wears a face mask as she leaves a nursing home at the centre of the outbreak in Washington state. Photo: AP
Washington state has confirmed nearly 2,000 cases of the virus that causes the respiratory disease Covid-19. Almost 100 people have died, including at least 35 patients at a single nursing home in Seattle's eastern suburbs.
The number of confirmed cases in the US overall as of Monday stood at more than 32,000, including about 400 deaths, making it the country with the most known infections after China and Italy.
The response of Washington state, which President Donald Trump on Sunday declared a national disaster area along with New York state, contrasts sharply with that of Asian authorities that have been credited with slowing the spread of the virus with strategies including the public disclosure of detailed information about the locations and movements of infected patients.
On January 22, Meagan Kay, Regional Health Administrator for King County in Seattle, wrote in a response to Jeffrey Duchin, the King County Health Officer, that recommendations he sent to her after consultations with the health secretary differed from an earlier plan shared with county officials by Chas DeBolt, a senior epidemiologist at the state department of health.
Emails obtained from the Washington State Department of Health. Photo: Handout alt=Emails obtained from the Washington State Department of Health. Photo: Handout
" ... this is different from what Chas just shared with our staff as the plan from DOH. They wanted to list the sites," Kay said.
Kay was referring to the locations visited by the first US patient, a man in his 30s from greater Seattle, before his diagnosis.
Emails obtained from the Washington State Department of Health. Photo: Handout alt=Emails obtained from the Washington State Department of Health. Photo: Handout
In two follow-up emails, Wiesman, the state's top health official, responded with "the team here has this decision" and "this is a decision made".
Under the plan cleared by Wiesman and Duchin, which is described in emails, it was decided not to disclose locations if they were not judged to be an "exposure risk", and to only identify people who came into close contact with the patient if they could not be contacted and advised by the department.
A chain of emails obtained from the Washington State Department of Health. Photo: Handout alt=A chain of emails obtained from the Washington State Department of Health. Photo: Handout
In a later email, Shauna Clark, a public health nurse for King County, wrote that she had informed DeBolt and Meredith Li-Vollmer, a risk communication specialist for King County, of the "plan for disclosure" agreed to by Wiesman and Duchin, and everyone was on the "same page now".
DeBolt did not respond to requests for comment.
US officials at ground zero for coronavirus overruled expert advice on disclosing locations visited by Patient 1. Photo: Handout alt=US officials at ground zero for coronavirus overruled expert advice on disclosing locations visited by Patient 1. Photo: Handout
Although Washington state officials have not specified the patient's precise movements in the US, he is known to have returned from Wuhan, China " where the virus was first detected " via Seattle-Tacoma International Airport on January 15, and taken group transport with other people from the airport.
Lisa Stromme, a spokeswoman for Washington State Department of Health, said officials had determined that two locations visited by the first patient were not a high risk to the public.
"Based on conversations with the first case, two public locations with no named close contacts that the case had visited after becoming ill could be identified," Stromme said. "The case could not provide exact times that the visit occurred, and he denied close contact with any persons present at either location. The decision against posting public information about these two locations was made based on the information available " i.e., persons that might have been present at either location did not seem to have been at high risk of exposure and exact times that the case had visited those locations could not be ascertained."
Stromme said authorities had worked meticulously to identify all close named contacts of the patient for follow-up, including quarantine and testing, adding that a public announcement would have required "exact times" and "a determination that persons present at the location were at high risk for transmission".
Asian jurisdictions such as Hong Kong, Singapore and South Korea have claimed some success in halting the virus with strategies that include disclosing detailed information about the movements of patients to encourage the public to contact authorities if they visited an at-risk area.
In Hong Kong, which has confirmed about 320 cases, authorities created a digital map which includes patients' travel histories, including flight numbers and taxi routes, as well as the names of buildings where they worked or stayed while symptomatic.
Singapore's government launched a contact tracing mobile app called TraceTogether which uses bluetooth to monitor if users were in close proximity to each other. The information becomes an encrypted log stored in the phone, and is only unscrambled if a user becomes infected and alerts health authorities.
South Korean authorities have gone even further, sending the public text alerts with detailed information about the movements of patients before their diagnosis, including the names of shops, hotels and restaurants.
Although it has raised some privacy concerns, South Korea's approach " which also includes the aggressive tracking down of contacts through the use of CCTV footage, credit card transactions, and GPS data from mobile phones " has received international plaudits for slowing the spread of the virus after a large-scale outbreak connected to a secretive religious sect.
"The point is to motivate those who were unknowingly at the same place at the same time in contact with the patients to report for triage examination, if they have symptoms," said Cho Sung-il, a professor of epidemiology at Seoul National University. "Otherwise they might go undetected and likely spread further."
Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations in New York, said while the public disclosure of the movements of patients would inevitably raise privacy fears in the US, it could have helped halt the spread of infections in the early days of the outbreak.
"I do think that people should consider a potential change of these rules, especially now that we are facing a virus that seems to have a lot of unknowns but seems to have high transmissibility and you could essentially get infected unknowingly," said Huang. "It seems there now are so many chances you could get infected."
Cho said it was difficult to assess the degree to which publicly disclosing locations associated with the first patient in Washington state could have helped control the outbreak, but it was "probably minor."
"Well-performing contract tracing would discover most of the contacts by CCTV, card receipts, and mobile tracking, even though they are strangers to the patients," said Cho. "However, this may be incomplete. It depends on how many of the undiscovered contacts actually do report because of the information release."
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This article originally appeared on the South China Morning Post (SCMP).
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