SACRAMENTO – The U.S. Centers for Disease Control and Prevention confirmed on Thursday a possible first case of person-to-person transmission of COVID-19 in California in the general public. The individual is a resident of Solano County and is receiving medical care in Sacramento County. The individual had no known exposure to the virus through travel or close contact with a known infected individual.

According to a San Jose Mercury News report, the Solano County woman, now critically ill with coronavirus, was hospitalized for 11 days before her infection was revealed to healthcare workers, raising the potential of broader community exposure to the dangerous respiratory disease.

Faced with the prospect of expanded spread of the disease, on Thursday morning Gov. Gavin Newsom vowed to expand the number of tests and testing locations to more quickly detect any spread of the virus in California. Newsom said that health officials throughout the state are monitoring as many as 8,400 people who have recently returned from China or are in close contact with someone who has.

California currently has only 200 test kits and all samples must be shipped back to the Atlanta-based U.S. Centers for Disease Control for processing, Gov. Newsom said at a Sacramento press briefing.

“This is simply inadequate to do the type of testing that is required to address this issue head on,” he said.

California has a strong health care system and public health infrastructure. California has prepared for the potential spread of diseases, such as H1N1, in the past and is prepared and actively responding to the potential community spread of COVID-19. Contact tracing in this case has already begun.

Health officials state health risk remains low

The health risk from novel coronavirus to the general public remains low at this time. While COVID-19 has a high transmission rate, it has a low mortality rate. From the international data we have, of those who have tested positive for COVID-19, approximately 80 percent do not exhibit symptoms that would require hospitalization. There have been no confirmed deaths related to COVID-19 in the United States to date. California is carefully assessing the situation as it evolves.

Suffering from flu-like symptoms, the Solano County patient brought herself to the 50-bed NorthBay VacaValley Hospital in Vacaville on Feb. 15. She was transferred to UC Davis’s medical center in Sacramento for advanced care four days later, on Feb. 19.

Suspecting coronavirus, UC Davis requested a test upon her arrival and took immediate precautions to protect their healthcare workers. The U.S. Centers for Disease Control conducted the test four days later, on Sunday, Feb. 23. Results were not returned until Wednesday, Feb. 26, according to a UC Davis statement.

She is the nation’s first case of coronavirus infection from an unknown source.

“This case marks a turning point,” said Dr. Sonia Y. Angell, director of the California Department of Public Health at the Thursday briefing. “We are expanding surveillance activity, increasing lab capacity and planning for increased demand on medical systems.”

Also on Thursday, an asymptomatic person quarantined at Travis Air Force Base was transported to a hospital in Marin County for monitoring after testing positive for the virus, according to health officials. Marin joins Contra Costa, Napa, Sonoma and several other regional counties who are accepting patients to reduce the burden on Solano County’s health care system.

The patient tested positive COVID-19 but is not currently showing any symptoms of the virus, such as a fever or heavy breathing, according to Marin County Health and Human Services.

Some experts are urging the federal government to widen its recommendation of who should be tested.

“It’s important that we consider broadening the screening criteria immediately to better detect community spread,” said Dr. Scott Gottlieb of the American Enterprise Institute and former U.S. Food and Drug Administration commissioner. “It could be broadened beyond travel history to include clinical criteria and clinician judgment.”

But the federal government has been reluctant to test everyone with a severe respiratory illness, given the limited availability of coronavirus kits and vast number of routine ailments. An estimated 45 million Americans get sick with the flu every year — with symptoms that are nearly identical to the new coronavirus.

To capture more coronavirus cases, it has promised to broaden the nation’s flu detection network to look for people in the general population who are very sick but test negative for the flu.

But the launch of the expanded system — planned for public health labs in San Francisco, Los Angeles, Seattle, Chicago, and New York City — has been delayed due to problems with a test reagent.

And the plan does not yet include testing sick people in Solano County, the home of the sick patient, or in Sacramento and the Bay Area.

On Thursday morning, Health and Human Services Secretary Alex Azar told the House Ways & Means Committee that a new and improved CDC test will be sent to 93 public health labs as soon as Monday. He did not specify which labs will receive the test.

UC Davis and the Vacaville hospital are monitoring the health of scores of staff members who may have come in contact with her. Most are tracking their own health, but staff who had direct contact with the woman have been tested for the virus.

A small number of medical center employees have been asked to stay home and monitor their temperatures, according to the statement. But “because of precautions we have had in place since this patient’s arrival, we believe there has been minimal potential for exposure here at UC Davis Medical Center,” according to the UC Davis statement.

Information on the woman’s family, work and social contacts was not immediately available.

State and federal health officials are tracking down contacts of the patient, as well as investigating whether she was unknowingly exposed to a returned traveler who was infected.

Solano County is home to Travis Air Force Base, where many travelers have been quarantined. But this patient became ill before the arrival of the passengers of the virus-stricken Diamond Princess cruise ship.

The Solano County patient’s test was delayed, according to UC Davis officials, because the patient did not fit into the CDC’s two criteria: a history of travel to China or close contact with a coronavirus patient.

But the patient was eligible for testing under a third CDC criteria: For severely ill individuals, testing can be considered when exposure history is equivocal — such as uncertain travel or exposure, or no known exposure — and another source has not been identified.

The CDC did not respond to requests for an interview to explain the delay.

Such community transmission is worrisome because a virus is much harder to control once it spreads in offices, schools, medical offices and other public sites. The case differs from others in the U.S., where the infected persons were known travelers who were quickly and safely quarantined, or persons in close contact with those travelers.

Though the goal is still to contain the virus, the new case raises concerns that it may already circulating undetected in the region.

At a media briefing earlier this week, Dr. Nancy Messonnier of the CDC’s National Center for Immunization and Respiratory Diseases said that the new surveillance at those five sites is just a starting point and that coronavirus surveillance will expand nationally in the coming weeks.

“We are aware and concerned for broader spread in the U.S.,” she said. “We have already started surveillance system sites in the U.S. and are rapidly working to expand that more broadly.”

On Thursday morning, HHS Secretary Azar told the House Ways & Means Committee that the CDC has tested 3,625 specimens so far. At least 40 public health laboratories across the U.S. should now be able to test using modified existing CDC test kits, he said.

A privately manufactured test based on the new CDC test also will soon be sent to labs, pending approval from the U.S. Food and Drug Administration, he said.

The Washington Post reported that neither Sacramento County nor the California Department of Public Health was doing testing when UC Davis needed it, according to a memo to UC Davis medical staff from David Lubarsky, vice-chancellor of human health services, and Brad Simmons, interim CEO of UC Davis Medical Center.

“Upon admission, our team asked public health officials if this case could be COVID-19,” the name of the respiratory disease, they said, according to the Washington Post. “We requested COVID-19 testing by the CDC.”

“Since the patient did not fit the existing CDC criteria for COVID-19, a test was not immediately administered,” they said. “UC Davis Health does not control the testing process,” they added.

“Keeping Californians safe and healthy is our number one priority,” said Dr. Sonia Angell, Director of the California Department of Public Health and State Public Health Officer. “This has been an evolving situation, which California has been monitoring and responding to since COVID-19 cases first emerged in China last year. This is a new virus, and while we are still learning about it, there is a lot we already know. We have been anticipating the potential for such a case in the U.S., and given our close familial, social and business relationships with China, it is not unexpected that the first case in the U.S. would be in California. That’s why California has been working closely with federal and local partners, including health care providers and hospitals, since the outbreak was first reported in China — and we are already responding.”

As in any public health emergency, the Department of Public Health’s Emergency Operations Center has been actively coordinating response efforts across the state and preparing for possible community transmission. California continues to prepare and respond in coordination with federal and local partners.

This would be the first known instance of person-to-person transmission in the general public in the United States. Previously known instances of person-to-person transmission in the United States include one instance in Chicago, Illinois, and one in San Benito County, California. Both cases were after close, prolonged interaction with a family member who returned from Wuhan, China and had tested positive for COVID-19, the disease caused by novel coronavirus. As of today, including this case, California has had 7 travel-related cases, one close contact case, and now one community transmission.

As with any virus, especially during the flu season, the Health Department reminds you there are a number of steps you can take to protect your health and those around you:

Washing hands with soap and water

Avoiding touching eyes, nose or mouth with unwashed hands.

Avoiding close contact with people who are sick are all ways to reduce the risk of infection with a number of different viruses

Staying away from work, school or other people if you become sick with respiratory symptoms like fever and cough.

The California Department of Public Health will not be providing additional information about this patient due to patient confidentiality. For more information about novel coronavirus, please visit the CDPH website. https://www.cdph.ca.gov/