New signs suggest coronavirus was in California far earlier than anyone knew

SACRAMENTO - A man found dead in his house in early March. A woman who fell sick in mid-February and later died.

These early COVID-19 deaths in the San Francisco Bay Area suggest that the novel coronavirus had established itself in the community long before health officials started looking for it. The lag time has had dire consequences, allowing the virus to spread unchecked before social distancing rules went into effect.

“The virus was freewheeling in our community and probably has been here for quite some time,” Dr. Jeff Smith, a physician who is the chief executive of Santa Clara County government, told county leaders in a recent briefing.

How long? A study out of Stanford suggests a dramatic viral surge in February.

But Smith on Friday said data collected by the federal Centers for Disease Control and Prevention, local health departments and others suggest it was “a lot longer than we first believed” - most likely since “back in December.”

“This wasn't recognized because we were having a severe flu season,” Smith said in an interview. “Symptoms are very much like the flu. If you got a mild case of COVID, you didn't really notice. You didn't even go to the doctor. The doctor maybe didn't even do it because they presumed it was the flu.”

Just as New York has strong ties to travelers from Europe, who are believed to have brought the coronavirus there from Italy, the Bay Area is a natural hub for those traveling to and from China. Santa Clara County had its first two cases of COVID-19 almost a week before federal approval of emergency testing for the disease Feb. 4. Both were in travelers returning from Wuhan, China, where the virus was rampant.

In January and most of February, there was little, if any, community testing in California.

The CDC provided testing materials to only some health departments, with restrictions that confined testing and thus the tracking of the novel coronavirus to those who were sick or exposed to someone already known to have COVID-19. The federal agency's focus was on cruise ships, with Princess Cruises' Diamond Princess carrying the largest known cluster of COVID-19 cases outside of China. The first passenger tested positive for COVID-19 five days after the ship's Jan. 20 departure from Japan. Eventually, 712 passengers and crew tested positive, and nine of them died.

COVID-19 did not reappear in the Bay Area until Feb. 27, when doctors finally decided to test a hospitalized woman who had been ill for weeks. She became the region's first case of community-spread coronavirus.

But from there, almost every positive test pointed toward local spread. “When public health (officials) tried to track down the start of the disease … we weren't able to find, specifically, a contact,” Smith told county supervisors. “That means the virus is in the community already - not, as was suspected by the CDC, as only in China and being spread from contact with China.”

Researchers still unsure how long the virus lurked are now turning to blood banks and other repositories to see if lingering antibodies can show them what was missed. A study funded by the National Institutes of Health is looking for virus antibodies in samples from blood banks in Los Angeles, San Francisco and four other cities across the country.

Santa Clara County's first community-spread case also became its first announced COVID-19 death.

Azar Ahrabi, 68, died March 9, the second COVID-19 fatality in California, five days after the first. For the first few weeks, the urban county that sits at the heart of Silicon Valley, home to Stanford University and tech giants Apple and Google, led California in coronavirus deaths.

Health investigators said they could find no source of Ahrabi's infection. Her family members said she stayed mostly at home, taking care of her mother. She seldom drove, and she walked to a local grocery store to shop. But she and her mother lived in a Santa Clara apartment complex in a neighborhood with a high density of international residents.

Relatives said she showed signs of illness in mid-February. For more than a week, they gave only a passing thought that her fever and sudden fatigue might be tied to the horrifying news out of China.

Ahrabi's son, Amir, said that when his mother checked into an emergency room Feb. 20 and was diagnosed with a nonspecific pneumonia, she was prescribed antibiotics and sent home. The next day, her doctor admitted her to the intensive care unit.

Amir said he asked that she be tested for COVID-19, and doctors told him the county health department would not approve the test. She met none of the qualifying criteria.