Three new deaths caused by the new coronavirus were reported in King County, Washington where an outbreak is occurring among patients at a nursing facility. There are now 14 cases in King County, including five deaths — two of which were previously reported. A sixth patient, whose case originated in Snohomish County, also died.

The deaths were in a man in his 70s, a woman in her 70s, and a woman in her 80s. Two of the three were patients at Life Care Center, a nursing facility in Kirkland, Washington. Another new case, a woman in her 80s who has been hospitalized, was also linked to Life Care. That brings the number of cases that are linked to Life Care to nine.

Long-term care facilities “provide an ideal environment for acquisition and spread of infection”

The Life Care cluster of illnesses appears to be the first in the US — and is alarming to health experts because the novel coronavirus, which causes the disease COVID-19, is particularly deadly for older people. Unfortunately, long-term care facilities “provide an ideal environment for acquisition and spread of infection,” according to a study from 2003. The residents are already vulnerable, either because of age or underlying health conditions or both — and they’re in close proximity, making it easier to transmit the illness.

Of the 108 residents and 180 staff at Life Care, 27 residents and 25 staff members have symptoms of the virus, Washington health officials said on Saturday. In addition, 25 firefighters as well as two police officers were exposed to the virus, though they haven’t shown any symptoms yet, The Washington Post reported. In response to the outbreak, family visits as well as those from volunteers and vendors, have been halted, Kaiser Health News reported. King County will buy a motel in order to place COVID-19 patients in isolation.

The virus may have been circulating in Washington for six weeks, according to a genetic analysis. Researchers compared two samples of the virus, one from a person who traveled to Snohomish County from China in January, and one from a recently diagnosed high school student with no obvious cause. The genetic sequences were nearly identical, according to Trevor Bedford, a computational biologist at Fred Hutchinson Cancer Research Center in Seattle. Although the work is early, Bedford believes there isn’t another good explanation for the similarity because of an unusual variant on one of the genes.

But most people had no idea the virus was circulating because the US Centers for Disease Control and Prevention wasn’t actively testing for the novel coronavirus in people with no known exposures to the illness — either from travel to an affected area or close contact with an existing case — until last week. That means detection of the novel coronavirus in the community lagged dangerously behind the virus’s actual circulation.

positive tests are essentially snapshots of where the virus was several days ago

Under the best of circumstances, testing would lag anyway — because most people don’t show symptoms of COVID-19 for a few days. So positive tests are essentially snapshots of where the virus was several days ago. But by keeping the test criteria narrow, the CDC lost valuable time to prevent outbreaks like the one at Life Care. Now health officials are scrambling to catch up.

On February 26th, the first possible case of community-spread COVID-19 in the country was announced in California. The patient, from Solano County, had already been placed on a ventilator when she arrived at the University of California Davis Medical Center on February 19th, where the team immediately requested testing for the coronavirus, according to the Davis Enterprise. The CDC didn’t test the patient until Feb. 23rd. The CDC claims it has not said no to any requests for testing.

Information has also been throttled by Vice President Mike Pence, who now controls all federal communication about the virus. Any federal expert who wishes to speak about the illness must now get Pence’s sign-off, The Washington Post reported. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, has pushed back on that reporting, claiming he is “not being muzzled.” As of this week, the CDC has dropped the number of people it’s tested from its website, just as the number of tests is set to rise.

Amid all this confusion, one health expert told ProPublica that efforts to corral the illness are “weeks behind.” To determine how widely the virus is circulating in areas like Washington and California, health officials could test a random sample of hundreds of people and find out how many of them test positive. (This is called “surveillance testing.”) Until widespread testing is the norm, we’ll still be behind the illness — with tragic consequences. At least in the case of Life Care, the delay on tracking and containing the disease seems to have been deadly.