The spread of coronavirus in the United States is inevitable.

That stark statement, made Tuesday by Dr. Nancy Messonnier, a top director at the U.S. Centers for Disease Control and Prevention, was a wake-up call for a nation hopeful that the current COVID-19 contagion could be contained to other continents or kept from spreading through careful quarantine on home soil.

To be sure, it’s a warning that has not yet come true in San Diego County. So far, the region has only seen two positive cases, both having arrived on quarantine flights from China, cared for under isolation protocols and sent home without any indication that they infected a single soul while they were here.

Just Friday, the county health department said local testing, brought online this week, cleared seven of eight people who showed possible coronavirus symptoms last week while under quarantine orders in their homes after returning from trips to locations in China outside Hubei Province.


Though she does not have a single local case yet, Dr. Wilma Wooten, the county’s public health officer, said Friday that she accepts the truth of Messonnier’s message. As the virus spreads rapidly to other countries, the probability of local cases increases. Quarantine efforts, after all, can’t cordon off all risk, and it only takes one undetected case in a community to spark a chain of transmission from person to person.

When that happens, Wooten said, she will not hesitate to use the tools at her disposal to fight spread in the community, but that doesn’t necessarily mean anything near the kind of lock down that has occurred in China.

A single case, she said, would spur an immediate investigation with all contacts identified as quickly as possible.

“We would move very quickly, I can say, to quarantine anyone who had close contact with someone who was a confirmed case for the full 14 days that has been used already for people returning from China,” Wooten said.


Those who were infected but not showing severe-enough symptoms to require a hospital stay would be sent home. But that does not necessarily mean, Wooten added, that they would ride out the disease in the company of their family members. Arrangements are being made, she said, to contract with a local hotel where family members of those who test positive could stay, lessening the chances that an infection would spread from one family member to another.

In some nations, public health agencies have been more aggressive.

Japan, for example, closed all schools for the rest of the school year, which ends in March, even though the island nation has not yet seen the kind of spread observed in other places such as South Korea, Iran and Italy. Switzerland, which has had only 15 confirmed novel coronavirus cases so far but which borders Italy, banned events with more than 1,000 attendees through March 15, effectively canceling the Geneva Motor Show.

Nothing similar is on the radar here, at least not yet.


Wooten said she could order similarly-broad actions but wouldn’t do so without significant evidence that the disease was spreading in the community beyond a few isolated cases.

“If we had sustained and consistent community-assisted spread of disease, we would start implementing social-distancing strategies,” Wooten said.

Exactly what sustained and consistent means, she said, has not yet been determined. Mathematical modeling, she said, will help calculate when curtailing public events, shutting down schools or finding ways to keep people further away from each other is necessary.

She said she expects the process to be similar to the one used in 2009 when a novel strain of the flu virus — then called swine flu or H1N1— caused a global pandemic. Some of the first cases in that saga were detected in San Diego, and Wooten said that the CDC was issuing regular advice to local health departments on when to close schools and take other actions.


In April 2009, Wooten ordered Christ the Cornerstone Academy in Mira Mesa shut down for at least seven days after a 7-year-old student tested positive for H1N1. At the time, Wooten said, she was acting on newly issued federal guidelines.

“Those guidelines changed by the end of the day, and we ended up allowing it to re-open the next day,” Wooten said.

She said she expects similar guidance from the CDC regarding shutdowns related to coronavirus, though no firm guidance has yet been issued by the nation’s top public health agency.

Even though there is no evidence that COVID-19 is presently moving through the community, the non-stop media focus on the virus’s growing global presence has pushed local organizations to work on getting organized for a threat that could arrive at any moment.


Caryn Sumek, vice president of the Hospital Association of San Diego and Imperial Counties, said she has been in regular contact with hospitals throughout the region that have been busy doing inventories of supplies they would need to have at the ready if large numbers of coronavirus patients needed to be seen. Much of this preparation, she noted, is covered by the county’s multi-hazard emergency plan and includes identifying less-used parts of hospitals that could be set up for treating patients with infectious diseases.

Experience gained in 2009, when so many flu cases arrived at hospitals that many were forced to handle the overflow inside temporary tents set up in parking lots, has informed the preparations that local hospitals are making.

“We woudn’t be caring for coronavirus patients in tents, because we would need to use isolation rooms, but a lot of the preparation is similar to what they would need to do if we had a bad flu year,” Sumek said.

Local health providers, she said, report to her organization that they have large enough supplies of respirator masks and other protective equipment to handle a wave of patients with infectious diseases. More such equipment, she said, is headed this way.


“The county, I know, has put in orders for more masks that should arrive in March and April,” Sumek said, adding that a recently-declared local health emergency seems to be helping local organizations get priority access to supplies.

A big part of the problem in China has been hospitals becoming so inundated with patients that they can’t provide the relatively-basic types of care needed to keep COVID cases from worsening to the point where patients die. Wooten said she does have the ability to act to make sure that hospitals in the region are using their beds for handling emergencies only if infections started generating large numbers of patients.

“Depending on the situation, public health officers do have the authority to order hospitals to rescind all elective surgeries and other procedures,” Wooten said.

Schools have been a large focus of public concern in recent days as the certainty of local spread sinks in.


Music Watson, chief of staff of the San Diego County Office of Education, said that her organization has been sending coronavirus updates to San Diego County’s 42 school districts since January. Many, she said, are now exploring how they would handle widespread shutdowns for extended periods of time. Some, especially those that issue computers to each student, might be able to shift much of their curriculums online so that students could continue working from home. But such a move would be difficult for others.

“The approach could be very different depending on the district,” Watson said. “What works in Borrego Springs might not work in Del Mar and vice-versa.”

School situations, she said, are complicated by the particular teacher contracts in place at each individual district.

“School districts have unions with rules that are quite specific about what teachers are expected to do and what they’re not expected to do,” Watson said. “So part of what we’re asking districts is, ‘have you spoken with your teachers about what they would feel comfortable doing?’”


For now, Wooten said, the public should be vigilant but not panicked.

“Certainly the risk is low in San Diego,” Wooten said. “We have had no cases so far, and our strategy is to continue with the close monitoring that we’re doing as we make additional preparations.”