Coronavirus: Clusters emerging around Bay Area. Here’s what we know. Why don’t we know more?

As the deadly coronavirus spreads, infections are emerging in alarming clusters among people who were in close contact, often before anyone felt sick. It’s happening at Bay Area nursing homes, Sacramento churches, a Vacaville hospital, on cruise ships and at a Santa Clara County workplace referenced in a recent study where five were infected.

But how much the public is allowed to know about these and other hot spots depends on the health official in charge where you live. In Los Angeles, you can see online how the county’s more than 3,000 confirmed cases are dispersed among cities and neighborhoods, the infection rate based on their population and nursing homes with outbreaks.

Yet little of that detail is available in the Bay Area, including Santa Clara County, which has a fifth as many people as L.A. but the second-most confirmed cases in California. Information about clusters here has trickled out and rarely comes from official sources.

Why? Reporting the location of outbreaks or individual cases could compromise patient privacy and also give residents who don’t live nearby a false sense of security, said Marianna Moles, a spokeswoman for Santa Clara County’s health department.

But others are pushing for more transparency. Santa Clara County Supervisor Dave Cortese said he’s hearing from residents and from people who provide services to the homeless who want more information about where infections are.

“It’s hard to be an elected official right now and not be able to give them answers to those questions, reasonable questions that have to do with everybody’s health and safety,” Cortese said. “We don’t need a medical file. We want a pin on the map, and we just can’t get that.”

Health experts say they understand the health officers’ concerns. But many argue, especially in the middle of the biggest public health crisis in generations, the public has a right to know.

“Reporting identifiable health information in a global pandemic is a bit of a moral gray area,” said Summer Johnson McGee, dean of the University of New Haven School of Health Sciences.

“Keeping everyone in Santa Clara County guessing about where confirmed cases are means that everyone has to be extra vigilant about social distancing no matter where you live,” McGee said. “If that is the reason, it’s a clever one. Still if I lived in Santa Clara County personally, I’d like to know if my town was a hot spot.”

Coronavirus infection clusters have been noted since the pandemic first emerged in December linked to a wholesale seafood market in the central Chinese city of Wuhan.

The pattern of clusters has repeated as COVID-19 has spread around the world: a church in South Korea, a nursing home near Seattle, a church choir in Mount Vernon, Washington, a family dinner party in New Jersey, a retired janitor’s funeral in Albany, Georgia, a synagogue in New Rochelle, New York.

In California, infection clusters have been reported sporadically. Officials in San Bernardino County, which, like Los Angeles, is reporting the location of cases, announced 51 residents and six staffers had tested positive at the Cedar Mountain Post Acute Rehabilitation nursing home in Yucaipa.

Los Angeles County identifies 10 institutions where cases have been reported. Sacramento County, which lists infections by city, said Wednesday that a third of its more than 300 cases involve church gatherings, though it didn’t identify congregations. The Sacramento Bee reported one congregation alone had 24 cases.

In the Bay Area, the scattered news about outbreaks is mostly coming one-by-one from the institutions themselves — not the health departments.

Several Bay Area nursing homes have reported cases among their patients and staff — the elderly are more vulnerable to the disease — including an alarming outbreak at San Francisco’s Laguna Honda nursing home involving two residents and nine workers.

This week, Mayor Deirdre Martin said five residents at the Pacifica Nursing and Rehab Center in the coastal Peninsula city have tested positive, and one has died. And Canyon Springs Post-Acute Care facility in San Jose confirmed that two residents and a staffer tested positive. Other Bay Area nursing homes have reported outbreaks including five sick at Atria Burlingame Assisted Living and Memory Care and two at the Vi in Palo Alto.

The Santa Clara County Sheriff this week said eight correctional deputies tested positive, along with a patrol deputy and two civilian employees of the agency. It was unclear whether the infections in that workplace cluster were related.

But health officials have mostly declined to comment about those clusters. In Santa Clara County, officials have not shared any details about the cluster cited in a recent research study as an unidentified workplace “associated with a large facility with multiple employers, large areas of shared space, and heavy pedestrian traffic.” That study said there were “several possible scenarios” that could explain the cluster, which remains under investigation, including that the virus was introduced “via different events or the workers were infected as a result of community transmission.”

The University of New Haven’s Johnson McGee said that information from the U.S. Centers for Disease Control and Prevention indicates that as many as one in four Americans could have COVID-19 but show no symptoms while unknowingly spreading the disease to others.

“Anyone who has been out of the house in the last few weeks could be part of a cluster and not know it,” McGee said.

A CDC report this week studying clusters in Singapore indicated an infected person with no symptoms could spread the virus through “respiratory droplets” and also through “speech and other vocal activities such as singing,” even through clothes, furniture, utensils and other objects the person contacted.

That characteristic is one of the main reasons public health officials have turned to unprecedented stay-at-home orders, with the Bay Area last month instituting the first widespread lockdown in the country.

Dr. Arnold S. Monto, an epidemiologist at the University of Michigan’s School of Public Health, said it’s unclear why clusters appear in some places and not others.

“They are scattered and related to something we don’t understand called a ‘superspreader,’ ” Monto said.

Two health workers at NorthBay VacaValley Hospital tested presumptive positive for the coronavirus after being exposed to a patient who was hospitalized for 11 days before she was tested and became the state’s first case not tied to exposure through travel or other confirmed cases.

And while those health workers represent a cluster at their hospital, one lives in Solano County and the other in Alameda County, illustrating the difficulty in defining a cluster.

But advocates for sharing more information about clusters say that, given the scope of the crisis, it’s impossible for public health officials to notify everyone individually who may have come in contact with somebody exposed at a nursing home, store or place of business.

“Our strong default should be towards sharing as much data as we can, since when the public finds out it has been kept in the dark, it is likely to lose trust and become less likely to trust the public health department in the future,” said I. Glenn Cohen, a Harvard Law School professor and expert in medical ethics.

Cortese agrees.

“It feels unnatural not to have much of that released to the public,” Cortese said. “But I’m not giving up.”

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