Rob O'Dell, Justin Price, Craig Harris and Mary Jo Pitzl

The Republic

When a member of the Adobe Bridge Club tested positive for the new coronavirus after a big Tucson tournament, board President Barry Abrahams was prepared to provide health officials with a roster of the club members who might have been exposed.

But the request from the Pima County Health Department never came. Not to him. And apparently not to any of the hundreds of club members who during the March 10 and 11 tournament came into close contact with bridge player Doug Couchman, who became ill with coronavirus. Bridge is a card game popular with retirees.

“I’m very surprised that the health department wasn’t pursuing it. I certainly expected to be contacted along with everyone else in the bridge club after Doug reported it to the health department,” Abrahams said.

Abrahams said the club has no idea how many people might be carrying the virus after coming in close contact with Couchman, whose COVID-19 test came back positive on March 16.

“We're certainly capable of giving them a full list of names, addresses, phone numbers for all the people,” Abrahams said. “But no request has come in.”

Instead, bridge club leadership took it upon themselves to contact all 700 bridge players they know of in Tucson — nearly double the Adobe Bridge Club's membership — and notify them that they might have been exposed to coronavirus.

“We have a responsibility to our bridge players in our club who have come in contact with someone who was infected,” Abrahams said.

A larger, American Contract Bridge League tournament held March 2-8, and attended by more than 800 people, including Couchman, also notified participants that they may have been exposed.

But the health department apparently hasn't contacted players who attended that bridge tournament either, said event Chairman Steve Reynolds. A 79-year-old woman who played in the tournament and handled cards touched by Couchman was hospitalized with pnuemonia and died within a week of the tournament.

“I certainly am concerned that she may have had pneumonia as a result of coronavirus," Abrahams said.

No one knows for certain. What is clear is that Pima County isn't following up to find people who had contact with Couchman, even though many of the players are elderly and some have underlying medical conditions.

The Arizona Republic attempted to do what the county has not: contact the bridge players who may have come in contact with Couchman. Four reporters obtained the rosters of who played in the ACBL and Adobe Bridge league games, figured out who was most likely to have been in contact with Couchman, and called more than 50 people who played in both of the bridge leagues.

On Friday, Abrahams, the Adobe Bridge Club president, said a second person exposed to the virus during the two bridge events in March had tested positive for the new coronavirus. He said the club does not have permission to release the name of the person, who developed symptoms in recent days, beginning with a high fever.

During the tournaments, the individual had direct contact with Couchman, the bridge player who first tested positive for the virus.

"He said he had a conversation with Couchman, he interacted him with quite a bit," Abrahams said.

'Decreasing the spread'

"Contact tracing" is a monitoring process that involves identifying and following up with anyone who may have come in close contact with an infected person. The goal during the coronavirus outbreak is to ensure those who had contact with the infected person isolate themselves for 14 days to prevent further spread of the disease.

"It can actually be good in decreasing the spread of the disease especially in the early stages of an outbreak," said Stephanie Silvera, an epidemiologist and professor of public health at Montclair State University in New Jersey. "One of the big challenges, I would say, is that it can be pretty expensive, and so it is a lot of work to track down everyone and identify who they are."

But Silvera said the two Tucson bridge tournaments are examples of where contact tracing could take much less time because the exposure was at a specific place and time and it would be easy to get a list of everyone who attended. Contact tracing for a public place like a mall would be much more difficult because there isn't a list of everyone who was there.

"You should be able to get that list and quickly reach out to those individuals and tell them to self-quarantine for both groups and ideally have them reach out to their friends and family who they have been in contact with since that time," Silvera said.

Many bridge players contacted by The Republic said they had no symptoms and were not concerned about being exposed to coronavirus. All them said they had not been contacted by health officials.

Many had quarantined themselves. Some had secured the new drive-by COVID-19 test. But many had been unable to get tested. And others were sick and wondering if they were another case in the global pandemic.

Contact tracing the 'gold standard'

Contact tracing was a key component of the response to COVID-19 in South Korea and Singapore, which have avoided the community spread that has occurred in the United States and Europe.

"The reason it is so critical is to be able to track the spread, how quickly it is spreading and which communities are most affected so as to be able to contain it," said Dr. Murtaza Akhter, an assistant professor in the Department of Emergency Medicine at the University of Arizona College of Medicine-Phoenix.

South Korea and Singapore, along with Hong Kong and Japan, have experienced outbreaks before, including H1N1 flu, SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome). Those countries and regions have a culture of immediately starting to social distance in an outbreak and listening to authorities, either because they want to or are forced to, he said.

In Singapore, government efforts to target every coronavirus case and find anyone who had close contact with the infected person was called the "gold standard" of case detection in a February Harvard University study.

World Health Organization officials said last week that "isolating, testing and treating every suspected case, and tracing every contact, must be the backbone of the response in every country." Countries like South Korea had used the "full package" of measures to turn the tide against the virus, said Director-General Dr. Tedros Adhanom Ghebreyesus.

Silvera, of Monclair State, said South Korea was particularly effective because it paired effective contact tracing with rigorous coronavirus testing.

"If we could combine robust contact tracing with robust testing and rapid processing of those tests, then there's a better chance for controlling the outbreak," she said.

South Korea has conducted about 5,200 tests per million people, while the United States has done 74 tests per million people, she said.

However, the most aggressive tactics used by Singapore and South Korea, such as using closed circuit television feeds, cellphone location tracking, financial transactions and medical records to pinpoint cases, likely wouldn't work in the United States because of privacy rules.

Pima County doesn't attempt contact tracing

But Pima County doesn't appear to have attempted even rudimentary contact tracing, despite having a group of elderly bridge players willing to make their search easier by providing players' contact information.

Sharon O'Connor, who has played bridge for 66 years, said most Arizonans in bridge clubs are between 60 and 90 years old, the most vulnerable age groups for COVID-19. Further, she said, the mechanics of the game make it easy to spread the virus.

Bridge is played in pairs. For tournaments, a group of four typically sits close together at a small table, and there could be up to 28 tables at tournaments that can last all day. The same cards are passed from table to table based on where the player is sitting. Serious bridge players can compete daily, she said.

"You can't do the 6-foot distancing and play bridge," said O'Connor, who is 79 and lives in Tucson.

Akhter, who works in emergency rooms for Valleywide Health, Florence Hospital and hospitals in Pennsylvania and Masschusetts, said he doesn't know the details of the Tucson case. But if there are not enough coronavirus tests available, authorities may not want to panic people by recommending they get tested, he said.

"Right now, we're struggling to make sure we have enough ... personal protective equipment just to be able to see the patients who are coming in, and trying to figure out which of them need to be tested," Akhter said. "Contact tracing is very important, but at the same time, we only have so many tests. It's almost like what's the point of contact tracing when certain people aren't going to be tested anyway?"

The Pima County Health Department said it does contact tracing, although it apparently hasn't done so with the case at the bridge tournament.

Aaron Pacheco, spokesman for the Pima County Health Department, said the county may have to give up contact tracing if it is overwhelmed by coronavirus cases, but as of now the department is still contacting people who may have been exposed.

He said he couldn't say if the county had contacted anyone from the bridge tournament, citing privacy laws. But health department officials appeared not to know about the positive coronavirus test involving someone who attended the bridge tournament until The Republic asked Pima County Health Department Interim Director Bob England about the case.

England said he was unsure why the health department had not contacted Couchman but added that he is unable to talk about individual patients because of privacy laws.

England requested that The Republic have Couchman call the health department, which Couchman later did. England also told The Republic it would be helpful to get a roster of all players at the bridge tournament.

When The Republic first contacted the health department last week, Couchman did not appear to be included in Pima County's statistics on positive coronavirus tests. The next day, a case that appeared to be Couchman showed up in the county's tally of positive cases. It's impossible, however, to definitively say that Couchman was added because the county doesn't provide information on specific cases, citing privacy.

Infectious disease expert William Haseltine, president of the global health think tank ACCESS Health International and chairman of the U.S.-China Health Summit in Wuhan in 2019, said all of the players from the tournament should have been quarantined for 14 days. He called the health department's failure to reach out "totally irresponsible."

He said Pima County authorities, along with state health officials and the governor, are failing the public in this case.

"They either don't understand or are not willing to take the action that is necessary to protect the people of Arizona," Haseltine said. "And they should be held accountable for that."

Bridge players get tested

Henry Buch, a 71-year-old Tucson resident, said he felt fine during the large ACBL tournament in Tucson, when he played on March 3, 4 and 8.

However, by the time he went to the Adobe Bridge Club in Tucson on March 12, he had begun feeling flush and was running a fever. So, he said, he went home and tried to isolate himself the best he could.

He found out March 19 from the Adobe Bridge Club president that Tucson Banner-University Medical Center was providing coronavirus tests, and he went that afternoon to a drive-up tent and had his nose swabbed for about 30 seconds. He said he was told he may not get the results for a week.

“I’m glad I did it. I have friends who are worried they may have coronavirus, and they got tested,” Buch said.

Buch said he’s happy the bridge club let members know they should get tested.

Abrahams, the Adobe board president, also said he was tested at the Banner drive-thru.

“The problem is until the testing is done, no one knows for sure,” he said. “We may be walking time bombs, and I don’t want people around me if I’m going to explode.”

Tucson resident Helene Miron questioned why she only learned of the positive test of a tournament player from her bridge club. “We have a problem with that,” she said. “We should have been notified by the health officials.”

Miron said she was feeling fine, and had not taken a test. However, she just learned Friday that Banner Health was offering tests and was contemplating getting one.

She was especially critical of the federal government for what she called inaction. “Why is the government doing what it’s doing?” said Miron, 83.

Emmanuel “Butch” Vuvunas spent at least 45 minutes at the same bridge table as Couchman during the Tucson tournament. When he saw Couchman’s photo on the front page of his local newspaper, disclosing that he had tested positive for COVID-19, Vuvunas paused.

"I'm like the prime example of people who they say will die from this," Vuvunas said. "I have serious heart problems."

Vuvunas said he nearly died last year from heart complications. As of Monday, with the 14-day incubation period past, he said he was feeling no worse than he usually does, and said he doubted he had contracted the virus.

He didn’t seek a test, which health officials might have recommended if they had talked to him.

“All the symptoms they have for this thing — shortness of breath, coughing — I have that. But I had those before,” he said.

Vuvunas, a retired judge from Wisconsin, is philosophical about his situation. "What the hell. If I got it (the virus), at least I got it doing something I like," said Vuvunas, adding that he has been self-quarantining.

Marc Hess was Vuvunas’ partner when their bridge pair played against Couchman. Late last week, he said he was feeling fine and was not showing any symptoms. Still, he said, he’d prefer to get a test, but didn’t meet the criteria.

“I was at the same table with this guy,” he said of Couchman. “But I was certainly less than 6 feet away.”

A test, he said, would answer some of his nagging worries. “It’s always better to know.”

Since learning of Couchman’s test result, Hess said he’s been self-quarantining at his Tucson home. “So far, the biggest problem is boredom,” he said.

Armin Cicala, a 78-year-old Tucson resident, said he wasn’t too concerned that he had been playing in the tournament. However, he said the day after the tournament ended, he came into close contact with a player who had played with Couchman. Cicala said he took a 20-minute car ride and played bridge with that player on March 16.

He’s since had sinus problems and a cough, but attributes it to seasonal allergies. Still, he asked for a COVID-19 test when he visited the Tucson VA Tuesday during a prescheduled exam for another matter. He was told because he was feeling fine there was no need for the test.

“There’s nothing you can do about it. There is no point to getting upset,” said Cicala, who served in the Army from 1964 to 1968. “It’s the same way you play bridge. If I don’t do good, it doesn’t bother me … It is what it is.”

Contact reporter Rob O'Dell at rob.odell@arizonarepublic.com or on Twitter @robodellaz.