Washington residents might have been lulled into a false sense of security earlier this winter when more than a month passed without a new case of coronavirus infection.

Then late last week, the news no one wanted to hear hit: Two more people had been confirmed to have the disease and one of them had died. By Saturday, the total number of diagnosed cases in the state ballooned to more than 100, with at least 16 deaths -- the vast majority in the Seattle area at a nursing home.

The rapidly evolving crisis might have lessons for Oregon.

Oregon disclosed three coronavirus cases from Feb. 28 to March 2 and then announced day after day of negative test results for dozens of people, bringing a sense of relief to some.

But Saturday brought four more cases, raising the total to seven people diagnosed in four Oregon counties: Washington, Umatilla, Jackson and Klamath. Clark County in Washington also reported one case just over the border from Portland. And Sunday brought seven more Oregon cases, for a total of 14 in the state.

Experts in the field of infectious disease say many more tests need to be administered to understand the extent of the problem in Oregon and elsewhere, but Oregonians should expect cases to grow and shouldn't become complacent.

Viruses can pass quickly from one community to another -- especially two as interconnected as Seattle and Portland, just a three-hour drive apart.

“They’re epidemiological mirrors of each other,” said Benjamin Dalziel, an Oregon State University assistant professor of integrative biology who has studied the spread of infectious diseases.

Dalziel believes just like with the flu, the new coronavirus will almost certainly move from one Northwest hub to the other as people travel and interact.

“What happens in Seattle is going to happen in Portland, in Corvallis, if it’s not all ready,” Dalziel said. “I think that’s the plausible scenario. ... They’re just so connected. Certainly enough to sync up.”

A view of the Seattle skyline. (Thomas Boyd/The Oregonian/File photo)LC- The Oregonian

So far, Seattle has launched a much bigger response in an attempt to contain the virus. It remains to be seen if Oregon will follow suit.

Oregon’s Gov. Kate Brown and public health leaders have repeatedly asked people to remain calm and go about their usual lives with a few exceptions – including washing their hands frequently and staying at home if they have cold-like or flu-like symptoms.

State and local health officials aren’t ready yet to impose major social distancing measures yet. In fact, the Multnomah County Health Department is encouraging the opposite. On Saturday, the department tweeted a photo of people attending a crowded concert and the following advice: “If you are feeling well, feel free to go out and have a good time this weekend.”

The Multnomah County Health Department sent out this tweet on Saturday, March 7, 2020 -- the same morning state health officials announced the diagnosed cases of novel coronavirus in Oregon doubled from 3 to 7.

That drew some shocked responses from the public, including: “This is screamingly irresponsible, it’s staggering," “This tweet will go down in history" and “This tweet is just negligent.” After being contacted by The Oregonian/OregonLive Sunday, the county said it regretted the tweet, and took it down.

But life should continue, Multnomah County officials explained in a news release earlier in the week: “Canceling events, telecommuting for work and closing schools are serious decisions that cause social disruption and can have far-reaching ripple effects on our kids’ education and our various workforce members."

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Hard-hit Washington has scrambled into high gear to stem the proliferation of the virus.

Its public health officials also have stressed handwashing and staying home when sick, but now Public Health-Seattle & King County is recommending that people 60 and older -- about 425,000 people within the county -- stay home “as much as possible.”

King County has advised an untold number of other people with underlying health conditions to do the same.

Public health officials in King County hold a news conference after the second and third cases of new coronavirus were announced in Washington. (AP Photo/Elaine Thompson)AP

According to one study out of China, where the outbreak originated late last year, people over 60 or people with abnormally high blood pressure, diabetes, heart disease, respiratory disease and cancer were the most likely to suffer a severe bout of COVID-19 or die from it.

The health department also has advised people of all ages to avoid large groups of people and to consider postponing and canceling events.

The department has urged businesses to allow people to work from home. Major employers such as Amazon, Microsoft, Google and Facebook have either urged or outright mandated their employees in the Seattle area to work from home. Amazon said this week that one of its Seattle-based employees had come down with the virus, and Facebook said one of its contractors had.

The University of Washington will shut down its 46,000-student campus starting Monday and will hold classes online at least until March 20, the end of winter quarter.

The U.S. District Court for Western Washington has canceled all in-person hearings in Tacoma and Seattle until further notice.

“This is a critical moment in the growing outbreak of COVID-19 in King County and these measures can potentially impact the spread of the disease,” reads a public announcement from the health department.

A man in protective clothing cleans the County Oak Medical Centre GP practice in Brighton, England, after Britain declared the new coronavirus a "serious and imminent threat to public health.'' (Steve Parsons/PA via AP)AP

Dalziel, the OSU scientist, praised the Seattle area’s strategy of social distancing. “Absolutely,” he said. “If you can do it, do it.”

Carrying out such measures, however, comes at a cost, including economic and personal tolls. It’s hard to stay cooped up at home, avoiding friends and nights out.

And how long can you shut down a huge university?

“There are certainly scenarios where if you were to start that relatively early, that’s good from a point of view of being aggressive in terms of control,” Dalziel said. “But it has downstream costs that start to accrue.”

Still, he said, starting aggressive measures too late means missing an important window to interrupt the daunting momentum of a disease.

“Portland is saying, ‘We are going to be doing the prudent things now and be ready to ramp it up when we need to,’” Dalziel said. “When is that moment? That’s just a really hard question.”

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One of the earliest steps Washington state took was the day after officials announced the second and third cases: Gov. Jay Inslee declared a state of emergency and directed state agencies to use all resources necessary to fight the outbreak. That also allows Inslee to use the Washington National Guard.

Inslee, a one-time candidate for the Democratic presidential nomination, also has made national waves by taking on President Trump and his administration for what he has implied is their lackadaisical coronavirus response.

Inslee tweeted late last month that “our work would be more successful if the Trump administration stuck to the science and told the truth.”

I just received a call from @VP Mike Pence, thanking Washington state for our efforts to combat the coronavirus.



I told him our work would be more successful if the Trump administration stuck to the science and told the truth. — Jay Inslee (@JayInslee) February 28, 2020

Trump on Friday called Inslee “a snake” and “not a good governor.”

Across the country as of Saturday afternoon, the U.S. logged more than 380 diagnosed cases in 28 states and at least 19 deaths.

Trump has urged people to remain calm, saying the number of U.S. cases is small in relation to some other parts of the world, and he warned against implementing stringent social distancing policies in places where the virus isn’t known to have taken hold.

Trump also tried to quell a widespread cry from many medical providers, public health officials and local government leaders that the virus is spreading undetected because of a massive shortage of test kits.

A medical staffer works with test systems for the diagnosis of coronavirus in Krasnodar, Russia (AP Photo)AP

A chorus of residents in Washington state have complained about not being able to get tested. They described a system in chaos as they tried to navigate through bureaucracy and sometimes were confronted with shortfalls.

New York City officials sent a letter imploring the U.S. Centers for Disease Control and Prevention to provide more tests.

“The slow federal action on this matter has impeded our ability to beat back this epidemic,” the letter reads.

In the past week, New York state went from zero to 76 confirmed cases. Thousands of people are on home quarantine.

Oregon has sent out conflicting messages about whether it needs more tests.

When asked during a live-streamed question-and-answer session if Oregon has an adequate number of tests, Dr. Dean Sidelinger told the governor that “we do.”

The Oregon Health Authority is live with with Governor Kate Brown, Oregon Health Authority Director Patrick Allen and Oregon State Health Officer and Epidemiologist Dr. Dean Sidelinger to discuss COVID-19 in Oregon. Posted by The Oregonian on Wednesday, March 4, 2020

Sidelinger said Oregon can test up to 40 people a day from a stockpile of tests that will allow up to 750 people to be tested. Oregon has tested 124 people since Jan. 24, with 40 tests still pending results.

“We currently don’t have any constraints on testing here in Oregon,” Sidelinger told Brown.

But that same day, another top Oregon official – the Oregon Health Authority’s public health director, Lillian Shirley – seemed to say the opposite. Shirley said Oregon doesn’t currently have enough capacity to provide widespread testing giving the CDC’s new, loosened criteria.

The CDC said anyone who has a fever, cough or respiratory troubles can be tested, as long as they have a doctor’s approval.

Sidelinger said the state wouldn’t test that group because it wants to keep capacity open for the people he believes are at the highest risk for having the disease.

Those are people exhibiting COVID-19 symptoms who have recently returned from a severely affected country or have been in close contact with a confirmed case.

Oregon also is testing people who require hospitalization and have a severe respiratory illness that isn’t the flu.

Sidelinger said sometime in the next two weeks he thinks commercial labs will gain the ability to test in Oregon, and the criteria for who can be tested could change.

The Oregonian/OregonLive requested an interview with Sidelinger for more explanation about his approach for this story, but he didn’t respond.

Chunhuei Chi, Oregon State’s director of the Center for Global Health, has studied the response to the virus in Taiwan, Japan, China, Singapore, South Korea, U.S. and Italy.

Because the virus is spreading among members of the community in Oregon and parts of the U.S. now -- and not just from people returning from highly affected countries -- Oregon needs to “test vigilantly,” he said.

Testing, Chi said, is crucial to understanding who’s infected and how big the problem really is.

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Kaiser Permanente Westside Medical Center, where Oregon's first coronavirus victim was put in isolation.

Medical providers in Oregon share Chi’s urgency.

Yet they’re reluctant to speak out for fear of retaliation, said Rachel Gumpert, a spokeswoman for the Oregon Nurses Association.

“Some hospitals have put out essentially gag orders ... demanding that nurses, if they see something, they don’t say anything publicly,” Gumpert said.

Aimee Patterson, a primary care physician at the Heart Spring Health medical clinic in downtown Portland, said she tried to get coronavirus tests this past week for three patients who all had fevers, coughs and shortness of breath.

A study of 55,000 recent coronavirus cases in China found that in 88 percent of those cases, the afflicted had a fever and in 68 percent of cases, they had a dry cough.

One of Patterson’s patients also had returned last week from Seattle. The person had mingled with Amazon employees and eaten from the same food carts before Amazon announced this week that one of its employees had contracted the virus.

But Patterson said when she called Multnomah County health officials and tried to get her patients tested, she ran into dead ends.

In two of the cases, officials told her to have her patients schedule a visit at a local emergency room for testing, but when the patients called, medical staff there said they wouldn’t run tests.

In the case of the third patient, Multnomah County denied the test, said Patterson, a naturopathic doctor.

She told her patients to stay home. She noted that she consulted with all of her patients over the phone, to avoid exposure to the virus.

But Patterson said she sees a glimmer of hope. Her clinic has been told that on Monday it will have tests on hand to administer, although she is still waiting for details.

“It frustrates me to look at the national numbers and see how many positive test cases there are in Washington and California,” Patterson said.

She said she finds it difficult to believe that Oregon has only the confirmed handful.

“I’m actually alarmed and a little afraid,” she said. “Because I have this horrible feeling that we’re behind the curve and once everyone who should be tested gets tested the numbers are going to be scary.”

-- Aimee Green; agreen@oregonian.com; @o_aimee

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