Oregonians still don’t know much about the first person diagnosed in the state with the new coronavirus.

State health officials have released virtually no information about the person except that the patient lives in Washington County and “had spent time” at Forest Hills Elementary School in Lake Oswego.

That tight-lipped strategy is markedly different than what some other places are doing to help the public understand the spread of the disease.

CORONAVIRUS IN OREGON: THE LATEST NEWS

Oregon – and governments across the U.S. and the globe -- are struggling to stop the outbreak. And with the ever-evolving knowledge about COVID-19, so goes the strikingly different tactics.

Three Oregon residents have been diagnosed since Friday, but the state’s top medical officer estimated earlier this week that there might be 300 to 500 coronavirus cases circulating in the state undetected.

Public health officials and the governor have repeatedly reassured Oregonians that the state is prepared to combat the disease. They’ve talked about readying hospital staff and testing and quarantining some of the people with concerning contacts.

Gov. Kate Brown has asked the public to stay calm and to know that officials are doing their jobs competently.

“From the outset of this health crisis, I have committed to you that my administration will be as transparent as possible in conveying information to the public,” Brown said during a live-streamed video chat Wednesday.

But state health officials have said they can’t release more information about individuals for privacy reasons. And they’ve said it’s not helpful to list the public places where infected people might have been because the virus is primarily spread through close contact.

But other states have taken different tacks in fighting the disease. Most notably, New York has provided more information about diagnosed people, where they have been and who might be exposed. The state also has quarantined large numbers of people, as well.

Different countries also run the gamut. Iran has maintained overarching secrecy about what it’s doing. But Taiwan has received high praise for its vigorous response and for heeding lessons learned from the SARS outbreak in 2003.

Several experts in public health and epidemiology who talked to The Oregonian/OregonLive spoke of more aggressive approaches that Oregon could take in trying to clamp down on COVID-19.

They also offered guidance on what we can learn from other countries that have been immersed in the fight for weeks or, in the case of China, months.

WHO HAS OREGON BEEN TESTING AND HAS THAT MADE SENSE?

Oregon is testing “persons under investigation” -- people who have shown symptoms of the disease and either recently returned from highly impacted countries (China, South Korea, Japan, Iran or Italy) or who’ve been in close contact with someone who has the virus.

Since last week, the state also has been testing people hospitalized with severe respiratory illness and no other explanation for it.

Since Jan. 24, that’s 61 people so far, in a state of more than 4 million -- raising concerns among Oregonians that the disease is circulating at far higher numbers than the three cases that have been identified.

Oregon isn’t testing any of the current 115 “persons under monitoring” – those who aren’t showing symptoms but may had close contact with someone confirmed to have the virus or have recently returned from a trip to China, according to guidelines posted on the Oregon Health Authority’s website. State officials have said they haven’t tested this group because it’s unclear how effective tests would be on asymptomatic people.

But data from the Diamond Princess cruise ship -- which was docked in Japan when the coronavirus tore across the ship -- shows testing seemingly healthy people can identify hundreds of cases. Of 705 people on board who tested positive, 400 of them reported showing no symptoms.

Scientists have yet to understand how much of the disease is spreading by an unknown number of people who haven’t shown symptoms.

“The asymptomatic rate -- that’s the 900-pound gorilla,” Dr. Justin Lessler, an expert in infectious diseases at Johns Hopkins University’s Bloomberg School of Public Health, said in a university podcast Wednesday.

“How many people have the disease and aren’t getting sick and aren’t showing symptoms, and do these people transmit?” Lessler said. “That’s one of the biggest open questions about the virus, and I think it’s critical to how we think about what we can do for control.”

Ideally, Lessler said, health officials would work to control a disease by focusing on any person as soon as they show symptoms -- by identifying them through screenings, isolating them and treating them.

But, he said, “imagine 80 percent of people who have a disease don’t show symptoms, then all of those things don’t work ... to reduce transmission.”

A CDC laboratory test kit for the new coronavirus. (Centers for Disease Control and Prevention/TNS)TNS

SO SHOULD OREGON BE TESTING “PERSONS UNDER MONITORING”?

Dr. Dean Sidelinger, Oregon’s top medical officer, told the governor in a question-and-answer session broadcast Wednesday that he believes Oregon has been testing an adequate number of people.

The state has completed tests on 48 people: 45 came back negative and three were positive. On top of that, 13 tests are pending.

All of those people showed signs of illness.

After a member of the public asked why the state isn’t doing more testing, Sidelinger said he believes that people who don’t show any symptoms indeed can have the virus and spread it.

But, he said, “People are most contagious when they have symptoms,” adding that the disease most easily spreads from the droplets of a sick person’s sneeze or cough.

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. He said the state can get more if it needs it.

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

State epidemiologist Dr. Dean Sidelinger fields questions from local journalists during a tour of the Oregon Health Authority's newly configured operations center in Portland on March 3, 2020. (Beth Nakamura/Staff)

But several experts in public health or epidemiology who spoke to The Oregonian/OregonLive said it makes sense to test symptomless people who had contact with infected people or had recently returned from countries where the disease is spreading uncontrolled.

The experts said limited resources can be an important reason not to test asymptomatic people -- that the clear priority should be testing people who are showing symptoms. But if a state has the resources, this seemingly “healthy” group should be tested, too.

“The right course of action right now -- and this probably should have been done for the last few weeks -- is more testing to catch asymptomatic transmission,” said David Hutton, an associate professor of Global Public Health at the University of Michigan. “I think it’s useful to test asymptomatic people to learn what we can detect.”

Hutton said testing should be done of even people with very mild symptoms, such as a Chinese businesswoman who infected a cluster of people during a visit to Germany in January. Her only symptom on the trip was some fatigue and muscle aches, which she took some painkillers to relieve.

IS IT JUST OREGON THAT’S LAGGING? HOW MUCH TESTING ARE OTHER COUNTRIES DOING?

Outside Oregon, some doctors and health officials are describing the lack of testing across the country as a national blunder.

According to the U.S. Centers for Disease Control and Prevention, 472 people had been tested in the U.S. as of Monday, the day the CDC removed overall testing figures from its website and suddenly canceled a press conference. The U.S. population is about 330 million.

Compare those numbers to South Korea, where 110,000 had been tested in a nation that’s roughly one-sixth the size of the U.S.

South Koreans also can get tested at drive-through sites from the comfort of their cars, and the country has vowed to painstakingly track down and test all 200,000-plus members of the Shincheonji church, even if they exhibit no symptoms of COVID-19.

A church member or members who traveled back to Korea from Wuhan, China, are thought to have brought the disease into the country and quickly spread it among members who engage in extensive touching during religious services.

Ambulances are sprayed with disinfectant as a precaution against the new coronavirus in front of a military hospital in Gyeongsan, South Korea, March 5, 2020. (Kim Hyun-tai/Yonhap via AP)AP

Italy, which is roughly one-fifth the size of the U.S., had tested more than 23,000. Observers say one reason Italy has identified so many cases -- more than 3,000, with more than 100 deaths -- is because it has been testing large numbers.

Lawmakers Matteo Dall'Osso, right, and Maria Teresa Baldini wear sanitary mask during a work session in the Italian lower chamber Tuesday, Feb. 25, 2020. (Roberto Monaldo/LaPresse via AP)AP

In China, the epicenter of the disease, officials say they have the capacity to produce and distribute 1.6 million tests per day.

Matt McCarthy, a doctor at New York-Presbyterian Hospital, told CNBC earlier this week that he doesn’t have the ability to rapidly test significant numbers of patients.

“I’m here to tell you, right now, at one of the busiest hospitals in the country, I don’t have it at my fingertips,” he said. “I still have to make my case, plead to test people. This is not good.

“In New York state, the (first) person who tested positive (on Sunday) is only the 32nd test we’ve done in this state,” McCarthy continued. “That is a national scandal.”

WILL OREGON START TESTING VAST NUMBERS OF PEOPLE NOW THAT THE CDC ON WEDNESDAY LOOSENED TESTING RESTRICTIONS?

The short answer is no, not in the immediate future.

The long answer: Part of the criticism from some state governments across the nation has been that the CDC has floundered in its implementation of testing for the virus -- at first issuing flawed tests and then not having enough tests.

States also complained that the criteria for testing was far too restrictive and was causing them to miss cases circulating in the community. For example, early on, the CDC would sanction testing only if a person was suffering from respiratory symptoms and had been to China or been in contact with someone confirmed to have the disease.

On Tuesday, Oregon’s governor wrote a letter Vice President Mike Pence asking for more flexibility in testing. But Pence already had a plan in the works, announcing that same day that he was loosening restrictions on testing.

Oregon Governor Kate Brown. (Beth Nakamura/The Oregonian)

On Wednesday, the CDC said the changes allow anyone to get tested if they have a fever, cough or trouble breathing as long as a doctor OKs the test -- leading some to worry that the U.S. doesn’t have the capacity. Federal officials have pledged to rapidly ramp up the number of available tests.

Thursday, Sidelinger, the state health officer, said Oregon wouldn’t expand testing to fall in line with the new expanded guidelines. He said the state wants to keep the capacity to test people who are at highest risk, and that if the state starts testing “anyone with a fever,” the system could be overloaded.

Sidelinger said he expects commercial tests to become available sometime in the next two weeks, and it’s then that more people might receive testing.

HOW DOES OREGON’S RESPONSE COMPARE TO WASHINGTON’S?

In King County, which encompasses Seattle and some of its suburbs, public officials are sending out dramatically different message than in Oregon.

In the course of one week, Washington has gone from one diagnosed coronavirus case and no deaths to 70 cases and 11 deaths. By far, most of that has hit King County.

In response, Washington is rapidly trying to ramp up testing to find more cases. Officials are advising anyone 60 years or older to anyone with a pre-existing health condition, such as heart or lung disease, to stay home. Large companies, such as Microsoft and Amazon, are urging employees to work from home if possible.

Officials also are advising the general public to avoid large events, especially indoor ones.

King County officials have announced plans to buy an 85-room Econo Lodge motel in Kent for $4.2 million, to house the foreseen onslaught of people diagnosed with coronavirus who will need to be quarantined but not require hospitalization.

The pool and courtyard area of an Econo Lodge motel in Kent, Wash., is shown Wednesday, March 4, 2020. (AP Photo/Ted S. Warren)AP

Meanwhile, a 3-hour drive south in Oregon, public health officials Thursday continued to reassure Oregonians that the disease isn’t widespread enough to prompt healthy people to make changes to their daily routines -- besides proper handwashing. Officials said, however, that they are preparing guidance for the elderly and vulnerable people who live in long-term care facilities or are homeless.

Dr. Jennifer Vines, lead tri-county health officer, encouraged Oregonians with no symptoms to go about their lives, as usual.

HOW DOES OREGON’S RESPONSE COMPARE TO NEW YORK’S?

In New York, where the number of coronavirus cases jumped to 22 by Thursday afternoon, the state has taken a more aggressive approach.

On Tuesday, New York announced its second diagnosed case, a 50-year-old lawyer. In the next two days, public health officials identified 17 other infected people who had contact with him, had contact with someone else who had contact with him or had been somewhere the man had been. Those people include the man’s wife, son, daughter, neighbor, friend and friend’s wife and three children.

By Wednesday, public health officials directed at least 1,000 people to quarantine at home -- including anyone who attended the Young Israel of New Rochelle synagogue on Feb. 22 and 23, the approximate time the lawyer had visited the temple.

But by Thursday, as the number of diagnoses grew, the number in home isolations increased. But it’s not clear by how much. New York City’s mayor said 2,773 people were in home isolation within the city, but many of them had returned from travels in high-risk countries.

FILE - In this Monday, March 2, 2020, file photo, New York Gov. Andrew Cuomo, left, and New York City Mayor Bill de Blasio discuss the state and city's preparedness for the spread of the coronavirus. (AP Photo/Mark Lennihan, File)AP

New York’s decision to call for the quarantine of so many people is in stark contrast to how Oregon health officials responded to the case of a Umatilla County man who attended a small-town basketball game Saturday. The resident was ill and was taken directly from the game to a nearby hospital, where he was tested and became Oregon’s third known case of the coronavirus.

Oregon health officials told game attendees not to panic, and that they were low-risk and should go about their daily lives.

Experts said the New York vs. Oregon response to its first coronavirus cases reflects a debate in public health about how to best respond to epidemics:

Do officials severely inconvenience the relative few -- in this case, at least 2,700 -- to protect the masses?

Chunhuei Chi, director of the Center for Global Health at Oregon State University, said New York’s action shows the urgency it is using to halt the virus, knowing the devastation it can wreak in such a densely populated area.

Chi said it shows how cautious New York is being, but he thinks the steps are “appropriate when you want to prevent mass transmission. One of the biggest dangers of the virus is when it expands to the scale it has in China, Italy, Iran and South Korea. It can easily collapse your health care system.”

Three commuters, center, wear masks as they walk through the World Trade Center transportation hub, Wednesday, March 4, 2020, in New York. (AP Photo/Mark Lennihan)AP

IS OREGON TOO TIGHT-LIPPED ABOUT RELEASING INFORMATION?

When Oregon public health officials and the governor announced the first diagnosed case of the coronavirus in the state last Friday, they would say only that the person had been at Forest Hills Elementary School in Lake Oswego and lived in Washington County.

They wouldn’t share the person’s relationship to the school -- whether that person was an employee or a parent or was just visiting the school for some particular reason. A school district spokeswoman later said the person was an employee and had little contact with students.

State health officials also wouldn’t reveal the person’s city, or any of the places the person had frequented recently, such as a church, health club or store.

Officials said the person had caught the virus through community transmission -- not from travel to a highly affected country or through direct contact with a known infected person.

Officials said they were putting together a detailed timeline of where the person had been and would contact the person’s close contacts. They just wouldn’t share that information publicly because they thought it was unlikely members of the public could catch the disease through exposure to the person in passing.

Two days later, officials said a “household contact” of the first person had also tested positive, but also would share no other information.

Oregon’s approach once again illustrates the public health debate over releasing too much information vs. too little.

If officials name restaurants or stores the person patronized, will that tank business? If they release the city where the person lives, will that unfairly stigmatize an entire community?

Earlier this week, officials in San Antonio, Texas, erred on the side of warning the public.

They told people to watch out for symptoms if they had patronized businesses that a woman with coronavirus had visited Saturday after she was mistakenly released from mandatory quarantine after flying back from Wuhan.

Officials said she’d been at a Holiday Inn Express near the airport, then visited North Star Mall, where she shopped at a Dillard’s, Talbot’s and Swarovski and ate in the food court.

In New York, officials also released noticeably more information than in Oregon. For the lawyer and his family, that included the name of the synagogue they attended, the man’s occupation, the family members’ ages, that the man has a pre-existing respiratory condition, the mass transit line he used to commute to work from his home in Westchester and the names of the schools that the man’s 14-year-old daughter and 20-year-old son attend.

The New York subway on Wednesday, March 4, 2020. (AP Photo/Mark Lennihan)AP

Some New York media organizations, through their own sources, printed the man’s name, his photo or the name of his law firm -- drawing criticism from some for violating the man’s privacy.

However, that information has, in turn, led some members of the public who recognized they had contact with the man to self-quarantine, according to media reports.

Gov. Andrew Cuomo explained why he was sharing more information than he had to.

“People get afraid when they think they don’t have the right information or they don’t trust the information they’re getting. … So I think it's very important here in New York that I provide the factual information to people so they know these are just the facts."

Cuomo didn’t mince words, saying the state planned to test many people.

“There are going to be many, many people who test positive,” he said. “By definition, the more you test, the more people you will find who test positive.”

In Washington, King County public health officials decided Thursday to release less information than they previously had.

They discontinued their practice of sharing basic details about the people who tested positive, including their gender and age range, whether they have underlying health conditions and whether and where they are hospitalized. They cited the increase in the number of people being tested.

An ambulance worker wheels a stretcher into Life Care Center of Kirkland, Wash., a nursing home hit hard by the COVID-19 virus.(AP Photo/Elaine Thompson)AP

DOES RESTRICTING INFORMATION UNDERMINE PUBLIC TRUST?

There are vast differences in how governments in the U.S. and China share information. China has been heavily criticized for allowing COVID-19 to spread within its borders and ultimately across the world because some government officials actively worked to cover it up. The virus is believed to have jumped from an animal population to humans who had been to a market that sold exotic animals for consumption in December or possibly earlier.

Li Wenliang, the 33-year-old Wuhan doctor who was among the first to sound the alarm about the new and highly concerning virus, said he was browbeaten by the government into retracting his statements. About a month later, he died after apparently contracting the virus from a patient. That drew outrage across Chinese social media, which the government quickly worked to take down.

While there are extensive differences in the flow of information and freedom of speech in China and the U.S., some observers still have seen some parallels.

“It sounds like the Chinese government is very sensitive to bad publicity,” said Hutton, the associate professor of Global Public Health at the University of Michigan. “They keep very tight controls on social media and communications that are going on. Sounds like they didn’t want panic.

“And there are a lot of people in the WHO (World Health Organization) and the U.S. government who don’t want panic, either,” he said. “But I think the more we kind of are open about what’s happening here, the better we can be at controlling this.”

Jonathan Modie, a spokesman for the Oregon Health Authority, acknowledged that restricting the flow of information can undermine public trust.

“That’s always a concern for us -- ‘Is our message resonating with people?’” Modie said. “That is a constant battle that we fight in public health. ... Because people’s understanding of risk is different than public health’s.”

Modie said his agency has been forthcoming with details that the public needs to know -- and that includes naming the elementary school where the person with Oregon’s first diagnosed case of coronavirus had been.

WHAT CAN WE LEARN FROM CHINA?

Although China was slow to acknowledge the disease, it ultimately went into full gear to combat the virus, first locking down Wuhan, a city of 11 million, on Jan. 23.

A month later, an analysis by The New York Times found that mandatory orders by the Communist government had locked down or limited the movements of at least half of the country’s population of 1.4 billion. Some extreme measures included blocking off the streets leading into neighborhoods with makeshift gates.

In this Friday, Feb. 21, 2020, photo, a doctor in a protective suit checks with patients at a temporary hospital at Tazihu Gymnasium in Wuhan in central China's Hubei province. (Chinatopix via AP)AP

But some say there are important lessons that can be learned from China’s response and used in other countries. China was reporting new cases of 3,000 or more at the peak of the epidemic. Wednesday, it had 120 new cases.

The WHO released a report last week outlining what worked to stop the first wave of the disease’s spread. (China now faces a new challenge of controlling the virus as many millions return to work).

China built new hospitals in days, opened fever clinics that provided mass examinations and testing, formed mobile testing teams that could churn out test results in four to seven hours, extended the length of prescription refills from 30 days to 90 days so people could remain at home on quarantine and made testing and treatment free, said Bruce Aylward, a WHO epidemiologist who led the team to China, in an interview with Vox.

In Oregon and federally this week, officials began to push for testing and possibly even treatment to be free. Multiple insurance companies in Oregon said Thursday that testing would be free.

Contrary to assumptions some people might make, China also had highly sophisticated health care treatments -- such as machines that remove blood from a person’s body and oxygenates it when ventilators don’t work.

“They have a survival rate for this disease I would not extrapolate to the rest of the world,” Aylward is quoted as saying in the Vox piece. “What you’ve seen in Italy and Iran is that a lot of people are dying. ...This suggests the Chinese are really good at keeping people alive with this disease.”

A study of nearly 45,000 coronavirus cases by the Chinese Center for Disease Control and Prevention determined the death rate was 2.3 percent in the country. Some experts have said they think the worldwide death rate will be more like 1 percent. But Wednesday, the WHO pegged the global death rate at 3.4 percent -- hitting the elderly and people with existing health conditions like lung and heart disease the hardest.

WHAT OTHER COUNTRIES CAN WE LEARN FROM?

Chi, the director of OSU’s Center for Global Health, is skeptical of China and the relationship the WHO had with it and does not trust data coming out of that country. China’s civil rights violations also were extreme, he said, noting that locks had literally been placed on the outside of some apartment complexes to keep people in.

“I don’t think that’s even imaginable in the U.S.,” Chi said.

He said, however, Oregon must take much more dramatic steps than it has taken.

“We’re kind of too late to stop the community spread. Because we’ve seen it, and once you see it, it’s unstoppable,” Chi said.

Chi believes Oregon and the U.S. must learn from Taiwan, which was hit hard by the 2003 SARS epidemic and planned extensively for when the next epidemic would hit.

Chi has studied the coronavirus in countries across the world, and in particular Taiwan, Japan, China, Singapore, South Korea, Italy and the U.S.

“No country did better than Taiwan,” Chi said.

People wear face masks in Taipei, Taiwan on Wednesday, Feb. 26, 2020. (AP Photo/Chiang Ying-ying)AP

As early as Dec. 31 -- weeks before the Chinese government acknowledged a problem -- Taiwan was sending inspectors on airplanes to check the health of all passengers flying in from Wuhan, Chi said.

The government took control of all mask sales, made sure medical providers had the masks they needed and then rationed them to the public. Chi said mask production has gone from 2 million a day to 8 million, with a goal of 13 million a day in two weeks.

Taiwan also has extensively monitored people who have had contact with confirmed cases, tested aggressively and quarantined when reasonable, Chi said. As of Thursday, Taiwan has had 44 cases and 1 death. That’s remarkable for the nation of 23 million, just 81 miles off of mainland China and with hundreds of thousands of citizens working and living there.

In the case of the one patient who ultimately died, Taiwan officials tested nearly 150 of that person’s contacts and followed up with another 200 people who also had contact, Chi said. Officials quarantined 60 medical staff.

(Kaiser Permanente’s Westside Medical Center in Hillsboro announced earlier this week that it has asked “dozens” of medical staff to quarantine at home for 14 days, because they might have been exposed to Oregon’s first confirmed coronavirus patient.)

Chi believes all U.S. states should be quarantining every person who returns home from one of the countries where the spread of the virus has run rampant.

The U.S. also needs to develop cheaper and faster tests -- instead of taking up to a day, Taiwan has tests that net results in five to 15 minutes, Chi said.

Does Chi think Oregon officials are sounding the alarm loud enough?

“On the one hand, it’s appropriate not to make the public panic,” he said. “But at the same time, they could probably warn the public a little more.”

Oregonian staff members Fedor Zarkhin, Brad Schmidt and Betsy Hammond contributed to this story.

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

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