The Washington Post examined the first week’s worth of cases, and found that slightly fewer than half the patients are older than 60; more are male than female. The cases spread to 17 jurisdictions in the first week, with most linked to either travel in a place where there was an outbreak or to a preexisting patient.

There are seven cases in which authorities have either not determined or not revealed the likely source of the virus.

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Here is an accounting of the first week of coronavirus patients in the region:

How it began

The virus’s first known appearance in the region was announced on March 5: three travel-related cases in Montgomery County, Md., a suburb of 1 million just north of the Washington, D.C.

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Over that weekend, more cases emerged, including the first positive test for covid-19 in the District — a rector at a prominent Georgetown church, which has since been connected to several other patients.

As health officials tried to track down people who were possibly infected and ramp up testing, the number of cases more than doubled every 48 hours and spread to 17 jurisdictions. While the one-week tally is a relatively small number, it is certain to grow, potentially mirroring the type of exponential increase first seen in China, then in Italy and now in metropolitan areas across the United States.

In New York, where the governor has created a one-mile containment zone in suburban New Rochelle, the caseload grew from zero to 216 in less than two weeks. In Washington state, where more than two dozen mostly elderly patients have died of the novel coronavirus, the number of cases grew from zero to 366 in 50 days.

Stopping the spread

Containment efforts are concentrated in emergency command centers around the region. In Maryland’s Montgomery County, health officials are hunkered in a converted conference room in Silver Spring, mobilizing staff and resources for what could be months of work.

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These officials have expertise in infectious diseases. Many led the response to the spread of Ebola and the H1N1 crisis, and some dealt with the 2001 anthrax attacks. But Sean O’Donnell, the health department’s lead on emergency planning, said containing covid-19 is especially challenging because it is highly contagious and spreads easily from person to person.

On Thursday, Prince George’s County announced Maryland’s first confirmed case of “community transmission,” a man in his 60s who had not recently traveled or interacted with an existing patient.

The case, which suggests that the virus is spreading unknowingly through the community, marks a “new phase” in the state’s covid-19 response, said Maryland Gov. Larry Hogan (R). State officials announced school and building closures, shut down the Port of Baltimore for cruise ships that had been in overseas ports and banned gatherings of more than 250 people.

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Given the evidence of community transmission, Hogan said, “We should expect the number of cases to rapidly and aggressively rise.”



D.C. resident Anne Chase, 69, also tested positive with no known exposure. She went to the hospital March 4 for headaches and confusion, then developed a cough and pneumonia. She was tested last weekend and learned she had the virus on Wednesday evening, hours after D.C. officials announced a 69-year-old woman with unknown causes had contracted the virus.

“It’s no joke, especially to older people,” Chase said in a phone interview from her hospital isolation room. “I have no idea how I got this, and I wish the government was testing more people.”

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Her daughter and husband are among those who have not been able to get approval for coronavirus testing, despite visiting Chase in the hospital daily before her diagnosis. But they were not ill as of Friday, and public health authorities are prioritizing tests for people showing symptoms. Experts warn that negative tests for asymptomatic people exposed to the virus could lead to a false sense of security, because those people could later develop symptoms and transmit the virus.

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Chase said she spoke to a representative from the D.C. Health Department on Thursday. She said the official told her that the hospital had provided an outdated home phone number, which may have caused a delay.

She was asked about hospital visitors, she said. But she did not recall being asked about social events she had attended before developing symptoms, including a 75th birthday party the weekend before her hospitalization and the wellness center at the University of the District of Columbia the day before her hospitalization.

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Lucy Wilson, an infectious-disease specialist and faculty member at the University of Maryland Baltimore County, said the nature of contact tracing changes as diseases spread.

“The point of contact tracing in early stages is to contain the disease and to try to limit the spread of the disease to others and to slow the disease down,” Wilson said. “Often once you get to a point where it’s more widespread, you need to focus your resources on prevention and treatment.”

Where did patients get the virus?

Twenty of the region’s known patients recently traveled overseas, including 10 who went on cruises in Egypt, though not all at the same time or on the same ship. The cruise ship Asara, which traveled along the Nile from Aswan to Luxor in early March, has been linked to more than 40 cases of coronavirus, including several Americans.

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It is not immediately clear whether the six Marylanders and four Virginians who went on a cruise in Egypt had been on the Asara or were guests on another ship. Their travel was in February.

There are also several patients in the region who appear to have caught the virus at recent conferences where multiple attendees have now tested positive. These include a Baltimore County man who attended an American Israel Public Affairs Committee conference in the District and a D.C. resident who attended the conference hosted by biotech firm Biogen in Boston.

Two patients in Northern Virginia have links to the military. One is a U.S. Marine who lives at Marine Corps Base Quantico and who reportedly works for the Defense Security Cooperation Agency at office spaces in Crystal City in Arlington County. He was traveling internationally for work before developing symptoms, authorities said.

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The other is a U.S. Navy civilian employee at the Navy’s Bureau of Medicine and Surgery in Falls Church. Health officials are unsure where the Navy employee, a man in his 50s who lives in Spotsylvania County, contracted the virus.

Five of the regions’s patients are connected to Christ Church Georgetown, an 800-family Episcopal church in the posh Northwest neighborhood. The Rev. Timothy Cole, the church rector, became the region’s first publicly named patient on Sunday when he wrote a letter to congregants saying he had tested positive for the virus.

On Monday, a church spokesman said organist Tom Smith had contracted the disease, and in the following days, three other individuals associated with the church also tested positive.

It is not immediately clear where Cole caught the virus. He has not traveled internationally in recent months, but he attended an Episcopal conference on Feb. 22 in Louisville, which has been linked to two other cases of coronavirus elsewhere.

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Cole, who presided over multiple services before he was diagnosed and isolated, is one of a handful patients in the region who may have exposed the virus to large groups of people, authorities say. Soon after his case was confirmed, D.C. Mayor Muriel E. Bowser (D) called for anyone who went to the church on certain days in recent weeks to self-quarantine.

Two of the first three Montgomery County patients also were reportedly with large groups of people when they may have been contagious. One interacted with school-age children and adults at an event in the Philadelphia suburbs and another attended a post-funeral reception at the Village at Rockville, a retirement community in Rockville, Md.

Hogan told attendees of the Rockville event to monitor their health and said Wednesday that anyone who was present or who lives or works at the Village can be tested for the virus if they want. Unlike Bowser, however, Hogan has not issued broad recommendations for them to self-quarantine.

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The decision to recommend self-quarantine is informed by several factors, said Montgomery County Health Officer Travis Gayles, including the nature and duration of an infected person’s interaction with others.

If bodily fluids are exchanged at any point — such as if a doctor has treated a patient without the right protective gear, or if food or liquid is shared — the individuals in contact with a patient are likely to be considered “high risk” and urged to self-quarantine, Gayles said.

In the case of the Feb. 28 shiva event in Rockville, attendees who are asymptomatic and do not recall having physical interaction with the patient are unlikely to have the virus.

How are the patients doing?

The novel coronavirus, which has mystified scientists, is significantly more harmful to older adults and those with existing chronic illnesses such as heart disease and diabetes. A recent World Health Organization report found that the fatality rate for covid-19 patients over the age of 80 in China was 21.9 percent.

Of the 32 patients in the Washington region whose ages are known, 16 are above the age of 60, placing them at higher risk. There are more men than women.

Officials have not released the medical status of all patients, but nearly half are being isolated at home. Eight have been hospitalized and one — the Prince George’s man whose exposure is unknown — is in critical condition, according to authorities.

But some patients have also made progress: the first three individuals who were reported to have covid-19 in Montgomery County have fully recovered, said Gayles, the county’s health officer, on Thursday.