U.S. communities are braced for coronavirus outbreaks. Seattle is already in the thick of it

SEATTLE — As much of the United States prepares to see large clusters of Covid-19, the disease caused by the novel coronavirus that’s circling the globe, this city and the surrounding area are already in the thick of it.

As of Tuesday afternoon, 190 people had tested positive for the coronavirus in King County, which includes Seattle, and 22 had died, including the first fatal case in the country. State and local health officials here have already issued emergency declarations, set up quarantine sites, and asked the public to avoid large, nonessential gatherings. The county spent $4 million to buy a motel in the suburb of Kent and set up modular housing units as living spaces for infected people who can’t be quarantined at home or are homeless.

In short, what’s happening in this part of the country could be a preview of what’s to come in other corners of the United States.

“We need to have the priority be Washington state, because we are the tip of that effort and the rest of the country frankly is looking to us for leadership on how we handle this crisis,” Gov. Jay Inslee told reporters late last week.

The region’s biggest employers, including Amazon and Microsoft, have urged employees to work from home. The streets of Seattle — the heart of a metropolitan area of nearly 4 million — have become less crowded, and rush-hour traffic has subsided. At the same time, the city is by no means a ghost town.

On Friday, vendors in Pike Place Market, the downtown tourist destination known for fishmongers tossing whole salmon back and forth, estimated foot traffic was down about 50%. In the International District on Saturday, when patrons ordinarily wait outside in even the dreariest Pacific Northwest weather for their favorite dim sum, the most popular restaurants were busy but none had the usual line out the door.

Experts stress that it’s possible other parts of the country may have just as many cases as Washington state — but that the outbreak here seems outsized because there has been more aggressive testing. Almost all the deaths so far are tied to an outbreak in a nursing home in Kirkland, located to the east across Lake Washington, exacerbating case counts because it involved a vulnerable population.

It’s also possible that Seattle just got unlucky.

Brandyn Graves, 30, sells N95 masks outside CenturyLink Field before a Sounders FC match in Seattle. Health authorities have urged the public not to buy the masks to avoid shortages for health care workers. Jovelle Tamayo for STAT

Starbucks at Pike Place Market over the weekend. Jovelle Tamayo for STAT

“It may be that Seattle … had an early introduction that did take off into a chain of transmission,” Marc Lipsitch, an epidemiologist at Harvard’s T.H. Chan School of Public Health, said in a call with reporters last week. “It’s quite possible that we’ll see some places with lots of cases once we start testing, and other places that you would have expected to have similar risks maybe having fewer cases. But it’s really early, and the only way to move this from speculation to fact is to test.”

The local health agency here, known as Public Health – Seattle & King County, is well-regarded. But, like many public health organizations, it’s chronically underfunded, and it’s trying to contain the outbreak in Kirkland while dealing with the reality that many people, perhaps more than 1,000, in the region are infected and don’t know it.

King County has “one of the best public health [departments], if not the best” in the country,” Centers for Disease Control and Prevention Director Robert Redfield told a House panel Tuesday. But, he added, “they’re struggling right now. That’s not what we need. We need to be prepared.”

Chrissie Juliano, executive director of the Big Cities Health Coalition, which represents health officials in the country’s 30 largest cities, praised state and local officials in Washington for their efforts, saying health officials’ “risk communication has been clear and transparent and shared on multiple media and in multiple languages.” But she said funding is undoubtedly an issue.

“They will need dollars, like those passed by the Congress … to backfill expenses that they’ve undertaken in the response to date,” Juliano said.

Sounders FC fans make their way to CenturyLink Field before a match over the weekend. Days after a worker at CenturyLink Field tested positive for novel coronavirus, the football club opted to keep the match as scheduled. Jovelle Tamayo for STAT

State officials have not called for the cancellation of sporting events and other mass gatherings. That decision has drawn some criticism, especially after 33,000 people attended a professional men’s soccer game Saturday. Inslee has authority under the state’s emergency declaration to cancel events, and has said he’s considering “mandatory measures” that would reduce “the number of social activities that are going on,” but hasn’t done so.

Philip Bagley, a Seattle Sounders season ticket holder — who described himself as “just a former history teacher who has spent way too much time on past epidemics and public health” — decided not to attend the match over the weekend. He said he disappointed his teenage son in doing so, but thought attending was too risky. He said he was “a little surprised King County hasn’t been more aggressive about social distancing.”

“It’s going to be a miserable few weeks here, maybe a couple of months, but the sooner we get ahead of it the better off we’re going to be,” Bagley said.

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Nancy Messonnier, the director of CDC’s National Center for Immunization and Respiratory Diseases, told reporters this week it’s up to local officials to decide whether events should be canceled. Authorities need to consider the risk of exposure to the virus and whether people were traveling for the event, Messonnier said, as well as whether attendees would include people at higher risk for the more severe consequences of an infection, like older residents.

“The decisions in Seattle may look quite different than in a location where there’s not community spread,” she said. “We’re going to need to follow the local community’s lead.”

King County has not recommended blanket school closures, although some universities and high schools are implementing tele-teaching and some districts have shuttered schools where Covid-19 cases, or potential cases, have been reported.

Patty Hayes, the director of public health in King County, said during a Friday press conference that, when away from school, children tend to congregate anyway, or be handed over to caregivers who are often older — putting those vulnerable populations at risk.

“Sometimes keeping children in the classroom and under the supervision of the school is the best advice,” Hayes said.

Sakayi Perkins, a security worker and host at Operation Sack Lunch, which offers daily meals to Seattle’s homeless population, steams dining tables and chairs. Jovelle Tamayo for STAT

A temporary public hand-washing station at Pike Place Market. Jovelle Tamayo for STAT

There are also concerns about the vulnerability of Seattle’s homeless population, the third largest in the U.S. At a meal site run by the group Operation Sack Lunch on a recent day, people shuffled past a large hand sanitizer dispenser before getting their beef curry and sitting down to eat in its cavernous dining hall.

Beverly Graham, the organization’s executive director, said food servers are always under strict hygiene and health requirements, but last week staff put out new signs and flyers directing people to wash their hands. They’ve also begun steam cleaning surfaces in the dining hall several times a day, instead of once daily. Some organizations that rely on volunteers to serve food have had to curtail services as people stay home, Graham said.

“We’re being overly cautious because this is a community that already has compromised immune systems and we need to be very careful with them,” she said.

As case counts build, the state has also taken steps to make testing more available.The University of Washington’s health care system UW Medicine is screening employees at a drive-through clinic in an open-air garage.

With all the response measures being rolled out, some officials here are worried about what it will mean for other health resources. It’s impossible for the public health agency here to do everything at once, County Executive Dow Constantine told reporters.

“If there’s a hot spot here, and then one there and then one there,” he told reporters, “people’s attention is being appropriately drawn to those and away from the community-wide public health work we need to be doing to keep everyone safe across the population of 2 1/4 million people.”

Andrew Joseph contributed reporting.