Three more people were reported dead from the COVID-19 coronavirus in the Seattle area on Tuesday, .
For an on-the-ground perspective, MedPage Today spoke with Helen Chu, MD, MPH, assistant professor of allergy and infectious diseases at the University of Washington School of Medicine in Seattle.
Chu may not be a front-line physician, but she is "a front-line researcher."
She runs a large research network for respiratory viruses and has been working on a over the past few years. The goal: find new ways to "detect, prevent, and treat the flu."
She is also involved in the NIH Vaccine Trials unit and will be working on antiviral treatment studies of the virus in Seattle.
News of the recent deaths in her community left her shaken. "It's not good," Chu said.
She warns hospitals in other cities to get their clinical labs up and running quickly, if they haven't already. With state labs now able to do the testing, "I think everyone's going to start finding their cases."
As for the city more broadly, people have been split into two camps for a while: those who believe there's too much hysteria and those that are worried -- the "pandemic preparedness group," as she calls them. Seattle is now skewing toward the latter.
She found over the weekend that toilet paper had disappeared from store shelves.
"I just did not understand that decision-making," she said; the more likely and important shortages will be medical supplies.
Chu said she's been struck by other changes as well, such as her newly beardless male colleagues. At a recent meeting she noticed that all the men on the infection control team were suddenly clean-shaven, in line with of N95 masks.
"We're in extraordinary times," she quipped.
(This interview has been edited for clarity and brevity.)
MedPage Today: What are you seeing on the ground in Seattle?
Chu: There's the two groups. There's the one group that says. "Well, it's not really that bad ... there's too much hysteria." And then there's the other group that's worried about what's coming: the "pandemic preparedness group." Those are the people who are clearing out the shelves at Costco, sort of getting ready. People are skewing towards pandemic camp.
We have so many deaths in King County. It's not good. People are understandably worried and so they buy toilet paper and water. You cannot get it. I went to Target this weekend. Shelves were clear. I just did not understand that decision-making.
When you think of what's going to happen, what is actually going to be a shortage, it's going to be ICU beds, ventilators, N-95s, tubing. Things that come from China, that aren't being made in China, that we will suddenly have a critical need for and that we don't have enough of in the stockpile.
That seems to me what you should be panicking about, not water and toilet paper. If your child needs medicine or an inhaler or EpiPens, those are the things that you're going to want to have enough of, because there's a chance that those supply chains will run out. I don't see that being a problem with toilet paper.
If you're quarantined and Amazon stops delivering things...
That's sort of the big conundrum. What happens when everyone has to stay at home and what if the delivery drivers get sick. We sort of have been thinking about that as well. What's the next step when you lose sort of your first responders and your essential workers?
What's changed between last week and this week in your work and in the message that your sharing with patients?
The most tangible difference is that people can now get tested very quickly and have a result. So if somebody is concerned, what I would say before is, "You need to talk to CDC and public health and go to your doctor" and they would refer you through the normal channels. Now a clinician can just order a test. And we'll find many more cases, and we'll probably find many more cases that aren't very severe.
Do you think Seattle is seeing more growth of coronavirus than other cities or is it just better at testing?
There's just a larger proportion of people flying into the West Coast, major cities of Seattle and Los Angeles and San Francisco. So I would think that the first cases in the United States were probably all introduced through the West Coast hubs.
In terms of do we actually have more cases in California and Oregon, I don't think so. The public health infrastructure has been pretty good in Washington state and in King County and in Snohomish County. So they have been able to very quickly get to 200 tests a day at the state lab.
And if other cities start doing 200 tests a day...
Now that the state labs are doing testing, I think everyone's going to start finding their cases. It was always there we just didn't see it.
Do you think there could have been previous deaths from coronavirus that were not recognized as due to the virus?
Yes. Now that we're pretty certain that coronavirus was here from January up until now probably circulating in the community, I think we'll start getting a better understanding of what else it was causing. In our study we have samples that we've saved over the last two years. We'll be able to get some information from those.
I think public health, everybody in King County are doing a good job of expanding the numbers of people who get tested, and expanding the criteria for testing. Practitioners are now aware of it. So, I think we're going to find that it's associated with a lot more things then we thought before.
What kinds of questions are you getting from your patients and from your neighbors, and what are you telling them?
There's just a lot of concern in the community about what is the right action to take at this point. Do I keep my kids home from school? Do I not go to work and work from home? Did my child have coronavirus a couple of weeks ago and I just didn't know it?
I think some of those can be answered but some of them will require a lot more testing over the next couple of weeks and as we expand the amount of testing we do. Then we'll get a much better sense of how much coronavirus there has been in the community over the last period of time and going forward.
As a mother, what are your thoughts about possible school closures. Would those be useful?
Children tend to be the spreaders of infectious diseases. We call them the "amplifiers."
For flu, many studies have been done to show that school closures decrease the spread of both epidemic and pandemic flu and we know that to be the case.
Coronavirus does not seem to cause a lot of disease in children yet, based on the early data coming from China. Obviously, we don't have the data from the United States yet. But as we get more and more information, I think we'll get a better sense of, are children actually getting sick from this or are they not?
But I think from my personal perspective, if it's for the sake of the children, it doesn't seem right now that it's causing a lot of severe disease in children, and that would not be the reason to close the schools.
The reason to close the schools would be if it's getting to the point where you can't control its spread anymore.
What about teleworking? Is that necessary?
I feel like a lot of these situations where you tell people to telework really benefits that 10% who can do that. And those aren't the people who are more likely to have to work when they're sick and potentially spread pathogens.
What concerns do you have about keeping healthcare providers safe?
I think the fact that there's a mask shortage is a real problem. We have enough, but it's getting to the point where I think we're going to end up with a shortage of masks.
Nationally, we don't have enough masks in the stockpile. In Seattle, right now in the hospitals it's very hard to get your hands on a mask. And it's because a lot of people who are worried, they're getting these masks and that creates difficulties for the people who actually need them.
As far as vulnerable communities, such as nursing homes, homeless shelters, and jails. Are you seeing more concern in Seattle for those kinds of spaces? You can't easily pull people out of jail, or a nursing home.
This is exactly the problem. There's that huge nursing home outbreak right now up north. It's not good. We don't really have a good strategy. Heightened infection control, isolation of those who are sick, those are things you can do when you have good resources. In places like homeless shelters and jails where those resources are not there, it's going to be a significant problem.
What can physicians in other parts of the country learn from Seattle's experience?
One of the key lessons from what's happened in Seattle is that we need early diagnostic testing and people need to start. If their labs are not ready, they need to get their clinical labs operational as soon as possible. That was a key limiting factor. And there's so much fear right now about cases in the community in general that having the ability to do these home assessments, that's been really really great from a public health perspective.