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Cruise Ship Held Off California Becomes New Focus of Concern


Gov. Gavin Newsom announced on Wednesday that a cruise ship returning to California from Hawaii that had suspected links to two coronavirus cases, one of them fatal, was being held off the coast of San Francisco, as public health officials prepared to screen everyone on the ship.

Eleven passengers and 10 crew members on the boat were showing symptoms on Wednesday, the governor said. “That number may significantly understate” the scope of infection, he said, or “it may indeed be abundance of caution.”

“The ship will not come on shore until we appropriately assess the passengers,” Mr. Newsom added.

[Read: Failures on the Diamond Princess shadow another cruise ship outbreak.]

The governor also announced that the state was declaring a state of emergency to help mobilize its response to the coronavirus outbreak. The number of cases in the state shot up to 54 on Wednesday, the most in the nation.

Governor Newsom said that about 2,500 people, more than half of them Californians, had been aboard the ship, identified by its owners as the Grand Princess, during a recent voyage from San Francisco to Mexico. One of those passengers died Wednesday in Placer County, Calif., the first U.S. coronavirus death outside Washington State and the 11th overall. Another passenger was being treated for the illness in Sonoma County. State and federal officials were racing to contact others who had been on board.

Mr. Newsom said the ship had gone on to Hawaii after its stop in Mexico, and then had sailed back toward California with some of the passengers from the original San Francisco-to-Mexico leg of the voyage still on board.

The person who died in Placer County had underlying health conditions and had been in isolation at a hospital after falling ill. Officials believe the patient was probably exposed to the virus on the San Francisco-to-Mexico leg of the voyage last month.

Health officials in Los Angeles County announced six new cases on Wednesday, and Santa Clara County announced three more cases. The virus has been detected across the United States, but so far has been concentrated on the West Coast.

A person who conducted medical screenings at Los Angeles International Airport tested positive for the virus, the Department of Homeland Security said on Wednesday. The person last worked at the airport on Feb. 21, eight days before showing symptoms of infection, the agency said.

Each of the six new cases reported by Los Angeles County was linked to a known exposure, a history of international travel or contact with someone who had traveled or been diagnosed with the virus, officials said.

Facebook on Wednesday said that a worker in the company’s Seattle offices tested positive for Covid-19, the disease caused by the new coronavirus, making it the second major tech company in the city to be affected by the outbreak.

The tech industry is vital to the economy of Washington State, where a cluster of infections has taken root and 10 people have died, leading companies there to take extra measures to halt the spread of the virus.

“A contractor based in our Stadium East office has been diagnosed with Covid-19,” said Andy Stone, a company spokesman. “We’ve notified our employees and are following the advice of public health officials to prioritize everyone’s health and safety.”

The Seattle area is Facebook’s largest engineering outpost outside of its Bay Area headquarters. It had 5,000 employees in the region as of last September, when it announced plans to expand even more.

The contractor was last in the office on Friday, Feb. 21, the company said. The Seattle office would be closed for three weeks. As an extra precaution, Facebook asked its Seattle-based employees to work from home until the end of March.

On Tuesday, Amazon told employees via email that a worker in one of its many office buildings in Seattle’s South Lake Union neighborhood had tested positive for the virus.

“We are supporting the affected employee, who remains in quarantine,” said Drew Herdener, an Amazon spokesman.

Late last week, Amazon indefinitely halted all nonessential travel of its employees, including domestic trips.

On Sunday, Twitter said it would also limit all nonessential business travel for its employees and partners.

Racing to confront a growing public health threat, key lawmakers in the House and Senate reached a deal on Wednesday to provide $8.3 billion in emergency aid to combat the novel coronavirus. The House voted Wednesday to approve it, and the Senate was expected to take it up on Thursday.

The bipartisan package came together after days of rapid negotiations. It includes nearly $7.8 billion for agencies dealing with the virus, substantially more than the White House initially proposed in late February.

It also authorizes roughly $500 million to allow Medicare providers to administer tele-health services, so that more elderly patients, who are at greater risk from the virus, can receive care at home, according to two officials who spoke on condition of anonymity in advance of a formal announcement.

An employee at the Dartmouth-Hitchcock Medical Center in New Hampshire who showed signs of possible coronavirus infection was told by a medical worker last week to avoid contact with other people, pending test results.

Instead, the man who had flu-like symptoms after a trip to Italy, attended a mixer for doctors and Dartmouth College students. Three days later, he was confirmed as the state’s first coronavirus case. A “close contact” of the man has since tested positive as well.

The episode heightened concerns about people who ignore requests to self-quarantine. The state health commissioner has now made the request a formal order.

Students learned of the possible exposure in an email sent out by the university on Tuesday, saying the man had attended the mixer at the college’s Tuck School of Business on Feb. 28. The college said an investigation was underway.

“The general vibe is we are all pretty concerned that this medical professional showed up to the event, despite being told to self-isolate,” said Christie Harrison, a first-year Tuck student who sang with the band that performed at the mixer.

A tenth person in Washington State has died from the coronavirus and several new infections have been confirmed, officials said on Wednesday, as ramped-up testing offered troubling evidence of how widely the virus had spread.

The Seattle area was grappling to contain a worsening crisis that has seen the virus overrun a suburban nursing home, killing at least seven residents. Ten of the 11 confirmed U.S. deaths so far have occurred in Washington, and all have been reported in the last few days.

The region’s medical resources are “under incredible stress right now,” said Patty Hayes, director of public health for Seattle and King County. “We need to slow the spread of disease to the point where our health care system can continue to handle the load.”

The county executive, Dow Constantine, said officials are recommending that older residents with underlying health problems stay home, that employers have workers telecommute, and that community organizations cancel events with more than 10 people.

Washington had its first confirmed coronavirus case in January, but officials had not found any others until late last week; expanded testing in recent days has identified dozens of infections.

On Tuesday, officials announced that the virus had killed two people a week ago, suggesting that the illness had spread in the Seattle area days earlier than was previously known.

A high school in Renton, a Seattle suburb, was closed on Wednesday through the end of the week, after a student tested positive for the virus.

Also on Tuesday, Amazon emailed its staff in the Seattle area saying that it had learned that an employee in one of its buildings in the South Lake Union neighborhood had tested positive. The employee had not been to work since Feb. 25, the email said.

Doctors were encouraged to first rule out other causes of respiratory illness, like influenza, and to take into consideration whether there are other local coronavirus cases, officials said.

Even so, the new standard greatly expands the pool of patients who qualify for testing, though the laboratory capacity to process the tests remains limited. The change could relieve some of the frustration of patients and doctors who have been denied access to the test when they thought it was warranted.

Previous guidelines required a patient to have symptoms of respiratory illness as well as a clear risk factor for exposure, like recent travel to China or a number of other affected countries, contact with a known coronavirus patient, or hospitalization with a severe and unexplained respiratory illness.

[Read: China pushes back as the coronavirus crisis damages its image.]

Experts said they feared a rush by the worried well who may flood the health care system, just as new private and hospital labs are gearing up for testing.

The federal government had promised to ramp up testing, but some companies and public health officials cast doubt on the government’s assurances. A spokesman for the Department of Health and Human Services said on Monday that the labs currently could handle 15,000 tests a day, though that figure was expected to grow.

With his administration under fire for its handling of the outbreak, President Trump sought to deflect criticism onto his predecessor on Wednesday, complaining that a federal regulation adopted under President Barack Obama made it harder to do widespread testing for the virus.

“The Obama administration made a decision on testing that turned out to be very detrimental to what we’re doing, and we undid that decision a few days ago so that the testing can take place at a much more accurate and rapid fashion,” Mr. Trump said during a White House meeting with airline executives.

“That was a decision we disagreed with,” he added. “I don’t think we would have made it, but for some reason it was made.”

He appeared to be referring to a regulation that limited the ability of laboratories run by states, universities and private companies to conduct medical screenings not approved by the Food and Drug Administration. On Saturday, the F.D.A. commissioner, Stephen M. Hahn, allowed those labs to use coronavirus tests they had developed independently, after submitting evidence that the tests work.

The government has stumbled several times in trying to keep up with the demand for coronavirus tests. Local health agencies and doctors have complained that a lack of tests have hindered their abilities to identify patients.

The C.D.C. at first maintained tight control on test production, and some of the early tests it sent to state health departments were defective.

The C.D.C. kept equally tight restrictions on who could be tested, but those have been eased significantly.

Nine people connected to the man who was confirmed as New York’s second case of the new coronavirus have all tested positive for the illness, state officials said on Wednesday.

The new cases included the man’s wife; his son, 20; his daughter, 14; and a neighbor in New Rochelle, N.Y., a Westchester County suburb, who drove the man to the hospital. A friend of the man who spent time “in close proximity” with him also tested positive for the virus, as did that man’s wife and three of their children, Gov. Andrew M. Cuomo said.

The discovery that the Westchester father, a man of about 50 who works with his wife at a law firm in Manhattan, had the illness set off a search by health officials across the region to determine whether he had infected others, and who might have infected him. So far, about 1,000 people were being asked to self-quarantine, Mr. Cuomo estimated.

The Westchester man’s son is a student at Yeshiva University. Classes at the university’s campus in the Washington Heights neighborhood of Manhattan will be canceled until Friday, Mr. Cuomo said. New York Law School in TriBeCa also canceled classes and closed its facilities after a student there reported having contact with the Westchester man.

The governor said that about 300 students and faculty members from various State University of New York and City University campuses who are in China, Italy, Japan, Iran, or South Korea — countries where the illness is raging — have been asked to return to New York, and remain in quarantine for two weeks.

[Read: Shinzo Abe, Japan’s political houdini, can’t escape coronavirus backlash.]

The New York authorities announced the state’s first confirmed case of the virus on Sunday, saying that a health care worker had been infected in Iran. She began exhibiting symptoms after returning home but had kept herself largely isolated. Her husband has tested negative for the virus, Mr. Cuomo said.

In Italy, site of by far the biggest outbreak in Europe, the number of infections and deaths surged again on Wednesday, and the country ordered all schools shut down from Thursday until at least March 15.

The number of deaths in Italy that the government has attributed to the coronavirus jumped from 79 on Tuesday to 107 on Wednesday — more than in any country but China, where the epidemic began. Italy’s people are the oldest in Europe — 23 percent of the population is 65 or over — and most of the victims have been elderly.

Italian officials reported 3,089 people infected so far — up more than 400 from Tuesday — a figure surpassed only in China and South Korea. Italy has 295 coronavirus patients in intensive care, and the health care system in parts of Lombardy, the northern region that has been hardest hit, is straining under the burden.

The authorities put two more towns under lockdown on Wednesday, raising the total to 13.

The school closure, announced by Education Minister Lucia Azzolini, affects everything from day care through universities. It was not “an easy decision to make,” she said.

Just as many of the early outbreaks around the world traced back to travel in China, many others, particularly in Europe, are linked to travel in Italy.

The next-largest outbreaks on the continent are in France, with 285 cases reported by Wednesday; Germany, with 240; and Spain, with 193. One of the sharpest increases was in Britain, which reported 87 cases, up from 51 on Tuesday. Poland recorded its first infection, in a person who had recently traveled to Germany.

In Spain, officials said they believe the death from pneumonia of a 69-year-old man in Valencia on Feb. 13 was the earliest known fatality in Europe connected to Covid-19, the disease caused by the new coronavirus.

The announcement suggests that the virus was circulating in Spain earlier than previously believed.

Covid-19, the disease caused by the new coronavirus, is much deadlier than seasonal flu but may not spread as easily, World Health Organization officials have reiterated.

But their statements also reinforced how much efforts to quantify the epidemic remain little more than rough estimates.

Among people who catch seasonal flus, about 0.1 to 0.2 percent die from the illness, though the number varies widely from year to year, depending on the strain of the virus and other factors. It has been apparent since January that the new virus had a significantly higher fatality rate — though lower than those of other coronaviruses like SARS and MERS.

“Globally, about 3.4 percent of reported Covid-19 cases have died,” Dr. Tedros Adhanom Ghebreyesus, the W.H.O.’s director general, said on Tuesday at a news conference in Geneva.

But the figure came loaded with caveats. Experts, including those at the W.H.O., say that when more is known about the epidemic, the death rate will be considerably lower.

The death rate Dr. Tedros cited does not include mild cases that were not detected because people did not seek medical attention. And it primarily reflects the experience in Wuhan, the Chinese city where the epidemic began — and where the numbers soared before China’s medical systems had gathered the knowledge and marshaled the resources to fight it.

Earlier estimates of the mortality rate in China had been closer to 2 percent.

Dr. Bruce Aylward, who is leading the W.H.O.’s coronavirus efforts, said he expects that ultimately, it will turn out to be between 1 and 2 percent. And it could be below 1 percent, according Dr. Anthony S. Fauci and Dr. H. Clifford Lane, of the National Institute of Allergy and Infectious Diseases, and Dr. Robert R. Redfield, director of the C.D.C.

The extent and mortality of the epidemic will not be known with great accuracy until a reliable test is developed for the antibodies present in people who have been infected, and that test is administered to large numbers of people.

Reporting was contributed by Farah Stockman, Maria Abi-Habib, Alex Marshall, Constant Méheut, Melissa Eddy, Michael Wolgelenter, Emily Cochrane, Elian Peltier, Elisabetta Povoledo, Joanna Berendt, Roni Caryn Rabin, Sarah Mervosh, Michael Gold, Luis Ferré-Sadurní, Azi Paybarah, Sean Plambeck, Mike Baker, Peter Baker, Mitch Smith, Jason Horowitz, Zolan Kanno-Youngs, Marc Santora, Iliana Magra, Aurelien Breeden, Amy Qin, Sui-Lee Wee, Choe Sang-Hun, Katie Rogers, Katie Thomas, Christina Goldbaum, Vindu Goel, Reed Abelson, Sopan Deb, Mike Isaac, Karen Weise, Dave Itzkoff, Paul Mozur, Keith Bradsher, Elaine Yu, Sarah Kliff, Julie Hirschfeld Davis and Davey Alba.


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