State health officials warned that COVID-19 likely is spreading in Western Washington after the nation’s first death from the new coronavirus occurred in King County and dozens of cases were suspected at a Kirkland nursing facility.

Gov. Jay Inslee declared a state of emergency in response to the escalating threat in the state from COVID-19 and the report of the first death due to the virus in the United States. State agencies will have access to additional state funds to respond to and prepare for the outbreak.

The state’s emergency response began in January when the first confirmed case of COVID-19 was reported in Everett. The Health Department’s response operation was initially based at the State Emergency Operations Center at Camp Murray but later moved to Shoreline.

The center continued to handle non-pharmaceutical intervention strategies or NPI, Karina Shagren, of the Military Department, said. It has representatives of other state agencies, including the Department of Commerce monitoring how the disease might impact business, the Office of Superintendent of Public Instruction for impacts on schools and the Department of Corrections, which could be needed to convert a facility for quarantine.

“The urgency is definitely increasing” with the developments of Friday night and Saturday, Shagren said.

The emergency center at Camp Murray will also be the site of a joint information center where communications staff from state agencies working on the outbreak will operate, she said.

Officials confirmed the death and the additional cases of COVID-19 at a news conference Saturday.

In total, there have been six confirmed cases of COVID-19, a respiratory virus with no vaccine or approved therapeutic treatment to date, in Washington. The first confirmed case of COVID-19 in the United States was in a Snohomish County man in late January, and he has since fully recovered after treatment with an experimental drug.

One King County man, who was already hospitalized and chronically ill, tested positive for the virus and died, health officials announced Saturday morning. His case is not thought to be connected to other confirmed cases in the county.

Two confirmed cases in King County are connected to Life Care Center, a skilled nursing facility in Kirkland. One health care worker there, a woman in her 40s, is receiving treatment at Overlake Hospital and is in satisfactory condition. One Life Care resident in her 70s is listed in serious condition at EvergreenHealth Hospital.

County health officials are monitoring more than 50 individuals associated with Life Care Center who are reportedly ill or hospitalized with symptoms. The Centers for Disease Control and Prevention is sending a team to Kirkland to support King County and state health officials in investigating and surveilling the spread of COVID-19 at Life Care Center.

Health care providers are testing hospitalized patients with respiratory symptoms for the virus and sending those specimens to the public health lab in Shoreline, Washington. Health officials expect the number of confirmed cases to grow following these test results.

The other confirmed cases in Washington include a teenager in Snohomish County with no travel history and a woman in her 50s who had recently traveled in South Korea and who is currently isolated in home quarantine and a teenager in Snohomish County.

Everett Public Schools announced that Jackson High School, where this student attends classes, will be closed on Monday to allow for three days of deep cleaning. Additionally, any close contacts with the student have been notified. The number of people the student came into close contact with is small, Heather Thomas with the Snohomish County Health District confirmed Saturday, and they will be quarantined at home for two weeks to monitor their symptoms.

CDC guidelines for testing currently require a person to be displaying symptoms, like a fever, cough or difficulty breathing, in addition to having a travel history in a country with community spread of the virus, close contact with a person who has COVID-19 or a person who already is hospitalized for a severe respiratory illness with no obvious cause for that illness.

The most recent guideline change came earlier this week, when the CDC allowed providers to test people with severe respiratory illness who were hospitalized, despite not having travel history. Dr. Frank Riedo, medical director of infection control at EvergreenHealth Hospital, said this rule change led his team to test two patients on Thursday night. Both patients tested positive: the man who died and the woman who was living at Life Care Center.

“Both of them tested positive, which initiated the cascade of events,” Riedo said.

The man who died was not a resident of the long-term care facility, however, and Riedo said that currently there is no evidence of connection between the two cases.

The four new confirmed cases of COVID-19 announced late Friday and Saturday morning are considered “presumptively positive” until the CDC confirms them, Kathy Lofy, state health officer, said at a news conference Saturday.

“The COVID-19 situation is rapidly evolving on the global scale, and in Washington we are starting to see some spread of this virus. Therefore we do feel that the risks to the general public is increasing, but we do not feel that transmission is occurring on a widespread basis,” Lofy said. “Therefore it means it’s more important than ever for people to practice good health habits.”

How can people prepare then?

“Hand washing, more hand washing. Less face touching. Stay away from others who are ill. Stay away from work if you are ill,” Dr. Jeff Duchin, King County health officer, said.

Duchin said he expects to see an increase of cases in King County in the coming days, noting that so far, elderly people and those with underlying health conditions, like heart or lung diseases or diabetes, are at higher risk.

“The people at greatest risk for novel coronavirus are elderly, over 60 or 65 (years old) and those who have underlying health conditions,” Duchin said at a news conference Saturday.

The majority of COVID-19 cases are mild, however, Duchin said, with little need for further health care.

“As we test more, we will likely find more cases of this disease because most of them are mild and not seeking health care and if they are they have a severe illness,” Duchin said.

King County health officials are continuing their investigation into the outbreak of COVID-19 at Life Care Center, Duchin said, including defining the cases in meticulous detail, finding connections and looking at their contacts for possible transmission.

The Washington State Department of Health can test for COVID-19 at its public health lab in Shoreline as of Friday, and Lofy said she hopes to ramp up the amount of tests per day to 200, although the department might have to rely on private labs for expanded capacity should the need arise. Currently, there is no backlog for testing at the Shoreline lab.

Health officials did not go so far as to cancel large group events or gatherings on Saturday. However, going forward, they said this is a possibility depending on how the virus spreads, in addition to school closures in the future.

Health officials encouraged businesses, schools and individuals to work on their own pandemic preparedness plans, thinking about what they would do if they needed to stay home from work or their child needed to stay home from school.

US ups travel restrictions as Trump says more cases ‘likely’

The U.S. is banning travel to Iran in response to the outbreak of the new coronavirus and elevating travel warnings to regions of Italy and South Korea.

Vice President Mike Pence announced the new restrictions and warnings as President Donald Trump said 22 people in the U.S. have been stricken by the new coronavirus and that additional cases are “likely.” Trump added that he was considering additional restrictions, including closing the U.S. border with Mexico in response to the virus’ spread.

“We want to lower the amount of travel to and from the most impacted areas,“ said Alex Azar, the secretary of health and human Services. “This is a basic containment strategy.”

Trump provided an update on the virus after the first reported U.S. death Saturday, of a woman he described as being in her late 50s and having a high medical risk. Robert Redfield, director of the Centers for Disease Control and Prevention said there was “no evidence of link to travel” in the case of the woman who died.

Trump said healthy Americans should be able to recover if they contract the new virus, as he tried to reassure Americans and global markets spooked by the virus threat.

On Friday, health officials confirmed a second case of coronavirus in the U.S. in a person who didn’t travel internationally or have close contact with anyone who had the virus. The U.S. has a total of about 60 confirmed cases.

But Trump encouraged Americans not to alter their daily routines, saying “there’s no reason to panic at all.”

He added he wasn’t altering his routine either. “You’re talking about 22 people right now in this whole very vast country. I think we’ll be in very good shape.”

Trump spoke a day after he denounced criticism of his response to the threat as a “hoax“ cooked up by his political enemies. Speaking at a rally in South Carolina he accused Democrats of “politicizing” the coronavirus threat and boasted about preventive steps he’s ordered in an attempt to keep the virus that originated in China from spreading across the United States. Those steps include barring entry by most foreign nationals who had recently visited China.

“They tried the impeachment hoax. … This is their new hoax,” Trump said of Democratic denunciations of his administration’s coronavirus response.

Trump said Saturday he was not trying to minimize the threat of the virus.

“Again, the hoax was used in respect to Democrats and what they were saying,“ he said.

Some Democrats have said Trump could have acted sooner to bolster the U.S. response to the virus. Democratic and Republican lawmakers also have said his request for an additional $2.5 billion to defend against the virus isn’t enough. They’ve signaled they will provide substantially more funding.

Trump said Democrats want him to fail and argued that steps he’s taken so far have kept cases to a minimum and prevented virus deaths in the U.S.

Serious health risk, despite small numbers

State officials now say coronavirus has the potential to be a serious health risk in the U.S., and test results at the Public Health Lab in Shoreline have been expedited, which will likely lead to more cases being identified locally, according to a news release. Healthcare systems are getting ready to see an increase in patients and schools are receiving guidance on preventative measures and how to stay safe if they have cases.

Officials still consider the number of coronavirus cases in the U.S. to be small, the Associated Press reported. Health officials think the virus spreads mainly from droplets when an infected person coughs or sneezes, similar to how the flu spreads. Most cases result in mild symptoms, including coughing and fever, though some can become more serious and lead to pneumonia. Older people, especially those with chronic illnesses such as heart or lung disease, are especially vulnerable.

Other new patients infected by uknown means, worrying West Coast health officials, include an older Northern California woman with chronic health conditions, and an employee at a Portland, Oregon-area school.

Earlier U.S. cases include three people who were evacuated from the central China city of Wuhan, epicenter of the outbreak; 14 people who returned from China, or their spouses; and 42 American passengers on the Diamond Princess cruise ship, who were flown to U.S. military bases in California and Texas for quarantining.

Detection efforts

Convinced that the number of cases will grow but determined to keep them from exploding, health agencies were ramping up efforts to identify patients.

The California Department of Public Health said Friday that the state will receive enough kits from the U.S. Centers for Disease Control to test up to 1,200 people a day for the COVID-19 virus – a day after Gov. Gavin Newsom complained to federal health officials that the state had already exhausted its initial 200 test kits.

Santa Clara County in the San Francisco Bay Area reported two cases where the source of infection wasn’t known. The older woman was hospitalized for a respiratory illness, and rapid local testing confirmed in one day that she had the virus, health officials said.

“This case represents some degree of community spread, some degree of circulation,” said Dr. Sara Cody, health officer for Santa Clara County and director of the County of Santa Clara Public Health Department.

“But we don’t know to what extent,” Cody said. “It could be a little, it could be a lot.”

“We need to begin taking important additional measures to at least slow it down as much as possible,” she said.

Cody said the newly confirmed case in Santa Clara County is not linked to two previous cases in that county, nor to others in the state.

The Santa Clara County resident was treated at a local hospital and is not known to have traveled to Solano County, where another woman was identified Wednesday as having contracted the virus from an unknown source.

Dozens of people had close contact with the Solano County woman. They were urged to quarantine themselves at home, while a few who showed symptoms of illness were in isolation, officials said.

At UC Davis Medical Center at least 124 registered nurses and other health care workers were sent home for “self-quarantine“ after the Solano County woman with the virus was admitted, National Nurses United, a nationwide union representing RNs, said Friday.

The case “highlights the vulnerability of the nation’s hospitals to this virus,“ the union said.

New out-of-state cases

Earlier Friday, Oregon confirmed its first coronavirus case, a person who works at an elementary school in the Portland area, which will be temporarily closed.

The Lake Oswego School District sent a robocall to parents saying that Forest Hills Elementary will be closed until Wednesday so it can be deep-cleaned by maintenance workers.

Some communities, including San Francisco, already have declared local emergencies in case they need to obtain government funding.

In Southern California’s Orange County, the city of Costa Mesa went to court to prevent state and federal health officials from transferring dozens of people exposed to the virus aboard a cruise ship in Japan to a state-owned facility in the city. The passengers, including some who tested positive for the virus and underwent hospital care, had been staying at Travis Air Force Base in Northern California.

On Friday, state officials said the federal decided it no longer had a crucial need to move those people to the Fairview Developmental Center in Costa Mesa. That’s because of the imminent end of the isolation period for those passengers and the relatively small number of persons who ended up testing positive, officials said.

The new coronavirus cases of unknown origin marks an escalation of the worldwide outbreak in the U.S. because it means the virus could spread beyond the reach of preventative measures like quarantines, though state health officials said that was inevitable and that the risk of widespread transmission remains low.

California public health officials on Friday said more than 9,380 people are self-monitoring after arriving on commercial flights from China through Los Angeles and San Francisco. That’s up from the 8,400 that Newsom cited on Thursday, though officials said the number increases daily as more flights arrive.

How is it spreading?

Officials are not too worried, for now, about casual contact, because federal officials think the coronavirus is spread only through “close contact, being within 6 feet of somebody for what they’re calling a prolonged period of time,” said Dr. James Watt, interim state epidemiologist at the California Department of Public Health.

The virus can cause fever, coughing, wheezing and pneumonia. Health officials think it spreads mainly from droplets when an infected person coughs or sneezes, similar to how the flu spreads.

As infectious disease experts fanned out in the Solano County city of Vacaville, some residents in the city between San Francisco and Sacramento stocked up on supplies amid fears things could get worse despite official reassurances, while others took the news in stride.

The woman in the community who has coronavirus first sought treatment at NorthBay VacaValley Hospital in Vacaville, before her condition worsened and she was transferred to the medical center in Sacramento.

Sacramento County’s top health official told The Sacramento Bee on Friday that he expects several medical workers to test positive themselves in the next few days. Numerous workers at both hospitals have been tested, but the tests were sent to labs approved by the CDC and generally take three to four days to complete.

Peter Beilenson, Sacramento County’s health services director, said he expects even those who test positive to become only mildly ill.

Confusion over how quickly the woman was tested for coronavirus concerned McKinsey Paz, who works at a private security firm in Vacaville. The company has already stockpiled 450 face masks and is scrambling for more “since they’re hard to come by.” The company’s owner bought enough cleaning and disinfectant supplies to both scrub down the office and send home with employees.

But they appeared to be at the extreme for preparations.

Eugenia Kendall was wearing a face mask, but in fear of anything including the common cold. Her immune system is impaired because she is undergoing chemotherapy, and she has long been taking such precautions.

“We’re not paranoid. We’re just trying to be practical,” said her husband of 31 years, Ivan Kendall. “We wipe the shopping carts if they have them, and when I get back in the car I wipe my hands – and just hope for the best.”

Other resources:

The Spokesman-Review recently put together a COVID-19 Q&A that gives a rundown on what we know, don’t know, and how to prepare.

We have been covering the coronavirus since it first reached Washington state and the U.S. in January.

We also reported on the use of an investigational, unapproved Ebola drug to treat that patient.

Last week, we reported on four COVID-19 patients being brought to Spokane for treatment.

When community scrutiny arose over how those patients were transferred, we reported on assurances from health officials that protocols were followed.

This week, we reported on how area school districts are preparing to adapt to the virus’ threat, Gonzaga University’s decision to recall students studying abroad in Italy,

Yesterday, we reported that those patients remained in satisfactory condition.

Coronavirus first emerged late last year, and China reported the first death from the virus in January.

China enforced strict measures in an effort to contain the virus’ spread, but that hasn’t stopped it from moving around the globe.

More coronavirus coverage can be found here.

Associated Press writer Adam Beam contributed to this report.