While no cases have been confirmed, COVID-19 is in Spokane, health officials say – they just don’t know where or how widespread it is.

“I think it’s important for us to understand that it is here, we just don’t necessarily have documentation that it is here,” Bob Lutz, health officer at the Spokane Regional Health District, said Wednesday. “And until we have those documented tests, it’s really sort of throwing a dart at a board guessing where it’s going to hit.”

For health officials to determine how prevalent the respiratory disease is in the community, they need health care providers who suspect a patient with symptoms might be infected to take samples from those patients.

So far, a number of tests from the Spokane area have been submitted to labs. While no cases have been confirmed, the SRHD is not notified each time samples are sent for testing, making it difficult for officials to keep track of the status of suspected local cases.

The symptoms of COVID-19, including fever, cough and difficulty breathing, are all very similar to those of the flu, making it difficult to differentiate between the two. However, influenza symptoms come on suddenly whereas COVID-19 symptoms develop over days.

Washington state, which had the first U. S. case of COVID-19 and is now ground zero for community spread, particularly in the Seattle area, had 373 confirmed cases Wednesday night, with 30 confirmed deaths. There are COVID-19 cases in 12 counties, two of which are east of the Cascades, one that resulted in the death of a Quincy resident. More than 30 cases are classified as “unassigned” while health officials work to determine which county has jurisdiction over those positive test results.

The delay in finding cases of COVID-19 is largely due to the delay in the production and availability of test kits for the disease, which were not available in Washington until the end of February.

Locally, Lutz said the State Public Health Lab in Shoreline initially had the test kit but could not validate it, which means samples from Eastern Washington must be sent to Seattle or elsewhere for testing.

WSU Spokane does not have the ability to test samples. LabCorp and Quest laboratories can process samples but must send them off to be tested. Health care providers can also send samples to the University of Washington for testing.

Now that the Centers for Disease Control and Prevention has loosened testing restrictions to any person with symptoms, Lutz expects providers to take advantage of that ability to test more, without overdoing it.

“I think it’s really important that providers judiciously use their clinical judgment to test,” Lutz said.

The SRHD will be informed of any positive test results that come back from the State Public Health Laboratory and the CDC. Those positive test results will help Lutz and health officials plan for further public health measures.

“I have no doubt that there are people walking about asymptomatic or minimally symptomatic in our community that have it,” Lutz said. “That’s why that sentinel testing for us is really important because once I know definitively that I have it, it changes the dynamic and the calibration of efforts we will be putting forth to prevent its spread.”

Protective supplies limited

In the last two days, the Washington State Department of Health and the CDC have downgraded their personal protective equipment standards for health care providers treating patients with COVID-19.

The primary difference between the two levels of protection for health care workers involves the type of mask required.

The CDC and DOH are now recommending health care providers use surgical, tie-on masks not respirators, or N95 masks, which block airborne transmission. The CDC acknowledged this is due to a limited supply of respirators.

“Based on local and regional situational analysis of PPE supplies, face masks are an acceptable alternative when the supply chain of respirators cannot meet the demand,” CDC guidelines say.

Locally, ensuring emergency responders have an adequate supply of personal protective equipment is a “big challenge,” said Mike Lopez, integrated medical services manager at Spokane Fire Department.

“We are getting more and more in,” Lopez said. “The availability on a nationwide basis is pretty scant for PPE, whether that’s for hospital personnel or EMS personnel.”

According to the fire department’s suppliers, it will be mid-April before the SFD can access additional supplies of personal protective equipment. In the meantime, it has relied on the health district to obtain and provide it with as much personal protective equipment as possible.

The department has already implemented personal protective equipment conservation measures in accordance with CDC guidelines.

“Distance from the patient, as well as the procedures that are done, will dictate the level of PPE and type of PPE that they’re going to be utilizing,” Lopez said.

As far as supplies go nationally, Lutz said, “we are starting from behind.”

Social distance, avoid crowds

Spokane officials are recommending that residents practice “social distancing” – physically separating from others by six feet or more – working from home when possible, avoiding large, crowded spaces and refraining from shaking hands.

People experiencing symptoms should stay home when they are sick, health officials say, and call their health care provider to see if they should be tested for the disease before going in to the doctor’s office or emergency department.

Ideally, preventive measures will help lessen the burden on a region’s health care system. The majority of people who get COVID-19 do not need to be hospitalized, but people over the age of 60 and those with underlying health conditions are at higher risk to develop severe illness.

So far, the majority of the 30 reported deaths in Washington state have occurred in residents of long-term care facilities in Western Washington. Five facilities are linked to deaths in former residents, including Life Care Center in Kirkland.

In just two days, the number of confirmed cases of COVID-19 in Washington has more than doubled, in part due to the increase in testing and the likelihood that the disease has been spreading in West Side communities for weeks without being detected or tested for.

Washington Gov. Jay Inslee issued an emergency order Wednesday banning gatherings of more than 250 people in King, Pierce and Snohomish counties, which have been the hardest hit as the coronavirus spreads across not only the state but also the world.

King County Public Health Officer Jeff Duchin warned the COVID-19 outbreak will go on for weeks and likely months.

He called it the “infectious disease equivalent of a major earthquake,” with the likelihood of continued aftershocks.

Inslee’s order covers concerts, religious services, festivals and athletic contests. Inslee said it was “highly likely” the order will be extended beyond March, and could be extended to other areas of the state if the COVID-19 virus spreads.

While these restrictions may impact people’s way of life, they’re important to the effort to contain the virus’ spread and to protect people at a higher risk of dying from the virus, Inslee said.

Seattle Public Schools, the state’s largest district, also announced Wednesday plans to close for at least two weeks.

That announcement came soon after Inslee urged school district officials to begin planning for potential closures and to figure out what to do for students who rely on school meals and for families who would need to find childcare.

Employers throughout the state also were encouraged to have as many employees as possible work remotely and to employ “social distancing” protocols in the workplace.

Locally, Lutz and other officials are reviewing events on a case-by-case basis considering how many attendees are anticipated, their ages, where they are traveling from and what the risk is to the public. On Wednesday, Lutz announced the cancellation of a middle school basketball tournament scheduled for this weekend in Spokane.

“Recommendations are changing day-to-day as we receive more information and as COVID-19 becomes more prevalent in the county,” Lutz said.

Reporters Adam Shanks and Daisy Zavala contributed to this story.

Correction: A previous version of this story incorrectly stated that the Spokane Regional Health District had the COVID-19 test kit initially. The State Public Health Lab in Shoreline initially had the test kit, not SRHD. We aplogize for the error.