Second Unexplained Coronavirus Case in California Raises Specter of Spread

The findings hint that the coronavirus may already be circulating locally within California, a circumstance that until this week had not been reported in the United States. Dr. Sara Cody, the public health director for Santa Clara County, confirmed the new coronavirus case, one that does not have any links to known cases. That is similar to the case revealed on Wednesday in Solano County, a 90-minute drive away.

“If we were worried yesterday, we are even more worried today,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center. “Now we have to ask: How widely, really widely, is this virus out there?”

Officials in Santa Clara County said on Friday afternoon that the newest unexplained case involved an older adult woman with chronic health conditions who was hospitalized for a respiratory illness. The woman had no history of travel to places like China, nor did she have any known contact with someone who had been overseas or been otherwise infected with the virus, the officials said.

A doctor treating the woman contacted the local public health department to discuss the case, the officials said, and to request testing for the novel coronavirus, which has killed more than 2,800 people worldwide and sickened some 83,000 people in at least 56 countries. The Santa Clara public health lab got the specimens on Thursday and performed the testing, which came back positive later that day. Since then, workers in Santa Clara County have been rushing to identify anyone the woman had been in contact with.

“This case does signal to us that it’s now time to shift how we respond to the novel coronavirus,” Cody said. “Now we need to add other public health tools to the mix.”

Santa Clara County, the heart of Silicon Valley, where Google and Apple have their headquarters, also includes San Jose, the 10th-largest city in the nation. Cody advised schools and businesses to begin planning for the possibility of absenteeism and to clean surfaces in their institutions, and California health officials said it had greatly expanded its ability to test for the virus.

There are more known cases of coronavirus in California than in any other state, though most of them have been the result of people traveling abroad. Sixty-three cases have now been reported in the United States, but all attention turned to California as the two new cases of mysterious origin emerged.

The two cases — both women — are the first ones in which health officials have not been able to determine how the patients got sick. That, officials said, might be a first sign of the virus spreading within the United States, where previous cases had been related to travel to Wuhan, China, the center of the outbreak; to relatives who had been abroad; or to a cruise ship carrying many infected patients.

Already, local and state health departments across the country have been stretched thin by the coronavirus outbreak, and the two cases of unknown origin signaled a new front in their efforts. “Most public health departments can respond to one case or two cases. But it’s going to be many more than that,” said Dr. Joshua Sharfstein, a public health professor at Johns Hopkins.

Experts said the public health response in the two California counties where the unexplained cases arose should include examining specimens of people who may have been hospitalized or died of respiratory illness in recent weeks.

In Solano County, which had the first U.S. case of unexplained origin, local officials have fielded calls from scores of concerned residents.

“I’m middling alarmed,” said Rick Lodwick, as he tossed a jumbo pack of sanitizing wipes into the back of his car in the parking of a big box store in Vacaville.

“When I heard it was here, I thought, ‘We’re going to have trouble,’” Lodwick said.

Solano County, northeast of San Francisco, is a place of cattle ranches, biotechnology research facilities, a military base and vineyards. Hiking trails wind their way through hills that at this time of year are brilliant green.

“People are concerned and they’re paying attention,” said Jeremy Craig, the city manager of Vacaville. “But I don’t think there’s a panic.”

Restaurants were full on Friday, the manager of a movie theater said there had been no decline in ticket sales, and it was very rare to see someone wearing a mask.

Jayleen Richards, public health administrator for Solano County, said her staff of around 200 people was being helped by officials from the California Department of Public Health, the Centers for Disease Control and Prevention and Travis Air Force Base.

“It’s a lot of work but we’re having the capacity to deal with it right now,” Richards said.

Her office had received “a lot of calls” regarding coronavirus but overall “the community does seem to be taking it in stride,” she said.

On Thursday, officials in the county declared a health emergency. An investigation was started into all contacts the sick woman from Solano County might have had with friends, neighbors and medical workers.

“It’s scary,” said Adrian Obando, a stay-at-home father who was watching his daughter turn cartwheels on the lawn of a park near NorthBay VacaValley Hospital, where the woman was treated before she tested positive for the coronavirus.

Still, Obando said that he was worried, but that he did not think there was much he could do. He said he could see with his children how easily colds and flus spread. “They get sick all the time,” he said.

Dr. Bela Matyas, the public health officer in Solano County, said officials had begun monitoring dozens of people with whom the woman had interacted in recent weeks — including relatives, co-workers and others she might have had contact with through her job — and had asked them to quarantine themselves at home. Those who experience symptoms, Matyas said, will be tested for the coronavirus and be asked to further isolate themselves. The officials would not say where the woman worked or what sort of work she did.

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On the edge of the San Francisco Bay and with a population of 450,000, Solano County is ethnically diverse and by national standards relatively well-off, with median incomes around $80,000.

When the authorities announced four weeks ago that hundreds of American citizens traveling from Asia would be quarantined at Travis Air Force Base, in the heart of the county, Solano County was thrust into the national spotlight.

“We saw Solano splashed all over the news with Travis and the quarantine — and we thought well it’s only a matter of time,” said Cricket Kanouff, the president of the Pena Adobe Historical Society, which preserves a home built by early settlers.

“We’d like to be known for our other virtues,” Kanouff said on Friday as she placed soap in the bathrooms of the museum at the adobe.

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Several of those quarantined at Travis tested positive for the virus. Yet on Thursday, health officials emphasized there was no indication that the woman had come in contact with anyone at the base, nor had she traveled recently.

Outside the Air Force base on Thursday, there were few signs of concern. Pilots in flight suits greeted one another with handshakes at a nearby fast-food restaurant. No one wore masks during the lunch rush.

“To me it’s just another flu,” said Beverly Garske, who was taking a walk a few minutes from the base’s entrance.

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Having a possible case of community transmission occur in her county made the virus feel “close to home,” she said. But she shrugged off the idea that she might become exposed.

“My husband and I don’t get out much,” Garske said. “If we do go out, usually it’s to go fishing.”

Nern Lewis, who lives minutes away from Travis Air Force Base, said she was not concerned. “I mostly just stay in my house,” she said, “so I’m not afraid.”

But as Lewis sat in the sunshine in front of her ranch house Thursday morning, she said some of her relatives had grown more nervous about the virus. The new case was a troubling mystery.

She had been planning to return to her native Thailand to visit her sister but was now putting off the trip.

“It’s not a good time for it,” Lewis said. “You might not be able to come back.”

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The woman in Solano County who has the coronavirus was initially treated in Vacaville and then taken by ambulance to the University of California, Davis Medical Center in Sacramento, where she was still being treated as of Thursday night.

At the hospital earlier in the day, some workers seemed deeply concerned about possible exposure.

“I’m worried how this will affect my baby,” said Vickie Poncalo, a cashier at the hospital’s cafe who is seven months pregnant.

“Should we be wearing a mask and worrying that people are walking around here?” she asked. “Should I even be here?”

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In the gift shop, Madeline Daniels said she was wondering about all of the possible ways the virus might spread.

“Money is the dirtiest thing,” she said.

Dr. Peter Beilenson, the director of Sacramento County’s Department of Health Services, said officials were bracing for a larger outbreak in Northern California.

“There’s almost assuredly going to be a significant number of people testing positive,” Beilenson said.

This article originally appeared in The New York Times .