CDC-confirmed county deaths indicate transmission prior to previous knowledge

COVID testing
Megan V. Winslow/Town Crier
A healthcare professional gathers medical information during a COVID-19 test in the parking lot of a private  practice near El Camino Hospital April 10.

Acting on a hunch, staff at the Santa Clara County Medical Examiner’s Office kept post-mortem samples of three residents whose autopsy results yielded more questions. Their persistence proved paramount in a new discovery about the coronavirus in the region: It’s been transmitting longer than experts thought, health officer Dr. Sara Cody said at a press briefing Wednesday (April 22).

According to a statement from the Medical Examiner’s Office read by public information officer Evelyn Ho, three people died – a 57-year-old woman Feb. 6, a 69-year-old man Feb. 17 and a 70-year-old man March 6 – before any COVID-19 cases unrelated to travel were known and reported. Following its protocol to test patients with flu-like symptoms for viral illness, coroners tested the bodies and found they were negative for all other viruses. But the examiners had continued suspicion, so they sent the autopsy tissue from all three people to the U.S. Centers for Disease Control and Prevention lab for testing.

The CDC confirmed Tuesday (April 21) that all three county residents had died of coronavirus infections. None of the three had “significant travel history,” Cody said. County health officials do not know when the samples were taken or how long the autopsy process, which Cody compared to an “iterative investigation,” took.

Cody said all three deaths occurred before she and the team at the Emergency Operations Center believed the county had its first coronavirus-related death. In early February, they were aware the virus had hit the area but had not identified the first case of community transmission due to the lack of testing available in January and February. She announced the first case of community transmission Feb. 28, when in reality, she noted, the deaths show the type of circulation was present “to a significant degree far earlier than we had known.”

“We know that each of these deaths were really like iceberg tips,” Cody said. “(These are) indicators, when you have an outcome like death or ICU (hospitalization). That means there’s some iceberg of cases of an unknown size that underlie those iceberg tips. … We had a robust influenza season, and it’s extraordinarily difficult to pick out what was influenza and what was COVID-19.”

Post-mortem samples will be routinely tested for COVID-19, Ho said. The results of all testing help both the Medical Examiner’s Office and the county’s Public Health Department understand the pace of the pandemic. The agencies are battling the virus in collaboration with the California Department of Public Health and the CDC. CDC representatives were present when cases began to ramp up in the county, but “now that the coronavirus has sprung up in every corner of the country,” Cody said, county staff has had to navigate on its own.

No letting up

When asked whether she would consider easing some of the shelter-in-place restrictions as her counterparts in nearby counties have done, Cody said she anticipated that the pandemic will be going on for a “very, very, very long time.”

“We know that we do not have immunity in the population, nor do we have a vaccine, so any time we let up on our mitigation measures we will expect to see a spike in cases, hospitalizations and deaths,” she said.

As of today, there are 1,962 confirmed coronavirus cases and 94 deaths in Santa Clara County, with 191 people hospitalized. Mountain View has 42 cases, Los Altos 22 cases and Los Altos Hills fewer than 10. Nearly 20,000 people have been tested for the virus, with 9.8% testing positive and the results of 275 tests pending. The average turnaround time for results is under two days.

The county will expand its online coronavirus dashboard today to include race/ethnicity data for all cases, data previously available only for those who died. Cody said the race/ethnicity data, presented with the caveat that it is incomplete, is important to track to ensure racial and health equity countywide and to understand the social and structural determinants of health and how they impact health outcomes.

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