2020 Novel Coronavirus llHealth SITUATION 15 WA DOH Incident Management Team OFFICIAL USE ONLY Dm: flme: Tuesday, February 4, 1600 2020 IMPAETED AREAS 5nonomish County, WA County/Regions, CURRENT Please contact the Poison Control Call Center at 1esuueszseo1z7 for further information SITUATION related to this autoreak Please contact the DOH Duty officer at 3608880838 or for question regarding incident management or emergency highlighted) preparedness arid/or response. Washington Confirmed Cases 2019nva Washington confirmed cases by County in 2020 County January 2020 Last Updated Snohomisn 1 1/21/2020 Total 1 1/21/2020 Persons under investigation--Updated 2/4/2ozn Total Persons under lnvesti tion in Washington': a -lncludes rlonewashirlgton State residents 2019nCoV Washington Test Results--Updated 2/4/2nzn Positive icontirmed) 1 Negative 13 Puls Pending Resuits 3 Total Tested 22 Washington Close Contacts Being Monitored -- Updated 2/4/2nzo County Close Contacts Snohamish 13 King 3 Skagit 1 Total 17 Current Currently the DOH Operations section is engaged in the foHowing activities: Operations Overall operations Background: Call with four impacted states and one local health jurisdiction to discuss common operating picture for response to nCov. Prepared by: Cody Carmichael, 5th Cindy Marron, Approved py: Last updated: 2/4/2ozu 1 FOR OFFICIAL USE ONLY - Developed four strategies for travelers from China and Hubei province being funneled through SeaTac airport based on symptom status, travel origin, and travel destination based on 1/31/2020 White House Press Conference. All groups worked on adjusting operations based on evolving CDC guidance and situational awareness around quarantine planning and operations. Epidemiology Branch Operations Background: - We are only reporting 1 confirmed case of novel coronavirus (n-CoV). Contacts are continuing to be monitored at this time. - Staff have led multiple calls involving Local Health Officers, Epidemiologists, Health Care Coalitions and other key partners to develop guidance and coordinate response efforts to ensure the safety of those within Washington State. Likewise staff have coordinated with Local and Federal partners to ensure timely and effective specimen collection, transportation and submission methods to test for 2019-nCoV. - Statewide contacts have been successfully tracked through WDRS. - Clarified communication flow with local health jurisdictions regarding persons under interest. - Developed metrics for surveillance reporting and persons under investigation (PUI) and case classification forms for surveillance system. - Surveillance report and metrics developed and will include data from WDRS, death data, and Syndromic Surveillance queries. - Call to discuss literature review tasks and draft preliminary guidance for ICU providers, coroners, and medical examiners. - WDRS new assessment form for PUI, potential PUI, and cases and workflows for managing cases will be live tonight (1/29/2020). - Staff are developing workflow protocols for contacts under enhanced surveillance that become symptomatic. - Local Health Jurisdiction call regarding WDRS and data management. Continued data entry and reconciliation. - Conducted a call with local health jurisdictions, officers, and tribes to relay operational and epidemiology updates. - WDRS nCoV outbreak module updated to reflect PUI definition changes. - Text illness monitoring (TIM) system developed by CDC being adapted for states to use for symptom monitoring by mid-week. - Building out WDRS surveillance module for different traveler classifications. Updates: - Surveillance and PHL met to determine flow of information from labs to disease reporting systems and streamline communications for case investigators. - Surveillance Group continues to gather information and develop text information messaging components. Prepared by: Cody Carmichael, SITL Approved by: Last updated: 2/4/2020 2 FOR OFFICIAL USE ONLY PHL Operations Background: - Staff have updated training requirements and guidance for shipping and specimen retention, ordered additional resources to handle future testing demand, and have initiated feasibility inquiries into local testing. CDC in support of these operations have provided both guidance and technical assistance. Staff are continuing to collect specimens for shipment to CDC. - Began LIMS system development pertinent to nCoV incident response. - Began preparation work to begin nCoV testing. - Added 2019nCoV to test menu at PHL to ease LHJ submittal process including updated sample submission form and epi contact information. - Received automated extraction machine today and receiving training tomorrow. Testing at PHL is still awaiting Emergency Use Authorization for testing n-CoV testing procedure to be released. - Collaborated with epidemiology team to design a web portal for communications between epidemiologists and the PHL to streamline sample submission, sample updates, and final results. Update: - Public Health Lab has gained EUA, and is currently seeking reagents to allow for diagnostic testing, with no noted ETA. - Public Health Lab is completing 2nd half of order for specimen collection kit requests. - Developing criteria for advanced testing at the Public Health Lab Guidance and Policy Background: - Healthcare call conducted that include LHJs, Coalitions and Professional Associations. - DOH, CDC, NWHRN, and local health jurisdiction staff conducted a site visit at Providence Colby in Snohomish County to provide recommendations for potential isolation and treatment of confirmed nCoV cases. - Reviewed and updated guidance for PUI home-testing kits. - Finalized signs for healthcare facilities to post within healthcare facilities. - Guidance documents posted to the DOH website will include the date guidance was updated moving forward. - Pending updated guidance from CDC. - Guidance for pathologists, medical examiners, and coroners who may perform autopsies on patients with nCoV completed and awaiting distribution. - Finalized standard operating procedures for guidance and policy group. - Conducted potential quarantine site assessment. - Conducted webinar for outpatient healthcare facilities. Update: - Identified overlaps between existing guidance documents and movement and monitoring documents to allow for refinement of documents and protocols. Prepared by: Cody Carmichael, SITL Approved by: Last updated: 2/4/2020 3 FOR OFFICIAL USE ONLY Healthcare Systems Readiness Branch Healthcare Readiness Background: - Staff have conducted site visits to healthcare facilities visited by the patient while they were infectious to ensure proper protection measures were taken, have arranged calls with designated treatment and assessment facilities to discuss recommendations, and provided guidance alongside CDC partners for local health jurisdictions and other healthcare partners. - Guidance for Local Healthcare and Public Health Partners have been developed: - Guidance for CoV Monitoring, which provides guidance to Local Health Jurisdictions that are monitoring contacts. - Exposure Risk Categories for 2019 Novel Coronavirus, which defines exposure categories to determine monitoring and activity restriction. Guidance for Contacts, which provides members of the public who are being monitored information on why they are being monitored, methods of monitoring, and key symptomatic information regarding n-CoV. - Health Care Provider Tracking Form, which is used to track healthcare worker contact with a Person Under Investigation or a confirmed case. - Novel Coronavirus (2019-nCoV) Interim Infection Prevention and Control Guidance - Prehospital and Healthcare Survey has been distributed to partners to assess gaps and needs and identify partners who can perform patient movement, specimen collection, and patient care. - Defined isolation guidance for non-healthcare facilities and gauging state agencies to support finding locations for isolating individuals. - Explored expansion of self-specimen collection using Bio-Fire rapid testing process. - Developed guidance for general non-pharmaceutical interventions and investigated feasibility of take-home kits. - Provided triage guidance to 911 operators and produced draft procedures for WATech. - Basecamp website established for local health jurisdictions, including infection prevention guidance, and additional guidance from DOH. - WATrac guidance for updating airborne infection isolation rooms completed and distributed. - Updated EMS and 911 guidance with new PUI screening criteria. - Awaiting CDC guidance and identifying possible quarantine facilities. - Patient movement plan in review with DOH EMS office. - REDi Healthcare Coalition working on replicating Harborview Home Assessment Team (HAT) at other hospitals across the state. Update: - Attended LERC/RERC Call which helped determine PPE distribution across the state. - Communicated with ASPR regarding potential shelf life extension of PPE based on warehouse conditions. Prepared by: Cody Carmichael, SITL Approved by: Last updated: 2/4/2020 4 FOR OFFICIAL USE ONLY Mitigation Operations Background: - This group shall focus on advanced planning related to mitigation efforts, recommendations, and implementation. Operations began 1/27/2020. - SMEs are currently working to develop work assignments and strategies to be implemented during the response. They will be working with partners to identify gaps or concerns with partners and help mitigate them. - Home health kits being developed for contacts to self-monitor symptoms. Supply chain shortages are limiting our ability to provide more than 72 kits at this time. These kits will be made available for public health partners who are impacted. - Completed assessment of PPE supplies across the state. Updates: - NPI Guidance Documentation is under development. - Mitigation Operations Group worked with Healthcare Facilities and PPE Distributors to determine PPE distribution status statewide. Northwest Health Response Network/ REDi Background: - Coordinated call with four King county hospitals that will prioritize symptomatic passengers from mainland China and Hubei province. - Creating outpatient survey with collaboration from Guidance and Policy Group that will be distributed to non-hospital healthcare facilities on 2/4/2020. - Coordinated call regarding situation awareness and supply chain issues with hospitals, EMS, and Pierce, King, and Snohomish counties. Update: - Policy and Gap assessments across the state, with implementation of the Harbor View Protocol - Outpatient Survey has been distributed to gauge preparedness and equipment supply related to a potential 2019n-CoV case. Quarantine Branch Background: - Working to assemble a task force to support quarantine facility and build capacity for determining facility readiness and potential needs. Update: - Obtained approval for placement of a pair of Liaison Officers for DGMQ positioning. - Successfully developed a quarantine site plan with a complementary gap analysis. - Assessment Team built to support any potential patient as needed in case of quarantine activities, with draft plan. Public Information Background: Prepared by: Cody Carmichael, SITL Approved by: Last updated: 2/4/2020 5 FOR OFFICIAL USE ONLY - - Staff have successfully prepared for and held multiple press briefings with local, national and international media outlets, as well as in partnership with the CDC and Local Health Jurisdictions and Hospitals. Likewise, there has been success in the opening of a toll-free number where individuals can obtain more information as well as an accompanying page upon the doh.wa.gov website. Lastly, a Communications Plan has been successfully drafted and finalized. Staff developed and distributed a press release regarding the 2019n-CoV and associated activities. A press conference with Governor Inslee and Secretary Wiesman with state and local health officials was successfully conducted. Coordinated LHJ Communicators Call – provided an update on the latest we know regarding the quarantine measures. Added workplace guidance to the DOH nCoV website. Update: - News Release out as of the afternoon of 02/04/20 - First statewide Joint Information Call conducted - Translations sent and received for clinical and social media materials FEMA Region 10 IMT Activation - Washington: Activation level 1. 1 case, 4 PUI. - Oregon: Activated for Information Collection and Observation. - Idaho: Currently pending further communication. - Alaska: Activation level 3. No cases or PUI. Literature Situation Report This is not official guidance from the CDC and is based on a Department of Health literature review. Reports can be found here: https://www.doh.wa.gov/Emergencies/Coronavirus/Resources Background: - While an origin for the virus has not been officially identified, current evidence points to bats with a reservoir in snakes. - Estimates of R0, incubation period, and illness duration are still inconsistent as researchers rely on a range of case reporting sources. Even so, some patterns are beginning to emerge and may be worth noting, with caution. Current research suggests: o R0 of up to around 4, with variation by community characteristics. o Incubation period of 1-11 days with an average of 4-6. o Roughly 14 days on average between illness onset and death among fatal cases. - One study found that patients who died tended to align with the MuLBSTA score for predicting mortality in viral pneumonia and often died of multiple organ failure. - Case fatality among hospitalized patients was estimated at 14% by one report, with case fatality among non-hospitalized cases assumed to be much lower. Prepared by: Cody Carmichael, SITL Approved by: Last updated: 2/4/2020 6 FOR OFFICIAL USE ONLY - - - - - KEY MESSAGES FROM PUBLIC INFORMATION OFFICER        Prepared by: Cody Carmichael, SITL Various sources report that the outbreak in China is likely significantly larger in case count and geography than current estimates suggest due to the frequency of undetected mild cases. A second case of 2019-nCoV was identified in Germany resulting from apparent asymptomatic transmission from an infected Chinese traveler. Several studies suggest that movement and travel restrictions in China remain important for curbing the spread of the outbreak and that there is a risk of selfsustained outbreaks in major cities where travel from Wuhan was high in the days leading up to the region’s movement restrictions. Phylogenetic studies of the origin of the virus continue to be published, with one recent report suggesting that the virus may have been circulating among humans as many as 200 days before the outbreak was detected in December. Implications of 2019-nCoV recognition of the human cell receptor angiotensin converting enzyme II (ACE2) is a hot topic, with researchers considering everything from potential therapies to novel transmission mechanisms based on this information. Accurate estimates of the basic reproductive number for 2019-nCoV are difficult to calculate given the current uncertainties in the developing epidemic. A recent paper using a pooled estimate found an estimated R0 of 3.1, with likely values ranging from 2.1-5.7 Despite a flawed earlier report, asymptomatic transmission has not been confirmed in peer-reviewed literature. Incubation period estimates are coalescing around 5 days, with the vast majority of persons developing symptoms within 11 days and a small number (<1%) extending beyond 14 days . Modeling assumptions continue to change with increasing information on the epidemic. Review articles are beginning to surface. Wang and Zhang’s review in The Lancet, published on-line today, is of particular note. On January 21, 2020, the Centers for Disease Control and Prevention (CDC) and Washington State Department of Health announced the first case of 2019 Novel Coronavirus (2019-nCoV) in the United States in Washington State. The Department of Health Incident Management Team (IMT) is activated. Much remains to be understood about this novel coronavirus (2019 nCoV). This is a serious situation. We have faced similar challenges before- first with SARS and later with MERS. Both outbreaks were complex and required a comprehensive public health response. Because of that experience, we know it’s crucial to be proactive and prepared. Outbreaks of new diseases among people are always of public health concern. This response will evolve as the outbreak evolves. Washington State has made improvements in our capacity to respond to disease outbreaks. We are now better poised to respond to this new threat quickly and collaboratively. For the latest information please refer to: www.doh.wa.gov/coronavirus Approved by: Last updated: 2/4/2020 7 FOR OFFICIAL USE ONLY Washington State 2019-nCoV news: 2/4/2020 CWU students react to peer being tested for coronavirus (KIMA TV) CWU student's coronavirus test results delayed (KIMA TV) Bellevue boy stranded in China arrives home amid coronavirus outbreak (KING 5) Snohomish County man diagnosed with coronavirus released from hospital (KING 5, KOMO, Q13, Everett Herald) Washington state businesses brace for impact of the coronavirus (Seattle Times) 11 coronavirus cases now reported in US, including three more in California (The Hill) U.S. novel coronavirus cases rise to 11, CDC reports (PBS.org) China deploys 1,400 military doctors, nurses to staff makeshift hospitals in Wuhan (Fox News) 3,700 quarantined on cruise ship in Japan after passenger tests positive for coronavirus (KING 5, USA Today) Hong Kong medical workers strike as China coronavirus death toll hits 425 (KING 5, Seattle Times) Coronavirus Live Updates: Xi Urges Tougher Response to the Crisis (New York Times) This Chinese doctor tried to save lives, but was silenced. Now he has coronavirus (CNN) This is where Wuhan coronavirus cases have been confirmed worldwide (CNN) Confirmed Wuhan coronavirus cases top 20,000 as China marks deadliest day (CNN) Coronavirus Crisis Shows China’s Governance Failure (New York Times) Why The World Cares More About The New Coronavirus Than The Flu (NPR) “No country is fully prepared”: Why the coronavirus outbreak is a huge wake-up call (VOX) China’s draconian response to the new coronavirus, explained by a China expert (VOX) VERIFY: Why Lysol already knew about the coronavirus — and can its products really fight it? (KREM) Talking Drones Take to China’s Skies to Fight Coronavirus Outbreak (Seattle Times) High-profile report on asymptomatic spread of coronavirus based on faulty information, health officials say (STAT) Coronavirus myths: CDC and World Health Organization address misinformation about the disease (mass Live) Procedures still unclear for coronavirus screening, quarantine of travelers arriving at Sea-Tac Airport from China (Seattle Times via Columbian) Prepared by: Cody Carmichael, SITL Approved by: Last updated: 2/4/2020 8