Covid-19: A Q & A on the first case in Orange County, Ca.

Matthew Zahn, MD, is medical director of the Division of Epidemiology and Assessment for the Orange County Health Care Agency. He answers questions here about one of the first patients confirmed to have the novel coronavirus, diagnosed, with what is now known as Covid-19, in Orange County, Ca. in January.

When the magnitude of the Ebola outbreak in West Africa became known in 2014, it was discovered, with the case of the first patient in the United States and the transmission of the virus to health providers here, that we were not as prepared as it needed to be. Can you compare that to the what you are seeing now?

The system did work this time: our case knew that they should get seen for medical care with their symptoms, and informed medical providers immediately of their situation when they arrived.  The health care workers who initially saw the patient recognized the infection control risk immediately and took steps to minimize exposures. Without these actions, our number of healthcare exposures could easily have been much higher.

Can you describe the challenges of evaluating both the cause and the severity of the illness of one of the first people in the United States diagnosed with this novel coronavirus?

Treatment of the initial cases is complex.  The virus causes indolent infection, with severe disease developing over several days.  It makes for difficulty in figuring out when a patient can be released from the hospital for clinical purposes, and then released from isolation in general.

What challenges did you face, compared to dealing with an already endemic infectious disease?

The initial response to these events is very labor-intensive.  With the concern for potential airborne spread, it’s like a public health measles response but with no vaccine and more uncertainty as to what works to contain the virus.

Can you compare the public response to this outbreak to concerns about previous public health threats?

With the rapid increase in cases and deaths worldwide and the media coverage of the extraordinary public health measures being taken in China, there is more general community agitation (sometimes bordering on hysteria) with this event than any public health event that I can recall.  

What role has the U.S. Centers for Disease Control and Prevention played in helping to address needs surrounding the discovery of the first case in your area and to prepare for more?

CDC’s assistance has been invaluable.  They have provided us direct guidance for care of the case and sent a team to help monitor all of those exposed.  Our response would not have been possible without them.  

Are we ready for next possible phase of this outbreak in the United States?

Our mindset is changing quickly to think through potential public health response if local spread eventually occurs. As hard as this initial response has been, the workload for this event may grow significantly larger.

Dr. Zahn currently serves on NACCHO’s Infectious Disease Workgroup, and is the liaison from NACCHO to the CDC’s Advisory Committee on Immunization Practices. He has served on multiple national public health committees, including CDC’s school-located vaccination advisory committee, and as president of the California Association of Communicable Disease Controllers. His primary work is in public health, but he continues to practice as a pediatric infectious disease physician.