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First COVID-19 death occurred weeks before previously thought

Deaths are “tip of the iceberg”, reveal “significant” community transmission

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Three individuals in Santa Clara County died with COVID-19 in February and early March, according to autopsy results from the Center for Disease Control (CDC), the County of Santa Clara Medical Examiner-Coroner announced on Tuesday. All three deaths occurred before March 9, the earliest known COVID-19 death in Santa Clara County before the announcement. 

The first of the three deaths, which occurred on Feb. 6, is now the earliest known COVID-19 death in the entire U.S., pre-dating the previously thought first death in the country by three weeks. 

“These three individuals died at home during a time when very limited testing was available only through the CDC,” states the Santa Clara County Public Health Department website. Testing criteria set by the CDC at the time restricted testing to only individuals with a known travel history and who sought medical care for specific symptoms.  

The victims included a 57-year-old woman, 69-year-old man and 70-year-old man, said County Health Officer Sara Cody ’85 in a Facebook live stream from the Santa Clara Public Health Department. 

“As far as we understand, none of these cases had a significant travel history,” Cody said. “We presume each of them represent community transmission and that there was some significant level of virus circulating in our community in early February.”

Since COVID-19 tests were not available at the time of death, the Medical Examiner-Coroner sent autopsy tissues for further analysis because the individuals had exhibited flu-like symptoms, according to a statement from the Medical Examiner-Coroner that was read during the Facebook livestream.

Yesterday, “CDC confirmed SARS-CoV-2 in these tissue samples” reads the statement. 

The Santa Clara County Public Health Department expects the Medical Examiner-Coroner to identify additional deaths from COVID-19 as further testing is conducted. Cody called each of the three cases an “iceberg tip.” 

“When you have an indicator like deaths of ICU, that means there’s some iceberg of cases of unknown size that underlie those iceberg tips,” Cody said. “With three of them, that tells us that there must have been some significant degree of community transmission. We had a robust influenza season so it would have been extraordinarily difficult to pick out what was influenza and COVID-19.”

The confirmation of COVID-19-related deaths as early as February changes the known timeline of coronavirus in Santa Clara County. 

“Back in early February, we did know that we had had COVID-19 in our county, but we had not yet identified our first case of community transmission,” Cody said. “That didn’t happen until Feb. 28. These deaths tell us that we had community transmission, probably to a significant degree, far earlier than we had known. That indicates that the virus was probably introduced and circulating in our community far earlier than we had known.” 

Part of the issue was that Santa Clara County was only initially testing people with travel history, Cody explained. 

“We were only looking among people who had traveled and we had been wondering how would we detect community transmission if we were not testing people who had not traveled,” Cody said. 

Previously, the earliest known COVID-19 related death in Santa Clara county occurred on March 9. The woman, in her 60s, was the third reported case of coronavirus in the county and the first infected “without any known history of international travel or contact with a traveler or infected person,” according to a county press release.

So far, 1,962 people have been diagnosed with COVID-19 in Santa Clara County. 191 of those patients are currently hospitalized, according to the county’s dashboard. 

20,416 patients in Santa Clara County have been tested for COVID-19 since the start of the outbreak, according to the county’s updated dashboards. The county is awaiting results for 285 of those patients who have been tested.

As of yesterday, Stanford is aware of 39 people “connected to the Stanford community either as faculty, staff, students or postdocs and who have received positive COVID-19 test results,” the University wrote in an update on Monday. The total had previously been at 38 since April 13.

The Centers for Disease Control (CDC) first issued an alert about the coronavirus outbreak in Wuhan, China, on Jan. 8. On Jan. 3, Stanford Environmental Health and Safety (EH&S) asked all Stanford community members who have returned from traveling to China within the past 14 days to “self-isolate,” regardless of whether they exhibited symptoms of coronavirus.

One day later, the CDC reported the first confirmed case of coronavirus in Santa Clara County. On Feb. 3, the second case of coronavirus in the county was confirmed.

Contact Ujwal Srivastava at ujwal ‘at’ stanford.edu and Emma Talley at emmat332 ‘at’ stanford.edu.

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