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California

Grand Princess cruise ship at center of coronavirus fight amid concerns about spread

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Gov. Gavin Newsom declared a state of emergency over the novel coronavirus after a California man died after falling ill with the virus while on a cruise ship.

Officials are trying to locate hundreds of other Californians who disembarked from the Grand Princess ship in San Francisco last month after a trip to Mexico. Officials want to determine whether they also might have contracted the virus.

That same ship, after a subsequent trip to Hawaii, canceled its stop in Baja California and was scheduled to return early to San Francisco on Wednesday, but it was being held off the coast so public health officials could screen everyone onboard, the governor said.

Some passengers on the vessel — both current and those exposed earlier — told The Times the response by the company and health officials has been filled with missteps. In particular, passengers interviewed by the Times said the company, Princess Cruises, was lax on health screening protocols prior to boarding and withheld information about the risks they faced, even as the ship’s condition became international news.

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The virus has now been reported in 12 counties in the state and has sickened more than 50 people.

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Newsom said he felt confident that the state could prevent the virus from being spread by passengers of the cruise who already had returned to California.

“We have the resources,” Newsom said. “We have the capacity. By this evening, we will have contacted every county health official that has someone who came off this cruise. They will have their contact information and begin a process to contact those individuals.”

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Newsom said his emergency declaration is intended to help California prepare for and contain the spread of the coronavirus by allowing state agencies to more easily procure equipment and services, share information on patients and alleviate restrictions on the use of state-owned properties and facilities.

“This proclamation, I want to point out, is not about money,” Newsom said of the emergency declaration. “It’s about resourcefulness. It’s about our ability to add tools to the tool kit.”

Placer County public health officials announced that patient who had tested positive for COVID-19 after returning from a cruise to Mexico last month died. The individual, later identified as a 71-year-old Rocklin resident, had underlying health conditions and was the county’s second confirmed case of COVID-19, reported Tuesday night. Officials said close contacts of the patient were being quarantined and monitored for the illness.

The person’s likely exposure occurred during travel on a Princess Cruises ship that departed Feb. 10 from San Francisco and sailed to Mexico, returning Feb. 21, officials said.

The patient tested positive Tuesday and had been placed in isolation at Kaiser Permanente Roseville Medical Center.

The person probably had minimal community exposure between returning from the cruise and arriving at the hospital by ambulance Thursday, health officials said. Ten Kaiser Permanente healthcare workers and five emergency responders, who were exposed before the patient was put in isolation, are now in quarantine.

None of those 15 workers is exhibiting symptoms, officials said.

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It’s possible that other cruise passengers may have been exposed, officials said. Placer County Public Health is working closely with Sacramento County Public Health and the U.S. Centers for Disease Control and Prevention to identify and contact other cruise passengers.

By one estimate, more than 50% of the roughly 2,500 passengers who traveled from San Francisco to Mexico and back on the cruise ship with the Placer County victim are Californians, Newsom said.

“We extend our deepest condolences to the loved ones of this patient,” Placer County health officer Dr. Aimee Sisson said. “While we have expected more cases, this death is an unfortunate milestone in our efforts to fight this disease, and one that we never wanted to see.

“While most cases of COVID-19 exhibit mild or moderate symptoms, this tragic death underscores the urgent need for us to take extra steps to protect residents who are particularly vulnerable to developing more serious illness, including elderly persons and those with underlying health conditions.”

Sisson said the resident first developed symptoms while on the cruise and continued to show symptoms while traveling through the Port of San Francisco.

The individual called 911 and was taken to the hospital Thursday, then tested for COVID-19 on Sunday. The results returned positive Tuesday, and the patient died Wednesday morning, Sisson said.

Placer County has six pending tests for COVID-19, and Sisson said she expects to see cases of community transmission soon.

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“I urge Placer County residents to be vigilant and to take steps to protect themselves,” Sisson said. “Wash your hands. Wash your hands. Wash your hands…. We are not at the point where I would consider canceling events, closing schools or requiring widespread distancing measures, but we do want the public to prepare for that possibility.”

Sisson recommended that residents have two weeks of supplies on hand in case they are asked to quarantine.

Rocklin Fire Chief Bill Hack said emergency responders are wearing protective masks and goggles when responding to 911 calls until it is clear whether a person has respiratory symptoms that could indicate COVID-19. Three of the five emergency responders who have been quarantined related to the Placer County death are Rocklin city firefighters.

“They’re obviously being hyper-vigilant that if they start to become symptomatic they know what to look for and they know what steps to take,” Hack said. “They’re in good spirits at this point.”

Placer County is requesting that any other individuals who were on the Grand Princess cruise to Mexico self-quarantine.

Princess Cruises said it was notified by the CDC that it is investigating a small cluster of cases in Northern California among guests who sailed on the Grand Princess Mexican voyage.

The next voyage on the boat was canceled.

The company said 62 guests on that voyage remain onboard for the trip to Hawaii that was returning to San Francisco after canceling its stop in Ensenada, Mexico.

Eleven passengers and 10 crew members on the boat were showing symptoms Wednesday, the governor said. “That number may significantly understate” the scope of infection, he said, or “it may indeed be abundance of caution.”

The state will contact every county health official with passengers in their area by Wednesday night, he said.

Newsom addressed the death shortly after the announcement.

“Jennifer and I extend our deepest condolences to the family and loved ones affected by this death in Placer County,” he said in a statement. “The state is working with federal officials to follow up on contact tracing of individuals that may have been exposed to provide treatment and protect public health.

“This case demonstrates the need for continued local, state and federal partnership to identify and slow the spread of this virus. California is working around the clock to keep our communities safe, healthy and informed.”

California has recorded at least 157 cases of COVID-19, including four deaths, in more than a dozen counties.

Newsom previously requested that the Legislature make $20 million available for the state to respond to the coronavirus and announced the California Department of Public Health is dipping into its reserves of millions of N95 masks to distribute to healthcare workers on the front lines of the coronavirus fights.

Newsom said Wednesday that a coronavirus lab test is now considered an essential benefit covered by government-sponsored health plans and private insurers. The governor added he is also extending price gouging protections in response to Amazon vendors’ taking advantage of people seeking hand sanitizer and other in-demand goods.

Los Angeles County, meanwhile, declared a health emergency Wednesday as the number of coronavirus cases in the county increased to seven, including six new patients.

None of the new cases are believed to be “community spread,"officials said. All individuals were exposed to COVID-19 through close contacts with others who were infected.

The additional cases were confirmed Tuesday night. Officials said three of the new cases were travelers who had visited northern Italy, two were family members who had close contact with a person outside of the county who was infected, and one had a job that put them in contact with travelers.

One patient has been hospitalized, and the others are isolated at home.

Additionally, the cities of Pasadena and Long Beach are declaring public health emergencies related to the novel coronavirus. There are currently no confirmed cases of the virus in either city.

The county’s move comes as the government has increased testing, which officials have warned will result in the identification of a significant number of new cases.

L.A. joins a growing number of California jurisdictions to take health-emergency action, which is designed to better marshal resources from across government agencies and give the fight against the virus more focus.

“I want to reiterate this is not a response rooted in panic,” L.A. County Supervisor Kathryn Barger said at a news briefing. “We need every tool at our disposal.”

Supervisor Hilda Solis acknowledged the ongoing spread of misinformation about the virus and xenophobia toward Asian communities.

“There’s been too much misinformation spreading around,” Solis said. “As we expected, it’s cultivating fears and leading to racial profiling.”

Los Angeles County will increase its capacity for testing of the virus at its public health laboratory. Officials will begin daily radio briefings for the public, post new guidelines for schools and colleges, and over the next week will send “technical assistance teams” to make site visits to temporary housing facilities including homeless shelters.

Officials urged the public to frequently wash their hands, opt for verbal salutations in place of hugs and handshakes and try to maintain a distance of six feet from strangers.

“We have to be prepared. We have to protect the well-being of our loved ones and our neighbors,” Los Angeles Mayor Eric Garcetti said.

Officials said they had tested more than two dozen people for COVID-19 before these recent test results came back positive and reiterated that there had been no sign of community spread in the county.

“I want to reassure everyone — we are not there today,” L.A. County Department of Public Health Director Barbara Ferrer said.

A screener of incoming flights from China and surrounding countries at Los Angeles International Airport is among the new cases that have tested positive for coronavirus in L.A. County, according to two sources familiar with the report.

The screener, who is attached to the CDC, last worked Feb. 21 at LAX and, after developing potential symptoms, alerted medical professionals and authorities. The person was formally identified Tuesday as having the COVID-19 virus and so far has a mild case and is isolated at home.

Family members of the person have also been tested, according to one of the sources. So far, nothing has been done to change intake at the airport. Sources say the person was wearing protective clothing during the screening process.

Marin County health officials Tuesday declared a local health emergency despite there being no cases of coronavirus reported among county residents. San Francisco, which has no reported cases, and Orange County, which has three cases, declared health emergencies last week.

The move comes amid more sobering news about the spread of the virus in the United States, including nine deaths in Washington state, a new quarantine in the suburbs of New York City and a warning that more cases are on the horizon.

“I want them to be prepared for the reality that they, there are going to be more cases in the community,” said Dr. Robert Redfield, director of the CDC. “But I want them to continue their daily lives. I want them to be mindful of the opportunity again to prepare themselves and their families.”

The World Health Organization announced Tuesday that the global mortality rate from coronavirus had risen to 3.4%, with more than 3,000 fatalities. The death rate so far is many times higher than the mortality rate of the seasonal flu, which is 0.1%. WHO Director-General Tedros Adhanom Ghebreyesus said that is at least partly because COVID-19 is a new disease, and no one has built up an immunity to it.

Still, he and other health officials said there was still time to slow the spread of the virus.

Officials say they have learned the coronavirus is less transmissible than the flu, which is often spread by people who are infected yet don’t have symptoms. That doesn’t seem to be the case for COVID-19, he said.

“There are not yet any vaccines or therapeutics … which is why we must do everything we can to contain it,” Tedros said.

Earlier reports had pointed to a mortality rate of about 2% for COVID-19. Experts say they suspect all analyses so far have overestimated the disease’s fatality rate because milder cases are largely not being diagnosed. In 80% of people, the disease causes only mild illness, experts say.

More than 50 people in California have the virus, with new cases reported in Berkeley and Santa Clara, Placer and Orange counties. Kaiser Permanente announced late Tuesday it was treating a patient in Los Angeles.

The city of Berkeley said its case involved an individual who visited a country with an outbreak. That person has remained at home in a self-imposed quarantine since returning.

“While the risk of infection remains low, the expanded presence of the virus in our community is a reality we should all prepare for,” said Berkeley’s public health officer, Dr. Lisa Hernandez. “There are steps that all of us in the community can take now to improve basic hygiene and also prepare for a wider spread in the future.”

In Orange County, two cases are pending confirmation from the CDC. The cases involve a man in his 60s and a woman in her 30s who had both recently traveled to countries with widespread transmission, according to the Orange County Health Care Agency.

Santa Clara County announced three more cases of coronavirus Wednesday, bringing the total count there to 14 — the highest number of cases in the sate.

One is a man who’s currently hospitalized. The source of his exposure to the virus is currently under investigation. Two other men are close contacts of an existing case.

California is also speeding up testing of possible coronavirus patients. This more aggressive testing, Newsom said, “may lead to a more rapid increase in the number of confirmed cases reported. That is not necessarily a sign that the rate of infection is increasing, but that our ability to test more people more rapidly is leading to better detection.”

Dr. Mike Ryan, who runs WHO‘s emergencies program, pushed back against officials who wanted to “wave the white flag” and surrender to the disease’s hold. China took drastic steps to fight the virus, he said, and case numbers are now on the decline there.

Countries such as China and South Korea “implemented very, very strong measures that have affected their own economies and their own societies,” Ryan said. “It’s really a duty of others to use the time that has been bought.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said there remained many unknowns about the virus, including the degree to which people who do not express symptoms can transmit it to others. He said doctors know that it happens but have not yet gauged the extent, a key piece of data that will help determine decisions on how to contain it.

Fauci said that Chinese data are believed to be accurate and that the spread of the virus there is slowing thanks to “draconian” methods that would never occur in the United States, including stringent travel and public gathering restrictions.

“They have taken social distancing to its furthest extreme,” he said.

Times staff writers Noah Bierman, Rong-Gong Lin II , Hannah Fry, Taryn Luna, Phil Willon, Richard Winton and Melody Gutierrez contributed to this report.


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