Dispatches from Seattle

Dispatches from Seattle DURING COVID-19

BY ROBERT MORRIS ’74

Shortly after the outbreak of COVID-19 in Seattle, WA, Dr. Robert D. Morris ’74, a physician and environmental epidemiologist who lives 10 miles from the first nursing home hit by the virus and just up the hill from the second, began publishing a blog, Ahead of the Curve: Covid-19, found at drbobmorris.com. Morris writes about his life in Seattle during the early days and weeks of the pandemic.

OUTBREAK IN SEATTLE: DAY 3

Few things defy comfort like the piercing, grey relentlessness of winter rain in the Pacific Northwest. Add to that the fact that my son, Sage, approaches heading off to high school on Monday mornings with all the enthusiasm of a cat about to be thrown into a cold pond, and perhaps you can understand why, on the morning of March 3, I was unimpressed by his complaints about feeling tired and achy. I just figured it came with being 16. So, I fed him and bundled him off with his twin brother, Skyler, not giving much thought to the fact that, over the weekend, six people had died of COVID-19 within 10 miles of my home.

I wasn’t even concerned when his nineyear-old brother, Chris, woke up with a dry cough. It had started a day or two earlier,

when he was still at his mother’s house, but he didn’t have a fever, which was supposed to be a feature of the new disease, and he seemed as energetic and upbeat as always. I knew I couldn’t send him to school with a deadly outbreak unfolding, so I gave him some juice, put him to bed, and settled down to get some work done.

An hour later, the phone rang. It was Sage. He had collapsed and could barely stand. Since that moment, an invisible virus from the lungs of a tiny bat has riveted my attention.

I had been following the unfolding pandemic since it began in Wuhan with intense interest. Ten years earlier, I had found the mystery of the first SARS epidemic so compelling that I wrote a book about it, The Twisted Helix (serialized on my blog). But that was pure fiction, a wild fantasy about a teenage boy with two brothers and an epidemiologist father facing down a deadly coronavirus outbreak in Seattle. I never imagined reality would steal my material.

So, even when the first case appeared in Seattle in January, I assumed we had it under control. I took the fact that I had heard nothing more about it to indicate that there were no more cases, so there was no outbreak. I couldn’t have been more wrong.

What I didn’t know was that the staff of the nursing facility where the first deaths occurred had been watching with concern for the past two weeks as one patient after another developed severe lung infections. They had become increasingly convinced that these patients had this strange, new disease, but had not been allowed to test them. Tests were exclusively reserved for

people who had recently traveled to China, regardless of symptoms and regardless of the fact that the disease had arrived in Seattle more than a month earlier. Those limits on testing were about to have devastating consequences for the United States.

The US CDC (Centers for Disease Control and Prevention), long recognized as the top agency in the world for controlling infectious disease outbreaks, had played a key role in managing every serious outbreak in the past and, based on my experience working with the CDC, I assumed they would be aggressively proactive in their response. In the coming weeks, I would learn that the CDC, with its scientists crippled and marginalized by politics, had become a shell of its former self, leaving us profoundly unprepared for the disaster unfolding at my door.

The first inkling I had that our public health infrastructure was in shambles came after I brought Sage home from school, settled him in bed, and called his pediatrician to see if he could be tested for the virus. The nurse told me they had no way to test and any testing had to be approved by the CDC. She gave me an 800 number to call. Nothing says phone-hold hell quite like a federal government 800 number. But it was my only choice. I called. After 15 minutes, the connection simply and suddenly dropped. At that point, it was clear that all the hold time in the world wouldn’t get him tested. Sage didn’t have a dry cough, so, if he had the disease, this wouldn’t be a typical presentation. I also knew that he was in the age group believed to be least likely to suffer serious effects. Even though there was no treatment for the disease, it was extremely important to know if he had just put all of his classmates, his teacher, and the school nurse at risk — and if his brothers and I were now at risk. Testing was vitally important and totally unavailable.

OUTBREAK IN SEATTLE: DAY 4

The next day, a friend posted a picture of empty shelves in Trader Joe’s as people began panicking about what lay ahead. Hand sanitizer and masks were disappearing from local stores. And yet, the America appearing on my social media seemed strangely oblivious to what was happening here, watching with the same detachment that I had felt watching the disaster in Wuhan. Seattle had slipped into a time warp, porting us two weeks forward to America’s strange, semi-apocalyptic future of shortages and overwhelmed medical facilities.

“Hand sanitizer and masks were disappearing from local stores. And yet, the America appearing on my social media seemed strangely oblivious to what was happening here, watching with the same detachment that I had felt watching the disaster in Wuhan.”

OUTBREAK IN SEATTLE: DAY 5

As I nursed Sage back to health, insisting he stay in his room and keep his distance from the rest of the family, I began to learn more about the scale of the disaster that was unfolding around me. I began to dig deeper into the emerging research on COVID-19 and was horrified by what I found. From the blog I started that day: “In the five days since the first COVID-19 death in Washington State, nine more people have died. In all likelihood, more will die today. From the perspective of an epidemiologist, the most striking things about the response to this pandemic are the inadequacy of resources to deal with the outbreak, the failure at the highest level to provide a clear, coordinated message, and the lack of honesty and transparency on the nature and extent of the crisis.”

OUTBREAK IN SEATTLE: DAY 7

One week into the outbreak, with the news reporting 14 new deaths in Seattle, I opened the website of the CDC, which routinely tracks reportable diseases, in hopes of getting more details. As I started to write, a friend texted me to let me know that a case of Covid-19 had just been reported at the nursing home at the foot of the hill where I live. This brought a new immediacy to my search.

What I found or, rather, what I didn’t find, only raised my concern. The CDC website stated simply that they were closed for the next two days and suggested I check with my state health department. The Washington Department of Health listed 11 cases in the state (not the 14 reported in the news) and advised me to check with my local health department for the number of cases. I moved to the King County Public Health website. “Eleven people in King County have died. It’s important that everyone take steps to reduce the spread of novel coronavirus. This is a quickly evolving situation and this site will be updated frequently.” This was clearly not up to date, but they offered a solution. “Additional updates are available from the federal CDC and Washington Dept. of Health.” In other words, as one of the worst epidemics in US history was taking root, the CDC was taking the weekend off, the State of Washington suggested we look to King County for detailed information, and King County was sending me back to the CDC and the State of Washington. And no one was as up to date as the news media. The circle of inadequate information was complete.

OUTBREAK IN SEATTLE: DAY 8

As Sage began to recover, my youngest son Chris’s cough persisted. He had no significant fever. No other symptoms beyond a runny nose. Ordinarily I would have assumed this was just another virus making the rounds, but these were not ordinary times. However, I knew there was no way I could get him tested.

Chris wasn’t that sick, but I already knew that COVID-19 tended to be relatively mild in children, and on the off chance he had it, I didn’t want to get it. Since the lozenges didn’t seem to control his cough, I decided to step up my game and headed out to buy some cough syrup. That was an education. Target was packed. I didn’t make much of it and headed to the pharmacy section. The first aisle had been stripped bare.

I moved to the next with visions of a desperate search through the emptied drugstores of greater Seattle. The Big Box Gods must have been smiling, because there, alone on the naked shelves, sat the absolute last bottle of cough suppressant in all of Target.

Moving on to the grocery section, I found shelves that were equally barren, but far larger. I thought I was just running errands and had honestly not realized I was supposed to be out shopping for the apocalypse, which, I discovered, apparently requires vast amounts of toilet paper. Among the advice floating around out there was the suggestion that people should stow away everything they would need to survive for two weeks at home. I assume the goal was to be prepared if you happen to get sick and require quarantine. This sounds like an invitation to the panic and the craziness I saw in Target. What was the scenario where you need this? You are quarantined, have nothing in your cupboards and either have no friends or neighbors who will bring you food, all the stores are closed, or the entire city has been ordered to shelter in place for two weeks, Wuhan style? I have always figured, when it gets bad, I’ll finally have an excuse to feed the kids that 40-pack of Ramen noodles and all the other stuff I over-accumulated at Costco over the years.

Chris didn’t have the fever that the CDC insisted he needed to be present to justify testing him, but I had become convinced there wasn’t a standard clinical picture, particularly in children.

The cough persisted, and, given my suspicions about his brother, I called to see if I could get him tested. This time I was told to call the County Health Department. Better, I supposed, than the CDC. At least, I would be stuck on hold and ignored by someone closer to home. So, I called. As I wrote in my blog that day, “I learned about [the woeful inadequacy of testing] firsthand today, when I called the King County Health Department about my son, who has had a dry cough for the past eight days, a symptom profile that could easily be consistent with Covid-19. After 20 minutes, a public health worker told me the only people who are currently being tested are those with a cough and a fever above 103 degrees after a negative test for the flu, people with known contact with a COVID-19 patient, or people with recent travel to China, South Korea, Iran, or Italy. To be clear, I firmly believe that the Health Department is doing the best they can with the resources available. The problem is lack of resources. Hopefully that is changing, but disease prevention works best if it happens before the disease.”

OUTBREAK IN SEATTLE: DAY 11

The number of infections at the nursing home at the foot of my hill rose to seven people, including one death. This was the beginning of an outbreak that would briefly give the town of Issaquah one of the highest death rates in the country. The Governor has declared a state of emergency. Since I actually might wind up quarantined, time to buy food.

OUTBREAK IN SEATTLE: DAY 19

The disaster has gone national and with it the shortages and confusion we had been living with for weeks. The Governor closed the schools two days ago, and after two weeks of coughing, I finally managed to get Chris tested, but only because his mother is a radiation oncologist, and families of health care workers were being offered tests without meeting strict criteria in order to protect physicians and nurses from infection. It turned out he was negative for the virus, but I still wonder if he wasn’t simply far enough along in the disease process that he was no longer carrying it. Someday I will get him tested for antibodies.

At the same time, a growing wave of patients was overwhelming hospitals and stripping them of necessary supplies. At one of Seattle’s largest hospitals, every single room was being converted to allow it to be used as a potential ICU bed. The local hospital here in Issaquah was so desperate for supplies that they had a sign out front requesting donations of hand sanitizer and face masks. The largest hospital group in the city was asking anyone with a sewing machine to begin assembling masks.

DAY 84: MEMORIAL DAY

Over the past two months, I have watched as city after city endured the same wave of disease that overtook Seattle. Now, on Memorial Day, 84 days into the epidemic, and 70 days into the shutdown we’re left wondering what comes next. With people still dying here, six just yesterday, and another 243 new cases, Seattle may be better off than many other parts of the country, but the situation seems far from stable, and I am deeply concerned that we will see a huge spike in cases this summer. What began as one death in a nursing home turned into 1,061 fatalities with 19,828 cases. For the moment, we are experiencing a lull in the storm. What happens next will depend on our capacity for restraint, the courage of our leadership, and our reliance on collective wisdom and science.

To watch a special Hotchkiss Zoom conversation with Dr. Morris on COVID-19, visit https://bit.ly/2BT7pyb