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 outbreak are the lack of resources to properly deal with the outbreak, the lack of a clear, coordinated message, and the lack of transparency on this issue.

1. With 10 deaths, the state only has 39 (now up to 70) confirmed cases. My epidemiologist colleagues all seem to agree with my assessment that there must be hundreds of cases with that many deaths. The reason there are only 39 (now up to 70) reported is because the state has not had enough test kits, so only the most severe cases are being tested. When my own son came home with flu like symptoms, his pediatrician said they did not test and any testing had to be approved by CDC. I was given an 800 number to call. After 15 minutes on hold I was disconnected from that number. I believe my son has the flu, but the barriers to testing are so high that they all but guarantee community spread of the disease. An oncologist I know at a major local hospital cannot get a proper mask, much less protective gear, when she is caring for a febrile patient and even the febrile cancer patient can’t get tested unless she is in respiratory distress. A single lab in Wuhan is running 10,000 tests a day. In Seattle’s King County, with a death rate higher than Italy’s, almost no one is getting tested As a result, WE HAVE NO IDEA HOW MANY CASES ARE IN THE COMMUNITY and no clue who all of them are.

2. There does not appear to be a clear and coordinated response to the outbreak. (How can there be when we have such incomplete information.) As a result, people are confused and either overly panicked or overly complacent. The response of businesses and schools seems utterly ad hoc. Some close, some stay open as they try to figure this out.

3. Medical friends and colleagues are receiving information not available to the general public. For example, I was told that one of the county’s largest hospital networks is sending all of their Covid-19 patients to a single hospital in the suburb where I live. I have seen no public announcement of this, I assume because they don’t want to scare away patients. When hospitals are run like businesses, information flow suffers. I am also told there are two patients on respirators in that hospital who are in their 20’s. This information is also not publicly available, but has huge implications for those taking comfort in reports that this is only bad for the elderly.

I fear that much of this is driven by a desire to downplay the seriousness of the epidemic for political reasons. A proper response to a serious public health threat requires adequate resources, faith in the science, honesty, and transparency. I am concerned that all may be lacking in the US response to this disease.