The first death from COVID-19 in the U.S.

Today, the CDC announced the first death from COVID-19 in the United States, a 50-year-old man in Washington state, and the source of the infection is unknown, with no known contact with an infected person. According to Robert Redfield, Director of the CDC, in today's White House press conference said there was  "no evidence of link of travel" to how the man contracted coronavirus.

While anthrax is not communicable, it sounds similar to a case during the Anthrax attacks in the U.S. in 2001, where a death occurred with no contact with anthrax-containing envelopes. Ollie Lundgren in Connecticut, was an elderly lady who only went out to have her hair done once a week. After extensive investigation involving a wide net, it was finally determined that she had a habit of ripping her junk mail before throwing it in the trash, thereby aerating the anthrax spores and exposing Ollie to a spray of anthrax spores. It happened that her mail had been exposed in mail sorting machines, and unfortunately, she became a victim.

Should we be looking for a similar pathway of infection? What if this individual had a habit of popping the air bubble/pillow packing material from China, where lots of our products are made and packed? The incredible viability of this virus to survive passing through vent systems in buildings might just allow it to survive in sealed plastic packing pillows, thereby releasing air contamined while in China.

The CDC has a corps of epidemiologists the EIS, Epidemiological Investigative Service, experienced and professional on-the-ground experts who search for the cause of infected humans and animals. I expect they are asking the same questions, right now.

COVID-19, WHO and US legal authorities and actions, disaster planning

Here is what has happened so far regarding legal authorities. WHO declared a Public Health Emergency of International Concern (PHEIC) on January 30. The U.S. issued a National Public Health Emergency declaration on Jan. 31, 2020: https://www.phe.gov/emergency/news/healthactions/phe/Pages/2019-nCoV.aspx .  This allows the use of non-programmed funds, allows certain waivers, etc.. States may issue emergency declarations, usually from the Office of the Governor, but they probably would not declare an emergency until there is a community transmission. That is, where it is spread from person to person, not a traveler returning with the infection. 

The American Bar Association issued disaster planning guidance today, and so I am going to address the framework for disaster planning for law schools that I would recommend as a starting point. There are typically a few levels that are triggered by certain events in a biological disaster. For example, we are at the equivalent of Level 1 preparation, taking precautions for COVID-19 which are the same precautions you would take to avoid influenza, including hand sanitizer stations. Level 2, might include cautioning students and faculty to stay home if they feel sick, postpone or cancel events that involve large numbers of people, and cancel travel to areas that have travel warnings. Preparation for teaching online should be fully in development. Level 2 might be triggered by person to person transmission in the state.  Level 3 would be full closure and teaching online. That is just an example of how a plan might unfold. Level 3 might be triggered by person to person transmission in the state, coupled with an emergency order by the Governor. 

While I served as Chief Counsel at US DOT, we spent a year planning for Bird Flu, back in 2005-2007. I am optimistic that we will not get to my Level 2, given that MERS, SARS (all in the coronovirus family) and Bird Flu and Swine Flu (the influenza family) did not reach the worst case planning scenarios. That said, given the epidemiological predictions, we have not reached the peak, and if we do reach a community transmission state, we will have our own peaks in the U.S. with the epidemiological curve. If the pandemic does move toward the worst end of the scenario, a vaccine may be ready as IND status in a few months, which means it is still not fully approved, but in investigational new drug status, and you can use it, but with your informed consent of that status. (Using an IND status vaccine is one of the waivers by the President available in a national emergency declaration.) 

Finally, if you are wondering whether you should call it a "pandemic", the global definition for the term includes person to person transmission, has consequences including death, and has spread worldwide. COVID-19 meets this standard definition for a pandemic, if spread to 38 countries constitutes a "worldwide" spread. Yet, WHO (through their committee of experts) has not yet declared COVID-19 a pandemic. In my opinion, the reason it has not yet been declared a pandemic, is mostly for diplomatic and political reasons. They may be hoping that with the shrinking number of new cases in China indicates we are past the peak and on the downside of the epidemiological curve, headed toward fewer and fewer cases. They may be right. Epi-curves often have a second peak, usually smaller than the first, with new cases generated from the first peak. But we can hope we have seen the peak and that is what we should all be hoping for.