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Investigating “Clusters” of the COVID-19 Coronavirus

Americans are inundated by the minute with updates regarding the novel coronavirus- COVID-19.  We receive alerts from our smartphones, newspapers, television news stations, email, and social media accounts – all reporting updated COVID-19 data at a local, regional, national and even global level.

One datapoint that health authorities continue to report on are “clusters” of positive cases of COVID-19 that have been identified in communities.  The identification of these clusters has been a tool used in other countries, such as China, South Korea, Singapore and Taiwan, to contain the spread of the COVID-19 contagion.  The identification of virus clusters can aid in stopping discrete outbreaks of COVID-19 with the implementation of rigorous contact tracing and investigation. However, this process requires intelligent, robust and flexible work by health officials and almost complete cooperation from the community’s population.

Unfortunately, new clusters of COVID-19 are identified and reported daily.  Many of these clusters are the result of social groups or institutions failing to abide by local and state health orders.  This article will first define several coronavirus key terms to offer a better understanding of the impact of clusters and community contact tracing.  It will detail the accounts of several instances of COVID-19 clusters and the suspected reasons for these discrete outbreaks. Finally, it will examine the processes of contact tracing and investigation, and how these processes and other tools can help to slow the spread of this novel coronavirus and other diseases.  As you read on, please keep in mind that this article was written by the coronavirus lawyers at Gomez Trial Attorneys, based upon public information published as of April 6, 2020.

Covid 19 Clusters

GLOSSARY OF COVID-19 KEY TERMS

News about the new coronavirus, COVID-19, emerges and changes at a rapid pace.  In order to keep up with and understand the overwhelming barrage of information, defining some key terms can provide some much needed clarity.  Familiarity with what these terms mean is especially useful in understanding the impact of coronavirus clusters on the continued spread of the COVID-19 virus.

  • Coronavirus:  Coronavirus refers not just to one virus, but to a large family of viruses – including SARS and other minor to major respiratory illnesses.  Typically, coronaviruses can be spread between animals and people. The root of the phrase, “corona,” from the Latin root meaning crown or ring of light, refers to the cellular shape of the virus under a microscope.
  • COVID-19: COVID-19 refers to the specific disease involved in the current 2019-2020 pandemic.  The phrase is an acronym crafted by the World Health Organization (“WHO”), to stand for “coronavirus disease 2019.”  This reflects the year that the virus was first identified and detected in Wuhan, China.
  • Cluster: A disease cluster or infection cluster refers to a group of similar health events that have occurred in the same area around the same time, like cases of COVID-19.  Where several people reside together in the same space, or many people gather in some type of group environment, there is a higher likelihood of mass infection if one of these persons has the new coronavirus.   This article refers to some identified cases as “outbreak clusters” of COVID-19. Typically, a cluster is defined as three or more cases in close proximity and similar time.
  • Person-to-Person Spread:  Person-to-person spread refers to the transmission of a disease, such as COVID-19, due to close contact between people.  The close contact may involve physical contact or just close proximity in close quarters. This is distinguishable from a disease spread by contaminated surfaces or animals.  The COVID-19 coronavirus strain is believed to be spread primarily through person-to-person contact.
  • Community Spread:  Community spread refers to the spread of a disease among a certain geographic area, in which there is no direct knowledge of when or how an infected person contracted the disease.  Certain COVID-19 cases can be connected to certain social gatherings, trips, associations between people or other events. Cases referred to as “community spread” are less specific than these and more difficult to trace back to a source.
  • Outbreak:  Outbreak refers to a higher than normal rate of occurrence of a disease.  Terms like epidemic and pandemic are often used to describe the nature or magnitude of an outbreak or series of outbreaks.
  • Pandemic:  Pandemic refers to the global spread of a disease.  While an outbreak is a higher than normal rate of occurrence of a disease, an ‘epidemic’ is more than a normal number of cases of an illness, specific health-related behavior or other health-related events in a community or region.  A pandemic is a worldwide epidemic. COVID-19 is the first pandemic declared by WHO since the H1N1 outbreak of 2009.

TROUBLING CASES OF CORONAVIRUS “CLUSTERS”

As the COVID-19 coronavirus spreads in the United States, local, regional and national health officials report on alarming clusters of infected persons.  If you’ve paid attention to news reports, you have seen examples of these clusters pop up in nursing homes and assisted living facilities, cruise ships, military bases, churches, workplaces, hospitals and households, among others.

Institutions Have a Responsibility to Take Preventative Measures

Any institution, organization or business that interacts with or operates with groups of people has the responsibility to make sure that their members or staff are not at risk for spreading disease or viruses.  This responsibility requires proper training regarding public health risks and concerns, like the COVID-19 coronavirus. This is especially important where the threat of the spread of a disease, like COVID-19, could affect many people and create a cluster of infected persons.  An institution’s, organization’s or business’ failure to provide proper care, safety measures, policies or training may rise to the level of negligence or gross negligence if that breach of duty leads to a cluster of infections. This negligence or gross negligence may give rise to a lawsuit – where all of the victims, or injured persons, join together to hold the institutional wrongdoer accountable for their actions.

Balancing Patient Privacy against Public Health Concerns

The amount of information disseminated to the public about these clusters often depends on the local health authorities in charge of releasing the information.  Differences in disclosure reflect public officials’ concerns with compromising patient privacy, and avoiding a false sense of security for those outside the geographic location of a cluster.  Moreover, preserving confidentiality is especially important when an illness is stigmatized – as is the case with COVID-19. The fear and anxiety surrounding COVID-19, may result in fear or anger expressed towards certain groups of people or people who have tested positive for the virus.  This stigma can result in social avoidance or rejection of the affected person, denials of healthcare, education, housing or employment, and even physical violence. Health officials must weigh the needs of the public against patients’ rights to keep their health information confidential.

Let’s examine the public information about clusters in California. For example – in Los Angeles, the County Department of Public Health has organized a webpage to detail the County’s nearly 6,000 confirmed cases of COVID-19 by certain demographics such as city/neighborhood location, age, gender, hospitalization status.  On the same site, L.A. County also lists institutional settings with confirmed positive cases.

Locally in San Diego, the County has organized a similar webpage with updated data on the total number of positive cases, how the cases are dispersed amongst age groups and gender and how many cases have resulted in hospitalizations, intensive care, or death.  The page also includes links to summaries of COVID-19 cases by city of residence and zip code.

However, in Bay Area communities, such as Santa Clara County, demographic information about positive cases and clusters is less available than in Los Angeles and San Diego Counties.  The Bay Area focused news outlet, The Mercury News, reports that “[i]nformation about clusters here has trickled out and rarely comes from official sources.”  These discrepancies from county to county reflect the different approaches to release of patient information regarding COVID-19.

EXAMPLES OF COVID-19 CLUSTERS IN CALIFORNIA

Bethany Slavic Missionary Church – Sacramento, CA*

One of the largest clusters of the novel coronavirus is linked to the Bethany Slavic Missionary Church in Sacramento, California.  The Sacramento County Department of Health Services confirmed that 71 members of the church are infected with COVID-19. The Sacramento Bee reports that one infected parishioner has died as a result of the virus and that the cluster at Bethany Slavic accounts for nearly one-fifth of all the COVID-19 cases in Sacramento County as of April 3, 2020.   The 3,500 member Pentecostal megachurch near Rancho Cordova reportedly stopped holding services on March 18, 2020. However, health authorities state that Bethany Slavic members continued to hold bible studies and fellowship meetings in congregants’ homes, in blatant violation of stay-at-home orders in effect to slow the spread of the coronavirus. A statement released by the church refuted most of the health department’s allegations, but did confirm that two prominent members of the church tested positive for COVID-19.  In response to the Church’s statement, the Sacramento County health department issued its own statement describing interviews conducted with church and community members during its ‘contact tracing investigation,’ and that those interviews revealed links to church gatherings. A county health spokesperson said, “while we know that the church as a whole has ceased to meet and the leadership is hosting online services, we have been told by multiple sources that there are groups that continue to meet in homes, despite the public health order to not gather with anyone outside of household members.  These gatherings have been directly linked to the cluster of cases in the community.”

* Gomez Trial Attorneys does not condone or endorse ridicule, hatred, or violence toward this church, any church, or any member of society.

The Bethany Slavic Missionary Church is just one of countless clusters that have been identified in an institutional or social setting throughout the state of California.  Other churches throughout the country are facing legal consequences as a result of their failure to abide by stay-at-home orders.

Early Coronavirus Clusters in San Diego County

In San Diego, two early clusters of infected persons with common social connections were identified on March 17, 2020.  The first cluster was a group of four active-duty military members, who were all known to each other. One of the individuals who tested positive for COVID-19 attended a music festival in the week before diagnosis – potentially infecting other individuals in attendance.   The second early cluster identified in San Diego involved seven people who went on a ski trip to Colorado. All began showing symptoms of the coronavirus and eventually tested positive for COVID-19. Two days after the second cluster was confirmed, a county health official expanded the cluster from seven to ten infected persons.  Little light was shed by health officials about a third cluster in San Diego that was confirmed on March 19, 2020. All that is known about the third cluster is that the group’s exposure to COVID-19 was connected to travel.

Nursing Homes and Assisted Living Facilities: Hot Spots for COVID-19 Clusters

An additional cluster of six confirmed cases of COVID-19 were linked to the Stellar Care memory-care center in El Cajon.  Four residents and two staff members at the senior-living home near San Diego State University tested positive for the novel coronavirus – highlighting a specific concern regarding the spread of the virus in nursing homes, assisted living and memory care facilities.  Stellar Care is one of multiple senior-living facilities in San Diego County to report positive COVID-19 cases. Four employees of La Vida Real in Rancho San Diego tested positive for the novel coronavirus.  Covenant Living at Mount Miguel in Spring Valley has also reported one positive case, but reported several within its organization throughout the country.  At least 30 patients and a number of staff members have tested positive for the coronavirus at the Extended Care Hospital in Riverside.  At least ten senior care homes in Northern California’s Bay Area also report multiple positive cases of COVID-19.    Despite the challenges in containing spread of the virus in senior-living facilities, all California senior-living homes are required to have a plan in place to deal with a mass exposure and prevent the spread of disease within the community of residents and staff.

One of the first clusters of COVID-19 was identified at the Life Care Center, a nursing home in Kirkland, Washington, where at least 81 individuals tested positive for the coronavirus and of those, 35 died as a result of the infection.  A report made by the Seattle Times on March 18, 2020 stated that the nursing home’s response to the outbreak was delayed. Despite cases of respiratory illness spreading throughout the facility since late January 2020, the facility didn’t obtain sufficient supplies to test all residents until March 7, and staff members lacked sufficient protective equipment.  Moreover, several staff worked at multiple facilities despite exhibiting symptoms of coronavirus.

CLUSTERS OF CORONAVIRUS SURGE THROUGHOUT THE U.S.

Clusters on Cruise Ships

Clusters of COVID-19 positive cases have been reported on several cruise ships, with the ocean liners carrying thousands of passengers becoming some of the earliest and most publicized spreaders of the new coronavirus.  In February 2020, the Diamond Princess (Princess Cruise Line) carrying approximately 3,700 passengers and crew members was forced to dock in Yokohama, Japan with its passengers quarantined on board.  Since the beginning of the Diamond Princess’s quarantine period, more than 700 passengers tested positive for COVID-19 and eight of those passengers have died. The Grand Princess (Princess Cruise Line) docked in Oakland, California on March 8, 2020, after 21 of its passengers tested positive for the new coronavirus.  On April 2, 2020, the MS Zaandam (Carnival Cruise Line, subsidiary Holland America Cruise Line) had to dock in Ft. Lauderdale, Florida, following at least eight of its passengers testing positive for COVID-19, and four passengers dying as a result of the coronavirus.  As of April 3, 2020 at least 77 cruise ships were still underway on the world’s seas.

Cluster of at least 100 Linked to Biogen Biotech Conference in Boston, MA

On February 26 and 27, 2020, Biogen, a Cambridge-based biotech firm, went forward with its conference in Boston, despite growing concerns over the new coronavirus.  More than 100 confirmed cases of COVID-19 have since been linked to the Biogen conference, held at the Marriott Long Wharf in Boston. The Biogen conference, which hosted 175 company executives, is linked to the majority of COVID-19 positive cases confirmed in the state of Massachusetts.  At least 12 additional people outside of Massachusetts have been linked to the Biogen conference, with cases confirmed in North Carolina, Indiana, New Jersey, Tennessee and Washington D.C. Two individuals linked to the conference have also tested positive in Europe.

There are countless reports of other clusters of the COVID-19 coronavirus, as the virus continues to spread throughout the U.S. and the world.  However, there is hope. The implementation of physical distancing and stay-at-home orders, along with scientific methods including contact tracing and investigation can potentially prevent further transmission of the virus.

WHAT IS CONTACT TRACING AND HOW CAN IT HELP?

According to WHO, persons in close contact with someone who is infected with a virus, such as the new coronavirus COVID-19, are at higher risk of contracting the infection themselves, and for continuing to spread the infection to others.  Close monitoring of an infected person’s contacts will help the contacts to get necessary care and treatment, and further prevent the transmission of the virus. This monitoring process is called contact tracing. According to an article posted on The World Health Organization’s website in May of 2017, contact tracing can be broken down into 3 basic steps:

  1. Contact Identification: Once someone is confirmed as infected with a virus, contacts are identified by asking about the person’s activities and the activities and roles of the people around them since the onset of illness.  Contacts can be anyone who has been in contact with an infected person: family members, work colleagues, friends, or health care providers.
  2. Contact Listing:  All persons considered to have contact with the infected person should be listed as contacts.  Efforts should be made to identify every listed contact and to inform them of their contact status, what it means, the actions that will follow, and the importance of receiving early care if they develop symptoms.  Contacts should also be provided with information about prevention of the disease. In some cases – such as instances of COVID-19 exposure – quarantine or isolation is required for high risk contacts, either at home, or in hospital.
  3. Contact Follow-Up: Regular follow-up should be conducted with all contacts to monitor for symptoms and test for signs of infection.

South Korea’s Successful Approach to Contact Tracing

South Korea is an example of successful implementation of contact tracing, resulting in the country “flattening the curve” of new COVID-19 infections.  As the New York Times reports, once a COVID-19 infection is confirmed in South Korea, the infected person goes into isolation in government shelters, and cell phone and credit card data are used to trace their prior movements and find their contacts.  Cellphone messages are then broadcast to all persons who may have come in contact with the infected individual. All persons even potentially exposed are quarantined at home, and their movements are monitored by GPS. If an exposed person violates their quarantine, they can be fined $8,000.00.  While South Korea’s contact tracing measurers may seem extreme and unlikely to be utilized in a similar way in the United States, the country’s program does serve as a model that could inspire contact tracing programs in the U.S.

In addition to contact tracing, South Korea moved early with testing for COVID-19.  In January, the country had contracted four companies to manufacture tests, and as of March 20, 2020 the country had tested 316,664 people for the new coronavirus.

Gomez Trial Attorneys – Committed to Our Clients and Our Community

Attorney John Gomez

John Gomez, Personal Injury Attorney

As a law firm, Gomez Trial Attorneys is committed to a set of established core values.  Two of our core values come especially into play during the current coronavirus pandemic: “we always do the right thing,” and “we improve our communities.”  At Gomez Trial Attorneys we are doing everything we can to help stop the spread of coronavirus and ultimately, save lives.  While we remain open for business and working hard for our clients, our attorneys and staff are working almost exclusively from home.  As a business, taking these proactive and preventative measures to prevent the spread of COVID-19 is our responsibility.

At Gomez Trial Attorneys we strive to be leaders in our community and encourage all of our potential clients, clients, friends, and family to #STAYHOME to stop the spread of coronavirus COVID-19.  We applaud businesses, institutions and organizations that are taking proactive preventative measures to avoid causing clusters of new infected persons.


Gomez Trial Attorneys
655 West Broadway, Suite 1700
San Diego, CA 92101
Phone: (619)-237-3490
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