Coronavirus was here before we knew it, Austin officials conclude

About 70 patients who have tested positive for the coronavirus reported having symptoms nearly two weeks before Austin health authorities confirmed the first cases here, a new and more comprehensive indication that the disease was swirling in Central Texas earlier than previously known.

Austin Public Health officials reveal that, based on interviews with COVID-19 patients, 68 of them reported symptoms as early as March 2, which was 11 days before officials diagnosed the first three Travis County cases.

Researchers fear that some patients might have inadvertently contributed to the early spread of the virus, mistakenly believing they had some other illness and not yet knowing the importance of self-isolation.

“Early infections and early cases coincided with flu season and may have been diagnosed with the flu or some kind of upper respiratory infection,” said Shelley Payne, director of the LaMontagne Center for Infectious Disease at the University of Texas. “They would have been infectious and able to spread the virus to their contacts, where, in tracking back, you can see where the virus was actually circulating before they were tested.”

Dr. Janet Pichette, Austin Public Health chief epidemiologist, said the data confirmed what she and others already suspected, underscoring how quickly the virus can move from person to person without quick detection and how early cases indicated a larger spread.

“I had no doubt that is what happened, and it appears based on our information, that is the case,” she said.

Testing in Austin was dictated by strict federal and state criteria in the first few weeks of the pandemic, and officials didn’t confirm their first cases until March 13, when health authorities announced three COVID-19 patients. That included one patient who was brought to an Austin hospital from a rural Texas town for treatment.

By the time some patients have been tested, doctors believe they could be near the end of their illness, meaning that they might have been carrying the virus for days or weeks.

“Everyone is at a different stage when they are tested, so what is most important is when their illnesses developed,” Pichette said.

Tracing cases back to February

The reality that COVID-19 was in Austin prior to an official diagnosis of the first COVID-19 patients mirrors what happened in other cities, where officials have backtracked to learn that the virus was infecting communities weeks before it was confirmed or reported.

In Santa Clara County, Calif., officials last month announced a newly discovered coronavirus death on Feb. 6, weeks before the first known COVID-19 death was announced in the U.S. At the time, Gov. Gavin Newsom said investigators in some California counties were examining coroner and autopsy reports going back to December.

In New York City, the U.S. epicenter of the disease, researchers believe thousands of infections were spreading before the city confirmed its first case March 1.

In Central Texas, Bastrop County Judge Paul Pape told the American-Statesman last week that he had recently tested positive for COVID-19 antibodies, leading him to believe that he had the virus. Pape said he had suffered what he thought was a nasal infection that started Feb. 9, nearly seven weeks before the county’s first COVID-19 positive test. He was treated with prescription steroids and antibiotics and recovered.

As of last week, the number of COVID-19 cases had surpassed 2,300 in Travis County as officials said there are indications that the spread of the virus had slowed. The number of cases was doubling about every 23 days, compared with every two to three days in the first few weeks of the virus. Fewer people — less than 3% of those tested — also had the virus.

Texas, which has diagnosed about 43,000 total cases, and Austin are still believed to have fared better than many states and cities, taking multiple steps early in the pandemic to stop its spread such as canceling the South by Southwest festival.

Officials say they still think it is possible that an untold number of people also had the virus, especially those early in the pandemic who did not meet rigorous testing standards and were never diagnosed.

“Knowing that the disease was circulating helps make it clear why we are having trouble containing this disease,” Payne said.

Early safeguards played role

Fearing that there might be infectious people who didn’t know it, Austin Public Health officials said they began monitoring airline passengers arriving from global coronavirus hotspots in January.

Pichette said the federal Centers for Disease Control and Prevention was receiving airline passenger manifests for the first two months of the year from China, Iran and Italy. Local officials in their cities of destination could then get in touch with them to monitor any possible symptoms, she said.

“We early on could see that storm cloud coming, and we were trying to prepare ourselves and prepare our community for that,” she said. “But because it was a new virus, we didn’t know what the storm consisted of — a hurricane or tornadoes — which made things even more worrisome.”

Officials did not have statistics available about the number of those people who tested positive but said most of Austin’s earliest cases were travel-related. Many of them were not tested, though, because they never developed symptoms and didn’t meet testing criteria.

Pichette said the suspicion of health authorities that the virus might already have been in the community is one reason officials so proactively began encouraging people to take more basic steps to protect themselves, preaching the importance of hand-washing, for instance.

In the nine weeks since officials confirmed their first cases, teams of researchers have contacted each COVID-19 patient, interviewing them to help understand how they might have contracted it and with whom they had been in subsequent contact. They quiz them on the moment they first noticed a dry cough, fever or headaches, then log the date of their first symptom.

Over time, Pichette said, that information will help researchers compile a more complete story on coronavirus in Austin that relies on more than testing data.

“The case investigation takes some time because we have to probe them,” Pichette said. “‘Do you know if it was before or after Easter?’ I have sat down with a calendar. We always try to go back in time because we know it is going to be the time before testing.”

Last month, Northeastern University researchers evaluated the timing of the virus in several U.S. cities, including New York, Boston, Chicago, San Francisco and Seattle.

As of March 1, those cities had reported 23 confirmed COVID-19 cases. However, modeling by the university showed that there might have been as many as 28,000 infections at that time.

Officials in some of those cities said they took proactive steps early to try to combat the spread of the virus, even though the number of confirmed cases were few.

In an interview with The New York Times, Seattle Mayor Jenny Durkan said, “We knew the numbers we saw were just the tip of the iceberg and that there were much greater numbers below the surface.”