As the coronavirus gained a foothold in the United States, thousands of employees from Seattle to Silicon Valley were told to work from home. Public school districts in several states have shut down, universities are moving classes to online only, and even churches are limiting services or prayer meetings. A global health conference in Orlando, Fla., planned for Monday, which President Trump was supposed to address, will no longer happen.
Off the California coast, another cruise ship with infected passengers is waiting for a place to dock. The State Department on Sunday advised Americans, especially those with underlying health conditions, not to travel on cruise ships.
As the coronavirus spread to two-thirds of the states, Americans began to grasp the magnitude of the threat facing them. The weekend’s case tally ballooned, veering toward nearly 600 cases and close to 20 deaths.
In Washington State, with the epicenter in the Seattle area, Gov. Jay Inslee said on Sunday that he was considering mandatory measures to help keep people apart. Federal public health officials also signaled that the degree of community spread — new cases popping up with no known link to foreign travel — indicated that the virus was beyond so-called containment in some areas and that new, stricter measures should be considered.
It’s a concept in public health known as shifting from containment of an outbreak to “mitigation,” which means acknowledging that the tried-and-true public health measures of isolating the sick and quarantining their contacts are no longer enough. So steps must be taken to minimize deaths from the disease and to slow its spread so that hospitals are not overwhelmed.
“You don’t want to alarm people, but given the spread we see, you know, anything is possible,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Fox News on Sunday. “And that’s the reason why we’ve got to be prepared to take whatever action is appropriate to contain and mitigate the outbreak.”
No one in the United States wants to use the word “lockdown,” in the manner of what Italy is doing in its northern regions to try to control the spread of the disease.
But the specter of isolation — of telling people in affected areas not to go out — is hovering in big cities where the infection has taken hold.
In an interview, Dr. Fauci said, “I don’t think you want to have folks shutting down cities like in northern Italy. We are not at that level. That is a hot spot. Social distancing like in Seattle is the way to go. I’m not talking about locking down anything. There’s a big difference between voluntary social distancing and locking anything down.”
If community spread is being detected now, that means it began, unseen, weeks ago. The greatest concern is for older people, particularly those who have underlying conditions like diabetes, heart disease, lung problems and weakened immunity.
“Don’t go to crowded places, think twice before a long plane trip, and for goodness sake don’t go on any cruises,” Dr. Fauci said.
For people who are particularly vulnerable, he said: “Don’t wait for community spread. Now is the time to do social distancing, whether there is spread in your community or not.”
If community spread has already started, as in Seattle, he said, everyone should practice social distancing.
“Everybody is going to be thinking about this, and trying to adapt it to their own circumstances,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University. “‘Maybe I can attend this meeting virtually.’ A family that’s religious will think about being reverent at home rather than attending services with the rest of the congregation. Maybe we don’t go to the movies.”
One goal of mitigation is at least to slow down an epidemic, he said, adding, “If you can stretch things out long enough, you buy more time for the development of the vaccine and the research to be done for treatments.”
The cruise ship stranded off the coast of California will be allowed to dock on Monday in the port of Oakland at an as-yet-undecided time, the state’s governor, Gavin Newsom, said at a news briefing on Sunday.
The site was chosen in part because of the ability to cordon off an 11-acre containment area at the port where the ship’s 2,421 passengers will disembark.
California residents, who make up around 40 percent of the passengers, will be transferred for a 14-day quarantine at military bases across the state, including the nearby Travis Air Force Base, where evacuees from China were quarantined last month. Passengers who are not from California will be flown to military bases in Texas and Georgia, the governor said.
Last week, 45 people were tested for coronavirus on the ship and 21 tested positive, 19 of them crew members.
Testing of the remaining passengers will be done in their quarantine areas, where they will remain for two weeks, officials said.
Foreign passengers will be sent home on charter flights from a section of Oakland International Airport where they can avoid contact with the general public, officials said at the briefing.
On Sunday afternoon advance medical teams were boarding the ship, Grand Princess, which is about 10 miles offshore, to assess the general health of passengers.
Most of the more than 1,000 crew members will remain onboard the cruise ship, which will leave the San Francisco Bay within about three days, Mr. Newsom said.
Oakland’s mayor, Libby Schaaf, said she had sought assurances that the ship would leave quickly and that there would be no local spread of the virus as a result of the ship’s docking at the Oakland port.
“This is a community that has suffered decades of environmental racism and injustice,” Ms. Schaaf said. “No one will be quarantined in Oakland or released to our community.”
Along with New York and Washington, California has the highest numbers of people infected with the virus.
Mr. Newsom said fewer than 1,000 people had been tested for the coronavirus in California and about 120 had tested positive. As the state ramps up its testing capabilities in the coming days, he expects the number of people confirmed to have the virus to increase.
In Washington State, the nursing home that has faced the brunt of the coronavirus outbreak thus far in the United States said on Sunday that it had seen some residents go from no symptoms to death in just a matter of a few hours.
Tim Killian, a spokesman for the nursing home, Life Care Center of Kirkland, said its medical staff had found the coronavirus to be troubling, volatile and unpredictable.
“It was surprising and shocking to us that we have seen that level of escalation from symptoms to death,” Mr. Killian said. He said the center was still in triage mode as it worked to get a handle on the issue for its remaining 55 residents.
On Sunday, health officials raised the death toll in Washington to 18, with 16 of those linked to Life Care, including 15 residents. Mr. Killian said other residents were in the process of getting test results, and six of them were ill.
Seventy of the center’s 180 staff members were out sick, but there weren’t enough test kits yet for them, he said. Three staff members have been hospitalized, one of whom has tested positive for the virus.
Some former government officials pointed out that the Trump administration was not acting quickly enough to stop the virus from spreading. Dr. Scott Gottlieb, the former commissioner of the Food and Drug Administration, said on “Face the Nation” on Sunday that the federal government needed to step in quickly.
“There’s no systematic plan of when a city should close school, when they should tell businesses that they have to telework, when they should close movie theaters and cancel large gatherings,” he said. “We leave these decisions to local officials, but we really should have a comprehensive plan in terms of recommendations to cities and in some support from the federal government for cities that make that step, make that leap, if you will.”
Mike Baker, Thomas Fuller and Mitch Smith contributed reporting.