The first COVID-19 death in America has taken place in Seattle.

As this continues to play out, I’m remembering the stories of the 1918 Spanish Flu in Philadelphia. Nana, my great grandmother, lived through that and I heard some of her stories from my grandmother. I read this week that Philadelphia was one of the places hit harder then (compared to places like St. Louis) due to indecision and political gridlock in responding to the threat that led to a slower response.

At Mass this morning at St. Stephen Martyr in Washington, the priest announced that Archbishop Wilton Gregory has dispensed with Sunday Mass obligation for the time-being for any who feel symptoms of flu. It was also announced that the chalice will be reserved at Communion for the priest alone and that handshaking at the sign of peace is suspended to avoid transmission. After Mass, the priest greeted everyone departing but shook no hands, his own kept under his chasuble.

We have two major public events this week, one at the National Press Club on Tuesday and another at the U.S. Supreme Court on Wednesday. I’m wondering whether we’ll start seeing N95 masks in public this week.

In the New England Journal of Medicine, Bill Gates writes on COVID-19, which he is describing as a pandemic:

In any crisis, leaders have two equally important responsibilities: solve the immediate problem and keep it from happening again. The Covid-19 pandemic is a case in point. We need to save lives now while also improving the way we respond to outbreaks in general. The first point is more pressing, but the second has crucial long-term consequences.

The long-term challenge — improving our ability to respond to outbreaks — isn’t new. Global health experts have been saying for years that another pandemic whose speed and severity rivaled those of the 1918 influenza epidemic was a matter not of if but of when.1 The Bill and Melinda Gates Foundation has committed substantial resources in recent years to helping the world prepare for such a scenario.

Now we also face an immediate crisis. In the past week, Covid-19 has started behaving a lot like the once-in-a-century pathogen we’ve been worried about. I hope it’s not that bad, but we should assume it will be until we know otherwise.

There are two reasons that Covid-19 is such a threat. First, it can kill healthy adults in addition to elderly people with existing health problems. The data so far suggest that the virus has a case fatality risk around 1%; this rate would make it many times more severe than typical seasonal influenza, putting it somewhere between the 1957 influenza pandemic (0.6%) and the 1918 influenza pandemic (2%).2

Second, Covid-19 is transmitted quite efficiently. The average infected person spreads the disease to two or three others — an exponential rate of increase. There is also strong evidence that it can be transmitted by people who are just mildly ill or even presymptomatic.3 That means Covid-19 will be much harder to contain than the Middle East respiratory syndrome or severe acute respiratory syndrome (SARS), which were spread much less efficiently and only by symptomatic people. In fact, Covid-19 has already caused 10 times as many cases as SARS in a quarter of the time.

National, state, and local governments and public health agencies can take steps over the next few weeks to slow the virus’s spread.

It seems inevitable that we’ll have the first official COVID-19 case in Washington this week or next. Whether the federal government and other offices begin to go remote to limit community transmission seems like it will be the question.