A second person in Pima County has been "presumptively diagnosed" with COVID-19 and is being treated at a local hospital, officials said.

How the patient contracted coronavirus is under investigation and that person's "household contacts are under observation in home isolation," officials said.

From Pima County:

A presumptive diagnosis was made March 13th at the Arizona State Public Health Laboratory in Phoenix. A sample will be sent to the Centers for Disease Control and Prevention in Atlanta, GA., for confirmation. The Health Department was notified Friday afternoon and is working hard to learn more about this individual’s potential exposure to the virus. At this time there is no clear link between this case and the presumptive case identified in Pima County on March 9. PCHD is working to identify additional close contacts that may have been exposed while the person was infectious. Any individuals who have been identified as having been exposed will be contacted directly. These individuals will be monitored for fever and respiratory symptoms in collaboration with PCHD and medical providers. This individual had recently traveled to another U.S. state, however, investigators are still working to identify whether or not this person contracted the virus during this travel.

"This new case highlights the importance of hospitals, doctors, public health, and the general public working closely together," said Dr. Bob England, director of the Pima County Health Department. "Our disease investigators have been working day and night to protect public health, and are in the process of identifying and reaching out to any people who may have been in contact with the case while infectious."

Cases tested in Arizona and other states are being deemed "presumptively positive," with test samples being sent to the CDC for further confirmation.

England said Friday evening that "there doesn't appear to be any link between" the two Pima cases. "Again, if you've got a disease where you're only able to test the sickest folks and you've got a lot of mild cases for each really sick person then you could have transmission from person to person to person, that you don't see, that links the two cases. But, we have no way of knowing that at this point."

Monday, officials announced that one other Pima County resident had been presumptively diagnosed with COVID-19. The patient, who had recently traveled to an area with "community spread," is "not severely ill" and is recovering at home.

"The patient is a resident of unincorporated Pima County. This individual is not severely ill, is currently recovering at home in isolation, and has been fully cooperative with public health monitoring," officials said.

Pima officials declined again Friday to release any details about the two COVID-19 patients here.

As of Friday morning, 143 people in Arizona have been tested for COVID-19 — the novel coronavirus that was first diagnosed in people late last year — with three confirmed positive cases and six "presumptive positive" cases the only ones in the state. Friday afternoon's announcement adds to that total. Another 40 tests were pending results, and 94 people have been ruled out, officials said.

The virus has caused the deaths of at least 47 people in the United States, with more than 2,000 people diagnosed as having the virus. There have been more than 4,000 deaths worldwide, with the World Health Organization declaring a pandemic Wednesday.

County officials refused to give any other details about the first person here who tested "presumptively" positive, only saying that they lived in unincorporated Pima County and had returned from traveling from an area known to be infected with COVID-19.

"We're keeping the details close because we don't want people to suspect their neighbor," England said.

'Common sense' urged

Earlier Monday, local officials urged residents to use "common sense" solutions against the COVID-19 virus, reminding people to wash their hands regularly, and stay home when they're sick. At that point, no positive tests had been announced in Pima County, but cases in Pinal County were evidence of "community transmission" there.

Tests still limited

Dr. Cara Christ, director of the Arizona Department of Health Services, said that state health authorities have a limited number of testing kits available.

"I understand and my numbers may be a little but outdated, we had enough to run 225 samples, we have not reached that capacity and we are expecting if we haven't already gotten another test kit in for another 150," she said Wednesday.

Tests are being limited because of the small supply, Gov. Doug Ducey and Christ said, despite President Trump's statement earlier this week that anyone who wants a test can get it.

"If you're symptomatic and you're in a position where you're part of the vulnerable population, that's where you would qualify for the test," the governor said.

Christ said that some patients require multiple test kits. "It's hard to determine how many patients that is because there's so many different factors that play a role in how many samples are getting utilized for each patient," she said.

Monday, Dr. England told TucsonSentinel.com that up to eight control tests are required for some individuals who are tested.

Arizona health emergency declared

Wednesday afternoon, Gov. Ducey declared a "public health emergency" prompted by the COVID-19 outbreak, allowing the state to request federal funds and deal with medical price-gouging.

"While our state is not currently facing the number of cases we've seen in some other states, we are anticipating additional positive cases — and we're not taking any chances," Ducey said in announcing his emergency declaration. "Arizonans should not panic — our approach will be calm and steady."

Ducey also ordered insurance companies to cover out-of-network providers and cover 100 percent of the cost for coronavirus care. He also announced that nursing homes and elder care facilities will begin implementing new visitor policies and enhanced symptom checks for staff members and visitors.

Ducey and Christ, speaking at a news conference Wednesday afternoon, downplayed suggestions that large gatherings be banned.

"At this time we are not recommending canceling mass gatherings in Arizona," Christ said. "So we are working right now with the CDC on brand-new community mitigation guidance that they just put out and we are not at a point where we would recommend those type of things, but we are constantly evaluating to see if those measures do take sense, but at this time we're not."

'Focus on protecting the vulnerable'

"I want you to think about three things that are our most important messages," county Chief Medical Officer Dr. Francisco Garcia said Monday. "Number one, this is the time to optimize your health and the health of your family. People who are healthy get over this virus, people who are unhealthy, or who are frail, who are elderly may have a harder time and it may have a more serious consequence," he said.

And, he said that people need to "focus on protecting the vulnerable."

"The vulnerable are the same vulnerable that are impacted every year during the flu season — these are our elders and medically frail individuals," he said, adding that they should stay our from crowds, including cruise ships and airplanes. "These folks need to be cocooned so that we can maintain their health," he said.

Garcia also said that the city and county should "settle-in for a long-term response," which includes making sure that employers allow people to stay home when they're sick.

England who also dealt with the county's response during the H1N1 outbreak in 2009, said that there hadn't been a positive result in Pima County, "but it really doesn't matter because it's going to be here, and it's going to transmit locally," he said. "and we need to begin treating it in that way as if we're expecting it."

"This is probably going to feel to us like a bad flu season, so just as we lose tens of thousands of Americans each and every year to the flu," COVID-19 "will tragically kill many people," said England. "There's no getting around that, but that' going to be something that we've all experienced every year because we go through the flu season every year," he said.

England said that while the illness might be deadly, testing in South Korea showed that COVID-19 might have a lower mortality rate than expected, running about 0.6 percent, or roughly one-fifth of the "often quoted figure that you see in the news."

"I'm sure we're much of the mild illnesses," he said, noting that cases from cruise ships showed that people were often "asymptomatic" and showed no signs of the disease, dragging the mortality rate down to the range of the flu. "We've got a lot to learn," he said, but he added that there were "good indications" for county and city officials to treat this in the same way that they treat influenza.

"So, I cannot foresee a circumstance under which we would close a school, or more the point all the schools," he said. "That would be terribly disruptive and the data just doesn't support it." He added that kids often have a less severe illness, and are often less likely to be infected by COVID-19.

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