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Two people who died in California in early and mid February have been confirmed through autopsies as coronavirus cases -- weeks before the first reported Covid-19 fatality in the United States.
The deaths, on February 6 and February 17, push back the timeline for the entry of the virus on US soil, experts said.
Given what we know about how long it takes for the virus to kill people, the disease began to spread in the US sometime between early and mid-January.
And the fact that it took astute health officials to carry out post-mortem examinations on these selected cases in turn means that the overall death toll of 45,000 is likely well below the real number.
"Models of epidemic spread in the US will have to be adjusted to account for an earlier start date," Jay Bhattacharya, a professor of medicine at Stanford University told AFP.
"This in turn should mean that the models will predict a larger number of current cases in the US now than they are currently predicting. How large an effect this will have on epidemic forecasting remains to be seen."
The earliest death attributed to the coronavirus was previously thought to be on February 26 in Washington state -- a man in his 30s who returned from the disease's epicentre in Wuhan and reported himself to authorities after experiencing symptoms.
Sara Cody, the public health officer of Santa Clara County where the new autopsies were performed, told The Washington Post it was not yet known how the two people were infected, with officials unaware of any history of overseas travel.
This further reinforces that the virus was already circulating in the community at a time that the Centers for Disease Control and Prevention (CDC) was continually assuring the public that the threat posed by Covid-19 was "low."
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