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By last Wednesday, the tickle in Alison McGrath Howard’s throat had turned into chills, though not severe enough to keep her from seeing six patients who came to her Northwest Washington office for psychotherapy.

Twenty-four hours later, while walking her dog, Howard felt dizzy and fatigued. She anxiously catalogued her recent activities: grocery shopping, hanging with her two teenagers, going to her book club and attending a conference in Manhattan with 1,100 therapists from around the world.

On Monday, Howard, 54, learned that she had tested positive for the novel coronavirus.

“Oh no,” she said when the infectious disease specialist called with the results.

Now she is quarantined in her apartment, among the growing list of more than 100 people from across greater Washington known, as of Monday night, to have the virus.

The victims span the region and all its variety: an Episcopal rector who may have infected congregants at his Georgetown church; two Northern Virginia military personnel; half a dozen Marylanders who traveled on a Nile River cruise ship; an American University student; the head of Gonzaga College High School; doctors and staff from the National Institutes of Health, Johns Hopkins Hospital and the United Medical Center.

As of Monday night, the region’s two fatalities were men in their 70s from Virginia’s Peninsula region. Both died of respiratory failure.

As she lies listless in her Cathedral Heights apartment, Howard thinks about whom she could have unwittingly infected: a patient with a heart condition; the pregnant woman who sat next to her at book group; her son and daughter, both of whom are now staying with her ex-husband.

Her week-long passage from perfect health to the grip of a ferocious virus is emblematic of what government officials fear awaits tens of thousands of Americans now ordered to remain at home.

While she does not know how she became infected, Howard suspects it was while she was in New York in early March, attending a conference of the American Group Psychotherapy Association.

Perhaps she caught the virus, she said, when she joined hundreds at a conference-sponsored dance at a Sheraton hotel near Times Square. Or maybe it occurred when she took a break and walked through the Metropolitan Museum of Art; or when she visited the top of Rockefeller Center and a stranger sneezed on her.

It was only after she came home, as she felt symptoms she initially associated with allergies, that she read on the association’s Internet mailing list that a number of therapists had reported not feeling well or had tested positive for the virus.

The outbreak echoed what occurred in Boston in February, when more than 100 people were infected at a meeting hosted by Biogen, a biotechnology company.

As of early March, people have tested positive for the coronavirus in about 70 countries. Officials are taking "unprecedented" actions. (The Washington Post)

Diane Feirman, a spokeswoman for the psychotherapy association, said 19 people who attended the conference had tested positive for the virus as of Tuesday, with “probably an equal number” reporting symptoms and either awaiting test results or trying to get tested. The conference drew therapists from two dozen countries, including Italy, Spain and Singapore.

In an email to members, association president Molyn Leszcz and chief executive Marsha Block said “there have been understandable expressions of anger” that the conference was held “in the current environment.” The association, they said, made “the best decisions that we could with the information we had at the time.”

“At the same time,” they added, “we deeply regret that our meeting may have contributed to peoples’ exposure and vulnerability to this illness.”

Howard said she attended the conference without worry.

“The people who were organizing the conference gave us the same spiel — that we should be careful about washing hands,” she said. “But when you’re at one of these conferences, it’s easy to let your guard down. None of us wanted to believe we were at risk.”

Cathi Cohen, a Northern Virginia therapist who is friendly with Howard and also attended the conference, said there was no obvious reason to be concerned about exposure.

“I didn’t see anyone with a sniffle,” Cohen, 59, said. “I saw one person in a mask. Everyone was in the restaurants and acting like everything was fine.”

The pandemic’s shifting reality — abrupt and jarring — is challenging for therapists trying to help patients “separate out what’s real from what’s anxiety-based,” Cohen said.

That Howard has the virus only adds a stunning personal twist, Cohen said, “because she’s young, healthy and in great shape.”

“If she can get sick, anyone can get sick.”

After returning to Washington on March 8, Howard bought groceries at the Whole Foods in Tenleytown. The next day, she saw eight patients, including five in a group session.

Two days later, Howard said, she felt a “slight tickle” in her throat, which she attributed to allergies. She saw nine patients before attending a gathering of the “Existential Book Club,” an assembly of 20 or so therapists who discussed Virginia Woolf’s “Mrs. Dalloway.”

Her throat was still scratchy on Wednesday last week, only now she also felt periodic chills as she saw six more patients. That night, as she spent time with her kids, Howard took her temperature, which was normal. Her daughter grabbed the thermometer, quickly wiped it on a bedsheet and took her own temperature.

“What did you just do?” Howard said, horrified.

“It’ll be fine, Mom,” she said.

On Thursday night, as her symptoms worsened, Howard contacted everyone she recalled encountering in the previous days, along with eight patients she was scheduled to see Friday. She told them that she may have been exposed to the virus and that they would have phone sessions instead of meeting face-to-face.

By the next morning, her fever was 101.3. Between patients, she called her doctor. After describing her symptoms, she was told someone from the District’s Department of Health would come to her apartment to test her. If not, she would need to go to an emergency room.

By 4 p.m., she was too weak to work and canceled her last two patients. She felt dizzy and exhausted. Her cough was unceasing. Somehow, she drove herself to Sibley Memorial Hospital, where an emergency room attendant gave her a mask and told her to wait for a chest X-ray and tests for strep and the flu.

An elderly woman in a wheelchair struggled to breathe. Several other patients complained of coughs and fatigue. At one point, Howard overheard a doctor tell a colleague, “If someone comes in with a fever and coughing with a fever, we assume it’s corona.”

“Why aren’t they testing me for corona right now?” Howard thought.

After her strep and flu tests, she waited for results in the reception area, where a couple of dozen people were seated, some wearing masks, some not.

“I’m sitting right next to people and coughing,” she recalled.

After three hours, she was led to a room where the sign on the door read, “Airborne Illness.” Another patient there was talking on her cellphone to her mother in Chinese.

The woman’s cough reminded Howard of her own.

“What’s going to happen?” she asked Howard.

“We’re going to get tested,” Howard answered. “If we’re positive, we have to self-quarantine.”

The woman repeated Howard’s answer in Chinese to her mother before asking, “What about treatment?”

“There is no treatment,” Howard said.

“No treatment,” the woman told her mother, only now in English. The woman began to cry.

A few minutes later, a doctor in anti-contamination gear came in to test Howard for the coronavirus, taking swabs from her throat and nose. Six hours after arriving at the hospital, she drove home.

Over the weekend, she left her apartment only to walk her Shih Tzu, Cooper.

“Don’t get on the elevator with me!” she warned a neighbor when the door slid open on another floor.

She struggled to breathe. Her head ached. She longed for her son and daughter.

On Sunday, her fever dropped to 99.

Her phone rang Monday at 7:30 a.m.

“You probably already know the results are positive,” the infectious disease specialist announced.

Around noon, Howard posted a letter on Facebook, reporting what had transpired and that “it is important for people to share their experiences with this illness.” She asked that everyone try “to refrain from spreading fear.”

She felt lonely, but fortunate to have a phone and a computer and friends and family nearby. She tries to remain positive. The sick can get better, she tells herself. Soon, she will feel stronger.

How soon?

On Tuesday morning, she felt well enough to take a shower, make her bed and fold clothes.

By noon, her temperature was 100.2. She felt dizzy. Breathing was more difficult.

It was time to lie down again and be still.