In a state with more patients and more in quarantine than any other, many questions remain unanswered as coronavirus develops in California.

As the number of cases and urgency around the coronavirus increases, Gov. Gavin Newsom said Wednesday that California is on high alert and working closely with the federal government on the return of Americans from overseas.

But in a state that has more people in quarantine than any other, many questions remain unanswered. Plans on where to house infected patients are not clear, local governments are declaring emergencies and at least one lawmaker said he’s getting “radio silence” from the governor’s administration.

“This changes quite literally by the hour,” Newsom said Wednesday. “As of last count, 31 people have been identified as having the coronavirus in the state of California and have gone through the repatriation process and are in various states of health.”

Newsom’s comment illustrated the uncertainty and rapid change around the issue.

His updated number differs from that currently being reported by the state’s public health department, which is publicly reporting only 10 cases in the state. Soon after his comment, the Centers for Disease Control and Prevention also confirmed a new California case that is the first example of coronavirus transmitted from person to person in the general public and not related to travel.

That person is a resident of Solano County, where hundreds of people have been quarantined over the last few weeks. The patient is receiving medical care in Sacramento County, the state’s public health department said.

“There’s no other state in America that has been more involved in addressing the issue,” Newsom said.

Hundreds of Americans being repatriated from Wuhan, China, where the virus was first identified, and from the Diamond Princess cruise ship, a ship that was quarantined in Japan after people tested positive for Coronavirus, were placed under mandatory quarantine, many of them in California.

Nationally, the Centers for Disease Control and Prevention confirmed 60 cases as of late Wednesday. This total seems to only take into account the 10 cases being reported by the state.

In early February, 234 people were evacuated from China and sent to Travis Air Force Base in Fairfield. Those people have completed their 14 day quarantine. Later, about 300 people who were evacuated from the cruise ship arrived at the same base, although some of those people were transferred to another military base in Texas. Of those passengers from the cruise ship, 14 were infected.

As concern grows, California communities are increasingly declaring local health emergencies.

On Wednesday, Orange County declared a local health emergency, following on San Francisco’s footsteps. San Diego and Santa Clara counties also have issued similar emergency declarations. This allows communities to roll out an accelerated emergency preparedness plan.

“Although there are still zero confirmed cases in San Francisco residents, the global picture is changing rapidly, and we need to step-up preparedness,” San Francisco Mayor London Breed said in a statement.

The reaction of communities echoes the growing concern by federal health officials who say further spread of the virus in the U.S. is expected. Earlier this week, officials at the Centers for Disease Control and Prevention told reporters that spread of the virus was a matter of time. In a press conference with President Donald Trump on Wednesday, however, Dr. Anne Schuchat, the principal deputy director at CDC, said, “The trajectory of what we’re looking at over the weeks and months ahead is very uncertain.”

But perhaps an even more time-sensitive concern is where to place patients who are under quarantine in the state and test positive for the virus.

People at Travis Air Force Base in Solano County, who test positive for the virus can’t stay at the base because there is no place for them to be properly isolated. Instead, they are being sent to hospitals in Northern California counties, including Napa, Contra Costa and Sonoma, even if they’re not showing symptoms. There, they are placed in isolation in specialized rooms until they are cleared from infection.

The current setup could place a burden on local hospitals, said California Health and Human Services Secretary Mark Ghaly and the Director of the state’s Office of Emergency Services Mark Ghilarducci in a letter sent Tuesday to Alex Azar, the U.S. Health and Human Services Secretary.

In the letter, Ghaly and Ghilarducci said they are committed to finding a location to place California residents but want the federal government to come up with a plan for non-California residents. About 70 of a reported 156 people at Travis Air Force Base are California residents.

Federal officials were considering a facility in Anniston, Alabama to house infected patients, but after the Republican governor and others protested, President Donald Trump assured them that Alabama would not receive any of these patients, raising questions about political favoritism.

“With the Anniston, Alabama site being placed on hold, we do have significant concerns that there is no alternative plan from the federal government,” the California letter said.

“We request that your team immediately provide us with information relative to any alternative plans for non-California residents. As more individuals test positive at Travis Air Force Base, the urgency to have alternative plans implemented grows,” the letter says.

Last Friday, California planned to move state residents who tested positive for the virus to the Fairview Developmental Center in Costa Mesa, an empty state-owned facility. City officials blocked the move with a restraining order from a federal judge and a decision that is still pending.

State Sen. John Moorlach, a Republican who represents Costa Mesa, on Wednesday sent a letter to Newsom seeking answers.

“Without having been consulted until after your Administration recommended (Fairview Developmental Center) to the federal government, I have been working hard to provide answers,” Moorlach wrote in his letter.

Moorlach said that last Thursday he got a call notifying him that 16 patients would be transferred to the Costa Mesa facility. “And after that, it’s been radio silence,” Moorlach told CalMatters.

“We’re not trying to be obstructionists, we’re looking for answers,” he said.

By Ana B. Ibarra. Originally published on CalMatters. is a nonprofit, nonpartisan media venture explaining California policies and politics.