When President Donald Trump began talking to the public about coronavirus disease 2019 (COVID-19) in February and March, scientists were stunned at his seeming lack of understanding of the threat. We assumed that he either refused to listen to the White House briefings that must have been occurring or that he was being deliberately sheltered from information to create plausible deniability for federal inaction. Now, because famed Washington Post journalist Bob Woodward recorded him, we can hear Trump’s own voice saying that he understood precisely that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was deadly and spread through the air. As he was playing down the virus to the public, Trump was not confused or inadequately briefed: He flat-out lied, repeatedly, about science to the American people. These lies demoralized the scientific community and cost countless lives in the United States.

A new study by American researchers, released on Thursday, suggests the deadly coronavirus may have already reached Los Angeles by late December, actively circulating in the area months before the first definitive cases in the United States were identified.

Researchers at the University of California, Los Angeles (UCLA), evaluated more than 10 million patient and health records for UCLA Health outpatient, emergency department and hospital facilities, spanning Dec. 1, 2019, to Feb. 29, 2020, and compared those records with data from the same period over the previous five years.

They found a troubling trend. The outpatient clinic visits by UCLA patients seeking care for coughs increased by over 50 percent and exceeded the average number of visits for the same complaint over the prior five years by more than 1,000.

They also discovered a “significant” excess in the number of patients seen in emergency departments for reports of coughs and of patients hospitalized with acute respiratory failure during this time period.

These excesses remained even after accounting for changes in patient populations and seasonal variation, according to the study, published in the peer-reviewed Journal of Medical Internet Research.

“For many diseases, data from the outpatient setting can provide an early warning to emergency departments and hospital intensive care units of what is to come,” said Joann Elmore, the study’s lead author and a professor of medicine at the David Geffen School of Medicine at UCLA.

Researchers noted the unusually high number of visitors, patients and hospitalizations suggests community spread of SARS-CoV-2 prior to established clinical awareness and testing capabilities.

It may indicate that the coronavirus had silently arrived and begun establishing a foothold undetected on the West Coast around Christmas 2019. If true, that would shake up the current narrative of the virus’ origins in the country.

The U.S. Centers for Disease Control and Prevention (CDC) reported the first U.S. COVID-19 case on Jan. 21, who was a man traveling from Wuhan, China to Washington state. And it was not until Feb. 26 that the CDC confirmed community spread of the coronavirus in the United States.

UCLA researchers did not conclude for certain that coronavirus was behind the trends laid out in their study, saying other factors could be responsible for some of this unexpected increase, such as the use of e-cigarettes, or flu.