The shift in strategy, with an emphasis on enlisting the public at large to take a more active role in curtailing the spread of the virus, came as health authorities announced on Monday that 18 Washington state residents had tested positive, including six who died. “We’re pivoting to a more community-based approach, very similar to what we use for influenza epidemics, where we give people, and schools and businesses good advice on how they can reduce their risks,” Dr Jeff Duchin, health officer for Seattle and King County’s public health agency, told reporters.