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In Wuhan, she visited a hospitalised relative regularly and visited other family members who had undiagnosed respiratory illnesses, one of whom was later hospitalised with viral pneumonia

First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA.

The Lancet, no. 10230 (2020): 1137-1144

Cited by: 42|Views142
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Abstract

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Introduction
  • Patients with confirmed COVID-19 were defined as those with a positive SARS-CoV-2 test.
  • Contacts were people with exposure to a patient with COVID-19 on or after the patient’s symptom onset date.
  • Contacts underwent active symptom monitoring for 14 days following their last exposure.
  • Cough, or shortness of breath became persons under investigation and were tested for SARS-CoV-2.
  • A convenience sample of 32 asymptomatic health-care personnel contacts were teste
Highlights
  • Patients with confirmed COVID-19 were defined as those with a positive SARS-CoV-2 test
  • Evidence before this study We searched PubMed for articles published between database inception and Feb 18, 2020, describing transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using the search terms “severe acute respiratory syndrome coronavirus 2”, “SARS-CoV-2”, “novel coronavirus”, “2019-nCoV”, or “COVID-19”; and “transmission”, “person-toperson”, or “human-to-human”
  • We found 34 articles, of which 13 were primary reports of person-to-person transmission
  • In Wuhan, she visited a hospitalised relative regularly and visited other family members who had undiagnosed respiratory illnesses, one of whom was later hospitalised with viral pneumonia
  • No add­ itional cases of COVID-19 were identified through active symptom monitoring of several hundred community and health-care personnel contacts, testing of symptomatic person under investigation, or screening of a subset of asymptomatic healthcare personnel contacts
  • These data suggest that personto-person transmission of COVID-19 might be most likely to occur through unprotected, prolonged exposure to a patient with symptomatic COVID-19
Methods
  • Patients with confirmed COVID-19 were defined as those with a positive SARS-CoV-2 test.
  • None provided full details of the contact investigation and none were from North America
Results
  • Patient 1 is a female in her 60s who travelled to Wuhan on Dec 25, 2019, and returned to Illinois on Jan 13, 2020, and who was not symptomatic while travelling.
  • In Wuhan, she visited a hospitalised relative regularly and visited other family members who had undiagnosed respiratory illnesses, one of whom was later hospitalised with viral pneumonia.
  • On DOI 6, she sought care at an outpatient clinic for fever, fatigue, and cough and was hospitalised that day for pneumonia.
  • She was reported to public health authorities as a PUI on DOI 7.
  • She reported that her symptoms, which included nausea, abdominal discomfort, and dizziness, started as early as 6 days before admission
Conclusion
  • This Article documents the first known person-to-person transmission of SARS-CoV-2 in the USA.
  • No add­ itional cases of COVID-19 were identified through active symptom monitoring of several hundred community and health-care personnel contacts, testing of symptomatic PUIs, or screening of a subset of asymptomatic healthcare personnel contacts.
  • These data suggest that personto-person transmission of COVID-19 might be most likely to occur through unprotected, prolonged exposure to a patient with symptomatic COVID-19.
  • In January, 2020, state, local, and federal public health agencies investigated the first case of COVID-19 in Illinois, USA
Tables
  • Table1: Illinois risk classification of health-care personnel and community contacts with potential exposure to COVID-19 contacts (including those that could not be reached for active symptom monitoring) seeking care for fever, cough, or shortness of breath at an emergency department, the Illinois Department of Public Health used locally available, near real-time surveillance data received from regional acute care hospitals, which included symptom and diagnoses data and personally identifiable infor­ mation for matching
  • Table2: Actively monitored contacts and PUIs owing to contact with a patient with COVID-19, Illinois, USA, 2020
Download tables as Excel
Funding
  • Funding None Introduction In January, 2020, a novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was iden­tified as the causative agent for a cluster of pneumonia cases initially detected in Wuhan City, Hubei province, China.[1] SARS-CoV-2, which causes the disease now named coronavirus disease 2019 (COVID-19), had spread throughout China and to 26 additional countries as of Feb 18, 2020.2 Phylogenetic data implicate a zoonotic origin,[3] and the rapid spread suggests ongoing personto-person transmission. Several studies offer additional insight into person-to-person transmission.[49] However, substantial knowledge gaps remain regarding the transmissibility between humans, including the level of exposure to a confirmed case at which transmission is more likely to occur. On Jan 23, 2020, Illinois, USA, reported the state’s first laboratory-confirmed case (index case) of COVID-19 in a traveller who returned from Wuhan in mid-January, 2020. Subsequently, the first evidence of secondary transmission in the USA was reported on Jan 30, when the husband of the index patient, who had not travelled outside the USA, tested positive for SARS-CoV-2. Public health authorities did an intensive epidemiological investigation of the two confirmed cases.
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Author
Isaac Ghinai
Isaac Ghinai
Tristan D McPherson
Tristan D McPherson
Jennifer C Hunter
Jennifer C Hunter
Hannah L Kirking
Hannah L Kirking
Demian Christiansen
Demian Christiansen
Kiran Joshi
Kiran Joshi
Rachel Rubin
Rachel Rubin
Shirley Morales-Estrada
Shirley Morales-Estrada
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