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Coronavirus: Infected couple came into contact with 370 people, but none of them tested positive

The analysis adds a new dimension to understanding how COVID-19 spreads
UPDATED MAR 20, 2020
 (AP Photo/Jeff Chiu)
(AP Photo/Jeff Chiu)

A woman in her 60s and her husband in the US, who tested positive for COVID-19, came in contact with 372 people. However, person-to-person transmission of COVID-19 occurred only between two people (the woman and her husband) with prolonged, unprotected exposure while the first patient was symptomatic (showing symptoms). 

Despite active monitoring and testing of 372 contacts — those who came into contact with either the woman or her husband — no further transmission was detected, says a new analysis by a team of researchers in the US.

The woman had returned from China in mid-January and later tested positive for COVID-19. Her husband (Patient 2) did not travel but had frequent close contact with his wife. According to figures till March 12, over 1,600 have fallen sick and 40 have died in the US, which has seen community transmission in some parts.

The current analysis — detailing the first known person-to-person transmission of new coronavirus in the US — adds a new dimension to scientists' understanding of the novel coronavirus and how it spreads.

"This report suggests that person-to-person transmission of COVID-19 might be most likely to occur through unprotected, prolonged exposure to an individual with symptomatic COVID-19," says Dr Jennifer Layden, Chief Medical Officer of the Chicago Department of Public Health, USA, who co-led the research, in The Lancet. 

Dr Eric Topol, founder and director of the Scripps Research Translational Institute, US, called the study findings reassuring. 

"Reassuring report on the 1st documented case of US person-to-person #COVID19 transmission: prolonged, exposure to a symptomatic individual but no transmission to 372 contacts," he tweeted.

On December 25, 2019, the female patient traveled to Wuhan where she visited a hospitalized relative and other family members with undiagnosed respiratory illness. She returned to Illinois on January 13 but was not symptomatic while traveling. 

On January 23, 2020, Illinois reported the state's first laboratory-confirmed case of COVID-19 in a woman in her 60s who returned from Wuhan, China in mid-January, 2020.

Subsequently, the first evidence of secondary transmission in the US was reported on January 30, when her husband, who had not traveled outside the US but had frequent, close contact with his wife since her return, tested positive for COVID-19. 

After her return to the US, she experienced six days of mild fever, fatigue, and cough before being hospitalized with pneumonia and testing positive for COVID-19. 

Before her hospitalization, she was living with her husband who has chronic obstructive pulmonary disease (COPD) and chronic cough. These conditions made it difficult to determine the timing of his symptom onset related to COVID-19.

Eight days after his wife was admitted to hospital, the husband was also hospitalized with worsening shortness of breath and coughing up blood, and also tested positive for COVID-19.

The current study describes the clinical and laboratory features of both patients and the assessment and monitoring of several hundred individuals with potential exposure to both.

A laboratory technician prepares COVID-19 patient samples for semi-automatic testing at Northwell Health Labs, NY (AP Photo/John Minchillo)

In all, 372 individuals were identified as potential contacts — 347 of these people were actively monitored after confirmation of exposure to the woman or her husband on or after the day of symptom onset. This includes 152 community contacts (44%) and 195 healthcare professionals (56%). 

"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. Contacts who developed fever, cough, or shortness of breath became persons under investigation and were tested for COVID-19," says the study.

The analysis shows that 25 people had insufficient contact information to complete active monitoring. A "convenience sample" of 32 asymptomatic healthcare personnel contacts were also tested.

These 347 contacts underwent active symptom monitoring for 14 days following their last exposure. Of these, 43 contacts who developed fever, cough, or shortness of breath were isolated and tested for COVID-19, as well as asymptomatic healthcare professionals. All 75 individuals tested negative for COVID-19.

Both patients — the woman and her husband — recovered and were discharged to home isolation. This was lifted 33 days after the woman returned from Wuhan, following two negative tests for COVID-19 taken 24 hours apart.

"Without using appropriate facemasks or other personal protective equipment, individuals living in the same household as, or providing care in a non-healthcare setting for, a person with symptomatic COVID-19 are likely to be at high risk of infection," says co-lead author, Dr Tristan McPherson from the Chicago Department of Public Health, US, in the study findings. 

"Current CDC recommendations for individuals with high-risk exposures to remain quarantined with no public activities might be effective in reducing onward person-to-person transmission of COVID," Dr McPherson adds.

Workers from a disaster recovery team wearing protective suits and respirators are given supplies as they line up before entering the Life Care Center in Kirkland, Washington, to begin cleaning and disinfecting the facility (AP Photo/Ted S. Warren)

Dr Jennifer Layden, Chief Medical Officer of the Chicago Department of Public Health, US, who co-led the research, explains that "our experience of limited transmission of COVID-19 differs from Wuhan where transmission has been reported to occur across the wider community and among healthcare professionals, and from experiences of other similar coronaviruses."

"Nevertheless, healthcare facilities should rapidly triage and isolate individuals suspected of having COVID-19, and notify infection prevention services and local health departments for support in testing, management, and containment efforts," adds Dr. Layden.

Before her hospitalization, she and her husband lived together, ate together, shared a bed. Facemasks or other personal protective equipment (PPE) were not used at the home. Her husband was thus classified as having high-risk exposure. 

"These findings also support the US Centers for Disease Control and Prevention or CDC's assessment that, without using appropriate PPE, people living in the same household as, or providing care in a non-health-care setting for, a person with symptomatic laboratory-confirmed COVID-19 have high-risk exposure," says the team. 

The experts emphasize that individuals who think they might have been exposed to COVID-19 and experiencing a fever, cough, shortness of breath, or other symptoms consistent with COVID-19 should call their healthcare provider before seeking help so that appropriate preventive actions can be taken.

According to researchers, the study has implications for public health recommendations regarding the type and duration of isolation required for patients with COVID-19 and will allow for more focused and targeted contact tracing and testing of appropriate specimens based on the duration of illness.

"Although further detailed reports of contact investigations of COVID-19 cases could improve our understanding of the transmissibility of this novel virus, the absence of COVID-19 among healthcare professionals supports CDC recommendations around appropriate infection control," says co-lead author Dr. Isaac Ghinai from the Illinois Department of Public Health, US, in the analysis.

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