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https://wwwnc.cdc.gov/eid/article/26/6/20-0412_article
Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People
Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.
Volume 26, Number 6—June 2020
Research Letter
Indirect Virus Transmission in Cluster of COVID-19 Cases, Wenzhou, China, 2020
Abstract
To determine possible modes of virus transmission, we investigated a cluster of COVID-19 cases associated with a shopping mall in Wenzhou, China. Data indicated that indirect transmission of the causative virus occurred, perhaps resulting from virus contamination of common objects, virus aerosolization in a confined space, or spread from asymptomatic infected persons.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of 2019 novel coronavirus disease (COVID-19), is presumed to spread primarily via respiratory droplets and close contact. However, these transmission modes do not explain all cases. To determine how the virus may have spread among a cluster of COVID-19 cases associated with a shopping mall in Wenzhou (a city with 8 million residents), China, we monitored and traced close contacts and hypothesized possible transmission modes. We analyzed clinical and laboratory data for cases by using real-time reverse transcription PCR (1). The study was approved with written consent from the Ethics Committee of Wenzhou Central Hospital and written informed consent from all case-patients.
On January 20, 2020, a 23-year-old man (patient E) sought care at a hospital after 11 days of fever and headache. On January 21, COVID-19 was confirmed for patient E and his co-worker, patient G. The Wenzhou Center for Disease Control and Prevention traced and tested their contacts, and by January 28, COVID-19 was confirmed for 7 persons (patients A–G) from the same office (on floor 7).
Patient A, a 30-year-old woman, the only case-patient who indicated that she had been in Wuhan, China, returned from Wuhan on December 18, 2019. On January 15–16, 2020, she had a fever, but symptoms resolved without treatment. Despite symptom resolution, on January 30 she was confirmed to have SARS-CoV-2 infection. If patient A is the index patient, infected in Wuhan, her incubation period would have been 28 days, which would be extremely long, according to updated information (W.J. Guan et al., unpub. data, https://www.medrxiv.org/content/10.1101/2020.02.06.20020974v1External Link). Asymptomatic carrier transmission has been reported for SARS-CoV-2 (2); hence, patient A could have been screened as a close contact during her incubation period and then hospitalized on the basis of a positive test (PCR) result only. However, her clinical symptoms did not appear until after hospitalization. Because persons with asymptomatic COVID-19 can spread the virus, patient A also could have been an asymptomatic carrier with a persistent infection (3).
On January 22, the mall was shut down. During January 19–February 9, COVID-19 was diagnosed for 7 mall staff from floors B1–3 and for 10 mall customers. Close contacts associated with the mall were traced, and COVID-19 was confirmed for 11 persons. Sixteen patients had had direct contact with other patients or had gone shopping in the mall. The average incubation period was 7.3 (range 1–17) days.
Cluster of COVID-19 cases associated with a shopping mall in Wenzhou, China. A) Distribution of COVID-19 case-patients by mall floor, time, and internal relationship. B) Dates of symptom onset, confirmed test...
Centers for Disease Control and Prevention. CDC twenty four seven. Saving Lives, Protecting People
Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.
Volume 26, Number 6—June 2020
Research Letter
Indirect Virus Transmission in Cluster of COVID-19 Cases, Wenzhou, China, 2020
Abstract
To determine possible modes of virus transmission, we investigated a cluster of COVID-19 cases associated with a shopping mall in Wenzhou, China. Data indicated that indirect transmission of the causative virus occurred, perhaps resulting from virus contamination of common objects, virus aerosolization in a confined space, or spread from asymptomatic infected persons.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of 2019 novel coronavirus disease (COVID-19), is presumed to spread primarily via respiratory droplets and close contact. However, these transmission modes do not explain all cases. To determine how the virus may have spread among a cluster of COVID-19 cases associated with a shopping mall in Wenzhou (a city with 8 million residents), China, we monitored and traced close contacts and hypothesized possible transmission modes. We analyzed clinical and laboratory data for cases by using real-time reverse transcription PCR (1). The study was approved with written consent from the Ethics Committee of Wenzhou Central Hospital and written informed consent from all case-patients.
On January 20, 2020, a 23-year-old man (patient E) sought care at a hospital after 11 days of fever and headache. On January 21, COVID-19 was confirmed for patient E and his co-worker, patient G. The Wenzhou Center for Disease Control and Prevention traced and tested their contacts, and by January 28, COVID-19 was confirmed for 7 persons (patients A–G) from the same office (on floor 7).
Patient A, a 30-year-old woman, the only case-patient who indicated that she had been in Wuhan, China, returned from Wuhan on December 18, 2019. On January 15–16, 2020, she had a fever, but symptoms resolved without treatment. Despite symptom resolution, on January 30 she was confirmed to have SARS-CoV-2 infection. If patient A is the index patient, infected in Wuhan, her incubation period would have been 28 days, which would be extremely long, according to updated information (W.J. Guan et al., unpub. data, https://www.medrxiv.org/content/10.1101/2020.02.06.20020974v1External Link). Asymptomatic carrier transmission has been reported for SARS-CoV-2 (2); hence, patient A could have been screened as a close contact during her incubation period and then hospitalized on the basis of a positive test (PCR) result only. However, her clinical symptoms did not appear until after hospitalization. Because persons with asymptomatic COVID-19 can spread the virus, patient A also could have been an asymptomatic carrier with a persistent infection (3).
On January 22, the mall was shut down. During January 19–February 9, COVID-19 was diagnosed for 7 mall staff from floors B1–3 and for 10 mall customers. Close contacts associated with the mall were traced, and COVID-19 was confirmed for 11 persons. Sixteen patients had had direct contact with other patients or had gone shopping in the mall. The average incubation period was 7.3 (range 1–17) days.
Cluster of COVID-19 cases associated with a shopping mall in Wenzhou, China. A) Distribution of COVID-19 case-patients by mall floor, time, and internal relationship. B) Dates of symptom onset, confirmed test...