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Leading driver for the Covid-19 pandemic Superspreader event

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SARS-COV-2, COVID-19

Colored scanning electron micrographs of apoptotic cells (green) strongly infected with SARS-COV-2 virus particles (yellow) isolated from patient samples. Image taken at the NIAID Integrated Research Facility (IRF) in Fort Detrick, Maryland. Credit: NIH / NIAID

Large-scale events that can sick dozens or even hundreds of people in churches, cruise ships, and even the White House show that the coronavirus can be transmitted in a dramatic outburst. I have.

According to experts, these large clusters are likely to be the main source of pandemics, not just extreme outliers.

And understanding where, when, and why they occur can help control the spread of the virus during the period before vaccines become widely available.

Research is increasingly suggesting SARS-CoV-2 does not spread evenly throughout the population, but it spreads extremely in almost all-or-nothing patterns.

Currently, many studies suggest that the vast majority of people with COVID-19 rarely pass it on to others, but when an infection occurs, it can explode and supercharge the outbreak. ..

The virus could then infect “10, 20, 50, or more people,” said Benjamin Althaus, a research scientist at the University of Washington’s Institute for Disease Modeling.

This corresponds to the epidemiological “80/20 rule”, where 80% of cases come from only 20% of infected people, but Althouse says that this coronavirus is even more extreme, with 90% of cases He said it could potentially come from only 10%. Career.

He told AFP that this transmission pattern was like “throwing a match at the mountain of fire.”

“If you throw one match, it won’t fire. If you throw another match, it won’t fire. If you throw another match, the flames will burn,” he said.

“For SARS-CoV-2, this means that it is difficult to establish in a new location, but once established, it can spread rapidly and far.”

“Characteristics” of the virus

The Superspreader event got a headline as it approached the unfolding pandemic story.

In February, Diamond Princess and her 4,000 passengers spent weeks quarantining at Japanese ports as the number of infections on board increased to 700.

In the same month, a 61-year-old woman known as “Patient 31” attended worship services at several churches of the Shincheonji Church of Jesus in Daegu, South Korea.

Since then, the Korea Disease Control and Prevention Headquarters has linked more than 5,000 infectious diseases to the new world.

Recently, the virus has been able to invade the White House, despite many measures to stop it.

Political rallies, business meetings, and sports tournaments all acted as infectious incubators, but these high-profile events could be just the tip of the iceberg.

Based on one of the world’s largest contact tracing operations, a study by US researchers published in Science in September found that “superspreaders dominate” in transmission.

Analyzing data from the first four months of the pandemic in Tamil Nadu and Andhra Pradesh, India, only 8% of infected people accounted for 60% of new cases, and 71% of virus-infected people did not. I found out. Pass it to one of your contacts.

Perhaps this is not surprising.

Infectious disease epidemiologist Maria van Kerhob, who is at the heart of the World Health Organization’s pandemic response, tweeted in October that the coronavirus “superspreaders are characteristic.”

Indeed, it has been observed in many infectious diseases.

One of the most famous superspreaders was Mary Maron, a chef who worked in New York in the early 1900s. He was first recorded as a healthy carrier of typhoid fever in the United States.

Accused of illness to dozens of people, she was given the unfriendly label “Typhoid Fever” and was forcibly imprisoned for years.

Measles, smallpox, and Ebola hemorrhagic fever, like other coronaviruses, SARS, and MERS, show a clustering pattern.

K factor

In the early days of the pandemic, much attention was paid to the basic reproduction number (R0) of SARS-CoV-2.

This helps to calculate the rate at which the disease spreads by looking at the average number of people infected with the virus.

However, looking at communications with this metric alone is often “not able to convey the big picture,” said Althouse, who co-authored a paper on R0 restrictions at this month’s Journal of the Royal Society Interface.

For example, Ebola, SARS-CoV-2, and influenza all have R0 values ​​of about 2-3, he said.

However, while people with the flu tend to “consistently” infect a few other people, most people have Ebola and SARS-CoV-2 infection patterns that are too dispersed. It is rarely infected and causes dozens of other cases.

Akira Endo, a research student at the London School of Economics and Tropical Medicine, uses a different metric, “k,” to capture this clustering behavior, but usually requires “more detailed data and methodologies.”

His modeling from the early international spread of the virus, published in Wellcome Open Research, suggested that SARS-CoV-2 could be very overdispersed.

A clear clue is that some countries have reported a large number of imported cases, but there are no signs of persistent infection as in the match analogy, while others are large with only a small number of imported cases. Reported a local outbreak.

But even k may not be able to give the big picture, said Felix Wong, a postdoctoral researcher at the Massachusetts Institute of Technology.

His study, which analyzed known COVID-19 superspreader events published in the journal PNAS this month, found that they happened more frequently than predicted by traditional epidemiological models.

They are “extreme but likely events,” Wong told AFP.

Biology and Opportunity

So why do superspreaders occur?

It is not clear whether biological factors such as viral load play many roles.

But what we know is that people can spread SARS-CoV-2 without symptoms, especially in places where people talk, scream and sing, in poorly ventilated and crowded spaces. Given that, the virus can spread.

This may be the reason why this month’s Nature study found that restaurants, gyms, and cafes were responsible for most COVID-19 infections in the United States.

Using data from 98 million mobile phones, researchers found that about 10% of the venue accounted for more than 80% of the cases.

Given this, experts say that these types of spaces should be focused on and reduce the chances of the virus accessing a large number of people.

Wong said his modeling showed that if each individual was restricted to 10 infectious contacts, “the virus infection would disappear soon.”

Tracking

Overspreading of the spread also means that most people who test positive for the virus are likely to be part of a cluster.

This opens up another way to track infections. It’s backwards.

“The idea is that tracking and quarantining Superspreaders is more efficient than tracking and quarantining downstream individuals who, if infected, can infect very few people with the virus,” Wong said. Mr. says.

Both Japan and South Korea, along with other control measures, used backward contact tracking, which is believed to have helped control their epidemic.

Altohaus said masks, social distance, and reduced contact were all ways to limit the chances of infection, adding that even characterizing people as “superspreaders” was misleading.

“There are big differences in biology between individuals. I may have a million times more. In my nose than you-but if I’m a recluse, I can’t infect anyone, “he said.


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