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Amidst patchy response, COVID has silently harassed us for weeks

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Two new studies involving evolutionary genomics, computer simulations and travel records of the COVID-19 pandemic suggest that inadequate travel monitoring, contact tracing and community surveillance allowed the novel coronavirus to spread unchecked to and throughout North America and Europe in late January or early. February.

The studies, published late last week in Science, traced the COVID-19 outbreak in the United States to a traveler who flew from China to Seattle in late January or early February, sowing the country’s first outbreak, which was then not detected for 3 to 6 weeks. .

Not detected, not verified

The first study, led by researchers at the University of Washington in Seattle, involved a genomic analysis of 453 SARS-CoV-2 viruses, responsible for COVID-19, collected during the Washington state outbreak of Feb. 20 to March 15, and coronavirus testing of more than 10,000 respiratory samples collected as part of the Seattle Flu Study Jan.1-March 15.

Finding that 84% of the virus’s genomes in Washington state were closely related and derived from a variant of the virus from Wuhan, China, the researchers concluded that the source of the outbreak was likely a traveler who flew from China in Seattle between Jan 22 and Feb 10.

The first confirmed case of the US coronavirus was identified on January 19 in a traveler, designated as “WA1,” who returned to Seattle on January 15 from Wuhan. The traveler’s virus genome was similar to that of others involved in the outbreak in Washington state, but different enough that it was unlikely to be the cause of the outbreak.

COVID-19 spread undetected in Washington state until February 28, after the U.S. Centers for Disease Control and Prevention’s testing criteria were broadened to include non-travelers, this which, according to the authors, underscores the importance of continuing widespread community surveillance even after an outbreak is under control. “We see the combination of community-based surveillance, genomic analysis and real-time public sharing of results as enabling new systems for infectious disease surveillance,” they wrote.

In one month, the state had reported 2,580 cases and 132 deaths, the result of both increased testing and community transmission.

The genomic sequences of most of the coronavirus samples collected in New York and Connecticut were different from those found in Washington state and similar to those found in Europe, the researchers said. Virus samples taken earlier in the pandemic and other locations will be needed to identify the specific date and geographic origin of the virus’s introduction into Washington state, they said.

Too little, too late

The second study consisted of computer simulations of epidemiological epidemiology and analysis of 1,000 SARS-CoV-2 genomes from around the world. His reconstruction of the coronavirus transmission in Washington state suggests that public health officials acted quickly to reverse the outbreak after the January 19 case was identified, which gave them time to prepare for community transmission.

Likewise, the authors attributed rapid responses to earlier virus introductions to Germany for relatively successful initial disease suppression.

But the failure of US authorities to closely monitor travelers returning from China in late January or early February, when contact tracing and isolation of cases could have been the most effective, may have led to multiple introductions. of COVID-19 in Washington and California, the authors said. The United States banned inbound flights from China on February 2.

Researchers studied the first confirmed case of COVID-19 in Europe, involving an auto supplier visiting the company’s headquarters in Bavaria, Germany, from Shanghai, China on January 20, suspected of being in the origin of the massive epidemic in Lombardy, Italy. But they found no such connection; on the contrary, a simulation showed that the virus likely spread directly from China to Germany and Italy and that several travelers from Italy brought the virus to New York.

Lead author Michael Worobey, PhD, of the University of Arizona at Tucson, said in an academic press release that the highly detailed computer simulations allowed researchers to ask questions about the behavior of the pandemic.

“In the case of Washington, we can ask, ‘What if this patient WA1 who arrived in the United States on January 15 really started this epidemic?’ Well, if he did, and you rerun this outbreak over and over, then sample infected patients from this outbreak and evolve the virus that way, do you get a diagram that looks like what we’re seeing? in reality? And the answer was no, ”he said. “If you sow this early Italian epidemic with the one in Germany, do you see the pattern you get in the evolutionary data? And the answer, again, is no.”

The study results also ruled out the theory that the virus spread in British Columbia before spreading to southern Washington state, the authors said. While the Washington state viral variants appeared similar to those in British Columbia, they did not match.

Today, many identical COVID-19 genomes are spreading rapidly because SARS-CoV-2 mutates more slowly than it spreads.

“This genetic similarity places limits on certain inferences such as calculating the ratio of imported cases to local transmissions in a given area,” the authors wrote. “Yet we have shown that precisely because of this slow pace, when hardly a mutation separates viruses, this difference can provide enough information to test hypotheses when appropriate methods are employed.

The study results underscore the value of implementing intensive community-level respiratory virus surveillance, like that of the Seattle flu study, before a pandemic, the authors said. “Our research shows that when you do early intervention and effective detection, it can have a huge impact, both in preventing pandemics and in controlling them once they progress,” Worobey said.

“As the epidemic has finally slipped, there have been early victories that show us the way forward: comprehensive testing and case identification are powerful weapons.”

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