Evidence for Limited Early Spread of COVID-19 Within the United States, January–February 2020

Details

• Personal Author:
  Jorden, Michelle A. ; Rudman, Sarah L. ; Villarino, Elsa ; Hoferka, Stacey ; Patel, Megan T. ; Bemis, Kelley ; Simmons, Cristal R. ; Jespersen, Megan ; Johnson, Jenna Iberg ; Mytty, Elizabeth ; Arends, Katherine D. ; Henderson, Justin J. ; Mathes, Robert W. ; Weng, Charlene X. ; Duchin, Jeffrey ; Lenahan, Jennifer ; Close, Natasha ; Bedford, Trevor ; Boeckh, Michael ; Chu, Helen Y. ; Englund, Janet A. ; Famulare, Michael ; Nickerson, Deborah A. ; Rieder, Mark J. ; Shendure, Jay ; Starita, Lea M.
• Corporate Authors:
  CDC COVID-19 Response Team. ; Santa Clara County (Calif.). Office of the Medical Examiner-Coroner. ; Santa Clara County (Calif.). Public Health Department. ; Illinois. Department of Public Health. ; Cook County (Ill.). Department of Public Health. ; Chicago (Ill.). Department of Public Health ; .Louisiana. Office of Public Health ; Michigan. Department of Health and Human Services. ; New York (N.Y.). Department of Health and Mental Hygiene. ; New York (State). Department of Health. ; Public Health--Seattle & King County. ; Washington State. Department of Health. ; Fred Hutchinson Cancer Research Center. ; University of Washington. ; Seattle Children’s Hospital. ; Institute for Disease Modeling. ; Brotman Baty Institute for Precision Medicine.
• Description:
  What is already known about this topic?: The first U.S. cases of nontravel–related COVID-19 were confirmed on February 26 and 28, 2020, suggTesting that community Transmission was occurring by late February.
  
  What is added by the report?: Four separate lines of evidence (syndromic Surveillance, Virus Surveillance, phylogenetic Analysis, and retrospectively identified cases) suggest that limited U.S. community Transmission likely began in late January or early February 2020, after a single importation from China, followed by multiple importations from Europe. Until late February, COVID-19 incidence was too low to be detected by emergency department syndromic Surveillance for COVID-19–like illness.
  
  What are the implications for public health practice?: Enhanced syndromic and Virus Surveillance will be needed to monitor COVID-19 Trends for the duration of the pandemic.
  
  From January 21 through February 23, 2020, public health agencies detected 14 U.S. cases of coronaVirus disease 2019 (COVID-19), all related to travel from China (1,2). The first nontravel–related U.S. case was confirmed on February 26 in a California resident who had become ill on February 13 (3). Two days later, on February 28, a second nontravel–related case was confirmed in the state of Washington (4,5). Examination of four lines of evidence provides insight into the timing of introduction and early Transmission of SARS-CoV-2, the Virus that causes COVID-19, into the United States before the detection of these two cases. First, syndromic Surveillance based on emergency department records from counties affected early by the pandemic did not show an increase in visits for COVID-19–like illness before February 28. Second, retrospective SARS-CoV-2 tTesting of approximately 11,000 respiratory specimens from several U.S. locations beginning January 1 identified no positive results before February 20. Third, Analysis of viral RNA sequences from early cases suggested that a single lineage of Virus imported directly or indirectly from China began circulating in the United States between January 18 and February 9, followed by several SARS-CoV-2 importations from Europe. Finally, the occurrence of three cases, one in a California resident who died on February 6, a second in another resident of the same county who died February 17, and a third in an unidentified passenger or crew member aboard a Pacific cruise ship that left San Francisco on February 11, confirms cryptic circulation of the Virus by early February. These data indicate that sustained, community Transmission had begun before detection of the first two nontravel–related U.S. cases, likely resulting from the importation of a single lineage of Virus from China in late January or early February, followed by several importations from Europe. The widespread emergence of COVID-19 throughout the United States after February highlights the importance of robust public health systems to respond rapidly to emerging infectious threats.
  
  Suggested citation for this article: Suggested citation for this article: , Jorden MA, Rudman SL, et al. Evidence for Limited Early Spread of COVID-19 Within the United States, January–February 2020. MMWR Morb Mortal Wkly Rep. ePub: 29 May 2020.
  
  mm6921e1-H.pdf
  
  
• Content Notes:
  Syndromic Surveillance -- Surveillance for Acute SARS-CoV-2 Infection -- Phylogenetic Analysis -- Known Cases in Persons with No Relevant Travel History Before February 26 -- Discussion -- Acknowledgments .
• Subjects:
  CoronaVirus Infections/Epidemiology COVID-19 Pandemics Sentinel Surveillance
• Source:
  MMWR: Morbidity and Mortality Weekly Report 2020; v. 69 Early Release
• Series:
  Weekly Report: Morbidity and Mortality Weekly Report (MMWR)
• ISSN:
  0149-2195 (print) ; 1545-861X (digital)
• Document Type:
  Journal Article
• Place as Subject:
  Los Angeles, CA
• Pages in Document:
  5 pdf pages
• Volume:
  69
• Collection(s):
  Morbidity and Mortality Weekly Report (MMWR)
• Main Document Checksum:
  urn:sha-512:fe72d75e3b94e2946dce593eeb2a2f05b8610f2d527c146baf1eed79b2e2429ec14c1c31f2f0524624c8cfe1c2b8456e3c6a4a99431ddceded21070cab9f05f0
• Download URL:
  https://stacks.cdc.gov/view/cdc/88535/cdc_88535_DS1.pdf
• File Type:
  [PDF - 178.18 KB ]