Sep 16, 2020
Study Hints COVID-19 May Have Been In The US As Early As December
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(CNN) — Researchers believe they have found evidence that the novel coronavirus may have been circulating in the US as early as late December, about a month before the current timeline from the US Centers for Disease Control and Prevention shows.
This study, published last Thursday in the Journal of Medical Internet Research, found a statistically significant uptick in clinic and hospital visits by patients who reported respiratory illnesses as early as the week of December 22.
The researchers noticed this trend by looking through nearly 10 million medical records from the UCLA Health system, including three hospitals and 180 clinics.
The first known case of Covid-19 in the US was thought to be a patient in Washington who had visited Wuhan,China, according to the CDC. The 35-year-old patient first went to a clinic for symptoms on January 19, according to a report that ran in March in the New England Journal of Medicine. It wasn’t until late February that the CDC detected the first cases of community spread, although the CDC later found evidence community transmission began in late February.
In China, the first known case of Covid-19 was in a person who developed symptoms on December 1, according to a study from the Lancet. That means the patient could have been exposed to the disease as early as November. A handful of ongoing studies have found some evidence that the virus may have been circulating in Europe in December, or earlier.
Dr. Joann Elmore, who worked on the new study, said she started looking through the records after receiving a number of emails from anxious patients in March through her clinic’s patient portal at UCLA. Patients kept asking if the cough they had in January could have been Covid-19. The UCLA physician, who also trained as an epidemiologist, said she was curious, so she started this study.
Elmore and her colleagues noticed the spike in respiratory cases by searching the field in medical records that lists why someone came to the clinic and searched for the symptom “cough.” They looked at the records for the month of December 2019 through February 2020 and compared their findings to records from the five prior years.
“With the outpatients, I found a 50% increase in the percentage of patients coming in complaining of a cough. It came out to over 1,000 extra patients above the average of what we would typically see,” Elmore said.
The number of patient visits to the ER for respiratory complaints, as well as the number of people hospitalized with acute respiratory failure between December 2019 and February 2020, showed a similar increase compared to records from the past five years. The uptick in cases started in the final week of December.
“Some of these cases could have been due to the flu, some could be for other reasons, but to see these kinds of higher numbers even in the outpatient setting is notable,” Elmore said.
While scientists may never know for sure if these excess patients were early Covid-19 cases, Elmore doesn’t think it’s out of the question.
“Our world is so interconnected. There are about 500 flights from China a month to LAX, so you could easily have one or two cases from that travel and it could get into the community,” Elmore said.
Elmore hopes this research shows that real time data collected on diseases like this could potentially help public health experts identify and track emerging outbreaks much earlier and potentially slow or stop the spread of disease.
Dr. Claudia Hoyen, is an infectious disease specialist at University Hospitals Cleveland Medical Center who did not work on the study, also believes it’s possible Covid-19 may have been in the US much sooner than first realized.
“Based on what we know of a few other studies and now this one, I think definitely this could be something,” Hoyen said. “It’s certainly something that needs to be considered.”
Hoyen said the bigger takeaway from this study for her was that it points to the possibility that data like this could augment some of the disease surveillance the CDC is already doing for diseases like flu.
“Is there a way to mine the data in other ways that may have picked up on some of the other symptoms that people were presenting with, so we had a better understanding of disease sooner?” Hoyen asked. “Then maybe instead of a month into it, like when we were seeing a lot of patients complaining of loss of taste and smell, if we had analyzed the data beforehand, we may have picked up those kinds of symptoms much sooner.”
Kristian Andersen, a professor in the Department of Immunology and Microbiology at Scripps Research, doesn’t believe Covid-19 is to blame for the rise in the number of patients with respiratory ailments in California in late December.
“We know from the SARS-CoV-2 genetic data that the pandemic started in late November / early December in China so there’s absolutely no way the virus could have been spreading widely in December 2019. From the same genetic data we know that widespread transmission didn’t start in the United States until (around) February 2020,” Andersen said in an email.
“The paper is picking up spurious signals and the hospitalizations are more likely from flu or other respiratory diseases,” Andersen wrote. “Again, the genomic data clearly shows that there was no widespread transmission of SARS-CoV-2 in the United States in December of last year – there may have been a few sporadic cases, but that’s it and certainly not something that would have been seen in ‘excess hospitalizations.'”
Dr. Jeanne Marrazzo an infectious disease specialist who also was not involved in the study, disagrees. She thinks the conclusion, particularly since the study captures outpatient records, is persuasive.
“If we had more precise genetic phylogenetic data of the spread of the virus, I think that could be very interesting, but in the absence of that, you can do a lot of work by inferring some preexisting patterns from these types of analyses,” said Marrazzo, the director of the division of infectious diseases at the University of Alabama School of Medicine at Birmingham. “Primary care data like this is useful and we really need to pay attention to it.”
“When you compare these numbers to previous years, there’s no good explanation in my mind why all of the sudden you would see that dramatic increase in the records, except for Covid,” Marrazzo said. “Just the strength of the numbers of information, when you include the outpatient, it shows a pattern.”
Neither the CDC nor the WHO responded to CNN’s request for perspective on the research or on the official time line of the pandemic.
Marrazzo said she and infectious disease colleagues across the country have been discussing how often they were seeing patients with what we now know as Covid-19 symptoms earlier than the official timeline. Because of the sharp restrictions the CDC placed on testing early in the pandemic, it was difficult to confirm if respiratory cases they were seeing were caused by coronavirus.
“I have no doubt that we all missed cases in the early part of the pandemic,” Marrazzo said. “This study offers a really interesting window into what might actually have been happening.”
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Josh Allens early MVP case only gets stronger with wild Bills win
The Bills could have suffered a crushing defeat after blowing the identical 25-point lead the Falcons once flushed in the Super Bowl.
But a late pass interference call and early MVP candidate Josh Allen’s fourth touchdown pass of the game with 15 seconds remaining kept the Bills unbeaten through three games with a 35-32 victory Sunday over the Rams.
“I love this team,” said Allen, who also had a 1-yard rushing TD. “Going up 28-3, that just means we’ve got to be better and make sure we’re keeping our foot on the pedal. We have to put that game away. I’m very happy we got the win, but I’m also a little mad for allowing us to dip a little there.”
Jared Goff (321 passing yards) led the Rams (2-1) back from a 28-3 third-quarter hole, posting 29 consecutive points to put his team up 32-28 on Darrell Henderson’s 1-yard scoring run with 4:30 remaining.
Allen, who has registered 10 TD passes and one interception through three games, moved the Bills to the Los Angeles 13-yard line for a fourth-and-8 play with 25 seconds left.
Allen’s pass to Gabriel Davis fell incomplete, but Rams cornerback Darious Williams was flagged for interference, and Allen found Tyler Kroft on the next play for a 3-yard touchdown.
“Disappointing end to a very resilient effort by our guys,” Rams coach Sean McVay said. “I love this football team. We’re not going to make any excuses. We’re going to use this as an opportunity to move forward.”The Bills’ Josh Allen celebrates his touchdown pass to Stefon Diggs.Getty Images
Allen, the third quarterback taken in the 2018 draft (No. 7 overall) behind Cleveland’s Baker Mayfield (No. 1) and the Jets’ Sam Darnold (No. 3), has engineered seven fourth-quarter comeback wins in his first three seasons. The Bills have started 3-0 for two consecutive seasons for the first time since 1991-92.
“The NFL, it’s tough to win. No matter what the score is, you’ve got to keep playing,” Bills coach Sean McDermott said. “It came down to one drive and that’s why we practice the way we do.”Foles Fries Falcons
The Bears made a decisive change at quarterback to remain unbeaten, and the Falcons suffered another ignominious defeat, blowing a big lead for the second consecutive week in a 30-26 home loss to Chicago.
Nick Foles replaced Mitchell Trubisky with the Bears trailing 26-10 in the second half and threw for three touchdowns in the fourth quarter, culminated by a 28-yarder to Anthony Miller with 1:53 remaining.
“I’ve been where [Trubisky’s] been, and it’s not easy,” said Foles, the former Super Bowl winner with Philadelphia who was acquired by the Bears in a March trade with Jacksonville. “It’s not easy coming in cold like that, but if you can approach it with mindset of one play at a time, you can’t get all the points back in one throw, that helps a lot.”
Dan Quinn’s Falcons, who infamously squandered a 28-3 lead in a Super Bowl LI loss to New England, also fell to Dallas last Sunday after leading 39-24 with five minutes remaining in the fourth quarter.
“These last two weeks have been nothing short of crushing,” Quinn said.see also
“It doesn’t get no worse than this,” defensive end Dante Fowler Jr. added. “We probably found the two worst ways you can lose a football game.”
Foles finished 16-for-29 for 188 yards in less than two quarters of play. Trubisky had thrown five TD passes in the Bears’ first two victories, but he was 13-for-22 for 128 yards with an interception Sunday before Bears coach Matt Nagy benched him in the third.
“The quarterback situation, there’s a lot of emotions that go into that [decision],” said Nagy, who declined to announce a starter for next week. “That was a move we ended up making and we’re super fired up to win the game.”The Fifth Dimension
Russell Wilson’s fifth touchdown throw of the game, a 29-yarder to DK Metcalf, with 1:47 remaining boosted Seattle (3-0) to a wild 38-31 home win over Dallas (1-2).
Wilson, who also had five TD tosses in last week’s win over New England, has 14 touchdowns and just one interception through three games. Three of those scoring throws Sunday went to Tyler Lockett, who finished with nine receptions for 100 yards.
The Cowboys appeared poised for their second consecutive fourth-quarter comeback victory, taking a 31-30 lead on Greg Zuerlein’s 42-yard field goal with 3:59 to go.
Dak Prescott surpassed 400 passing yards (career-high 472) for the second straight week, connecting for two TD tosses to Cedrick Wilson and one to Michael Gallup, but he was picked off by Ryan Neal in the end zone with six seconds remaining.Russell Wilson threw five touchdown passes on Sunday.Getty Images Tie, Eagles, Tie
Carson Wentz and No. 1-overall pick Joe Burrow played well enough not to lose Sunday, but neither emerged victorious either as the Eagles and Bengals played to a 23-23 tie to each move to 0-2-1.
Philly kicker Jake Elliott lined up for a 59-yard field-goal attempt with 19 seconds remaining in overtime, but after a false start moved the Eagles back 5 yards, coach Doug Pederson elected to punt to preserve the tie.
“Tying is no fun, it’s an awkward way to end a game,” said Wentz, who was intercepted twice.
Burrow, still seeking his first NFL win, threw for 312 yards and two touchdowns — both to Tee Higgins — for the Bengals.
“This is a loss to me. We didn’t win, so that’s all it is to me,” said Burrow, the 2019 Heisman Trophy winner at LSU. “If you don’t win, you lose. That’s the mindset to me.”Bad Beats
The Bills’ late touchdown not only gave them the three-point victory, but the extra point enabled their backers to cover the 2 ½-point spread. The over/under in the 23-23 tie between the Eagles and Bengals was 47, so even an overtime safety would have cinched it.The Hurt Locker
Jets tackle Mekhi Becton (shoulder) wasn’t the only prominent rookie injured Sunday. Washington defensive end Chase Young, the No. 2 pick in the draft, left the Football Team’s 34-20 loss to Cleveland with a groin injury.
The Falcons, playing without cornerback CB A.J. Terrell (COVID-19) and wide receiver Julio Jones (hamstring), lost wide receiver Russell Gage to a concussion.see also
The Seahawks’ victory was costly, with former Jets safety Jamal Adams (groin) and running back Chris Carson (knee) not returning.
Other notable injuries: Giants safety Jabrill Peppers (ankle), Bills wide receiver John Brown (calf) and safety Micah Hyde (ankle), Eagles wide receiver Desean Jackson (hamstring) and tight end Dallas Goedert (ankle), Falcons wide receiver Russell Gage (concussion), Bears running back Tarik Cohen (knee), 49ers cornerback Emmanuel Mosley (head) and tight end Jordan Reed (ankle), Texans safety A.J. Moore (hamstring), Steelers running back Diontae Johnson (concussion), Raiders cornerback Damon Arnette (thumb), Titans left tackle Taylor Lewan (shoulder), Rams safety Jordan Fuller (shoulder).Post Patterns
Titans kicker Stephen Gostkowski connected on a career-high 6 of 6 field-goal attempts and nailed a game-winner for the third straight week — a 55-yarder with 1:44 remaining — as Tennessee improved to 3-0 with a 31-30 win over Minnesota (0-3). Titans running back Derrick Henry added 119 rushing yards and two touchdowns. … Buccaneers quarterback Tom Brady threw for 297 yards and three scores in Tampa Bay’s second straight win, 28-10, over Denver. … Steelers quarterback Ben Roethlisberger tossed two TDs and passed Hall of Fame center Mike Webster for the most games in team history (221) as 3-0 Pittsburgh kept Houston winless, 28-21. … Patriots running back Rex Burkhead had 98 scrimmage yards and scored three touchdowns and running back Sony Michel added 117 yards on nine carries in New England’s 36-20 win over Las Vegas. … Browns running back Nick Chubb ran for 108 yards and scored twice, giving Cleveland its first winning record (2-1) since 2014. … Panthers kicker Joey Slye nailed five field goals to give Matt Rhule his first coaching win in Carolina’s 21-16 win over the Chargers. Rookie quarterback Justin Herbert was 35-for-49 for 330 yards and one TD for the Chargers, whose final drive stalled at the Panthers’ 15-yard line. … Lions kicker Matt Prater drilled a 39-yard field goal as time expired in Detroit’s first win, 26-23, win over Arizona (2-1).Filed under buffalo bills , chicago bears , josh allen , philadelphia eagles , russell wilson , the 5th quarter , 9/27/20