The first confirmed case of the SARS-CoV2 virus (formely known as 2019-nCoV) in the U.S. has been traced back to January 15, 2020. That case was directly linked to a visit to Wuhan. However, is it possible that ‘community spread’ of the virus began around that same time? There is no way to know without widespread testing using an antibody-based test (one has been successfully demonstrated in Singapore).
Although this is by no means definitive, I offer below some anecdotal support for the possibility. It makes sense to me, but judge for yourself.
My 17-year-old son became sick around February 8 with an intermittent fever and serious cough that kept him home from school for almost a week, with the cough persisting for another week or so. I developed similar symptoms around February 12. After about 10 days of ‘not being myself’ (according to my wife’s observations), I went to see a doctor (at her insistence). The physician stated that there had been a lot of non-flu respiratory-type infections going around, with symptoms being intermittent fever and persistent cough. He attributed the infections to a mycoplasma bacterium, and prescribed 5 days of antibiotics (azithromycin). After I started antibiotic treatment, it took about 5 or 6 days before I began feeling mostly ‘normal’. That bout with whatever-it-was represented the worst cold- or flu-type illness I have ever experienced. For what it’s worth, somewhere in the midst of that illness, I had done something semi-exerting and found myself so short of breath that I literally thought to myself (for a very brief period of maybe 1 or 2 minutes), “I am going to die from this illness.” I did not feel as if I was about to die at that moment, but I felt that if this illness were to get worse, it would literally take my breath away (and my life with it). Over the time period from February 6 to 22, our 7-year-old and 8-year-old daughters also became ill, although their illnesses were much less severe and far shorter than the illnesses my son and I experienced. My wife never experienced any symptoms of illness.
When I shared my ‘hypothesis’ (that our family’s previous illnesses may have been caused by SARS-CoV2) with my wife (who is a healthcare provider), she listened respectfully with little or no comment. However, the next day she came home from the clinic where she works commenting that another provider (at a different clinic who is the husband of one of her co-workers) had stated, “We have been treating patients with symptoms that match the coronavirus symptoms for weeks now. It is possible we have already been battling the coronavirus, without knowing it.”
A couple weeks ago, I had a conversation with a close friend whose 18-year-old daughter ended up with a sickness around February 18 that tested negative for the flu, but developed into pneumonia. This friend (a 60-year-old female) also had a serious flu-like illness that tested negative for the flu virus and persisted for weeks. Her 20-year-old daughter also had a persistent, but less-severe case (that also tested negative for the flu virus).
Putting all this together, I believe it is plausible that the coronavirus has been going through ‘community spread’ in the U.S. for at least 5 or 6 weeks; we just have not been testing for it (because the test protocol required international travel or direct contact with someone who had recently traveled internationally).
I suggest widespread antibody-based testing of those who experienced illnesses beginning in January and February so that we can definitively answer the question of when ‘community spread’ of this virus actually began, and how widely it might have spread before we began systematically testing for it. Detailed knowedge from such testing would enable epidemiologists to make much better predictions about the extent to which additional social-distancing measures are needed and for how long.
UPDATE (3/18/20): An article published 3/16/20 in Science estimated that 86% of all SARS-CoV2 infections in China were never documented (Li et al., 2020) and further stated “Our findings also indicate that a radical increase in the identification and isolation of currently undocumented infections would be needed to fully control SARS-CoV2” (Li et al., 2020: 3). This fully supports my call (above) to begin widespread antibody-based testing in the U.S. of those who experienced flu-like symptoms beginning late January. In addition, individuals who have had any social contact with confirmed COVID-19 patients should be tested, even if they have never experienced symptoms (which may already be happening).
Li, R., Pei, S., Chen, B., Song, Y., Zhang, T., Yang, W., & Shaman, J. (2020). Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2). Science.
UPDATE (3/27/20): A virologist who worked directly with the Ebola outbreak in Sierra Leone in 2015 has published an op-ed in the Wall Street Journal calling for “widespread testing” throughout the U.S. “to document immunity in those who haven’t fallen sick” from SARS-CoV2. In addition, he and his co-author are recommending a national coronavirus-immunity registry so that those who have immunity can be quickly called in to assist in the event medical facilities become overwhelmed.
NOTE: This post was originally published on 3/17/20 on ISFE’s website (fe.okstate.edu). At that time, we did not have an active blog. I have reposted it here, backdated it to the original posting date, and separated it from its sister post.
Steve Trost is Associate Director of the Institute for the Study of Free Enterprise and can be contacted at trost@okstate.edu. He has a bachelor’s degree in engineering from MIT, a master’s degree and PhD in engineering from Oklahoma State University and a PhD in entrepreneurship (also from OSU).
Follow Dr. Trost on twitter: @TrostParadox
Organizational Disclaimer: All comments, observations, and statements presented herein represent the opinions of the author and in no way reflect the views of Oklahoma State University or the Institute for the Study of Free Enterprise.
Author Disclaimer: I am an engineer by training, not an epidemiologist. I am applying an engineering mindset to this problem (which may or may not be ‘correct’). I invite experts in epidemiology to openly debate this (or similar) proposed solutions.
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