Sustained nCoV Transmission In Germany Via Asymtomatic Employee

[niman]

A German auto parts company with offices in China is the epicenter of sustained nCoV transmission in Bavaria after child of employee confirmed.

https://www.stmgp.bayern.de/presse/aktuelle-informationen-zur-coronavirus-lage-in-bayern-bayerisches-gesundheitsministerium-2/

Edited January 31, 2020 by niman

[niman]

Current information on the coronavirus situation in Bavaria - Bavarian Ministry of Health: Now a total of six cases

The Bavarian Ministry of Health informed on Friday about the current development of the new corona virus in Bavaria. A ministry spokesman said in Munich that, according to the State Office for Health and Food Safety (LGL), another coronavirus case in Bavaria was confirmed at noon. It is a child of the man from the district of Traunstein, the positive finding of which was published late Thursday evening. The man is an employee of the company from the district of Starnberg, which also deals with the other four cases known to date.

There are a total of six coronavirus cases in Bavaria. According to doctors, all those affected are currently in a stable state of health.

Tests by other people who also work for this company showed no further positive results until midday on Friday. The Bavarian Ministry of Health will provide further details later today. The contacts identified so far should isolate themselves at home and continuously report to the health department with information on their health status.

[niman]

The cluster in Germany began with an employee stationed in Shanghai came to the company headquarters in Starnberg, Bavaria (suburban Munich) for a meeting.

She developed symptoms during her flight back to Shanghai, where she was nCoV confirmed. 

At least one employee at the meeting developed symptoms.

The sequence of the nCoV from the first case Starnberg, BetaCoV/Munich/BavPat1/2020, has been deposited at GISAID.

Subsequently, nCoV was confirmed in four additional employees at the headquarters, and now a child of one of the employees has been nCoV confirmed.

[niman]

Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany

TO THE EDITOR:

The novel coronavirus (2019-nCoV) from Wuhan is currently causing concern in the medical community as the virus is spreading around the world.¹ Since its identification in late December 2019, the number of cases from China that have been imported into other countries is on the rise, and the epidemiologic picture is changing on a daily basis. We are reporting a case of 2019-nCoV infection acquired outside of Asia in which transmission appears to have occurred during the incubation period in the index patient.

A 33-year-old otherwise healthy German businessman (Patient 1) became ill with a sore throat, chills, and myalgias on January 24, 2020. The following day, a fever of 39.1°C (102.4°F) developed, along with a productive cough. By the evening of the next day, he started feeling better and went back to work on January 27.

Figure 1.Timeline of Exposure to Index Patient with Asymptomatic 2019-CoV Infection in Germany.

Before the onset of symptoms, he had attended meetings with a Chinese business partner at his company near Munich on January 20 and 21. The business partner, a Shanghai resident, had visited Germany between Jan. 19 and 22. During her stay, she had been well with no signs or symptoms of infection but had become ill on her flight back to China, where she tested positive for 2019-nCoV on January 26 (index patient in Figure 1).

On January 27, she informed the company about her illness. Contact tracing was started, and the above-mentioned colleague was sent to the Division of Infectious Diseases and Tropical Medicine in Munich for further assessment. At presentation, he was afebrile and well. He reported no previous or chronic illnesses and had no history of foreign travel within 14 days before the onset of symptoms. Two nasopharyngeal swabs and one sputum sample were obtained and were found to be positive for 2019-nCoV on quantitative reverse-transcriptase–polymerase-chain-reaction (qRT-PCR) assay.² Follow-up qRT-PCR assay revealed a high viral load of 10⁸ copies per milliliter in his sputum during the following days, with the last available result on January 29.

On January 28, three additional employees at the company tested positive for 2019-nCoV (Patients 2 through 4 in Figure 1). Of these patients, only Patient 2 had contact with the index patient; the other two patients had contact only with Patient 1. In accordance with the health authorities, all the patients with confirmed 2019-nCoV infection were admitted to a Munich infectious diseases unit for clinical monitoring and isolation. So far, none of the four confirmed patients show signs of severe clinical illness.

This case of 2019-nCoV infection was diagnosed in Germany and transmitted outside of Asia. However, it is notable that the infection appears to have been transmitted during the incubation period of the index patient, in whom the illness was brief and nonspecific.³

The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak. In this context, the detection of 2019-nCoV and a high sputum viral load in a convalescent patient (Patient 1) arouse concern about prolonged shedding of 2019-nCoV after recovery. Yet, the viability of 2019-nCoV detected on qRT-PCR in this patient remains to be proved by means of viral culture.

Despite these concerns, all four patients who were seen in Munich have had mild cases and were hospitalized primarily for public health purposes. Since hospital capacities are limited — in particular, given the concurrent peak of the influenza season in the northern hemisphere — research is needed to determine whether such patients can be treated with appropriate guidance and oversight outside the hospital.

Camilla Rothe, M.D.
Mirjam Schunk, M.D.
Peter Sothmann, M.D.
Gisela Bretzel, M.D.
Guenter Froeschl, M.D.
Claudia Wallrauch, M.D.
Thorbjörn Zimmer, M.D.
Verena Thiel, M.D.
Christian Janke, M.D.
University Hospital LMU Munich, Munich, Germany
[email protected]

Wolfgang Guggemos, M.D.
Michael Seilmaier, M.D.
Klinikum München-Schwabing, Munich, Germany

Christian Drosten, M.D.
Charité Universitätsmedizin Berlin, Berlin, Germany

Patrick Vollmar, M.D.
Katrin Zwirglmaier, Ph.D.
Sabine Zange, M.D.
Roman Wölfel, M.D.
Bundeswehr Institute of Microbiology, Munich, Germany

Michael Hoelscher, M.D., Ph.D.
University Hospital LMU Munich, Munich, Germany

Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.

This letter was published on January 30, 2020, at NEJM.org.

3 References

1. 1.Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. DOI: 10.1056/NEJMoa2001017.

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2. 2.Corman V, Bleicker T, Brünink S, et al. Diagnostic detection of Wuhan coronavirus 2019 by real-time RT-PCR. Geneva: World Health Organization, January 13, 2020 (https://www.who.int/docs/default-source/coronaviruse/wuhan-virus-assay-v1991527e5122341d99287a1b17c111902.pdf. opens in new tab).

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3. 3.Callaway E, Cyranoski D. China coronavirus: six questions scientists are asking. Nature 2020;577:605-607.

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https://www.nejm.org/doi/full/10.1056/NEJMc2001468

[Judith]

Are you sure, that the infected employees are German?

I read somewhere that they are from China for to work here in Germany...?

[niman]

27 minutes ago, Judith said:

Are you sure, that the infected employees are German?

I read somewhere that they are from China for to work here in Germany...?

The employee/business associate from Shanghai visited headquarters in Bavaria (near Munich).

Those at the headquarters near Munich are German, based on initial reports on index case.  Most recent case in Canary Island is described as tourist with contact with confirmed cases in Germany.  Also traveling with others from Germany.

[niman]

36 minutes ago, Judith said:

Are you sure, that the infected employees are German?

I read somewhere that they are from China for to work here in Germany...?

A 33-year-old otherwise healthy German businessman (Patient 1) became ill with a sore throat, chills, and myalgias on January 24, 2020. The following day, a fever of 39.1°C (102.4°F) developed, along with a productive cough. By the evening of the next day, he started feeling better and went back to work on January 27.

https://www.nejm.org/doi/full/10.1056/NEJMc2001468

[Judith]

I follow this Cases from the beginning and I never read that it whas a German who get infected...

A Journalist wrote on Twitter that the man is a chinese worker there...

In the newspapers they are never clear to us, they write that the infectet People are working there (and Family members) but not that they are German...???

 

I remember, that SARS infectet almost ? only Chinese?

 

Sorry for my bad english.

[Judith]

Maybe, thats the reason why our Health Minister is so relaxed?

[niman]

41 minutes ago, Judith said:

I follow this Cases from the beginning and I never read that it whas a German who get infected...

A Journalist wrote on Twitter that the man is a chinese worker there...

In the newspapers they are never clear to us, they write that the infectet People are working there (and Family members) but not that they are German...???

 

I remember, that SARS infectet almost ? only Chinese?

 

Sorry for my bad english.

According to auto-parts supplier Webasto SE, seven of its employees -- five German and two Chinese -- have been infected with the new coronavirus, the cause of a massive pneumonia outbreak in China that the World Health Organization declared a global emergency on Thursday.

https://www.bloomberg.com/news/articles/2020-01-31/coronavirus-spreading-in-munich-shows-difficulty-halting-new-bug?utm_source=dlvr.it&utm_medium=twitter

[Judith]

Thank you!

[niman]

Germans repatriated from Wuhan, China, arrive at an army barracks on 1 February to be examined for signs of infection with the new coronavirus.

 

FRANK RUMPENHORST/PICTURE-ALLIANCE/DPA/AP IMAGES

Study claiming new coronavirus can be transmitted by people without symptoms was flawed

By Kai KupferschmidtFeb. 3, 2020 , 5:30 PM

A paper published on 30 January in The New England Journal of Medicine (NEJM) about the first four people in Germany infected with a novel coronavirus made many headlines because it seemed to confirm what public health experts feared: that someone who has no symptoms from infection with the virus, named 2019-nCoV, can still transmit it to others. That might make controlling the virus much harder.

Chinese researchers had previously suggested asymptomatic people might transmit the virus but had not presented clear-cut evidence. “There’s no doubt after reading [the NEJM] paper that asymptomatic transmission is occurring,” Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, told journalists. “This study lays the question to rest.”

But now, it turns out that information was wrong. The Robert Koch Institute (RKI), the German government’s public health agency, has written a letter to NEJM to set the record straight, even though it was not involved in the paper. 

The letter in NEJM described a cluster of infections that began after a businesswoman from Shanghai visited a company near Munich on 20 and 21 January, where she had a meeting with the first of four people who later fell ill. Crucially, she wasn’t sick at the time: “During her stay, she had been well with no sign or symptoms of infection but had become ill on her flight back to China,” the authors wrote. “The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak.”

But the researchers didn’t actually speak to the woman before they published the paper. The last author, Michael Hoelscher of the Ludwig Maximilian University of Munich Medical Center, says the paper relied on information from the four other patients: “They told us that the patient from China did not appear to have any symptoms.” Afterward, however, RKI and the Health and Food Safety Authority of the state of Bavaria did talk to the Shanghai patient on the phone, and it turned out she did have symptoms while in Germany. According to people familiar with the call, she felt tired, suffered from muscle pain, and took paracetamol, a fever-lowering medication. (An RKI spokesperson would only confirm to Science that the woman had symptoms.)

Hoelscher was not on the call, he says. “I asked the Bavarian Health and Food Safety Authority whether the information from that phone conversation called for a correction and I was told that is not the case,” he says. (The Bavarian ministry of health, of which the agency is part, has not responded to a request for information from ScienceInsider.) But RKI disagreed. The agency’s spokesperson confirms that a letter about the error has been submitted to NEJM. RKI also informed the World Health Organization (WHO) and European partner agencies about the new information.

“I feel bad about how this went, but I don’t think anybody is at fault here,” says virologist Christian Drosten of the Charité University Hospital in Berlin, who did the lab work for the study and is one of its authors. “Apparently the woman could not be reached at first and people felt this had to be communicated quickly.”

Marc Lipsitch, an epidemiologist at the Harvard T.H. Chan School of Public Health, says calling a case asymptomatic without talking to the person is problematic. “In retrospect, it sounds like this was a poor choice,” he says. However, “In an emergency setting, it’s often not possible to talk to all the people,” he adds. “I’m assuming that this was an overstretched group trying to get out their best idea of what the truth was quickly rather than somebody trying to be careless.”

The Public Health Agency of Sweden reacted less charitably. “The sources that claimed that the coronavirus would infect during the incubation period lack scientific support for this analysis in their articles,” says a document with frequently asked questions the agency posted on its website yesterday. “This applies, among other things, to an article in [NEJM] that has subsequently proven to contain major flaws and errors.” Even if the patient’s symptoms were unspecific, it wasn’t an asymptomatic infection, says Isaac Bogoch, an infectious disease specialist at the University of Toronto. “Asymptomatic means no symptoms, zero. It means you feel fine. We have to be careful with our words.”

Hoelscher agrees that the paper should have been clearer about the origin of the information about the woman’s health. “If I was writing this today, I would phrase that differently,” he says. The need to share information as fast as possible, along with NEJM’s push to publish early, created a lot of pressure, he says.

Given how fast data are coming out amid the growing global crisis, it’s good to read even peer-reviewed papers with some extra caution at the moment, Lipsitch says: “I think peer review is lighter in the middle of an epidemic than it is at normal speed, and also the quality of the data going into the papers is necessarily more uncertain.”

The fact that the paper got it wrong doesn’t mean transmission from asymptomatic people doesn’t occur.  Fauci, for one, still believes it does. "This evening I telephoned one of my colleagues in China who is a highly respected infectious diseases scientist and health official," he says. "He said that he is convinced that there is asymptomatic infection and that some asymptomatic people are transmitting infection." But even if they do, asymptomatic transmission likely plays a minor role in the epidemic overall, WHO says. People who cough or sneeze are more likely to spread the virus, the agency wrote in a situation report on Saturday. “More data may come out soon. We will just have to wait,” Lipsitch says.

The German cluster does reveal another interesting aspect about the new virus, Drosten says. So far most attention has gone to patients who get seriously ill, but all four cases in Germany had a very mild infection. That may be true for many more patients, Drosten says, which may help the virus spread. “There is increasingly the sense that patients may just experience mild cold symptoms, while already shedding the virus,” he says. “Those are not symptoms that lead people to stay at home.” 

https://www.sciencemag.org/news/2020/02/paper-non-symptomatic-patient-transmitting-coronavirus-wrong

[niman]

The Bavarian Ministry of Health informed on Wednesday about the current development in cases with the novel corona virus in Bavaria. A ministry spokesman said in Munich that, according to the State Office for Health and Food Safety (LGL), there were no further confirmed coronavirus cases in Bavaria until Wednesday afternoon. There are currently 14 confirmed coronavirus cases in Bavaria (as of 1:00 p.m.).

Two of these had become known on Tuesday evening. The 13th case is a 49-year-old who is now medically monitored and isolated at Munich Clinic Schwabing. The man is an employee of the company from the district of Starnberg, where most of the previously known cases are also employed.

The 14th case is a family member of another employee of the company. This employee, whose findings were positive the previous week, is also in the Munich Clinic Schwabing. Further details are not given with a view to the required protection of privacy.

https://www.stmgp.bayern.de/presse/aktuelle-informationen-zur-coronavirus-lage-in-bayern-bayerisches-gesundheitsministerium-16/

[Judith]

Prof. Drosten informed also Wednesday that the infectet People are Chinese origins (not German origins)

It is in the Video from the Pressconference about Minute 28, Drosten is talking....