Spread of the COVID-19 Pandemic from China to the World: Part Three.

In part three, we provide an overview of the COVID-19 pandemic from November- March. We summarize what we know about the disease spread from its origins in Wuhan, Hubei, China, probably in November 2019, to its rapid expansion all over our highly connected world through March 2020. Within this summary are many links to news and information sources, some of which have further links.

For additional autoimmune resources please read Useful Basics for Autoimmune Patients around COVID-19, Stories of Self-isolation and Functional Medicine Advice for Autoimmune and Immunocompromised Patients, and important tips on Food Safety.

What is the COVID-19 pandemic?

Based on many news sources, including social media, and confirmed by genomic analyses of the virus (see NextStrain below), this new strain of coronavirus, called SARS-COV-2 (COVID-19 refers to the disease pandemic) emerged in Wuhan, Hubei Province, China, perhaps in mid-November (although data are missing for the earliest weeks). By mid-December, this outbreak was growing exponentially (see below) throughout Hubei.

November: Wuhan, Hubei, China

Wuhan is a center of industry and research (the only Level-4 virus containment laboratory in China is in Wuhan) with many connections to the rest of the world. Before the Chinese government realized they had a problem, and for weeks thereafter, travelers for business and the Lunar New Year Spring Festival (last week in January) carried the virus out of China to other big cities (hubs) connected to trade and social flows of people (spokes). 

Since the infection is subtle in its earliest stages, especially among younger healthier people (those most likely to be traveling), many infected people without symptoms (or ignoring them!) were unwitting vectors that carried the virus all over the world via land, air and sea. On January 21, the Chinese government took drastic action through draconian quarantine of the entire city of Wuhan and then other cities in Hubei.

This long infographic from the South China News (Hong Kong) focuses on China and contains a wealth of information about the virus, the disease and its spread. In addition to many links that are included, you can also view the daily updates in Coronavirus: the new disease Covid-19 explained.

January: Middle East

The situation in Iran is dire, with many senior officials affected and hospitals overwhelmed. The disease has spread from Iran to many other spots in the Middle East and Europe. 

January: Europe and UK

Italy’s first cases (confirmed January 31) were directly connected with China, since Milan’s textile industry employs many Chinese workers. Some no doubt, traveled to China for the New Year. Italy is in the worst shape of any European country so far, with a death toll that may have passed China’s (although China’s data is less accurate than Italy’s).

A big cluster has been traced to an Austrian ski resort (February – early March) From recreational and business travel, the virus has spread to the rest of Europe. Spain has a rapidly growing epidemic, Denmark seems to have acted quickly to stem growth. The UK, however, seems to be behind both in virus spread and mitigation tactics.

January: Washington State, USA

Patient Zero for the Seattle area hotspot, the first diagnosed US patient, is a man who traveled to Wuhan and was out and about for four days after his return before he felt ill, was tested and isolated on January 20. He had already passed the virus to some 60 people, some of whom apparently passed it to a nursing home that has been the hottest spot in terms of cases and deaths so far. 

Staff members from the Kirkland nursing home (which has a history of poor infection control!) then passed it to multiple other nursing homes and into the community at large. Washington State had the highest case numbers in the US, until surpassed by New York in mid-March.

February: Cruise Ships

Two cruise ships, the Diamond Princess (February 3) and the Grand Princess (February 11-21), were early hotspots. The Diamond Princess was quarantined off Japan, and has provided a natural experiment on how the disease spreads and affects passengers of different ages. Other cruise ships have had outbreaks. 

February: USA

The Boston hotspot starts with a senior management meeting of 175 people at Biogen (how ironic) February 25-26. Managers from around the world met there, and someone brought the virus too. As anyone who has been to such a meeting can recall, there’s lots of hand-shaking, hugging, and food sharing. Two executives traveled from that meeting to a financial analyst meeting and infected more people. One traveled back to China, hiding her symptoms (because she couldn’t get tested in Boston) and exposing passengers on her airplane. She is now under arrest in China. 

The USA also has hotspots in the San Francisco Bay Area (including the Grand Princess, Silicon Valley and Berkeley cases), Sacramento and San Diego, seeded at various times in January and February. While the low death rate offers some comfort, with the current low testing rates in California, it is very difficult to trace cases or predict growth. 

New York City is a major hub, with many spoke-like connections to the rest of the world. It is currently on a growth trajectory similar to Italy’s. The case rate is understated and fears of overwhelming hospitals and ICUs loom in NYC.

With the delay of widespread testing in the US we do not know how far the disease has spread. Multiply the confirmed case numbers by 10-50 (depending on your model) to get an approximation. As testing ramps up, we will get a clearer picture.

Worldwide growth of COVID-19 pandemic.
Worldwide growth of COVID-19 pandemic. http://nrg.cs.ucl.ac.uk/mjh/covid19/

Part Four will provide links to COVID-19 trackers and background on coronaviruses, SARS-COV-2 and basic epidemiological statistics.

Part Five will cover social/physical distancing and other mitigation approaches, testing and protective masks.

Let us know your thoughts!

The COVID-19 pandemic is a rapidly moving situation and it’s hard to keep up with the tsunami of information, misinformation, disinformation and the high noise-to-signal ratio, especially on social media. Let us know in the comments if you have good sources to share, have questions, or if you spot errors or outdated information in our posts. Also if there are additional topics you’d like us to tackle.

Stay well!

Written by: Bonnie Feldman, DDS, MBA, Ellen M. Martin

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