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Case Reports
. 2020 Apr 4;395(10230):1137-1144.
doi: 10.1016/S0140-6736(20)30607-3. Epub 2020 Mar 13.

First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA

Isaac Ghinai  1 , Tristan D McPherson  2 , Jennifer C Hunter  3 , Hannah L Kirking  4 , Demian Christiansen  5 , Kiran Joshi  5 , Rachel Rubin  5 , Shirley Morales-Estrada  5 , Stephanie R Black  6 , Massimo Pacilli  6 , Marielle J Fricchione  6 , Rashmi K Chugh  7 , Kelly A Walblay  6 , N Seema Ahmed  8 , William C Stoecker  8 , Nausheen F Hasan  9 , Deborah P Burdsall  10 , Heather E Reese  11 , Megan Wallace  12 , Chen Wang  13 , Darcie Moeller  13 , Jacqueline Korpics  13 , Shannon A Novosad  3 , Isaac Benowitz  3 , Max W Jacobs  14 , Vishal S Dasari  15 , Megan T Patel  10 , Judy Kauerauf  10 , E Matt Charles  10 , Ngozi O Ezike  10 , Victoria Chu  12 , Claire M Midgley  4 , Melissa A Rolfes  16 , Susan I Gerber  4 , Xiaoyan Lu  4 , Stephen Lindstrom  4 , Jennifer R Verani  17 , Jennifer E Layden  18 ; Illinois COVID-19 Investigation Team
Collaborators, Affiliations
Case Reports

First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA

Isaac Ghinai et al. Lancet. .

Abstract

Background: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first detected in China in December, 2019. In January, 2020, state, local, and federal public health agencies investigated the first case of COVID-19 in Illinois, USA.

Methods: Patients with confirmed COVID-19 were defined as those with a positive SARS-CoV-2 test. Contacts were people with exposure to a patient with COVID-19 on or after the patient's symptom onset date. Contacts underwent active symptom monitoring for 14 days following their last exposure. Contacts who developed fever, cough, or shortness of breath became persons under investigation and were tested for SARS-CoV-2. A convenience sample of 32 asymptomatic health-care personnel contacts were also tested.

Findings: Patient 1-a woman in her 60s-returned from China in mid-January, 2020. One week later, she was hospitalised with pneumonia and tested positive for SARS-CoV-2. Her husband (Patient 2) did not travel but had frequent close contact with his wife. He was admitted 8 days later and tested positive for SARS-CoV-2. Overall, 372 contacts of both cases were identified; 347 underwent active symptom monitoring, including 152 community contacts and 195 health-care personnel. Of monitored contacts, 43 became persons under investigation, in addition to Patient 2. These 43 persons under investigation and all 32 asymptomatic health-care personnel tested negative for SARS-CoV-2.

Interpretation: Person-to-person transmission of SARS-CoV-2 occurred between two people with prolonged, unprotected exposure while Patient 1 was symptomatic. Despite active symptom monitoring and testing of symptomatic and some asymptomatic contacts, no further transmission was detected.

Funding: None.

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Figure
Symptoms and results of rtPCR testing for SARS-CoV-2 by day of investigation Gradient shading indicates unclear period of symptom onset from patient report. inc=inconclusive result. rtPCR=real-time RT-PCR. SARS-CoV-2=severe acute respiratory syndrome coronavirus 2. *Patient 1 and Patient 2 in home isolation.
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