SARS-CoV-2 genomes sampled between December 2019 and 15 March 2020 appear to be closely related, with between 0 and 12 mutations relative to a common ancestor estimated to exist in Wuhan between late November and early December 2019 ( Fig. We conclude that SARS-CoV-2 was circulating for several weeks undetected by the surveillance apparatus in Washington state from late January to early February 2020.Īlthough publicly available SARS-CoV-2 genomes ( 9, 10) are not sampled in strict proportion to the burden of infections through time and across geography, their genetic relationships can still shed light on underlying patterns of spread. Here, we report on the putative history of early community transmission in Washington state as revealed by genomic epidemiology. One month later, on 25 March, as a result of increased testing and ongoing transmission, Washington state reported 2580 confirmed cases and 132 deaths ( 8). On 28 February 2020, a community case was identified in Snohomish County ( 7). In the 6 weeks between 19 January and 27 February, 59 confirmed cases were reported in the United States ( 6), all outside of Washington state and with either direct travel history or exposure to a known, confirmed case. Cases of respiratory disease with no known risk factors were not routinely tested. Centers for Disease Control and Prevention (CDC) guidance recommended prioritizing testing for COVID-19 on persons with direct travel history from an affected area or with exposure to a known case. The first confirmed case in the United States was travel associated and was detected in Snohomish County, Washington state, on 19 January 2020. After its initial emergence in China, travel-associated cases with travel histories related to Wuhan appeared in other parts of the world ( 5). As of, there have been >4 million confirmed cases of coronavirus disease 2019 (COVID-19)-the disease caused by SARS-CoV-2-that have resulted in >300,000 deaths ( 4). The novel coronavirus, referred to alternately as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ( 1) or human coronavirus 2019 (hCoV-19) ( 2), emerged in Wuhan, Hubei, China, in late November or early December 2019 ( 3). Serial, independent introductions triggered the major outbreaks in the United States and Europe that still hold us in the grip of control measures. Unfortunately, several major travel events occurred in February, including repatriations from China, with lax public health follow-up. found that early introductions into Germany and the west coast of the United States were extinguished by vigorous public health efforts, but these successes were largely unrecognized. The other viruses detected had origins in Europe. The viral genome from the first case detected had mutations similar to those found in Chinese samples and rapidly spread and dominated subsequent undetected community transmission. found that the virus arrived in Washington state in late January or early February. Now that many thousands of virus sequences are available, two studies analyzed some of the key early events in the spread of SARS-CoV-2. Several narratives have been propagated by social media and, in some cases, national policies were forged in response. The history of how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread around the planet has been far from clear. Chu, 2, 7, § Jay Shendure, 2, 3, 17, § and Keith R. Duchin, 7, 13 Romesh Gautom, 14 Geoff Melly, 14 Brian Hiatt, 14 Philip Dykema, 14 Scott Lindquist, 14 Krista Queen, 15 Ying Tao, 15 Anna Uehara, 15 Suxiang Tong, 15 Duncan MacCannell, 16 Gregory L. Neher, 9, 10 Xianding Deng, 12 Wei Gu, 12 Scot Federman, 12 Charles Chiu, 12 Jeffrey S. Hodcroft, 9, 10 John Huddleston, 1, 11 Louise H. Englund, 2, 6, 8 The Seattle Flu Study Investigators ‡, James Hadfield, 1 Emma B. Sibley, 1 Melissa Truong, 2, 3 Caitlin R. Frazar, 3 Misja Ilcisin, 1 Kirsten Lacombe, 6 Jover Lee, 1 Anahita Kiavand, 2, 3 Matthew Richardson, 3 Thomas R. Nguyen, 4 Amanda Adler, 6 Elisabeth Brandstetter, 7 Shari Cho, 2, 3 Danielle Giroux, 3 Peter D. Starita, 2, 3, † Michael Famulare, 5, † Meei-Li Huang, 1, 4 Arun Nalla, 4 Gregory Pepper, 4 Adam Reinhardt, 4 Hong Xie, 4 Lasata Shrestha, 4 Truong N. Greninger, 1, 4, † Pavitra Roychoudhury, 1, 4, † Lea M. Trevor Bedford, 1, 2, 3, * † Alexander L.
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