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Research Continues to Indicate the COVID-19 Pandemic May Have Started Earlier Than Initially Thought

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Recent research indicates that the COVID-19 pandemic may have reached the United States much earlier than initially anticipated. While the first reported case of COVID-19 in the United States was Jan. 21, 2020, researchers now believe that the beginning of the pandemic in the United States may have even preceded the initial awareness of an unusual cluster of pneumonia cases in Wuhan, China.

Researchers from University of California, Los Angeles (UCLA) and their colleagues at the University of Washington performed an analysis of electronic medical records from UCLA hospitals and clinics to better understand the early spread of COVID-19. During this study, researchers found an increase in the number of patients seeking treatment for coughs. This increase was found to begin Dec.22, 2019, and persisted into February 2020.

The research team was not able to verify the history of SARS-CoV-2 infection in those who sought treatment during this earlier timeframe. The pattern of increased COVID-19-type symptoms in this timeframe, however, strongly indicates a viral spread that is very consistent with known COVID-19 infection patterns.

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“A significantly higher number of patients with respiratory complaints and diseases starting in late December 2019 and continuing through February 2020 suggests community spread of SARS-CoV-2 prior to established clinical awareness and testing capabilities,” wrote the team led by Joann Elmore, MD, MPH. Elmore is both an internist and a professor of health policy and management at UCLA.

Additional study authors are Dr. Judith Currier, Dr. David Schriger, Pin-Chieh Wang, Douglas Morrison and Ron Brookmeyer, all of UCLA, and Kathleen Kerr and Dr. Thomas Payne of the University of Washington.

The finding that COVID-19 may have appeared in the US earlier than thought is supported by other studies. Notably, a study by Harvard researchers used novel applications of technology to pinpoint an earlier timeframe for the Wuhan outbreak than was originally thought. (See: Technology Allows Researchers Insights Into the Origins of the COVID-19 Outbreak Without Clinical Laboratory Testing?) The research team at Harvard used analysis of satellite imagery of hospital traffic in Wuhan and online search queries to identify a concurrent abnormal increase in both. This led researchers to identify August 2019 as the potential start of the global pandemic.

Another study in Italy showed that COVID-19 may have been present in Italy as early as Dec. 18, 2019. Studies of sewage waste from Milan and Turin from that timeframe later tested positive for SARS-CoV-2 genetic material, indicating the presence of the virus in the early epicenter of Italy earlier than thought.

Research continues to show that the beginnings of the pandemic may have not been as clear as initially thought. As research provides greater insights into the origins of SARS-CoV-2, clinical laboratories and other stakeholders will be able to better understand the spread of COVID-19, allowing better responses to both COVID-19 and future pandemics that may occur. 

While the initial understanding of the origins of the virus have become mainstream, clinical laboratories should stay apprised of research that delves deeper into the understanding of how SARS-CoV-2 originated. Laboratory testing has played, and will continue to play, a significant role in research into the virus’s origins, and clinical laboratory leaders should continue to stay apprised of information into the nuances of the origins of the virus.

Caleb Williams

—By Caleb Williams, Editor, COVID-19 STAT

Related Resources:

Los Angeles Times: The coronavirus may have reached Los Angeles even before China announced its outbreak

ABC News: Timeline: How coronavirus got started

Reuters: Italy sewage study suggests COVID-19 was there in December 2019

JMIR: Excess Patient Visits for Cough and Pulmonary Disease at a Large US Health System in the Months Prior to the COVID-19 Pandemic: Time-Series Analysis