Abstract
In the early phases of the SARS coronavirus type 2 (SARS-CoV-2) pandemic, testing focused on individuals fitting a strict case definition involving a limited set of symptoms together with an identified epidemiological risk, such as contact with an infected individual or travel to a high-risk area. To assess whether this impaired our ability to detect and control early introductions of the virus into the UK, we PCR-tested archival specimens collected on admission to a large UK teaching hospital who retrospectively were identified as having a clinical presentation compatible with COVID-19. In addition, we screened available archival specimens submitted for respiratory virus diagnosis, and dating back to early January 2020, for the presence of SARS-CoV-2 RNA. Our data provides evidence for widespread community circulation of SARS-CoV-2 in early February 2020 and into March that was undetected at the time due to restrictive case definitions informing testing policy. Genome sequence data showed that many of these early cases were infected with a distinct lineage of the virus. Sequences obtained from the first officially recorded case in Nottinghamshire - a traveller returning from Daegu, South Korea – also clustered with these early UK sequences suggesting acquisition of the virus occurred in the UK and not Daegu. Analysis of a larger sample of sequences obtained in the Nottinghamshire area revealed multiple viral introductions, mainly in late February and through March. These data highlight the importance of timely and extensive community testing to prevent future widespread transmission of the virus.
Highlights
Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is a novel zoonotic virus, first identified in the city of Wuhan in the Chinese province of Hubei, following a cluster of patients presenting with severe pneumonia [1]
We describe the detection of SARS-CoV-2 from eight patients admitted to hospital with severe respiratory distress who were not tested at the time because they had no travel history or contact with someone infected and did not meet the case definition applied at the time
A review of case histories revealed an additional five individuals whose symptoms were compatible with COVID-19 but who were not tested as they did not meet the epidemiological criteria of the contemporary case definition (Patients 4–8)
Summary
Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is a novel zoonotic virus, first identified in the city of Wuhan in the Chinese province of Hubei, following a cluster of patients presenting with severe pneumonia [1] Since this first detection in December 2019, SARS-C oV-2 has rapidly spread across the globe and, as of 30 March 2021, there have a been a total of 127349248 confirmed cases globally, resulting in 2787593 deaths [2]. Infection with SARS-CoV-2 can lead to the development of coronavirus disease 2019 (COVID-19), characterised by fever, persistent cough, fatigue and shortness of breath [3, 4] In severe cases, this can progress into acute respiratory distress syndrome (ARDS), which often requires artificial ventilation, and even multi-o rgan failure and death [5]. Asymptomatic and pre-symptomatic carriage of SARS-CoV-2 is well documented [6, 7] and transmission has been reported
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