The ‘super-spreaders’: From the Irish cook dubbed Typhoid Mary to British man at the centre of UK coronavirus cluster – why DO some patients transmit infections far more than others?
- People who come into close contact with a lot of people may be super-spreaders
- And others may unknowingly shed unusually large amounts of a virus
- British coronavirus patient has infected at least 11 people in France and England
- He had visited friends and been to a pub, yoga class and ski resort in a fortnight
- Infamous super-spreader ‘Typhoid Mary’ infected 50 because she was never ill
Four new cases of the Chinese coronavirus were diagnosed in England today and all were linked to one man who has now been dubbed a ‘super spreader’.
The man, a middle-aged gas salesman who caught the infection while on a work trip to Singapore, is believed to have passed it on to at least 11 people.
He had stayed at a chalet with friends in the French ski resort of Les Contamines- Montjoie and infections have since been diagnosed in both France and the UK.
He may have been so contagious because his symptoms were so mild he didn’t notice them, because he was more socially active than normal or because he carried a higher amount of the virus in his body than is usual, scientists say.
Super spreaders have existed throughout history, with Irish chef ‘Typhoid Mary’ one of the most famous, for passing on typhoid without ever becoming ill herself.
And there are likely to be many more in China’s ongoing coronavirus outbreak, which has so far infected more than 40,000 people and killed 910.
Mary Mallon, aka Typhoid Mary, is pictured (right) with a nurse at one of the hospitals in which she was kept. Ms Mallon was believed to be the first person in the US to carry the typhoid bacteria but never suffer from the disease and, as a result, she passed it on to more than 50 people over her lifetime
A British businessman has infected at least 11 people with the coronavirus after catching it in Singapore and visiting friends in France and Brighton
While the coronavirus outbreak is seeing each patient infect between two and three people before they are isolated and recover, some people infect may more.
Scientists have realised some people can be what are deemed ‘super-spreaders’.
This means they infect many more people before realising they are ill or before they stop becoming contagious.
They are particularly dangerous because those unaware they are sick are less likely to change their behaviour to avoid passing the infection on.
Speaking about the news that the British coronavirus patient was confirmed to have infected a further four people today, Cardiff University researcher Dr Andrew Freedman said: ‘He could be termed a “super-spreader”.
The vast majority of coronavirus cases have been in mainland China, but more than 25 other countries and territories have declared infections:
- Belgium: 1 case, first case February 4
- Spain: 2 case, first case January 31
- Sweden: 1 case, first case January 31
- Russia: 2 cases, first case January 31
- UK: 8 cases, first case January 31
- India: 3 cases, first case January 30
- Philippines: 3 cases, first case January 30
- Italy: 3 cases, first case January 30
- Finland: 1 case, first case January 29
- United Arab Emirates: 7 cases, first case January 29
- Germany: 14 cases, first case Jan 27
- Sri Lanka: 1 case, first case Jan 27
- Cambodia: 1 case, first case Jan 27
- Canada: 7 cases, first case Jan 25
- Australia: 15 cases, first case Jan 25
- Malaysia: 18 cases, first case Jan 25
- France: 11 cases, first case January 24
- Nepal: 1 case, first case January 24
- Vietnam: 14 cases, first case Jan 24
- Singapore: 43 cases, first case January 23
- Macau: 10 cases, first case Jan 22
- Hong Kong: 36 cases, first case January 22
- Taiwan: 18 cases, first case Jan 21
- USA: 12 cases, first case January 20
- South Korea: 27 cases, first case January 20
- Japan: 156 cases, first case January 16
- Thailand: 32 cases, first case Jan 13
‘This may occur as result of someone being infectious despite having few or no symptoms, meaning they are unaware they have the infection.
‘It can also result from someone coming into close contact with an unusually large number of people or someone carrying a larger than normal quantity of the virus.’
An infamous example is a woman called Mary Mallon, nicknamed Typhoid Mary, who was a cook working in New York in the late 1800s and early 1900s.
She was one of the first people ever to carry the bacteria that cause typhoid but not to suffer from the disease.
As a result of not knowing she had the infection, she is believed to have passed it on to 51 people, three of whom died of the illness, and to have triggered an outbreak which affected around 3,000 people in New York City.
And as nothing specific can be done to stop these super-spreading events, they still happen today.
In the West Africa Ebola outbreak between 2013 and 2016, just three per cent of the patients were believed to be responsible for more than half of some 28,000 infections, the BBC reported.
The British coronavirus patient, who has not been identified, has unknowingly left panic in his wake after he went to a ski resort, EasyJet flight, pub, yoga class and hospital while infected during the past fortnight.
Eleven people at the Les Contamines- Montjoie resort are confirmed to have been infected after coming into contact with him and six more are in isolation for tests.
Four cases in the UK were diagnosed today, with all having links to the super-spreader, and a further five confirmed cases were diagnosed in France.
EasyJet and UK officials have had to contact 183 passengers and crew who shared the EZS8481 flight from Geneva to Gatwick with the man on January 28.
Five staff at The Grenadier pub in Hove, the man’s local, are now in self-isolation at home after he went there for a pint on Feburary 1, still unaware that he was ill.
And a manager and volunteers at the Cornerstone Community Centre in Hove are also on high alert after he attended a yoga class there in early February.
There is not necessarily a type of person who is more likely to be a super-spreader.
It may be where they live or their job that means more people are at risk – someone living in a densely-packed city or a large household, for example, or someone who works as a member of cabin crew or on a supermarket checkout.
And people with worse personal hygiene may be more likely to be a super-spreader.
‘Kids are good at that. That’s why closing schools can be a good measure,’ Dr John Edmunds, from the London School of Hygiene and Tropical Medicine, told the BBC.
And some people’s bodies may just release higher than normal amounts of a virus – a process known as shedding – making them more contagious through no fault of their own.
WHAT DO WE KNOW ABOUT THE DEADLY CORONAVIRUS IN CHINA?
Someone who is infected with the Wuhan coronavirus can spread it with just a simple cough or a sneeze, scientists say.
At least 910 people with the virus are now confirmed to have died and more than 40,640 have been infected in at least 28 countries and regions. But experts predict the true number of people with the disease could be 100,000, or even as high as 350,000 in Wuhan alone, as they warn it may kill as many as two in 100 cases. Here’s what we know so far:
What is the Wuhan coronavirus?
A coronavirus is a type of virus which can cause illness in animals and people. Viruses break into cells inside their host and use them to reproduce itself and disrupt the body’s normal functions. Coronaviruses are named after the Latin word ‘corona’, which means crown, because they are encased by a spiked shell which resembles a royal crown.
The coronavirus from Wuhan is one which has never been seen before this outbreak. It is currently named 2019-nCoV, and does not have a more detailed name because so little is known about it.
Dr Helena Maier, from the Pirbright Institute, said: ‘Coronaviruses are a family of viruses that infect a wide range of different species including humans, cattle, pigs, chickens, dogs, cats and wild animals.
‘Until this new coronavirus was identified, there were only six different coronaviruses known to infect humans. Four of these cause a mild common cold-type illness, but since 2002 there has been the emergence of two new coronaviruses that can infect humans and result in more severe disease (Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses).
‘Coronaviruses are known to be able to occasionally jump from one species to another and that is what happened in the case of SARS, MERS and the new coronavirus. The animal origin of the new coronavirus is not yet known.’
The first human cases were publicly reported from the Chinese city of Wuhan, where approximately 11million people live, after medics first started seeing infections on December 31.
By January 8, 59 suspected cases had been reported and seven people were in critical condition. Tests were developed for the new virus and recorded cases started to surge.
The first person died that week and, by January 16, two were dead and 41 cases were confirmed. The next day, scientists predicted that 1,700 people had become infected, possibly up to 7,000.
Just a week after that, there had been more than 800 confirmed cases and those same scientists estimated that some 4,000 – possibly 9,700 – were infected in Wuhan alone. By that point, 26 people had died.
By January 27, more than 2,800 people were confirmed to have been infected, 81 had died, and estimates of the total number of cases ranged from 100,000 to 350,000 in Wuhan alone.
By January 29, the number of deaths had risen to 132 and cases were in excess of 6,000.
By February 5, there were more than 24,000 cases and 492 deaths.
Where does the virus come from?
According to scientists, the virus has almost certainly come from bats. Coronaviruses in general tend to originate in animals – the similar SARS and MERS viruses are believed to have originated in civet cats and camels, respectively.
The first cases of the virus in Wuhan came from people visiting or working in a live animal market in the city, which has since been closed down for investigation.
Although the market is officially a seafood market, other dead and living animals were being sold there, including wolf cubs, salamanders, snakes, peacocks, porcupines and camel meat.
A study by the Wuhan Institute of Virology, published in February 2020 in the scientific journal Nature, found that the genetic make-up virus samples found in patients in China is 96 per cent similar to a coronavirus they found in bats.
There may have been an animal which acted as a middle-man, contracting it from a bat before then transmitting it to a human, researchers suggested, although details of this are less clear.
Dr Michael Skinner, a virologist at Imperial College London, was not involved with the research but said: ‘The discovery definitely places the origin of nCoV in bats in China.
‘We still do not know whether another species served as an intermediate host to amplify the virus, and possibly even to bring it to the market, nor what species that host might have been.’
So far the fatalities are quite low. Why are health experts so worried about it?
Experts say the international community is concerned about the virus because so little is known about it and it appears to be spreading quickly.
It is similar to SARS, which infected 8,000 people and killed nearly 800 in an outbreak in Asia in 2003, in that it is a type of coronavirus which infects humans’ lungs.
Another reason for concern is that nobody has any immunity to the virus because they’ve never encountered it before. This means it may be able to cause more damage than viruses we come across often, like the flu or common cold.
Speaking at a briefing in January, Oxford University professor, Dr Peter Horby, said: ‘Novel viruses can spread much faster through the population than viruses which circulate all the time because we have no immunity to them.
‘Most seasonal flu viruses have a case fatality rate of less than one in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case fatality rate could be as high as two per cent.’
If the death rate is truly two per cent, that means two out of every 100 patients who get it will die.
‘My feeling is it’s lower,’ Dr Horby added. ‘We’re probably missing this iceberg of milder cases. But that’s the current circumstance we’re in.
‘Two per cent case fatality rate is comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally.’
How does the virus spread?
The illness can spread between people just through coughs and sneezes, making it an extremely contagious infection. And it may also spread even before someone has symptoms.
It is believed to travel in the saliva and even through water in the eyes, therefore close contact, kissing, and sharing cutlery or utensils are all risky.
Originally, people were thought to be catching it from a live animal market in Wuhan city. But cases soon began to emerge in people who had never been there, which forced medics to realise it was spreading from person to person.
There is now evidence that it can spread third hand – to someone from a person who caught it from another person.
What does the virus do to you? What are the symptoms?
Once someone has caught the virus it may take between two and 14 days for them to show any symptoms – but they may still be contagious during this time.
If and when they do become ill, typical signs include a runny nose, a cough, sore throat and a fever (high temperature). The vast majority of patients – at least 97 per cent, based on available data – will recover from these without any issues or medical help.
In a small group of patients, who seem mainly to be the elderly or those with long-term illnesses, it can lead to pneumonia. Pneumonia is an infection in which the insides of the lungs swell up and fill with fluid. It makes it increasingly difficult to breathe and, if left untreated, can be fatal and suffocate people.
What have genetic tests revealed about the virus?
Scientists in China have recorded the genetic sequences of around 19 strains of the virus and released them to experts working around the world.
This allows others to study them, develop tests and potentially look into treating the illness they cause.
Examinations have revealed the coronavirus did not change much – changing is known as mutating – much during the early stages of its spread.
However, the director-general of China’s Center for Disease Control and Prevention, Gao Fu, yesterday said the virus was mutating and adapting as it spread through people.
This means efforts to study the virus and to potentially control it may be made extra difficult because the virus might look different every time scientists analyse it.
More study may be able to reveal whether the virus first infected a small number of people then change and spread from them, or whether there were various versions of the virus coming from animals which have developed separately.
How dangerous is the virus?
The virus has so far killed 910 people out of a total of at least 40,640 officially confirmed cases – a death rate of around two per cent. This is a similar death rate to the Spanish Flu outbreak which, in 1918, went on to kill around 50million people.
However, experts say the true number of patients is likely considerably higher and therefore the death rate considerably lower. Imperial College London researchers estimate that there were 4,000 (up to 9,700) cases in Wuhan city alone up to January 18 – officially there were only 444 there to that date. If cases are in fact 100 times more common than the official figures, the virus may be far less dangerous than currently believed, but also far more widespread.
Experts say it is likely only the most seriously ill patients are seeking help and are therefore recorded – the vast majority will have only mild, cold-like symptoms. For those whose conditions do become more severe, there is a risk of developing pneumonia which can destroy the lungs and kill you.
Can the virus be cured?
The Wuhan coronavirus cannot currently be cured and it is proving difficult to contain.
Antibiotics do not work against viruses, so they are out of the question. Antiviral drugs can, but the process of understanding a virus then developing and producing drugs to treat it would take years and huge amounts of money.
No vaccine exists for the coronavirus yet and it’s not likely one will be developed in time to be of any use in this outbreak, for similar reasons to the above.
The National Institutes of Health in the US, and Baylor University in Waco, Texas, say they are working on a vaccine based on what they know about coronaviruses in general, using information from the SARS outbreak. But this may take a year or more to develop, according to Pharmaceutical Technology.
Currently, governments and health authorities are working to contain the virus and to care for patients who are sick and stop them infecting other people.
People who catch the illness are being quarantined in hospitals, where their symptoms can be treated and they will be away from the uninfected public.
And airports around the world are putting in place screening measures such as having doctors on-site, taking people’s temperatures to check for fevers and using thermal screening to spot those who might be ill (infection causes a raised temperature).
However, it can take weeks for symptoms to appear, so there is only a small likelihood that patients will be spotted up in an airport.
Is this outbreak an epidemic or a pandemic?
The outbreak is an epidemic, which is when a disease takes hold of one community such as a country or region.
Although it has spread to dozens of countries, the outbreak is not yet classed as a pandemic, which is defined by the World Health Organization as the ‘worldwide spread of a new disease’.
The head of WHO’s global infectious hazard preparedness, Dr Sylvie Briand, said: ‘Currently we are not in a pandemic. We are at the phase where it is an epidemic with multiple foci, and we try to extinguish the transmission in each of these foci,’ the Guardian reported.
She said that most cases outside of Hubei had been ‘spillover’ from the epicentre, so the disease wasn’t actually spreading actively around the world.
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