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Travel From New York City Seeded Wave of U.S. Outbreaks Travel From New York City Seeded Wave of U.S. Outbreaks
(3 days later)
New York City’s coronavirus outbreak grew so large by early March that the city became the primary source of new infections in the United States, new research reveals, as thousands of infected people traveled from the city and seeded outbreaks around the country.New York City’s coronavirus outbreak grew so large by early March that the city became the primary source of new infections in the United States, new research reveals, as thousands of infected people traveled from the city and seeded outbreaks around the country.
The research indicates that a wave of infections swept from New York City through much of the country before the city began setting social distancing limits to stop the growth. That helped to fuel outbreaks in Louisiana, Texas, Arizona and as far away as the West Coast.The research indicates that a wave of infections swept from New York City through much of the country before the city began setting social distancing limits to stop the growth. That helped to fuel outbreaks in Louisiana, Texas, Arizona and as far away as the West Coast.
The findings are drawn from geneticists’ tracking signature mutations of the virus, travel histories of infected people and models of the outbreak by infectious disease experts.The findings are drawn from geneticists’ tracking signature mutations of the virus, travel histories of infected people and models of the outbreak by infectious disease experts.
“We now have enough data to feel pretty confident that New York was the primary gateway for the rest of the country,” said Nathan Grubaugh, an epidemiologist at the Yale School of Public Health.“We now have enough data to feel pretty confident that New York was the primary gateway for the rest of the country,” said Nathan Grubaugh, an epidemiologist at the Yale School of Public Health.
The central role of New York’s outbreak shows that decisions made by state and federal officials — including waiting to impose distancing measures and to limit international flights — helped shape the trajectory of the outbreak and allowed it to grow in the rest of the country.The central role of New York’s outbreak shows that decisions made by state and federal officials — including waiting to impose distancing measures and to limit international flights — helped shape the trajectory of the outbreak and allowed it to grow in the rest of the country.
The city joins other densely populated urban hot spots around the world, starting with Wuhan, China, and then Milan, that have become vectors for the virus’s spread.The city joins other densely populated urban hot spots around the world, starting with Wuhan, China, and then Milan, that have become vectors for the virus’s spread.
Travel from other American cities also sparked infections across the country, including from an early outbreak centered in the Seattle area that seeded infections in more than a dozen states, researchers say. Even if New York had managed to slow the virus, it probably would have continued to spread from elsewhere, they say.Travel from other American cities also sparked infections across the country, including from an early outbreak centered in the Seattle area that seeded infections in more than a dozen states, researchers say. Even if New York had managed to slow the virus, it probably would have continued to spread from elsewhere, they say.
But the Seattle outbreak proved to be a squall before the larger storm gathering in New York, where, at the end of February, thousands of infected people packed trains and restaurants, thronged tourist attractions and passed through its three major airports.But the Seattle outbreak proved to be a squall before the larger storm gathering in New York, where, at the end of February, thousands of infected people packed trains and restaurants, thronged tourist attractions and passed through its three major airports.
During crucial weeks in March, New York’s political leaders waited to take aggressive action, even after identifying hundreds of cases, giving the virus a head start. And by mid-March, when President Trump restricted travel from Europe, the restrictions were essentially pointless, the data suggest, as the disease was already spreading widely within the country.During crucial weeks in March, New York’s political leaders waited to take aggressive action, even after identifying hundreds of cases, giving the virus a head start. And by mid-March, when President Trump restricted travel from Europe, the restrictions were essentially pointless, the data suggest, as the disease was already spreading widely within the country.
Acting earlier would most likely have blunted the virus’s march across the country, researchers say.Acting earlier would most likely have blunted the virus’s march across the country, researchers say.
“It means that we missed the boat early on, and the vast majority in this country is coming from domestic spread,” said Kristian Andersen, a professor in the department of immunology and microbiology at Scripps Research. “I keep hearing that it’s somebody else’s fault. That’s not true. It’s not somebody else’s fault, it’s our own fault.”“It means that we missed the boat early on, and the vast majority in this country is coming from domestic spread,” said Kristian Andersen, a professor in the department of immunology and microbiology at Scripps Research. “I keep hearing that it’s somebody else’s fault. That’s not true. It’s not somebody else’s fault, it’s our own fault.”
A lack of testing obscured the true extent of the outbreak for months, and officials acted on incomplete and sometimes conflicting information. The enormous growth of New York’s outbreak partly reflects its volume of international visitors, especially from Europe, where most of its infections came from.A lack of testing obscured the true extent of the outbreak for months, and officials acted on incomplete and sometimes conflicting information. The enormous growth of New York’s outbreak partly reflects its volume of international visitors, especially from Europe, where most of its infections came from.
Dani Lever, communications director for Gov. Andrew M. Cuomo, criticized federal authorities, describing an “enormous failure by the federal government to leave New York and the East Coast exposed to flights from Europe, while at the same time instilling a false sense of security by telling the State of New York that we had no Covid cases throughout the entire month of February.”Dani Lever, communications director for Gov. Andrew M. Cuomo, criticized federal authorities, describing an “enormous failure by the federal government to leave New York and the East Coast exposed to flights from Europe, while at the same time instilling a false sense of security by telling the State of New York that we had no Covid cases throughout the entire month of February.”
A White House spokesman, Judd Deere, said that Mr. Trump had acted quickly. The president blocked most visitors from Europe starting on March 13, more than a month after he restricted travel from China.A White House spokesman, Judd Deere, said that Mr. Trump had acted quickly. The president blocked most visitors from Europe starting on March 13, more than a month after he restricted travel from China.
“Just as he acted early on to cut off travel from the source of the virus, President Trump was advised by his health and infectious disease experts that he should cut off travel from Europe — an action he took decisively without delay to save lives while Democrats and the media criticized him and the global health community still did not fully comprehend the level of transmission or spread,” Mr. Deere said.“Just as he acted early on to cut off travel from the source of the virus, President Trump was advised by his health and infectious disease experts that he should cut off travel from Europe — an action he took decisively without delay to save lives while Democrats and the media criticized him and the global health community still did not fully comprehend the level of transmission or spread,” Mr. Deere said.
The travel that helped spread the virus includes New York residents who left the city and non-New Yorkers who visited or passed through the city. Now that infections are dispersed around the country, travel from New York is no longer a main factor shaping the progression of the epidemic, researchers said.The travel that helped spread the virus includes New York residents who left the city and non-New Yorkers who visited or passed through the city. Now that infections are dispersed around the country, travel from New York is no longer a main factor shaping the progression of the epidemic, researchers said.
As states around the nation begin to relax their restrictions, the findings demonstrate that it is difficult, if not impossible, to prevent those actions from affecting the rest of the nation.As states around the nation begin to relax their restrictions, the findings demonstrate that it is difficult, if not impossible, to prevent those actions from affecting the rest of the nation.
Geneticists have analyzed and shared more than 2,000 samples of the virus from infected people. As the virus infects new people and replicates, it picks up mutations along the way. These mutations typically do not change the behavior of the virus, but they can provide a signature of a virus’s origin.Geneticists have analyzed and shared more than 2,000 samples of the virus from infected people. As the virus infects new people and replicates, it picks up mutations along the way. These mutations typically do not change the behavior of the virus, but they can provide a signature of a virus’s origin.
Most samples taken in Texas, Ohio, Louisiana, Idaho, Wisconsin and many other states carry distinct mutations that can be traced back to viruses introduced into New York.Most samples taken in Texas, Ohio, Louisiana, Idaho, Wisconsin and many other states carry distinct mutations that can be traced back to viruses introduced into New York.
Over all, Dr. Grubaugh estimated, infections spreading from New York account for 60 to 65 percent of the sequenced viruses across the country.Over all, Dr. Grubaugh estimated, infections spreading from New York account for 60 to 65 percent of the sequenced viruses across the country.
Other scientists said that they would like to see more samples before calculating precise figures. But they agreed that New York’s prominence in seeding the national spread appears to have begun in early March, two weeks before stay-at-home orders were put in place.Other scientists said that they would like to see more samples before calculating precise figures. But they agreed that New York’s prominence in seeding the national spread appears to have begun in early March, two weeks before stay-at-home orders were put in place.
“New York acted as the Grand Central Station for this virus, with the opportunity to move from there in so many directions, to so many places,” said David Engelthaler, head of the infectious disease branch of the Translational Genomics Research Institute in Arizona.“New York acted as the Grand Central Station for this virus, with the opportunity to move from there in so many directions, to so many places,” said David Engelthaler, head of the infectious disease branch of the Translational Genomics Research Institute in Arizona.
The most commonly detected viruses tied to New York have a distinct genetic signature linking them to outbreaks in Europe. Those spreading from Washington State have a signature linking them directly to China.The most commonly detected viruses tied to New York have a distinct genetic signature linking them to outbreaks in Europe. Those spreading from Washington State have a signature linking them directly to China.
Benjamin M. Branham, a spokesman for the Port Authority of New York and New Jersey, which controls the airports, said that before the flight restrictions from Europe, the federal government’s Customs and Border Protection “only screened passengers from China,” not from Europe.Benjamin M. Branham, a spokesman for the Port Authority of New York and New Jersey, which controls the airports, said that before the flight restrictions from Europe, the federal government’s Customs and Border Protection “only screened passengers from China,” not from Europe.
At this stage, scientists say, genetic fingerprints alone are not sufficient for pinpointing the source of the viruses. But travel patterns and case histories of early known cases support the idea, they said.At this stage, scientists say, genetic fingerprints alone are not sufficient for pinpointing the source of the viruses. But travel patterns and case histories of early known cases support the idea, they said.
“It is a combination, still, of what genomic epidemiology and shoe-leather epidemiology is going to tell us,” Dr. Engelthaler said.“It is a combination, still, of what genomic epidemiology and shoe-leather epidemiology is going to tell us,” Dr. Engelthaler said.
Scientists modeling the progression of the disease nationally said the prominence of New York as a national hub was broadly consistent with their findings, although the picture was still emerging.Scientists modeling the progression of the disease nationally said the prominence of New York as a national hub was broadly consistent with their findings, although the picture was still emerging.
Updated June 12, 2020Updated June 12, 2020
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
“I would say this is not surprising in a sense,” said Alessandro Vespignani, director of the Network Science Institute at Northeastern University in Boston. “The picture emerging is consistent with numerical models.”“I would say this is not surprising in a sense,” said Alessandro Vespignani, director of the Network Science Institute at Northeastern University in Boston. “The picture emerging is consistent with numerical models.”
Earlier research by Dr. Vespignani showed just how rapidly, and invisibly, the outbreak exploded in New York. By March 1, when the first coronavirus case was confirmed in New York, the city probably had over 10,000 undetected infections, his research group showed.Earlier research by Dr. Vespignani showed just how rapidly, and invisibly, the outbreak exploded in New York. By March 1, when the first coronavirus case was confirmed in New York, the city probably had over 10,000 undetected infections, his research group showed.
New York and Washington State are not the only sources of the outbreak. Other large domestic hubs contributed to the spread, scientists believe, and a more diverse genetic mix is still seen in some places around the country, particularly in the Midwest and parts of the South.New York and Washington State are not the only sources of the outbreak. Other large domestic hubs contributed to the spread, scientists believe, and a more diverse genetic mix is still seen in some places around the country, particularly in the Midwest and parts of the South.
Even as domestic travel began to drive the outbreak, some infections were still seeded around the country by international travelers, geneticists said. It is possible, experts said, that some of the virus samples attributed to New York may have instead been seeded in other cities by direct flights from Europe, or from travelers laying over in New York before traveling elsewhere.Even as domestic travel began to drive the outbreak, some infections were still seeded around the country by international travelers, geneticists said. It is possible, experts said, that some of the virus samples attributed to New York may have instead been seeded in other cities by direct flights from Europe, or from travelers laying over in New York before traveling elsewhere.
For that reason, some scientists said they would like to see more samples before linking the majority of infections in the United States to New York.For that reason, some scientists said they would like to see more samples before linking the majority of infections in the United States to New York.
“I think that’s probably the story line that’s going to emerge, but I’d like to see more data,” said Harm van Bakel, a geneticist at Mount Sinai in New York.“I think that’s probably the story line that’s going to emerge, but I’d like to see more data,” said Harm van Bakel, a geneticist at Mount Sinai in New York.
A New York Times analysis of travel data supports the idea that the chains of infection originated in New York, experts said. The number of cases across the country was closely related to how many travelers each place received from New York in early March, based on anonymized cellphone tracking data from Cuebiq, a data intelligence company.A New York Times analysis of travel data supports the idea that the chains of infection originated in New York, experts said. The number of cases across the country was closely related to how many travelers each place received from New York in early March, based on anonymized cellphone tracking data from Cuebiq, a data intelligence company.
“It looks like most of the domestic spread is basically people traveling out from New York,” said Dr. Kari Stefansson, founder and chief executive of deCODE Genetics, a leading genome analysis firm based in Reykjavik, Iceland.“It looks like most of the domestic spread is basically people traveling out from New York,” said Dr. Kari Stefansson, founder and chief executive of deCODE Genetics, a leading genome analysis firm based in Reykjavik, Iceland.
Last week, Dr. Andersen of Scripps Research and other scientists analyzing the outbreak in New Orleans reported that all of the samples taken from New Orleans were from the line linked back to New York. The virus swept through the area in March and has killed more than 1,000 people.Last week, Dr. Andersen of Scripps Research and other scientists analyzing the outbreak in New Orleans reported that all of the samples taken from New Orleans were from the line linked back to New York. The virus swept through the area in March and has killed more than 1,000 people.
“You can figure out, with travel patterns, that the most likely thing to have happened is those came into New Orleans directly from New York,” Dr. Grubaugh said.“You can figure out, with travel patterns, that the most likely thing to have happened is those came into New Orleans directly from New York,” Dr. Grubaugh said.
Josh Holder, Michael Crowley and Derek Watkins contributed reporting.Josh Holder, Michael Crowley and Derek Watkins contributed reporting.