The Earliest Infections

The Corona pandemic began much earlier than is often acknowledged.

Multiple converging lines of evidence show that SARS-2 spread unnoticed for months, especially in Italy, from October 2019. There is the case of a four-year old boy from Milan, with no travel history, who developed typical symptoms on 21 November and whose oropharyngeal sample (they suspected he had measles) later tested positive for SARS-2. There is the French-Algerian fishmonger who was admitted on 27 December to a Parisian ICU and whose respiratory sample later tested positive for SARS-2. He had likely been infected by his child, who was sick before him. His only recent travel was a trip to Algeria that August.

Then there are the wastewater treatment studies, which test archival frozen sewage samples for the presence of the SARS-2 genome. These have established, conclusively, “that SARS-CoV-2 was already circulating in northern Italy at the end of 2019 … in different geographic regions simultaneously”—specifically in Milan and Turin. While the sensational claims of this Spanish preprint to have found evidence of SARS-2 in Barcelona wastewater from March 2019 are not credible and were removed from the published version of the article, the authors’ more fundamental finding, that SARS-2 virus was in Barcelona sewage beginning on 15 January 2020, over a month before Spain’s first official case, remains firm.

And there is the serological evidence: This widely reported study found SARS-2 antibodies in blood samples taken from Italians enrolled in a lung cancer screening trial as early as September 2019. As an outlier, the results are sometimes questioned, but they were confirmed by microneutralisation assay, which found functioning, neutralising antibodies in six of the samples, the earliest from October 2019. Such evidence is not easily discounted. Another study finds convincing evidence of SARS-2 antibodies in French samples taken as early as November 2019. The authors even interviewed some of the seropositive individuals, who remembered getting sick at the same time as various acquaintances.

The Italian evidence points clearly to introduction well before November 2019. There is just no doubt that Corona was circulating in Europe much earlier than anybody realised. All that early press coverage of the first official cases in Italian tourists and German businessmen unfolded while many ordinary people in Paris, Milan, Turin and elsewhere were quietly getting the virus and passing it among themselves. There was the official pandemic of the media, the contact tracers and the epidemiologists, but this was nothing but an illusion—an arbitrarily selected subset of the much larger, real pandemic, which started earlier, involved many more people, and which early containment was always powerless to stop.

Official views of Corona reflect an increasingly stale orthodoxy, the fundaments of which were fixed around April 2020. None of this evidence for the early chronology of Corona is new, but it has never been allowed to influence our broader conception of the pandemic, and there has been almost no reflection on the significance of these findings.

To begin with, this new chronology shows that our impressions of the first wave were all wrong. The upside of those waves, as they washed ashore in each of our countries, was an artefact of increasing diagnostic capacity and the ramping up of mass testing through March and April. In many places, true infections were probably already receding as capacity increased, generating false case peaks where the two lines came to intersect. This was certainly the case in Germany, and it fuelled exaggerated views of SARS-2 transmissibility in those early months that have remained with us ever since.

The new chronology als shows that standard views of the transmissibility and pathogenicity of SARS-2 have been wildly exaggerated. Community spread went unnoticed for months in Italy and France and surely elsewhere in Europe too. Some doctors noted strange bilateral pneumonia cases in their elderly patients in the last months of 2019, but there was no obvious hospitalisation or mortality signal until very late in the winter. The earliest identified cases in Italy are all concentrated in the northern Italian pandemic epicentre, but the lesson is that it took multiple months for these early infections to reach critical mass. The Lombardy outbreak wasn’t seeded in the middle of February by Patient 1 from Codogno. All of this mind-numbing discussion of exponential growth has obscured the intriguing fact that the earliest stages of the pandemic, in the absence of all restrictions, unfolded very slowly indeed.

Finally, this adjusted chronology drives us to wonder to what degree our own policies encourage the primary public health signals of SARS-2 infections, namely high hospitalisation rates and mortality. The sequence of events was the same everywhere in the world outside China: Mass testing programs, followed by surging hospital admissions and then excess mortality spikes. Overuse of ventilators caused many early deaths, but it is worth considering if there are not also other, subtler ways that our suppression policies enhance Corona as well. More than anything else, and like MERS and SARS-1 before it, SARS-2 wants to be in institutions. It is a disease of hospitals and nursing homes, and until it gets into those places, its potential to inflict damage is strictly limited. How many people end up in hospitals and other medical facilities as a byproduct of our strange desire to tabulate every last case—people who would’ve never come to the attention of our health systems otherwise? And then there are the broader health consequences of keeping the vast majority of everyone indoors, where infection is more likely, for months at a time.

All of this is of course an elaborate defense of yesterday’s post. An early date for the origins of the Chinese outbreak are a near certainty. Corona causes mild disease in the spring and summer, and transmission is broadly suppressed in warmer months by climactic effects. The Wuhan outbreak first came to light in Fall 2019, because that was the first chance SARS-2 had to cause widespread illness. The virus entered humans substantially earlier.