New study suggests COVID-19 spread to France in December

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Conventional wisdom has it that the SARS-CoV-2 virus started to spread in China in late 2019 and then spread to the rest of the world from the beginning of 2020. However, a new study in France indicates that the virus was already arrived – and spread … in this country well before the start of the new year. In a new article published in the International Journal of Antimicrobial Agents, investigators from the Paris Seine Saint-Denis hospital group in France report the case of a man hospitalized in December 2019 for hemoptysis. The man was treated and discharged on December 29, but after 2019 coronavirus disease (COVID-19) became a pandemic, hospital staff retrospectively tested a patient’s respiratory sample for SARS-CoV-2. It came back positive.

Before this study, it was thought that France did not have a case of COVID-19 before January.

“Based on this result, it appears that the COVID-19 epidemic started much earlier,” report Yves Cohen, MD, PhD, and colleagues.

On January 24, France reported that 2 patients who had recently traveled to Wuhan, China had tested positive for the disease. Given the direct link to the Chinese epidemic and the lack of suspected cases before that date, public health officials there believed they had identified the country’s “patient zeros”.

In early April, however, Cohen and his colleagues decided to dig deeper to assess this premise. Investigators took 14 samples from the hospital’s respiratory sample bank taken from hospital patients. The samples selected came from patients admitted between December 2, 2019 and January 16, 2020, who had influenza-like illness and frosted glass opacity. These samples were RT-PCR tested for the new coronavirus, and one returned positive. The result was confirmed using the COVID-19 Plus RealAmp Gene Finder Kit.

Notably, the positive patient – a 42-year-old man – had no apparent connection to China. He was a longtime resident of France who worked as a fishmonger and had last visited his native Algeria in August 2019. The patient had a history of asthma and type 2 diabetes, and came to the emergency room from the hospital with symptoms such as hemoptysis, cough, headache and fever. He received antibiotics, responded favorably and was discharged after 2 days.

Cohen said the patient’s travel history – or absence – confuses the story that had previously prevailed about COVID-19 in France.

” [T]The absence of a link with China and the lack of recent trips suggest that the disease was already spreading in the French population at the end of December 2019, “they write.

As of May 5, the French government has listed more than 133,000 cases of COVID-19 and 25,000 deaths; however, the new study suggests that the number of cases and deaths may be considerably higher.

“In addition, as these results change our understanding of the dynamics of the epidemic, it also means that several models used to predict the course and outcomes of the spread of SARS-CoV-2 could be based on biased data and should be readjusted for the real profile of the epidemic, ”write Cohen and colleagues.

The authors note a number of limitations, such as the fact that their medical records were not exhaustive and may lack key information. However, they also note that their research is based on a small number of samples in a single hospital; therefore, the actual number of patients infected at the time was likely higher.

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