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New Report Suggests Coronavirus May Have Made an Early Appearance in France New Report Suggests Coronavirus May Have Made Early Appearance in France
(about 3 hours later)
PARIS — French doctors say they just discovered that a patient treated in late December north of Paris had the coronavirus, a finding that, if verified, suggests that the virus appeared in Europe nearly a month earlier than previously understood. PARIS — Weeks before Chinese authorities acknowledged that the coronavirus could be transmitted by humans, and nearly a month before the first officially recorded cases in Europe, a 42-year-old fishmonger showed up at a hospital in suburban Paris coughing, feverish and having trouble breathing. It was Dec. 27.
The finding came this week after French doctors retested samples taken on Dec. 27 from a patient who had pneumonia — days before Chinese authorities first reported the previously unknown virus to the World Health Organization, and weeks before the Chinese acknowledged that human-to-human transmission of the virus was even possible. Now doctors in France are suggesting that the December patient may have been the earliest known coronavirus case in Europe.
It was nearly a month before the disease was first officially acknowledged to have emerged in France. If confirmed — the doctors are certain, and the French government says it is looking at the report — the case of the fishmonger, Amirouche Hammar, would mean the deadly virus made an appearance on the continent long before officials there began tackling it. The discovery would bring a strange new wrinkle to the story of the virus in Europe, one that has the potential of blowing up the previously established chronology.
The doctors who made the finding said they tested the samples twice to avoid false positives. But they acknowledged that they could not completely rule out that possibility.The doctors who made the finding said they tested the samples twice to avoid false positives. But they acknowledged that they could not completely rule out that possibility.
They also cautioned that it was unclear whether the man, if the tests were accurate, had passed the virus on to anyone else. They also cautioned that without further analysis of the sample, it was unclear whether the man had passed the virus on to anyone else, or whether his case was tied in any way to the epidemic that arrived later.
The French government did not comment on the case on Tuesday. But if the timeline of when the virus appeared in Europe does change, the official efforts to combat the contagion would turn out not to have been just too late, but hopelessly too late.
The new case may add to an understanding of how late authorities in Europe were in recognizing that the virus had arrived in their midst and in fashioning a full-throttle response. By the time the first serious measures were put in place — the French government didn’t order a lockdown until March 16 — the virus may have already appeared three months earlier, according to a study of the new case that has been peer-reviewed and accepted for formal publication in the International Journal of Antimicrobial Agents.
It also suggests that the virus had made its way out of Asia, let alone China, long before measures to cut it off and contain its spread. The first case outside of China was reported in Thailand on Jan. 13. That in turn would help explain the rapidly developing catastrophe that has since unfurled in France and Europe. There have been thousands of cases, hospitalizations and deaths, in numbers that only in recent weeks have begun to abate somewhat, as a result of the government’s rigid confinement measures.
The detection of the new case in France comes as doctors in the United States have documented deaths from the virus weeks earlier than initially reported, and a model has suggested that silent outbreaks had spread for weeks before detection. France alone has recorded over 25,000 coronavirus deaths.
The new French case was found at the Avicenne and Jean Verdier hospitals, in the northern suburbs of Paris. Dr. Yves Cohen, the head of intensive care at those hospitals said on Sunday that his staff had decided to test samples from patients diagnosed with atypical pneumonia in December and January for the coronavirus. “If confirmed, what this case does highlight is the speed at which an infection starting in a seemingly remote part of the world, can quickly seed infections elsewhere,” said Prof. Rowland Kao, the Sir Timothy O’Shea Professor of Veterinary Epidemiology and Data Science at the University of Edinburgh, in an interview for Britain’s Science Media Centre.
At the time, the patients had been checked for seasonal flu and for other coronaviruses, but not for the new coronavirus, which was little known and not thought to have reached Europe. “Why is this important?” he added. “It means that the lead time we have for assessment and decision-making can be very short.”
Dr. Cohen told the BFM TV news channel that the doctors detected one case of Covid-19, the disease caused by the virus, from a Dec. 27 sample, adding that the sample had been tested several times to rule out a false positive. The journal publishing the report about the case has had a brush with controversy over the coronavirus, walking back a study it published about treatments for the virus. And much about this apparent first case remains a mystery.
The patient, a 42-year-old man born in Algeria who has lived in France for many years, had not been abroad since August, according to Dr. Cohen and others, whose study of the case has been peer-reviewed and accepted for publication in the International Journal of Antimicrobial Agents. But the authors of the paper, doctors at the Avicenne Hospital in the Paris suburb of Bobigny, among others, declare flatly: Their study is of a “patient infected with Covid-19 one month before the first reported cases in our country” whose “lack of recent travel suggests that the disease was already spreading among the French population at the end of December 2019.”
“He could be patient zero, but maybe there were others in other regions,” Dr. Cohen said, meaning the first person to be infected with the virus in France. French authorities declared the first official cases of coronavirus in the country — three people who had all recently been in China — on Jan. 24. That was four days after China for the first time confirmed human-to-human transmission.
It is not yet entirely clear how the man caught the infection. But experts have long suspected that the coronavirus may have spread internationally before the first officially reported cases. The doctors retested samples from a man who had suffered from pneumonia. They found the coronavirus.
France’s health ministry said on Tuesday that authorities were in contact with scientists and experts from other countries on the timeline of the spread of the virus, and that they would carry out further investigations “if they appear necessary.” “There’s no doubt for us,” said Dr. Yves Cohen, head of intensive care at the Avicenne and Jean Verdier hospitals, in the northern suburbs of Paris, and one of the authors of the study, in a telephone interview Tuesday. “It was already there in December.”
“We are in permanent contact with our European and Chinese counterparts on the issue, in order to better understand the spread of the virus at the global level,” the ministry said. What is not clear is how the patient, Mr. Hammar, got it. Apart from a trip to Algeria last summer, he had not traveled. His wife, however, briefly exhibited some of the symptoms — coughing, principally — of the coronavirus, Dr. Cohen said.
French experts warned that the case could not be directly tied to France’s current outbreak without a genomic analysis of the sample. “We’ve got some theories,” he said. “His wife had a little cough.”
“One really has to make a distinction between the epidemic wave and isolated cases,” Samuel Alizon, an infectious diseases and epidemics specialist at the CNRS, France’s national public research organization, said in a telephone interview. “It is quite possible that there were isolated cases that led to transmission chains that died down.” Mr. Hammar’s wife, Fatiha, who works in a supermarket near Charles de Gaulle airport in Paris, told French television this week that she serves customers who come directly from the airport, “with their suitcases,” she said.
There were direct flights between that airport and the one in Wuhan, China, before borders were closed.
Experts warned that the case could not be directly tied to France’s current outbreak without a genomic analysis.
“One really has to make a distinction between the epidemic wave and isolated cases,” Samuel Alizon, an infectious diseases and epidemics specialist at the CNRS, France’s national public research organization, said in a telephone interview.
“It is quite possible,” he explained, “that there were isolated cases that led to transmission chains that died down.”
Mr. Alizon said it was common for epidemics imported from abroad into a given country to undergo several false starts, with transmission chains that died down on their own before one of the imported cases led to an actual epidemic.Mr. Alizon said it was common for epidemics imported from abroad into a given country to undergo several false starts, with transmission chains that died down on their own before one of the imported cases led to an actual epidemic.
“So the question is more: How many importation events did it take to launch the epidemic wave?” he said.“So the question is more: How many importation events did it take to launch the epidemic wave?” he said.
The first case outside of China was reported in Thailand on Jan. 13. But experts have long suspected that the coronavirus may have spread internationally before the first officially reported cases.
The detection of the potential new case in France follows similar instances in the United States, where deaths from the virus were identified weeks earlier than first reported, and a model suggested that silent outbreaks had spread for weeks before detection.
The French government has said very little about the case so far.
France’s health ministry said on Tuesday that authorities were in contact with scientists and experts from other countries on the timeline of the spread of the virus, and that they would carry out further investigations “if they appear necessary.”
“We are in permanent contact with our European and Chinese counterparts on the issue, in order to better understand the spread of the virus at the global level,” the ministry said.
Dr. Olivier Bouchaud, an infectious disease specialist at the same hospital as Dr. Cohen, told the LCI news channel on Tuesday that it was common to keep frozen samples from patients with lung infections for later testing.
“It isn’t very surprising,” Dr. Bouchaud said of the Dec. 27 positive case, noting that in China the virus also circulated under the radar for weeks before the first official cases were detected.
Frédéric Keck, a biosecurity expert at CNRS, said, “If Covid existed in November” — which some reports suggest was the case — “it is certainly possible that it was here in December.”
“We never really know when an epidemic starts,” Mr. Keck said.
Mr. Hammar, who lives in Bobigny, a northern suburb of Paris, said in an interview with BFM TV that he drove himself to the emergency ward at 5 a.m. on Dec. 27 after several days of coughing, difficulty breathing and chest pains.
Mr. Hammar, who has a history of asthma and diabetes, was diagnosed with a pulmonary infection but quickly recovered and was discharged two days later.
“I was surprised, given the devastation that the illness is causing,” Mr. Hammar said of learning, months later, that he had been tested positive for Covid-19.
Benjamin Mueller contributed reporting from London.