Questioning the "First Known Person-to-Person Transmission of SARS-CoV-2"

Was it or wasn't it?

Remember the *first* covid case in Illinois?

It was a nurse who had returned from Wuhan, China, on January 13, 2020. During her trip, she’d visited a hospitalized relative, as well as family members who had undiagnosed respiratory illness.

The nurse developed covid symptoms after her return, was hospitalized with pneumonia, tested positive for the virus, and recovered. Her husband was eventually admitted and tested positive too. The couple was reported in the Chicago Tribune as the first person-to-person case of covid in the U.S.

Three months later, The Lancet published a case investigation of the couple, authored by a bevy of Chicago & Illinois public health officials & CDC staff, entitled “First Known Person-to-Person Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the USA.” (Ghani, et al, 2020).

After having read this study many times, I think its central finding may be incorrect.

Why?

Because evidence from a second study, also published in Nature in April 2020, suggests the husband may not have contracted the virus from his wife.

The Cases At-A-Glance

The basics of these two cases is shown in a helpful graphic from the Lancet study that distills the timeline, symptom onset/type, and test results for the wife (Patient 1) and husband (Patient 2).

The wife was hospitalized after presenting with several symptoms at an outpatient facility and being diagnosed with pneumonia. The husband’s symptom onset was difficult to determine, investigators noted, due to chronic obstructive pulmonary disease, “with a chronic, productive cough and baseline dyspnoea.”

People with medical backgrounds can read and make observations about the details of each case, but I’ve always found it interesting that not one of the 100+ individuals contact-traced, monitored, and/or tested in connection with either the husband or the wife was diagnosed with covid during the study timelines. The authors give myriad potential reasons for that finding, including infection control measures, duration of exposure, and testing limitations.

Here They Are Again

The couple appears again, in another study published in Nature, on April 23, 2020: “Clinical and Virologic Characteristics of the First 12 Patients with Coronavirus Disease 2019 (COVID-19) in the United States.”

They’re easy to spot among the 12 subjects based on the timing and descriptions.¹

The wife is Patient 7. The husband is Patient 8.

The interesting part is in the extended data. Genomic sequencing shows their variants don’t cluster together in the phylogenetic tree. Independent researcher Rossana Segreto² goes further, observing that "the husband was infected with a variant that already evolved specific mutations not found in China."

The authors make an explicit note about the “failure to cluster” in the study’s supplemental material:

"For the other case and contact pair, while the sequences were >99% identical, the case (USAIL1, Pt 7) and the contact (USAIL2, Pt 8) did not cluster together in the tree; we observed mixed base calling in the case USAIL1 (Pt 7) across eight locations in the genome, while the contact (USAIL2, Pt 8) only showed the unique base from those eight genome locations.”

Possible Explanations

What are some possible explanations for the difference? The authors don’t say, but I’ll take a stab:

• There was a sequencing error.

• There was a testing error.

• The husband was carrying multiple variants.

• The husband contracted the virus from elsewhere.

• ?

Do the researchers on the Lancet study know about the findings in the Nature study? A few do, at least, because they are listed on both studies.

This spring, I reached out to the respective corresponding authors for each study, asking for their thoughts about the wife’s and husband’s variants. Neither responded.

I also contacted the editor of The Lancet, with a request to review and possibly retract the “First Person-to-Person” study, on the basis of evidence suggesting the husband may not have contracted SARS-CoV-2 from his wife. Likewise, I didn’t receive a response

There could be a very good & reasonable explanation for the wife’s and husband’s variants - one beyond my novice grasp of the relevant science and one supporting the conclusion that the husband got covid from his wife, who picked it up in Wuhan.

I hope readers of different backgrounds will read each study and share their thoughts in the comments.

UPDATE, 2/24/23: The husband from these studies spoke to a Chicago news station in January 2021. His comments indicate he either wasn’t sick — or didn’t perceive he was sick.

"They just did a real good job taking care of me," [Tom] Panocha said. "They treated me like a person, not an illness. It was almost two weeks before I found out that I had it and I really didn't think I was sick."

1. A comparison of their test results in this study with the Lancet study also confirms it’s the same couple.

2. I’m grateful to Rossana and our conversations via Twitter last spring, when we connected each other with these studies.