ArticlePDF Available

Early transmission patterns of coronavirus disease 2019 (COVID-19) in travellers from Wuhan to Thailand, January 2020


Abstract and Figures

We report two cases of coronavirus disease 2019 (COVID-19) in travellers from Wuhan, China to Thailand. Both were independent introductions on separate flights, discovered with thermoscanners and confirmed with RT-PCR and genome sequencing. Both cases do not seem directly linked to the Huanan Seafood Market in Hubei but the viral genomes are identical to four other sequences from Wuhan, suggesting early spread within the city already in the first week of January. © 2020 European Centre for Disease Prevention and Control (ECDC). All rights reserved.
Content may be subject to copyright.
R 
Early transmission patterns of coronavirus disease 2019
(COVID-19) in travellers from Wuhan to ailand,
January 2020
Pilailuk Okada¹ , Rome Buathong² , Siripaporn Phuygun¹ , Thanutsapa Thanadachakul¹ , Sittiporn Parnmen¹ , Warawan
Wongboot¹ , Sunthareeya Waicharoen¹ , Supaporn Wacharapluesadee³ , Sumonmal Uttayamakul² , Apichart Vachiraphan2 ,
Malinee Chittaganpitch¹ , Nanthawan Mekha¹ , Noppavan Janejai¹ , Sopon Iamsirithaworn² , Raphael TC Lee , Sebastian Maurer-
1. Department of Medical Sciences, Ministry of Public Health, Thailand
2. Department of Disease Control, Ministr y of Public Health, Thailand
3. Thai Red Cross Emerging Infectious Diseases - Health Science Centre, Chulalongkorn Universit y, Thailand
4. Bioinformatics Institute, Agency for Science Technology and Research, Singapore
5. Department of Biological Sciences, National University of Singapore, Singapore
Correspondence: Pilailuk Okada (
Citation style for this article:
Okada Pilailuk , Buathong Rome , Phuygun Siripapor n , Thanadachaku l Thanutsapa , P arnmen Sittiporn , Wong boot Warawan , Waicharoen Sunthareeya ,
Wachara pluesadee Supap orn , Uttayamakul Sumonmal , Vachira phan Apichart , Chittag anpitch Malinee , Mekha Nanthawan , Janejai Nopp avan , Iamsirithaworn
Sopon , Lee Raphael T C , Maurer-Stroh Sebastian . Early transmission patter ns of coronaviru s disease 2019 (COVID -19) in travelle rs from Wuhan to Thailand, January
2020. Euro Surveill. 2020;25(8):pii=20 00097. 25.8.2000097
Article submit ted on 06 Feb 2020 / accepted on 27 Feb 2020 / publishe d on 27 Feb 2020
We report two cases of coronavirus disease 2019
(COVID-19) in travellers from Wuhan, China to
Thailand. Both were independent introductions on
separate flights, discovered with thermoscanners
and confirmed with RT-PCR and genome sequencing.
Both cases do not seem directly linked to the Huanan
Seafood Market in Hubei but the viral genomes are
identical to four other sequences from Wuhan, sug-
gesting early spread within the city already in the first
week of January.
In late December 2019, an outbreak with an initially
undiagnosed pneumonia was reported in the city of
Wuhan, Hubei Province, China, and linked to the Huanan
Seafood Market [1,2]. The causative pathogen was
identified as a novel betacoronavirus within the severe
acute respiratory syndrome (SARS) coronavirus (CoV)
family, recently termed SARS-CoV-2 [3-7]. In response
to the outbreak, several countries including Thailand,
established thermal screening at the airport for travel-
lers from Wuhan since 3 January. On 8 January and 13
January, suspected cases of infection with SARS-CoV-2
were identified at Bangkok Suvarnabhumi airport. We
report the investigation, basic clinical characteristics
and viral genomes derived from these cases.
Case 1
A woman in her early 60s from Wuhan developed a
fever with chills, sore throat and headache on 5 January
2020. She went to a local health facility in China and
received undisclosed medication. On 8 January 2020,
she took a direct ca 4 h flight to Thailand from Wuhan,
with five family members, as part of a tour group of 16
(including the case). Her measured temperature at the
arrival gate was 38.6 °C by thermoscanner, and con-
firmed with a tympanic thermometer. After being inter-
viewed by quarantine officers, she was transferred to
Bamrasnaradura Infectious Disease Institute (BIDI)
Hospital, Nonthaburi, for isolation and laborator y inves-
tigations. She reported a runny nose and sore throat
but no dyspnea or diarrhoea. Upon admission, her vital
signs were normal except for elevated blood pressure.
Her physical examination was unremarkable including
inconspicuous lung sounds. Her complete blood count
suggested a viral infection from relatively decreased
neutrophil (48%; norm: 35–75%) to lymphocyte (40%;
norm: 20–59%) ratio [8]. The chest X-ray (CXR) results
on 8 January were compatible with pneumonia with
mild thickening lung marking at both lower lungs pos-
sibly because of crowded lung rather than infiltration.
It also showed borderline cardiomegaly. Repeat CXR
after 7 days showed no remarkable changes.
In the interview, the patient explicitly stated that she
had not visited the Huanan Seafood Market but she
was living near another local market, which she visited
daily until illness onset. This market was at ca 7.5 km
distance from the Huanan Seafood Market. The patient
also reported that she had not purchased live animals
and or visited stalls with live animals. She did not visit
Jinyintai Hospital or other hospitals in Wuhan. However,
she visited local dispensaries in Wuhan to obtain medi-
cation. She also repor ted no contact with persons with
respiratory symptoms.
Clinical specimens collected on admission included
the upper respiratory tract secretions and sputum.
These specimens tested positive on 12 January for the
CoV family by using a conventional nested RT-PCR [9].
Genomic sequencing analysis included Sanger and
next generation sequencing were performed by the
Emerging Infectious Diseases Health Science Center,
the Thai Red Cross Society and the Thai National
Institute of Health, Department of Medical Sciences
and the sequence shared via the Global Initiative
on Sharing All Influenza Data (GISAID) EpiCoV data-
base (EPI_ISL_403962). The sequencing protocol and
details are provided in the Supplementary Materials.
The patient recovered after testing negative for SARS-
CoV-2, and returned to China without signs and symp-
toms on 18 January 2020.
Case 2
A woman in her mid-70s from Wuhan landed at
Suvarnabhumi airport on 13 January. She travelled
to Thailand with three family members as part of
a tour group of 20 (including the case). An airport
thermoscanner detected a fever of 38.0 °C that was
confirmed with a tympanic thermometer. The patient
reported a sore throat, that her fever onset date was 13
January and that she had a cough for an undetermined
period. The patient was hospitalised at BIDI. Upon
admission, she reported mild tachypnoea, and her
CXR was compatible with pneumonia. Similar to case
1, the first CXR taken on 13 January, showed thickening
interstitial lung marking at both lower lung fields and
both perihilar regions because of interstitial infiltra-
tion or crowded lung marking, mild cardiomegaly and
dilated aorta. Follow-up CXR on 17 January additionally
showed recent hazy with reticular opacities at left mid-
dle lung field. The patient was not in severe condition
but stable.
In the patient interview, she reported that she did not
visit the Huanan Seafood Market or other markets.
She also reported no contact with pigs, camels, other
F 1
Phylogenetic trees of Thai sequences in context of all coronavirus families (A) and structural mapping of mutations in the
spike glycoprotein between SARS CoV (PDB:6CG [12]) and the current SARS-CoV-2 using YASARA [20] (B)
Bovine respiratory coronavirus AH187/NC 012948/1-30969
Bovine coronavirus/NC 003045/1-31028
Bovine respiratory coronavirus bovine/US/OH-440-TC/1996/NC 012949/1-30953
Human enteric coronavirus strain 4408/NC 012950/1-30953
Human coronavirus OC43/NC 005147/1-30738
Porcine hemagglutinating encephalomyelitis virus/NC 007732/1-30480
Equine coronavirus/NC 010327/1-30992
Rabbit coronavirus HKU14/NC 017083/1-31100
Rat coronavirus Parker/NC 012936/1-31250
Murine hepatitis virus strain A59/NC 001846/1-31357
Murine hepatitis virus strain JHM/NC 006852/1-31526
Human coronavirus HKU1/NC 006577/1-29926
Bat coronavirus HKU9-1/NC 009021/1-29114
Human betacoronavirus 2c EMC 2012/JX869059/1-30118
Bat coronavirus HKU5-1/NC 009020/1-30482
Bat coronavirus HKU4-1/NC 009019/1-30286
Bat coronavirus BtCoV/133/2005/NC 008315/1-30307
Bat coronavirus BM48-31/BGR/2008/NC 014470/1-29276
SARS coronavirus/NC 004718/1-29751
MG772933.1 Bat SARS-like coronavirus isolate bat-SL-CoVZC45/1-29802
MG772934.1 Bat SARS-like coronavirus isolate bat-SL-CoVZXC21/1-29732
BetaCoV/Nonthaburi/61/2020|EPI ISL 403962/1-29848
BetaCoV/Nonthaburi/74/2020|EPI ISL 403963/1-29859
Feline infectious peritonitis virus/NC 002306/1-29355
Human coronavirus NL63/NC 005831/1-27553
Human coronavirus 229E/NC 002645/1-27317
Bat coronavirus HKU2/NC 009988/1-27165
Scotophilus bat coronavirus 512/NC 009657/1-28203
Porcine epidemic diarrhea virus/NC 003436/1-28033
Bat coronavirus HKU8/NC 010438/1-28773
Bat coronavirus 1B/NC 010436/1-28476
Bat coronavirus 1A/NC 010437/1-28326
Turkey coronavirus/NC 010800/1-27657
Avian infectious bronchitis virus/NC 001451/1-27608
Beluga Whale coronavirus SW1/NC 010646/1-31686
Night-heron coronavirus HKU19/NC 016994/1-26077
Wigeon coronavirus HKU20/NC 016995/1-26227
Common-moorhen coronavirus HKU21/NC 016996/1-26223
Thrush coronavirus HKU12-600/NC 011549/1-26396
White-eye coronavirus HKU16/NC 016991/1-26041
Munia coronavirus HKU13-3514/NC 011550/1-26552
Magpie-robin coronavirus HKU18/NC 016993/1-26689
Sparrow coronavirus HKU17/NC 016992/1-26083
Porcine coronavirus HKU15/NC 016990/1-25437
A. B.
CoV: coronavirus; MERS: Middle East respiratory syndrome coronavirus; SARS: severe acute respiratory syndrome.
Panel A: blue: SARS-CoV-2; red: SARS; purple: MERS; green: common cold.
Panel B: cyan: ACE2 human host receptor; grey: CoV spike glycoprotein trimer (PDB:6ACG); red: mutations between SARS- CoV vs SARS-CoV-2.
The phylogenetic tree was created from whole genome alignment with MAFFT using the neighbour-joining method with maximum composite
likelihood (MCL) model, uniform site rates and 500 bootstrap tests using MEGA X .
mammals (or areas with dead birds), or any consump-
tion of raw or undercooked foods. She stated that
she was not in contact with persons with respiratory
A conventional nested RT-PCR test of this patient was
positive for the CoV family [9]. Subsequent genome
sequencing was again compatible with the SARS-
CoV-2 and shared via the GISAID EpiCoV database
(EPI_ISL_ 403963). A nasopharyngeal swab also tested
positive by RT-PCR for adenovirus. The patient was no
longer febrile as of 17 January, and after testing nega-
tive for the CoV family by conventional nested RT-PCR,
she was discharged and she returned to China.
Genome sequence analysis
Comparing the two genome sequences with a non-
redundant selection of representatives from all known
CoV families by alignment [10] and phylogenetic tree
(Figure 1A) [11] shows that they belong to the SARS
family of betacoronaviruses and while related to SARS-
CoV (80% genome identity), they were most closely
related to SARS-like bat CoV from China (88% identity)
as closest known sequence at the time of emergence.
Structural mapping of mutations in the spike glyco-
protein between SARS CoV and the two cases of the
SARS-CoV-2 reported here shows only 76% identity
at the protein level (Figure 1B). This surface protein is
critical for ACE2 host receptor interaction and is also
a target of the immune response [12,13]. Given several
mutations in the binding interface, it may differ in host
cell binding efficiency compared with SARS-CoV which
could result in differences in virulence and transmis-
sion potential [14,15].
The genomes of the two separate cases of coronavi-
rus disease 2019 (COVID-19) are identical over the full
length of close to 30 kb and are furthermore identical
to five other sequences (four from Wuhan and one from
Zhejiang); together these sequences form the largest
cluster of identical cases within the early outbreak,
comprising a core of at least indirectly linked cases
(Figure 2). Within-outbreak sequence divergence is
generally low with 0–9 nt differences over the whole
genome and mutations unique to individual strains are
possibly related to quality differences of the samples
and noise of the methods used for sequencing.
Follow-up of contacts
Case 1 travelled in a tour group with 15 others and 40
close contacts were identified: 15 members of the tour
group, 15 people sitting within two rows in front and
back of the seat of case 1 on the same airplane, nine
crew members and one port health officer. They were
F 2
Within-outbreak SARS-CoV-2 sequence divergence and clusters, China and Thailand, January 2020
2019-12-24 WUHAN/IPBCAMS-WH-01
2019-12-30 WUHAN/HBCDC-HB-01
2019-12-30 WUHAN/IPBCAMS-WH-02
2019-12-30 WUHAN/IPBCAMS-WH-03
2019-12-30 WUHAN/IPBCAMS-WH-04
2019-12-30 WUHAN/IVDC-HB-01
2019-12-30 WUHAN/IVDC-HB-05
2019-12-30 WUHAN/WIV02
2019-12-30 WUHAN/WIV04
2019-12-30 WUHAN/WIV05
2019-12-30 WUHAN/WIV06
2019-12-30 WUHAN/WIV07
2020-01-01 WUHAN/IVDC-HB-04
2020-01-08 NONTHABURI/61
2020-01-13 NONTHABURI/74
2020-01-14 GUANGDONG/20SF012
2020-01-15 GUANGDONG/20SF013
2020-01-15 GUANGDONG/20SF014
2020-01-15 GUANGDONG/20SF025
2020-01-16 ZHEJIANG/WZ-01
2020-01-17 GUANGDONG/20SF028
2020-01-18 GUANGDONG/20SF040
2020-01-17 ZHEJIANG/WZ-02
9 7
4 2 7
3 1 6 1
3 1 6 1 0
5 3 8 3 2 2
5 3 8 3 2 2 4
3 1 6 1 0 0 2 2
5 3 8 3 2 2 4 4 2
3 1 6 1 0 0 2 2 0 2
5 3 8 3 2 2 4 4 2 4 2
6 4 9 4 3 3 5 5 3 5 3 5
3 1 6 1 0 0 2 2 0 2 0 2 3
3 1 6 1 0 0 2 2 0 2 0 2 3 0
6 4 9 4 3 3 5 5 3 5 3 5 6 3 3
6 4 9 4 3 3 5 5 3 5 3 5 6 3 3 0
4 2 7 2 1 1 3 3 1 3 1 3 4 1 1 4 4
6 4 9 4 3 3 5 5 3 5 3 5 6 3 3 0 0 4
5 3 8 3 2 2 4 3 2 4 2 4 5 2 2 5 5 3 5
4 2 7 2 1 1 3 3 1 3 1 3 4 1 1 4 4 2 4 3
3 1 6 1 0 0 2 2 0 2 0 2 3 0 0 3 3 1 3 2 1
4 2 7 2 1 1 3 3 1 3 1 3 4 1 1 4 4 2 4 3 0 1
Number of pair-wise nt dif ferences across whole genomes colour-coded from zero (green) to nine (red). Blue: Thai sample names. Orange:
samples with sequences identical to each other and the Thai sequences.
We gratefully acknowledge the authors, the originating and submit ting laboratories for their sequence and metadata shared through GISAID,
on which this research is based (as listed in Supplementary Table 1).
monitored for COVID-19 with RT-PCR tests on days 1, 12
and 14 ; all tested negative.
Case 2 travelled in a tour group with 19 others and 44
close contacts were identified: 19 members of the tour
group, 15 within two rows front and back of the seat of
case 2, nine crew members and one port health officer.
All were monitored for COVID-19 with RT-PCR tests on
days 1, 12 and 14 and all tested negative.
Discussion and conclusion
According to the cases’ history, the two impor ted
COVID-19 cases described here are not directly linked,
yet their genomes are identical. Further, according to
information provided by the cases, they have no direct
link to the Huanan Seafood Market but their genomes
are identical to four sequences from Wuhan collected
on 30 December 2019 and sequenced by three differ-
ent laboratories, indicating potential wider distribution
in the city. Although within-outbreak sequence diver-
gence is low for this virus, identical genomes of up to
30 kb are rare and a strong sign of recent transmis-
sion linkage, albeit with unknown number of genera-
tions within the transmission chain. The missing link to
the market, the time of travel and onset of symptoms
in the two COVID-19 cases together with the incuba-
tion period of mean 6.4 days (range: 5.6–7.7) [16] and
the time of closest genome neighbours obtained from
sequences in Wuhan, suggest that transmission within
Wuhan beyond the Huanan Seafood Market is likely to
have occurred in the first week of Januar y or earlier.
People travelling out of the city since then may have
spread the virus further before travel restrictions were
enforced on 23 January [17].
Thailand implemented measures for screening
patients travelling from Wuhan since 3 January 2020
at Suvarnabhumi Airport, Don Mueang, Phuket and
Chiang Mai airpor ts, and stepped up sur veillance at
public and private hospitals. The two cases described
here who tested positive for SARS-CoV-2 were the first
confirmed exported cases from China, suggesting
early international spread. Therefore, while one can-
not exclude the possibility that asymptomatic cases in
their incubation period would be missed and become
infectious later, screening of incoming travellers from
an affected area proved successful at least in these
two instances, when COVID-19 cases were detected,
isolated, observed and only discharged once they
tested negative for SARS-CoV-2. Rapid response includ-
ing genome sequencing and sharing via GISAID [18,19]
( enabled fast dissemination
of results and provided a glimpse of early transmission
patterns in this outbreak.
The authors wish to thank all the participants in this study.
We would like to thank GISAID President Peter Bogner for
help in sharing with GISAID and Dr Opart Karnkawinpong
(Director General of Depar tment of Medical Sciences) for his
support and guidance during the investigation.
Conflict of interest
None declared.
Authors’ contributions
PO, SPh, TT, SPa, WW, SWai, MC, NM and NJ contributed
work in the Department of Medical Sciences; RB, AV, SU and
SI in the Department of Disease Control; and SWac in the
Health Science Centre. RTCL and SMS provided the sequence
analysis and figures. PO and SMS drafted the manuscript.
All authors saw and agreed to the final version.
1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical
features of patients infected with 2019 novel coronavirus in
Wuhan, China. Lancet. 2020;395(10223):497-506. https://doi.
org/10.1016/S0140-6736(20)30183-5 PMID: 31986264
2. Mahase E. China coronavirus: what do we know so far? BMJ.
2020;368:m308. PMID:
3. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel
Coronavirus from Patients with Pneumonia in China, 2019. N
Engl J Med. 2020;NEJMoa2001017.
NEJMoa2001017 PMID: 31978945
4. Du Toit A. Outbreak of a novel coronavirus. Nat Rev Microbiol.
PMID: 31988490
5. Wang C, Horby PW, Hayden FG, Gao GF. A novel
coronavirus outbreak of global health concern. Lancet.
6736(20)30185-9 PMID: 31986257
6. Munster VJ, Koopmans M, van Doremalen N, van Riel D, de
Wit E. A Novel Coronavirus Emerging in China - Key Questions
for Impact Assessment. N Engl J Med. 2020;NEJMp2000929. PMID: 31978293
7. Gorbalenya AE, Baker SC, Baric RS, de Groot RJ, Drosten C,
Gulyaeva AA , et al. Severe acute respiratory syndrome-related
coronavirus: The species and its viruses – a statement of the
Coronavirus Study Group. bioRxiv. 2020;937862: (Preprint).
Available from:
8. Naess A, Nilssen SS, Mo R, Eide GE, Sjursen H. Role of
neutrophil to lymphocyte and monocyte to lymphocyte ratios
in the diagnosis of bacterial infection in patients with fever.
Infection. 2017;45( 3):299-307.
016-0972-1 PMID: 27995553
9. Department of Medical Sciences, Ministry of Public Health,
Thailand. Diagnostic detection of Novel coronavirus 2019
by real time RT-PCR. 23 Jan 2020. [Accessed 26 Feb 2020].
Available from:
10. Nakamura T, Yamada KD, Tomii K, Katoh K. Parallelization
of MAF FT for large-scale multiple sequence alignments.
Bioinformatics. 2018;34(14):2490-2.
bioinformatics/bty121 PMID: 29506019
11. Kumar S, Stecher G, Li M, Knyaz C, Tamura K. MEGA X:
Molecular Evolutionary Genetics Analysis across Computing
Platforms. Mol Biol Evol. 2018;35(6):1547-9. https://doi.
org/10.1093/molbev/msy096 PMID: 29722887
12. Song W, Gui M, Wang X, Xiang Y. Cryo-EM structure of the
SARS coronavirus spike glycoprotein in complex with its
host cell receptor ACE2. PLoS Pathog. 2018;14(8):e1007236. PMID: 30102747
13. Du L, He Y, Zhou Y, Liu S, Zheng B-J, Jiang S. The spike
protein of SARS- CoV--a target for vaccine and therapeutic
development. Nat Rev Microbiol. 2009;7( 3):226-36. https:// PMID: 19198616
14. Zhou P, Yang X-L, Wang X- G, Hu B, Zhang L, Zhang W, et al.
A pneumonia outbreak associated with a new coronavirus of
probable bat origin. Nature. 2020.
s41586- 020-2012-7 PMID: 32015507
15. Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor
recognition by novel coronavirus from Wuhan: An analysis
based on decade-long struc tural studies of SARS. J Virol.
PMID: 31996437
16. Backer JA, Klinkenberg D, Walling a J. Incubation period
of 2019 novel coronavirus (2019-nCoV ) infections among
travellers from Wuhan, China, 20 -28 Januar y 2020. Euro
Surveill. 2020;25(5).
ES.2020.25.5.2000062 PMID: 32046819
17. Crossley G. Wuhan lockdown ‘unprecedented’, shows
commitment to contain virus: WHO representative in China.
Reuters. 23 Jan 2020. Available from: ht tps://www.reuters.
18. Shu Y, McCauley J. GISAID: Global initiative on sharing
all influenza data - from vision to reality. Euro Surveill.
ES.2017.22.13.30494 PMID: 28382917
19. Elbe S, Buckland-Merrett G. Data, disease and diplomacy:
GISAID’s innovative contribution to global health. Glob Chall.
2017;1(1):33-46. PMID:
20. Krieger E, Vriend G. YASARA View - molecular graphics for all
devices - from smartphones to workstations. Bioinformatics.
btu426 PMID: 24996895
License, supplementary material and copyright
This is an open-access article distributed under the terms of
the Creative Commons Attribution (CC BY 4.0) Licence. You
may share and adapt the material, but must give appropriate
credit to the source, provide a link to the licence and indicate
if changes were made.
Any supplementary material referenced in the article can be
found in the online version.
This article is copyright of the authors or their affiliated in-
stitutions, 2020.
... Animal coronaviruses can also infect humans and have previously resulted in outbreaks. For example, the early infections of COVID-19 in Wuhan suggested zoonotic transmission [37,[65][66][67]. In the last two decades, three documented highly pathogenic and lethal coronavirus have affected humans: SARS-CoV and MERS-CoV, and SARS-CoV-2 [37,38,45,49]. Figure 4 presents the conceptual view of these coronaviruses (bottom left cluster). ...
... In the next month following (January 2020), scientists identified a novel coronavirus (nCoV) strain as the causative agent [66]. The common belief was that the virus originated from a local seafood/wild animal market [42,67], suggesting that it spread from animals to humans. The infection continued to spread among humans to several other countries. ...
Several publications on the concept and structure of SARS-CoV-2 and COVID-19 over the past three years target medical and biomedical scientists, and rightly so, as experts in search of solutions made efforts to understand the molecular structure of the coronavirus. The multidisciplinary audience who needs help understanding the scientific discourse and the complexity of SARS-CoV-2 is left to guess in the dark. Studies show that a lack of proper understanding of the pandemic can have several consequences, including accepting conspiracy theories, misinformation, negative attitudes against public health safety measures, and the COVID-19 vaccine hesitation. This study uses metadata extracted from published documents on the concepts and structure of COVID-19 indexed on the Web of Science between 2020 to 2021 to create an abstract visual metaphor about the pandemic. Based on the cognitive connection theory, we develop a model and visualization that explains the conceptual structure of SARS-CoV-2 and COVID-19 for the non-biomedical multidisciplinary audience. The visual analytics highlights the concepts, characteristics, and interrelationships on a network map, connecting some past viral/coronavirus pandemics and epidemics, particularly H1N1, SARS-CoV, and MERS-CoV. The conceptual model and visualization generate insight and understanding of the ongoing pandemic for multidisciplinary audiences.
... In contrast [17] , China took an active role in this regard by kicking a diplomatic mechanism as a means of the international response. China has given protective gear to fifty-four countries, and also bolstered diplomacy by announcing African Centre for Disease Prevention and Control plan in Nairobi [18] . Subsequently, several conspiracy theories are hitting the global relationships. ...
... (2020). 18 Brennan, Richard, Rana Hajjeh, and Ahmed Al-Mandhari. "Responding to health emergencies in the Eastern Mediterranean region in times of conflict." ...
... Early on in the pandemic, before preventive measures were taken, air travel was found to be contributing to the spread of COVID-19 outside of China. 2,3 As described for other pandemic viruses such as influenza A/H1N1 2009 and SARS-CoV, 4,5 inflight transmission of SARS-CoV-2 has been reported. [6][7][8][9] In their systematic review, Rosca et al. 10 identified 130 unique flights where 273 index cases led to 64 reported secondary cases, with an attack rate ranging from 0% to 8.2% in studies where >80% of the passengers and crew were followed-up. ...
SARS-CoV-2 can be effectively transmitted between individuals located in close proximity to each other for extended durations. Aircraft provide such conditions. Although high attack rates during flights were reported, little was known about the risk levels of aerosol transmission of SARS-CoV-2 in aircraft cabins. The major objective was to estimate the risk of contracting COVID-19 from transmission of aerosol particles in aircraft cabins. In two single-aisle and one twin-aisle aircraft, dispersion of generated aerosol particles over a seven-row economy class cabin section was measured under cruise and taxi conditions and simulated with a computational fluid dynamic model under cruise conditions. Using the aerosol particle dispersion data, a quantitative microbial risk assessment was conducted for scenarios with an asymptomatic infectious person expelling aerosol particles by breathing and speaking. Effects of flight conditions were evaluated using generalized additive mixed models. Aerosol particle concentration decreased with increasing distance from the infectious person, and this decrease varied with direction. On a typical flight with an average shedder, estimated mean risk of contracting COVID-19 ranged from 1.3×10^−3 to 9.0×10^−2. Risk increased to 7.7×10^−2 with a super shedder (<3% of cases) on a long flight. Risks increased with increasing flight duration: 2–23 cruise flights of typical duration and 2–10 flights of longer duration resulted in at least 1 case of COVID-19 due to onboard aerosol transmission by one average shedder, and in the case of one super shedder, at least 1 case in 1–3 flights of typical duration cruise and 1 flight of longer duration. Our findings indicate that the risk of contracting COVID-19 by aerosol transmission in an aircraft cabin is low, but it will not be zero. Testing before boarding may help reduce the chance of a (super)shedder boarding an aircraft and mask use further reduces aerosol transmission in the aircraft cabin.
... (Okada et al., 2020). This outbreak was named coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). ...
Conference Paper
Full-text available
The purpose of this study is to find out the application of a marketing mixed strategy to increase room occupancy rates and determine the strengths, weaknesses, opportunities and threats at Karma Kandara Resort Bali during the Covid-19 pandemic. Data collection techniques in this study were interview studies and documentation. The collected data were analysed using qualitative descriptive analysis techniques supported by SWOT analysis. The results of this study are SO strategy (strength opportunities) by utilizing the Karma brand as a benchmark to promote the latest products, maintaining and improving distribution channels as well as maintaining good relationships and service quality with customers to help promote through word of mouth. WO (weakness opportunity) strategy by accelerating CHSE (Cleanliness, Health, Safety, Environment Sustainability) certification. ST strategy (strength-threat) by maintaining competitive prices with competitors, expanding and increasing promotional activities that have been carried out. WT (weakness-threat) strategy by holding promos at restaurants and spas to be added to room sales, cooperating with events or wedding organizers. Therefore, it can be concluded that the right SWOT strategy to increase room occupancy rates is seen from the indicators in the 7P marketing mixed elements are ST (strength threat) strategy and the WT (weakness threat) strategy.
... Hypertension, [6] The magnitudes of ACE-2 receptor, Asian people are more susceptible for COVID-19 due to high expression of ACE-2 receptor [121] Pro-inflammatory Cytokines [163] High amount of C-reactive proteins [150] Disease severity is increased with rennin angiotensin system (RAS) [154] Bacterial and viral infection such as Klebsiella and influenza infection. [156] Older age population is more susceptible for infection [152] Smoking increase the chances of COVID-19 [144] However, all the mentioned comorbidities and risk factors significantly increased the chances of COVID-19 and make individual more susceptible for infection, which need to strict implementations of all SOPs released by concerned health authorities such as using of strong disinfectant on nearby surfaces, frequent hand washing with efficient sanitizer, regular using of mask and gloves and avoiding the crowded areas [168]. The health authorities need to strictly implement the standard operating procedures (SOPs) and aware the people about all those risk factors and susceptibilities of COVID-19 [169, 170.] ...
Full-text available
The Chinese population having epidemiological link with wholesale market of seafood develop respiratory illness with pneumonia like clinical presentations in Hubei Province, Wuhan City, recently in December 2019. Laboratory results revealed a novel coronavirus that was named severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) and disease it caused given name of coronavirus disease 2019 (COVID-19). COVID-19 turn out to be third outbreak of human pathogenic coronaviruses and first pandemic of 21 st century. The previous coronaviruses proved merely as a tip of iceberg after emergence of recently identified SARS-CoV-2 with potential of pandemic status that significantly revealed the concealed 991 capabilities of virulence and contagiousness of betacoronaviruses group. The aim of this review is to discuss the origin of COVID-19, transmission patterns, susceptible hosts, factors that increase disease severity, nucleic acid base diagnosis, mortality and morbidity rates and therapeutic option against COVID-19. The diagnostic methods like microarray and RNA-targeting CRISPR were adopted recently for COVID-19 diagnosis after advancing them further for rapid and accurate detection of COVID-19 and high throughput.
Coronavirus disease 2019 (COVID-19) is a worldwide pandemic infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). World Health Organization (WHO) has defined the viral variants of concern (VOC) which cause more severe disease, higher transmissibility, and reduced vaccine efficacy. In this study, the “Nano COVID-19” workflow based on Oxford nanopore sequencing of the full-length spike gene combined with flexible data analysis options was developed to identify SARS-CoV-2 VOCs. The primers were designed to cover the full-length spike gene and can amplify all VOC strains. The results of VOC identification based on phylogenetic analysis of the full-length spike gene were comparable to the whole genome sequencing (WGS). Compared to the standard VOC identification pipeline, the fast analysis based on Read Assignment, Mapping, and Phylogenetic Analysis in Real Time (RAMPART) and the user-friendly method based on EPI2ME yielded 89.3% and 97.3% accuracy, respectively. The EPI2ME pipeline is recommended for researchers without bioinformatic skills, whereas RAMPART is more suitable for bioinformaticians. This workflow provides a cost-effective, simplified pipeline with a rapid turnaround time. Furthermore, it is portable to point-of-care SARS-CoV-2 VOC identification and compatible with large-scale analysis. Therefore, “Nano COVID-19” is an alternative viral epidemic screening and transmission tracking workflow.
Purpose: The SARS-CoV-2 pandemic prompted the development and use of next-generation vaccines. Among these, mRNA-based vaccines consist of injectable solutions of mRNA encoding for a recombinant Spike, which is distinguishable from the wild-type protein due to specific amino acid variations introduced to maintain the protein in a prefused state. This work presents a proteomic approach to reveal the presence of recombinant Spike protein in vaccinated subjects regardless of antibody titer. Experimental design: Mass spectrometry examination of biological samples was used to detect the presence of specific fragments of recombinant Spike protein in subjects who received mRNA-based vaccines. Results: The specific PP-Spike fragment was found in 50% of the biological samples analyzed, and its presence was independent of the SARS-CoV-2 IgG antibody titer. The minimum and maximum time at which PP-Spike was detected after vaccination was 69 and 187 days, respectively. Conclusions and clinical relevance: The presented method allows to evaluate the half-life of the Spike protein molecule "PP" and to consider the risks or benefits in continuing to administer additional booster doses of the SARS-CoV-2 mRNA vaccine. This approach is of valuable support to complement antibody level monitoring and represents the first proteomic detection of recombinant Spike in vaccinated subjects.
Full-text available
Announced on December 31, 2019, the novel coronavirus arising in Wuhan City, Hubei Province resulted in millions of cases and lives lost. Following intense tracking, coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) in 2020. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the cause of COVID-19 and the continuous evolution of the virus has given rise to several variants. In this review, a comprehensive analysis of the response to the pandemic over the first three-year period is provided, focusing on disease management, development of vaccines and therapeutics, and identification of variants. The transmissibility and pathogenicity of SARS-CoV-2 variants including Alpha, Beta, Gamma, Delta, and Omicron are compared. The binding characteristics of the SARS-CoV-2 spike protein to the angiotensin-converting enzyme 2 (ACE2) receptor and reproduction numbers are evaluated. The effects of major variants on disease severity, hospitalisation, and case-fatality rates are outlined. In addition to the spike protein, open reading frames mutations are investigated. We also compare the pathogenicity of SARS-CoV-2 with SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV). Overall, this study highlights the strengths and weaknesses of the global response to the pandemic, as well as the importance of prevention and preparedness. Monitoring the evolution of SARS-CoV-2 is critical in identifying and potentially predicting the health outcomes of concerning variants as they emerge. The ultimate goal would be a position in which existing vaccines and therapeutics could be adapted to suit new variants in as close to real-time as possible.
Full-text available
In recent years, COVID-19 has evolved into many variants, posing new challenges for disease control and prevention. The Omicron variant, in particular, has been found to be highly contagious. In this study, we constructed and analyzed a mathematical model of COVID-19 transmission that incorporates vaccination and three different compartments of the infected population: asymptomatic [Formula: see text], symptomatic [Formula: see text], and Omicron [Formula: see text]. The model is formulated in the Caputo sense, which allows for fractional derivatives that capture the memory effects of the disease dynamics. We proved the existence and uniqueness of the solution of the model, obtained the effective reproduction number, showed that the model exhibits both endemic and disease-free equilibrium points, and showed that backward bifurcation can occur. Furthermore, we documented the effects of asymptomatic infected individuals on the disease transmission. We validated the model using real data from Thailand and found that vaccination alone is insufficient to completely eradicate the disease. We also found that Thailand must monitor asymptomatic individuals through stringent testing to halt and subsequently eradicate the disease. Our study provides novel insights into the behavior and impact of the Omicron variant and suggests possible strategies to mitigate its spread.
Full-text available
The present outbreak of lower respiratory tract infections, including respiratory distress syndrome, is the third spillover, in only two decades, of an animal coronavirus to humans resulting in a major epidemic. Here, the Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses, which is responsible for developing the official classification of viruses and taxa naming (taxonomy) of the Coronaviridae family, assessed the novelty of the human pathogen tentatively named 2019-nCoV. Based on phylogeny, taxonomy and established practice, the CSG formally recognizes this virus as a sister to severe acute respiratory syndrome coronaviruses (SARS-CoVs) of the species Severe acute respiratory syndrome-related coronavirus and designates it as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To facilitate communication, the CSG further proposes to use the following naming convention for individual isolates: SARS-CoV-2/Isolate/Host/Date/Location. The spectrum of clinical manifestations associated with SARS-CoV-2 infections in humans remains to be determined. The independent zoonotic transmission of SARS-CoV and SARS-CoV-2 highlights the need for studying the entire (virus) species to complement research focused on individual pathogenic viruses of immediate significance. This research will improve our understanding of virus-host interactions in an ever-changing environment and enhance our preparedness for future outbreaks.
Full-text available
A novel coronavirus (2019-nCoV) is causing an outbreak of viral pneumonia that started in Wuhan, China. Using the travel history and symptom onset of 88 confirmed cases that were detected outside Wuhan in the early outbreak phase, we estimate the mean incubation period to be 6.4 days (95% credible interval: 5.6 7.7), ranging from 2.1 to 11.1 days (2.5th to 97.5th percentile). These values should help inform 2019-nCoV case definitions and appropriate quarantine durations. © 2020 European Centre for Disease Prevention and Control (ECDC). All rights reserved.
Full-text available
Since the SARS outbreak 18 years ago, a large number of severe acute respiratory syndrome-related coronaviruses (SARSr-CoV) have been discovered in their natural reservoir host, bats1–4. Previous studies indicated that some of those bat SARSr-CoVs have the potential to infect humans5–7. Here we report the identification and characterization of a novel coronavirus (2019-nCoV) which caused an epidemic of acute respiratory syndrome in humans in Wuhan, China. The epidemic, which started from 12 December 2019, has caused 2,050 laboratory-confirmed infections with 56 fatal cases by 26 January 2020. Full-length genome sequences were obtained from five patients at the early stage of the outbreak. They are almost identical to each other and share 79.5% sequence identify to SARS-CoV. Furthermore, it was found that 2019-nCoV is 96% identical at the whole-genome level to a bat coronavirus. The pairwise protein sequence analysis of seven conserved non-structural proteins show that this virus belongs to the species of SARSr-CoV. The 2019-nCoV virus was then isolated from the bronchoalveolar lavage fluid of a critically ill patient, which can be neutralized by sera from several patients. Importantly, we have confirmed that this novel CoV uses the same cell entry receptor, ACE2, as SARS-CoV.
Full-text available
In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed another clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.).
The recent emergence of Wuhan coronavirus (2019-nCoV) puts the world on alert. 2019-nCoV is reminiscent of the SARS-CoV outbreak in 2002 to 2003. Our decade-long structural studies on the receptor recognition by SARS-CoV have identified key interactions between SARS-CoV spike protein and its host receptor angiotensin-converting enzyme 2 (ACE2), which regulate both the cross-species and human-to-human transmissions of SARS-CoV. One of the goals of SARS-CoV research was to build an atomic-level iterative framework of virus-receptor interactions to facilitate epidemic surveillance, predict species-specific receptor usage, and identify potential animal hosts and animal models of viruses. Based on the sequence of 2019-nCoV spike protein, we apply this predictive framework to provide novel insights into the receptor usage and likely host range of 2019-nCoV. This study provides a robust test of this reiterative framework, providing the basic, translational, and public health research communities with predictive insights that may help study and battle this novel 2019-nCoV.
The emergence of a new coronavirus in China raises global alarm.