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The coronavirus may have reached Los Angeles by Christmas



Was the new coronavirus free in Los Angeles back in December, before the World Health Organization even knew of an unusual cluster of pneumonia cases in Wuhan, China?

A new analysis of medical records from UCLA hospitals and clinics suggests that the answer may be yes.

Researchers from UCLA and their colleagues at the University of Washington have documented an unmistakable increase in patients seeking cough treatment. The increase began during the week of December 22, 2019 and lasted until the end of February.

Some of these patients were treated in outpatient centers. Others came to the emergency rooms, and some were eventually admitted to Ronald Reagan̵

7;s UCLA Medical Center or other UCLA-operated hospitals.

Officials at the U.S. Centers for Disease Control and Prevention first admitted that the coronavirus reached the U.S. coast in mid-January when a Washington man traveling to the Wuhan area tested positive for infection. Until then, UCLA doctors may have treated dozens of patients with COVID-19 without understanding, the study authors write. (In fact, it will take another three weeks for COVID-19 to receive its official name.)

The researchers did not perform any diagnostic tests, so they cannot say for sure when doctors first encountered someone infected with the virus, which became known as SARS-CoV-2. But if the coronavirus had indeed spread under the radar around Christmas, the pattern of patient visits to UCLA facilities would have looked much like what actually happened, they wrote in a study published Thursday in the Journal of Medical Internet Research.

“A significantly higher number of patients with respiratory complaints and diseases, beginning in late December 2019 and continuing in February 2020, suggests the spread of SARS-CoV-2 in the community before the established opportunities for clinical awareness and testing,” writes the team led by Dr. Joan Elmore, who is both an internist and a professor of health policy and management at UCLA.

To look for signs of early patients with COVID-19, Elmore and her colleagues searched more than 9.5 million outpatient visits, nearly 575,000 emergency room visits and nearly 250,000 hospital admissions, going back more than five years. The analysis included medical records according to which a patient complained of cough.

The researchers counted a total of 2,938 patients who went to a clinic seeking cough relief in the 13 weeks between December 1, 2019 and February 29, 2020. That’s about 1,047 more than the average number of cough patients. observed during the same quarterly period in the previous five years. This was also about 739 more than the number of patients observed in the winter of 2016-17, which until this year was the busiest cough season for clinics since 2014.

In the emergency rooms, the researchers collected 1,708 cough patients in December, January and February. This is about 514 more than the average for the previous five winters and about 229 more than 2018-19, the busiest of the five previous winters, the researchers estimate.

Finally, a search of medical records revealed 1,138 patients who were hospitalized in December, January, or February and treated for acute respiratory failure. This was about 387 more than the average number of patients with acute respiratory failure admitted in the previous five winters, and about 210 more than the number admitted in the winter of 2018-19, the worst of the five earlier winters.

“It is possible that part of this excess is an early disease of COVID-19 before clinical recognition and testing,” Elmore and colleagues wrote.

Breaking things down week after week, the study’s authors found that the number of cough patients coming to clinics last winter was higher with a statistically significant margin in 10 of the 13 weeks analyzed. This also applies to patients with a cough in HP after six of the 13 weeks. And in hospitals, the number of patients with acute respiratory distress is significantly higher in seven of the 13 weeks.

Even if only some of these “unnecessary visits” were from patients with COVID-19, this could still be a sign that the new coronavirus is spreading silently in and around Los Angeles, the researchers wrote. As it became clear later in the pandemic, about 40% of those infected with SARS-CoV-2 never develop any symptoms of the disease, and those with minor symptoms may not bother to seek medical treatment. This means that patients who have gone to a clinic or hospital are probably just the tip of the iceberg, the study authors explained.

Of course, some of these patients with an additional cough may have had regular seasonal flu, especially since flu cases peaked earlier than usual this winter, the researchers wrote. It is also possible that the outbreak of vaping-related respiratory disease in 2019 will contribute to the surplus, they added.

But the idea that the coronavirus was circulating in California before December 31, when the Wuhan Municipal Health Commission first announced its group of unexplained cases of pneumonia, may not be exaggerated.

We now know that seven patients treated at the Los Angeles County Medical Center at the USC in mid-March for flu-like illness actually had COVID-19. The fact that they all feel well enough to leave their homes and have not had a clear relationship with anyone who has recently visited a COVID-19 hotspot suggests that they became infected through a long-term community broadcast, another wrote. a group of researchers in the Journal of American Medical Assn.

Similar cases observed in Santa Clara County at the same time suggest that the virus had been at large in the Gulf region until then, according to a study in the CDC’s weekly Morbidity and Mortality Report.

We may never know for sure exactly when the coronavirus arrived in Los Angeles – or anywhere else in the United States. However, the results of the new study show that data obtained from the clinic’s medical records “can provide early warning to emergency departments and hospital intensive care units about what lies ahead,” the UCLA team wrote.

“The lessons learned from this pandemic will hopefully lead to better preparation and the ability to provide rapid warnings and follow-up to the next pandemic,” they added.




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