A high-profile scientific paper that found that a patient with the new coronavirus had transmitted it to other people in Germany before showing any symptoms was based on faulty information, health officials say.
The woman, whose case was reported last week in the New England Journal of Medicine, had experienced mild symptoms and was taking fever-suppressing medication at the time she infected two colleagues, the Robert Koch Institute, Germany’s public health agency, confirmed via email. The woman, from China, was on a work trip to her company’s headquarters in Bavaria.
The revelation, first reported by ScienceInsider, the news arm of the journal Science, knocks the foundation out from under the report, which triggered significant concern after its publication because of the implications of asymptomatic spread of the virus, provisionally known as 2019-nCoV.
It does not mean on its own that asymptomatic spread cannot or has not happened. Chinese officials have reported some other cases of asymptomatic spread. Still, the NEJM paper was the first — and perhaps only — well-documented case.
On Friday the Centers for Disease Control and Prevention used the NEJM paper as part of its rationale for ordering a 14-day quarantine of Americans who had been evacuated from Wuhan, the epicenter of the coronavirus outbreak.
“There has been an increasing number of reports of person-to-person spread. And now most recently, a report from the New England Journal of Medicine of asymptomatic spread,” said Dr. Nancy Messonnier, director of CDC’s National Center for Immunization and Respiratory Diseases. “While we still don’t have the full picture and we can’t predict how this situation will play out in the U.S., the current situation, the current scenario is a cause for concern.”
Over the weekend, the head of the World Health Organization’s health emergencies program called into question whether people who were pre-symptomatic were playing a role in the spread of this new virus.
“We still believe, looking at the data, that the force of infection here, the major driver, is people who are symptomatic, unwell, and transmitting to others along the human-to-human route,” Dr. Mike Ryan told STAT. “That is the pressure wave.”
In the German case, public health authorities in Bavaria and at the Robert Koch Institute tracked down the woman who was infected and inquired about any symptoms she may have had. The NEJM report had been based only on the recollections of her German colleagues.
A spokeswoman for NEJM said Tuesday that the journal is looking into the reports.
Christian Drosten, a virologist whose laboratory validated the lab data in the NEJM study, said the authors should have made clear that they could not reach the woman to interview her before the article was submitted to NEJM.
“In such a fast paper, the clinicians must trust the lab people and vice versa. I trusted them,” Drosten, director of the Institute of Virology at Charité University Hospital in Berlin, said in an email.
Drosten said he is working on a more comprehensive work-up of the cluster of cases, one that will include data on when the infected people were emitting viruses.
The number of infections with the new coronavirus — a relative of the viruses that cause SARS and MERS — has grown to nearly 21,000. While most infections have occurred in China, about two dozen countries have reported roughly 200 cases outside of mainland China, and a number have reported limited person-to-person transmission. To date, 427 people are known to have died.
Andrew Joseph contributed reporting.