Was COVID-19 Already in France Last December?

Revisiting the coronavirus timeline.

Posted May 06, 2020

Was COVID-19 already present in France in December 2019?

Until a few days ago, the first known COVID-19 cases in France were described on January 24, 2020, in people coming from China; no earlier case was described. But a study in International Journal of Antimicrobial Agents casts events in a new light.

Yves Cohen, Intensive Care Unit director in two hospitals northeast of Paris, was aware of several patients hospitalized in the ICU in December 2019 and early January 2020 with typical COVID-19 symptoms (fever, cough, sore throat, muscle aches) and who also had typical COVID-19 Chest CT scan (the lungs look like ground glass).  

Those sick patients were admitted during the flu season and were tested for the flu, but their flu test was negative as well as other bacteriological and viral tests. Those patients were never tested for SARS-CoV-2 (the virus responsible for COVID-19). The origin of the patients’ pneumonia was a mystery. 

Looking to solve that mystery, Cohen teamed up with A. Deslandes (microbiologist) in early April 2020 to retrieve respiratory samples (samples are kept four years) from the laboratory freezer of 14 patients who fit the clinical and radiological description of COVID-19, and to test the respiratory samples for SARS-CoV-2.  

Out of those 14 samples, one tested positive for SARS-CoV-2, the virus responsible for COVID-19. To decrease the probability of a false positive, the French team repeated the test and got the same positive result a second time. Deslandes and Cohen published their results in the International Journal of Antimicrobial agents this week.

The sample that tested positive for SARS-CoV-2 belonged to a 42-year-old diabetic man who was born in Algeria but had been living in France for a long time and had not visited China.  

The man was admitted to the ICU in December 27, 2019 for a four-day history of fever, headaches, coughing, and blood in his sputum. He was diagnosed with pneumonia, placed on antibiotics, got better and was discharged 2 days later. It is interesting that one of the man’s children had the same kind of symptoms before the man got sick.

Deslandes and Cohen conclude: “the absence of a link with China and the lack of recent travel suggest that the disease was already spreading among the French population at the end of December 2019.”

The French researchers said that their study has limitations, such as possible false negative test results given that they only examined a few respiratory samples. Cohen recommends that other studies be done retrospectively in other hospitals to determine the real onset the COVID-19 in France. 

I asked William Haseltine, former Harvard Medical School professor, founder of the university’s cancer and HIV/AIDS research departments, and Chair and President of the global health think tank ACCESS Health International, for comment on the French study. He said, “The recent report that SARS-CoV-2 RNA was retrospectively found in a patient admitted for respiratory distress in late December 2019 provides evidence that the infection occurred in early December.”

Haseltine added, “Few details regarding how the infection might have been acquired are provided. Assuming the observation is correct, it is not surprising that a virus as infectious a SARS-CoV-2 could be transmitted to a person in France either directly or via intermediate person or persons from an Asian source in early December given the observation that a majority of those infected are asymptomatic or experience only minor cold symptoms.“

Why is the French discovery important?

  1. Because no deaths from coronavirus were recorded in France from early December 2019 (when the first French patient was likely infected) until February 14, 2020, the timeline shows that it can take over two months for a nascent epidemic to rear its head. 
  2. The first documented hospitalization for COVID-19 in China was December 16, so the initial COVID-19 infections in China and France could have occurred almost simultaneously in early December. Thus, the timeline and origin of the disease may be far less clear than previously thought.
  3. What are the implications of the French discovery for the world outside of France and China? Could retrospective studies of respiratory samples of flu-negative, ground-glass-lung- appearing pneumonia patients in Northern Italian ICUs in December 2019, or even in November, find COVID-19 infections? What about in the United States, particularly in New York ICUs?

More retrospective studies are warranted.

References

https://www.sciencedirect.com/science/article/pii/S0924857920301643

International Journal of Antimicrobial Agents, May 3rd, 2020