The New York City coronavirus outbreak grew so large in early March that the city became the main source of new infections in the United States, new research revealed, when thousands of infected people traveled from the city and spread the epidemic throughout the country. Research shows that the wave of infection spread from New York City to many countries before the city began to set social distance limits to stop growth. That helped trigger an outbreak in Louisiana, Texas, Arizona and as far as the West Coast. This finding was taken from tracking mutations of the signatures of viral geneticists, the travel history of infected people and models of outbreaks by infectious disease experts. “We now have enough data to feel confident enough that New York is the main gateway for the entire country,” said Nathan Grubaugh, an epidemiologist at the Yale School of Public Health. The central role of the New York outbreak shows that decisions made by state and federal officials – including waiting to impose actions that distance and limit international flights – help shape the path of the outbreak and allow it to grow in other parts of the country. The city is joined by other dense urban hot spots around the world, starting with Wuhan, China, and then Milan, which has become a vector of spreading the virus. Trips from other American cities have also triggered infections throughout the country, including from the initial outbreak centered in the Seattle area that spread infections in more than a dozen states, the researchers said. Even if New York had succeeded in slowing down the virus, it might continue to spread from elsewhere, they said. But the Seattle outbreak proved to be a hurricane before a larger hurricane meeting in New York, where, at the end of February, thousands of infected people packed trains and restaurants, packed tourist attractions and passed through three major airports. During important weeks in March, New York political leaders waited to take aggressive action, even after identifying hundreds of cases, getting the virus started. And in mid-March, when President Trump restricted travel from Europe, restrictions were basically useless, the data showed, because the disease had already spread widely at home. Acting early is likely to blunt virus attacks across the country, researchers say. “That means that we missed the boat early on, and much of this country comes from domestic distribution,” said Kristian Andersen, a professor in the department of immunology and microbiology at Scripps Research. “I keep hearing that it’s someone else’s fault. It’s not true. It’s not someone else’s fault, it’s our own fault.” Lack of testing obscures the extent of the plague for months, and officials act on incomplete and sometimes mutually exclusive information. The extraordinary growth of the New York epidemic partly reflects the volume of international visitors, especially from Europe, where most of the transmission originated. Dani Lever, communications director for Governor Andrew M. Cuomo, criticized federal authorities, describing “a major failure by the federal government to leave New York and the East Coast on flights from Europe, while at the same time instilling a false sense of security by telling the State of New York that we did not have a Covid case in February. “A White House spokesman, Judd Deere, said that Trump has acted swiftly, the President blocked part b The number of visitors from Europe began on March 13, more than a month after he restricted travel from China. “Just as he acted from the start to stop the journey from the source of the virus, President Trump was advised by his health and infectious disease experts that he must decide on a journey from Europe – actions he took decisively without delay to save lives while Democrats and the media criticized him and the global health community still don’t fully understand the level of transmission or spread, “Deere said. Now infections are spreading across the country, travel from New York is no longer a major factor shaping the development of the epidemic, researchers say. As countries across the country begin to relax their borders “These findings show that it is difficult, if not impossible, to prevent these actions from affecting other countries. Geneticists have analyzed and shared more than 2,000 samples of the virus from infected people. When the virus infects new people and replicates, the virus take mutations d i along the way. These mutations do not usually change the behavior of viruses, but they can provide a signature from the origin of the virus. Most of the samples taken in Texas, Ohio, Louisiana, Idaho, Wisconsin and many other countries carry different mutations that can be traced back to the virus. introduced to New York. Overall, Dr. Grubaugh estimates, the virus that spreads from New York accounts for 60 to 65 percent of infections identified throughout the country. Other scientists say that they want to see more samples before calculating the right number. But they agreed that the superiority of New York in seeding a national spread seems to have begun in early March, two weeks before a stay-at-home order is enforced. “New York is acting as the Grand Central Station for this virus, with the opportunity to move from there in many directions, to many places,” said David Engelthaler, head of the infectious disease branch of the Translational Genomics Research Institute in Arizona. The most commonly detected viruses associated with New York have different genetic signatures connecting them. for outbreaks in Europe. Those who spread from Washington State have signatures connecting them directly to China. At this stage, scientists say, genetic fingerprints alone are not enough to pinpoint the source of the virus. But the travel patterns and case histories of the first known cases support the idea, they said. “This is a combination of what genomic epidemiology and shoe-skin epidemiology will tell us,” Dr. Engelthaler. about disease nationally said New York’s superiority as a national center was broadly consistent with their findings, although that picture still emerged. “I would say this is not surprising in a certain sense,” said Alessandro Vespignani, director of Network Science. Institute at Northeastern University in Boston. “The picture that appears is consistent with the numerical model.” Previous research by Dr. Vespignani shows how fast, and without being seen, the plague exploded in New York. On March 1, when the first coronavirus case was confirmed in New York, the city probably had more than 10,000 undetected infections, its research group showed. The States of New York and Washington are not the only source of outbreaks. Other large domestic hubs contribute to the spread, scientists believe, and a more diverse genetic mix is still seen in several places throughout the country, especially in the Midwest and the South. Even when domestic travel began to drive outbreaks, some infections were still favored throughout the country by international travelers, geneticists said. It is possible, experts say, that some virus samples linked to New York might be favored in other cities by direct flights from Europe, or from travelers lying in New York before traveling to other places. For that reason, some scientists say they want to see more samples before connecting most infections in the United States to New York. “I think it might be a story line that will emerge, but I want to see more data,” said Harm van Bakel, a geneticist at Mount Sinai in New York. Analysis of the New York Times travel data supports the idea that the infection chain originated in New York, experts said. The number of cases across the country is closely related to how many travelers were received each place from New York in early March, based on anonymous cell phone tracking data from Cuebiq, a data intelligence company. “It looks like most of the domestic spread is basically people traveling from New York,” said Dr. Kari Stefansson, founder and chief executive of deCODE Genetics, a leading genome analysis company based in Reykjavik, Iceland. Last week, Dr. Andersen from Scripps Research and other scientists who analyzed the outbreak in New Orleans reported that all samples taken from New Orleans came from a path that was connected back to New York. The virus spread throughout the region in March and has killed more than 1,000 people. “You can know, with travel patterns, that the most likely thing to happen is to come to New Orleans directly from New York, “said Dr. Grubaugh. Josh Holder, Michael Crowley, and Derek Watkins contributed reporting.
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