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In February, a Chicago man hugged members of a grieving family at a funeral and shared meals with them. A few days later, he attended a birthday party where he hugged and shared food with members of another family.
With these friendly gestures at family meetings, the man – who later tested positive for COVID-19 – inadvertently infected as many as 15 other people with the virus before implementing social distance measures in Illinois and other states in the United States.
Three of these people died from the virus.
The transmission chain triggered by the man – who had mild airways at the time he attended the funeral and party – was detailed in a report released by the CDC on Wednesday.
The report highlighted the dangerous potential of a “super-proliferating event” and showed how extended family gatherings may have facilitated the transfer of COVID-19 “beyond household contacts and into wider society.”
The patients in this multifamily cluster in Chicago were between 5 and 86 years old. They came into contact with each other at the funeral, the birthday and a church service.
The three patients who died were over 60, and all three had at least one underlying cardiac or respiratory or respiratory disease, the report says.
The CDC said that the results in this tragic case illustrate how important social distance is to prevent the spread of COVID-19, even within families.
The night before the funeral in February, the Chicago man shared a three-hour take-out meal, eaten from regular serving dishes, with two family members to the deceased at home.
The man (in the report called “an index patient”) was the close friend of the grieving family. He had recently traveled out of the state and was experiencing mild airways at that time. He was only later tested as part of the broader epidemiological study and then diagnosed with COVID-19.
The following day, at the two-hour funeral, the man shared a pot meal with other participants and hugged at least four members of the grieving family to express their condolences. These four people developed symptoms of COVID-19 within six days of the funeral.
One of them was hospitalized, required “endotracheal intubation and mechanical ventilation for acute respiratory failure,” and died.
Before the person died, they were visited at the hospital by a family member who had also been in close physical contact with the index patient at the funeral.
That family member embraced his COVID-19-infected relative in the hospital ward and took care of the patient without having personal protective equipment. Three days after that visit, the person developed COVID-19 symptoms, including fever and cough.
The index patient, who was still experiencing mild respiratory symptoms, then attended a birthday party with nine members of another family, three days after he attended the funeral.
At the three hour party, the man hugged and shared food with the other guests. Seven of the guests developed COVID-19 within a week.
Five of them experienced mild symptoms, including low quality cough and fever. Two others were in hospitals, required endotracheal intubation and mechanical ventilation, and died.
A family member and a caregiver who took care of one of the party guests who died probably developed COVID-19, the report says. The other party guest who died was likely to transmit the virus to a household contact who had not attended the birthday party.
Three participants with symptomatic birthday parties with probable cases of COVID-19 then participated in a worship service, six days after they developed their first symptoms.
They talked to and sent the offer plate to another church attendant who sat in the same row for 90 minutes. The church participant, a healthcare professional, was diagnosed with COVID-19.
The index patient “obviously was able to transmit infection to 10 other people, even though he had no household contacts and experienced only weak symptoms for which no medical care was sought,” the report said.
It is not yet clear how common this type of transmission has been during the current pandemic, the report noted.
“Super-spreading events have played an important role in the transmission of other newly emerged coronaviruses,” the report said, but added that their relevance to the COVID-19 spread is “debated.”
The most notable “super-spreading event” probably occurred during a driving practice in the state of Washington when at least 45 of 60 singers were either diagnosed with COVID-19 or showed symptoms. In another potentially super-prevalent case, a New York lawyer was affiliated with one of the earliest clusters of COVID-19 cases developed in New Rochelle.
Dr. Mark Dworkin, an epidemiology professor at the School of Public Health at the University of Illinois at Chicago, noted that it was important not to refer to people as “super-distributors” but to acknowledge how funerals and birthday parties are. of events that enable super-proliferation.
These events include a close gathering of people who are socially and physically more familiar with each other, Dworkin told BuzzFeed News.
At a family event, “it’s kiss, kiss, kiss, hug, hug, hug,” with people sitting inches away from each other, he said.
The authors of the CDC report said that their results emphasized the importance of following the current recommendations on social distance.
Eight states have not yet issued home orders, and those who have been forced to remind residents to take social distance measures seriously. As of Wednesday, Illinois has reported 15,078 positive cases and 462 people have died. The Government J.B. Pritzker issued a stay-at-home order in the state on March 20.
While the Chicago cluster occurred before implementing social distance measures, Dworkin said he could not fault the authorities for introducing them at a time when the community’s spread of the disease was already evident across the United States.
He said that the current orders for home and social distance measures at that time were considered to be “really super-extreme things to do.”
“It’s really hard to get a recommendation to the public so if you don’t have proof why it’s absolutely necessary,” he said. And how much evidence the public needs “right in front of them to buy in these extreme recommendations varies from population to population and from culture to culture,” Dworkin said.
He called the Chicago Cluster a tragedy that shows how “the virus exploits our positive behavior” in celebrating milestones, supporting loved ones or turning to faith.
“It’s really sad that such events have to be limited at a time to promote our health,” Dworkin said. “But we have to remember that this is temporary. We must be patient. The more we accept and are patient with this scientific development, the more successful we will be.”