On Feb. 26, 175 executives at the biotech company Biogen gathered at a Boston hotel for the first night of a conference. At the time, the coronavirus seemed a faraway problem, limited mostly to China.
But the virus was right there at the conference, spreading from person to person. A new study suggests that the meeting turned into a superspreading event, seeding infections that would affect tens of thousands of people across the United States and in countries as far as Singapore and Australia.
The study, which the authors posted online on Tuesday and has not yet been published in a scientific journal, gives an unprecedented look at how far the coronavirus can spread given the right opportunities.
“It’s a really valuable study,” said Dr. Joshua Schiffer, a physician and mathematical modeling expert who studies infectious diseases at the Fred Hutchinson Cancer Research Center in Seattle and was not involved in the research.
Dr. Schiffer said that the new genetic evidence fit well with what epidemiologists and disease modelers have been learning about the coronavirus. The Biogen conference, he said, was just one of many similar events that amplified and spread the virus in its early months. “I don’t think it’s a fluke at all,” he said.
The results came out of a project that began in early March at the Broad Institute of Harvard and M.I.T., a research center specializing in large-scale genome sequencing. As a wave of Covid-19 patients crashed into Massachusetts General Hospital, the Broad researchers analyzed the genetic material of the viruses infecting the patients’ cells. The scientists also looked at samples from the Massachusetts Department of Public Health, which ran tests around Boston at homeless shelters and nursing homes. All told, the scientists analyzed the viral genomes of 772 people with Covid-19 between January and May.
The researchers then compared all of these genomes to trace where each virus came from. When a virus replicates, its descendants inherit its genetic material. If a random mutation pops up in one of its genes, it will also get passed down to later descendants. The vast majority of such mutations don’t change how the virus behaves. But researchers can use them to track the spread of an epidemic.
“It’s kind of like a fingerprint we can use to follow viruses around,” said Bronwyn MacInnis, a genomic epidemiologist at the Broad Institute.
The first confirmed case of the coronavirus in Boston turned up on Jan. 29. The patient had traveled from Wuhan, China, and his virus carried distinctive mutations found in Wuhan. But Dr. MacInnis and her colleagues didn’t find any other viruses in Boston from later months with the same genetic fingerprint. It’s likely that the patient’s isolation prevented the virus from spreading.
But as February rolled on, the researchers determined, at least 80 other people arrived in Boston with the virus. Undiagnosed, they spread it to others.
Most of the viral lineages in Boston have a genetic fingerprint linking them to earlier cases in Europe, the study found. Some travelers brought the virus directly from Europe in February and March, whereas others may have picked up the European lineage elsewhere in the northeastern United States.
Dr. MacInnis and her colleagues took a detailed look at a few key places to see how the virus swept through the city. At Massachusetts General Hospital, for example, they found that coronaviruses in patients did not share many of the same mutations. That was a relief, because it meant that the hospital was not a breeding ground where a single virus could spread quickly from patient to patient.
But that’s exactly what happened in a skilled nursing home where 85 percent of patients and 37 percent of the staff were infected. The researchers identified three different virus lineages in the home, but one of them accounted for 90 percent of the infections.
Such superspreading events are a hallmark of the coronavirus. When an infected person shows up in the right place — generally inside, with poor ventilation and close contact with other people — the virus can infect a lot of people in very little time. These unfortunate events don’t happen often, and so most people who get infected with the coronavirus don’t pass it on to anyone else.
The virus that raged through the nursing home didn’t spread beyond its walls, as far as Dr. MacInnis and her colleagues could tell. But when the virus showed up at the Biogen conference, the story turned out very differently.
The researchers were able to sequence 28 viral genomes from people at the meeting. All of them shared the same mutation, called C2416T. The only known samples with that mutation from before the Biogen event came from two people in France on Feb. 29.
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Frequently Asked Questions
Updated August 27, 2020
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- There are a few basic things to consider. Does it have at least two layers? Good. If you hold it up to the light, can you see through it? Bad. Can you blow a candle out through your mask? Bad. Do you feel mostly OK wearing it for hours at a time? Good. The most important thing, after finding a mask that fits well without gapping, is to find a mask that you will wear. Spend some time picking out your mask, and find something that works with your personal style. You should be wearing it whenever you’re out in public for the foreseeable future. Read more: What’s the Best Material for a Mask?
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- In the beginning, the coronavirus seemed like it was primarily a respiratory illness — many patients had fever and chills, were weak and tired, and coughed a lot, though some people don’t show many symptoms at all. Those who seemed sickest had pneumonia or acute respiratory distress syndrome and received supplemental oxygen. By now, doctors have identified many more symptoms and syndromes. In April, the C.D.C. added to the list of early signs sore throat, fever, chills and muscle aches. Gastrointestinal upset, such as diarrhea and nausea, has also been observed. Another telltale sign of infection may be a sudden, profound diminution of one’s sense of smell and taste. Teenagers and young adults in some cases have developed painful red and purple lesions on their fingers and toes — nicknamed “Covid toe” — but few other serious symptoms.
Why does standing six feet away from others help?
- The coronavirus spreads primarily through droplets from your mouth and nose, especially when you cough or sneeze. The C.D.C., one of the organizations using that measure, bases its recommendation of six feet on the idea that most large droplets that people expel when they cough or sneeze will fall to the ground within six feet. But six feet has never been a magic number that guarantees complete protection. Sneezes, for instance, can launch droplets a lot farther than six feet, according to a recent study. It’s a rule of thumb: You should be safest standing six feet apart outside, especially when it’s windy. But keep a mask on at all times, even when you think you’re far enough apart.
I have antibodies. Am I now immune?
- As of right now, that seems likely, for at least several months. There have been frightening accounts of people suffering what seems to be a second bout of Covid-19. But experts say these patients may have a drawn-out course of infection, with the virus taking a slow toll weeks to months after initial exposure. People infected with the coronavirus typically produce immune molecules called antibodies, which are protective proteins made in response to an infection. These antibodies may last in the body only two to three months, which may seem worrisome, but that’s perfectly normal after an acute infection subsides, said Dr. Michael Mina, an immunologist at Harvard University. It may be possible to get the coronavirus again, but it’s highly unlikely that it would be possible in a short window of time from initial infection or make people sicker the second time.
I’m a small-business owner. Can I get relief?
- The stimulus bills enacted in March offer help for the millions of American small businesses. Those eligible for aid are businesses and nonprofit organizations with fewer than 500 workers, including sole proprietorships, independent contractors and freelancers. Some larger companies in some industries are also eligible. The help being offered, which is being managed by the Small Business Administration, includes the Paycheck Protection Program and the Economic Injury Disaster Loan program. But lots of folks have not yet seen payouts. Even those who have received help are confused: The rules are draconian, and some are stuck sitting on money they don’t know how to use. Many small-business owners are getting less than they expected or not hearing anything at all.
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It’s possible that a single person came to the meeting from Europe carrying the C2416T mutation. It’s also possible that the virus carrying this mutation had already been in Boston for a week or two, and someone brought it into the meeting.
As the attendees spent hours together in close quarters, in poorly ventilated rooms, without wearing masks, the virus thrived. While replicating inside the cells of one meeting attendee, the virus gained a second mutation, called G26233T. Everyone who was subsequently infected by that person carried the double-mutant virus.
From the meeting, the researchers concluded, this lineage spread into the surrounding community. In a Boston homeless shelter, for example, researchers found 51 viral samples with the C2416T mutation, and 54 with both mutations.
“We had no idea it would be associated with the conference,” Dr. MacInnis said. “It came as a complete surprise.”
The researchers estimated that roughly 20,000 people in the Boston area could have acquired the conference virus.
New York saw a similar pattern, according to Matthew Maurano, a computational biologist at N.Y.U. Langone Health. After many viral strains arrived from Europe in February, a few came to dominate the city. “A lot of lineages die off, and some spread enormously,” Dr. Maurano said.
The Boston double-mutant spread particularly far. Researchers identified this lineage in samples collected later in Virginia, North Carolina and Michigan. Overseas, it turned up in Europe, Asia and Australia.
Dr. Jacob Lemieux, a co-author of the new study and an infectious disease physician at Massachusetts General Hospital, said it was impossible at the moment to determine how many people acquired the virus in the months after the Biogen conference. But it would be in the tens of thousands.
Six months after the conference, Dr. MacInnis said that it should serve as a warning to anyone who thinks life can return to an unmasked version of normal before the virus is brought under control.
“One bad decision can affect a lot of people,” she said. “And the ones who suffer the most from that reality are the most vulnerable among us.”