Mai Ianuali 21 a hiki i Pepeluali 23, 2020, ua ʻike nā keʻena olakino lehulehu he 14 mau hihia US o ka maʻi coronavirus 2019 (COVID-19), nā mea āpau e pili ana i ka huakaʻi mai Kina (1,2). Ua hoʻokūpaʻa ʻia ka hihia US pili mua nontravel – ma Pepeluali 26 ma kahi kamaʻāina Kaleponi i maʻi ʻia ma Pepeluali 13 (3). ʻElua mau lā ma hope mai, ma Pepeluali 28, ua hoʻokūpaʻa ʻia kahi hihia pili pili lua ʻole i ka mokuʻāina ʻo Wakinekona (4,5). Hāʻawi ka hoʻokolokolo ʻana i ʻehā mau laina hōʻike i ka ʻike i ka manawa o ka hoʻolauna a me ka lawe mua ʻana o SARS-CoV-2, ʻo ka maʻi hoʻomaʻamaʻa e hoʻopuka nei iā COVID-19, i ʻAmelika Hui Pū ʻIa ma mua o ka ʻike ʻia ʻana o kēia mau hihia ʻelua.

ʻO ka mea mua, ʻo ka nānā ʻana i ka syndromic e pili ana i nā moʻolelo o nā keʻena pōpilikia mai nā kalana i hoʻopili mua ʻia e ka maʻi ahulau i hōʻike ʻole i ka hoʻonui ʻana o nā kipa no COVID-19 – e like me ka maʻi ma mua o Pepeluali 28. ʻO ka lua, ʻo ka hoʻāʻo hou ʻana o SARS-CoV-2 e nānā ana ma kahi o 11,000 mau aniani hanu mai kekahi mau ʻO nā wahi o ʻAmelika e hoʻomaka ana i Ianuali 1 ʻaʻole i ʻike ʻia nā hopena maikaʻi ma mua o Pepeluali 20. ʻO ke kolu, ʻo ka hōʻuluʻulu ʻana i nā kaʻina RNA viral mai nā hihia mua i hōʻike ʻia e hoʻomaka kahi ka lālani o ka maʻi i lawe pololei ʻia a mai ʻole mai Kina i ʻAmelika Hui Pū ʻIa ma waena o Ianuali 18 a me Pepeluali 9, a ukali ʻia. e kekahi mau mea hoʻokomo SARS-CoV-2 mai ʻEulopa.

ʻO ka mea hope loa, ke kū ʻana o ʻekolu mau hihia, hoʻokahi ma Kaleponi noho i make ma Pepeluali 6, kahi lua ma kekahi kamaʻāina o ia kalana i make i Pepeluali 17, a me kahi hapakolu o ka mea mākaʻikaʻi ʻole i ʻike ʻia ma luna o ka moku holo moana Pākīpika i haʻalele ʻO Kapalakiko ma Pepeluali 11, e hōʻoia i ka holo cryptic o ka maʻi ma ka mua o Pepeluali. Hōʻike kēia mau ʻikepili i ka hoʻomau ʻia ʻana, ua hoʻomaka ka lawe kaiāulu ma mua o ka ʻike ʻana i nā hihia US ʻelua e pili ana i ka nontravel, i hopena ʻia ma muli o ka lawe ʻia ʻana mai o kahi laina laina o ka mea hoʻomaʻamaʻa mai Kina i ka hopena o Ianuali a i ʻole ka mua o Pepeluali, a ukali ʻia e kekahi mau mea i lawe ʻia mai ʻEulopa. ʻO ka puka ākea o COVID-19 ma loko o ʻAmelika Hui Pū ʻIa ma hope o Pepeluali e hōʻike ana i ka koʻikoʻi o nā ʻōnaehana olakino olakino e pane wikiwiki i nā ʻōlelo hoʻoweliweli e kū mai nei.

Nānā Syndromic

Ma o ka National Syndromic Surveillance Program, ua loaʻa i nā keʻena olakino lehulehu US ka ʻikepili manawa maoli mai nā keʻena pōpilikia ma kahi o 4,000 mau keʻena olakino ma 47 mau mokuʻāina ʻo US a me ka Apana o Columbia. Ma nā kalana he 14 me nā hihia i loaʻa i ke kaiāulu o COVID-19, ʻaʻole i ʻike ʻia ka hoʻonui nui ʻana i ka mahele o COVID-19-e like me ka maʻi (ke kuni a me ke kahe a me ka liʻiliʻi o ka hanu a me ka pilikia o ka hanu ʻana, a i ʻole ka papa inoa o kahi code diagnostical coronavirus) ma mua o Pepeluali 28.

ʻO ka nānā ʻana no ka maʻi ʻo SARS-CoV-2 ākea Ka Seattle Flu Study (5) i hoʻomaka i ka nānā ʻana i nā maʻi hanu nui ma ka mahele nui ʻo Seattle i Nowemapa 2018. I ka hopena o Pepeluali 2020, ua hoʻomaka ka noiʻi e hoʻāʻo i nā hiʻohiʻona e hoʻohana ana i ka transcription – polymerase chain reaction (RT- PCR) e hoʻāʻo ana no SARS-CoV-2. ʻO ka hopena o ke keʻena hoʻokolohua maikaʻi mua loa no ka SARS-CoV-2 i ʻike ʻia ma Pepeluali 28 mai kahi hōʻike i hōʻiliʻili ʻia Pepeluali 24. Ma hope o kēia ʻike ʻana, ua hoʻāʻo ʻia nā hiʻohiʻona i ʻike ʻia i hōʻiliʻili ʻia no ka maʻi. ʻAʻohe hopena maikaʻi ma waena o 5,270 nā hanana hanu i hōʻiliʻili ʻia ma Ianuali 1 – Pepeluali 20 (5) (T. Bedford, Fred Hutchinson Cancer Research Center, Seattle, Wakinekona, kamaʻilio pilikino, Mei 6, 2020). ʻO ka hōʻike mua i hoʻāʻo maikaʻi ma waena o kēia mau hiʻohiʻona i hoʻāʻo ʻia i hōʻiliʻili ʻia i hōʻiliʻili ʻia Pepeluali 21. I loko o ka pule e hoʻomaka nei ma Pepeluali 21, ʻewalu o 1,255 kikoʻī (0.6%) i hoʻāʻo maikaʻi, a i loko o ka pule aʻe, 29 o 1,862 (1.6%) nā mea i hoʻāʻo ʻia. maikaʻi ʻElua mau ʻōnaehana hoʻomaʻamaʻa hoʻomaʻamaʻa influenza i hoʻopaʻa ʻia me nā pūnaewele ma nā mokuʻāina ʻeono (Michigan, Pennsylvania, Tennessee, Texas, Wakinekona, a me Wisconsin) i hoʻāʻo hou i nā hiʻohiʻona hanu mai nā mea maʻi me ka maʻi hanu nui no SARS-CoV-2 e RT-PCR. Ma ka pūnaewele Wakinekona, ʻaʻohe o nā hiʻohiʻona 497 i hōʻiliʻili ʻia ma Ianuali 19 – Pepeluali 24 i hōʻoia maikaʻi; ʻo ka mea hōʻike mua i hoʻāʻo maikaʻi i hōʻiliʻili ʻia ma Pepeluali 25. Ma nā pūnaewele ʻelima (Ann Arbor a me Detroit, Michigan; Pittsburgh, Pennsylvania; Temple, Texas; Marshfield, Wisconsin; a me Nashville, Tennessee), ʻaʻohe o 2,620 mau laʻana i hōʻiliʻili ʻia i loko o Ianuali 19 – Pepeluali 29 i hōʻoia maikaʻi no SARS-CoV-2. Ma Mei 22, 2020, ʻehā (<0.2%) o ma kahi o 3,000 mau laʻana i hōʻiliʻili ʻia mai nā keiki a me nā ʻōpio <18 mau makahiki i kākau inoa ʻia i ka Pūnaewele Nānā Hou Aia † ma Ianuali 1-Malaki 31 i hōʻoia maikaʻi no SARS-CoV-2. ʻO ka hopena maikaʻi mua loa mai kahi specimen i hōʻiliʻili ʻia ma Malaki 20 ma Seattle.

Nānā Phylogenetic

ʻImi ʻia ka ʻano genomic o ka SARS-CoV-2 mai nā hihia mua o COVID-19 mai kahi o Seattle i ʻike ʻo ka hapa nui o nā mea ʻino i loko o kahi clade hoʻokahi (ka Washington State clade), nona ka kūpuna ma mua loa i manaʻo ʻia aia ma waena o Ianuali 18 a me Pepeluali 9 (kuhi helu = Pepeluali 1) .§ ʻO ke kaʻina genomic wānana ʻia o kēlā maʻi wānana progenitor e kūlike me ia mai ka hihia US mua o COVID-19 i lawe ʻia mai, i kū i kahi kāne i hōʻea i Seattle mai Wuhan, Kina. , ma Ianuali 15 a lilo i maʻi 4 lā ma hope. Eia nō naʻe, hiki i ka Washington State clade ke ala aʻe mai kahi maʻi me kahi ʻano like a like paha mai kahi kanaka ʻē aʻe me ka maʻi SARS-CoV-2. Kuhi ʻia nā virus ma Kaleponi a me ka ʻākau hikina o ʻAmelika Hui Pū ʻIa mai Pepeluali a waena midMarch i ʻōlelo ʻia ua nui nā lawe ʻia mai o ka maʻi, mai ʻEulopa mai, a ma hope o ka lawe ʻia ʻana o nā maʻi ma loko o ʻAmelika Hui Pū ʻIa.

Nā hihia i ʻike ʻia i ka poʻe me ka ʻole o ka mōʻaukala huakaʻi kūpono

Ma mua o Pepeluali 26 ʻElua mau hihia koʻikoʻi o COVID-19 i hana ʻia ma Santa Clara County, Kaleponi: hoʻokahi i loko o kahi wahine i maʻi i Ianuali 31 a make i Pepeluali 6 a me kekahi i kahi kāne pili ʻole i make ma ka home ma waena o Pepeluali 13 a me 17. ʻAʻole hoʻi i huakaʻi me ka honua i nā pule ma mua o ko lākou make ʻana. Ua ʻike ʻia ʻo SARS-CoV-2 RNA e ka hoʻāʻo ʻana RT-PCR ma CDC mai nā hōʻike kikoho postmortem mai kēia mau maʻi. Ua hōʻoia ʻia kēia mau make e kekahi loiloi e like me COVID-19– make i pili. Ke hoʻomau nei ka noiʻi ʻana i kēia mau hihia. ʻO ka laha ʻana o COVID-19 i loko o nā huakaʻi holo ʻelua o kahi moku holoholo Grand Princess (7). ʻO ke kaʻina genomic o nā virus mai kēia mau laha i loko o ka wā o ka mokuʻāina ʻo Wakinekona, e ʻōlelo ana he mākaʻi a he limahana paha i loaʻa i ua maʻi lā i luna o ka moku i ka wā i haʻalele ai i ke awa o Kapalakiko ma Pepeluali 11 no ka holo huakaʻi huakaʻi. ʻAʻole ʻike ʻia ka ʻike o kēlā kanaka. Kūkākūkā ka ʻike mai kēia mau kumuwaiwai ʻikepili ʻokoʻa e pili ana i ka lawe ʻia ʻana o ke kaiāulu o ka SARS-CoV-2 ma United States ma waena o ka hapa hope o Ianuali a me ka hoʻomaka o Pepeluali, ma hope o ka lawe ʻia mai o SARS-CoV-2 mai Kina. Ua hoʻokumu ʻia kēia hoʻoilina i kahi laina, ka wīwī o ka Mokuʻāina ʻo Wakinekona, a laila pālahalaha aʻe ma nā wahi ākea o Seattle a ma nā wahi ʻē aʻe paha. ʻO nā lawe ʻia mai o SARS-CoV-2 mai ʻEulopa i ukali ʻia i Pepeluali a me Malaki. ʻAʻole ʻike ʻia ehia US ua loaʻa nā maʻi i loko o Pepeluali a me Malaki, akā ʻo nā hanana maʻi āpau ma mua o Pepeluali 28 ua haʻahaʻa loa ia e ʻike ʻia ai ma o ka ʻikepili kūpuna syndromic surveillance data. ʻAʻole maopopo ʻia nā lā o ke komo ʻana o nā virus i lawe ʻia mai i ʻAmelika Hui Pū ʻIa a me nā ʻike o ka poʻe nāna lākou i lawe. ʻO kahi kumuwaiwai hiki mua ke hōʻike mua ʻia ʻo US hihia o COVID-19, i hana ʻia ma kahi kanaka Wakinekona i maʻi i ka lā 19 o Ianuali ma hope o kona hoʻi ʻana mai Wuhan, Kina, ma Ianuali 15; ke kaʻina genomic o ka maʻi i hoʻokaʻawale ʻia mai kēlā kanaka e kūlike me kāna kumu kūpono o ka Washington State clade, ʻoiai ke kikoʻī o ka hoʻokolokolo hoʻokolokolo ʻana o kēia hihia a me ka ʻike ʻole ʻia o nā hihia ʻelua i kūʻē i kēia (8). Eia nō naʻe, ua hōʻike ʻia nā hōʻike i paʻi ʻia aʻe nei e hōʻike pinepine ʻia ka maʻi me ka SARS-CoV-2 pinepine ʻia a hiki ke hana i ka lawe ma mua o ka hoʻomaka ʻana o nā hōʻailona (9). Ke hāpai nei ka hiki o ka lawe presymptomatic ma kahi o ʻekolu mau hanana e pili ana i kēia hihia: 1) i loaʻa i hoʻokahi a ʻoi paha mau maʻi maʻi asymptomat ma waena o nā pilina o ka mea maʻi a alakaʻi ʻia kēia i ka hoʻolaha ʻana o ka maʻi. 2) i loaʻa i ke kāne i nā pilina ma mua o ka hoʻomaka ʻana o kāna ʻōuli (ʻaʻole ʻike ʻia ia mau pilina ma o ka hoʻokolokolo maʻamau i koi ʻia i kēlā manawa); a i ʻole 3) ua loaʻa ʻo ia a me kekahi mea ʻē aʻe i kekahi maʻi ʻē aʻe ma ka lele like ʻana mai Wuhan, a ua ʻike ʻole ʻia e hoʻolaha ʻia mai nā poʻe maʻi ʻē aʻe i hoʻokumu i ka pākaua o ka Mokuʻāina ʻo Wakinekona. Ka mea, inā kekahi, o kēia mau hanana i kū paha e ʻike ʻole ʻia. Hiki nō hoʻi, ke hāʻawi ʻia nei ka launa like ʻole o ka global filogenetic o ka SARS-CoV-2 i kēlā manawa, ua lawe ʻia mai ka mokuʻāina ʻo Wakinekona i ʻAmelika Hui Pū ʻIa e kekahi kanaka ʻike ʻole ʻia a puni ka manawa like. ʻAʻole hōʻike ʻia nā hopena o ka hoʻāʻo serologic ma aneʻi, no ka mea, ʻo ka serology (ʻo ia hoʻi, ka hoʻāʻo ʻana no ka antibody i ka SARS-CoV-2) he mea maʻalahi ʻole paha ia no ka ʻike ʻana i kahi virus hou, i ka wā i hōʻiliʻili ʻia nā mea kikoʻī ma kahi wale nō ma mua o maʻi paha nā kānaka (i ka ʻokoʻa, no ka laʻana, i ka hoʻokolohua viral o nā mea kūwaho a i ʻole nā mea maʻi i loaʻa i ka haukapila me nā maʻi hanu koʻikoʻi) a no ka mea ʻaʻole hele kokoke nā mākaukau serologic i ka 100% kikoʻī ke ʻole loaʻa kekahi ʻano hōʻoia hōʻoia. ʻO kahi laʻana, kahi anamanaʻo serologic hypothetical ma ka mahele nui ʻo Seattle (ka heluna o 3.5 miliona) i mālama ʻia ma hope o nā maʻi he 3,500 e loaʻa i kahi seroprevalence maoli o 0.1%, akā ʻo ka hoʻohana ʻana o kahi hoʻāʻo me 99% kikoʻī e manaʻo ʻia e hoʻopuka i nā hopena maikaʻi ʻole. i nā manawa he 10 i nā hāpana he nui. ʻO nā ana loiloi Serologic, eia nō naʻe, he mea maikaʻi i ka nānā ʻana i ka holomua o ka maʻi ahulau i hoʻokumu ʻia a loaʻa iā ia ka pōmaikaʻi kūpono o ka ʻike ʻana i nā maʻi āpau, me ka nānā ʻole i ka hiʻohiona hōʻailona. Loaʻa nā ʻike i kēia hōʻike ma ka liʻiliʻi o ʻekolu mau palena. ʻO ka mea mua, ʻike hope ʻia ka ʻikepili i hōʻike ʻia ma aneʻi. ʻOiai he ʻano like ʻole kā lākou o ka honua, ʻaʻole hiki iā lākou ke hāʻawi i ke ʻano o ke kiʻi e like me ka loaʻa inā loaʻa koke ka hoʻāʻo ākea ma hope o ka loaʻa ʻana o ka maʻi. ʻO ka lua, ʻo kekahi o nā noiʻi i hōʻike ʻia a me nā mea ʻē aʻe paha ke hoʻomau nei i ka hoʻāʻo ʻana i nā laʻana a ʻike paha i nā hihia ma mua o nā mea i hōʻike ʻia i kēia hōʻike. ʻO ka mea hope loa, ʻo ka homogeneity e like me kaloglogetic o SARS-CoV-2 ma ka honua āpau i Ianuali a me ka mua o Pepeluali i kaupalena ʻia i ka mea i hiki ke noʻonoʻo ʻia mai ka hoʻopili genomic. Kakaʻikahi nā ʻāina i pale i ka lawe mai a hoʻomau i ka hoʻolaha ʻana o COVID-19. Ma ʻAmelika Hui Pū ʻIa, ke hoʻolaha nei ʻo SARS-CoV-2 i kēia manawa ma hope o ka lawe ʻia ʻana mai Kina, ʻEulopa, a me nā wahi ʻē aʻe. Ke hoʻomaka nei nā ʻanuʻu ma loko o ka US ka ʻōnaehana olakino lehulehu e hoʻomaikaʻi i nā hōʻailona o ka hana SARS-CoV-2, me ka hoʻonui ʻana i ka nānā ʻana i ka syndromic ma waena o nā keʻena pilikia a hoʻonui i ka loaʻa o ka hoʻāʻo ʻana no ka SARS-CoV-2. Hāʻawi ʻia ka likelika i ka hapa nui o ka US

# pūnaehulehu

He aha e lawe ʻia mai kēia ʻatikala:

Finally, the occurrence of three cases, one in a California resident who died on February 6, a second in another resident of the same county who died February 17, and a third in an unidentified passenger or crew member aboard a Pacific cruise ship that left San Francisco on February 11, confirms cryptic circulation of the virus by early February.
In 14 counties with early community-acquired cases of COVID-19, no substantial increase was observed in the proportion of COVID-19–like illness (fever and cough or shortness of breath or difficulty breathing, or the listing of a coronavirus diagnostic code) before February 28.
Third, analysis of viral RNA sequences from early cases suggested that a single lineage of virus imported directly or indirectly from China began circulating in the United States between January 18 and February 9, followed by several SARS-CoV-2 importations from Europe.