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With COVID-19 emerging in new countries, health officials worry about untraceable clusters


In South Korea, Singapore and Iran, clusters of infections are leading to a jump in cases of the new viral illness outside China. But it’s not the numbers that are worrying experts: it’s that increasingly they can’t trace where the clusters started.

World Health Organization officials said China’s crackdown on parts of the country bought time for the rest of the world to prepare for the new virus. But as hot spots emerge around the globe, trouble finding each source — the first patient who sparks every new cluster — might signal the disease has begun spreading too widely for tried-and-true public health steps to stamp it out.

“A number of spot fires, occurring around the world is a sign that things are ticking along, and what we are going to have here is probably a pandemic,” said Ian Mackay, who studies viruses at Australia’s University of Queensland.

That worst-case isn’t here yet, the WHO insists. It isn’t convinced that countries outside China need more draconian measures, but it pointed to spikes in cases in Iran and South Korea to warn that time may be running out to contain the virus.

“What we see is a very different phase of this outbreak depending where you look,” said WHO’s Dr. Sylvie Briand. “We see different patterns of transmission in different places.”

The World Health Organization defines a “global pandemic” as a disease spreading on two continents, though some public health experts would call an outbreak a pandemic if the spread is over a wide area or across many international borders.

The newest red flag: Iran reported 18 cases, including four deaths, in just two days. The cluster began in the city of Qom, a popular religious destination, but it’s not clear how. Worse, infected travellers from Iran already have been discovered in Lebanon and Canada.

In South Korea, most of the more than 280 new cases detected since Wednesday are linked to a church in the city of Daegu and a nearby hospital. But health authorities have not yet found the “index case,” the person among the church’s 9,000 followers who set off the chain of infections.

There also have been several cases in the capital, Seoul, where the infection routes have not yet been traced. In Europe, Italy saw cases of the new virus more than quadruple in a day as it grapples with infections in a northern region that apparently have spread through a hospital and a cafe.

A cluster of cases isn’t inherently worrying — in fact, it’s expected as an infection that’s easy to spread is carried around the world by travellers. The first line of defence: Isolate the sick to treat them and prevent further spread, and quarantine people who came in contact with them until the incubation period is over.

But as the virus becomes more widespread, trying to trace every contact would be futile, Singapore’s Prime Minister Lee Hsien Loong acknowledged earlier this month.

“If we still hospitalize and isolate every suspect case, our hospitals will be overwhelmed,” he said. So far, the city-state has identified five clusters of transmission, including two churches. But there remain eight locally transmitted cases with no links to earlier cases, or to China.


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