Korean nightclub-goers linked to 246-person COVID-19 outbreak

At least 246 COVID-19 cases have been tied to reopened nightclubs in Seoul, South Korea, after the Apr 30 to May 5 Golden Week holiday, with 61% among contacts of nightclub revelers, according to a research letter published yesterday in Emerging Infectious Diseases.

Coronavirus cases in South Korea had plateaued in April, and nightclubs reopened on Apr 30. People from around the country visited the Itaewon neighborhood, known for its diversity and home to a US Army base and several embassies, in downtown Seoul over the holiday. On May 6, several COVID-19 cases were confirmed among nightclub visitors.

Researchers with the Seoul government and a university medical center conducted large-scale testing to find contacts of the young adult nightclub visitors using data from mobile devices, credit card payment history, GPS, drug use review, public transportation pass records, and closed-circuit cameras. They also offered anonymous testing after media outlets reported that the bars at the epicenter of the outbreak were gay nightclubs, and gay men in South Korea are often subject to stigma and discrimination.

Of 41,612 tests conducted by May 25, 35,827 (86.1%) were among nightclub visitors, 5,785 (13.9%) among their contacts, and 1,627 (3.9%) among anonymous people. Prevalence of positive tests in nightclub visitors was 0.19% (67 of 35,827), 0.88% (51/5,785) in their contacts, and 0.06% (1/1,627) in anonymous people.

Ninety-six of 246 cases (39%) were primary cases, while 150 (61%) were secondary cases. Among nightclub visitors, estimated attack rate was 1.74% (96/5,517). Of all confirmed cases, 118 positive cases (47.9%) lived in Seoul.

Infections related to the nightclubs continued to spread in the community, and nightclubs were temporarily closed on May 9 to limit transmission. In Seoul, coronavirus cases tied to the nightclubs were found in nine workplaces, including the US Army base and a hospital, and six multiuse facilities such as pubs, coin karaoke facilities, and a gym. Seven cases of household transmission were also found.

"Despite the low incidence of COVID-19 in the postpeak period of the pandemic, superspreading related to visiting nightclubs in Seoul has the potential to spark a resurgence of cases in South Korea," the authors wrote.
Jul 7 Emerg Infect Dis research letter

Deferred state-level COVID-19 public health measures tied to lives lost

An observational study published today in Clinical Infectious Diseases found that each day's delay in ordering statewide public health measures such as emergency declarations ordering physical distancing and school closures in the United States was associated with a 5% to 6% hike in the risk of COVID-19 death.

Researchers from the University of Pennsylvania in Philadelphia obtained state-level data of 55,146 people who died of the novel coronavirus from Jan 21 to Apr 29 from the Johns Hopkins Center for Systems Science and Engineering Coronavirus Resource Center and analyzed their association with timing of emergency declarations and school closures.

Thirty-seven of 50 states had reported at least 10 deaths and 28 follow-up days by the time of analysis on Apr 29. Delays in emergency declaration (adjusted mortality rate ratio [aMRR], 1.05 per day's delay; 95% confidence interval [CI], 1.00 to 1.09; P = 0.040) and school closures (aMRR, 1.05; 95% CI, 1.01 to 1.09; P = 0.008) were associated with more deaths by day 28 of the state's epidemic.

When the researchers considered day 1 to be the date a state recorded its first COVID-19 death, waiting to declare an emergency (aMRR, 1.05; 95% CI, 1.01 to 1.09; P = 0.020) or close schools (aMRR, 1.06; 95% CI, 1.03 to 1.09; P < 0.001) was also associated with higher death rates. When New Jersey and New York were excluded, results were unchanged.

This translates to a 5% higher death rate for every day emergency declarations were delayed and a 6% higher death rate per each day's delay in closing schools.

The authors noted that states that delayed emergency declarations and school closures were more populous, including the early hot spots of California, New York, and Washington. "To our knowledge, this is the first demonstration of an association between statewide social distancing orders and mortality during COVID-19," they wrote. "Our results support early social distancing as a nonpharmaceutical intervention for reducing mortality."
Jul 8 Clin Infect Dis study

Study details neurologic complications in COVID-19 patients

COVID-19 patients may be at an increased risk for delirium, brain inflammation, stroke, and nerve damage, according to a study published today in Brain. Though the study included only 29 COVID-19 patients, the findings suggest neurologic conditions may be the only presenting symptoms in some infected people.

Of 43 patients with neurologic symptoms studied at the University College London, 29 tested positive for COVID-19, 8 with probable infections and 6 with possible infections. Ten of the 43 patients presented with delirium or psychosis, and 12 had inflammatory central nervous system (CNS) syndromes. Eight patients had strokes, and eight others had nerve damage, mostly caused by Guillain-Barre syndrome.

Of the 12 patients with inflammatory CNS syndromes, 9 had acute disseminated encephalomyelitis, a rare and sometimes fatal condition. The patients ranged in age from 16 to 85 years.

"We should be vigilant and look out for these complications in people who have had Covid-19. Whether we will see an epidemic on a large scale of brain damage linked to the pandemic— perhaps similar to the encephalitis lethargica outbreak in the 1920s and 1930s after the 1918 influenza pandemic—remains to be seen," said senior author Michael Zandi, PhD, in a university press release.
Jul 8 Brain study
Jul 8 University College London press release