A Woman’s Tragic Covid-19 Death Traced to Tainted Donated Lungs, Report Finds

Illustration for article titled A Woman's Tragic Covid-19 Death Traced to Tainted Donated Lungs, Report Finds

Photo: Christopher Furlong/ (Getty Images)

Doctors say that a Michigan woman’s untimely death last fall was caused by covid-19 unknowingly spread through a double lung transplant. It’s likely the first clear case of covid-19 linked to transplantation. Another doctor contracted the viral illness through the procedure, but survived.

The woman’s tragic case was detailed in a report published earlier this month by doctors at the University of Michigan Medical School, in the American Journal of Transplantation. According to the report, the woman needed the transplant because of her chronic obstructive pulmonary disease. Her donor was a woman who had recently died of severe brain injury from a car accident. Standard screening, including a nasal and throat swab test for the coronavirus (SARS-CoV-2) on the donor and recipient, turned up nothing unusual and the procedure appeared to go off without a hitch.

Three days following the transplant, however, the recipient spiked a fever and began to have trouble breathing. A nasal swab test initially showed no traces of the coronavirus, but she obviously had pneumonia and a later direct test of her lungs came back positive for the virus. Over the next two months, the woman’s condition only worsened, and she developed septic shock. Though she was treated with antivirals, convalescent plasma, and ECMO (a last resort medical device that takes over for the heart and lungs), the woman succumbed to her illness 61 days after her transplant.

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The donor had no history indicating recent exposure to the coronavirus or symptoms of covid-19 prior to her death, along with a negative nasal swab test. But doctors had held onto a fluid sample collected from her lungs and when they tested it after the recipient became sick, it came back positive. Genetic sequencing of the virus found in both the donor and recipient showed they were nearly identical, effectively proving the recipient’s infection came from the tainted lungs. A third person—one of the woman’s surgeons who handled the lungs—became sick and tested positive for the virus soon after the procedure, and this infection was also traced back to the donated lungs. The surgeon recovered, however, and no other member of the transplant team was affected.

There have been other suspected cases of covid-19 spread through transplantation, but this is thought to be the first known case to demonstrate transmission by using genetic sequencing. Despite the tragedy of this death, however, it’s likely still an incredibly rare risk. This same month, scientists with the Centers for Disease Control and Prevention looked into eight suspected cases of covid-19 linked to organ donation documented between March to May 2020. They ultimately concluded that the most likely source of transmission in these cases “was community or healthcare exposure, not the organ donor.”

Rare as it might be, the Michigan doctors do think more can be done to ensure the safety of organ recipients and their doctors during this time, particularly when lungs are being transplanted.

“Transplant centers and organ procurement organizations should perform SARS‐CoV‐2 testing of lower respiratory tract specimens from potential lung donors, and consider enhanced personal protective equipment for health care workers involved in lung procurement and transplantation,” they wrote.

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WHO Scientists Say Wuhan Lab Leak ‘Extremely Unlikely’ to Have Caused Covid-19 Pandemic

The P4 laboratory (center) on the campus of the Wuhan Institute of Virology in Wuhan in China’s central Hubei province on May 13, 2020.

The P4 laboratory (center) on the campus of the Wuhan Institute of Virology in Wuhan in China’s central Hubei province on May 13, 2020.
Photo: Hector Retamal / AFP (Getty Images)

Scientists assembled by the World Health Organization to investigate the origins of the covid-19 pandemic have announced their early findings. They concluded that the first known cases traced to a seafood market in Wuhan, China in December 2019 likely don’t represent the original source of the outbreak. At the same time, they considered the possibility of a lab accident causing the pandemic “extremely unlikely,” and speculated that the virus wasn’t circulating locally in people for very long before the first cases were discovered.

The international team of scientists began their investigation in mid-January 2021, traveling to various areas of China, including the Huanan Seafood Market in Wuhan where the first cases of a then-mysterious pneumonia were reported in late December 2019. The investigation was a joint mission with local scientists from China, as part of an agreement made with the Chinese government in order to gain entry into the country. At a press conference held in Wuhan on Tuesday, the scientists laid out what they had found out so far.

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The team’s conclusions are not final, and there will no doubt continue to be criticism of China’s handling of the pandemic, especially early on. Activists and local journalists have accused the Chinese government of silencing scientists and members of the public who tried to warn of the threat of covid-19 when it was first discovered. And it took close to a month before the country would acknowledge that the virus was indeed capable of spreading from person to person.

Even recently, the AP reported in December, China has tried to limit efforts by scientists to investigate the origins of the pandemic, while some officials have promoted unfounded theories about the virus having originated elsewhere in the world. That said, the AP has also reported that WHO scientists were granted as much access as they asked for during this investigation.

Among other things, the team said they found numerous bits of evidence suggesting that the Huanan cases weren’t the first cases of covid-19 in humans. One key finding, according to Liang Wannian—China’s lead scientist on the mission—was signs of diversity in samples of the coronavirus (formally called SARS-CoV-2) taken from these cases. That likely means the Huanan cluster wasn’t the original transmission event.

The team also looked at hospital surveillance data from Wuhan and the surrounding province of Hubei and determined that there weren’t unusual spikes in flu-like illness earlier than December 2019. This suggests, Wannian said, that “there was no substantial unrecognized circulation of SARS-CoV-2 in Wuhan during the latter part of 2019.” It’s worth noting that this finding is at odds with other evidence in China and in other countries suggesting that the virus may have been making people sick in November 2019 or earlier.

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Another part of the investigation involved visiting the Wuhan Institute of Virology, which has been singled out by some as the possible source of a lab accident that somehow released the coronavirus into the community (some have even argued that the virus was deliberately created and dispersed). No definitive evidence for this theory has emerged to date, while other studies have found no indication that the coronavirus was artificially made in the lab. The WHO team concluded that the lab leak theory was improbable enough to effectively close the book on it.

“The findings suggest that the laboratory incident hypothesis is extremely unlikely to explain the introduction of the virus to the human population,” said Peter Ben Embarek, the leader of the WHO mission as well as an infectious disease and food safety expert, at the press conference.

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The most likely possibility for the pandemic’s origin, Embarek said, is that the coronavirus leaped from bats to an intermediate host (possibly pangolins) and then to humans. Yet another possibility still being explored is that the virus could have been introduced to people through via frozen food products, since other evidence has suggested that it can survive in these conditions for a short time. However, the researchers did not go into detail as to how that pathway may have played out. And the WHO scientists still aren’t ruling out the possibility that bats alone transmitted the virus to humans.

The Murky Connection Between the Coronavirus and Climate Change

Illustration for article titled The Murky Connection Between the Coronavirus and Climate Change

Image: Silvia Izquierdo (AP)

Climate change is basically messing up everything in our lives. It’s tempting to find a way to pin the coronavirus pandemic on it, and a new study released today does just that, claiming that climate change “may have driven the emergence” of coronavirus. But it may be more complicated than it seems at first blush.

Scientists have known for a while that changes in habitat, including those precipitated by climate change, can cause humans to come into closer contact with wild animals that may be carrying dangerous viruses. The new study, released on Friday in Science of the Total Environment, takes a much more specific look at how climate change may have shifted the makeup of bat habitats. Changing ecosystems along the China-Laos border, the study says, increased the number of bat species living there, and upped the chances of a disease being passed on to humans.

“Understanding how the global distribution of bat species has shifted as a result of climate change may be an important step in reconstructing the origin of the covid-19 outbreak,” lead author Robert Beyer, a researcher in the University of Cambridge’s zoology department, said in a press release.

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Some wild animals are common transmitters of diseases that can be harmful to humans, like coronaviruses, ebola, and rabies. Bats in particular seem to be a warning sign for humans when it comes to viruses: The world’s bats carry around 3,000 different kinds of coronavirus, and research has shown that there’s a positive correlation between the number of types bat species that live in a particular area and bat-to-human disease transmission. This likely isn’t a special evil superpower unique to bats: Researchers have established that the more species an animal group has, the more different viruses they can host. Bats just happen to have a lot of different species.

Climate change has shifted ecosystems around the world as rising temperatures and changing rainfall patterns create different assemblages of plants and animals. What was a lush tropical forest in the 1800s now may be filled with very different types of flora and fauna. That’s the case, the study says, in forests in southern China and along the border with Myanmar and Laos.

The researchers created a map of what the world’s vegetation may have looked like 100 years ago using temperature, precipitation, and cloud cover records, and filled in this map with the habitat needs of different bat species. They then compared this information to current vegetation and data on bat populations to conclude that the changes in habitat may have prompted around 40 different species to migrate to the area along the China-Laos border.

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Each bat carries, on average, 2.7 different different types of coronavirus, the study says. The study goes on to posit that when those 40 species migrated beyond their original habitat over the past 100 years, they toted along with them around 100 different versions of coronaviruses, upping the chance of cross-species infection.

In concept, this theory is an alluring one. It’s clear the climate crisis is having a massive impact on the natural and built worlds. And it feels like a pretty straightforward explanation of how our warming planet may have shifted a deadly virus closer to human contact. But just because it feels straightforward may not make it correct.

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“It is undeniable that global change including climatic change, land use change, and demographic change will affect emerging pathogen risk,” Rachel Baker, a research scholar at Princeton University’s Environmental Institute who wasn’t involved with the study, said in an email.However, finding a causal relationship between these changes and the emergence of a specific pathogen, such as SARS-CoV-2, is tricky thing to do.”

She noted that while climate change can make weather events like hurricanes or wildfires more common or extreme, it’s not the only thing causing them. So it is with the virus. Attributing it to climate changeis much harder to do with viral emergence, as you have to account more many more factors.”

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Baker pointed out that the study is also not clear on how exactly how more bat species in an area actually impacts bat-to-human disease transmission. The methodology did not use any specific on-the-ground observations on bat populations, just habitat and species range data. That means it lacks a key piece of the scientific puzzle that is needed to support its strong assertions.

“While climate change is one piece of the puzzle, there have been many changes to human society over the past 100 years that have likely elevated the risk from emerging pathogens,” Baker said.

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