生物与医学2020doi.org
SARS-CoV-2 早在 2019 年 12 月下旬就已在法国传播
SARS-CoV-2 was already spreading in France in late December 2019
进阶 · 约 15 分钟读完前置知识：RT-PCR 原理、流行病学基本概念、病毒基因组测序
导读
这篇论文对法国早期存留的呼吸道样本做回溯性 RT-PCR 检测，报告 2019 年 12 月下旬一例 SARS-CoV-2 阳性样本，提示病毒可能早于法国官方首例就已本地传播。作为回顾性研究，样本量有限，结论仍需基因组测序和血清学调查进一步确认。
HN 关注点：把欧洲疫情时间线前移，并围绕回溯检测的可靠性（假阳性/样本污染）、早期接触者追踪和血清学验证展开讨论。
HN 评论精选
这几条评论里：质疑 1 补充 2 亲历 1
质疑质疑该阳性可能来自样本交叉污染/假阳性，需测序和血清学验证，并指出此前类似回溯检测未发现阳性。
他们讨论了潜在假阴性，但更应该讨论样本交叉污染导致的假阳性；这个孤立病例似乎与我们所知的法国传播史相矛盾，一位密切跟踪病毒演化树的研究者对此很怀疑。现在需要对该患者、家人和同事做基因组测序和血清学检测。这也不是法国第一家这么做的医院：因 Raoult 和氯喹出名的 IHU Méditerranée Infection 在疫情初期中国暴发时也做过，他们检测了数月前的 2500 份样本，什么也没发现。
hokkos查看英文原文
They talk about potential false negative, but should have talked about potential false positive from sample cross contamination, because this isolated case seems in contradiction from everything we know about the french contamination history, a researcher that follow closely the phylogeny of the virus seems very dubious about that one. Now we need a sequence of the genome and serological test of the patient, the family and co-workers. Also this is not the first hospital to do that in France, IHU Méditerannée Infection, from Raoult and Chloroquine fame did that at the beginning of the epidemic in China, they tested 2500 samples from several month ago and found absolutely nothing.
亲历以全家严重“流感”经历（含味嗅觉丧失）推测欧洲 1 月可能已有未被检测的感染，希望血清学验证。
作为住在欧洲的人，我觉得这些数据很有意思。我们经历了超强的流感季，传染性极强；这是十年来第一次我全家都中招：一个孩子先，然后另一个，然后妻子，然后帮忙带孩子的祖父母；只有我没得，因为那段时间在旅行。孩子症状轻，祖父母用了 14 天恢复，妻子失去味觉和嗅觉。我真想做新冠血清检测，看看我们是否在 1 月就感染过，当时我们附近（斯洛文尼亚，紧邻意大利）报告零病例。
luka-birsa查看英文原文
As somebody living in Europe I find this data very interesting. We had a super strong flu season, which was incredibly contagious. This is the first year (in a decade) that everybody in my family got it. One kid first, then the other, then wife, then grandparents that were babysitting while wife was down. I'm the only one that didn't get it, but I was on travels during that time. Effects were mild on the kids, while the grandparents needed 14 days to recover. Wife lost sense of taste and smell. I really want to do a serological test for Covid just to see if we might have gone through it in January, when 0 cases were reported in our vicinity (Slovenia, which is next to Italy).
补充根据中国传染病报告系统和媒体动向推测，中国可能早在 11—12 月已察觉疫情，质疑“措手不及”叙事（含未证实传闻）。
我目前不在中国，但从中国媒体的动向看，几乎可以肯定中国的新冠/SARS 数字在 11 月上中旬已过百；11 月底政府开始注意，12 月初已完全紧张起来。中国怎么知道？首次 SARS 后建立了全国电子传染病报告系统，专门监测 SARS 复发，医院依法必须报告任何稍像 SARS 的病例，且每年有演练。因此说中国措手不及很难相信。12 月初已有可靠信息称北京向省级政府下达应对“灾难”的命令，所以我很怀疑他们 12 月已知是 SARS；还听到无法证实传闻，如 12 月初香港边境拥堵和私人飞机离境激增。
baybal2查看英文原文
I am out of China at the moment, but I can say from Chinese media buzz is that it is now almost certain that China's SARS numbers already passed hundreds by early-mid November. It appears that by late November, the government first took a notice of the outbreak, and by early December it was already a complete freak out. How the government knew? China has built a nationwide electronic infectious disease reporting system after the first SARS outbreak with specific intent of spotting SARS recurrence. Hospitals in China are required by law to report anything with a remote semblance of SARS into the system. China also holds nationwide drills for infectious disease specialists annually with SARS comeback in mind. Any claim that China was caught unprepared are hard to believe. Given that first reliably confirmed info on Beijing dispatching orders to provincial governments on handling a "disaster" also comes onto first days of December, it seems very, very likely to me that they already knew of it being SARS in December. I also heard of what I have no ability to confirm, like the talk of huge pileups at HK border crossings in first days of December, and a spike of private jet departures.
补充以拉斯维加斯早期大型活动却死亡数异常低为例，感叹若早期有更好接触者追踪或可更清楚传播情况。
对我来说，病毒活动最反常的地点之一是拉斯维加斯，恰恰因为它缺少病例。一个像 Vegas 这样的全球城市，1/2 月甚至 3 月初有多个大型活动，尤其中国新年期间有大量游客，却至今只报告 215 例死亡。这数字虽令人难过但仍异常低。在 220 万人口、健康和医院声誉不佳的地区，死亡率只有 0.01%，相比纽约和法国、西班牙、意大利的情况，令人惊讶。像这项研究和以后肯定会有更多研究，让我真希望我们从一开始就有更好的接触者追踪，希望未来能有更好的实施。
lvspiff查看英文原文
One of the standout locations of virus activity for me, and just due to sheer lack of it, is Vegas. It makes no sense how a global city like Vegas who had multiple large scale events during the January/February even into early March time frame, and tons of visitors especially for the Chinese new year...215 reported deaths so far. That number although sad is still remarkably low. In a region of 2.2 million with a not great reputation for health and hospitals to only have a death rate of .01% seems amazing with how NY, and countries like France, Spain and Italy have fared. Studies like this and I'm sure the many to come make me really wish we had better contact tracing from the get go and hopefully in years to come there can be some better implementations
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