![]() ![]() Other case-patients who had been on other floors denied any direct contact with confirmed patients from floor 7, but they shared common building facilities (e.g., restrooms, elevators). ![]() Patients A–G ( Figure, panel A) worked in the same room on floor 7. We found no convincing evidence of definitive transmission pathways in this building. However, most customers reported early symptom onset in a concentrated time frame ( Figure, panel B). The possibility of customers being infected from other sources cannot be excluded. We created an illustration showing the floors where the eventual COVID-19 case-patients worked or shopped, along with dates of symptom onset, potential incubation periods, symptom durations, confirmed times of positive diagnosis, and times of discharge ( Figure, panel A).Įxcept for those who had been on floor 7, all other case-patients denied direct close contact with other case-patients. The mall has 8 floors above ground and several basement levels floors B1 to 6 are commercial shopping space, and floor 7 contains shopping and office space. B) Dates of symptom onset, confirmed test. A) Distribution of COVID-19 case-patients by mall floor, time, and internal relationship. Cluster of COVID-19 cases associated with a shopping mall in Wenzhou, China. The average incubation period was 7.3 (range 1–17) days.įigure. Sixteen patients had had direct contact with other patients or had gone shopping in the mall. Close contacts associated with the mall were traced, and COVID-19 was confirmed for 11 persons. During January 19–February 9, COVID-19 was diagnosed for 7 mall staff from floors B1–3 and for 10 mall customers. Because persons with asymptomatic COVID-19 can spread the virus, patient A also could have been an asymptomatic carrier with a persistent infection ( 3). However, her clinical symptoms did not appear until after hospitalization. Asymptomatic carrier transmission has been reported for SARS-CoV-2 ( 2) hence, patient A could have been screened as a close contact during her incubation period and then hospitalized on the basis of a positive test (PCR) result only. If patient A is the index patient, infected in Wuhan, her incubation period would have been 28 days, which would be extremely long, according to updated information (W.J. Despite symptom resolution, on January 30 she was confirmed to have SARS-CoV-2 infection. On January 15–16, 2020, she had a fever, but symptoms resolved without treatment. Patient A, a 30-year-old woman, the only case-patient who indicated that she had been in Wuhan, China, returned from Wuhan on December 18, 2019. The Wenzhou Center for Disease Control and Prevention traced and tested their contacts, and by January 28, COVID-19 was confirmed for 7 persons (patients A–G) from the same office (on floor 7). On January 21, COVID-19 was confirmed for patient E and his co-worker, patient G. On January 20, 2020, a 23-year-old man (patient E) sought care at a hospital after 11 days of fever and headache. The study was approved with written consent from the Ethics Committee of Wenzhou Central Hospital and written informed consent from all case-patients. We analyzed clinical and laboratory data for cases by using real-time reverse transcription PCR ( 1). To determine how the virus may have spread among a cluster of COVID-19 cases associated with a shopping mall in Wenzhou (a city with 8 million residents), China, we monitored and traced close contacts and hypothesized possible transmission modes. ![]() However, these transmission modes do not explain all cases. ![]() Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease (COVID-19), is presumed to spread primarily via respiratory droplets and close contact. ![]()
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