This last December 2019, this writer had a house guest, an old classmate from University of California Los Angeles (UCLA). At least once a year this friend typically visits, often remaining for at least a week if not two. This past December was different from past visits in that he had a horrific dry cough that just didn’t stop—the dry hack would come in waves and it’s as if he couldn’t breathe for moments due to the waves of hacking. At one point in the visit, his cough was so bad that he was offered a trip to the urgent care clinic. He didn’t bother but rumblings of a novel coronavirus materializing in China soon followed in January. Could it be possible that that horrific cough the friend picked up in Los Angeles was in fact the result of the SARS-CoV-2 infection? Ironically, the common bond between this author and the guest from Los Angeles was UCLA. So, it’s a little ironic that UCLA researchers recently released study results suggesting the possibility that COVID-19 had already traveled to Los Angeles by late December 2019, indicating that SARS-CoV-2, the virus behind the COVID-19 pandemic, was actually present in North America before New Year’s Day 2020.
The UCLA fellow alumni traveled from Los Angeles to Salt Lake City in mid-December, bothered with what appeared to be the worst cough this author has ever seen. Even prior to the recently announced UCLA study, this author suspected that the friend was in fact infected with COVID-19. There were reports of a very nasty cough moving around the Los Angeles basin in December. And, of course, now the Bruin-originated study certainly points to evidence of unusually high numbers of visitors, patients and hospitalizations during this time frame. COVID-19 may in fact have circulated around the globe significantly earlier than what is commonly understood today. Did COVID-19 make its way to the American West Coast by late December? If this is true, the UCLA researchers suggest this certainly disrupts the existing narrative of COVID-19’s origins in America.
The Official Narrative
The first reported cases of this new virus occurred in Wuhan, China, where cases with SARS-CoV-2 symptoms surfaced by December 1, 2019. The World Health Organization (WHO) reported on the earliest onset of individuals in Wuhan with symptoms was December 8, 2019. However, actual human-to-human transmission wasn’t officially confirmed by Chinese officials and WHO until January 20, 2020.
According to the U.S. Centers for Disease Control and Prevention (CDC), the first COVID-19 case in the United States involved a man traveling from Wuhan, China to Washington state on January 21, 2020. The CDC actually verified and confirmed the spread of the virus around America on February 26, 2020.
The UCLA researchers aggregated, queried and analyzed over 10 million patient records from UCLA’s Health outpatient, emergency department and hospital facilities representing a period from December 1, 2019 to February 29, 2020. This data set was compared to and analyzed against a set of data from the same time span from the last five years. Appearing in the peer-reviewed Journal of Medical Internet Research, the team uncovered that outpatient clinic visits by UCLA patients complaining with coughs spiked by 50%; the total number of patient visits for this period was greater than average number of patient visits for the same symptoms over the past five years by more than 1,000. Moreover, UCLA declared in a recent press release that the reported number of patient visits to emergency departments for symptoms related to coughs, as well as actual hospitalizations with acute respiratory failure, were far higher during this past December than previous years. This material increase starting December 2019 remained even after adjusting the mathematical formula for seasonal variation and patient population changes.
Investigator Point of View
Data analysis of outpatient settings can potentially foretell what’s to come, suggested Joann Elmore, MD, MPH, lead of this study. The professor of medicine at the David Geffen School of Medicine at UCLA commented, “For many diseases, data from the outpatient setting can provide an early warning to emergency departments and hospital intensive care units of what is to come.”
Dr. Elmore emphasized the importance for these retrospective analyses s not to just peer into hospitalization data; of course, most patients first turn to the outpatient setting and a wealth of real world evidence (RWE) exists there in the electronic health records.
Just an Observation: Not Proof
Of course, this UCLA-based study doesn’t prove that this tremendous spike in SARS-like symptoms was in fact caused by the novel coronavirus. For example, other factors may in fact be the cause of the unexpected increase in patient symptoms, from the use of e-cigarettes to the flu to simply a random anomaly.
Dr. Elmore commented, “We may never truly know if these excess patients represented early and undetected COVID-19 cases in our area.”
Unless there is a way to use genetic science or some other means to pinpoint with a high degree of certainty, this data and the author’s observations back in mid to late December are just, that—observations.
Real Point of the Study
The real point of this study; the valuable golden nugget and take way, was summarized by Dr. Elmore. Moving forward in America and elsewhere, a number of lessons have been learned from the pandemic experience. Unfortunately, America has been the epicenter of this horrific event. Health systems and agencies around the nation will institute practices and procedures to protect populations against any future pandemic. Dr. Elmore, summarizing the value of this recent study, regardless of whether they can ever prove the hypothesis, “But the lessons learned from this pandemic, paired with healthcare analytics, such as outpatient data, can inform and enable real-time surveillance of disease and symptoms, can potentially help us identify and track emerging outbreaks and future epidemics.”
Another co-author, Dr. Michael Pfeffer, chief information officer for UCLA Health, commented, “The pandemic has really highlighted our need for agile health care analytics that enable real-time symptom and disease surveillance using electronic health records data.” Dr. Pfeffer further declared the opportunity for technology vendors moving forward to offer value-added solutions: “Technology, including artificial intelligence powered by machine learning, has further potential to identify and track irregular changes in health data, including significant excesses of patients with specific disease-type presentations in the weeks or months prior to an outbreak.”
Joann Elmore, MD, MPH, professor of medicine at the David Geffen School of Medicine at UCLA
Michael Pfeffer, MD, Assistant Vice Chancellor, chief information officer, UCLA Health
Dr. Elmore and Dr. Pfeffer worked with several other authors from UCLA as well as University of Washington. Follow the link to review the study as well as the full list of authors.
Call to Action: With the advent of EHR, cloud technologies, analytics and machine learning, and AI, as identified by Dr. Pfeffer, undoubtedly new business offerings could be packaged around continuous monitoring of EHR and public health data as a subscription service.