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Id Subject Object Predicate Lexical cue
T1 0-117 Sentence denotes Early transmission patterns of coronavirus disease 2019 (COVID-19) in travellers from Wuhan to Thailand, January 2020
T2 119-127 Sentence denotes Abstract
T3 128-231 Sentence denotes We report two cases of coronavirus disease 2019 (COVID-19) in travellers from Wuhan, China to Thailand.
T4 232-368 Sentence denotes Both were independent introductions on separate flights, discovered with thermoscanners and confirmed with RT-PCR and genome sequencing.
T5 369-595 Sentence denotes Both cases do not seem directly linked to the Huanan Seafood Market in Hubei but the viral genomes are identical to four other sequences from Wuhan, suggesting early spread within the city already in the first week of January.
T6 597-776 Sentence denotes In late December 2019, an outbreak with an initially undiagnosed pneumonia was reported in the city of Wuhan, Hubei Province, China, and linked to the Huanan Seafood Market [1,2].
T7 777-953 Sentence denotes The causative pathogen was identified as a novel betacoronavirus within the severe acute respiratory syndrome (SARS) coronavirus (CoV) family, recently termed SARS-CoV-2 [3-7].
T8 954-1108 Sentence denotes In response to the outbreak, several countries including Thailand, established thermal screening at the airport for travellers from Wuhan since 3 January.
T9 1109-1231 Sentence denotes On 8 January and 13 January, suspected cases of infection with SARS-CoV-2 were identified at Bangkok Suvarnabhumi airport.
T10 1232-1335 Sentence denotes We report the investigation, basic clinical characteristics and viral genomes derived from these cases.
T11 1337-1343 Sentence denotes Case 1
T12 1344-1454 Sentence denotes A woman in her early 60s from Wuhan developed a fever with chills, sore throat and headache on 5 January 2020.
T13 1455-1536 Sentence denotes She went to a local health facility in China and received undisclosed medication.
T14 1537-1689 Sentence denotes On 8 January 2020, she took a direct ca 4 h flight to Thailand from Wuhan, with five family members, as part of a tour group of 16 (including the case).
T15 1690-1807 Sentence denotes Her measured temperature at the arrival gate was 38.6 °C by thermoscanner, and confirmed with a tympanic thermometer.
T16 1808-1996 Sentence denotes After being interviewed by quarantine officers, she was transferred to Bamrasnaradura Infectious Disease Institute (BIDI) Hospital, Nonthaburi, for isolation and laboratory investigations.
T17 1997-2067 Sentence denotes She reported a runny nose and sore throat but no dyspnea or diarrhoea.
T18 2068-2147 Sentence denotes Upon admission, her vital signs were normal except for elevated blood pressure.
T19 2148-2226 Sentence denotes Her physical examination was unremarkable including inconspicuous lung sounds.
T20 2227-2328 Sentence denotes Her complete blood count suggested a viral infection from relatively decreased neutrophil (48%; norm:
T21 2329-2362 Sentence denotes 35–75%) to lymphocyte (40%; norm:
T22 2363-2381 Sentence denotes 20–59%) ratio [8].
T23 2382-2568 Sentence denotes The chest X-ray (CXR) results on 8 January were compatible with pneumonia with mild thickening lung marking at both lower lungs possibly because of crowded lung rather than infiltration.
T24 2569-2608 Sentence denotes It also showed borderline cardiomegaly.
T25 2609-2662 Sentence denotes Repeat CXR after 7 days showed no remarkable changes.
T26 2663-2852 Sentence denotes In the interview, the patient explicitly stated that she had not visited the Huanan Seafood Market but she was living near another local market, which she visited daily until illness onset.
T27 2853-2922 Sentence denotes This market was at ca 7.5 km distance from the Huanan Seafood Market.
T28 2923-3029 Sentence denotes The patient also reported that she had not purchased live animals and or visited stalls with live animals.
T29 3030-3095 Sentence denotes She did not visit Jinyintai Hospital or other hospitals in Wuhan.
T30 3096-3166 Sentence denotes However, she visited local dispensaries in Wuhan to obtain medication.
T31 3167-3235 Sentence denotes She also reported no contact with persons with respiratory symptoms.
T32 3236-3337 Sentence denotes Clinical specimens collected on admission included the upper respiratory tract secretions and sputum.
T33 3338-3445 Sentence denotes These specimens tested positive on 12 January for the CoV family by using a conventional nested RT-PCR [9].
T34 3446-3818 Sentence denotes Genomic sequencing analysis included Sanger and next generation sequencing were performed by the Emerging Infectious Diseases Health Science Center, the Thai Red Cross Society and the Thai National Institute of Health, Department of Medical Sciences and the sequence shared via the Global Initiative on Sharing All Influenza Data (GISAID) EpiCoV database (EPI_ISL_403962).
T35 3819-3899 Sentence denotes The sequencing protocol and details are provided in the Supplementary Materials.
T36 3900-4029 Sentence denotes The patient recovered after testing negative for SARS-CoV-2, and returned to China without signs and symptoms on 18 January 2020.
T37 4031-4037 Sentence denotes Case 2
T38 4038-4117 Sentence denotes A woman in her mid-70s from Wuhan landed at Suvarnabhumi airport on 13 January.
T39 4118-4221 Sentence denotes She travelled to Thailand with three family members as part of a tour group of 20 (including the case).
T40 4222-4322 Sentence denotes An airport thermoscanner detected a fever of 38.0 °C that was confirmed with a tympanic thermometer.
T41 4323-4452 Sentence denotes The patient reported a sore throat, that her fever onset date was 13 January and that she had a cough for an undetermined period.
T42 4453-4490 Sentence denotes The patient was hospitalised at BIDI.
T43 4491-4579 Sentence denotes Upon admission, she reported mild tachypnoea, and her CXR was compatible with pneumonia.
T44 4580-4829 Sentence denotes Similar to case 1, the first CXR taken on 13 January, showed thickening interstitial lung marking at both lower lung fields and both perihilar regions because of interstitial infiltration or crowded lung marking, mild cardiomegaly and dilated aorta.
T45 4830-4941 Sentence denotes Follow-up CXR on 17 January additionally showed recent hazy with reticular opacities at left middle lung field.
T46 4942-4993 Sentence denotes The patient was not in severe condition but stable.
T47 4994-5099 Sentence denotes In the patient interview, she reported that she did not visit the Huanan Seafood Market or other markets.
T48 5100-5237 Sentence denotes She also reported no contact with pigs, camels, other mammals (or areas with dead birds), or any consumption of raw or undercooked foods.
T49 5238-5316 Sentence denotes She stated that she was not in contact with persons with respiratory symptoms.
T50 5317-5403 Sentence denotes A conventional nested RT-PCR test of this patient was positive for the CoV family [9].
T51 5404-5533 Sentence denotes Subsequent genome sequencing was again compatible with the SARS-CoV-2 and shared via the GISAID EpiCoV database (EPI_ISL_403963).
T52 5534-5602 Sentence denotes A nasopharyngeal swab also tested positive by RT-PCR for adenovirus.
T53 5603-5777 Sentence denotes The patient was no longer febrile as of 17 January, and after testing negative for the CoV family by conventional nested RT-PCR, she was discharged and she returned to China.
T54 5779-5803 Sentence denotes Genome sequence analysis
T55 5804-6219 Sentence denotes Comparing the two genome sequences with a non-redundant selection of representatives from all known CoV families by alignment [10] and phylogenetic tree (Figure 1A) [11] shows that they belong to the SARS family of betacoronaviruses and while related to SARS-CoV (80% genome identity), they were most closely related to SARS-like bat CoV from China (88% identity) as closest known sequence at the time of emergence.
T56 6220-6452 Sentence denotes Figure 1 Phylogenetic trees of Thai sequences in context of all coronavirus families (A) and structural mapping of mutations in the spike glycoprotein between SARS CoV (PDB:6CG [12]) and the current SARS-CoV-2 using YASARA [20] (B)
T57 6453-6476 Sentence denotes CoV: coronavirus; MERS:
T58 6477-6563 Sentence denotes Middle East respiratory syndrome coronavirus; SARS: severe acute respiratory syndrome.
T59 6564-6635 Sentence denotes Panel A: blue: SARS-CoV-2; red: SARS; purple: MERS; green: common cold.
T60 6636-6682 Sentence denotes Panel B: cyan: ACE2 human host receptor; grey:
T61 6683-6771 Sentence denotes CoV spike glycoprotein trimer (PDB:6ACG); red: mutations between SARS-CoV vs SARS-CoV-2.
T62 6772-6983 Sentence denotes The phylogenetic tree was created from whole genome alignment with MAFFT using the neighbour-joining method with maximum composite likelihood (MCL) model, uniform site rates and 500 bootstrap tests using MEGA X.
T63 6984-7166 Sentence denotes Structural mapping of mutations in the spike glycoprotein between SARS CoV and the two cases of the SARS-CoV-2 reported here shows only 76% identity at the protein level (Figure 1B).
T64 7167-7287 Sentence denotes This surface protein is critical for ACE2 host receptor interaction and is also a target of the immune response [12,13].
T65 7288-7489 Sentence denotes Given several mutations in the binding interface, it may differ in host cell binding efficiency compared with SARS-CoV which could result in differences in virulence and transmission potential [14,15].
T66 7490-7876 Sentence denotes The genomes of the two separate cases of coronavirus disease 2019 (COVID-19) are identical over the full length of close to 30 kb and are furthermore identical to five other sequences (four from Wuhan and one from Zhejiang); together these sequences form the largest cluster of identical cases within the early outbreak, comprising a core of at least indirectly linked cases (Figure 2).
T67 7877-8123 Sentence denotes Within-outbreak sequence divergence is generally low with 0–9 nt differences over the whole genome and mutations unique to individual strains are possibly related to quality differences of the samples and noise of the methods used for sequencing.
T68 8124-8227 Sentence denotes Figure 2 Within-outbreak SARS-CoV-2 sequence divergence and clusters, China and Thailand, January 2020
T69 8228-8329 Sentence denotes Number of pair-wise nt differences across whole genomes colour-coded from zero (green) to nine (red).
T70 8330-8335 Sentence denotes Blue:
T71 8336-8354 Sentence denotes Thai sample names.
T72 8355-8433 Sentence denotes Orange: samples with sequences identical to each other and the Thai sequences.
T73 8434-8641 Sentence denotes We gratefully acknowledge the authors, the originating and submitting laboratories for their sequence and metadata shared through GISAID, on which this research is based (as listed in Supplementary Table 1).
T74 8643-8664 Sentence denotes Follow-up of contacts
T75 8665-8751 Sentence denotes Case 1 travelled in a tour group with 15 others and 40 close contacts were identified:
T76 8752-8924 Sentence denotes 15 members of the tour group, 15 people sitting within two rows in front and back of the seat of case 1 on the same airplane, nine crew members and one port health officer.
T77 8925-9019 Sentence denotes They were monitored for COVID-19 with RT-PCR tests on days 1, 12 and 14 ; all tested negative.
T78 9020-9106 Sentence denotes Case 2 travelled in a tour group with 19 others and 44 close contacts were identified:
T79 9107-9240 Sentence denotes 19 members of the tour group, 15 within two rows front and back of the seat of case 2, nine crew members and one port health officer.
T80 9241-9336 Sentence denotes All were monitored for COVID-19 with RT-PCR tests on days 1, 12 and 14 and all tested negative.
T81 9338-9363 Sentence denotes Discussion and conclusion
T82 9364-9501 Sentence denotes According to the cases’ history, the two imported COVID-19 cases described here are not directly linked, yet their genomes are identical.
T83 9502-9803 Sentence denotes Further, according to information provided by the cases, they have no direct link to the Huanan Seafood Market but their genomes are identical to four sequences from Wuhan collected on 30 December 2019 and sequenced by three different laboratories, indicating potential wider distribution in the city.
T84 9804-10036 Sentence denotes Although within-outbreak sequence divergence is low for this virus, identical genomes of up to 30 kb are rare and a strong sign of recent transmission linkage, albeit with unknown number of generations within the transmission chain.
T85 10037-10196 Sentence denotes The missing link to the market, the time of travel and onset of symptoms in the two COVID-19 cases together with the incubation period of mean 6.4 days (range:
T86 10197-10426 Sentence denotes 5.6–7.7) [16] and the time of closest genome neighbours obtained from sequences in Wuhan, suggest that transmission within Wuhan beyond the Huanan Seafood Market is likely to have occurred in the first week of January or earlier.
T87 10427-10566 Sentence denotes People travelling out of the city since then may have spread the virus further before travel restrictions were enforced on 23 January [17].
T88 10567-10792 Sentence denotes Thailand implemented measures for screening patients travelling from Wuhan since 3 January 2020 at Suvarnabhumi Airport, Don Mueang, Phuket and Chiang Mai airports, and stepped up surveillance at public and private hospitals.
T89 10793-10947 Sentence denotes The two cases described here who tested positive for SARS-CoV-2 were the first confirmed exported cases from China, suggesting early international spread.
T90 10948-11317 Sentence denotes Therefore, while one cannot exclude the possibility that asymptomatic cases in their incubation period would be missed and become infectious later, screening of incoming travellers from an affected area proved successful at least in these two instances, when COVID-19 cases were detected, isolated, observed and only discharged once they tested negative for SARS-CoV-2.
T91 11318-11527 Sentence denotes Rapid response including genome sequencing and sharing via GISAID [18,19] (https://www.gisaid.org/) enabled fast dissemination of results and provided a glimpse of early transmission patterns in this outbreak.
T92 11529-11545 Sentence denotes Acknowledgements
T93 11546-11607 Sentence denotes The authors wish to thank all the participants in this study.
T94 11608-11827 Sentence denotes We would like to thank GISAID President Peter Bogner for help in sharing with GISAID and Dr Opart Karnkawinpong (Director General of Department of Medical Sciences) for his support and guidance during the investigation.
T95 11829-11850 Sentence denotes Conflict of interest:
T96 11851-11865 Sentence denotes None declared.
T97 11866-12082 Sentence denotes Authors’ contributions: PO, SPh, TT, SPa, WW, SWai, MC, NM and NJ contributed work in the Department of Medical Sciences; RB, AV, SU and SI in the Department of Disease Control; and SWac in the Health Science Centre.
T98 12083-12139 Sentence denotes RTCL and SMS provided the sequence analysis and figures.
T99 12140-12174 Sentence denotes PO and SMS drafted the manuscript.
T100 12175-12223 Sentence denotes All authors saw and agreed to the final version.
T101 12225-12243 Sentence denotes Supplementary Data
T102 12244-12257 Sentence denotes Supplement S1
T103 12258-12294 Sentence denotes Click here for additional data file.
T104 12296-12314 Sentence denotes Supplementary Data
T105 12315-12337 Sentence denotes Supplementary Table S1
T106 12338-12374 Sentence denotes Click here for additional data file.