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A Pandemic in Times of Global Tourism: Superspreading and Exportation of COVID-19 Cases from a Ski Area in Austria

2020; American Society for Microbiology; Volume: 58; Issue: 6 Linguagem: Inglês

10.1128/jcm.00588-20

1098-660X

Carlos L. Correa-Martínez, Stefanie Kampmeier, Philipp Kümpers, Vera Schwierzeck, Marc Tim Hennies, Wali Hafezi, Joachim Kühn, Hermann Pavenstädt, Stephan Ludwig, Alexander Mellmann,

COVID-19 Clinical Research Studies

O n 7 January 2020, the World Health Organization (WHO) announced a novel coronavirus to be the cause of pneumonia cases whose cause was unclear in China.The infection came to be known as a coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).After the disease spread to 114 countries, a COVID-19 pandemic was declared by WHO on 11 March (https:// www.who.int/emergencies/diseases/novel-coronavirus-2019).Between 9 and 16 March, increasing numbers of COVID-19 cases were detected at University Hospital Münster (UKM), a tertiary care center in northwestern Germany.Of 90 patients, 36 had recently visited Ischgl (39.6%) (Fig. 1), a popular ski town in the Austrian Alps.With 22,626 beds for visitors, 492,798 tourists arrived in the 2018/2019 season, including guests from over 20 different countries.American tourists represented the most relevant group of non-European guests, with 6,886 overnight stays (https://www.tirol.gv.at/statistik-budget/statistik/publikationen/).Several of our patients had visited après-ski bars in Ischgl, and some recalled having contact with subjects with subsequently confirmed cases.Patients were predominantly male (61.1%) and aged 20 to 71 years (mean, 43.3).All displayed symptoms, including cough (69.4%), fever (55.6%), and dysphagia (33.3%) (Fig. 2).Quantitative real-time PCR analysis of nasopharyngeal swabs was performed (1), yielding positive SARS-CoV-2 results in 36 Ischgl cases.Another nine Ischgl tourists had equivocal test results, implying a potentially higher proportion of Ischgl-related COVID-19 cases.Thus, we included Ischgl as a risk region in our internal COVID-19 case definition, which was officially recommended by the German authorities 2 days later.Iceland declared Ischgl a risk region as early as 5 March after travelers returning from a ski trip tested positive upon arrival (https://www.landlaeknir.is/um-embaettid/frettir/frett/item39457/Skidasvadid-Ischgl-i-Austurriki-i-hop-skilgreindra-ahattusvada).Norway reported 161 cases imported from Austria, representing 57.1% of all imported cases (https://www.fhi.no/en/id/infectious-diseases/coronavirus/daily-reports/daily-reports-COVID19/).In Denmark, this proportion reached 50% (https://files.ssi.dk/COVID19-overvaagningsrapport-18032020).On 7 March, an employee of a popular après-ski bar in Ischgl tested positive for COVID-19.However, local authorities estimated the transmission to visitors to be very unlikely (https://www.tirol.gv.at/meldungen/ meldung/artikel/erhebungen-zu-am-coronavirus-erkrankten-norweger-im-bezirk -landeck-weiter-im-gange/).As cases continued to increase in number, a quarantine was declared in Ischgl on 13 March (https://www.bundeskanzleramt.gv.at/bundeskanzleramt/ nachrichten-der-bundesregierung/2020.html) and the ski season was finally terminated on 14 March (https://www.ischgl.com/news-de).The local public prosecutor's office