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New evidence in race to find France's COVID-19 'patient zero'

“We can only manage the future if we understand the past,” Dr. Michel Schmitt explained.
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PARIS — French doctors may have made a breakthrough in the race to establish where and when the coronavirus pandemic first hit Europe, by establishing that the virus may have been in France much earlier than anyone thought.

A team of researchers in the city of Colmar in northeastern France announced in a release last week that it had identified two X-rays, from Nov. 16 and Nov. 18, showing symptoms consistent with the novel coronavirus. NBC News has exclusively obtained these scans.

If confirmed, this is evidence that the virus was spreading in Europe two months before France declared its first cases Jan. 24 and well before COVID-19, the disease caused by the coronavirus, had been officially identified in China.

The news comes a week after a separate team of scientists in Paris established that a patient had the coronavirus Dec. 27, so far the earliest known case in Europe.

Officials in the Chinese city of Wuhan confirmed the existence of a then-unknown illness with pneumonia-like symptoms to the World Health Organization’s China office on Dec. 31, but it wasn’t established as a new coronavirus until Jan. 7.

U.S. spy agencies have gathered intelligence hinting at a public health crisis in Wuhan in November.

Scientists believe mapping the spread of the disease in its early stages is key to understanding how to protect people and prevent a second outbreak.

“We can only manage the future if we understand the past,” said Dr. Michel Schmitt of Albert Schweitzer Hospital in Colmar, who led the new research. “Today, we clearly do not understand this outbreak."

Under Schmitt's leadership, his radiology department has spent the last few weeks poring over thousands of chest X-rays from late 2019.

The scan of a suspected COVID-19 case under investigation by Dr. Michel Schmitt and his team. The first case can be traced back to November 16.
The scan of a suspected COVID-19 case under investigation by Dr. Michel Schmitt and his team. The first case can be traced back to November 16.Courtesy Albert Schweitzer Hospital

Dr. Vin Gupta, a pulmonologist, global health expert at the University of Washington and NBC News contributor, examined the scans for this article and found them to be "consistent" with what he had seen treating COVID-19 patients, noting that the scans appear to show evidence of "atypical pneumonia."

"This fits a pattern we're seeing with coronavirus — especially early coronavirus infection where you're seeing some abnormalities in some parts of the lungs but not abnormalities everywhere," he said. In many cases patients in that condition "have been just fine."

Schmitt, who cautions against making conclusions from his early results, led his team in examining almost 2,500 chest X-rays taken from Nov. 1, 2019, to April, looking for patterns. As well as the two suspected cases in mid-November, they identified 12 in December and 16 in January. After that, the numbers tick up dramatically.

If the virus arrived in the fall of 2019, rather than appear in February and explode across the country throughout March as has been assumed, the public health implications are vast.

"This could completely change the government's management strategy," Schmitt added.

And while Schmitt's team looked over old scans, Vincent Breton, a research director at the French National Centre for Scientific Research or CNRS, launched a social survey in the same region to improve understanding of the raw medical data.

“At this point to understand the epidemic, we need feedback from citizens because we know so little about this virus,” he said, explaining how families are asked to fill out an online questionnaire describing everything from past symptoms to social interactions.

The radiology team at Albert Schweitzer hospital in Colmar, France.
The radiology team at Albert Schweitzer hospital in Colmar, France.Courtesy Albert Schweitzer Hospital

Breton's goal is to cross-reference this data with medical data to pinpoint the path of the virus and identify areas and time periods in which people caught the virus. With that information, he explained, governments can make smarter decisions about what to reopen and when.

Breton cites the city of Mulhouse, the country’s first epicenter, as an example of why their work and their coordination are so vital. In mid-February, a religious conference at a church in Mulhouse was widely reported as an accelerant in the region, but Breton says his team’s data suggests COVID-19 was already circulating weeks before the event.

“The testimonies are really rich, they show that people felt that something strange was going on, but they were not in a capacity to raise the alarm,” he explained.

“That is something we can learn from this pandemic, we should think of new ways to raise alarm for emerging diseases.”

In Colmar, Schmitt said he is just beginning and his team will now look back to scans from October. The more information they have now, the more prepared they'll be for a possible second wave.

Dr. Yves Cohen, who led the Paris study, looked back at the records of intensive care unit patients from late last year who had flu-like symptoms but tested negative for pneumonia. He retested 14 patients and one tested positive for COVID-19. He urged all doctors around the world to do the same.

"To fight an enemy, we have to know the life of the enemy," he said, echoing Schmitt. Last week, the World Health Organization agreed, encouraging other countries to revisit old cases.

Nancy Ing contributed reporting from Paris.