How One Singapore Sales Conference Spread Coronavirus Around the World
One meeting, attended by 109 people, sent virus hunters scurrying to a French Alpine ski town, a British pub and locations in Malaysia and South Korea
Last month, 109 people gathered in a Singapore hotel for an international sales conference held by a U.K.-based company that makes products to analyze gas.
When the attendees flew home, some unwittingly took the coronavirus with them.
The virus had a 10-day head start on health authorities who, after belatedly learning a 41-year-old Malaysian participant was infected, began a desperate effort to track the infection through countries including South Korea, England and France. Health investigators have found at least 20 people in six Asian and European countries who were sickened, some who attended the conference and others who came in contact with participants.
A globalized economy, one that’s far more integrated than in the early 2000s when the SARS virus broke out, is complicating the task of responding to epidemics.
After this one conference alone, 94 participants left Singapore, authorities determined. Some joined Lunar New Year dinners. Others went on vacation, one to an Alpine ski town. They had eaten, taken car rides and shared a roof with others who then boarded more planes to places the virus hadn’t yet reached.
Health officials used international communications channels to share names of the potentially infected and relied on self-reporting by sickened conference-goers, creating “activity maps” that detailed their movement. They checked flight manifests and called passengers. French authorities closed down schools in sparsely populated towns. U.K. public-health officials isolated health-care workers who got the illness and searched for patients with whom they came in contact.
Tracking even a relatively small number of cases such as those linked to the conference requires meticulous detective work. To stop the contagion’s global spread, it is critical to identify people who might have caught the virus before they pass it on.
“There’s a lot of classic, boots-on-the-ground epidemiology going on right now tracing these cases,” says Dr. Matthew Ferrari, associate professor of biology at the Center for Infectious Disease Dynamics at Pennsylvania State University.
Singapore, whose health authorities have confirmed 86 cases there, has deployed dozens of contact tracers and data analysts to hunt down every bit of information. The work begins in hospitals where specialists are interviewing sickened people to map their whereabouts for the days before they were isolated and might have infected others, seeking details such as whom they ate with and met, which shoe shop they visited, how many salespeople shook their hands.
“There are basically no gaps in the activity map,” says Pream Raj, an assistant director in the Singapore Health Ministry’s communicable-diseases division. In Singapore, he and his associates are seeking help from police, drawing on security-camera footage and working with ride-hailing companies for information to identify which driver fetched whom.
One big puzzle piece has been the source of the infection. Somebody brought the virus to the conference. Who?
Global infections
The broader coronavirus crisis goes back to December, when Chinese authorities disclosed the outbreak after dozens of people fell ill with pneumonia in Wuhan, in China’s Hubei province. Authorities identified it as a new strain of coronavirus. It spread in China, where 74,600 people had been sickened as of Feb. 20, according to the World Health Organization, and there have been 1,073 confirmed cases outside China. The WHO says more than 2,100 people have died.
With news of new deaths and infections globally, other countries are drawing more attention. South Korea reported a surge in confirmed cases on Friday. The first deaths were reported in Iran and among cruise-ship passengers in Japan this week.
When the conference began Jan. 19, Singapore had no confirmed cases. The gathering was a 2020 sales kickoff hosted by U.K.-based Servomex Group Ltd. For four days, guests from around the world mingled at Grand Hyatt Singapore. A dance troupe performed traditional shows in elaborate costumes to entertain the guests, and with Lunar New Year around the corner, the mood was festive.
Some participants were from China, including Hubei province, Singapore health officials later learned.
The first report of trouble came from Malaysia, 10 days after most attendees left Singapore. A 41-year-old Malaysian participant had traveled to his hometown in the country’s north, according to the activity map investigators compiled. By the time he returned to the central Malaysian town where he works, he had a cough and fever. On Feb. 3, doctors confirmed he had the coronavirus.
Malaysian health authorities notified Singapore counterparts, who soon put their virus sleuths into action. First, they got the list of 109 participants and learned 94 weren’t from Singapore. They activated international communication channels to let other governments know which of their nationals were at the conference. “We informed them pretty early on,” Mr. Raj says, “before it started to balloon.”
A Servomex spokesman says the company worked closely with public-health authorities and put preventive measures in place as new information about the infections emerged, such as restricting employee travel and asking conference attendees to self-isolate.
In Malaysia, health investigators grilled the 41-year-old patient for details about where he had been, which flights he took, who picked him up from the airport and other details, Malaysian health officials say. Virus sleuths there compiled a list of 74 people he had come in contact with—family, friends, doctors, nurses. They contacted those people one by one, seeking phone numbers and addresses along the way.
He shared holiday meals with his family and rode in a car with his sister. She told them she had a sore throat; a test came back positive for coronavirus. His mother-in-law, who complained of a headache and fatigue but no fever, also had the disease, Malaysia’s Health Ministry says. The man and his mother-in-law have recovered, and his sister is under treatment.
The infected Malaysian had dined with an associate from South Korea at the conference. After his Feb. 3 diagnosis, he contacted the associate with a warning: Get yourself tested.
After the conference, the South Korean had flown to his country’s main international airport, taken the airport express to Seoul and eaten at a soft-tofu restaurant, according to South Korea’s Centers for Disease Control and Prevention, then took a high-speed train to his hometown of Daegu.
He spent the night at his parents’ home, visited his parents-in-law the next day, then boarded a train back to Seoul. He rode the subway, then took a cab home. Even before he heard from his Malaysian friend, the man felt flulike symptoms, says Lee Wang-jun, chairman at Myongji Hospital, which treated him. The man made trips to medical facilities, stopped at a rice-congee store and visited a supermarket.
After his Malaysian colleague’s warning, he took a coronavirus test: positive.
That triggered a virus hunt in South Korea, where authorities also notified their Singaporean counterparts. A South Korean investigator traveled to Guri, a Seoul suburb where the man lives, collecting information from other sources for a time-stamped travel log, health officials say. Authorities listed his contacts: 188 people to start with, then 290 as the probe progressed, all of whom health officials needed to brief. The KCDC says another South Korean conference attendee was confirmed to have the illness.
Back in Singapore, Mr. Raj and his team turned to the 15 participants living in Singapore. Eleven said they were well, four weren’t. Three of them tested positive; all have recovered.
Health-care specialists interviewed the trio about when they got to the conference and started feeling sick, and whom they interacted with. Contact tracers phoned dozens of people the infected people had named and gleaned more details about whom they might have exposed.
Singapore had already pressed into action seven groups of 10 people each, who work closely with Mr. Raj’s core team for this work. The team pored over the material to arrive at critical decisions. The Health Ministry quarantined people with significant exposure to the three patients—interaction, for instance, that exceeded 30 minutes, Mr. Raj says. They created a second category, of people who had less-prolonged contact with the three conference-goers, and placed them under home surveillance.
Mr. Raj’s team prepared questions for conference attendees in other countries, and their counterparts relayed answers back.
Westward spread
Meanwhile, the virus trail emerged in the West. U.K. citizen Steve Walsh, a Servomex employee at the conference, was back in Europe by Jan. 24, stopping with friends in a French ski town, Les Contamines-Montjoie, says Mayor Etienne Jacquet.
The group stayed in a six-bedroom unit owned by a British friend, Mayor Jacquet says. Mr. Walsh left France Jan. 28, the mayor says, while several of his friends stayed behind.
Mr. Walsh, through the Servomex spokesman, declined to comment. In a statement through the spokesman, he said that back in the U.K. he learned he had been exposed to a confirmed coronavirus case. He had no symptoms, he said, but contacted U.K. health authorities anyway.
His test was positive, the third case confirmed in the U.K., health authorities there say. Authorities raced to find everyone he might have exposed—from the staff of a Brighton pub to airline passengers he sat near.
British authorities called French counterparts, who in the middle of the night phoned Mayor Jacquet of Les Contamines-Montjoie. Mr. Walsh’s friends had spent the week unaware they might have been infected, Mr. Jacquet says.
“In Les Contamines, we enjoy drinking good wine, we enjoy eating fondue, we like cheese and we ski,” he says. “This group didn’t really go out that much.”
On Feb. 7, French health officials pinpointed the location of the people Mr. Walsh had stayed with to a lodge not far from the region’s famous slopes, French health authorities and the mayor say. Authorities identified 11 close contacts, including the lodge’s owner and his three children, the mayor says. All were at high risk of transmission, and health authorities transported them in sanitized emergency vehicles to three nearby hospitals, the French Health Ministry says.
Their test results began coming back positive that same day. Mr. Jacquet says a senior health official called him at 1 a.m. confirming the virus had in fact reached the remote town, and by 3 a.m. health officials established a local crisis center. The next day, the investigation widened with each confirmed case—five in total, including a 9-year-old boy.
The child’s infection set off a challenging inquiry, says Jean-Marc Peillex, the mayor of neighboring Saint-Gervais-les-Bains. Officials tried to reconstruct what happened over the days the boy’s virus was undetected, piecing together interviews with children, who don’t always remember whose hand they touched or how many people were in a room.
They determined the boy attended regular classes at one school and French lessons at another in a neighboring town. Widening their search, they learned he had taken an exam sometime between Jan. 24 and Feb. 7 at a Montessori school in another nearby town. Authorities closed all three schools for more than a week.
Virus sleuths kept finding new cases linked to Mr. Walsh. U.K. health officials detected one in the U.K. related to the France cluster. Some 830 miles south on the island of Mallorca, where another man had traveled from France, local health authorities confirmed another case on Feb. 9. The next day, U.K. authorities linked four more cases to Mr. Walsh. The government there called the virus a “serious and imminent threat.”
Of the four cases, Public Health England discovered two were health-care workers south of London. Yvonne Doyle, Public Health England’s medical director, said in a statement that officials worked to identify patients and colleagues the two might have exposed.
Health officials say Mr. Walsh has recovered. “I’m happy to be home and feeling well,” he said in a statement.
Singapore authorities haven’t reported deaths among the conference-goers. They still don’t know how the virus got there, Mr. Raj says.
