x to y to z covid-19 (33) patient (33) transmission (23) sars-cov-2 (22) patients (20) confirmed (19) health (18) 2020 (18) investigation (16) probable (15)

Study With Me

“Study with me” videos just show creators studying, and they amass large audiences whose viewership peaks during the school year and drops off during breaks. These videos provide motivation and inspiration for an activity that can be difficult to start.

study with me live
study with me unjaded jade
study with me pomodoro session

Creativity

These videos explore the act of creation, whether it’s creating a drawing or creating a makeup look, and invite viewers in on the act of creating something from nothing.

Pre 2011
The"with me" trend started in 2007 when "draw with me" videos began to pop up.

#MelGibson's #antisemitic #BlackLivesmatter #antimatter met #WynonaRyder - #JohnnyDepp's disabused ex-girlfriend (survivor), her #personnel #nonessential during #COVID19 #plague has her overhearing Mel's #epithet-laden #solo | read complete poem https://t.co/tPcU7KtepN pic.twitter.com/75S9kTOaGj
— mrjyn (@mrjyn) June 28, 2020

"Paint with me" edged out "draw with me" to become the most popular creativity trend.

On turning around, I was instantly riveted by his amazing emaciation; he seemed another"Lazarus, come forth" without his grave-clothes,

[…]Below the ribs, the trunk so immediately curves in, that the red band of the silk covering, though it is only loosely placed, seems a tourniquet to constrict the bowels within their prison-house, and the hip-bones, being of their natural size, the waist is like a wasp's.

By this part of the frame we are reminded of some descriptions of the abstemious and Bedouin Arab of the desert, in whom it is said the abdomen seems to cling to the vertbræ.

MIGHT AS WELL HAVE BIG TITS, DRIVING PANTIELESSWITH A PLATE OF DRY RUB ON YOUR SNATCH.

INSTEAD HE DRAWS more BY HALF-TRUTHslessRESPECT OWED, EQUAL AUTHORITYPLUSTWO MINUTES MASHING THE ACCELERATOR OF THE ROLLS TOWARD HOME, OR RANCH, WHERE GUNSMOKE ON TV, OR BEDROOM WALLS NEED SHOOTIN'—
mrjyn (@mrjyn) July 4, 2020

https://t.co/9YdkmIp9TT

pic.twitter.com/0xBz9kU4BS

COVID Dishes: Ortolan is a *very* uncommon dish AND Best old YouTube Channels to Eat them to And make a video of yourself doing it ©Trash Inc.https://t.co/ncfClTzidM pic.twitter.com/knTDLAbh8m
— mrjyn (@mrjyn) July 4, 2020

Creating art can be an inherently solitary activity. “Draw with me” videos and livestreams invite others into the process, and viewers receive the benefit of seeing a favorite artist create something from start to finish.

Draw With Me
procreate me baby

Related Hashtags
draw with me buildings
draw with me disney

paint with me
“Paint with me” videos share much in common with “get ready with me” videos. While the viewer watches the viewer assemble an image together, creators use these videos as an opportunity to talk to their audiences.

paint with me acrylic
paint with me jim reno
paint with me abstract

penpal with me
People have formed long-distance connections with strangers since well before the Internet. Through this modern twist on a classic hobby, people invite viewers to participate in the crafty construction of letters to pen pals.

real-time pen pal with me
penpal with me themes
kpop penpal with me

Around The World With Me
Participating in different activities with me through video is a worldwide phenomenon. In South Korea, “study with me” goes by the name “Gongbang” or “study broadcast.”

The Korean channel Irudabegan streaming study sessions in 2019 and gets thousands of views per session. South Korea also gave us “mukbang,” videos in which viewers are invited to share in the eating of a meal.
Viewers who speak Spanish are more familiar with “conmigo” content like “limpia conmigo,” which English speakers would recognize as “clean with me.”

Many of the most-viewed “limpia conmigo” videos come from Chula, who is based in Los Angeles but viewed across the Spanish-speaking world.
Translations are not necessary. For example, videos with “get ready with me” in the title amass millions of views a year in Germany. German creator Dagi Bee regularly uploaded “get ready with me” videos as she amassed over 4 million subscribers.
Whether it’s cooking, cleaning, studying, or writing a letter to a pen pal, “with me” videos represent the transformation of some of the loneliest tasks we perform into opportunities for connection. Creators morph these mundane tasks into creative expressions and connect with viewers looking for motivation, inspiration, or perhaps some other feeling of solidarity. In doing so, they suggest that there are more ways for human beings to connect than we previously realized.

We analyzed a collection of videos that contained the phrase “with me” in the title. After excluding music videos (e.g., Frank Sinatra’s “Come Fly With Me”), we determined which words were most commonly paired with the phrase “with me,” such as “draw,” “study,” “travel,” etc.

We then calculated the monthly views for each category of “with me” videos, since 2007 to present day.
Related

stories
The Explainer: Workout At Home
📹 fionaapplerocks: I don’t know who this is, but I found this video from 2016 while tidying up my computer. Watching it now, I can’t help but wonder ‘could this be the grown up Shameika’?? https://t.co/14d9yK3tSM https://t.co/w5p4FnBMSI
— mrjyn (@mrjyn) July 4, 2020
stories
The Explainer Learning Videos
You're not hearing me!
Refuse all fault, burden's contemptuous proof;
truth belies casual excoriation;
inaction insults apology;
lack of defense withheld, omissive denial;
dis-incrimination, disregard, contemptuous silence, mute omission.
— mrjyn (@mrjyn) July 4, 2020
stories
The Explainer: Face Mask Sewing Tutorials
dougmeet NONABSTEMIOUS UNTRANSLATABLE IMPULSIVITÉ DE L’ESCALIER NON-ABSTEMIOUS

It's great that you're coming out of crazy. Ahhhhh! !! !!

On the edge of this, you'll have a rest and you'll want it! !! !! !! !! Grinning cat face with smiling eyes
stories
Broadcast Delivered: YouTube Culture and Trends Insights
View this post on Instagram
He Needs Me (Shelley Duvall) Harry Nilsson for Fiona Apple, not from ex-husband P. T. Anderson and his masterful Punch-Drunk Love, but from the source. The source in this case being also the end. The end being, the end and barely begun beginnings for the assembly line formula which would render it critically cold but popularly potent, inventing whole India ustries and once serious directors of American auteur status as just the guy on Henry Ford ‘s line, whose job, while most important seeds steel did hmm un he’d andthe mega Hollywood remake machine, which is now so familiar as to in many cases proved itself of some desultory use as film class, pop culture history and last chance reference checker of that other last of generation marker whose last letter is now stricken from the choice of 26 employable, where only three of its last number would ever be used. Generation X, Y (who knows?), and ‘Z,’ that most dismally dormant out there not pounding pavement, nails, or some other perfectly malleable thing which it takes a generation to pound, but whose pounding will be fire gone by either some less épicène dandified Wyldean generation, perhaps, that ironically American ex-pat group whose irony comes from its battle fatigued world-wearisome cigarette dangling, wife eater grease monkey real men whose testosterone oozed muscularity, virility, laudatory exemplified machismo of men like Hemingway to run with bulls through, not only streets of Spain, but in and out of its China shops, broke but bohemian rhapsodic in blue sky, writing contemporaneous unboastful but brazen with bravado, sexual heat enough to populate the Boomers, and dilute them only of a World War boon for an unpopular second act w ose first was impossible to beat, so they settled into their fnew roles as breadwinners harbingering the Lillie path from lost to x to y to z z z z. #robertaltman #jonbrion #macmiller #paulthomasanderson #punchdrunklove #fionaapple #shelleyduvall #popeye #popeyefilm #popeyesoundtrack #heneedsme #shelleyduvalloliveoilstyleiconforever #robertevans
A post shared by Doug Meet (@dougmeet) on Jul 4, 2020 at 8:13am PDT
dougmeet
He Needs Me (Shelley Duvall) Harry Nilsson for Fiona Apple, not from ex-husband P. T. Anderson and his masterful Punch-Drunk Love, but from the source.

The source in this case being also the end. The end being, the end and barely begun beginnings for the assembly line formula which would render it critically cold but popularly potent, inventing whole industries, once serious directors of American auteur status, as just the guy on Henry Ford ‘s line, whose job, the important mega Hollywood remake machine, now so familiar as to, in many cases, prove itself some desultory use as pop culture history, last chance reference checker of that lastgeneration marker whose last letter is now ~~stricken~~ from the choice of 26 employable, where only three of its last number, letters would ever be used.

GenerationX, Y(who knows?), and ‘Z,’ that most dismally dormant, not pounding pavement,nails, or some other perfectly malleable thing, which takes a generation to pound, but whose pounding will be forgone by some less épicène, dandified, Wyldeangeneration, which ironicallyAmerican ex-pat groups whose battle fatigued, world-wearisome, cigarette dangling, wife-eater, greasemonkey under the hood irony emanates: real men whose testosterone oozed muscularity, virility, laudatory machismo -- men like Hemingway -- to run with bulls through, not only through the streets of Spain, but in and out of its China shops -- broke bohemians, rhapsodic in blue, skywriting contemporaneously unboastfully brazen with bravado, sexual heat enough to populate Boomers and dilute a World War boon for an unpopular second act impossible to beat into their new role as breadwinners, harbingering thelillied path from lost to x to y to z

#robertaltman #jonbrion #macmiller #paulthomasanderson #punchdrunklove #fionaapple #shelleyduvall #popeye #popeyefilm #popeyesoundtrack #heneedsme #shelleyduvalloliveoilstyleiconforever #robertevans
Summary:
In this cluster, two family gatherings outside the household likely facilitated the spread of SARS-CoV-2; one index patient who attended both events likely triggered a chain of transmission that included 15 other confirmed and probable cases of COVID-19 and ultimately resulted in three deaths. (255)
Patients were classified as having probable COVID-19 if they developed new symptoms of fever, cough, or shortness of breath within 14 days of contact with a patient with confirmed or probable COVID-19 but did not undergo laboratory testing (consistent with CDC recommendations,* the Illinois Department of Public Health prioritizes testing for hospitalized patients and other high-risk groups). (244)
This report describes the cluster of 16 cases of confirmed or probable COVID-19, including three deaths, likely resulting from transmission of SARS-CoV-2 at two family gatherings (a funeral and a birthday party). (218)
Three days after the funeral, on investigation day 5, patient A1.1, who was still experiencing mild respiratory symptoms, attended a birthday party attended by nine other family members, hosted in the home of patient A2.1. Close contact between patient A1.1 and all other attendees occurred; patient A1.1 embraced others and shared food at the 3-hour party. (190)
Patient D3.1 was a health care professional, and, despite not seeing any patients with known COVID-19, might have acquired SARS-CoV-2 during clinical practice rather than through contact with members of this cluster. (184)
Seven party attendees subsequently developed COVID-19 3–7 days after the event (Figure 2), including three with confirmed cases (patients A2.1, A2.2, and A2.3) and four with probable cases (patients A2.4, A2.5, A2.6, and A2.7). Two patients with confirmed COVID-19 (A2.1 and A2.2) were hospitalized; both required endotracheal intubation and mechanical ventilation, and both died. (182)
Best words:
covid-19 (33)
patient (33)
transmission (23)
sars-cov-2 (22)
patients (20)
confirmed (19)
health (18)
2020 (18)
investigation (16)
probable (15)
Keyword highlighting:
In this cluster, two family gatherings outside the household likely facilitated the spread of SARS-CoV-2; one index patient who attended both events likely triggered a chain of transmission that included 15 other confirmed and probable cases of COVID-19 and ultimately resulted in three deaths.
Patients were classified as having probable COVID-19 if they developed new symptoms of fever, cough, or shortness of breath within 14 days of contact with a patient with confirmed or probable COVID-19 but did not undergo laboratory testing (consistent with CDC recommendations,* the Illinois Department of Public Health prioritizes testing for hospitalized patients and other high-risk groups).
This report describes the cluster of 16 cases of confirmed or probable COVID-19, including three deaths, likely resulting from transmission of SARS-CoV-2 at two family gatherings (a funeral and a birthday party).
Three days after the funeral, on investigation day 5, patient A1.1, who was still experiencing mild respiratory symptoms, attended a birthday party attended by nine other family members, hosted in the home of patient A2.1. Close contact between patient A1.1 and all other attendees occurred; patient A1.1 embraced others and shared food at the 3-hour party.
Patient D3.1 was a health care professional, and, despite not seeing any patients with known COVID-19, might have acquired SARS-CoV-2 during clinical practice rather than through contact with members of this cluster.
Seven party attendees subsequently developed COVID-19 3–7 days after the event (Figure 2), including three with confirmed cases (patients A2.1, A2.2, and A2.3) and four with probable cases (patients A2.4, A2.5, A2.6, and A2.7). Two patients with confirmed COVID-19 (A2.1 and A2.2) were hospitalized; both required endotracheal intubation and mechanical ventilation, and both died.
Sentences:
On April 8, 2020, this report was posted online as an MMWR Early Release.

Early reports of person-to-person transmission of SARS-CoV-2 have been among household contacts, health care workers, and within congregate living facilities.
Investigation of COVID-19 cases in Chicago identified a cluster of 16 confirmed or probable cases, including three deaths, likely resulting from one introduction.
Extended family gatherings including a funeral and a birthday party likely facilitated transmission of SARS-CoV-2 in this cluster.
U.S. residents should adhere to CDC recommendations for social distancing, avoid gatherings, and follow stay-at-home orders when required by state or local authorities.
SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), has spread rapidly around the world since it was first recognized in late 2019.
Most early reports of person-to-person SARS-CoV-2 transmission have been among household contacts, where the secondary attack rate has been estimated to exceed 10% (1), in health care facilities (2), and in congregate settings (3).
However, widespread community transmission, as is currently being observed in the United States, requires more expansive transmission events between nonhousehold contacts.
In February and March 2020, the Chicago Department of Public Health (CDPH) investigated a large, multifamily cluster of COVID-19.
Patients with confirmed COVID-19 and their close contacts were interviewed to better understand nonhousehold, community transmission of SARS-CoV-2.
This report describes the cluster of 16 cases of confirmed or probable COVID-19, including three deaths, likely resulting from transmission of SARS-CoV-2 at two family gatherings (a funeral and a birthday party).
These data support current CDC social distancing recommendations intended to reduce SARS-CoV-2 transmission.
U.S residents should follow stay-at-home orders when required by state or local authorities.
During January 1–March 20, 2020, specimens that tested positive for SARS-CoV-2 at hospital, commercial, or public health laboratories were reported to CDPH; each triggered an epidemiologic investigation.
Contact tracing interviews were conducted with patients with confirmed COVID-19 using a structured questionnaire designed to identify the date of symptom onset and any person with whom the patient had close contact since that date.
The type of contact and setting in which the contact occurred were recorded.
Close contacts of patients with confirmed or probable COVID-19 were interviewed and enrolled in active symptom monitoring using Research Electronic Data Capture software (REDCap, version 8.8.0, Vanderbilt University, 2020).
Patients were classified as having confirmed COVID-19 if SARS-CoV-2 was detected by real-time reverse transcription–polymerase chain reaction testing of a nasopharyngeal or oropharyngeal specimen.
Patients were classified as having probable COVID-19 if they developed new symptoms of fever, cough, or shortness of breath within 14 days of contact with a patient with confirmed or probable COVID-19 but did not undergo laboratory testing (consistent with CDC recommendations,* the Illinois Department of Public Health prioritizes testing for hospitalized patients and other high-risk groups).
In February 2020, a funeral was held for a decedent with a non-COVID-19, nonrespiratory cause of death.
A close friend of the bereaved family (patient A1.1) attended the funeral; patients in this investigation were referred to by their family cluster letter (A or B), then by the assumed transmission generation (1–4), and finally, in sequence order within each generation (1–7)† (Figure 1).
Patient A1.1 had recently traveled out of state and was experiencing mild respiratory symptoms; he was only tested later as part of the epidemiologic investigation and received a diagnosis of confirmed COVID-19.
The evening before the funeral (investigation day 1), patient A1.1 shared a takeout meal, eaten from common serving dishes, with two family members of the decedent (patients B2.1 and B2.2) at their home.
At the meal, which lasted approximately 3 hours, and the funeral, which lasted about 2 hours and involved a shared “potluck-style” meal, patient A1.1 also reported embracing family members of the decedent, including patients B2.1, B2.2, B2.3, and B3.1, to express condolences.
Patients B2.1 and B2.2 subsequently developed confirmed COVID-19 with onset of symptoms 2 and 4 days, respectively, after the funeral; patient B2.3 developed probable COVID-19 with symptom onset 6 days after the funeral (investigation day 8).
Patient B2.1 was hospitalized on investigation day 11, required endotracheal intubation and mechanical ventilation for acute repiratory failure, and died on investigation day 28.
Patients B2.2 and B2.3 were managed as outpatients, and both recovered.
During investigation days 11–14, another family member who had close physical contact with patient A1.1 at the funeral (patient B3.1) visited patient B2.1 on the acute medical inpatient ward, embraced patient B2.1, and provided limited personal care, while wearing no personal protective equipment (PPE).
Patient B3.1 developed signs and symptoms consistent with COVID-19, including a fever and cough on investigation day 17, 3 days after last visiting B2.1. Patient B3.1 had also attended the funeral 15 days before symptom onset but described more extensive exposure while visiting patient B2.1 in the hospital.
Three days after the funeral, on investigation day 5, patient A1.1, who was still experiencing mild respiratory symptoms, attended a birthday party attended by nine other family members, hosted in the home of patient A2.1. Close contact between patient A1.1 and all other attendees occurred; patient A1.1 embraced others and shared food at the 3-hour party.
Seven party attendees subsequently developed COVID-19 3–7 days after the event (Figure 2), including three with confirmed cases (patients A2.1, A2.2, and A2.3) and four with probable cases (patients A2.4, A2.5, A2.6, and A2.7). Two patients with confirmed COVID-19 (A2.1 and A2.2) were hospitalized; both required endotracheal intubation and mechanical ventilation, and both died.
One patient with a confirmed case (A2.3) experienced mild symptoms of cough and subjective low-grade fever, as did the four others who received diagnoses of probable COVID-19.
Two attendees did not develop symptoms within 14 days of the birthday party.
Two persons who provided personal care for patient A2.1 without using PPE, including one family member (patient A3.1) and a home care professional (patient C3.1), both developed probable COVID-19.
It is likely that patient A3.1 subsequently transmitted SARS-CoV-2 to a household contact (patient A4.1), who did not attend the birthday party, but developed a new onset cough 3 days following unprotected, close contact with patient A3.1 while patient A3.1 was symptomatic.
Three symptomatic birthday party attendees with probable COVID-19 (patients A2.5, A2.6, and A2.7) attended church 6 days after developing their first symptoms (investigation day 17).
Another church attendee (patient D3.1, a health care professional) developed confirmed COVID-19 following close contact with patients A2.5, A2.6, and A2.7, including direct conversations, sitting within one row for 90 minutes, and passing the offering plate.
The patients described in this report ranged in age from 5 to 86 years.
The three patients who died (patients A2.1, B2.1 and A2.2) were aged >60 years, and all had at least one underlying cardiovascular or respiratory medical condition.
This cluster comprised 16 cases of COVID-19 (seven confirmed and nine probable), with transmission mostly occurring between nonhousehold contacts at family gatherings.
The median interval from last contact with a patient with confirmed or probable COVID-19 to first symptom onset was 4 days.
Within 3 weeks after mild respiratory symptoms were noted in the index patient, 15 other persons were likely infected with SARS-CoV-2, including three who died.
Patient A1.1, the index patient, was apparently able to transmit infection to 10 other persons, despite having no household contacts and experiencing only mild symptoms for which medical care was not sought (patient A1.1 was only tested later as part of this epidemiologic investigation).
Super-spreading events have played a significant role in transmission of other recently emerged coronaviruses such as SARS-CoV and MERS-CoV (4,5), although their relevance to SARS-CoV-2 spread is debated (6).
These data illustrate the importance of social distancing for preventing SARS-CoV-2 transmission, even within families.
In this cluster, extended family gatherings (a birthday party, funeral, and church attendance), all of which occurred before major social distancing policies were implemented, might have facilitated transmission of SARS-CoV-2 beyond household contacts into the broader community.
These findings support CDC recommendations to avoid gatherings (7) and reinforce the executive order from the governor of Illinois prohibiting all public and private gatherings of any number of persons occurring outside a single household (8).
The findings in this investigation are subject to at least three limitations.
First, lack of laboratory testing for probable cases means some probable COVID-19 patients might have instead experienced unrelated illnesses, although influenza-like illness was declining in Chicago at the time.
Second, phylogenetic data, which could confirm presumed epidemiologic linkages, were unavailable.
For example, patient B3.1 experienced exposure to two patients with confirmed COVID-19 in this cluster, and the causative exposure was presumed based on expected incubation periods.
Patient D3.1 was a health care professional, and, despite not seeing any patients with known COVID-19, might have acquired SARS-CoV-2 during clinical practice rather than through contact with members of this cluster.
Similarly, other members of the cluster might have experienced community exposures to SARS-CoV-2, although these transmission events occurred before widespread community transmission of SARS-CoV-2 in Chicago.
Finally, despite intensive epidemiologic investigation, not every confirmed or probable case related to this cluster might have been detected.
Persons who did not display symptoms were not evaluated for COVID-19, which, given increasing evidence of substantial asymptomatic infection (9), means the size of this cluster might be underestimated.
In this cluster, two family gatherings outside the household likely facilitated the spread of SARS-CoV-2; one index patient who attended both events likely triggered a chain of transmission that included 15 other confirmed and probable cases of COVID-19 and ultimately resulted in three deaths.
Media reports suggest the chain of transmission described in Chicago is not unique within the United States.§ Together with evidence emerging from around the world (10), these data shed light on transmission beyond household contacts, including the potential for super-spreading events.
More comprehensive information is needed to better understand the transmission of SARS-CoV-2 in community settings and households to better inform initiation and termination of public health policies related to social distancing or stay-at-home orders.
Overall, these findings highlight the importance of adhering to current social distancing recommendations,¶ including guidance to avoid any gatherings with persons from multiple households and following state or local stay-at-home orders.
The patients described in this report; the health care personnel who cared for them; the staff members and leaders of the Chicago Department of Public Health, particularly the Communicable Disease investigators and supervisors; the Epidemiology Task Force of the COVID-19 Response Team, CDC.
Corresponding author: Jennifer E.
Layden, jennifer.layden@cityofchicago.org, 770-488-7100.
1Chicago Department of Public Health; 2Epidemic Intelligence Service, CDC; 3Center for Surveillance, Epidemiology, and Laboratory Services, CDC; 4COVID-19 Response Team, CDC.
All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest.
No potential conflicts of interest were disclosed.
* CDC.
Evaluating and testing persons for coronavirus disease 2019 (COVID-19).

§ New York Times.
After a funeral in a Georgia town, coronavirus ‘hit like a bomb.’ March 20, 2020.
¶ CDC.
Coronavirus disease 2019 (COVID-19).
How to protect yourself and others.
Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2020.
Burke RM, Midgley CM, Dratch A, et al.
Active monitoring of persons exposed to patients with confirmed COVID-19—United States, January–February 2020.
MMWR Morb Mortal Wkly Rep 2020;69:245–6.
Kluytmans M, Buiting A, Pas S, et al.
SARS-CoV-2 infection in 86 healthcare workers in two Dutch hospitals in March 2020.
medRxiv.
Epub March 31, 2020.
McMichael TM, Currie DW, Clark S, et al.
Epidemiology of COVID-19 in a long-term care facility in King County, Washington.
N Engl J Med 2020;NEJMoa2005412.
Stein RA.
Super-spreaders in infectious diseases.
Int J Infect Dis 2011;15:e510–3.
Han Y, Yang H.
The transmission and diagnosis of 2019 novel coronavirus infection disease (COVID-19): a Chinese perspective.
Frieden TR, Lee CT.
Identifying and interrupting superspreading events—implications for control of severe acute respiratory syndrome coronavirus 2.
Emerg Infect Dis 2020;26.
CDC.
Implementation of mitigation strategies for communities with local COVID-19 transmission.
US Department of Health and Human Services; CDC; 2020.
Pritzker JB.
Executive Order 2020–10, issued March 20, 2020: executive order to expand telehealth services and protect health care providers in response to COVID-19 (COVID-19 Executive Order No.
8).
Kimball A, Hatfield KM, Arons M, et al.; Public Health – Seattle & King County; CDC COVID-19 Investigation Team.
Asymptomatic and presymptomatic SARS-CoV-2 infections in residents of a long-term care skilled nursing facility—King County, Washington, March 2020.
MMWR Morb Mortal Wkly Rep 2020;69:377–81.
Pung R, Chiew CJ, Young BE, et al.; Singapore 2019 Novel Coronavirus Outbreak Research Team.
Investigation of three clusters of COVID-19 in Singapore: implications for surveillance and response measures.
Lancet 2020;395:1039–46.
FIGURE 1.
Abbreviation: COVID-19 = coronavirus disease 2019.
Notes: Patients were designated by their family cluster letter (A or B), then by the assumed transmission generation (1–4), and finally, by sequence within each generation (1–7).
Patient A2.1 died on investigation day 18; patient A2.2 died on investigation day 27; and patient B2.1 died on investigation day 28.
FIGURE 2.
*The exposure of infection for the index patient, and consequently the incubation period, was unknown.
Suggested citation for this article: Ghinai I, Woods S, Ritger KA, et al.
Community Transmission of SARS-CoV-2 at Two Family Gatherings — Chicago, Illinois, February–March 2020.
MMWR Morb Mortal Wkly Rep 2020;69:446–450.
DOI: external icon.
MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services.
Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services.
CDC is not responsible for the content of pages found at these sites.
URL addresses listed in MMWR were current as of the date of publication.
All HTML versions of MMWR articles are generated from final proofs through an automated process.
This conversion might result in character translation or format errors in the HTML version.
Users are referred to the electronic PDF version ( ) and/or the original MMWR paper copy for printable versions of official text, figures, and tables.

Study With Me

Creativity

Draw With Me

paint with me

penpal with me

Around The World With Me

This report describes the cluster of 16 cases of confirmed or probable COVID-19, including three deaths, likely resulting from transmission of SARS-CoV-2 at two family gatherings (a funeral and a birthday party). (218)

Patient D3.1 was a health care professional, and, despite not seeing any patients with known COVID-19, might have acquired SARS-CoV-2 during clinical practice rather than through contact with members of this cluster. (184)

On April 8, 2020, this report was posted online as an MMWR Early Release.

Early reports of person-to-person transmission of SARS-CoV-2 have been among household contacts, health care workers, and within congregate living facilities.

Investigation of COVID-19 cases in Chicago identified a cluster of 16 confirmed or probable cases, including three deaths, likely resulting from one introduction.

Extended family gatherings including a funeral and a birthday party likely facilitated transmission of SARS-CoV-2 in this cluster.

U.S. residents should adhere to CDC recommendations for social distancing, avoid gatherings, and follow stay-at-home orders when required by state or local authorities.

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), has spread rapidly around the world since it was first recognized in late 2019.

Most early reports of person-to-person SARS-CoV-2 transmission have been among household contacts, where the secondary attack rate has been estimated to exceed 10% (1), in health care facilities (2), and in congregate settings (3).

However, widespread community transmission, as is currently being observed in the United States, requires more expansive transmission events between nonhousehold contacts.

In February and March 2020, the Chicago Department of Public Health (CDPH) investigated a large, multifamily cluster of COVID-19.

Patients with confirmed COVID-19 and their close contacts were interviewed to better understand nonhousehold, community transmission of SARS-CoV-2.

This report describes the cluster of 16 cases of confirmed or probable COVID-19, including three deaths, likely resulting from transmission of SARS-CoV-2 at two family gatherings (a funeral and a birthday party).

These data support current CDC social distancing recommendations intended to reduce SARS-CoV-2 transmission.

U.S residents should follow stay-at-home orders when required by state or local authorities.

During January 1–March 20, 2020, specimens that tested positive for SARS-CoV-2 at hospital, commercial, or public health laboratories were reported to CDPH; each triggered an epidemiologic investigation.

Contact tracing interviews were conducted with patients with confirmed COVID-19 using a structured questionnaire designed to identify the date of symptom onset and any person with whom the patient had close contact since that date.

The type of contact and setting in which the contact occurred were recorded.

Close contacts of patients with confirmed or probable COVID-19 were interviewed and enrolled in active symptom monitoring using Research Electronic Data Capture software (REDCap, version 8.8.0, Vanderbilt University, 2020).

Patients were classified as having confirmed COVID-19 if SARS-CoV-2 was detected by real-time reverse transcription–polymerase chain reaction testing of a nasopharyngeal or oropharyngeal specimen.

In February 2020, a funeral was held for a decedent with a non-COVID-19, nonrespiratory cause of death.

A close friend of the bereaved family (patient A1.1) attended the funeral; patients in this investigation were referred to by their family cluster letter (A or B), then by the assumed transmission generation (1–4), and finally, in sequence order within each generation (1–7)† (Figure 1).

Patient A1.1 had recently traveled out of state and was experiencing mild respiratory symptoms; he was only tested later as part of the epidemiologic investigation and received a diagnosis of confirmed COVID-19.

The evening before the funeral (investigation day 1), patient A1.1 shared a takeout meal, eaten from common serving dishes, with two family members of the decedent (patients B2.1 and B2.2) at their home.

At the meal, which lasted approximately 3 hours, and the funeral, which lasted about 2 hours and involved a shared “potluck-style” meal, patient A1.1 also reported embracing family members of the decedent, including patients B2.1, B2.2, B2.3, and B3.1, to express condolences.

Patients B2.1 and B2.2 subsequently developed confirmed COVID-19 with onset of symptoms 2 and 4 days, respectively, after the funeral; patient B2.3 developed probable COVID-19 with symptom onset 6 days after the funeral (investigation day 8).

Patient B2.1 was hospitalized on investigation day 11, required endotracheal intubation and mechanical ventilation for acute repiratory failure, and died on investigation day 28.

Patients B2.2 and B2.3 were managed as outpatients, and both recovered.

One patient with a confirmed case (A2.3) experienced mild symptoms of cough and subjective low-grade fever, as did the four others who received diagnoses of probable COVID-19.

Two attendees did not develop symptoms within 14 days of the birthday party.

Two persons who provided personal care for patient A2.1 without using PPE, including one family member (patient A3.1) and a home care professional (patient C3.1), both developed probable COVID-19.

It is likely that patient A3.1 subsequently transmitted SARS-CoV-2 to a household contact (patient A4.1), who did not attend the birthday party, but developed a new onset cough 3 days following unprotected, close contact with patient A3.1 while patient A3.1 was symptomatic.

Three symptomatic birthday party attendees with probable COVID-19 (patients A2.5, A2.6, and A2.7) attended church 6 days after developing their first symptoms (investigation day 17).

Another church attendee (patient D3.1, a health care professional) developed confirmed COVID-19 following close contact with patients A2.5, A2.6, and A2.7, including direct conversations, sitting within one row for 90 minutes, and passing the offering plate.

The patients described in this report ranged in age from 5 to 86 years.

The three patients who died (patients A2.1, B2.1 and A2.2) were aged &gt;60 years, and all had at least one underlying cardiovascular or respiratory medical condition.

This cluster comprised 16 cases of COVID-19 (seven confirmed and nine probable), with transmission mostly occurring between nonhousehold contacts at family gatherings.

The median interval from last contact with a patient with confirmed or probable COVID-19 to first symptom onset was 4 days.

Within 3 weeks after mild respiratory symptoms were noted in the index patient, 15 other persons were likely infected with SARS-CoV-2, including three who died.

Patient A1.1, the index patient, was apparently able to transmit infection to 10 other persons, despite having no household contacts and experiencing only mild symptoms for which medical care was not sought (patient A1.1 was only tested later as part of this epidemiologic investigation).

Super-spreading events have played a significant role in transmission of other recently emerged coronaviruses such as SARS-CoV and MERS-CoV (4,5), although their relevance to SARS-CoV-2 spread is debated (6).

These data illustrate the importance of social distancing for preventing SARS-CoV-2 transmission, even within families.

In this cluster, extended family gatherings (a birthday party, funeral, and church attendance), all of which occurred before major social distancing policies were implemented, might have facilitated transmission of SARS-CoV-2 beyond household contacts into the broader community.

These findings support CDC recommendations to avoid gatherings (7) and reinforce the executive order from the governor of Illinois prohibiting all public and private gatherings of any number of persons occurring outside a single household (8).

The findings in this investigation are subject to at least three limitations.

First, lack of laboratory testing for probable cases means some probable COVID-19 patients might have instead experienced unrelated illnesses, although influenza-like illness was declining in Chicago at the time.

Second, phylogenetic data, which could confirm presumed epidemiologic linkages, were unavailable.

For example, patient B3.1 experienced exposure to two patients with confirmed COVID-19 in this cluster, and the causative exposure was presumed based on expected incubation periods.

Patient D3.1 was a health care professional, and, despite not seeing any patients with known COVID-19, might have acquired SARS-CoV-2 during clinical practice rather than through contact with members of this cluster.

Similarly, other members of the cluster might have experienced community exposures to SARS-CoV-2, although these transmission events occurred before widespread community transmission of SARS-CoV-2 in Chicago.

Finally, despite intensive epidemiologic investigation, not every confirmed or probable case related to this cluster might have been detected.

Persons who did not display symptoms were not evaluated for COVID-19, which, given increasing evidence of substantial asymptomatic infection (9), means the size of this cluster might be underestimated.

In this cluster, two family gatherings outside the household likely facilitated the spread of SARS-CoV-2; one index patient who attended both events likely triggered a chain of transmission that included 15 other confirmed and probable cases of COVID-19 and ultimately resulted in three deaths.

Media reports suggest the chain of transmission described in Chicago is not unique within the United States.§ Together with evidence emerging from around the world (10), these data shed light on transmission beyond household contacts, including the potential for super-spreading events.

More comprehensive information is needed to better understand the transmission of SARS-CoV-2 in community settings and households to better inform initiation and termination of public health policies related to social distancing or stay-at-home orders.

Overall, these findings highlight the importance of adhering to current social distancing recommendations,¶ including guidance to avoid any gatherings with persons from multiple households and following state or local stay-at-home orders.

The patients described in this report; the health care personnel who cared for them; the staff members and leaders of the Chicago Department of Public Health, particularly the Communicable Disease investigators and supervisors; the Epidemiology Task Force of the COVID-19 Response Team, CDC.

Corresponding author: Jennifer E.

Layden, jennifer.layden@cityofchicago.org, 770-488-7100.

1Chicago Department of Public Health; 2Epidemic Intelligence Service, CDC; 3Center for Surveillance, Epidemiology, and Laboratory Services, CDC; 4COVID-19 Response Team, CDC.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest.

No potential conflicts of interest were disclosed.

* CDC.

Evaluating and testing persons for coronavirus disease 2019 (COVID-19).

§ New York Times.

After a funeral in a Georgia town, coronavirus ‘hit like a bomb.’ March 20, 2020.

¶ CDC.

Coronavirus disease 2019 (COVID-19).

How to protect yourself and others.

Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2020.

Burke RM, Midgley CM, Dratch A, et al.

Active monitoring of persons exposed to patients with confirmed COVID-19—United States, January–February 2020.

MMWR Morb Mortal Wkly Rep 2020;69:245–6.

Kluytmans M, Buiting A, Pas S, et al.

The three patients who died (patients A2.1, B2.1 and A2.2) were aged >60 years, and all had at least one underlying cardiovascular or respiratory medical condition.

Kimball A, Hatfield KM, Arons M, et al.; Public Health – Seattle & King County; CDC COVID-19 Investigation Team.