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Where Did the 2019 Coronavirus Pandemic Begin and How Did it Spread? The People's Liberation Army Hospital in Wuhan China and Line 2 of the Wuhan Metro System Are Compelling Answers

Steven Carl Quay, MD, PhD

The origin of the SARS-CoV-2 coronavirus that has caused the COVID-19 worldwide
pandemic remains unknown. Here I report that the earliest genomic cluster is a group of four
patients associated with the General Hospital of Central Theater Command of People's Liberation
Army (PLA) of China in Wuhan. This cluster contains the “Founder Patients” of both Clade A and
Clade B, from which every SARS-CoV-2 coronavirus that has infected every patient with COVID-
19 anywhere in the world has arisen, including the infection of the President of the United States.
The observation that the genomic files for these patients were created on December 10, 2019 but
the PLA Hospital did not record the collection of the specimens until weeks later is unusual and
unexplained. However, it would be consistent with a vaccine challenge clinical trial (in which case
files are set up in anticipation of getting samples later) or it suggests that the collection dates were
actually before December 10, 2019 (in which case the reported dates for specimen collection are
not accurate but may have been recorded incorrectly to suggest the infection was spreading later
than it really was). The PLA Hospital is about one mile from the Wuhan Institute of Virology
(WIV) and the closest hospital to WIV. Both the PLA Hospital and WIV are serviced by Line 2 of
the Wuhan Metro System. The Hunan Seafood Market is also located adjacent to Line 2. All
patients between December 1st, 2019 and early January 2020 were first seen at hospitals that are
also serviced by Line 2 of the Metro system. With hospitals located near seven of the nine Metro Lines, the likelihood that all early patients were seen at hospitals only near Line 2 by chance is about 1 in 68,500 (p-value = 0.0000146). The inference then would be that the early spread of SARS-CoV-2 was through human-to human infection on Line 2. Line 2 connects to all eight other lines of the Wuhan Metro System (1, 3, 4, 6, 7, 8, 11, and Yanglu) facilitating rapid spread in Wuhan and Hubei Province, and also services both the high speed rail station (Hankou Railway Station), facilitating rapid spread throughout China, and the Wuhan International Airport (Tianhe International Airport), facilitating rapid spread throughout Asia, Europe, and to the United States. In fact, direct human-to-human spread from the Reference Sequence patient to patients around the world is suggested by an unexpectedly reduced genome base substitution rate seen in patient specimens in cities with direct flights from Wuhan.
In conclusion, Line 2 of the Wuhan Metro System services the PLA Hospital with the first genomic cluster of patients with COVID-19, the hospitals where patients first went in December 2019 and early January 2020, and is the likely conduit for human-to-human spread throughout Wuhan, China, and the world. The Hunan Seafood Market, Wuhan Institute of Virology, and the Wuhan CDC, all locations suggested to be the possible source of SARS-CoV-2 in Wuhan, are also all serviced by Line 2 of the Metro system, suggesting this public transit line should become the focus for further investigations into the origin of this pandemic.

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