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Kasper MR, Geibe JR, Sears CL, Riegodedios AJ, Luse T, Von Thun AM, McGinnis MB, Olson N, Houskamp D, Fenequito R, Burgess TH, Armstrong AW, DeLong G, Hawkins RJ, Gillingham BL. An Outbreak of Covid-19 on an Aircraft Carrier. N Engl J Med 2020; 383:2417-2426. [PMID: 33176077 PMCID: PMC7675688 DOI: 10.1056/nejmoa2019375] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND An outbreak of coronavirus disease 2019 (Covid-19) occurred on the U.S.S. Theodore Roosevelt, a nuclear-powered aircraft carrier with a crew of 4779 personnel. METHODS We obtained clinical and demographic data for all crew members, including results of testing by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). All crew members were followed up for a minimum of 10 weeks, regardless of test results or the absence of symptoms. RESULTS The crew was predominantly young (mean age, 27 years) and was in general good health, meeting U.S. Navy standards for sea duty. Over the course of the outbreak, 1271 crew members (26.6% of the crew) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by rRT-PCR testing, and more than 1000 infections were identified within 5 weeks after the first laboratory-confirmed infection. An additional 60 crew members had suspected Covid-19 (i.e., illness that met Council of State and Territorial Epidemiologists clinical criteria for Covid-19 without a positive test result). Among the crew members with laboratory-confirmed infection, 76.9% (978 of 1271) had no symptoms at the time that they tested positive and 55.0% had symptoms develop at any time during the clinical course. Among the 1331 crew members with suspected or confirmed Covid-19, 23 (1.7%) were hospitalized, 4 (0.3%) received intensive care, and 1 died. Crew members who worked in confined spaces appeared more likely to become infected. CONCLUSIONS SARS-CoV-2 spread quickly among the crew of the U.S.S. Theodore Roosevelt. Transmission was facilitated by close-quarters conditions and by asymptomatic and presymptomatic infected crew members. Nearly half of those who tested positive for the virus never had symptoms.
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Affiliation(s)
- Matthew R Kasper
- From the U.S. Navy Bureau of Medicine and Surgery, Falls Church (M.R.K., B.L.G.), and the Navy and Marine Corps Public Health Center, Portsmouth (J.R.G., A.J.R., T.L., A.M.V.T., G.D., R.J.H.) - both in Virginia; U.S. Navy Seventh Fleet, Yokosuka, Japan (C.L.S.); U.S. Pacific Fleet, Pearl Harbor, Hawaii (M.B.M.); the U.S. Naval Hospital Guam, Apra Harbor (N.O., D.H., R.F.); and the Uniformed Services University of the Health Sciences, Bethesda (T.H.B.), and the Naval Medical Research Center, Silver Spring (A.W.A.) - both in Maryland
| | - Jesse R Geibe
- From the U.S. Navy Bureau of Medicine and Surgery, Falls Church (M.R.K., B.L.G.), and the Navy and Marine Corps Public Health Center, Portsmouth (J.R.G., A.J.R., T.L., A.M.V.T., G.D., R.J.H.) - both in Virginia; U.S. Navy Seventh Fleet, Yokosuka, Japan (C.L.S.); U.S. Pacific Fleet, Pearl Harbor, Hawaii (M.B.M.); the U.S. Naval Hospital Guam, Apra Harbor (N.O., D.H., R.F.); and the Uniformed Services University of the Health Sciences, Bethesda (T.H.B.), and the Naval Medical Research Center, Silver Spring (A.W.A.) - both in Maryland
| | - Christine L Sears
- From the U.S. Navy Bureau of Medicine and Surgery, Falls Church (M.R.K., B.L.G.), and the Navy and Marine Corps Public Health Center, Portsmouth (J.R.G., A.J.R., T.L., A.M.V.T., G.D., R.J.H.) - both in Virginia; U.S. Navy Seventh Fleet, Yokosuka, Japan (C.L.S.); U.S. Pacific Fleet, Pearl Harbor, Hawaii (M.B.M.); the U.S. Naval Hospital Guam, Apra Harbor (N.O., D.H., R.F.); and the Uniformed Services University of the Health Sciences, Bethesda (T.H.B.), and the Naval Medical Research Center, Silver Spring (A.W.A.) - both in Maryland
| | - Asha J Riegodedios
- From the U.S. Navy Bureau of Medicine and Surgery, Falls Church (M.R.K., B.L.G.), and the Navy and Marine Corps Public Health Center, Portsmouth (J.R.G., A.J.R., T.L., A.M.V.T., G.D., R.J.H.) - both in Virginia; U.S. Navy Seventh Fleet, Yokosuka, Japan (C.L.S.); U.S. Pacific Fleet, Pearl Harbor, Hawaii (M.B.M.); the U.S. Naval Hospital Guam, Apra Harbor (N.O., D.H., R.F.); and the Uniformed Services University of the Health Sciences, Bethesda (T.H.B.), and the Naval Medical Research Center, Silver Spring (A.W.A.) - both in Maryland
| | - Tina Luse
- From the U.S. Navy Bureau of Medicine and Surgery, Falls Church (M.R.K., B.L.G.), and the Navy and Marine Corps Public Health Center, Portsmouth (J.R.G., A.J.R., T.L., A.M.V.T., G.D., R.J.H.) - both in Virginia; U.S. Navy Seventh Fleet, Yokosuka, Japan (C.L.S.); U.S. Pacific Fleet, Pearl Harbor, Hawaii (M.B.M.); the U.S. Naval Hospital Guam, Apra Harbor (N.O., D.H., R.F.); and the Uniformed Services University of the Health Sciences, Bethesda (T.H.B.), and the Naval Medical Research Center, Silver Spring (A.W.A.) - both in Maryland
| | - Annette M Von Thun
- From the U.S. Navy Bureau of Medicine and Surgery, Falls Church (M.R.K., B.L.G.), and the Navy and Marine Corps Public Health Center, Portsmouth (J.R.G., A.J.R., T.L., A.M.V.T., G.D., R.J.H.) - both in Virginia; U.S. Navy Seventh Fleet, Yokosuka, Japan (C.L.S.); U.S. Pacific Fleet, Pearl Harbor, Hawaii (M.B.M.); the U.S. Naval Hospital Guam, Apra Harbor (N.O., D.H., R.F.); and the Uniformed Services University of the Health Sciences, Bethesda (T.H.B.), and the Naval Medical Research Center, Silver Spring (A.W.A.) - both in Maryland
| | - Michael B McGinnis
- From the U.S. Navy Bureau of Medicine and Surgery, Falls Church (M.R.K., B.L.G.), and the Navy and Marine Corps Public Health Center, Portsmouth (J.R.G., A.J.R., T.L., A.M.V.T., G.D., R.J.H.) - both in Virginia; U.S. Navy Seventh Fleet, Yokosuka, Japan (C.L.S.); U.S. Pacific Fleet, Pearl Harbor, Hawaii (M.B.M.); the U.S. Naval Hospital Guam, Apra Harbor (N.O., D.H., R.F.); and the Uniformed Services University of the Health Sciences, Bethesda (T.H.B.), and the Naval Medical Research Center, Silver Spring (A.W.A.) - both in Maryland
| | - Niels Olson
- From the U.S. Navy Bureau of Medicine and Surgery, Falls Church (M.R.K., B.L.G.), and the Navy and Marine Corps Public Health Center, Portsmouth (J.R.G., A.J.R., T.L., A.M.V.T., G.D., R.J.H.) - both in Virginia; U.S. Navy Seventh Fleet, Yokosuka, Japan (C.L.S.); U.S. Pacific Fleet, Pearl Harbor, Hawaii (M.B.M.); the U.S. Naval Hospital Guam, Apra Harbor (N.O., D.H., R.F.); and the Uniformed Services University of the Health Sciences, Bethesda (T.H.B.), and the Naval Medical Research Center, Silver Spring (A.W.A.) - both in Maryland
| | - Daniel Houskamp
- From the U.S. Navy Bureau of Medicine and Surgery, Falls Church (M.R.K., B.L.G.), and the Navy and Marine Corps Public Health Center, Portsmouth (J.R.G., A.J.R., T.L., A.M.V.T., G.D., R.J.H.) - both in Virginia; U.S. Navy Seventh Fleet, Yokosuka, Japan (C.L.S.); U.S. Pacific Fleet, Pearl Harbor, Hawaii (M.B.M.); the U.S. Naval Hospital Guam, Apra Harbor (N.O., D.H., R.F.); and the Uniformed Services University of the Health Sciences, Bethesda (T.H.B.), and the Naval Medical Research Center, Silver Spring (A.W.A.) - both in Maryland
| | - Robert Fenequito
- From the U.S. Navy Bureau of Medicine and Surgery, Falls Church (M.R.K., B.L.G.), and the Navy and Marine Corps Public Health Center, Portsmouth (J.R.G., A.J.R., T.L., A.M.V.T., G.D., R.J.H.) - both in Virginia; U.S. Navy Seventh Fleet, Yokosuka, Japan (C.L.S.); U.S. Pacific Fleet, Pearl Harbor, Hawaii (M.B.M.); the U.S. Naval Hospital Guam, Apra Harbor (N.O., D.H., R.F.); and the Uniformed Services University of the Health Sciences, Bethesda (T.H.B.), and the Naval Medical Research Center, Silver Spring (A.W.A.) - both in Maryland
| | - Timothy H Burgess
- From the U.S. Navy Bureau of Medicine and Surgery, Falls Church (M.R.K., B.L.G.), and the Navy and Marine Corps Public Health Center, Portsmouth (J.R.G., A.J.R., T.L., A.M.V.T., G.D., R.J.H.) - both in Virginia; U.S. Navy Seventh Fleet, Yokosuka, Japan (C.L.S.); U.S. Pacific Fleet, Pearl Harbor, Hawaii (M.B.M.); the U.S. Naval Hospital Guam, Apra Harbor (N.O., D.H., R.F.); and the Uniformed Services University of the Health Sciences, Bethesda (T.H.B.), and the Naval Medical Research Center, Silver Spring (A.W.A.) - both in Maryland
| | - Adam W Armstrong
- From the U.S. Navy Bureau of Medicine and Surgery, Falls Church (M.R.K., B.L.G.), and the Navy and Marine Corps Public Health Center, Portsmouth (J.R.G., A.J.R., T.L., A.M.V.T., G.D., R.J.H.) - both in Virginia; U.S. Navy Seventh Fleet, Yokosuka, Japan (C.L.S.); U.S. Pacific Fleet, Pearl Harbor, Hawaii (M.B.M.); the U.S. Naval Hospital Guam, Apra Harbor (N.O., D.H., R.F.); and the Uniformed Services University of the Health Sciences, Bethesda (T.H.B.), and the Naval Medical Research Center, Silver Spring (A.W.A.) - both in Maryland
| | - Gerald DeLong
- From the U.S. Navy Bureau of Medicine and Surgery, Falls Church (M.R.K., B.L.G.), and the Navy and Marine Corps Public Health Center, Portsmouth (J.R.G., A.J.R., T.L., A.M.V.T., G.D., R.J.H.) - both in Virginia; U.S. Navy Seventh Fleet, Yokosuka, Japan (C.L.S.); U.S. Pacific Fleet, Pearl Harbor, Hawaii (M.B.M.); the U.S. Naval Hospital Guam, Apra Harbor (N.O., D.H., R.F.); and the Uniformed Services University of the Health Sciences, Bethesda (T.H.B.), and the Naval Medical Research Center, Silver Spring (A.W.A.) - both in Maryland
| | - Robert J Hawkins
- From the U.S. Navy Bureau of Medicine and Surgery, Falls Church (M.R.K., B.L.G.), and the Navy and Marine Corps Public Health Center, Portsmouth (J.R.G., A.J.R., T.L., A.M.V.T., G.D., R.J.H.) - both in Virginia; U.S. Navy Seventh Fleet, Yokosuka, Japan (C.L.S.); U.S. Pacific Fleet, Pearl Harbor, Hawaii (M.B.M.); the U.S. Naval Hospital Guam, Apra Harbor (N.O., D.H., R.F.); and the Uniformed Services University of the Health Sciences, Bethesda (T.H.B.), and the Naval Medical Research Center, Silver Spring (A.W.A.) - both in Maryland
| | - Bruce L Gillingham
- From the U.S. Navy Bureau of Medicine and Surgery, Falls Church (M.R.K., B.L.G.), and the Navy and Marine Corps Public Health Center, Portsmouth (J.R.G., A.J.R., T.L., A.M.V.T., G.D., R.J.H.) - both in Virginia; U.S. Navy Seventh Fleet, Yokosuka, Japan (C.L.S.); U.S. Pacific Fleet, Pearl Harbor, Hawaii (M.B.M.); the U.S. Naval Hospital Guam, Apra Harbor (N.O., D.H., R.F.); and the Uniformed Services University of the Health Sciences, Bethesda (T.H.B.), and the Naval Medical Research Center, Silver Spring (A.W.A.) - both in Maryland
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