A COVID-19 outbreak across four states that has infected at least 11 people was started by a 13-year-old girl who spread the coronavirus during a family vacation, according to a recent report from the Centers for Disease Control and Prevention.
The data contributes to the "increasing evidence that children and adolescents can efficiently transmit SARS-CoV-2, the virus that causes (COVID-19)," the CDC said in the report. It also serves as a warning for families considering traveling and staying under the same roof this the holiday season.
How the outbreak happened
Fourteen members of the family featured in the report, including the 13-year-old, shared the same house for eight to 25 days. They did not wear masks or social distance, and all but two became infected.
The girl who was the source of the outbreak is believed to have been exposed during a large outbreak in June and sought out testing before the family vacation as a result. Four days after her exposure, she took a rapid antigen test while she was pre-symptomatic, and it came back negative. She started to experience symptoms (mainly nasal congestion) the same day that she, her parents and two brothers left for the family gathering.
Of the 12 family members, in total, who caught COVID-19, one was hospitalized and another visited an emergency department for treatment for respiratory symptoms. Both recovered.
Notably, six members of the family who did not stay in the house but visited on two separate occasions for several hours outdoors did not become infected. These individuals stayed outside and practiced social distancing, the CDC stated in the report.
"The findings in this report highlight the need for those potentially exposed to COVID-19 to self-quarantine for 14 days after exposure or after interstate travel when mandated by state, territorial, tribal or local authorities," the CDC said in a statement to TODAY. "Social distancing, mask use, and hand hygiene reduce transmission in group settings and might have prevented this outbreak had they been used."
The CDC did not respond to TODAY's request to speak with the family, and TODAY's multiple attempts to contact the family went unanswered.
What this means for the holiday season
While the report mainly serves as additional confirmation that children can spread the virus, it's significant because of how "relatable" the situation is, especially ahead of the holiday season, Dr. Allison Agwu, an infectious disease pediatrician at Johns Hopkins in Baltimore, told TODAY.
"Sometimes COVID isn't real for people until they have a story, (either) their story or one that looks like their story," she said.
For the families considering traveling and spending extended periods of time together indoors in coming months, Dr. Anthony Fauci, the nation's leading infectious disease physician, offered words of caution to CNN on Tuesday.
People living in less-affected areas, he said, can celebrate Thanksgiving "with some mild precautions" and have a "relatively normal" holiday, but those in high-positivity areas should consider only gathering with people in their household.
"Make sure you do it in a way that people wear masks," Fauci said. "Don't have large crowds of people ... I’d like to say everything’s going to be great by Thanksgiving, but honestly I’m not so sure it is."
Precautions to take this holiday season
The CDC report demonstrates the effectiveness of social distancing and staying outdoors to prevent the spread of the coronavirus, Dr. John Christenson, medical director of infection prevention for Riley Children's Health in Indianapolis, told TODAY.
"Older children and adolescents probably are more effective transmitters than young children, but transmission can occur in any environment, especially if you're close and people aren't using masks."
As a result, kids old enough to wear masks should take the same precautions as adults this holiday season. In addition, a negative test — especially if it's of the rapid antigen variety — is not a replacement for following these measures, both Agwu and Christenson stressed.
"Because of false negatives, you may get a false sense of security," Christenson said. "As it stands right now, there is no test that detects (COVID-19 in) 100% of people all the time."
For families staying together this holiday season, the safest way requires the groups traveling and the hosts to quarantine for two weeks beforehand, Christenson said. You should have little to no contact with outside people, including when traveling. Driving is the safest option.
That said, this strategy is "not perfect because there are some people that may be shedding virus asymptomatically," Christenson clarified. "But at least the quarantine is a period of time that if somebody is infectious ... usually you're not contagious anymore."
Agwu, who's decided not to host her family's Thanksgiving this year, added that the more time spent together, the more likely the virus will spread — in part because people tend to abandon precautions after a while.
"Get together, but limit that time. Try to be careful and then go back to your pod," she explained, referencing the recent CDC report. "This is a family that thought they were doing everything that they could ... and this is what happened."
CORRECTION (Oct. 9, 11:57 a.m. ET): A previous version of this story stated that per the CDC report, the 13-year-old was asymptomatic, when in fact she was presymptomatic. The CDC has confirmed and addressed their mistake.