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In February, well before Gov. JB Pritzker enacted the COVID-19 stay-at-home order, a Chicago resident who had been traveling out of state attended a funeral.
As a close family friend of the deceased, the resident went despite having mild respiratory symptoms and shared a potluck-style meal with the family the evening before, embracing some of them to express condolences.
Over the 28 days that followed, 16 people between the ages of 5 and 86 were infected with COVID-19, three of whom died.
A study conducted by medical experts with the Centers for Disease Control and Prevention followed this early "super-spread" of the COVID-19 to 16 people, seven of which were confirmed cases and nine more deemed probable based on the onset of related symptoms.
The report, released Wednesday, provides a new, step-by-step look into how COVID-19 spreads through communities and further illustrates the need for social distancing.
"Together with evidence emerging from around the world, these data shed light on transmission beyond household contacts, including the potential for super-spreading events," according to the study.
The Chicago resident is referred to as "Patient A1.1" to denote their position as the first patient in the first generation of transmissions in family cluster A, according to the report.
One of the hosts of the potluck dinner (Patient B2.1) developed symptoms of the virus just two days after the funeral. The other host began showing symptoms two days later.
A third person who came in close contact with Patient A1.1 that night developed symptoms six days after the funeral, according to the study.
Just a week later, the dinner host, Patient B2.1, was hospitalized and, after being intubated and placed on a ventilator for acute respiratory failure, passed away on day 28 of the study.
A family member visited Patient B2.1 at the hospital and "embraced [them], and provided limited personal care, while wearing no personal protective equipment [PPE]," according to the study.
Shortly after, the visitor, Patient B3.1, developed symptoms consistent with COVID-19, including fever and a cough.
Three days after the funeral, on day five of the study, Patient A1.1, who was still only showing mild symptoms, attended a family birthday party with nine other people. According to the study, the family dined together and embraced each other during the three-hour celebration.
This interaction led to the infection of seven family members (three confirmed and four probable) over the course of seven days. Five of them were fortunate to experience only mild symptoms of the virus: low-grade fevers and a cough.
For two members of the family, however; the illness worsened resulting in hospitalization, intubation, ventilator support and, ultimately, death.
As one of the patients' health deteriorated, another family member and a home care professional provided care without using PPE and, subsequently, both reported symptoms of the virus.
One of them, Patient A3.1, spread the virus to a person in their household, bringing the case count to 15, according to the study.
On investigation day 17, three symptomatic family members who had attended the birthday party went to church.
They sat near Patient D3.1, a health care professional, and engaged in "direct conversations, sitting within one row for 90 minutes, and passing the offering plate," according to the report.
Patient D3.1 later tested positive for COVID-19, bringing the case count to a total of 16 people across four families.
While the study does not negate the possibility that Patient D3.1 could have contracted the virus from working in health care, according the report, that the virus was not known to be widespread in area hospitals at the time.
The report goes on to hypothesize that this early cluster of cases could have played a role in the spread of COVID-19 to other communities in Chicago. The CDC concludes the report by urging readers to use this information as a reminder of the importance of following social distancing guidelines.
"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," according to the report.
When Pritzker announced on March 20 that he would enact a stay-at-home order, the state had only 585 confirmed cases of COVID-19 and five deaths.
Even then, Dr. Emily Landon, Lead Epidemiologist for the University of Chicago Medicine, said there was a consensus among her colleagues that a lockdown was "the only way forward."
“We can’t take care of everyone at once and we can’t keep that low mortality promise if we can’t provide the support that our patients need,” Landon said. “... all we have to slow the spread is distance, social distance.”
"If we let every single patient with this infection infect three more people and then each of them infect two or three more people, there won't be a hospital bed when my mother can't breathe very well or when yours is coughing too much," she said. "... So please don't give up."
As of Thursday afternoon, there were 15,078 confirmed cases of COVID-19 in Illinois and 462 people had died from the virus, according to the Illinois Department of Public Health.