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The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application.
Ann Intern Med. 2020 May 05; 172(9):577-582.AIM

Abstract

Background

A novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019. There is limited support for many of its key epidemiologic features, including the incubation period for clinical disease (coronavirus disease 2019 [COVID-19]), which has important implications for surveillance and control activities.

Objective

To estimate the length of the incubation period of COVID-19 and describe its public health implications.

Design

Pooled analysis of confirmed COVID-19 cases reported between 4 January 2020 and 24 February 2020.

Setting

News reports and press releases from 50 provinces, regions, and countries outside Wuhan, Hubei province, China.

Participants

Persons with confirmed SARS-CoV-2 infection outside Hubei province, China.

Measurements

Patient demographic characteristics and dates and times of possible exposure, symptom onset, fever onset, and hospitalization.

Results

There were 181 confirmed cases with identifiable exposure and symptom onset windows to estimate the incubation period of COVID-19. The median incubation period was estimated to be 5.1 days (95% CI, 4.5 to 5.8 days), and 97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection. These estimates imply that, under conservative assumptions, 101 out of every 10 000 cases (99th percentile, 482) will develop symptoms after 14 days of active monitoring or quarantine.

Limitation

Publicly reported cases may overrepresent severe cases, the incubation period for which may differ from that of mild cases.

Conclusion

This work provides additional evidence for a median incubation period for COVID-19 of approximately 5 days, similar to SARS. Our results support current proposals for the length of quarantine or active monitoring of persons potentially exposed to SARS-CoV-2, although longer monitoring periods might be justified in extreme cases.

Primary Funding Source

U.S. Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases, National Institute of General Medical Sciences, and Alexander von Humboldt Foundation.

Authors+Show Affiliations

Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (S.A.L., K.H.G., Q.B., F.K.J., Q.Z., H.R.M., A.S.A., J.L.).Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (S.A.L., K.H.G., Q.B., F.K.J., Q.Z., H.R.M., A.S.A., J.L.).Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (S.A.L., K.H.G., Q.B., F.K.J., Q.Z., H.R.M., A.S.A., J.L.).Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (S.A.L., K.H.G., Q.B., F.K.J., Q.Z., H.R.M., A.S.A., J.L.).Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (S.A.L., K.H.G., Q.B., F.K.J., Q.Z., H.R.M., A.S.A., J.L.).Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (S.A.L., K.H.G., Q.B., F.K.J., Q.Z., H.R.M., A.S.A., J.L.).Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (S.A.L., K.H.G., Q.B., F.K.J., Q.Z., H.R.M., A.S.A., J.L.).School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, and Ludwig-Maximilians-Universität, Munich, Germany (N.G.R.).Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (S.A.L., K.H.G., Q.B., F.K.J., Q.Z., H.R.M., A.S.A., J.L.).

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32150748

Citation

Lauer, Stephen A., et al. "The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application." Annals of Internal Medicine, vol. 172, no. 9, 2020, pp. 577-582.
Lauer SA, Grantz KH, Bi Q, et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med. 2020;172(9):577-582.
Lauer, S. A., Grantz, K. H., Bi, Q., Jones, F. K., Zheng, Q., Meredith, H. R., Azman, A. S., Reich, N. G., & Lessler, J. (2020). The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Annals of Internal Medicine, 172(9), 577-582. https://doi.org/10.7326/M20-0504
Lauer SA, et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med. 2020 May 5;172(9):577-582. PubMed PMID: 32150748.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. AU - Lauer,Stephen A, AU - Grantz,Kyra H, AU - Bi,Qifang, AU - Jones,Forrest K, AU - Zheng,Qulu, AU - Meredith,Hannah R, AU - Azman,Andrew S, AU - Reich,Nicholas G, AU - Lessler,Justin, Y1 - 2020/03/10/ PY - 2020/3/10/pubmed PY - 2020/5/14/medline PY - 2020/3/10/entrez SP - 577 EP - 582 JF - Annals of internal medicine JO - Ann. Intern. Med. VL - 172 IS - 9 N2 - Background: A novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019. There is limited support for many of its key epidemiologic features, including the incubation period for clinical disease (coronavirus disease 2019 [COVID-19]), which has important implications for surveillance and control activities. Objective: To estimate the length of the incubation period of COVID-19 and describe its public health implications. Design: Pooled analysis of confirmed COVID-19 cases reported between 4 January 2020 and 24 February 2020. Setting: News reports and press releases from 50 provinces, regions, and countries outside Wuhan, Hubei province, China. Participants: Persons with confirmed SARS-CoV-2 infection outside Hubei province, China. Measurements: Patient demographic characteristics and dates and times of possible exposure, symptom onset, fever onset, and hospitalization. Results: There were 181 confirmed cases with identifiable exposure and symptom onset windows to estimate the incubation period of COVID-19. The median incubation period was estimated to be 5.1 days (95% CI, 4.5 to 5.8 days), and 97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection. These estimates imply that, under conservative assumptions, 101 out of every 10 000 cases (99th percentile, 482) will develop symptoms after 14 days of active monitoring or quarantine. Limitation: Publicly reported cases may overrepresent severe cases, the incubation period for which may differ from that of mild cases. Conclusion: This work provides additional evidence for a median incubation period for COVID-19 of approximately 5 days, similar to SARS. Our results support current proposals for the length of quarantine or active monitoring of persons potentially exposed to SARS-CoV-2, although longer monitoring periods might be justified in extreme cases. Primary Funding Source: U.S. Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases, National Institute of General Medical Sciences, and Alexander von Humboldt Foundation. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/32150748/full_citation L2 - https://www.acpjournals.org/doi/10.7326/M20-0504?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -