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Temporal dynamics in viral shedding and transmissibility of COVID-19.
Nat Med. 2020 05; 26(5):672-675.NMed

Abstract

We report temporal patterns of viral shedding in 94 patients with laboratory-confirmed COVID-19 and modeled COVID-19 infectiousness profiles from a separate sample of 77 infector-infectee transmission pairs. We observed the highest viral load in throat swabs at the time of symptom onset, and inferred that infectiousness peaked on or before symptom onset. We estimated that 44% (95% confidence interval, 25-69%) of secondary cases were infected during the index cases' presymptomatic stage, in settings with substantial household clustering, active case finding and quarantine outside the home. Disease control measures should be adjusted to account for probable substantial presymptomatic transmission.

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Authors+Show Affiliations

He X
Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Lau EHY
World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, University of Hong Kong, Hong Kong, SAR, China. ehylau@hku.hk.
Wu P
World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, University of Hong Kong, Hong Kong, SAR, China.
Deng X
Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Wang J
Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Hao X
World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, University of Hong Kong, Hong Kong, SAR, China.
Lau YC
World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, University of Hong Kong, Hong Kong, SAR, China.
Wong JY
World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, University of Hong Kong, Hong Kong, SAR, China.
Guan Y
Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Tan X
Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Mo X
Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Chen Y
Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Liao B
Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Chen W
Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Hu F
Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Zhang Q
Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Zhong M
Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Wu Y
Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Zhao L
Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Zhang F
Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Cowling BJ
World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, University of Hong Kong, Hong Kong, SAR, China.
Li F
Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
Leung GM
World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, University of Hong Kong, Hong Kong, SAR, China.

MeSH

BetacoronavirusCOVID-19Coronavirus InfectionsHumansPandemicsPneumonia, ViralSARS-CoV-2Virus Shedding

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32296168

Clinical Trial Links

CICERO- A Care Home Study of COVID-19

Citation

He, Xi, et al. "Temporal Dynamics in Viral Shedding and Transmissibility of COVID-19." Nature Medicine, vol. 26, no. 5, 2020, pp. 672-675.
He X, Lau EHY, Wu P, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. 2020;26(5):672-675.
He, X., Lau, E. H. Y., Wu, P., Deng, X., Wang, J., Hao, X., Lau, Y. C., Wong, J. Y., Guan, Y., Tan, X., Mo, X., Chen, Y., Liao, B., Chen, W., Hu, F., Zhang, Q., Zhong, M., Wu, Y., Zhao, L., ... Leung, G. M. (2020). Temporal dynamics in viral shedding and transmissibility of COVID-19. Nature Medicine, 26(5), 672-675. https://doi.org/10.1038/s41591-020-0869-5
He X, et al. Temporal Dynamics in Viral Shedding and Transmissibility of COVID-19. Nat Med. 2020;26(5):672-675. PubMed PMID: 32296168.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Temporal dynamics in viral shedding and transmissibility of COVID-19. AU - He,Xi, AU - Lau,Eric H Y, AU - Wu,Peng, AU - Deng,Xilong, AU - Wang,Jian, AU - Hao,Xinxin, AU - Lau,Yiu Chung, AU - Wong,Jessica Y, AU - Guan,Yujuan, AU - Tan,Xinghua, AU - Mo,Xiaoneng, AU - Chen,Yanqing, AU - Liao,Baolin, AU - Chen,Weilie, AU - Hu,Fengyu, AU - Zhang,Qing, AU - Zhong,Mingqiu, AU - Wu,Yanrong, AU - Zhao,Lingzhai, AU - Zhang,Fuchun, AU - Cowling,Benjamin J, AU - Li,Fang, AU - Leung,Gabriel M, Y1 - 2020/04/15/ PY - 2020/03/15/received PY - 2020/04/01/accepted PY - 2020/4/17/pubmed PY - 2020/5/19/medline PY - 2020/4/17/entrez SP - 672 EP - 675 JF - Nature medicine JO - Nat Med VL - 26 IS - 5 N2 - We report temporal patterns of viral shedding in 94 patients with laboratory-confirmed COVID-19 and modeled COVID-19 infectiousness profiles from a separate sample of 77 infector-infectee transmission pairs. We observed the highest viral load in throat swabs at the time of symptom onset, and inferred that infectiousness peaked on or before symptom onset. We estimated that 44% (95% confidence interval, 25-69%) of secondary cases were infected during the index cases' presymptomatic stage, in settings with substantial household clustering, active case finding and quarantine outside the home. Disease control measures should be adjusted to account for probable substantial presymptomatic transmission. SN - 1546-170X UR - https://www.unboundmedicine.com/medline/citation/32296168/full_citation L2 - https://doi.org/10.1038/s41591-020-0869-5 DB - PRIME DP - Unbound Medicine ER -