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Epidemiological parameters of COVID-19 and its implication for infectivity among patients in China, 1 January to 11 February 2020.
Euro Surveill. 2020 10; 25(40)ES

Abstract

BackgroundThe natural history of disease in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remained obscure during the early pandemic.AimOur objective was to estimate epidemiological parameters of coronavirus disease (COVID-19) and assess the relative infectivity of the incubation period.MethodsWe estimated the distributions of four epidemiological parameters of SARS-CoV-2 transmission using a large database of COVID-19 cases and potential transmission pairs of cases, and assessed their heterogeneity by demographics, epidemic phase and geographical region. We further calculated the time of peak infectivity and quantified the proportion of secondary infections during the incubation period.ResultsThe median incubation period was 7.2 (95% confidence interval (CI): 6.9‒7.5) days. The median serial and generation intervals were similar, 4.7 (95% CI: 4.2‒5.3) and 4.6 (95% CI: 4.2‒5.1) days, respectively. Paediatric cases < 18 years had a longer incubation period than adult age groups (p = 0.007). The median incubation period increased from 4.4 days before 25 January to 11.5 days after 31 January (p < 0.001), whereas the median serial (generation) interval contracted from 5.9 (4.8) days before 25 January to 3.4 (3.7) days after. The median time from symptom onset to discharge was also shortened from 18.3 before 22 January to 14.1 days after. Peak infectivity occurred 1 day before symptom onset on average, and the incubation period accounted for 70% of transmission.ConclusionThe high infectivity during the incubation period led to short generation and serial intervals, necessitating aggressive control measures such as early case finding and quarantine of close contacts.

Authors+Show Affiliations

These authors contributed equally to this manuscript. Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, China.School of Mathematical Sciences, Beijing Normal University, Beijing, China. These authors contributed equally to this manuscript.Department of Biostatistics, College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, United States.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.Department of Biostatistics, College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, United States.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China. Department of Biostatistics, College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, United States.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.School of Mathematical Sciences, Beijing Normal University, Beijing, China.School of Mathematical Sciences, Beijing Normal University, Beijing, China.Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, China.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, China.Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, China.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.These senior authors contributed equally to this manuscript. School of Statistics, Beijing Normal University, Beijing, China.These senior authors contributed equally to this manuscript. State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.These senior authors contributed equally to this manuscript. Department of Biostatistics, College of Public Health and Health Professions, and Emerging Pathogens Institute, University of Florida, Gainesville, United States.These senior authors contributed equally to this manuscript. State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

33034281

Citation

Lu, Qing-Bin, et al. "Epidemiological Parameters of COVID-19 and Its Implication for Infectivity Among Patients in China, 1 January to 11 February 2020." Euro Surveillance : Bulletin Europeen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin, vol. 25, no. 40, 2020.
Lu QB, Zhang Y, Liu MJ, et al. Epidemiological parameters of COVID-19 and its implication for infectivity among patients in China, 1 January to 11 February 2020. Euro Surveill. 2020;25(40).
Lu, Q. B., Zhang, Y., Liu, M. J., Zhang, H. Y., Jalali, N., Zhang, A. R., Li, J. C., Zhao, H., Song, Q. Q., Zhao, T. S., Zhao, J., Liu, H. Y., Du, J., Teng, A. Y., Zhou, Z. W., Zhou, S. X., Che, T. L., Wang, T., Yang, T., ... Fang, L. Q. (2020). Epidemiological parameters of COVID-19 and its implication for infectivity among patients in China, 1 January to 11 February 2020. Euro Surveillance : Bulletin Europeen Sur Les Maladies Transmissibles = European Communicable Disease Bulletin, 25(40). https://doi.org/10.2807/1560-7917.ES.2020.25.40.2000250
Lu QB, et al. Epidemiological Parameters of COVID-19 and Its Implication for Infectivity Among Patients in China, 1 January to 11 February 2020. Euro Surveill. 2020;25(40) PubMed PMID: 33034281.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epidemiological parameters of COVID-19 and its implication for infectivity among patients in China, 1 January to 11 February 2020. AU - Lu,Qing-Bin, AU - Zhang,Yong, AU - Liu,Ming-Jin, AU - Zhang,Hai-Yang, AU - Jalali,Neda, AU - Zhang,An-Ran, AU - Li,Jia-Chen, AU - Zhao,Han, AU - Song,Qian-Qian, AU - Zhao,Tian-Shuo, AU - Zhao,Jing, AU - Liu,Han-Yu, AU - Du,Juan, AU - Teng,Ai-Ying, AU - Zhou,Zi-Wei, AU - Zhou,Shi-Xia, AU - Che,Tian-Le, AU - Wang,Tao, AU - Yang,Tong, AU - Guan,Xiu-Gang, AU - Peng,Xue-Fang, AU - Wang,Yu-Na, AU - Zhang,Yuan-Yuan, AU - Lv,Shou-Ming, AU - Liu,Bao-Cheng, AU - Shi,Wen-Qiang, AU - Zhang,Xiao-Ai, AU - Duan,Xiao-Gang, AU - Liu,Wei, AU - Yang,Yang, AU - Fang,Li-Qun, PY - 2020/10/9/entrez PY - 2020/10/10/pubmed PY - 2020/10/21/medline KW - China KW - SARS-CoV-2 KW - coronavirus disease 2019 KW - generation interval KW - incubation period KW - serial interval JF - Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin JO - Euro Surveill VL - 25 IS - 40 N2 - BackgroundThe natural history of disease in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remained obscure during the early pandemic.AimOur objective was to estimate epidemiological parameters of coronavirus disease (COVID-19) and assess the relative infectivity of the incubation period.MethodsWe estimated the distributions of four epidemiological parameters of SARS-CoV-2 transmission using a large database of COVID-19 cases and potential transmission pairs of cases, and assessed their heterogeneity by demographics, epidemic phase and geographical region. We further calculated the time of peak infectivity and quantified the proportion of secondary infections during the incubation period.ResultsThe median incubation period was 7.2 (95% confidence interval (CI): 6.9‒7.5) days. The median serial and generation intervals were similar, 4.7 (95% CI: 4.2‒5.3) and 4.6 (95% CI: 4.2‒5.1) days, respectively. Paediatric cases < 18 years had a longer incubation period than adult age groups (p = 0.007). The median incubation period increased from 4.4 days before 25 January to 11.5 days after 31 January (p < 0.001), whereas the median serial (generation) interval contracted from 5.9 (4.8) days before 25 January to 3.4 (3.7) days after. The median time from symptom onset to discharge was also shortened from 18.3 before 22 January to 14.1 days after. Peak infectivity occurred 1 day before symptom onset on average, and the incubation period accounted for 70% of transmission.ConclusionThe high infectivity during the incubation period led to short generation and serial intervals, necessitating aggressive control measures such as early case finding and quarantine of close contacts. SN - 1560-7917 UR - https://www.unboundmedicine.com/medline/citation/33034281/Epidemiological_parameters_of_COVID_19_and_its_implication_for_infectivity_among_patients_in_China_1_January_to_11_February_2020_ L2 - http://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.40.2000250 DB - PRIME DP - Unbound Medicine ER -