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Abstract

Background

The natural history of disease in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remained obscure during the early pandemic.

Aim

Our objective was to estimate epidemiological parameters of coronavirus disease (COVID-19) and assess the relative infectivity of the incubation period.

Methods

We 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.

Results

The 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.

Conclusion

The 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.

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2020-10-08
2024-04-19
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2020.25.40.2000250
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Epidemiological parameters of COVID-19 and its implication for infectivity among patients in China, 1 January to 11 February 2020
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Qing-Bin+Lu&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lu Qing-Bin</a>, <a href="/search?value1=Yong+Zhang&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zhang Yong</a>, <a href="/search?value1=Ming-Jin+Liu&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Liu Ming-Jin</a>, <a href="/search?value1=Hai-Yang+Zhang&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zhang Hai-Yang</a>, <a href="/search?value1=Neda+Jalali&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jalali Neda</a>, <a href="/search?value1=An-Ran+Zhang&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zhang An-Ran</a>, <a href="/search?value1=Jia-Chen+Li&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Li Jia-Chen</a>, <a href="/search?value1=Han+Zhao&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zhao Han</a>, <a href="/search?value1=Qian-Qian+Song&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Song Qian-Qian</a>, <a href="/search?value1=Tian-Shuo+Zhao&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zhao Tian-Shuo</a>, <a href="/search?value1=Jing+Zhao&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zhao Jing</a>, <a href="/search?value1=Han-Yu+Liu&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Liu Han-Yu</a>, <a href="/search?value1=Juan+Du&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Du Juan</a>, <a href="/search?value1=Ai-Ying+Teng&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Teng Ai-Ying</a>, <a href="/search?value1=Zi-Wei+Zhou&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zhou Zi-Wei</a>, <a href="/search?value1=Shi-Xia+Zhou&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zhou Shi-Xia</a>, <a href="/search?value1=Tian-Le+Che&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Che Tian-Le</a>, <a href="/search?value1=Tao+Wang&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wang Tao</a>, <a href="/search?value1=Tong+Yang&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Yang Tong</a>, <a href="/search?value1=Xiu-Gang+Guan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Guan Xiu-Gang</a>, <a href="/search?value1=Xue-Fang+Peng&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Peng Xue-Fang</a>, <a href="/search?value1=Yu-Na+Wang&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wang Yu-Na</a>, <a href="/search?value1=Yuan-Yuan+Zhang&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zhang Yuan-Yuan</a>, <a href="/search?value1=Shou-Ming+Lv&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lv Shou-Ming</a>, <a href="/search?value1=Bao-Cheng+Liu&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Liu Bao-Cheng</a>, <a href="/search?value1=Wen-Qiang+Shi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Shi Wen-Qiang</a>, <a href="/search?value1=Xiao-Ai+Zhang&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zhang Xiao-Ai</a>, <a href="/search?value1=Xiao-Gang+Duan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Duan Xiao-Gang</a>, <a href="/search?value1=Wei+Liu&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Liu Wei</a>, <a href="/search?value1=Yang+Yang&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Yang Yang</a>, <a href="/search?value1=Li-Qun+Fang&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fang Li-Qun</a></span>. Epidemiological parameters of COVID-19 and its implication for infectivity among patients in China, 1 January to 11 February 2020. <a href="/content/ecdc">Euro Surveill.</a> 2020;25(40):pii=2000250. <a href="https://doi.org/10.2807/1560-7917.ES.2020.25.40.2000250" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2020.25.40.2000250</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 06 Mar 2020;&nbsp;&nbsp; <span class="generated">Accepted</span>: 14 Jul 2020 </span> </p>
/content/10.2807/1560-7917.ES.2020.25.40.2000250
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