epiH Search

CLOSE



Epidemiol Health > Volume 42; 2020 > Article
Ryu, Chun, and Korean Society of Epidemiology 2019-nCoV Task Force Team: An interim review of the epidemiological characteristics of 2019 novel coronavirus

Abstract

OBJECTIVES

The 2019 novel coronavirus (2019-nCoV) from Wuhan, China is currently recognized as a public health emergency of global concern.

METHODS

We reviewed the currently available literature to provide up-to-date guidance on control measures to be implemented by public health authorities.

RESULTS

Some of the epidemiological characteristics of 2019-nCoV have been identified. However, there remain considerable uncertainties, which should be considered when providing guidance to public health authorities on control measures.

CONCLUSIONS

Additional studies incorporating more detailed information from confirmed cases would be valuable.

INTRODUCTION

Several clusters of patients with pneumonia of unknown etiology in Wuhan, Hubei Province, China were reported to the Chinese health authorities starting on December 8, 2019, and most of these cases were epidemiologically linked to a local fish and animal market [1,2]. The pathogenic agent responsible for these clusters of pneumonia was identified as a 2019 novel coronavirus (2019-nCoV) [1]. At the very beginning of the 2019-nCoV outbreak in China, much remained unknown, except for the fact that it was transmitted by direct exposure at the market [3]. However, person-to-person transmission of 2019-nCoV has been confirmed [4], and asymptomatic individuals have been identified as potential sources of infection [5]. The number of identified cases has been steadily growing, and as of February 3, a total of 14,557 cases had been reported globally (14,411 in China and 146 in 22 other countries) [6]. Since the first laboratory-confirmed case was identified on January 20, 2020 in Korea, the number of reported cases grew to 15 as of February 3, 2020 (Figure 1 and Table 1) [7].
There remain considerable knowledge gaps on 2019-nCoV; therefore, the public health authorities in countries with any likelihood of experiencing imported cases of 2019-nCoV should update the case definition to reflect newly updated epidemiological data. Herein, we present a review of the literature on the epidemiological characteristics of human infections with 2019-nCoV to provide an interim summary to public health authorities.

MATERIALS AND METHODS

We searched the literature for studies reporting epidemiological characteristics of 2019-nCoV, including the reproductive number, incubation period, serial interval, infectious period, generation time, latent period, and the fatality rate of hospitalized cases. The Korean Society of Epidemiology 2019-nCoV Task Force Team (KSE 2019-nCoV TFT) searched for peer-reviewed articles published from December 8, 2019 to February 1, 2020. Articles were eligible for inclusion if they reported any epidemiological characteristics of 2019-nCoV.

Ethics statement

The ethical approval or individual consent was not applicable.

RESULTS

Six articles were identified and included in this review (Table 2) [2,8-12] . Four relevant studies estimated the reproductive number [8,10-12]. A study of confirmed cases from Wuhan, China estimated the reproductive number to be 1.9 (95% confidence interval [CI], 1.3 to 3.2) [10]. Three other studies estimated the mean reproductive number as 0.3, 2.2, and 2.68, respectively [8,11,12]. A study reported the mean incubation period to be 6.1 days (95% CI, 3.8 to 9.7), and the mean serial interval to be 7.7 days (95% CI, 4.9 to 13.0) [10]. Two studies predicted the mean doubling time to be between 6.4 days and 8.7 days [10,11]. Three studies estimated the fatality rate of hospitalized cases as 14-15% [2,8,9]. We could not identify any studies that reported the infectious and latent periods.

DISCUSSION

We reviewed the epidemiological characteristics of 2019-nCoV. The estimated reproductive number of 0.3 was obtained from a small number of infected persons with imperfect information in the very early stages of the outbreak [8]; therefore the reproductive number of 2019-nCoV is likely to be similar to that of the 2002/2003 severe acute respiratory syndrome (SARS) coronavirus during the pre-intervention period (range, 2 to 3) and that of the 2009 pandemic A/H1N1 influenza virus in the United States (range, 1.3 to 1.7) [13-15]. The incubation period is likely similar to that of the SARS coronavirus, but with a wider confidence interval (mean, 4.8 days; 95% CI, 4.2 to 5.5) [16]. Furthermore, it is longer than that of the 2009 pandemic A/H1N1 influenza virus (median incubation period, 1.4 days; 95% CI, 1.0 to 1.8) [17]. Therefore, the evidence reviewed above shows that the current control measures for 2019-nCoV, including a quarantine and observation period of 14 days for suspected cases, can be considered appropriate [10]. The generation time and serial interval of 2019-nCoV are longer than those of the 2009 pandemic A/H1N1 influenza virus (median generation time, 2.7 days; 95% CI, 2.0 to 3.5; and mean serial interval: range, 2.6 to 3.2) [14,18]. However, the mean serial interval of 2019-nCoV is similar to that of the SARS coronavirus (mean, 8.4 days; standard deviation, 3.8) [19]. The overall case fatality rate of 2019-nCoV was estimated by international experts to range from 3% to 14% [15,20], and it is more likely to cause infection in older age groups with commodities [2].
Epidemiological parameters are usually obtained from a consecutive timeline of the number of reported cases and contact-tracing data. However, most of the studies included in our review made estimates using data obtained from the early stages of the outbreak in Wuhan, in which the reporting of confirmed cases may have been incomplete. Furthermore, differences in the simulation methodology used in various scenarios may result in a wide spectrum of estimated values [21]. Therefore, caution is needed when interpreting these reported results.
The number of confirmed cases is increasing in China and in other countries, including Korea. Furthermore, the likelihood of local transmission is increasing as a result of cases entering from China.
In light of a report describing a case of human-to-human transmission in the asymptomatic period [5], it is necessary to consider updating the case definition for surveillance; however, more detailed studies presenting evidence on the epidemiological nature, clinical presentation, and pathogenesis of 2019-nCoV are necessary to provide information for public health decision-making.

SUPPLEMENTARY MATERIALS

Korean version is available at http://www.e-epih.org/.
epih-42-e2020006-suppl.pdf

CONFLICT OF INTEREST

The authors have no conflicts of interest to declare for this study.

NOTES

FUNDING
None.

NOTES

AUTHOR CONTRIBUTIONS
Conceptualization: BCC, SR. Data curation: KSE 2019-nCoV TFT. Formal analysis: BCC, SR. Methodology: BCC, SR. Writing - original draft : BCC, SR. Writing - review & editing: BCC, KSE 2019-nCoV TFT, SR.

ACKNOWLEDGEMENTS

A full list of the members of KSE 2019-nCoV TFT (alphabetically ordered): Byung Chul Chun (Department of Preventive Medicine, Korea University College of Medicine, Seoul); Dong Hyun Kim (Department of Social and Preventive Medicine, Hallym University College of Medicine, Chuncheon); Hae-Kwan Cheong (Sungkyunkwan University School of Medicine, Suwon); Heeyoung Lee (Center for Preventive Medicine and Public Health, Seoul National University Bundang Hosptial, Seongnam); Hyunjin Son (Busan Center for Infectious Disease Control and Prevention, Busan National University Hospital); Ji-Hyuk Park (Department of Preventive Medicine, Dongguk University, Gyeongju), Jong-Hun Kim (Sungkyunkwan University School of Medicine, Suwon); Kwan Lee (Department of Preventive Medicine, Dongguk University, Gyeongju); Kwang-Pil Ko (Department of Preventive Medicine, Gachon University, College of Medicine, Incheon); Sukhyun Ryu (Department of Preventive Medicine, Konyang University, Daejeon); Sung-il Cho (Graduate School of Public Health, Seoul National University, Seoul); Young June Choe (Department of Social and Preventive Medicine, Hallym University College of Medicine, Chuncheon).

Figure 1.
Timeline of individuals with laboratory-confirmed 2019 novel coronavirus infections in Korea, as of February 3, 2020.
epih-42-e2020006f1.jpg
Table 1.
List of confirmed cases of 2019 novel coronavirus infection in Korea, as of February 3, 2020
Case No. Age (yr) Sex Nationality Date of entry to Korea Suspected infection of place or origin
#1 35 Female Chinese Jan 19, 2020 Wuhan, China
#2 55 Male Korean Jan 22, 2020 Wuhan, China
#3 54 Male Korean Jan 20, 2020 Wuhan, China
#4 55 Male Korean Jan 20, 2020 Wuhan, China
#5 33 Male Korean Jan 24. 2020 Wuhan, China
#6 55 Male Korean - Case #3
#7 28 Male Korean Jan 23, 2020 Wuhan, China
#8 62 Female Korean Jan 23, 2020 Wuhan, China
#9 28 Female Korean - Case #5
#10 54 Female Korean - Case #6
#11 25 Male Korean - Case #6
#12 48 Male Chinese Jan 19, 2020 Osaka, Japan
#13 28 Male Korean Jan 31, 2020 Wuhan, China
#14 40 Female Chinese - Case #12
#15 43 Male Korean Jan 20, 2020 Wuhan, China
Table 2.
Summary of reviews included in the study
Study Study setting Reproductive (n) Incubation period (d) Serial interval (d) Infectious period Doubling time (d) Latent period Fatality rate among hospitalized cases (%)
Wu et al. [8] Publicly-available data in China as at Jan 22, 2020 0.30 (95% CI: 0.17, 0.44) NA NA NA NA NA 14.0 (95% CI: 3.9, 32.0)
Huang et al. [9] 41 confirmed cases admitted to a designated hospital in Wuhan by Jan 2, 2020 NA NA NA NA NA NA 15.0
Chen et al. [2] 99 confirmed cases admitted in Wuhan Jinyintan Hosptial between Jan 1 and Jan 20, 2020 NA NA NA NA NA NA 14.6
Li et al. [10] 425 confirmed cases in Wuhan as at Jan 22, 2020 1.9 (95% CI: 1.3, 3.2) 6.1 (95% CI: 3.8, 9.7) 7.7 (95% CI: 4.9, 13.0) NA 8.7 (95% CI: 4.8, 17.0) NA NA
Riou et al. [12] Modelling study 2.2 (90% CI: 1.4, 3.8) NA NA NA NA NA NA
Wu et al. [11] Modeling study 2.68 (95% CrI: 2.47, 2.86) NA NA NA 6.4 (95% CrI: 5.8, 7.1) NA NA

CI, confidence interval; Crl, credible interval; NA, not available.

REFERENCES

1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; doi: https://doi.org/10.1056/NEJMoa2001017.
crossref
2. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; doi: https://doi.org/10.1016/S0140-6736(20)30211-7.
crossref
3. The Lancet. Emerging understandings of 2019-nCoV. Lancet 2020; 395: 311. PMID: 31986259
pmid pmc
4. Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020; doi: https://doi.org/10.1016/S0140-6736(20)30154-9.
crossref
5. Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med 2020; doi: https://doi.org/10.1056/NEJMc2001468.
crossref
6. World Health Organization. Novel Coronavirus (2019-nCoV) situation reports. [cited 2020 Feb 3]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports.

7. Korean Ministry of Health Welfare. 2019-nCoV. [cited 2020 Feb 3]. Available from :http://ncov.mohw.go.kr/tcmBoardList.do?brdId=&brdGubun=&dataGubun=&ncvContSeq=&contSeq=&board_id=(Korean).

8. Wu P, Hao X, Lau EH, Wong JY, Leung KS, Wu JT, et al. Real-time tentative assessment of the epidemiological characteristics of novel coronavirus infections in Wuhan, China, as at 22 January 2020. Euro Surveill 2020; 25: 2000044.
crossref
9. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; doi: https://doi.org/10.1016/S0140-6736(20)30183-5.
crossref
10. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020; doi: https://doi.org/10.1056/NEJMoa2001316.
crossref
11. Wu JT, Leung K, Leung GM. Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. Lancet 2020; doi: https://doi.org/10.1016/S0140-6736(20)30260-9.
crossref
12. Riou J, Althaus CL. Pattern of early human-to-human transmission of Wuhan 2019 novel coronavirus (2019-nCoV), December 2019 to January 2020. Euro Surveill 2020; 25: 2000058.
crossref
13. Wallinga J, Teunis P. Different epidemic curves for severe acute respiratory syndrome reveal similar impacts of control measures. Am J Epidemiol 2004; 160: 509-516.
crossref pdf
14. Yang Y, Sugimoto JD, Halloran ME, Basta NE, Chao DL, Matrajt L, et al. The transmissibility and control of pandemic influenza A (H1N1) virus. Science 2009; 326: 729-733. PMID: 19745114
crossref pmid pmc
15. European Centre for Disease Prevention and Control. Risk assessment: outbreak of acute respiratory syndrome associated with a novel coronavirus, China: first local transmission in the EU/EEA − third update; 2020 Jan 31 [cited 2020 Feb 3]. Available from: https://www.ecdc.europa.eu/en/publications-data/risk-assessment-outbreak-acute-respiratory-syndrome-associated-novel-1.

16. Wong TW, Tam W. Estimating SARS incubation period. Emerg Infect Dis 2004; 10: 1503-1504. PMID: 15503397
crossref pmid pmc
17. Lessler J, Reich NG, Cummings DA; New York City Department of Health and Mental Hygiene Swine Influenza Investigation Team, Nair HP, Jordan HT, et al. Outbreak of 2009 pandemic influenza A (H1N1) at a New York City school. N Engl J Med 2009; 361: 2628-2636.
crossref
18. Balcan D, Hu H, Goncalves B, Bajardi P, Poletto C, Ramasco JJ, et al. Seasonal transmission potential and activity peaks of the new influenza A(H1N1): a Monte Carlo likelihood analysis based on human mobility. BMC Med 2009; 7: 45. PMID: 19744314
crossref pmid pmc pdf
19. Lipsitch M, Cohen T, Cooper B, Robins JM, Ma S, James L, et al. Transmission dynamics and control of severe acute respiratory syndrome. Science 2003; 300: 1966-1970. PMID: 12766207
crossref pmid pmc
20. Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet 2020; doi: https://doi.org/10.1016/S0140-6736(20)30185-9.
crossref
21. De Angelis D, Presanis AM, Birrell PJ, Tomba GS, House T. Four key challenges in infectious disease modelling using data from multiple sources. Epidemics 2015; 10: 83-87. PMID: 25843390
crossref pmid pmc


ABOUT
ARTICLE CATEGORY

Browse all articles >

BROWSE ARTICLES
FOR AUTHORS AND REVIEWERS
Editorial Office
Department of Preventive Medicine, Yonsei University College of Medicine
50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
TEL: +82-2-745-0662   FAX: +82-2-764-8328    E-mail: office.epih@gmail.com

Copyright © 2021 by Korean Society of Epidemiology.

Developed in M2PI

Close layer
prev next