January 29, 2020
COVID-19 Literature Situation Report January 29, 2020
Category: COVID-19 Literature Situation Report
The scientific literature on COVID-19 is rapidly evolving and these articles were selected for review based on their relevance to Washington State decision making around COVID-19 response efforts. Included in these Lit Reps are some manuscripts that have been made available online as pre-prints but have not yet undergone peer review. Please be aware of this when reviewing articles included in the Lit Reps.
Key Takeaways
- Estimates of R0, incubation period, and illness duration are still inconsistent as researchers rely on a range of case reporting sources. Even so, some patterns are beginning to emerge and may be worth noting, with caution. Current research suggests:
- R0 of up to around 4, with variation by community characteristics.
- Incubation period of 1-11 days with an average of 4-6.
- Roughly 14 days on average between illness onset and death among fatal cases.
- One study found that patients who died tended to align with the MuLBSTA score for predicting mortality in viral pneumonia and often died of multiple organ failure.
- Germany has reported what may be the first *known* case of asymptomatic person-to-person transmission of the virus.
Article Summaries
Transmission
Germany confirms human transmission of coronavirus
Limited information is available about potential person-to-person transmission in Germany. A person who had not travelled to China was diagnosed with 2019-nCoV after attending a company training with a colleague from China. The Chinese colleague had recently been visited by family who came from Wuhan. It appears that transmission between the traveler and the German national occurred while the traveler was still asymptomatic.
Available from: https://www.dw.com/en/germany-confirms-human-transmission-of-coronavirus/a-52169007
Modeling and Prediction
The incubation period of 2019-nCoV infections among travelers from Wuhan, China
- Based on travel history and symptom onset of 34 confirmed cases detected outside of Wuhan during Jan 20-23, researchers estimated a mean incubation period of 5.8 days (95% CI, 4.6-7.9) with a range of 1.3-11.3 days. These cases were likely infected in Wuhan.
- Details for modeling the incubation period are included as well as a table comparing mean incubation period estimates across studies of 2019-nCoV, SARS-CoV, and MERS-CoV.
Backer et al. (Jan 28, 2020). The incubation period of 2019-nCoV infections among travelers from Wuhan, China. Pre-Print. http://dx.doi.org/10.1101/2020.01.27.20018986
Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia
- Researchers provide demographic characteristics, exposure history, and epidemic for 425 laboratory-confirmed cases of 2019-nCoV reported prior to Jan 22, 2020 divided over three time periods: cases with illness onset prior to Jan 1, onset Jan 1-Jan 11, and onset Jan 12 or after.
- Patients with earlier onset were more likely to report exposure to the Huanan Seafood Wholesale Market.
- Mean incubation period estimated to be 5.2 days (95% CI: 4.1-7.0).
- R0 was estimated at 2.2 (95% CI: 1.4-3.9).
- There was some variation in time between illness onset and first clinical visit and hospitalization across the three time periods.
- Findings support a 14-day observation period for exposed persons.
Li et al. (Jan 29, 2020). Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. NEJM. DOI: 10.1056/NEJMoa2001316 https://www.nejm.org/doi/full/10.1056/NEJMoa2001316
Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak.
- Researchers modeled confirmed cases of 2019-nCoV in mainland China from Jan 10-Jan 24. They estimated an R0 of 2.24-3.35.
Zhao et al. (Jan 29, 2020). Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak. Pre-Print. https://doi.org/10.1101/2020.01.23.916395
Epidemiological characteristics of novel coronavirus infection: A statistical analysis of publicly available case data
- Using publicly available case data in official reports from government institutes, researchers used modelling techniques to estimate:
- Incubation period of 2-9 days with a median incubation period of 4-5 days.
- Median time from illness onset to hospitalization = 3 days
- Recommended length of isolation and quarantine should be at least 9 days.
- Median time delay of 13.8 days from illness onset to death should be used for estimating case fatality risk.
Linton et al. (Jan 29, 2020). Epidemiological characteristics of novel coronavirus infection: A statistical analysis of publicly available case data. Pre-Print. http://dx.doi.org/10.1101/2020.01.26.20018754
This modeling study indicates that 2019-nCoV has a higher 2 effective reproduction number than SARS with a comparable fatality rate.
- Using daily case reports from China CDC, researchers estimate the effective reproductive number (R, not R0) for 2019-nCoV. R is the number of secondary cases expected for each infectious case once an epidemic is already underway.
- R is estimated as 4.08, compared to SARS-CoV in Beijing (2.76) and Guangzhou (3.01).
- They also predict the future outbreak profile, and in doing so evidence suggests that human-to-human transmission likely began before 12/16/2020, contradicting current estimates.
- Case fatality is estimated to reach 6.5%, compared to SARS-CoV in Beijing (7.66%) and Guangzhou (3.61%).
Cao et al. (Jan 29, 2020). This modeling study indicates that 2019-nCoV has a higher
2 effective reproduction number than SARS with a comparable fatality rate. Pre-Print. http://dx.doi.org/10.1101/2020.01.27.20018952
Origins, Reservoir, and Virus Background
Full-genome evolutionary analysis of the novel corona virus (2019-nCoV) rejects the hypothesis of emergence as a result of a recent recombination event
- Researchers in Greece aimed to characterize genetic relationships and to identify the presumed recombination within the sarbecovirus subgenus. Similar to other studies, they found around 96% similarity between 2019-nCoV and BatCoV RaTG13, associated with bats from Yunnan Province. Results indicate that this virus is not the result of a recent recombination event.
- Results still point to bats as the likely origin.
Paraskevis et al (Jan 27, 2020). Full-genome evolutionary analysis of the novel corona virus (2019-nCoV) rejects the hypothesis of emergence as a result of a recent recombination event. Pre-Print. https://doi.org/10.1101/2020.01.26.920249
Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding
- Samples from nine patients, eight with Wuhan travel history, were evaluated. Genome sequence identity between patients was 99.98%. 2019-nCoV had 88% sequence identity (similarity) with two SARS-like coronaviruses with bat origin but was less similar to SARS-CoV (79%) and MERS-CoV (50%). Receptor-binding domain structure was similar to SARS-CoV.
- In line with other studies, the virus appears to be within the subgenus Sarbecovirus of genus Betacoronavirus.
- While bats are identified as the likely origin, evidence points to a potential intermediary host sold at the Wuhan seafood market.
Lu et al. (Jan 29, 2020). Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. The Lancet. https://doi.org/10.1016/S0140-6736(20)30251-8
Clinical Characteristics
Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study
- All 99 cases identified from Jan 1 – Jan 20, 2020 at a single Wuhan hospital confirmed by RT-PCR are described. Patients who died aligned with the MuLBSTA score for predicting mortality in viral pneumonia.
- 49% had exposure to the Huanan seafood market
- 51% had chronic diseases
- Clinical manifestations: fever (83%), cough (82%), shortness of breath (31%), muscle ache (11%) and confusion, headache, sore throat, rhinorrhea, chest pain, diarrhea, and nausea/vomiting all less than 10%.
- 75% had bilateral pneumonia, 14% had multiple mottling and ground glass opacity, one patient had pneumothorax.
- 17 patients (17%) developed acute respiratory distress syndrome.
- 11 of these died of multiple organ failure.
Chen et al. (Jan 29, 2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. https://marlin-prod.literatumonline.com/pb-assets/Lancet/pdfs/S0140673620302117.pdf
International, Federal, and State Guidelines and Advice
- 1/29/2020: Advice on the Use of Masks the Community, During Home Care and in Health Care Settings in the Context of the Novel Coronavirus (2019–nCoV) Outbreak – WHO
- 1/28/2020: CDNA (Communicable Diseases Network Australia) National Guidelines for Public Health Units: Novel Coronavirus (2019–nCoV) – AUSTRALIA
- 1/26/2020: Risk Communication and Community Engagement (RCCE) Readiness and Response to the 2019 Novel Coronavirus (2019–nCoV): Interim Guidance V2 – WHO
- 1/26/2020: Outbreak of Acute Respiratory Syndrome Associated With a Novel Coronavirus, China: First Cases Imported in the EU/EEA; Second Update; Rapid Risk Assessment – ECDC
- 1/26/2020: PHLN (Public Health Laboratory Network) Guidance on Laboratory Testing for 2019–nCoV – AUSTRALIA
- 1/25/2020: Household Transmission Investigation Protocol for 2019-Novel Coronavirus (2019–nCoV) Infection – WHO
- 1/25/2020: Healthcare Professional Preparedness Checklist For Transport and Arrival of Patients Potentially Infected with 2019–nCoV – CDC
- 1/25/2020: Hospital Preparedness Checklist for Suspected or Confirmed 2019–nCoV Patients – CDC
- 1/23/2020: Statement on the Meeting of the International Health Regulations (2005) Emergency Committee Regarding the Outbreak of Novel Coronavirus (2019–nCoV) – WHO
- 1/23/2020: Novel Coronavirus Information Sheet for Emergency Departments – AUSTRALIA
- 1/23/2020: Novel Coronavirus Information Sheet for Primary and Community Health Workers – AUSTRALIA
- 1/22/2020: Outbreak of Acute Respiratory Syndrome Associated with a Novel Coronavirus, Wuhan, China: First Update; Rapid Risk Assessment – ECDC
- 1/21/2020: 2019 Novel Coronavirus, Wuhan, China – CDC
- 1/21/2020: Global Surveillance for Human Infection with Novel Coronavirus (2019–nCoV): Interim Guidance – WHO
- 1/21/2015: Coronaviruses: SARS, MERS, and 2019–nCoV – JOHNS HOPKINS
- 1/20/2020: Home Care for Patients with Suspected Novel Coronavirus (nCoV) Infection Presenting with Mild Symptoms and Management of Contacts: Interim Guidance – WHO
- 1/18/2020: 2019 Novel Coronavirus, Wuhan, China: Interim Healthcare Infection Prevention and Control Recommendations for Patients Under Investigation for 2019 Novel Coronavirus – CDC
- 1/18/2020: 2019 Novel Coronavirus, Wuhan, China: Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus (2019–nCoV) – CDC
- 1/17/2020: Laboratory Testing for 2019 Novel Coronavirus (2019–nCoV) in Suspected Human Cases – WHO
- 1/17/2020: 2019 Novel Coronavirus, Wuhan, China: Interim Guidance for Healthcare Professionals – CDC
- 1/17/2020: 2019 Novel Coronavirus, Wuhan, China: Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Patients Under Investigation (PUIs) for 2019 Novel Coronavirus (2019–nCoV) – CDC
- 1/17/2020: 2019 Novel Coronavirus, Wuhan, China: Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with 2019 Novel Coronavirus (2019–nCoV) – CDC
- 1/17/2020: Cluster of Pneumonia Cases Caused by a Novel Coronavirus, Wuhan, China: Rapid Risk Assessment – ECDC
- 1/15/2020: Surveillance Case Definitions for Human Infection with Novel Coronavirus (nCoV): Interim Guidance V2 – WHO
- 1/2020: WHO (World Health Organization) Recommendations to Reduce Risk of Transmission of Emerging Pathogens from Animals to Humans in Live Animal Markets – WHO
- 1/2020: Risk Assessment Guidelines for Infectious Diseases Transmitted on Aircraft (RAGIDA): Middle East Respiratory Syndrome Coronavirus (MERS-CoV); Technical Report – ECDC
- 1/2020: Emerging Respiratory Viruses, Including nCoV: Methods for Detection, Prevention, Response and Control – WHO