The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China
17 Feb 2020-Chinese journal of epidemiology (Zhonghua Liu Xing Bing Xue Za Zhi)-Vol. 41, Iss: 2, pp 145-151
TL;DR: The COVID-19 epidemic has spread very quickly and only took 30 days to expand from Hubei to the rest of Mainland China, with many people returning from a long holiday, China needs to prepare for the possible rebound of the epidemic.
Abstract: Objective
An outbreak of 2019 novel coronavirus diseases (COVID-19) in Wuhan, China has spread quickly nationwide. Here, we report results of a descriptive, exploratory analysis of all cases diagnosed as of February 11, 2020.
Methods
All COVID-19 cases reported through February 11, 2020 were extracted from China’s Infectious Disease Information System. Analyses included: 1) summary of patient characteristics; 2) examination of age distributions and sex ratios; 3) calculation of case fatality and mortality rates; 4) geo-temporal analysis of viral spread; 5) epidemiological curve construction; and 6) subgroup analysis.
Results
A total of 72 314 patient records-44 672 (61.8%) confirmed cases, 16 186 (22.4%) suspected cases, 10567 (14.6%) clinical diagnosed cases (Hubei only), and 889 asymptomatic cases (1.2%)-contributed data for the analysis. Among confirmed cases, most were aged 30-79 years (86.6%), diagnosed in Hubei (74.7%), and considered mild/mild pneumonia (80.9%). A total of 1 023 deaths occurred among confirmed cases for an overall case-fatality rate of 2.3%. The COVID-19 spread outward from Hubei sometime after December 2019 and by February 11, 2020, 1 386 counties across all 31 provinces were affected. The epidemic curve of onset of symptoms peaked in January 23-26, then began to decline leading up to February 11. A total of 1 716 health workers have become infected and 5 have died (0.3%).
Conclusions
The COVID-19 epidemic has spread very quickly. It only took 30 days to expand from Hubei to the rest of Mainland China. With many people returning from a long holiday, China needs to prepare for the possible rebound of the epidemic.
Key words:
2019 Novel Coronavirus; Outbreak; Epidemiological characteristics
Citations
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TL;DR: These early estimates give an indication of the fatality ratio across the spectrum of COVID-19 disease and show a strong age gradient in risk of death.
Abstract: Background In the face of rapidly changing data, a range of case fatality ratio estimates for coronavirus disease 2019 (COVID-19) have been produced that differ substantially in magnitude. We aimed to provide robust estimates, accounting for censoring and ascertainment biases. Methods We collected individual-case data for patients who died from COVID-19 in Hubei, mainland China (reported by national and provincial health commissions to Feb 8, 2020), and for cases outside of mainland China (from government or ministry of health websites and media reports for 37 countries, as well as Hong Kong and Macau, until Feb 25, 2020). These individual-case data were used to estimate the time between onset of symptoms and outcome (death or discharge from hospital). We next obtained age-stratified estimates of the case fatality ratio by relating the aggregate distribution of cases to the observed cumulative deaths in China, assuming a constant attack rate by age and adjusting for demography and age-based and location-based under-ascertainment. We also estimated the case fatality ratio from individual line-list data on 1334 cases identified outside of mainland China. Using data on the prevalence of PCR-confirmed cases in international residents repatriated from China, we obtained age-stratified estimates of the infection fatality ratio. Furthermore, data on age-stratified severity in a subset of 3665 cases from China were used to estimate the proportion of infected individuals who are likely to require hospitalisation. Findings Using data on 24 deaths that occurred in mainland China and 165 recoveries outside of China, we estimated the mean duration from onset of symptoms to death to be 17·8 days (95% credible interval [CrI] 16·9-19·2) and to hospital discharge to be 24·7 days (22·9-28·1). In all laboratory confirmed and clinically diagnosed cases from mainland China (n=70 117), we estimated a crude case fatality ratio (adjusted for censoring) of 3·67% (95% CrI 3·56-3·80). However, after further adjusting for demography and under-ascertainment, we obtained a best estimate of the case fatality ratio in China of 1·38% (1·23-1·53), with substantially higher ratios in older age groups (0·32% [0·27-0·38] in those aged Interpretation These early estimates give an indication of the fatality ratio across the spectrum of COVID-19 disease and show a strong age gradient in risk of death. Funding UK Medical Research Council.
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Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Alongside investigations into the virology of SARS-CoV-2, understanding the fundamental physiological and immunological processes underlying the clinical manifestations of COVID-19 is vital for the identification and rational design of effective therapies. Here, we provide an overview of the pathophysiology of SARS-CoV-2 infection. We describe the interaction of SARS-CoV-2 with the immune system and the subsequent contribution of dysfunctional immune responses to disease progression. From nascent reports describing SARS-CoV-2, we make inferences on the basis of the parallel pathophysiological and immunological features of the other human coronaviruses targeting the lower respiratory tract - severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Finally, we highlight the implications of these approaches for potential therapeutic interventions that target viral infection and/or immunoregulation.
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References
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TL;DR: Investigation on patients in a local hospital who were infected with a novel coronavirus found the presence of 2019-nCoV in anal swabs and blood, and more anal swab positives than oral swabs positives in a later stage of infection, suggesting shedding and thereby transmitted through oral–fecal route.
Abstract: In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
1,524 citations
TL;DR: It is reported for the first time that a SARS-CoV-specific human monoclonal antibody,CR3022, could bind potently with 2019-nCoV RBD (KD of 6.3 nM), suggesting that CR3022 may have the potential to be developed as candidate therapeutics, alone or in combination with other neutralizing antibodies, for the prevention and treatment of 2019- nCoV infections.
Abstract: The newly identified 2019 novel coronavirus (2019-nCoV) has caused more than 11,900 laboratory-confirmed human infections, including 259 deaths, posing a serious threat to human health. Currently, however, there is no specific antiviral treatment or vaccine. Considering the relatively high identity of receptor-binding domain (RBD) in 2019-nCoV and SARS-CoV, it is urgent to assess the cross-reactivity of anti-SARS CoV antibodies with 2019-nCoV spike protein, which could have important implications for rapid development of vaccines and therapeutic antibodies against 2019-nCoV. Here, we report for the first time that a SARS-CoV-specific human monoclonal antibody, CR3022, could bind potently with 2019-nCoV RBD (KD of 6.3 nM). The epitope of CR3022 does not overlap with the ACE2 binding site within 2019-nCoV RBD. These results suggest that CR3022 may have the potential to be developed as candidate therapeutics, alone or in combination with other neutralizing antibodies, for the prevention and treatment of 2019-nCoV infections. Interestingly, some of the most potent SARS-CoV-specific neutralizing antibodies (e.g. m396, CR3014) that target the ACE2 binding site of SARS-CoV failed to bind 2019-nCoV spike protein, implying that the difference in the RBD of SARS-CoV and 2019-nCoV has a critical impact for the cross-reactivity of neutralizing antibodies, and that it is still necessary to develop novel monoclonal antibodies that could bind specifically to 2019-nCoV RBD.
1,099 citations
TL;DR: The epidemiological evidence has shown possible transmission of 2019 novel coronavirus during the incubation period, including an 88-year-old man with limited mobility who was exposed only to asymptomatic family members whose symptoms developed later.
Abstract: An ongoing outbreak of pneumonia associated with 2019 novel coronavirus was reported in China. It is unclear whether the virus is infective exists during the incubation period, although person-to-person transmission has been reported elsewhere. We report the epidemiological features of a familial cluster of 4 patients in Shanghai, including an 88-year-old man with limited mobility who was exposed only to asymptomatic family members whose symptoms developed later. The epidemiological evidence has shown possible transmission of 2019 novel coronavirus during the incubation period.
581 citations
TL;DR: Residents reported a high level of risk perception towards COVID-19 in Chongqing and it was impacted by the population demographic characteristics, and the perceived risk increased by 4.9% for every one-year increase of age.
Abstract: To assess perceptions of risk and related factors concerning COVID-19 epidemic among residents in Chongqing city, China With convenience sampling, a web questionnaire survey was conducted among 476 residents living in Chongqing on February 13rd to 14th in 2020, when citizens just started to get back to work Residents’ estimated perceived risks were (463 ± 057), (419 ± 076), (323 ± 091) and (229 ± 096) for the infectivity, pathogenicity, lethality and self-rated infection possibility of COVID-19, respectively Females (OR = 4234), people with income ≥ 2000 yuan (2000–4999 yuan: OR = 5052, 5000–9999 yuan: OR = 4301, ≥ 10,000 yuan: OR = 23459), the married status (OR = 1811), the divorced status, widows or widowers (OR = 3038), people living with families including children (OR = 5085) or chronic patients (OR = 2423) had a higher perceived risk level, as well as people who used free media websites (OR = 1756), community workers (OR = 4064) or community information platforms (OR = 2235) as main media information sources The perceived risk increased by 49% for every one-year increase of age People who used WeChat contacts (OR = 0196) as the main media information source, reported a lower perceived risk Residents reported a high level of risk perception towards COVID-19 in Chongqing and it was impacted by the population demographic characteristics Media information sources, including community information platforms and community workers may cause the increase of public risk perceptions
76 citations
TL;DR: The study suggests that the vast majority of the health care professionals have adequate knowledge and awareness related to COVID-19, however some aspects of practice of health Care professionals were found to be deficient.
Abstract: Objective: To assess the knowledge, awareness and practice level of health care workers towards Corona Virus disease - 2019 (COVID-19).
Methods: A cross sectional study was conducted by administering a well-structured questionnaire comprising of three sections including knowledge, attitude and practice amongst health care professionals in various hospitals and clinics, over a duration of two months ‘Feb-March’ 2020. The data from 810 participants were collected manually as well as through online survey registered on www.surveys.google.com, using a validated questionnaire. The questionnaire comprised of three sections assessing knowledge, awareness and practice of participants. The descriptive analysis was carried out for demographics and dependent variables with statistical program for social sciences. Spearman test was used to detect any relationship between the health care professional response with respect to their gender and level of education. A p-value of < 0.05 was considered statistically significant.
Results: More than half (57.2%) of the health care professionals were working in a hospital setting. Fifty two percent of health care professionals had awareness and 72% were practicing adequate measures to combat COVID-19. The majority (81.9%) believed that the sign and symptoms are similar to a common flu and the main strata of population that could be affected by COVID-19 are elderly (79%). Seventy three percent of participants did not attend any lecture, workshop or seminar on COVID-19 for awareness purpose. Sixty seven percent of health care professionals were practicing universal precaution for infection control and 57.4% were using sodium hypochlorite as a surface disinfectant in dental surgeries. There was no significant relationship (p > 0.05) between the health care professionals’ responses with gender and their education level.
Conclusion: The study suggests that the vast majority of the health care professionals have adequate knowledge and awareness related to COVID-19. However some aspects of practice of health care professionals were found to be deficient including, following CDC guidelines during patient care, acquiring verified knowledge related to COVID-19, disinfection protocol and the use of N-95 mask. Mandatory Continued professional development programs including lectures and workshops on COVID-19 for all health care professionals are the need of the hour, to manage the pandemic and limiting the morbidity and mortality related to it.
doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2704
How to cite this:Ahmed N, Shakoor M, Vohra F, Abduljabbar T, Mariam Q, Rehman MA. Knowledge, Awareness and Practice of Health care Professionals amid SARS-CoV-2, Corona Virus Disease Outbreak. Pak J Med Sci. 2020;36(COVID19-S4):COVID19-S49-S56. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2704
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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