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. 2020 Mar 26;382(13):1199-1207.
doi: 10.1056/NEJMoa2001316. Epub 2020 Jan 29.

Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia

Qun Li  1 , Xuhua Guan  1 , Peng Wu  1 , Xiaoye Wang  1 , Lei Zhou  1 , Yeqing Tong  1 , Ruiqi Ren  1 , Kathy S M Leung  1 , Eric H Y Lau  1 , Jessica Y Wong  1 , Xuesen Xing  1 , Nijuan Xiang  1 , Yang Wu  1 , Chao Li  1 , Qi Chen  1 , Dan Li  1 , Tian Liu  1 , Jing Zhao  1 , Man Liu  1 , Wenxiao Tu  1 , Chuding Chen  1 , Lianmei Jin  1 , Rui Yang  1 , Qi Wang  1 , Suhua Zhou  1 , Rui Wang  1 , Hui Liu  1 , Yinbo Luo  1 , Yuan Liu  1 , Ge Shao  1 , Huan Li  1 , Zhongfa Tao  1 , Yang Yang  1 , Zhiqiang Deng  1 , Boxi Liu  1 , Zhitao Ma  1 , Yanping Zhang  1 , Guoqing Shi  1 , Tommy T Y Lam  1 , Joseph T Wu  1 , George F Gao  1 , Benjamin J Cowling  1 , Bo Yang  1 , Gabriel M Leung  1 , Zijian Feng  1
Affiliations

Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia

Qun Li et al. N Engl J Med. .

Abstract

Background: The initial cases of novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, Hubei Province, China, in December 2019 and January 2020. We analyzed data on the first 425 confirmed cases in Wuhan to determine the epidemiologic characteristics of NCIP.

Methods: We collected information on demographic characteristics, exposure history, and illness timelines of laboratory-confirmed cases of NCIP that had been reported by January 22, 2020. We described characteristics of the cases and estimated the key epidemiologic time-delay distributions. In the early period of exponential growth, we estimated the epidemic doubling time and the basic reproductive number.

Results: Among the first 425 patients with confirmed NCIP, the median age was 59 years and 56% were male. The majority of cases (55%) with onset before January 1, 2020, were linked to the Huanan Seafood Wholesale Market, as compared with 8.6% of the subsequent cases. The mean incubation period was 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days. In its early stages, the epidemic doubled in size every 7.4 days. With a mean serial interval of 7.5 days (95% CI, 5.3 to 19), the basic reproductive number was estimated to be 2.2 (95% CI, 1.4 to 3.9).

Conclusions: On the basis of this information, there is evidence that human-to-human transmission has occurred among close contacts since the middle of December 2019. Considerable efforts to reduce transmission will be required to control outbreaks if similar dynamics apply elsewhere. Measures to prevent or reduce transmission should be implemented in populations at risk. (Funded by the Ministry of Science and Technology of China and others.).

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Figures

Figure 1
Figure 1. Onset of Illness among the First 425 Confirmed Cases of Novel Coronavirus (2019-nCoV)–Infected Pneumonia (NCIP) in Wuhan, China.
The decline in incidence after January 8 is likely to be due to delays in diagnosis and laboratory confirmation. China CDC denotes Chinese Center for Disease Control and Prevention, NHC National Health Commission of the People’s Republic of China, PCR polymerase chain reaction, WHC Wuhan Health Commission, and WHO World Health Organization.
Figure 2
Figure 2. Key Time-to-Event Distributions.
The estimated incubation period distribution (i.e., the time from infection to illness onset) is shown in Panel A. The estimated serial interval distribution (i.e., the time from illness onset in successive cases in a transmission chain) is shown in Panel B. The estimated distributions of times from illness onset to first medical visit are shown in Panel C. The estimated distributions of times from illness onset to hospital admission are shown in Panel D.
Figure 3
Figure 3. Detailed Information on Exposures and Dates of Illness Onset in Five Clusters Including 16 Cases.
Numbers in boxes are calendar dates in December 2019 and January 2020. Data from the 5 secondary cases (patients who had clear exposure to only one index case and had no other potential source of infection) were used to estimate the serial interval distribution. The first four clusters were identified in Wuhan, and the fifth cluster was identified in Huanggang.
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