ncov 2019 incubation period

  • 9 min read
  • Feb 03, 2020

Transmission of 2019-nCoV Infection from an Asymptomatic Contact ...
Transmission of 2019-nCoV Infection from an Asymptomatic Contact …

Stephen A. Lauer, MS, PhD; Kyra H. Grantz, BA; Qifang Bi, MHS; Forrest K. Jones, MPH; Qulu Zheng, MHS; Hannah R. Meredith, PhD; Andrew S. Azman, PhD; Nicholas G. Reich, PhD; Justin Lessler, PhD

Acknowledgment: The authors thank all that have been collected, compiled, and share data throughout this plague. They are very grateful to Dr. Kaiyuan Sun, Ms. Jenny Chen, and Dr. Cecile Viboud of the International Division of Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health; Dr. Moritz Kraemer and open COVID-19 Data working group; and the Johns Hopkins Center for Systems Science and Engineering

Support Grant :. With the United States Centers for Disease Control and Prevention (NU2GGH002000), National Institute of Allergy and Infectious Diseases (R01 AI135115), the National Institute of General Medical Sciences (R35 GM119582), and the Alexander von Humboldt Foundation

Disclosure :. Dr. Lauer reported a grant from the National Institute of Allergy and Infectious Diseases and the Center for Disease Control and Prevention during the study. Ms. Grantz reported a grant from the US Centers for Disease Control and Prevention during the study. Dr. Reich reported a grant from the National Institute of General Medical Sciences and the Alexander von Humboldt Foundation for conducting research. Dr. Lessler reported a grant from the US Centers for Disease Control and Prevention during the study. The author is not mentioned here have disclosed no conflicts of interest. Disclosures can also be seen at

Disclosure Editor :. Christine Laine, MD, MPH, Editor in Chief, reported that her husband had stock options / ownership with Diagnostic and Therapeutic Targets. Darren B. Taichman, MD, PhD, Executive Editor, reports that he does not have a financial relationship or interest to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that it has no relationship or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that he has ownership shares / options in Eli Lilly and Pfizer. Christina C. Wee, MD, MPH, Deputy Editor, statements of work with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he does not have a financial relationship or interest to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that it has no financial relationship or interest to disclose

Research Statement reproduced :. Study protocol: Not applicable. Statistical code and data set: Available at

According to author :. Justin Lessler, PhD, Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205; e-mail,

Current Author Addresses :. Drs. Lauer, Meredith, and Lessler; Ms. Grantz; Ms. Bi; Pak Jones; and Zheng :. Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205

Dr. Azman: Médecins Sans Frontières, Rue de Lausanne 72, 1202 Genève, Switzerland

Dr .. Reich: Department of Biostatistics and Epidemiology, Amherst School of Public Health and Health Sciences, University of Massachusetts, 715 North Pleasant Street, Amherst, MA 01003-9304

Author Contributions :. Conception and design: SA Lauer, KH Grantz, F.K. Jones, N.G. Reich, J. Lessler

Analysis and interpretation of data :. S.A. Lauer, K.H. Grantz, T. Bi, F.K. Jones, N.G. Reich, J. Lessler

Drafting of the article :. S.A. Lauer, K.H. Grantz, T. Bi, F.K. Jones, A.S. Azman, N.G. , Reich

Critical revision of the article for important intellectual content: T. Bi, F.K. Jones, A.S. Azman, N.G. , Reich, J. Lessler

Final approval of the article: S.A. Lauer, K.H. Grantz, T. Bi, F.K. Jones, T. Zheng, H.R. Meredith, A.S. Azman, N.G. , Reich, J. Lessler

Statistical expertise: T. Bi, N.G. Reich, J. Lessler

Collection and assembly of data :. S.A. Lauer, K.H. Grantz, T. Bi, F.K. Jones, T. Zheng, HR Meredith

Post Previous :. This text has been posted as a preprint on medRxiv on February 4, 2020. doi:

A new human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019. There limited support for many major epidemiological features, including the incubation period of clinical disease (coronavirus disease in 2019 [COVID-19]), which has an important implications for surveillance and control activities.

In order to estimate the length of the incubation period COVID-19 and describe the public health implications.

Pooled analysis confirmed COVID 19 cases reported between January 4, 2020 and February 24th 2020.

news reports and press releases of 50 provinces, regions, and countries outside Wuhan , Hubei province, China.

People with confirmed SARS-2 infection CoV- outside the province of Hubei, China.

the demographic characteristics of the patients and the date and time of possible exposure, symptom onset, fever onset and hospitalization.

There were 181 confirmed cases with exposure to onset of symptoms is identified and a window to estimate the incubation period COVID-19. The incubation period is estimated median of 5.1 days (95% CI, 4.5 to 5.8 days), and 97.5% of those who develop symptoms will do so in 11.5 days (CI, 8.2 to 15.6 day) infection. These estimates imply that, under conservative assumptions, 101 out of every 10 000 cases (99 percentile, 482) will develop symptoms after 14 days of monitoring or active quarantine.

Public cases reported may overrepresent severe cases, the incubation period which may vary from the mild cases.

This work provides additional evidence for the average incubation period for COVID-19 about 5 days, similar to SARS. Our results support the current proposal is for a long quarantine or active monitoring of people potentially exposed to SARS-CoV-2, although the monitoring period longer justified in extreme cases.

U.S. Center for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases, National Institute of General Medical Sciences, and the Alexander von Humboldt Foundation.

SARS-CoV-2 exposures (blue), symptom onset (ed.), And detection of cases (green) times for 181 cases confirmed

area Shaded representing intervals of time possible full exposure, symptom onset and case detection; points represent the midpoint of this interval. SARS-CoV-2 = acute respiratory syndrome coronavirus 2.

Table 1. Characteristics of Patients With Confirmed COVID-19 included in this analysis (n = 181) *

The cumulative distribution function of COVID-19 estimate the incubation period of the log-normal models.

The estimated median incubation period of COVID-19 was 5.1 days (CI, 4.5 to 5.8 days). We estimate that less than 2.5% of those infected will display symptoms within 2.2 days (CI, 1.8 to 2.9 days) of exposure, whereas the onset of symptoms will occur in 11.5 days (CI, 8, 2 to 15.6 days) to 97.5% of the people infected. Horizontal bars represent 95% CI of the 2.5th, 50, and 97.5 percentiles of the distribution of the incubation period. 1:52 dispersion parameter estimates (CI, 1.32 to 1.72). COVID-19 = coronavirus disease, 2019.

Appendix Table 1. Percentile of SARS-CoV-2 incubation period From Selected Sensitivity Analysis *

Appendix Table 2. Parameter Estimates for Various Parametric Distribution Incubation period of SARS-CoV-2 uses 181 Cases Confirmed *

the proportion of known symptoms of SARS-CoV-2 infection who have not yet developed symptoms, the number of days since infection, using estimates bootstrapped from a accelerated failure time Model log-normal.

Table 2. expected amount of symptoms of SARS-CoV-2 infection would not be detected during Active Monitoring, Monitoring Given Length Variation and Risk for Symptomatic Infection After Exposure *

SARS-CoV- 2 exposures (blue), symptom onset (red), and detection of cases (green) times to 181 confirmed cases.

Shaded areas represent time intervals may be full to the exposure, the onset of symptoms, and case detection; points represent the midpoint of this interval. SARS-CoV-2 = acute respiratory syndrome coronavirus 2.

The cumulative distribution function of the 19th COVID estimated incubation period of the log-normal models.

estimated median incubation period of COVID-19 was 5.1 days (CI, 4.5 to 5.8 days). We estimate that less than 2.5% of those infected will display symptoms within 2.2 days (CI, 1.8 to 2.9 days) of exposure, whereas the onset of symptoms will occur in 11.5 days (CI, 8, 2 to 15.6 days) to 97.5% of the people infected. Horizontal bars represent 95% CI of the 2.5th, 50, and 97.5 percentiles of the distribution of the incubation period. 1:52 dispersion parameter estimates (CI, 1.32 to 1.72), COVID-19 = disease coronavirus 2019.

The proportion of known symptoms of SARS-CoV-2 infection who have not yet developed symptoms, the number of days since infection, using lighted estimates of accelerated failure time log-normal model.

Table 1. Characteristics of Patients With Confirmed COVID-19 included in this analysis (n = 181) *

Appendix Table 1. Percentile of SARS-CoV-2 incubation period of Selected Analysis sensitivity *

Appendix Table 2. parameter estimates for Various Parametric Distribution Incubation Period of SARS-CoV-2 Using 181 Cases Confirmed *

Table 2. expected amount of the symptoms of SARS-CoV-2 infections that will not be detected during Active Monitoring, Monitoring Given Length Variation and Risk for infection After Exposure symptoms *

Richard M Fleming, PhD, MD, JD; Matthew R Fleming, BS, NRP; Tapan K Chaudhuri, MD

FHHI-OI-Camelot; FHHI-OI-Camelot; Eastern Virginia Medical School

March 10, 2020

Conflict of interest:

No COI to declare.

The biggest thing we have to fear from CoVid-19.

The coronavirus behave exactly like a virus. By that we mean it is transmitted in a certain way: sticking to certain tissues in the body and its purpose is not to kill its host but to survive in host.If we know nothing else, that should be enough to calm our fears and improve cooperation between us all: that should be enough to stop the run in the store product and stop price gouging tissue, hand cleaner and other items; and while quietly promoting the recovery of stock markets, the world economy and our country. Why? Because this is not some unknown enemy attacked us that we do not know how to handle. The virus is spread by people sneezing or coughing on you. Masks are for people who are coughing and sneezing for them to wear to reduce the virus coughs or sneezes them to you-not for you to wear when you are not coughing or sneezing. This behavior of everyone wearing masks do not stop the spread; may actually increase the potential for warm humid regions for the virus to survive and promote unnecessary fear. (1) A primary method of spreading the virus, including touching your face with your hands and then spread the virus to others touching, and further increases the likelihood of infecting yourself with more of the virus. As Ignaz Semmelweis showed more than 150 years ago, wash your hands (hand soap) dramatically reduce transmission of pathogens from person to person. (2) The virus attaches itself to the lungs and GI track, where IgA is primarily responsible for handling the immunological response. This means that we know what to look for and what to treat, allowing those most ill be best taken care of. This is why we see elderly people and immune compromised people with heart problems and lung most vulnerable. (3) The virus does not try to kill their host. If they are successful it is, it will prevent them from reproducing themselves and surviving.CoVid-19 also presents us with an opportunity to study and potentially develop new treatments for disorders of IgA, CAD, and cancer. This is not an unknown assailant who we need to be afraid. It is a virus with all the limitations of virus-not a zombie apocalypse.

R Matthew Chico MPH PhD, Nguyen Tien Huy MD PhD

London School of Hygiene and Tropical Medicine, Nagasaki University School of Tropical Medicine and Global Health

March 17, 2020

Conflict of interest:

no one

COVID-19 symptoms and viral shedding: Implications for testing and self-isolation

In 10 weeks time, COVID-19 has spread from Hubei Province in Central China for 110 countries, prompting the World Health Organization to declare a global pandemic outbreak in the recognition that the new coronavirus threatens to affect all sectors of each country in which world.Lauer and associates contributed important for understanding our new born COVID 19 in the Annals of their publications recently about the incubation infectio symptomsns. The average period was 5.1 days (95% CI, 4.5 to 5.8 days), an estimate based on an analysis of 181 confirmed cases include 24 countries and regions outside China mainland, and 25 provinces in mainland China (1 ). Thus, under the best of circumstances, the average person would seek a diagnosis within five days of exposure, the results are available two days later.Wölfel and colleagues have added equally valuable piece with COVID 19 puzzles in a report non- peer-review (2). Nine patients in Germany, for whom the time of exposure to the index case of SARS-CoV-2 are known, the biological sample is provided for virological testing. viral load in the upper respiratory tract were detected among the first samples were collected 48 hours of onset of symptoms and peak before day five. virus concentration 1000 times higher than that observed in Hong Kong during the 2004 outbreak of SARS, the coronavirus related (3). Compared with SARS, virus concentrations COVID-19 have made contact tracing difficult, especially in Western countries with a huge population of the circumference. Regardless, it remains important diagnostic test to predict COVID-19 case-fatality rate, identify and respond to emerging hotspots, and adjust medical care at the individual level. In this context there is now a clear reason to prioritize self-isolation of the elderly and immunocompromised for a period, and promoting social distance behavior to others. Whether or not a lower risk population groups exposed to the infection of SARS-CoV-2 will end up developing associated IgG, IgM, IgA antibody and reduce the risk of exposure to groups most at risk of death, individuals who obtain immunological defenses will be better able to provide social support to the masses in self-isolation. It is one of the most justifiable now as we wait for our time to deployable COVID-19 vaccine 12 to 18 months from now. References1. Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The incubation period Coronavirus Disease 2019 (COVID-19) From the public Confirmed Cases Reported: Estimation and Applications. Annals of Internal Medicine. 2020.2. Woelfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Mueller MA, et al. Clinical presentation and virological assessment of cases hospitalized in 2019 in the cluster coronavirus disease transmission related trip. medRxiv. 2020: 2020.03.05.20030502.3. Poon LL, Chan KH, Wong OK, TK Cheung, Ng me, Zheng B, et al. Detection of SARS coronavirus in patients with severe acute respiratory syndrome by conventional and real-time test quantitative reverse transcription-PCR. clinical chemistry. 2004; 50 (1): 67-72.

Lauer SA, Grantz KH, Bi Q, et al. The incubation period Coronavirus Disease 2019 (COVID-19) From the public Confirmed Cases Reported: Estimation and Applications. Ann Intern Med. 2020;:. [Epub ahead of print March 10, 2020]. doi:

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© 2020

Published: Ann Intern Med. 2020.

DOI: 10.7326 / M20-0504

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Copyright © 2020 American College of Physicians. , All Rights Reserved

Print ISSN: 0003-4819 | Online ISSN: 1539-3704

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