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      Airport risk of importation and exportation of the COVID-19 pandemic

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          Abstract

          On March 11, 2020, the Director-General of the World Health Organization (WHO) characterized the spread of the coronavirus disease, COVID-19, as a pandemic on the basis of “alarming levels of spread and severity, and by the alarming levels of inaction.” Hence, it is urgent and imperative to evaluate the risk of COVID-19 for as many global locations as possible. This study calculates the relative risk of the importation and exportation of the COVID-19 virus. The study's most important contribution is the calculation of the overall relative risk of the importation and exportation of COVID-19 from every airport in local municipalities around the world, based on global spatial and mapping information. Three scenarios of air travel restriction are considered, and the change in the risk of importation and exportation of COVID-19 is calculated. The relative risk of importation and exportation of COVID-19 clearly shows that not only China, Europe, Middle East, and East Asia, but also the U.S., Australia, and countries in northeast Asia and Latin America are subject to risk. Further, a larger reduction in air travel through airports in a large part of the cumulative incidence area would lead to a gradual decrease in the risk flow. Importantly, the exportation risk of the disease from some airports in China, Iran, and European countries has a higher global spread than the importation risk during the pandemic stage. Therefore, every airport, or government with airports in their jurisdiction, should implement strict countermeasures. It is also indispensable for these countries to undertake countermeasures for COVID-19, such as home quarantine within each country and restricting infected or suspected individuals from flying on airplanes.

          Highlights

          • •

            COVID-19 risk flow of importation and exportation exists despite strict measures.

          • •

            Exportation risk from China, Iran, and European countries has high global spread.

          • •

            Exportation risk has higher global spread than importation risk during the pandemic.

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            Over 90% reduction in air travel is necessary in high cumulative incidence areas.

          • •

            To prevent multiple pandemic waves, it is indispensable to track such risk flow.

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          Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study

          Joseph Wu, Kathy Leung, Gabriel Leung (2020)
          Summary Background Since Dec 31, 2019, the Chinese city of Wuhan has reported an outbreak of atypical pneumonia caused by the 2019 novel coronavirus (2019-nCoV). Cases have been exported to other Chinese cities, as well as internationally, threatening to trigger a global outbreak. Here, we provide an estimate of the size of the epidemic in Wuhan on the basis of the number of cases exported from Wuhan to cities outside mainland China and forecast the extent of the domestic and global public health risks of epidemics, accounting for social and non-pharmaceutical prevention interventions. Methods We used data from Dec 31, 2019, to Jan 28, 2020, on the number of cases exported from Wuhan internationally (known days of symptom onset from Dec 25, 2019, to Jan 19, 2020) to infer the number of infections in Wuhan from Dec 1, 2019, to Jan 25, 2020. Cases exported domestically were then estimated. We forecasted the national and global spread of 2019-nCoV, accounting for the effect of the metropolitan-wide quarantine of Wuhan and surrounding cities, which began Jan 23–24, 2020. We used data on monthly flight bookings from the Official Aviation Guide and data on human mobility across more than 300 prefecture-level cities in mainland China from the Tencent database. Data on confirmed cases were obtained from the reports published by the Chinese Center for Disease Control and Prevention. Serial interval estimates were based on previous studies of severe acute respiratory syndrome coronavirus (SARS-CoV). A susceptible-exposed-infectious-recovered metapopulation model was used to simulate the epidemics across all major cities in China. The basic reproductive number was estimated using Markov Chain Monte Carlo methods and presented using the resulting posterior mean and 95% credibile interval (CrI). Findings In our baseline scenario, we estimated that the basic reproductive number for 2019-nCoV was 2·68 (95% CrI 2·47–2·86) and that 75 815 individuals (95% CrI 37 304–130 330) have been infected in Wuhan as of Jan 25, 2020. The epidemic doubling time was 6·4 days (95% CrI 5·8–7·1). We estimated that in the baseline scenario, Chongqing, Beijing, Shanghai, Guangzhou, and Shenzhen had imported 461 (95% CrI 227–805), 113 (57–193), 98 (49–168), 111 (56–191), and 80 (40–139) infections from Wuhan, respectively. If the transmissibility of 2019-nCoV were similar everywhere domestically and over time, we inferred that epidemics are already growing exponentially in multiple major cities of China with a lag time behind the Wuhan outbreak of about 1–2 weeks. Interpretation Given that 2019-nCoV is no longer contained within Wuhan, other major Chinese cities are probably sustaining localised outbreaks. Large cities overseas with close transport links to China could also become outbreak epicentres, unless substantial public health interventions at both the population and personal levels are implemented immediately. Independent self-sustaining outbreaks in major cities globally could become inevitable because of substantial exportation of presymptomatic cases and in the absence of large-scale public health interventions. Preparedness plans and mitigation interventions should be readied for quick deployment globally. Funding Health and Medical Research Fund (Hong Kong, China).
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            The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak

            Matteo Chinazzi, Jessica Davis, Marco Ajelli … (2020)
            Motivated by the rapid spread of COVID-19 in Mainland China, we use a global metapopulation disease transmission model to project the impact of travel limitations on the national and international spread of the epidemic. The model is calibrated based on internationally reported cases, and shows that at the start of the travel ban from Wuhan on 23 January 2020, most Chinese cities had already received many infected travelers. The travel quarantine of Wuhan delayed the overall epidemic progression by only 3 to 5 days in Mainland China, but has a more marked effect at the international scale, where case importations were reduced by nearly 80% until mid February. Modeling results also indicate that sustained 90% travel restrictions to and from Mainland China only modestly affect the epidemic trajectory unless combined with a 50% or higher reduction of transmission in the community.
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              Preparedness and vulnerability of African countries against importations of COVID-19: a modelling study

              Marius Gilbert, Giulia Pullano, Francesco Pinotti … (2020)
              Summary Background The novel coronavirus disease 2019 (COVID-19) epidemic has spread from China to 25 countries. Local cycles of transmission have already occurred in 12 countries after case importation. In Africa, Egypt has so far confirmed one case. The management and control of COVID-19 importations heavily rely on a country's health capacity. Here we evaluate the preparedness and vulnerability of African countries against their risk of importation of COVID-19. Methods We used data on the volume of air travel departing from airports in the infected provinces in China and directed to Africa to estimate the risk of importation per country. We determined the country's capacity to detect and respond to cases with two indicators: preparedness, using the WHO International Health Regulations Monitoring and Evaluation Framework; and vulnerability, using the Infectious Disease Vulnerability Index. Countries were clustered according to the Chinese regions contributing most to their risk. Findings Countries with the highest importation risk (ie, Egypt, Algeria, and South Africa) have moderate to high capacity to respond to outbreaks. Countries at moderate risk (ie, Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana, and Kenya) have variable capacity and high vulnerability. We identified three clusters of countries that share the same exposure to the risk originating from the provinces of Guangdong, Fujian, and the city of Beijing, respectively. Interpretation Many countries in Africa are stepping up their preparedness to detect and cope with COVID-19 importations. Resources, intensified surveillance, and capacity building should be urgently prioritised in countries with moderate risk that might be ill-prepared to detect imported cases and to limit onward transmission. Funding EU Framework Programme for Research and Innovation Horizon 2020, Agence Nationale de la Recherche.
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                Author and article information

                Contributors
                Hiroki Nakamura
                Shunsuke Managi
                Journal
                Journal ID (nlm-ta): Transp Policy (Oxf)
                Journal ID (iso-abbrev): Transp Policy (Oxf)
                Title: Transport Policy
                Publisher: Elsevier Ltd.
                ISSN (Print): 0967-070X
                ISSN (Electronic): 1879-310X
                Publication date PMC-release: 1 July 2020
                Publication date (Print): September 2020
                Publication date (Electronic): 1 July 2020
                Volume: 96
                Pages: 40-47
                Affiliations
                [a ]Institute of Social Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
                [b ]Urban Institute & Department of Civil Engineering, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, 819-0395, Japan
                Author notes
                [∗ ]Corresponding author. hnakamu@ 123456iss.u-tokyo.ac.jp
                Article
                Publisher ID: S0967-070X(20)30351-6
                DOI: 10.1016/j.tranpol.2020.06.018
                PMC ID: 7328638
                PubMed ID: 32834679
                SO-VID: 515fff06-b127-48f0-b71e-44e4b9619ff1
                Copyright © © 2020 Elsevier Ltd. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 18 April 2020
                Date revision received : 19 June 2020
                Date accepted : 29 June 2020
                Categories
                Subject: Article

                Keywords: covid-19,exportation risk,importation risk,pandemic countermeasures
                Data availability:
                Keywords: covid-19, exportation risk, importation risk, pandemic countermeasures

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