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      An investigation of transmission control measures during the first 50 days of the COVID-19 epidemic in China

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          Abstract

          Responding to an outbreak of a novel coronavirus (agent of COVID-19) in December 2019, China banned travel to and from Wuhan city on 23 January and implemented a national emergency response. We investigated the spread and control of COVID-19 using a unique data set including case reports, human movement and public health interventions. The Wuhan shutdown was associated with the delayed arrival of COVID-19 in other cities by 2.91 days (95%CI: 2.54-3.29). Cities that implemented control measures pre-emptively reported fewer cases, on average, in the first week of their outbreaks (13.0; 7.1-18.8) compared with cities that started control later (20.6; 14.5-26.8). Suspending intra-city public transport, closing entertainment venues and banning public gatherings were associated with reductions in case incidence. The national emergency response appears to have delayed the growth and limited the size of the COVID-19 epidemic in China, averting hundreds of thousands of cases by 19 February (day 50).

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          A Novel Coronavirus from Patients with Pneumonia in China, 2019

          Summary In December 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. (Funded by the National Key Research and Development Program of China and the National Major Project for Control and Prevention of Infectious Disease in China.)
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            A pneumonia outbreak associated with a new coronavirus of probable bat origin

            Since the outbreak of severe acute respiratory syndrome (SARS) 18 years ago, a large number of SARS-related coronaviruses (SARSr-CoVs) have been discovered in their natural reservoir host, bats 1–4 . Previous studies have shown that some bat SARSr-CoVs have the potential to infect humans 5–7 . Here we report the identification and characterization of a new coronavirus (2019-nCoV), which caused an epidemic of acute respiratory syndrome in humans in Wuhan, China. The epidemic, which started on 12 December 2019, had caused 2,794 laboratory-confirmed infections including 80 deaths by 26 January 2020. Full-length genome sequences were obtained from five patients at an early stage of the outbreak. The sequences are almost identical and share 79.6% sequence identity to SARS-CoV. Furthermore, we show that 2019-nCoV is 96% identical at the whole-genome level to a bat coronavirus. Pairwise protein sequence analysis of seven conserved non-structural proteins domains show that this virus belongs to the species of SARSr-CoV. In addition, 2019-nCoV virus isolated from the bronchoalveolar lavage fluid of a critically ill patient could be neutralized by sera from several patients. Notably, we confirmed that 2019-nCoV uses the same cell entry receptor—angiotensin converting enzyme II (ACE2)—as SARS-CoV.
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              Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia

              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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                Author and article information

                Journal
                Science
                Science
                SCIENCE
                Science (New York, N.y.)
                American Association for the Advancement of Science
                0036-8075
                1095-9203
                31 March 2020
                : eabb6105
                Affiliations
                [1 ]State Key Laboratory of Remote Sensing Science, College of Global Change and Earth System Science, Beijing Normal University, Beijing, China.
                [2 ]Department of Zoology, University of Oxford, Oxford, UK.
                [3 ]Mathematical Sciences, University of Southampton, Southampton, UK.
                [4 ]Department of Land, Air and Water Resources, University of California Davis, CA, USA.
                [5 ]Harvard Medical School, Harvard University, Boston, MA, USA.
                [6 ]Boston Children’s Hospital, Boston, MA, USA.
                [7 ]Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing, China.
                [8 ]Beijing Center for Disease Prevention and Control, Beijing, China.
                [9 ]State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.
                [10 ]Department of Urban Planning and Design, The University of Hong Kong, Hong Kong.
                [11 ]Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, China.
                [12 ]Center for Infectious Disease Dynamics, Department of Biology, Pennsylvania State University, University Park, Pennsylvania, USA.
                [13 ]Department of Entomology, College of Agricultural Sciences, Pennsylvania State University, University Park, Pennsylvania, USA.
                [14 ]Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
                [15 ]Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.
                Author notes
                [*]

                These authors contributed equally to this work.

                Author information
                https://orcid.org/0000-0001-7758-1032
                https://orcid.org/0000-0001-9386-725X
                https://orcid.org/0000-0003-3496-2876
                https://orcid.org/0000-0001-8838-7147
                https://orcid.org/0000-0001-9495-1226
                https://orcid.org/0000-0002-1920-5829
                https://orcid.org/0000-0002-5030-0963
                https://orcid.org/0000-0003-4686-646X
                https://orcid.org/0000-0001-9558-1220
                https://orcid.org/0000-0002-1158-3753
                https://orcid.org/0000-0002-8797-2667
                https://orcid.org/0000-0002-2957-1793
                Article
                abb6105
                10.1126/science.abb6105
                7164389
                32234804
                83ee72e0-7f5a-4570-98ee-d1ebfd22c292
                Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works

                This open access article is distributed under Creative Commons Attribution License 4.0 (CC BY).

                History
                : 06 March 2020
                : 27 March 2020
                Funding
                Funded by: doi http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81673234
                Funded by: Young Elite Scientist Sponsorship Program by CAST (YESS);
                Award ID: 2018QNRC001
                Funded by: Beijing Natural Science Foundation;
                Award ID: JQ18025
                Funded by: Beijing Advanced Innovation Program for Land Surface Science;
                Award ID: None
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