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      Epidemiologie von SARS-CoV-2-Infektion und COVID-19 Translated title: Epidemiology of SARS-CoV-2 infection and COVID-19

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          Abstract

          Das „severe acute respiratory syndrome coronavirus 2“ (SARS-CoV-2) ist ein neues β‑Coronavirus, das Ende 2019 in Wuhan, China, erstmals entdeckt wurde und sich in den folgenden Monaten weltweit verbreitete. Wir stellen hier die bisher bekannten Parameter und Daten zur Epidemiologie des Virus dar. SARS-CoV‑2 repliziert vor allem im oberen und unteren Respirationstrakt und wird überwiegend von asymptomatisch wie symptomatisch Infizierten durch Tröpfchen übertragen. Die Basisreproduktionszahl wird derzeit auf einen Wert zwischen 2 und 3 geschätzt, die Inkubationszeit beträgt im Median 6 (2–14) Tage. Die überwiegende Zahl der Infektionen verläuft unkompliziert, bei 5–10 % der Infizierten tritt eine Pneumonie auf, die zur Hospitalisierung und auch zum Organversagen führen kann. Wichtigste Risikofaktoren für einen komplizierten Verlauf sind höheres Alter, Hypertonie und chronische Herz- und Lungenerkrankungen sowie Immundefekte. Nosokomiale Übertragungen und Infektionen bei medizinischem Personal werden beobachtet. Die „case fatality rate“ über alle Altersgruppen beträgt etwa 1,4 %, sie steigt ab der sechsten Lebensdekade an. Mit der Reduktion von sozialen Kontakten sind bisher in vielen Regionen Ausbrüche begrenzt worden. Welche Maßnahmen im Einzelnen wirksam sind, ist noch offen.

          Translated abstract

          Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new β‑Coronavirus that was first detected in 2019 in Wuhan, China. In the ensuing months it has been transmitted worldwide. Here the authors present the current knowledge on the epidemiology of this virus. SARS-CoV‑2 replicates mainly in the upper and lower respiratory tract and is primarily transmitted by droplets from asymptomatic and symptomatic infected subjects. The estimate for the basic reproduction number (R) is currently between 2 and 3, while the incubation period is 6 (median, range 2–14) days. Although most infections are uncomplicated, 5–10% of cases develop pneumonia, which can lead to hospitalization, respiratory failure and multiorgan failure. Risk factors for a complicated disease course include age, hypertension, chronic cardiovascular and pulmonary disease and immunodeficiency. The overall case fatality rate is 1.4%, with the rate rising in the sixth decade of life. Nosocomial and infections in medical personnel have been reported. Drastic reductions in social contact have been implemented in many countries with outbreaks of SARS-CoV‑2, leading to rapid reductions in R. Which of the measures have been effective is still unknown.

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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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            Virological assessment of hospitalized patients with COVID-2019

            Coronavirus disease 2019 (COVID-19) is an acute infection of the respiratory tract that emerged in late 20191,2. Initial outbreaks in China involved 13.8% of cases with severe courses, and 6.1% of cases with critical courses3. This severe presentation may result from the virus using a virus receptor that is expressed predominantly in the lung2,4; the same receptor tropism is thought to have determined the pathogenicity-but also aided in the control-of severe acute respiratory syndrome (SARS) in 20035. However, there are reports of cases of COVID-19 in which the patient shows mild upper respiratory tract symptoms, which suggests the potential for pre- or oligosymptomatic transmission6-8. There is an urgent need for information on virus replication, immunity and infectivity in specific sites of the body. Here we report a detailed virological analysis of nine cases of COVID-19 that provides proof of active virus replication in tissues of the upper respiratory tract. Pharyngeal virus shedding was very high during the first week of symptoms, with a peak at 7.11 × 108 RNA copies per throat swab on day 4. Infectious virus was readily isolated from samples derived from the throat or lung, but not from stool samples-in spite of high concentrations of virus RNA. Blood and urine samples never yielded virus. Active replication in the throat was confirmed by the presence of viral replicative RNA intermediates in the throat samples. We consistently detected sequence-distinct virus populations in throat and lung samples from one patient, proving independent replication. The shedding of viral RNA from sputum outlasted the end of symptoms. Seroconversion occurred after 7 days in 50% of patients (and by day 14 in all patients), but was not followed by a rapid decline in viral load. COVID-19 can present as a mild illness of the upper respiratory tract. The confirmation of active virus replication in the upper respiratory tract has implications for the containment of COVID-19.
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              The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application

              Background: A novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019. There is limited support for many of its key epidemiologic features, including the incubation period for clinical disease (coronavirus disease 2019 [COVID-19]), which has important implications for surveillance and control activities. Objective: To estimate the length of the incubation period of COVID-19 and describe its public health implications. Design: Pooled analysis of confirmed COVID-19 cases reported between 4 January 2020 and 24 February 2020. Setting: News reports and press releases from 50 provinces, regions, and countries outside Wuhan, Hubei province, China. Participants: Persons with confirmed SARS-CoV-2 infection outside Hubei province, China. Measurements: Patient demographic characteristics and dates and times of possible exposure, symptom onset, fever onset, and hospitalization. Results: There were 181 confirmed cases with identifiable exposure and symptom onset windows to estimate the incubation period of COVID-19. The median incubation period was estimated to be 5.1 days (95% CI, 4.5 to 5.8 days), and 97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection. These estimates imply that, under conservative assumptions, 101 out of every 10 000 cases (99th percentile, 482) will develop symptoms after 14 days of active monitoring or quarantine. Limitation: Publicly reported cases may overrepresent severe cases, the incubation period for which may differ from that of mild cases. Conclusion: This work provides additional evidence for a median incubation period for COVID-19 of approximately 5 days, similar to SARS. Our results support current proposals for the length of quarantine or active monitoring of persons potentially exposed to SARS-CoV-2, although longer monitoring periods might be justified in extreme cases. Primary Funding Source: U.S. Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases, National Institute of General Medical Sciences, and Alexander von Humboldt Foundation.
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                Author and article information

                Contributors
                bernd.salzberger@ukr.de
                Journal
                Internist (Berl)
                Internist (Berl)
                Der Internist
                Springer Medizin (Heidelberg )
                0020-9554
                1432-1289
                16 June 2020
                : 1-5
                Affiliations
                [1 ]GRID grid.411941.8, ISNI 0000 0000 9194 7179, Abt. Krankenhaushygiene und Infektiologie, , Universitätsklinikum Regensburg, ; Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Deutschland
                [2 ]Sachgebiet Infektionsschutz und Hygiene, Gesundheitsamt Regensburg, Regensburg, Deutschland
                [3 ]Klinik und Poliklinik für Rheumatologie und Klinische Immunologie, Fachklinikum Bad Abbach, Bad Abbach, Deutschland
                Author notes
                [Redaktion]

                B. Salzberger, Regensburg

                T. Welte, Hannover

                Article
                834
                10.1007/s00108-020-00834-9
                7296906
                32548652
                8d50cc66-9413-4185-a5f3-24bf8a997078
                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2020

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

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                Schwerpunkt: COVID-19

                „severe acute respiratory syndrome coronavirus 2“ (sars-cov-2),„coronavirus disease 2019“ (covid-19)/epidemiologie,basisreproduktionszahl,inkubationsphase,letalität,severe acute respiratory syndrome coronavirus 2 (sars-cov-2),“coronavirus disease 2019” (covid-19)/epidemiology,basic reproduction number,incubation period,mortality rate

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