Der Ausbruch von COVID-19 in China

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Abstract

Die Übertragungsdynamik des „severe acute respiratory syndrome coronavirus 2“ (SARS-CoV-2) in Wuhan und der Provinz Hubei unterscheidet sich erheblich von der im restlichen China. Initial stiegen die Infektionszahlen in der Provinz Hubei rasant an. Weitreichende Reise- und Ausgangssperren sowie intensive Kontaktnachverfolgung und Isolierung führten zu einer Eindämmung des Ausbruchs. In der Folge reduzierte sich die Übertragung von SARS-CoV‑2 erheblich. Trotz dieser Maßnahmen kam es auch zum Auftreten von Fällen im restlichen China. Hier wurde durch konsequente Identifikation sowie Isolierung von Infizierten und Kontaktpersonen („containment“) ein größerer Ausbruch erfolgreich verhindert.

Translated abstract

The transmission dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan and Hubei Province differ considerably from those in the rest of China. In Hubei province SARS-CoV‑2 led to a dramatic outbreak. Intensive control measures (travel restrictions, isolation of cases, quarantine of contacts and others) led to the control of the outbreak. Despite travel restrictions SARS-CoV‑2 was detected in other provinces in the following weeks. Consistent and intensive identification and isolation of infected persons (“containment”) was able to prevent an outbreak outside Hubei province, providing an example for the control of SARS-CoV‑2.

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Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Chaolin Huang, Yeming Wang, Xingwang Li … (2020)

Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.

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

Qun Li, Xuhua Guan, Peng Wu … (2020)

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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Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2)

Ruiyun Li, Sen Pei, Bin Chen … (2020)

Estimation of the prevalence and contagiousness of undocumented novel coronavirus (SARS-CoV2) infections is critical for understanding the overall prevalence and pandemic potential of this disease. Here we use observations of reported infection within China, in conjunction with mobility data, a networked dynamic metapopulation model and Bayesian inference, to infer critical epidemiological characteristics associated with SARS-CoV2, including the fraction of undocumented infections and their contagiousness. We estimate 86% of all infections were undocumented (95% CI: [82%–90%]) prior to 23 January 2020 travel restrictions. Per person, the transmission rate of undocumented infections was 55% of documented infections ([46%–62%]), yet, due to their greater numbers, undocumented infections were the infection source for 79% of documented cases. These findings explain the rapid geographic spread of SARS-CoV2 and indicate containment of this virus will be particularly challenging.

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Author and article information

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B. Salzberger: bernd.salzberger@ukr.de

Journal

Journal ID (nlm-ta): Internist (Berl)

Journal ID (iso-abbrev): Internist (Berl)

Title: Der Internist

Publisher: Springer Medizin (Heidelberg )

ISSN (Print): 0020-9554

ISSN (Electronic): 1432-1289

Publication date (Electronic): 16 June 2020

Pages: 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 ]Klinik und Poliklinik für Rheumatologie und Klinische Immunologie, Fachklinikum Bad Abbach, Bad Abbach, Deutschland

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[Redaktion]

B. Salzberger, Regensburg

T. Welte, Hannover

Article

Publisher ID: 833

DOI: 10.1007/s00108-020-00833-w

PMC ID: 7296908

PubMed ID: 32548651

SO-VID: cbeede6e-cf10-4fd5-9cb7-b4e142d10ba9

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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.

Der Ausbruch von COVID-19 in China Translated title: The outbreak of COVID-19 in China

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Novel Coronavirus Disease COVID-19

Most cited references 12

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

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

Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2)

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