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Our estimates support the implementation of a wide array of social distancing measures to rapidly contain the outbreak in Korea

Transmission potential of COVID-19 in South Korea

medrxiv, (2020)

被引用6|浏览163
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摘要

Since the first identified individual of 2019 novel coronavirus (COVID-19) infection on Jan 20, 2020 in South Korea, the number of confirmed cases rapidly increased. As of Feb 26, 2020, 1,261 cases of COVID-19 including 12 deaths were confirmed in South Korea. Using the incidence data of COVID-19, we estimate the reproduction number at 1....更多

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简介
  • A novel coronavirus (SARS-CoV-2) that emerged out of the city of Wuhan, China in December 2019 has already demonstrated its potential to generate explosive outbreaks in confined settings and cross borders following human mobility patterns [1].
  • While COVID-19 frequently induces mild symptoms common to other respiratory infections, it has exhibited an ability to generate severe disease among certain groups including older populations and individuals with underlying health issues such as cardiovascular disease and diabetes [2].
  • A clear picture of the epidemiology of this novel coronavirus is still being elucidated
重点内容
  • In this report, using a mathematical model parameterized with cases series of the COVID-19 outbreak in Korea, we investigate the transmission potential of COVID-19 in Korea using data of local and imported cases up until February 26, 2020
  • Reconstructed incidence of COVID-19 The reconstructed daily incidence curve of COVID-19 after the imputing the onset dates for the Korean cases is shown in Figure 1
  • Transmission clusters Spatial distribution of the Korean clusters is shown in Figure 3 and the characteristics of each cluster are presented in Table 1
  • No further cases have been added in this cluster since February 21, 2020. This is the first study to report estimates of the transmission potential of COVID-19 in Korea based on the trajectory of the epidemic, which was reconstructed by using the dates of onset of the first reported cases in Korea
  • Effective reproduction number ( ) from daily case incidence Under the empirical reporting delay distribution from Korean cases with available dates of onset, the intrinsic growth rate (r) was estimated at 0.6 (95% CI: 0.5, 0.7) and the scaling of growth parameter (p) was estimated at 0.76 (95% CI: 0.73, 0.79), indicating sub-exponential growth dynamics of COVID-19 in Korea (Figure 2, Table 1)
  • Our estimates support the implementation of a wide array of social distancing measures to rapidly contain the outbreak in Korea
方法
  • Data The authors obtained the daily series of confirmed cases of COVID-19 in South Korea from January 20, 2020 to February, 26, 2020 that are publicly available from the Korea Centers for Disease Control and Prevention (KCDC) [4].
  • All of the dates of symptoms onset are available for the imported cases
  • The authors utilize this empirical distribution of reporting delays from the onset to diagnosis to impute the missing dates of onset for the remainder of the cases with missing data.
  • The authors reconstruct 300 epidemic curves by dates of symptoms onset from which the authors derived a mean incidence curve of local case incidence and drop the last three data points from the analysis to adjust for reporting delays in the real-time analysis [11]
结果
  • Reconstructed incidence of COVID-19 The reconstructed daily incidence curve of COVID-19 after the imputing the onset dates for the Korean cases is shown in Figure 1.
  • Effective reproduction number ( ) from daily case incidence Under the empirical reporting delay distribution from Korean cases with available dates of onset, the intrinsic growth rate (r) was estimated at 0.6 (95% CI: 0.5, 0.7) and the scaling of growth parameter (p).
  • This largest cluster is associated with Shincheonji Church of Jesus, with the first case confirmed on Feb. 18
  • It is unclear how this case contracted the illness, as she does not present a recent history of travel or contact with another infected patient.
  • The Shincheonji church of Jesus has temporarily closed its facilities and halted the church activities as of February 18, 2020
结论
  • This is the first study to report estimates of the transmission potential of COVID-19 in Korea based on the trajectory of the epidemic, which was reconstructed by using the dates of onset of the first reported cases in Korea.
  • The imported cases contribute little to the secondary disease transmission in Korea, as majority of these cases occurred in the early phase of the epidemic, with the most recent imported case reported on February 9, 2020
  • These findings support the range of social distancing interventions that the Korean government put in place in order to bring the outbreak under control as soon as possible.
表格
  • Table1: Mean estimates and the corresponding 95% confidence intervals for the effective reproduction number, growth rate and the scaling of growth parameter during the early growth phase as of February 26, 2020
Download tables as Excel
基金
  • Keywords: coronavirus, COVID-19, Korea, reproduction number Conflict of interest: None Funding statement: For ES and WC, this work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No 2018R1C1B6001723)
研究对象与分析
cases: 1261
Since the first identified individual of 2019 novel coronavirus (COVID-19) infection on Jan 20, 2020 in South Korea, the number of confirmed cases rapidly increased. As of Feb 26, 2020, 1,261 cases of COVID-19 including 12 deaths were confirmed in South Korea. Using the incidence data of COVID-19, we estimate the reproduction number at 1.5 (95% CI: 1.4-1.6), which indicates sustained transmission and support the implementation of social distancing measures to rapidly control the outbreak

reported cases: 28
Data We obtained the daily series of confirmed cases of COVID-19 in South Korea from January 20, 2020 to February, 26, 2020 that are publicly available from the Korea Centers for Disease Control and Prevention (KCDC) [4]. Our data includes the dates of reporting for all confirmed cases, the dates of symptom onsets for the first 28 reported cases, and whether the case is autochthonous (local transmission) or imported. We also summarize the case clusters comprising one or more cases according to the source of infection according to the field investigations conducted by the KCDC [4]

reported cases: 28
Accordingly, four major clusters were identified.

Imputing the date of onset To estimate the growth rate of the epidemic, it is ideal to characterize the epidemic curve according to dates of symptoms onset rather than according to dates of reporting. For the COVID-19 data in Korea, the symptom onset dates are available for only the first 28 reported cases. Moreover, all of the dates of symptoms onset are available for the imported cases

reported cases: 28
For this purpose, we reconstruct 300 epidemic curves by dates of symptoms onset from which we derived a mean incidence curve of local case incidence and drop the last three data points from the analysis to adjust for reporting delays in our real-time analysis [11].Data We obtained the daily series of confirmed cases of COVID-19 in South Korea from January 20, 2020 to February, 26, 2020 that are publicly available from the Korea Centers for Disease Control and Prevention (KCDC) [4]. Our data includes the dates of reporting for all confirmed cases, the dates of symptom onsets for the first 28 reported cases, and whether the case is autochthonous (local transmission) or imported. We also summarize the case clusters comprising one or more cases according to the source of infection according to the field investigations conducted by the KCDC [4]

reported cases: 28
Imputing the date of onset To estimate the growth rate of the epidemic, it is ideal to characterize the epidemic curve according to dates of symptoms onset rather than according to dates of reporting. For the COVID-19 data in Korea, the symptom onset dates are available for only the first 28 reported cases. Moreover, all of the dates of symptoms onset are available for the imported cases

people: 2500000
However, the number of confirmed cases of SARS-CoV2 infection started to increase rapidly on February 19, 2020 with a total of 1,261 confirmed COVID-19 cases including twelve deaths reported as of February 26, 2020 according to the Korea Centers for Disease Control and Prevention (KCDC) [4]. The epicenter of the South Korean COVID-19 outbreak has been identified in Daegu, a city of 2.5 million people, approximately 150 miles South East of Seoul. The rapid spread of COVID-19 in South Korea has been attributed one case linked to a superspreading event that has led to at least 40 secondary cases stemming from church services in the city of Daegu [5, 6]

secondary cases: 40
The epicenter of the South Korean COVID-19 outbreak has been identified in Daegu, a city of 2.5 million people, approximately 150 miles South East of Seoul. The rapid spread of COVID-19 in South Korea has been attributed one case linked to a superspreading event that has led to at least 40 secondary cases stemming from church services in the city of Daegu [5, 6]. This has led to sustained transmission chains of COVID-19, with about 52% of the cases associated with the church cluster in Daegu [7]

cases: 114
This has led to sustained transmission chains of COVID-19, with about 52% of the cases associated with the church cluster in Daegu [7]. Moreover, three other clusters have been reported including one set in Chundo Daenam hospital in Chungdo-gun, Gyeongsanggbuk-do (114 cases), one Pilgrimage to Israel cluster in Gyeongsanggbuk-do (31 cases) and a cluster A composed of one imported and 11 local cases in Seoul. These few clusters have become the major driving force of the infection

cases: 33
These few clusters have become the major driving force of the infection. A total of 33 cases were imported while the three major clusters are composed of local cases as described in Supplementary Table S1. Transmission of SARS-CoV-2 in Korea has been exacerbated by amplified transmission in confined settings including a hospital and a church in the city of Daegu

individuals: 114
Transmission of SARS-CoV-2 in Korea has been exacerbated by amplified transmission in confined settings including a hospital and a church in the city of Daegu. The hospital-based outbreak alone involves 114 individuals including 9 hospital staff [8], which is reminiscent of past outbreaks of SARS. and MERS [9]

reported cases: 28
Data We obtained the daily series of confirmed cases of COVID-19 in South Korea from January 20, 2020 to February, 26, 2020 that are publicly available from the Korea Centers for Disease Control and Prevention (KCDC) [4]. Our data includes the dates of reporting for all confirmed cases, the dates of symptom onsets for the first 28 reported cases, and whether the case is autochthonous (local transmission) or imported. We also summarize the case clusters comprising one or more cases according to the source of infection according to the field investigations conducted by the KCDC [4]

new cases: 2
Results Reconstructed incidence of COVID-19 The reconstructed daily incidence curve of COVID-19 after the imputing the onset dates for the Korean cases is shown in Figure 1. Between January 20 and February 18, 2020 an average of 2 new cases were reported each day, whereas between February 19- 26, 2020, 153 new cases were reported each day on average. Effective reproduction number ( ) from daily case incidence Under the empirical reporting delay distribution from Korean cases with available dates of onset, the intrinsic growth rate (r) was estimated at 0.6 (95% CI: 0.5, 0.7) and the scaling of growth parameter (p) was estimated at 0.76 (95% CI: 0.73, 0.79), indicating sub-exponential growth dynamics of COVID-19 in Korea (Figure 2, Table 1)

confirmed cases: 1261
Transmission clusters Spatial distribution of the Korean clusters is shown in Figure 3 and the characteristics of each cluster are presented in Table 1. Shincheonji Church of Jesus cluster As of February 26, 2020, 597 (or 47%) of the country's 1261 confirmed cases of COVID-19 are linked to this cluster, according to the KCDC [4]. This largest cluster is associated with Shincheonji Church of Jesus, with the first case (the 31st patient in the country) confirmed on Feb. 18

people: 166
However, this case attended Shincheonji Church of Jesus in Daegu four times before and after becoming a symptomatic case of COVID-19, and visited the hospital in Cheongdo after a car accident. According to the KCDC, the patient had contact with 166 people mostly at Shincheonji Church and the hospital in Cheongdo, who now placed themselves into self-quarantine. The Shincheonji church of Jesus has temporarily closed its facilities and halted the church activities as of February 18, 2020

infected cases: 31
The Shincheonji church of Jesus has temporarily closed its facilities and halted the church activities as of February 18, 2020. Pilgrimage tour to Israel related A total of 31 infected cases belonging to a group of 39 Catholic pilgrims who visited Israel between February 8, 2020 and February 16, 2020 were confirmed for COVID-19 [22]. Amongst these, 11 individuals were diagnosed on February 17, 2020, while 20 others were confirmed positive between February 21-25, 2020 and quarantined immediately

individuals: 11
Pilgrimage tour to Israel related A total of 31 infected cases belonging to a group of 39 Catholic pilgrims who visited Israel between February 8, 2020 and February 16, 2020 were confirmed for COVID-19 [22]. Amongst these, 11 individuals were diagnosed on February 17, 2020, while 20 others were confirmed positive between February 21-25, 2020 and quarantined immediately. Of the 31 infected pilgrims, 19 belong to the Euiseong County, North Gyeongsang Province, while one patient, a tour guide belongs to Seoul

cases: 29
Of the 31 infected pilgrims, 19 belong to the Euiseong County, North Gyeongsang Province, while one patient, a tour guide belongs to Seoul. Health authorities have traced 170 contacts from these 29 cases, raising concerns about the potential risk of secondary infections. Chungdo Daenam hospital cluster This cluster comprised of 114 local cases and five deaths is associated with Chungdo Daenam hospital, where South Korea's first coronavirus associated case fatality occurred

local cases: 114
Health authorities have traced 170 contacts from these 29 cases, raising concerns about the potential risk of secondary infections. Chungdo Daenam hospital cluster This cluster comprised of 114 local cases and five deaths is associated with Chungdo Daenam hospital, where South Korea's first coronavirus associated case fatality occurred. Of the 114 cases, 92 were confirmed on Feb 22, 2020 [4]

cases: 114
Chungdo Daenam hospital cluster This cluster comprised of 114 local cases and five deaths is associated with Chungdo Daenam hospital, where South Korea's first coronavirus associated case fatality occurred. Of the 114 cases, 92 were confirmed on Feb 22, 2020 [4]. A 63-year-old man who died of pneumonia at the hospital on Feb 19 was posthumously tested positive for COVID-19

local cases: 12
The exact route of the infection is not yet known. Cluster A This cluster is composed of one imported case and 12 local cases, and was identified with its first case (the 3rd patient in the country) confirmed on Jan 26, 2020. Its first case is suspected to be an imported case from Wuhan, China, transmitting SARS-CoV-2 to the 6th and 28th confirmed cases in Korea, which resulted in secondary cases

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作者
Eunha Shim
Eunha Shim
Amna Tariq
Amna Tariq
Wongyeong Choi
Wongyeong Choi
Yiseul Lee
Yiseul Lee
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