First-wave COVID-19 transmissibility and severity in China outside Hubei after control measures, and second-wave scenario planning: a modelling impact assessment
First-wave COVID-19 transmissibility and severity in China outside Hubei after control measures, and second-wave scenario planning: a modelling impact assessment
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DOI：
10.1016/s0140-6736(20)30746-7
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发表时间：
2020-04-25
期刊：
影响因子：
168.9
通讯作者：
Leung, Gabriel M.
中科院分区：
文献类型：
--
作者：
Leung, Kathy;Wu, Joseph T.;Leung, Gabriel M.
背景截至2020年3月18日，中国大陆已报告13415例与2019冠状病毒病（COVID-19）相关的确诊病例和120例死亡病例，湖北省除外-爆发的震中。自1月下旬以来，在全国范围内实施了大规模的公共卫生干预措施，以控制疫情。方法我们估计了北京、上海、深圳、温州和中国确诊病例最多的10个省份的COVID-19瞬时繁殖数（R-t）;以及北京、上海、深圳和温州以及中国所有31个省份的确诊病死率风险（cCFR）。我们使用了一个易感染的恢复模型，以显示在第一波感染后放松遏制措施的潜在影响，在预期可能的第二波。结果在所有选定的城市和省份，R-t大幅下降，因为1月23日，当控制措施实施，并一直保持在1以下。湖北以外地区的cCFR为0.98%（95%CI 0.82-1.16），比湖北地区（5.91%，5.73-6.09）低近5倍。在疫情规模仍然较小的情况下放松干预措施（导致R-t>1），将使累计病例数随放松时间呈指数级增加，即使积极的干预措施随后可能将疾病患病率推回到基线水平。解读由于积极的非药物干预措施，湖北以外的第一波COVID-19疫情已经减弱。然而，考虑到病毒重新引入的巨大风险，特别是来自海外输入的风险，需要密切监测R-t和cCFR，以告知针对潜在第二波的策略，从而在健康和经济保护之间实现最佳平衡。
Background As of March 18, 2020, 13 415 confirmed cases and 120 deaths related to coronavirus disease 2019 (COVID-19) in mainland China, outside Hubei province-the epicentre of the outbreak-had been reported. Since late January, massive public health interventions have been implemented nationwide to contain the outbreak. We provide an impact assessment of the transmissibility and severity of COVID-19 during the first wave in mainland Chinese locations outside Hubei.Methods We estimated the instantaneous reproduction number (R-t) of COVID-19 in Beijing, Shanghai, Shenzhen, Wenzhou, and the ten Chinese provinces that had the highest number of confirmed COVID-19 cases; and the confirmed case-fatality risk (cCFR) in Beijing, Shanghai, Shenzhen, and Wenzhou, and all 31 Chinese provinces. We used a susceptible-infectious-recovered model to show the potential effects of relaxing containment measures after the first wave of infection, in anticipation of a possible second wave.Findings In all selected cities and provinces, the R-t decreased substantially since Jan 23, when control measures were implemented, and have since remained below 1. The cCFR outside Hubei was 0.98% (95% CI 0.82-1.16), which was almost five times lower than that in Hubei (5.91%, 5.73-6.09). Relaxing the interventions (resulting in R-t>1) when the epidemic size was still small would increase the cumulative case count exponentially as a function of relaxation duration, even if aggressive interventions could subsequently push disease prevalence back to the baseline level.Interpretation The first wave of COVID-19 outside of Hubei has abated because of aggressive non-pharmaceutical interventions. However, given the substantial risk of viral reintroduction, particularly from overseas importation, close monitoring of R-t and cCFR is needed to inform strategies against a potential second wave to achieve an optimal balance between health and economic protection.