The incubation period of COVID-19 – A rapid systematic review and meta-analysis of observational research

ABSTRACTBackgroundReliable estimates of the incubation period are important for decision making around the control of infectious diseases. Knowledge of the incubation period distribution can be used directly to inform decision-making or as inputs into mathematical models.ObjectivesThe aim of this study was to conduct a rapid systematic review and meta-analysis of estimates of the incubation periods of COVID-19.DesignRapid systematic review and meta-analysis of observational researchData sourcesPublications on the electronic databases PubMed, Google Scholar, MedRxiv and BioRxiv were searched. The search was not limited to peer-reviewed published data, but also included pre-print articles.Study appraisal and synthesis methodsStudies were selected for meta-analysis if they reported either the parameters and confidence intervals of the distributions fit to the data, or sufficient information to facilitate calculation of those values. The majority of studies suitable for inclusion in the final analysis modelled incubation period as a lognormal distribution. We conducted a random effects meta-analysis of the parameters of this distribution.ResultsThe incubation period distribution may be modelled with a lognormal distribution with pooled mu and sigma parameters of 1.63 (1.51, 1.75) and 0.50 (0.45, 0.55) respectively. The corresponding mean was 5.8 (5.01, 6.69 days). It should be noted that uncertainty increases towards the tail of the distribution: the pooled parameter estimates resulted in a median incubation period of 5.1 (4.5, 5.8) days, whereas the 95th percentile was 11.6 (9.5, 14.2) days.Conclusions and implicationsThe choice of which parameter values are adopted will depend on how the information is used, the associated risks and the perceived consequences of decisions to be taken. These recommendations will need to be revisited once further relevant information becomes available. Finally, we present an RShiny app that facilitates updating these estimates as new data become available.ARTICLE SUMMARYStrengths and limitations of this studyThis study provides a pooled estimate of the distribution of incubation periods which may be used in subsequent modelling studies or to inform decision-makingThis estimate will need to be revisited as subsequent data become available. We present an RShiny app to allow the meta-analysis to be updated with new estimates

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Incubation period of COVID-19: a rapid systematic review and meta-analysis of observational research

BMJ Open ◽

10.1136/bmjopen-2020-039652 ◽

2020 ◽

Vol 10 (8) ◽

pp. e039652 ◽

Cited By ~ 25

Author(s):

Conor McAloon ◽

Áine Collins ◽

Kevin Hunt ◽

Ann Barber ◽

Andrew W Byrne ◽

...

Keyword(s):

Systematic Review ◽

Incubation Period ◽

Lognormal Distribution ◽

Meta Analysis ◽

Observational Research ◽

Cochrane Library ◽

Parameter Estimates ◽

Sufficient Information ◽

International Studies ◽

Shiny App

ObjectivesThe aim of this study was to conduct a rapid systematic review and meta-analysis of estimates of the incubation period of COVID-19.DesignRapid systematic review and meta-analysis of observational research.SettingInternational studies on incubation period of COVID-19.ParticipantsSearches were carried out in PubMed, Google Scholar, Embase, Cochrane Library as well as the preprint servers MedRxiv and BioRxiv. Studies were selected for meta-analysis if they reported either the parameters and CIs of the distributions fit to the data, or sufficient information to facilitate calculation of those values. After initial eligibility screening, 24 studies were selected for initial review, nine of these were shortlisted for meta-analysis. Final estimates are from meta-analysis of eight studies.Primary outcome measuresParameters of a lognormal distribution of incubation periods.ResultsThe incubation period distribution may be modelled with a lognormal distribution with pooled mu and sigma parameters (95% CIs) of 1.63 (95% CI 1.51 to 1.75) and 0.50 (95% CI 0.46 to 0.55), respectively. The corresponding mean (95% CIs) was 5.8 (95% CI 5.0 to 6.7) days. It should be noted that uncertainty increases towards the tail of the distribution: the pooled parameter estimates (95% CIs) resulted in a median incubation period of 5.1 (95% CI 4.5 to 5.8) days, whereas the 95th percentile was 11.7 (95% CI 9.7 to 14.2) days.ConclusionsThe choice of which parameter values are adopted will depend on how the information is used, the associated risks and the perceived consequences of decisions to be taken. These recommendations will need to be revisited once further relevant information becomes available. Accordingly, we present an R Shiny app that facilitates updating these estimates as new data become available.

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The incubation period of COVID-19: A scoping review and meta-analysis to aid modelling and planning

10.1101/2020.10.20.20216143 ◽

2020 ◽

Author(s):

Prakashini Banka ◽

Catherine Comiskey

Keyword(s):

Incubation Period ◽

Scoping Review ◽

Meta Analysis ◽

Accurate Estimate ◽

Mitigation Strategies ◽

Global Index ◽

Distribution Modelling ◽

Period Distribution ◽

Incubation Periods ◽

The Mean

AbstractBackgroundAn accurate estimate of the distribution of the incubation period for COVID-19 is the foundational building block for modelling the spread of the SARS COV2 and the effectiveness of mitigation strategies on affected communities. Initial estimates were based on early infections, the aim of this study was to provide an updated estimate and meta-analysis of the incubation period distribution for COVID-19.MethodsThe review was conducted according to the PRISMA Scoping Review guidelines. Five databases were searched; CINAHL, MEDLINE, PUBMED, EMBASE, ASSIA, and Global Index Medicus for studies published between 1 January 2020 - 27 July 2020.ResultsA total of 1,084 articles were identified through the database searches and 1 article was identified through the reference screening of retrieved articles. After screening 64 articles were included. The studies combined had a sample of 45,151 people. The mean of the incubation periods was 6.71 days with 95% CIs ranging from 1 to 12.4 days. The median was 6 days and IQR ranging from 1.8 to 16.3. The resulting parameters for a Gamma Distribution modelling the incubation period were Γ(α, λ) = Γ(2.810,0.419) with mean, μ = α/λ.ConclusionGovernments are planning their strategies on a maximum incubation period of 14 days. While our results are limited to primarily Chinese research studies, the findings highlight the variability in the mean period and the potential for further incubation beyond 14 days. There is an ongoing need for detailed surveillance on the timing of self-isolation periods and related measures protecting communities as incubation periods may be longer.

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Comprehensive estimation for the length and dispersion of COVID-19 incubation period: a systematic review and meta-analysis

Infection ◽

10.1007/s15010-021-01682-x ◽

2021 ◽

Author(s):

Yongyue Wei ◽

Liangmin Wei ◽

Yihan Liu ◽

Lihong Huang ◽

Sipeng Shen ◽

...

Keyword(s):

Systematic Review ◽

Incubation Period ◽

Meta Analysis

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A systematic review and meta-analysis of effectiveness of decision aids for vaccination decision-making

Vaccine ◽

10.1016/j.vaccine.2021.05.021 ◽

2021 ◽

Author(s):

Cassandra Vujovich-Dunn ◽

Jessica Kaufman ◽

Catherine King ◽

S. Rachel Skinner ◽

Handan Wand ◽

...

Keyword(s):

Systematic Review ◽

Decision Making ◽

Meta Analysis ◽

Decision Aids ◽

Vaccination Decision

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Focal Concerns and Police Decision Making in Sexual Assault Cases: A Systematic Review and Meta-Analysis

Trauma Violence & Abuse ◽

10.1177/1524838021991285 ◽

2021 ◽

pp. 152483802199128

Author(s):

David S. Lapsey ◽

Bradley A. Campbell ◽

Bryant T. Plumlee

Keyword(s):

Systematic Review ◽

Decision Making ◽

Sexual Assault ◽

Meta Analysis ◽

The United States ◽

Empirical Literature ◽

Campbell Collaboration ◽

Focal Concerns ◽

Police Decision Making ◽

The Impact

Sexual assault and case attrition at the arrest stage are serious problems in the United States. Focal concerns have increasingly been used to explain police decision making in sexual assault cases. Because of the popularity of the focal concerns perspective and potential to inform evidence-based training, a systematic review and meta-analysis are needed to condense the literature. In this study, we assess the overall strength of the relationship between focal concerns variables and police decisions to arrest in cases of sexual assault. Our assessment of the effects of focal concerns variables on arrest decision making in sexual assault cases followed the systematic review protocols provided by the Campbell Collaboration of Systematic Reviews. Specifically, we used the Campbell Collaboration recommendations to search empirical literature and used meta-analysis to evaluate the size, direction, and strength of the impact of focal concerns variables on arrest decisions. Our search strategy detected 14 eligible studies and 79 effect sizes. The meta-analysis found several robust and statistically significant correlates of arrest. In fact, each focal concerns concept produced at least one robust arrest correlate. Overall, focal concerns offers a strong approach for explaining police decisions in sexual assault cases. Although practical concerns and resource constraints produced the strongest arrest correlates, results show the importance of additional case characteristics in officers’ decision to arrest.

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A systematic review and meta-analysis of treatment-related toxicities of curative and palliative radiation therapy in non-small cell lung cancer

Scientific Reports ◽

10.1038/s41598-021-85131-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

M. Or ◽

B. Liu ◽

J. Lam ◽

S. Vinod ◽

W. Xuan ◽

...

Keyword(s):

Lung Cancer ◽

Systematic Review ◽

Decision Making ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Meta Analysis ◽

Small Cell ◽

Small Cell Lung ◽

Cardiac Events ◽

Grade 3

AbstractTreatment-related toxicity is an important component in non-small cell lung cancer (NSCLC) management decision-making. Our aim was to evaluate and compare the toxicity rates of curative and palliative radiotherapy with and without chemotherapy. This meta-analysis provides better quantitative estimates of the toxicities compared to individual trials. A systematic review of randomised trials with > 50 unresectable NSCLC patients, treated with curative or palliative conventional radiotherapy (RT) with or without chemotherapy. Data was extracted for oesophagitis, pneumonitis, cardiac events, pulmonary fibrosis, myelopathy and neutropenia by any grade, grade ≥ 3 and treatment-related deaths. Mantel–Haenszel fixed-effect method was used to obtain pooled risk ratio. Forty-nine trials with 8609 evaluable patients were included. There was significantly less grade ≥ 3 acute oesophagitis (6.4 vs 22.2%, p < 0.0001) and any grade oesophagitis (70.4 vs 79.0%, p = 0.04) for sequential CRT compared to concurrent CRT, with no difference in pneumonitis (grade ≥ 3 or any grade), neutropenia (grade ≥ 3), cardiac events (grade ≥ 3) or treatment-related deaths. Although the rate of toxicity increased with intensification of treatment with RT, the only significant difference between treatment regimens was the rate of oesophagitis between the use of concurrent and sequential CRT. This can aid clinicians in radiotherapy decision making for NSCLC.

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Systematic review of economic evaluations of vaccination programs in mainland China: Are they sufficient to inform decision making?

Vaccine ◽

10.1016/j.vaccine.2015.09.081 ◽

2015 ◽

Vol 33 (46) ◽

pp. 6164-6172 ◽

Cited By ~ 11

Author(s):

Xiong-Fei Pan ◽

Ulla K. Griffiths ◽

Mark Pennington ◽

Hongjie Yu ◽

Mark Jit

Keyword(s):

Systematic Review ◽

Decision Making ◽

Mainland China ◽

Economic Evaluations ◽

Vaccination Programs ◽

Inform Decision Making

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How does decisional capacity evolve with normal cognitive aging: systematic review of the literature

European Geriatric Medicine ◽

10.1007/s41999-019-00251-8 ◽

2019 ◽

Vol 11 (1) ◽

pp. 117-129 ◽

Cited By ~ 1

Author(s):

Thomas Tannou ◽

Séverine Koeberlé ◽

Régis Aubry ◽

Emmanuel Haffen

Keyword(s):

Systematic Review ◽

Decision Making ◽

Processing Speed ◽

Cognitive Aging ◽

Social Issues ◽

Meta Analysis ◽

Decisional Capacity ◽

Literature Reviews ◽

Decision Making Processes ◽

Motivation Profiles

Abstract Purpose Aging is associated with increased needs related to complex decisions, particularly in medical and social issues. However, the complexity of decision-making involves many neurological functions and structures which are potentially altered by cognitive aging. Methodology A systematic review was conducted in accordance with PRISMA guidelines to examine changes in decision-making occurring in normal cognitive aging. The keywords “decision making” and “normal aging” were used to find the clinical studies and literature reviews focused on these changes. Results A total of 97 articles were considered in the review, and ultimately 40 articles were selected, including 30 studies and 10 literature reviews. The data from these studies were of uneven quality and too disparate to allow meta-analysis according to PRISMA criteria. Nevertheless, a key result of the analysis is the decrease of processing speed with aging. In ambiguous decision-making situations, the alteration of the ventromedial system is associated with changes in motivation profiles. These changes can be compensated by experience. However, difficulties arise for older adults in the case of one-off decisions, which are very common in the medical or medico-social domains. Conclusions Cognitive aging is associated with a slowdown in processing speed of decision-making, especially in ambiguous situations. However, decision-making processes which are based on experience and cases in which sufficient time is available are less affected by aging. These results highlight the relativity of decision-making capacities in cognitive aging.

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