Epidemiological characteristics of the first 53 laboratory-confirmed cases of COVID-19 epidemic in Hong Kong, 13 February 2020

Background COVID-19, caused by SARS-CoV-2, first appeared in China and subsequently developed into an ongoing epidemic. Understanding epidemiological factors characterising the transmission dynamics of this disease is of fundamental importance. Aims This study aimed to describe key epidemiological parameters of COVID-19 in Hong Kong. Methods We extracted data of confirmed COVID-19 cases and their close contacts from the publicly available information released by the Hong Kong Centre for Health Protection. We used doubly interval censored likelihood to estimate containment delay and serial interval, by fitting gamma, lognormal and Weibull distributions to respective empirical values using Bayesian framework with right truncation. A generalised linear regression model was employed to identify factors associated with containment delay. Secondary attack rate was also estimated. Results The empirical containment delay was 6.39 days; whereas after adjusting for right truncation with the best-fit Weibull distribution, it was 10.4 days (95% CrI: 7.15 to 19.81). Containment delay increased significantly over time. Local source of infection and number of doctor consultations before isolation were associated with longer containment delay. The empirical serial interval was 4.58–6.06 days; whereas the best-fit lognormal distribution to 26 certain-and-probable infector–infectee paired data gave an estimate of 4.77 days (95% CrI: 3.47 to 6.90) with right-truncation. The secondary attack rate among close contacts was 11.7%. Conclusion With a considerable containment delay and short serial interval, contact-tracing effectiveness may not be optimised to halt the transmission with rapid generations replacement. Our study highlights the transmission risk of social interaction and pivotal role of physical distancing in suppressing the epidemic.

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Epidemiology and contact tracing assessment of COVID-19 and potential risk of transmission at different exposure settings: A prospective cohort study

10.21203/rs.3.rs-442709/v1 ◽

2021 ◽

Author(s):

Abu Shadat M Noman ◽

Mohammed Rezaul Karim ◽

ASM Zahed ◽

ATM Rezaul Karim ◽

Syed S Islam

Keyword(s):

Risk Ratio ◽

Attack Rate ◽

Close Contact ◽

Household Contact ◽

Control Measures ◽

Effective Control ◽

Secondary Contact ◽

Epidemiological Characteristics ◽

Index Cases ◽

Close Contacts

Abstract Background: Transmission risk of coronavirus disease 2019 (COVID-19) to close contacts and at different exposure settings are yet to be fully understood for the evaluation of effective control measures. Methods: We traced 1171 close contact cases who were linked to 291 index cases between July 3, 2020 and September 3, 2020. Clinical and epidemiological characteristics of all index cases, close contacts, and secondary contact cases were collected and analyzed the secondary attack rate and risk of transmission at different exposure settings. Results: Median age of 291 index cases were 43.0 years (range 18.5-82.3) including 213 male and 78 females. Among all 1171 close contact cases, 39(3.3%) cases were identified as secondary infected cases. Among 39 secondary cases, 33(84.62%) cases were symptomatic and 3 (7.69%) cases were asymptomatic. Of the 33 symptomatic cases, 31(86.1%) male and 5(13.9%) female. Of these 36 symptomatic cases, 24(66.7%) cases between age 20-59 and remaining 12(33.3%) cases were age 60 and over. Of the 36 symptomatic cases, 11(30.6%) cases were identified as severe, 19(52.8%) as moderate and 6(16.7%) as mild. The overall secondary clinical attack rate was 3.07% (95% CI 2.49-3.64). The attack rate was higher among those aged between 50 to 69 years and shows higher risk of transmission than age below 50 years. The attack rate was higher among household contact (6.17%(95%CI 4.7-7.6; risk ratio 2.44[95%CI1.5-3.4]), and lower in hospital facility (2.29%,95%CI0.58-3.40; [risk ratio 0.91,95%CI 0.17-1.9]), funeral ceremony (2.53%,95%CI 0.32-4.73), work places (3.95%,95% CI2.5-5.42 [risk ratio 1.56,95%CI 0.63-2.5]), family contacts (3.87%,95%CI 2.4-5.3; risk ratio 1.53,95%CI 0.61-2.45]). Conclusions: Among all exposure settings analyzed, household contact exposure setting remained the highest transmission probability and risk of transmission of COVID-19 with the increase of age and disease severity.

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Transmission dynamics, serial interval and epidemiology of COVID-19 diseases in Hong Kong under different control measures

Wellcome Open Research ◽

10.12688/wellcomeopenres.15896.2 ◽

2020 ◽

Vol 5 ◽

pp. 91

Author(s):

Yung-Wai Desmond Chan ◽

Stefan Flasche ◽

Tin-Long Terence Lam ◽

Mei-Hung Joanna Leung ◽

Miu-Ling Wong ◽

...

Keyword(s):

Hong Kong ◽

Population Level ◽

Credible Interval ◽

Control Measures ◽

Transmission Dynamics ◽

Local Data ◽

First Case ◽

Serial Interval ◽

Imported Cases ◽

Epidemiological Characteristics

Background: The outbreak of coronavirus disease 2019 (COVID-19) started in Wuhan, China in late December 2019, and subsequently became a pandemic. Hong Kong had implemented a series of control measures since January 2020, including enhanced surveillance, isolation and quarantine, border control and social distancing. Hong Kong recorded its first case on 23 January 2020, who was a visitor from Wuhan. We analysed the surveillance data of COVID-19 to understand the transmission dynamics and epidemiology in Hong Kong. Methods: We constructed the epidemic curve of daily COVID-19 incidence from 23 January to 6 April 2020 and estimated the time-varying reproduction number (Rt) with the R package EpiEstim, with serial interval computed from local data. We described the demographic and epidemiological characteristics of reported cases. We computed weekly incidence by age and residential district to understand the spatial and temporal transmission of the disease. Results: COVID-19 disease in Hong Kong was characterised with local cases and clusters detected after two waves of importations, first in late January (week 4 to 6) and the second one in early March (week 9 to 10). The Rt increased to approximately 2 95% credible interval (CI): 0.3-3.3) and approximately 1 (95%CI: 0.2-1.7), respectively, following these importations; it decreased to below 1 afterwards from weeks 11 to 13, which coincided with the implementation, modification and intensification of different control measures. Compared to local cases, imported cases were younger (mean age: 52 years among local cases vs 35 years among imported cases), had a lower proportion of underlying disease (9% vs 5%) and severe outcome (13% vs 5%). Cases were recorded in all districts but the incidence was highest in those in the Hong Kong Island region. Conclusions: Stringent and sustained public health measures at population level could contain the COVID-19 disease at a relatively low level.

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Estimating the serial interval of the novel coronavirus disease (COVID-19): A statistical analysis using the public data in Hong Kong from January 16 to February 15, 2020

10.1101/2020.02.21.20026559 ◽

2020 ◽

Cited By ~ 28

Author(s):

Shi Zhao ◽

Daozhou Gao ◽

Zian Zhuang ◽

Marc KC Chong ◽

Yongli Cai ◽

...

Keyword(s):

Hong Kong ◽

Contact Tracing ◽

Distributed Model ◽

Serial Interval ◽

Public Data ◽

Interval Censored ◽

Large Outbreak ◽

Emerging Virus ◽

Novel Coronavirus ◽

Censored Likelihood

AbstractBackgroundsThe emerging virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a large outbreak of novel coronavirus disease (COVID-19) in Wuhan, China since December 2019. Based on the publicly available surveillance data, we identified 21 transmission chains in Hong Kong and estimated the serial interval (SI) of COVID-19.MethodsIndex cases were identified and reported after symptoms onset, and contact tracing was conducted to collect the data of the associated secondary cases. An interval censored likelihood framework is adopted to fit a Gamma distribution function to govern the SI of COVID-19.FindingsAssuming a Gamma distributed model, we estimated the mean of SI at 4.4 days (95%CI: 2.9−6.7) and SD of SI at 3.0 days (95%CI: 1.8−5.8) by using the information of all 21 transmission chains in Hong Kong.ConclusionThe SI of COVID-19 may be shorter than the preliminary estimates in previous works. Given the likelihood that SI could be shorter than the incubation period, pre-symptomatic transmission may occur, and extra efforts on timely contact tracing and quarantine are recommended in combating the COVID-19 outbreak.

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Epidemiological characteristics of COVID-19 cases among Indians residing in Kuwait

Eastern Mediterranean Health Journal ◽

10.26719/emhj.21.006 ◽

2021 ◽

Author(s):

Jagan K. Baskaradoss ◽

Aishah Alsumait ◽

Shaheer Malik ◽

Jitendra Ariga ◽

Amrita Geevarghese ◽

...

Keyword(s):

Healthcare Workers ◽

Contact Tracing ◽

Indian Community ◽

Asymptomatic Patients ◽

Serial Interval ◽

The World ◽

Early Increase ◽

The Mean ◽

Epidemiological Characteristics ◽

Close Contacts

Background: The coronavirus disease 2019 (COVID-19) pandemic has rapidly spread to most countries around the world. Disproportionate spread of COVID-19 among the Indian community in Kuwait prompted heightened surveillance in this community. Aims: To study the epidemiological characteristics of COVID-19 patients and their contacts among the Indian community in Kuwait. Methods: Data collection was done as a part of contact tracing efforts undertaken by the Kuwaiti Ministry of Health. Results: We analysed contact-tracing data for the initial 1348 laboratory-confirmed Indian patients and 6357 contacts (5681 close and 676 casual). The mean (standard deviation) age of the patients was 39.43 (10.5) years and 76.5% of the cases were asymptomatic or had only mild symptoms. Asymptomatic patients were significantly older [40.05 (10.42) years] than patients with severe symptoms [37.54 (10.54) years] (P = 0.024). About 70% of the patients were living in shared accommodation. Most of the close contacts were living in the same household, as compared with casual contacts, who were primarily workplace contacts (P < 0.001). Among the different occupations, healthcare workers had the highest proportion of cases (18.4%). Among the 216 pairs of cases with a clear relationship between the index and secondary cases, the mean serial interval was estimated to be 3.89 (3.69) days, with a median of 3 and interquartile range of 1–5 days. Conclusion: An early increase in the number of COVID-19 cases among the Indian community could be primarily attributed to crowded living conditions and the high proportion of healthcare workers in this community.

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High transmissibility of COVID-19 near symptom onset

10.1101/2020.03.18.20034561 ◽

2020 ◽

Cited By ~ 19

Author(s):

Hao-Yuan Cheng ◽

Shu-Wan Jian ◽

Ding-Ping Liu ◽

Ta-Chou Ng ◽

Wan-Ting Huang ◽

...

Keyword(s):

Symptom Onset ◽

Attack Rate ◽

Paired Data ◽

Rapid Reduction ◽

Social Distancing ◽

Household Contacts ◽

Exposure Windows ◽

Index Cases ◽

Over Time ◽

Close Contacts

AbstractBackgroundThe dynamics of coronavirus disease 2019 (COVID-19) transmissibility after symptom onset remains unknown.MethodsWe conducted a prospective case-ascertained study on laboratory-confirmed COVID-19 cases and their contacts. Secondary clinical attack rate (considering symptomatic cases only) was analyzed for different exposure windows after symptom onset of index cases and for different exposure settings.ResultsThirty-two confirmed patients were enrolled and 12 paired data (index-secondary cases) were identified among the 1,043 contacts. The secondary clinical attack rate was 0.9% (95% CI 0.5–1.7%). The attack rate was higher among those whose exposure to index cases started within five days of symptom onset (2.4%, 95% CI 1.1–4.5%) than those who were exposed later (zero case from 605 close contacts, 95% CI 0–0.61%). The attack rate was also higher among household contacts (13.6%, 95% CI 4.7–29.5%) and non- household family contacts (8.5%, 95% CI 2.4–20.3%) than that in healthcare or other settings. The higher secondary clinical attack rate for contacts near symptom onset remained when the analysis was restricted to household and family contacts. There was a trend of increasing attack rate with the age of contacts (p for trend < 0.001).ConclusionsHigh transmissibility of COVID-19 near symptom onset suggests that finding and isolating symptomatic patients alone may not suffice to contain the epidemic, and more generalized social distancing measures are required. Rapid reduction of transmissibility over time implies that prolonged hospitalization of mild cases might not be necessary in large epidemics.

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Transmission dynamics, serial interval and epidemiology of COVID-19 diseases in Hong Kong under different control measures

Wellcome Open Research ◽

10.12688/wellcomeopenres.15896.1 ◽

2020 ◽

Vol 5 ◽

pp. 91 ◽

Cited By ~ 4

Author(s):

Yung-Wai Desmond Chan ◽

Stefan Flasche ◽

Tin-Long Terence Lam ◽

Mei-Hung Joanna Leung ◽

Miu-Ling Wong ◽

...

Keyword(s):

Hong Kong ◽

Population Level ◽

Underlying Disease ◽

Control Measures ◽

Transmission Dynamics ◽

Local Data ◽

First Case ◽

Serial Interval ◽

Imported Cases ◽

Epidemiological Characteristics

Background: The outbreak of coronavirus disease 2019 (COVID-19) started in Wuhan, China in late December 2019, and subsequently became a pandemic. Hong Kong had implemented a series of control measures since January 2020, including enhanced surveillance, isolation and quarantine, border control and social distancing. Hong Kong recorded its first case on 23 January 2020, who was a visitor from Wuahn. We analysed the surveillance data of COVID-19 to understand the transmission dynamics and epidemiology in Hong Kong. Methods: Based on cases recorded from 23 January to 6 April 2020, we constructed the epidemic curve of daily COVID-19 incidence and used this data to estimate the time-varying reproduction number (Rt) with the R package EpiEstim, with serial interval computed from local data. We described the demographic and epidemiological characteristics of reported cases. We computed weekly incidence by age and residential district to understand the spatial and temporal transmission of the disease. Results: COVID-19 disease in Hong Kong was characterised with local cases and clusters detected after two waves of importations, first in late January and the second one in early March. The Rt increased to approximately 2 and approximately 1, respectively, following these importations; it decreased to below 1 afterwards, which coincided with the implementation, modification and intensification of different control measures. Compared to local cases, imported cases were younger (mean age: 52 years among local cases vs 35 years among imported cases), had a lower proportion of underlying disease (9% vs 5%) and severe outcome (13% vs 5%). Cases were recorded in all districts but the incidence was highest in those in the Hong Kong Island region. Conclusions: Stringent and sustained public health measures at population level could contain the COVID-19 disease at a relatively low level.

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Transmission dynamics and epidemiological characteristics of Delta variant infections in China

10.1101/2021.08.12.21261991 ◽

2021 ◽

Author(s):

Min Kang ◽

Hualei Xin ◽

Jun Yuan ◽

Sheikh Taslim Ali ◽

Zimian Liang ◽

...

Keyword(s):

Viral Load ◽

Confidence Interval ◽

Southern China ◽

Transmission Dynamics ◽

Wild Type ◽

Viral Loads ◽

Serial Interval ◽

The Mean ◽

Epidemiological Characteristics ◽

Close Contacts

Background: The Delta variant of SARS-CoV-2 has become predominant globally. We evaluated the transmission dynamics and epidemiological characteristics of the Delta variant in an outbreak in southern China. Methods: Data on confirmed cases and their close contacts were retrospectively collected from the outbreak that occurred in Guangdong, China in May-June 2021. Key epidemiological parameters, temporal trend of viral loads and secondary attack rates were estimated and compared between the Delta variant and the wild-type SARS-CoV-2 virus. We also evaluated the association of vaccination with viral load and transmission. Results: We identified 167 patients infected with the Delta variant in the Guangdong outbreak. The mean estimates of the latent period and the incubation period were 4.0 days and 5.8 days, respectively. A relatively higher viral load was observed in Delta cases than in wild-type infections. The secondary attack rate among close contacts of Delta cases was 1.4%, and 73.9% (95% confidence interval: 67.2%, 81.3%) of the transmissions occurred before onset. Index cases without vaccination (OR: 2.84, 95% confidence interval: 1.19, 8.45) or with one dose of vaccination (OR: 6.02, 95% confidence interval: 2.45, 18.16) were more likely to transmit infection to their contacts than those who had received 2 doses of vaccination. Discussion: Patients infected with the Delta variant had more rapid symptom onset. The shorter and time-varying serial interval should be accounted in estimation of reproductive numbers. The higher viral load and higher risk of pre-symptomatic transmission indicated the challenges in control of infections with the Delta variant.

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Stringent containment measures without complete city lockdown to achieve low incidence and mortality across two waves of COVID-19 in Hong Kong

BMJ Global Health ◽

10.1136/bmjgh-2020-003573 ◽

2020 ◽

Vol 5 (10) ◽

pp. e003573

Author(s):

Martin C S Wong ◽

Rita W Y Ng ◽

Ka Chun Chong ◽

Christopher K C Lai ◽

Junjie Huang ◽

...

Keyword(s):

Hong Kong ◽

Moving Average ◽

Linear Regression Analysis ◽

Leisure Activities ◽

Multiple Linear Regression Analysis ◽

Mitigation Strategies ◽

Incidence And Mortality ◽

Containment Measures ◽

Epidemiological Characteristics ◽

Second Wave

IntroductionAn international city, Hong Kong, in proximity to the first epicentre of COVID- 19, experienced two epidemic waves with different importation pressure. We compared the epidemiological features of patients with COVID-19 in the context of containment policies between the first and second waves.MethodsWe retrieved information on the first 1038 cases detected in Hong Kong (23 January to 25 April 2020) to analyse the epidemiological characteristics including age/gender-specific incidence, clustering, reproduction number (Rt) and containment delay; in relation to the containment measures implemented. Factors associated with containment delay were evaluated by multiple linear regression analysis with age, gender, epidemic wave and infection source as covariates. A time series of 5-day moving average was plotted to examine the changes across the two epidemic waves.ResultsThe incidence and mortality (135.5 and 0.5 per 1 000 000 population) was among the lowest in the world. Aggressive escalation of border control correlated with reductions in Rt from 1.35 to 0.57 and 0.92 to 0.18, and aversions of 450 and 1650 local infections during the first and second waves, respectively. Implementing COVID-19 tests for overseas returners correlated with an upsurge of asymptomatic case detection, and shortened containment delay in the second wave. Medium-sized cluster events in the first wave were family gatherings, whereas those in the second wave were leisure activities among youngsters. Containment delay was associated with older age (adjusted OR (AOR)=1.01, 95% CI 1.00 to 1.02, p=0.040), male gender (AOR=1.41, 95% CI 1.02 to 1.96, p=0.039) and local cases (AOR=11.18, 95% CI 7.43 to 16.83, p<0.001), and with significant improvement in the second wave compared with the first wave (average: 6.8 vs 3.7 days). A higher incidence rate was observed for males, raising possibility of gender predilection in susceptibility of developing symptoms.ConclusionPrompt and stringent all-round containment strategies represent successful measures in pandemic control. These findings could inform formulation and implementation of pandemic mitigation strategies.

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Incubation Period and Other Epidemiological Characteristics of 2019 Novel Coronavirus Infections with Right Truncation: A Statistical Analysis of Publicly Available Case Data

Journal of Clinical Medicine ◽

10.3390/jcm9020538 ◽

2020 ◽

Vol 9 (2) ◽

pp. 538 ◽

Cited By ~ 436

Author(s):

Natalie Linton ◽

Tetsuro Kobayashi ◽

Yichi Yang ◽

Katsuma Hayashi ◽

Andrei Akhmetzhanov ◽

...

Keyword(s):

Incubation Period ◽

Case Fatality ◽

Illness Onset ◽

Event Date ◽

History Of ◽

Novel Coronavirus ◽

Case Fatality Risk ◽

Right Truncation ◽

Epidemiological Characteristics ◽

Mean Time

The geographic spread of 2019 novel coronavirus (COVID-19) infections from the epicenter of Wuhan, China, has provided an opportunity to study the natural history of the recently emerged virus. Using publicly available event-date data from the ongoing epidemic, the present study investigated the incubation period and other time intervals that govern the epidemiological dynamics of COVID-19 infections. Our results show that the incubation period falls within the range of 2–14 days with 95% confidence and has a mean of around 5 days when approximated using the best-fit lognormal distribution. The mean time from illness onset to hospital admission (for treatment and/or isolation) was estimated at 3–4 days without truncation and at 5–9 days when right truncated. Based on the 95th percentile estimate of the incubation period, we recommend that the length of quarantine should be at least 14 days. The median time delay of 13 days from illness onset to death (17 days with right truncation) should be considered when estimating the COVID-19 case fatality risk.

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Epidemiological characteristics of the first 100 cases of coronavirus disease 2019 (COVID-19) in Hong Kong Special Administrative Region, China, a city with a stringent containment policy

International Journal of Epidemiology ◽

10.1093/ije/dyaa106 ◽

2020 ◽

Vol 49 (4) ◽

pp. 1096-1105 ◽

Cited By ~ 3

Author(s):

Christopher K C Lai ◽

Rita W Y Ng ◽

Martin C S Wong ◽

Ka Chun Chong ◽

Yun Kit Yeoh ◽

...

Keyword(s):

Hong Kong ◽

Incubation Period ◽

Mainland China ◽

Control Measures ◽

Contact Tracing ◽

Border Control ◽

Government Information ◽

Epidemic Curve ◽

Containment Policy ◽

Epidemiological Characteristics

Abstract Background Hong Kong (HK) is a densely populated city near the epicentre of the coronavirus disease 2019 (COVID-19) outbreak. Stringent border control together with aggressive case finding, contact tracing, social distancing and quarantine measures were implemented to halt the importation and spread of the virus. Methods We performed an epidemiological study using government information covering the first 100 confirmed cases to examine the epidemic curve, incidence, clusters, reproduction number (Rt), incubation period and time to containment. Results A total of 93 of the 100 cases were HK residents (6 infected in Mainland China, 10 on the Diamond Princess Cruise). Seven were visitors infected in Mainland China before entering HK. The majority (76%) were aged ≥45 years, and the incidence increased with age (P < 0.001). Escalation of border control measures correlated with a decrease in the proportion (62.5% to 0%) of cases imported from Mainland China, and a reduction in Rt (1.07 to 0.75). The median incubation period was 4.2 days [95% confidence interval (CI), 4.0–4.5; 5th and 95th percentiles: 1.3 and 14.0). Most clusters with identifiable epidemiological links were households involving 2–4 people. Three medium-spreading events were identified: two from New Year gatherings (6–11 people), and another from environmental contamination of a worship hall (12 people). Despite intensified contact tracing, containment was delayed in 78.9% of cases (mean = 5.96 days, range = 0–24 days). An unusual transmission in a multi-storey building via faulty toilet plumbing was suspected with >100 residents evacuated overnight. Our analysis indicated that faulty plumbing was unlikely to be the source of this transmission. Conclusion Timely stringent containment policies minimized the importation and transmission of COVID-19 in HK.

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