Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures
Yixuan Wang
Laboratory of Human Virology and Oncology, Shantou University Medical College, Shantou, Guangdong, China
Search for more papers by this authorYuyi Wang
Laboratory of Human Virology and Oncology, Shantou University Medical College, Shantou, Guangdong, China
Search for more papers by this authorYan Chen
Department of Pediatric, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Search for more papers by this authorCorresponding Author
Qingsong Qin
Laboratory of Human Virology and Oncology, Shantou University Medical College, Shantou, Guangdong, China
Correspondence Qingsong Qin, Laboratory of Human Virology and Oncology, Shantou University Medical College, Shantou, Guangdong, 515041, China.
Email: [email protected]
Search for more papers by this authorYixuan Wang
Laboratory of Human Virology and Oncology, Shantou University Medical College, Shantou, Guangdong, China
Search for more papers by this authorYuyi Wang
Laboratory of Human Virology and Oncology, Shantou University Medical College, Shantou, Guangdong, China
Search for more papers by this authorYan Chen
Department of Pediatric, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Search for more papers by this authorCorresponding Author
Qingsong Qin
Laboratory of Human Virology and Oncology, Shantou University Medical College, Shantou, Guangdong, China
Correspondence Qingsong Qin, Laboratory of Human Virology and Oncology, Shantou University Medical College, Shantou, Guangdong, 515041, China.
Email: [email protected]
Search for more papers by this authorAbstract
By 27 February 2020, the outbreak of coronavirus disease 2019 (COVID-19) caused 82 623 confirmed cases and 2858 deaths globally, more than severe acute respiratory syndrome (SARS) (8273 cases, 775 deaths) and Middle East respiratory syndrome (MERS) (1139 cases, 431 deaths) caused in 2003 and 2013, respectively. COVID-19 has spread to 46 countries internationally. Total fatality rate of COVID-19 is estimated at 3.46% by far based on published data from the Chinese Center for Disease Control and Prevention (China CDC). Average incubation period of COVID-19 is around 6.4 days, ranges from 0 to 24 days. The basic reproductive number (R0) of COVID-19 ranges from 2 to 3.5 at the early phase regardless of different prediction models, which is higher than SARS and MERS. A study from China CDC showed majority of patients (80.9%) were considered asymptomatic or mild pneumonia but released large amounts of viruses at the early phase of infection, which posed enormous challenges for containing the spread of COVID-19. Nosocomial transmission was another severe problem. A total of 3019 health workers were infected by 12 February 2020, which accounted for 3.83% of total number of infections, and extremely burdened the health system, especially in Wuhan. Limited epidemiological and clinical data suggest that the disease spectrum of COVID-19 may differ from SARS or MERS. We summarize latest literatures on genetic, epidemiological, and clinical features of COVID-19 in comparison to SARS and MERS and emphasize special measures on diagnosis and potential interventions. This review will improve our understanding of the unique features of COVID-19 and enhance our control measures in the future.
CONFLICT OF INTERESTS
The authors declare that there are no conflict of interests.
REFERENCES
- 1Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020; 382(8): 727-733.
- 2Zhou P, Yang XL, Wang XG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020; 579, https://doi.org/10.1038/s41586-020-2012-7
- 3Wu F, Zhao S, Yu B, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020; 579, https://doi.org/10.1038/s41586-020-2008-3
- 4Chen L, Liu W, Zhang Q, et al. RNA based mNGS approach identifies a novel human coronavirus from two individual pneumonia cases in 2019 Wuhan outbreak. Emerg Microbes Infect. 2020; 9(1): 313-319.
- 5Ren LL, Wang YM, Wu ZQ, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J. 2020. https://doi.org/10.1097/CM9.0000000000000722
- 6Chan JFW, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020; 395(10223): 514-523.
- 7Gorbalenya AE, Baker SC, Baric RS, et al. Severe acute respiratory syndrome-related coronavirus: the species and its viruses—a statement of the Coronavirus Study Group. bioRxiv. 2020.
- 8Chen Y, Liu Q, Guo D. Emerging coronaviruses: genome structure, replication, and pathogenesis. J Med Virol. 2020; 92(4): 418-423.
- 9 Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi. 2020; 41(2): 145-151.
- 10Zumla A, Chan JF, Azhar EI, Hui DS, Yuen KY. Coronaviruses—drug discovery and therapeutic options. Nat Rev Drug Discov. 2016; 15(5): 327-347.
- 11Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020; 395: 565-574.
- 12Li X, Zai J, Zhao Q, et al. Evolutionary history, potential intermediate animal host, and cross-species analyses of SARS-CoV-2. J Med Virol. 2020. https://doi.org/10.1002/jmv.25731
- 13Phan T. Genetic diversity and evolution of SARS-CoV-2. Infect Genet Evol. 2020; 81:104260.
- 14Wrapp D, Wang N, Corbett KS, et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. bioRxiv. 2020.
- 15Lam TT-Y, Shum MH-H, Zhu H-C, et al. Identification of 2019-nCoV related coronaviruses in Malayan pangolins in southern China. bioRxiv. 2020.
- 16Ji W, Wang W, Zhao X, Zai J, Li X. Homologous recombination within the spike glycoprotein of the newly identified coronavirus may boost cross-species transmission from snake to human. J Med Virol. 2020; 92: 433-440.
- 17Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020. https://doi.org/10.1056/NEJMoa2001316
- 18Riou J, Althaus CL. Pattern of early human-to-human transmission of Wuhan 2019 novel coronavirus (2019-nCoV), December 2019 to January 2020. Euro Surveill. 2020; 25(4):2000058.
10.2807/1560-7917.ES.2020.25.4.2000058 Google Scholar
- 19Wu JT, Leung K, Leung GM. Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. Lancet. 2020; 395: 689-697.
- 20Liu Y, Gayle AA, Wilder-Smith A, Rocklov J. The reproductive number of COVID-19 is higher compared to SARS coronavirus. J Travel Med. 2020; 27(2), https://doi.org/10.1093/jtm/taaa021
- 21Lai A, Bergna A, Acciarri C, Galli M, Zehender G. Early phylogenetic estimate of the effective reproduction number of SARS-CoV-2. J Med Virol. 2020. https://doi.org/10.1002/jmv.25723
- 22Backer JA, Klinkenberg D, Wallinga J. Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20-28 January 2020. Euro Surveill. 2020; 25(5):2000062.
10.2807/1560-7917.ES.2020.25.5.2000062 Google Scholar
- 23Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020. https://doi.org/10.1001/jama.2020.1585
- 24 Respiratory Care Committee of Chinese Thoracic Society. Expert consensus on preventing nosocomial transmission during respiratory care for critically ill patients infected by 2019 novel coronavirus pneumonia. Zhonghua Jie He He Hu Xi Za Zhi. 2020; 17: E020.
- 25Tong ZD, Tang A, Li KF, et al. Potential presymptomatic transmission of SARS-CoV-2, Zhejiang Province, China, 2020. Emerg Infect Dis. 2020; 26(5), https://doi.org/10.3201/eid2605.200198
- 26Bai SL, Wang JY, Zhou YQ, et al. Analysis of the first cluster of cases in a family of novel coronavirus pneumonia in Gansu Province. Zhonghua Yu Fang Yi Xue Za Zhi. 2020; 54: E005.
- 27Rocklov J, Sjodin H, Wilder-Smith A. COVID-19 outbreak on the Diamond Princess cruise ship: estimating the epidemic potential and effectiveness of public health countermeasures. J Travel Med. 2020. https://doi.org/10.1093/jtm/taaa030
- 28Chen H, Guo J, Wang P, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020; 395: 809-815.
- 29Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol. 2020. https://doi.org/10.1016/j.ajog.2020.02.017
- 30Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020. https://doi.org/10.1056/NEJMoa2002032
- 31Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020; 382: 929-936.
- 32Hoehl S, Berger A, Kortenbusch M, et al. Evidence of SARS-CoV-2 infection in returning travelers from Wuhan, China. N Engl J Med. 2020. https://doi.org/10.1056/NEJMc2001899
- 33Zou L, Ruan F, Huang M, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020; 382(12). https://doi.org/10.1056/NEJMc2001737
- 34National Health Commission of China. The guidelines for diagnosis and treatment of novel coronavirus (2019-nCoV) infected pneumonia (the sixth edition draft) issued by the National Health Commission of China. http://www.gov.cn/zhengce/zhengceku/2020-02/19/content_5480948.htm2020. Accessed February, 2020.
- 35Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395(10223): 507-513.
- 36Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223): 497-506.
- 37Fan C, Li K, Ding Y, Lu W, Wang J. ACE2 expression in kidney and testis may cause kidney and testis damage after 2019-nCoV infection. medRxiv. 2020.
- 38Chai X, Hu L, Zhang Y, et al. Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. bioRxiv. 2020.
- 39Hui DS, Wong PC, Wang C. SARS: clinical features and diagnosis. Respirology. 2003; 8(suppl): S20-S24.
- 40Pan Y, Guan H, Zhou S, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol. 2020. https://doi.org/10.1007/s00330-020-06731-x
- 41Fang Y, Zhang H, Xie J, et al. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology. 2020. https://doi.org/10.1148/radiol.2020200432
- 42Wang M, Wu Q, Xu W, et al. Clinical diagnosis of 8274 samples with 2019-novel coronavirus in Wuhan. medRxiv. 2020. https://doi.org/10.1101/2020.02.12.20022327
- 43Chu DKW, Pan Y, Cheng SMS, et al. Molecular diagnosis of a novel coronavirus (2019-nCoV) causing an outbreak of pneumonia. Clin Chem. 2020. https://doi.org/10.1093/clinchem/hvaa029
- 44Xiao SY, Wu Y, Liu H. Evolving status of the 2019 novel coronavirus infection: proposal of conventional serologic assays for disease diagnosis and infection monitoring. J Med Virol. 2020; 92(5), https://doi.org/10.1002/jmv.25702
- 45Lan L, Xu D, Ye G, et al. Positive RT-PCR test results in patients recovered from COVID-19. JAMA. 2020. https://doi.org/10.1001/jama.2020.2783
- 46Sun ZF, Meng XJ. Antigenic cross-reactivity between the nucleocapsid protein of severe acute respiratory syndrome (SARS) coronavirus and polyclonal antisera of antigenic group I animal coronaviruses: implication for SARS diagnosis. J Clin Microbiol. 2004; 42(5): 2351-2352.
- 47Zhou G, Chi C. A model simulation study on effects of intervention measures in Wuhan COVID-19 epidemic. med Rxiv. 2020. https://doi.org/10.1101/2020.02.14.20023168
- 48Bernard Stoecklin S, Rolland P, Silue Y, et al. First cases of coronavirus disease 2019 (COVID-19) in France: surveillance, investigations and control measures, January 2020. Euro Surveill. 2020; 25(6).
10.2807/1560-7917.ES.2020.25.6.2000094 Google Scholar
- 49Notice on the issuance of strategic guidelines for diagnosis and treatment of novel coronavirus (2019-nCoV) infected pneumonia (first edition draft).
- 50Lim J, Jeon S, Shin HY, et al. Case of the index patient who caused tertiary transmission of COVID-19 infection in Korea: the application of lopinavir/ritonavir for the treatment of COVID-19 infected pneumonia monitored by quantitative RT-PCR. J Korean Med Sci. 2020; 35(6):e79.
- 51Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020; 30: 269-271.
- 52Chu CM, Cheng VC, Hung IF, et al. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax. 2004; 59(3): 252-256.
- 53Vincent MJ, Bergeron E, Benjannet S, et al. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virol J. 2005; 2: 69.
- 54Sheahan TP, Sims AC, Graham RL, et al. Broad-spectrum antiviral GS-5734 inhibits both epidemic and zoonotic coronaviruses. Sci Transl Med. 2017; 9(396), https://doi.org/10.1126/scitranslmed.aal3653
- 55Warren TK, Jordan R, Lo MK, et al. Therapeutic efficacy of the small molecule GS-5734 against Ebola virus in rhesus monkeys. Nature. 2016; 531(7594): 381-385.
- 56Xia S, Yan L, Xu W, et al. A pan-coronavirus fusion inhibitor targeting the HR1 domain of human coronavirus spike. Sci Adv. 2019; 5(4), https://doi.org/10.1126/sciadv.aav4580
- 57Li XY, Du B, Wang YS, et al. The keypoints in treatment of the critical coronavirus disease 2019 patient. Zhonghua Jie He He Hu Xi Za Zhi. 2020; 43: E026.
- 58Bai Y, Yao L, Wei T, et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA. 2020. https://doi.org/10.1001/jama.2020.2565
- 59Liu WJ, Zhao M, Liu K, et al. T-cell immunity of SARS-CoV: implications for vaccine development against MERS-CoV. Antiviral Res. 2017; 137: 82-92.
- 60Chen WH, Du L, Chag SM, et al. Yeast-expressed recombinant protein of the receptor-binding domain in SARS-CoV spike protein with deglycosylated forms as a SARS vaccine candidate. Hum Vaccin Immunother. 2014; 10(3): 648-658.
- 61Yu F, Du L, Ojcius DM, Pan C, Jiang S. Measures for diagnosing and treating infections by a novel coronavirus responsible for a pneumonia outbreak originating in Wuhan, China. Microbes Infect. 2020; 22(2), https://doi.org/10.1016/j.micinf.2020.01.003
- 62Chen Q, Liang M, Li Y, et al. Mental health care for medical staff in China during the COVID-19 outbreak. Lancet. 2020; 7(4), https://doi.org/10.1016/S2215-0366(20)30078-x
- 63Chen J. Pathogenicity and transmissibility of 2019-nCoV—a quick overview and comparison with other emerging viruses. Microbes Infect. 2020; 22(2), https://doi.org/10.1016/j.micinf.2020.01.004
- 64Zhao S, Lin Q, Ran J, et al. Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: a data-driven analysis in the early phase of the outbreak. Int J Infect Dis. 2020; 92: 214-217.
- 65Hui DSC, Zumla A. Severe acute respiratory syndrome: historical, epidemiologic, and clinical features. Infect Dis Clin North Am. 2019; 33(4): 869-889.
- 66Cao C, Chen W, Zheng S, Zhao J, Wang J, Cao W. Analysis of spatiotemporal characteristics of pandemic SARS spread in Mainland China. BioMed Res Int. 2016; 2016:7247983.
- 67Hui DS. Epidemic and emerging coronaviruses (severe acute respiratory syndrome and Middle East respiratory syndrome). Clin Chest Med. 2017; 38(1): 71-86.
- 68de Wit E, van Doremalen N, Falzarano D, Munster VJ. SARS and MERS: recent insights into emerging coronaviruses. Nat Rev Microbiol. 2016; 14(8): 523-534.
- 69Judson SD, Munster VJ. Nosocomial transmission of emerging viruses via aerosol-generating medical procedures. Viruses. 2019; 11(10): 940.
- 70Sharif-Yakan A, Kanj SS. Emergence of MERS-CoV in the Middle East: origins, transmission, treatment, and perspectives. PLoS Pathog. 2014; 10(12):e1004457.
- 71Aevermann BD, Pickett BE, Kumar S, et al. A comprehensive collection of systems biology data characterizing the host response to viral infection. Sci Data. 2014; 1:140033.
- 72Malik YS, Sircar S, Bhat S, et al. Emerging novel coronavirus (2019-nCoV)—current scenario, evolutionary perspective based on genome analysis and recent developments. Vet Q. 2020; 40: 68-76.
- 73Guan W-J, Ni Z-Y, Hu Y, et al. Clinical characteristics of 2019 novel coronavirus infection in China. medRxiv. 2020.
- 74Peiris JS, Lai ST, Poon LL, et al. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet. 2003; 361(9366): 1319-1325.
- 75Leung WK, To KF, Chan PK, et al. Enteric involvement of severe acute respiratory syndrome-associated coronavirus infection. Gastroenterology. 2003; 125(4): 1011-1017.
- 76GENG QS. Guidelines for the prevention and treatment of SARS. Dongguan Sci Technol J. 2003; 5: 7.
- 77Chau TN, Lee KC, Yao H, et al. SARS-associated viral hepatitis caused by a novel coronavirus: report of three cases. Hepatology. 2004; 39(2): 302-310.
- 78Du HWQ, Ma Y. Analysis of SARS inpatients in Beijing in 2003. Chin Gen Pract 2004; 7(4): 231-232.
- 79Assiri A, Al-Tawfiq JA, Al-Rabeeah AA, et al. Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study. Lancet Infect Dis. 2013; 13(9): 752-761.
- 80Hijawi B, Abdallat M, Sayaydeh A, et al. Novel coronavirus infections in Jordan, April 2012: epidemiological findings from a retrospective investigation. East Mediterr Health J. 2013; 19(suppl 1): S12-S18.
- 81Assiri AM, Mcgeer A, Perl TM, et al. Hospital outbreak of Middle East respiratory syndrome coronavirus. N Engl J Med. 2013; 369: 407-416.
- 82State of knowledge and data gaps of Middle East respiratory syndrome coronavirus (MERS-COV) in humans. PLoS Curr. 2013; 5.
- 83Guery B, Poissy J, el Mansouf L, et al. Clinical features and viral diagnosis of two cases of infection with Middle East respiratory syndrome coronavirus: a report of nosocomial transmission. Lancet. 2013; 381(9885): 2265-2272.
- 84Memish ZA, Zumla AI, Al-Hakeem RF, Al-Rabeeah AA, Stephens GM. Family cluster of Middle East respiratory syndrome coronavirus infections. N Engl J Med. 2013; 368(26): 2487-2494.
- 85 National Health and Family Planning Commission of People's Republicao of China. Diagnosis and treatment plan for Middle East respiratory syndrome cases (2015 edition). Virologica Sinica. 2015;(5):352354.
- 86Lee JY, Kim YJ, Chung EH, et al. The clinical and virological features of the first imported case causing MERS-CoV outbreak in South Korea, 2015. BMC Infect Dis. 2017; 17(1): 498.
- 87 World Health Organization. WHO MERS global summary and assessment of risk. https://www.who.int/csr/disease/coronavirus_infections/risk-assessment-august-2018.pdf. Accessed July, 2019.
- 88Wong RS, Wu A, To KF, et al. Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis. BMJ. 2003; 326(7403): 1358-1362.
- 89Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus AD, Fouchier RA. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med. 2012; 367(19): 1814-1820.
- 90Drosten C, Seilmaier M, Corman VM, et al. Clinical features and virological analysis of a case of Middle East respiratory syndrome coronavirus infection. Lancet Infect Dis. 2013; 13(9): 745-751.
- 91Dyall J, Gross R, Kindrachuk J, et al. Middle East respiratory syndrome and severe acute respiratory syndrome: current therapeutic options and potential targets for novel therapies. Drugs. 2017; 77(18): 1935-1966.
- 92Chan PK, Tang JW, Hui DS. SARS: clinical presentation, transmission, pathogenesis and treatment options. Clin Sci. 2006; 110(2): 193-204.