Some findings from @WHO #China report (1/n): #COVID19 is transmitted via droplets and fomites during close unprotected contact. Airborne spread has not been reported and it is not believed to be a major driver of transmission who.int/docs/default-s…
2/n: Fecal shedding has been demonstrated from some patients, and viable virus has been identified in a limited number of case reports. However, the fecal-oral route does not appear to be a driver of COVID-19 transmission.
3/n: In China, human-to-human transmission is largely occurring in families. Among 344 clusters involving 1308 cases most (78%-85%) occurred in families. Preliminary studies estimate the secondary attack rate in households ranges from 3-10%.
4/n: In Wuhan more than 1800 teams of epidemiologists, with a minimum of 5 people/team, are tracing tens of thousands of contacts a day [Wow!]. Between 1% and 5% of contacts were subsequently laboratory confirmed cases of COVID-19, depending on location.
5/n: In Wuhan, COVID-19 testing of ILI samples (20/week) in Nov and Dec 2019 and first two weeks of Jan 2020 found no pos results in 2019, 1 adult pos in 1st week of Jan, and 3 adults pos in 2nd week of Jan; all children tested were negative.
6/n: The cordon sanitaire around Wuhan and neighboring municipalities imposed since 23 January 2020 effectively prevented further exportation of infected individuals to the rest of the country.
7/n: As of 20 February 2020, there were 2,055 COVID-19 laboratory-confirmed cases reported among HCW from 476 hospitals across China. The majority of HCW cases (88%) were reported from Hubei.
8/n: 40,000+ HCW deployed from other areas to Wuhan. Trnsmsn in health care settings not a major feature. Most HCW infections identified early in outbreak when supplies and experience were lower. Many HCW may have been infected in household rather than health care setting.
9/n: Children only 2.4% of all reported cases. Infected children largely identified through contact tracing in households of adults. Interviewees could not recall episodes in which transmission occurred from a child to an adult.
10/n: Mean incubation period 5-6 days (range 1-14 days). 80% of laboratory confirmed patients have had mild/moderate disease, 13.8% have severe disease, 6.1% are critical. Asymptomatic infection relatively rare and does not appear to be a major driver of transmission.
11/n: 2114/55,924 lab confirmed cases died (CFR 3.8%). 5.8% in Wuhan vs. 0.7% in other areas. 17.3% with symptom onset 1- 10 Jan; 0.7% with symptom onset after 1 Feb. 80+ y.o. CFR 21.9%. Males vs. females, 4.7% vs. 2.8%. No comorbid conditions had CFR 1.4%.
12/n: Median time from symptom onset to laboratory confirmation nationally decreased from 12 days in early Jan to 3 days by early Feb. This has allowed for earlier case and contact identification, isolation and treatment.
13/n: Median from onset to clinical recovery for mild cases is approximately 2 weeks and is 3-6 weeks for patients with severe or critical dz. Time from onset to severe disease is 1 week. Among patients who died, time from symptom onset to outcome ranges 2-8 weeks.
14/n: China rolled out perhaps most ambitious, agile and aggressive disease containment effort in history. A science and risk-based approach was taken to tailor implementation. Containment measures were adjusted to the provincial, county and community context.
15/n: A relentless focus on improving key performance indicators, for example constantly enhancing speed of case detection, isolation and early treatment. Implementation supported and enabled by the innovative and aggressive use of cutting edge technologies.
16/n: ...deep commitment of Chinese people to collective action in face of common threat. ...remarkable solidarity of provinces and cities in support of most vulnerable populations and communities. Chinese people reacted to this outbreak with courage and conviction.
17/n: COVID-19 virus is unique among human coronaviruses in its combination of high transmissibility, substantial fatal outcomes in some high-risk groups, and ability to cause huge societal and economic disruption.
18/n: 3. Global community is not yet ready, in mindset and materially. Fundamental: extremely proactive surveillance, very rapid diagnosis, immediate isolation, rigorous tracking and quarantine of contacts, exceptionally high degree of population understanding and acceptance.
