key: cord-0720685-h13v8i14
authors: Du, Wenjun; Han, Shaolei; Li, Qiang; Zhang, Zhongfa
title: Epidemic update of COVID-19 in Hubei Province compared with other regions in China
date: 2020-04-20
journal: International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
DOI: 10.1016/j.ijid.2020.04.031
sha: dee3d174fc94a900e7f001f6771c64ded546be36
doc_id: 720685
cord_uid: h13v8i14

Abstract Aims & Background The COVID-19 outbreak spread in China and is a threat to the world. The aims of this study to help health workers better understand the epidemic of the COVID-19 and provide different control strategies toward Hubei Province and other regions in China. Methods A comprehensive search of the Chinese Center for Disease Control and Prevention official websites and announcements was performed between 20 Jan 2019 and 29 Feb 2020. The relevant data of the distribution of the infection on each reported day were obtained. Results& findings Up to 29 Feb 2020, 79,824 confirmed cases with the COVID-19 including 66,907 in Hubei Province and 12,377 in other administrative regions were reported. The SARS-COV-2 showed faster epidemic trends compared with the 2003-SARS-CoV. A total of 2,870 deaths have been reported nationwide among 79,824 confirmed cases, with a mortality of 3.6%. The mortality of the COVID-19 was significantly higher in Hubei Province than that in other regions(4.1% versus 0.84%). Since 1 Feb 2020 the number of discharged cases exceeded the number of the dead. By 29 Feb 2020, the number of discharged patients was 41,625, which exceeded the number of hospitalized patients, and the trend has further increased. Conclusions The infection of the SARS-COV-2 is spreading and increasing nationwide, and Hubei Province is the main epidemic area, with higher mortality. The outbreak is now under initial control especially in other regions outside of Hubei Province. Due to the different epidemic characteristics between Hubei Province and other regions, we should focus on different prevention and control strategies.

Since the first atypical pneumonia case, caused by a novel coronavirus was reported in Wuhan, China on December 31, 2019 [1] , the novel cases were also reported in Thailand, Japan, the Republic of Korea, Hong Kong, Taiwan, the US, and some countries in Europe [2] . The outbreak is still on-going.

A coronavirus was soon identified as the cause of the outbreak and tentatively named as the 2019-nCoV by the World Health Organization (WHO) [3] . On 11 Feb 2020, the World Health Organization officially named it SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2)and the SARS-CoV-2 infection was named (Coronavirus disease 2019) [4] . Coronaviruses are enveloped non-segmented positive-sense RNA viruses belonging to the family J o u r n a l P r e -p r o o f 5 Coronaviridae. Most human coronavirus infections are mild, except for two beta-coronaviruses, the severe acute respiratory syndrome coronavirus (SARS-CoV) [5] [6] [7] and the Middle East respiratory syndrome coronavirus (MERS-CoV), [8, 9] which have caused more than 10,000 cumulative cases in the past, with mortality rates of 10% for the SARS-CoV and 37% for the MERS-CoV. [10, 11] The SARS-CoV-2 infectious pneumonia has similar clinical features including fever, cough, and shortness of breath [12, 13] to SARS-CoV infectious pneumonia.

However, current trends suggest that the SARS-CoV-2 is more transmissible and spreads faster than the SARS-CoV and the MERS-CoV.

In this study, we analyzed and compared the epidemic features of the COVID-19 in Hubei Province and other regions in China. We further explored the differences between regions to better understand the epidemic of the COVID-19 and provide different control strategies toward Hubei Province and other regions in China.

A comprehensive search of the Chinese Center for Disease Control and Prevention official websites and announcements [14] was performed between 20 Jan 2020 and 29 Feb 2020. The relevant data of the distribution of infection on each reported day were obtained. [15] (Fig.1) The differences suggested that the SARS-CoV-2 is more infectious and transmittable compared with the SARS-CoV.

Since the Chinese national health commission announcements of confirmed and suspected cases on 20 Jan 2020, the number of confirmed cases has continued to increase, especially in Hubei Province. By 29 Feb 2020, the total number of confirmed cases in China had reached 79,824, including 66,907 in Hubei Province, with Wuhan having 41,625 confirmed cases( Fig.2 and 3) . However, the growth rate began to decrease on 27 Jan 2020 and has continued to decline over the past days after rebounding on 14 Feb 2020, and fell earlier in other regions than in Hubei Province. At present, the growth rate of confirmed cases is 0.01% nationwide while the growth rate is significantly higher in Hubei Province than in other regions(0.09% versus 0.00%)(( Fig.2 and 4 ).

The number of suspected patients is also declining. By 29 Feb 2020, the total number of suspected cases was 851 in China including 646 in Hubei Province (Fig.5 ). The number of suspected patients and the growth rate of increased suspected patients were significantly higher in Hubei Province than that in other regions( Fig.5and 6 ).The number of suspected patients began to decline in Hubei Province from 9 Feb 2020 and in other regions from 14 Feb 2020 after slowly increasing (Fig.5 ).

Of the 79,824, confirmed cases, 2,870 deaths were reported nationwide J o u r n a l P r e -p r o o f 8 by 29 Feb 2020, with a mortality of 3.6%, while the mortality was 4.1%(2,761/66,907) and 0.84%(109/12,917) in Hubei Province and other regions nationwide, respectively (Fig.7) . The mortality of the COVID-19 was significantly increased in Hubei Province compared with other regions nationwide.

More patients admitted to hospitals for treatment were discharged than died since 1 Feb 2020, and the trend has significantly increased (Fig.8) .By 29 Feb 2020, the number of discharged patients was 41,625, which has exceeded the number of hospitalized patients. This change suggested initial control of the outbreak and further enhanced confidence in fighting the disease.

Since the first official announcement on 31 Dec 2019 by the Wuhan Municipal Health Commission. [1] The infection quickly spread in China, and internationally. WHO defined it as a Public Health Emergency of International Concern (PHEIC)on 31 January 2020.The pathogen was soon isolated from apatient's alveolar lavage and identified as a novel coronavirus. [16] The human Severe Acute Respiratory Syndrome (SARS) virus, the Middle Eastern Respiratory Syndrome (MERS) virus, and the SARS-CoV-2 all belong to beta-CoVs. Bat coronavirus (BCoV) and the SARS-CoV-2 share 96.2% sequence identity, confirming that SARS-CoV-2 has a zoonotic origin. [17, 18] R 0 is an indication of the transmissibility of a virus, representing the average number of new infections generated by an infectious person in a totally naïve population. R 0 estimates for SARS were reported to range between 2-5. Different mathematical methods used to estimate R 0 for SARS-COV-2 produced a range from 1.5 to 6.49 based on different epidemic stages. [19] [20] [21] [22] [23] The most prominent area of Hubei Province is Wuhan with 49,122 cases, which suggested that mass outbreak of COVID-19 and community spread in Wuhan. A previous report indicated that among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city, [24] which suggested that it was mostly associated to Feb 2020 because test reagents for RT-PCR assay began to be widely used in Hubei Province along with lung CT as the diagnostic criteria. This did not represent a large number of patients in a mass outbreak on 14 Feb 2020, and the decrease in the rate of confirmed patients before the 14 Feb 2020 was an illusion due to a lack of enough test reagents. Also, suspected cases began to significantly decrease from 14 Feb 2020 because suspected cases were confirmed or ruled out by test reagents widely used and the new diagnostic criteria of lung CT.

According to a recent report by the Chinese Center for Disease Control and Prevention, the overall mortality was 2.3% and non-co-morbidity mortality was 0.9% in patients with COVID-19, [25] which is lower than SARS and MERS. The mortality of the COVID-19 was significantly higher in Hubei Province than other regions nationwide(4.1% versus 0.84%). This may be because of the following factors: 1) the virulence and pathogenicity of the virus decreased in the 2nd and 3rd generation of transmission [26] , 2)a significant number of mild and asymptomatic patients did not seek medical attention, 3)early patients cannot be confirmed due to lacking the nucleic acid test, and 4)some severe patients with co-morbidity lost the opportunity for timely treatment due to insufficient medical resources in the early days of the epidemic. So, the high mortality in Hubei Province may be overestimated and mortality of other regions should better reflect the pathogenicity of the COVID-19.

The good news is that since 1Feb 2020 the number of recovered cases has exceeded the number of deaths, and the number of discharged patients has exceeded the number of hospitalized patients and this trend has further increased over the past days, which suggests initial control of the outbreak and has enhanced confidence in fighting the disease.

Initially, the lack of disease awareness and inappropriate prevention and control led to a rapid epidemic of infections in Hubei Province, and the emergence of 2nd and 3rd-generation infections and community spread. 

Thanks to Dr. Edward C. Mignot, Shandong University, for linguistic advice.

DWJ and HSL had full access to all data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. LQ had the idea of and designed the study. ZZF contributed to reviewed and approved the final version.

The authors have no conflicts of interest to disclose.

Approval was not required. The number of discharged cases exceeds the number of the dead.

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