key: cord-0990797-acmfhbtm authors: Xu, Liangde; Yuan, Jian; Zhang, Yaru; Zhang, Guosi; Lu, Fan; Su, Jianzhong; Qu, Jia title: Highland of COVID-19 outside Hubei: epidemic characteristics, control and projections of Wenzhou, China date: 2020-02-29 journal: nan DOI: 10.1101/2020.02.25.20024398 sha: da5ecffba8c5d1b7afee057ff61149fb976501ce doc_id: 990797 cord_uid: acmfhbtm In late December 2019, Chinese authorities reported a cluster of pneumonia cases of unknown aetiology in Wuhan, China. Wenzhou, as a southeast coastal city with the most cases outside Hubei Province, its policy control and epidemic projections have certain references for national and worldwide epidemic prevention and control. The maximum number of illness onset in Wenzhou appeared on January 26 (38 cases). Since January 27, the incidence per day in Wenzhou has continued to decline is likely to be due to isolation of people return to Wenzhou, implementation of region quarantine and suspension of public transportation system. Under the current control efforts, we estimate that the daily incidence by March 3-9, 2020 will drop to 0 in Wenzhou using SEIR model. The total number of affected people is 538. In late December 2019, Chinese authorities reported a cluster of pneumonia cases of unknown aetiology in Wuhan, China 1 . A novel strain of coronavirus named Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was isolated and identified on 2 January 2020 2 . Human-to-human transmission have been confirmed by a study of a family cluster and have occurred in health-care workers 3, 4 . Until 10 February 2020, 42638 cases of 2019 novel coronavirus disease (COVID-19) have been confirmed in China, of which 31728 came from Hubei Province (Figure) . Wenzhou, as a southeast coastal city with the most cases outside Hubei Province, its policy control and epidemic projections have certain references for national and worldwide epidemic prevention and control. We described the epidemiologic characteristics of COVID-19 in Wenzhou and made a transmission model to predict the expected number of cases in the coming days. In this epidemiologic and modelling study, we first gathered transmission data for 434 confirmed COVID-19 patients in the ongoing Wenzhou outbreak from the the National Health Commission of the People's Republic of China and the Health Commission of Wenzhou by February 10, 2020. We then investigate a deterministic (susceptible-exposed-infectious-recovered) SEIR compartmental model based on the clinical progression of the disease, epidemiological status of the individuals, and the intervention measures to inferred the basic reproductive number of SARS-CoV-2 and the transmission among Wenzhou and three prefecture-level cities. Finally, we forecasted and compared the spread of SARS-CoV-2 across Wenzhou (Southeastern), Shenzhen (Southern), Zhengzhou (Central) and Harbin (Northern), accounting for the effect of the Wenzhou quarantine implemented since Jan 27, 2020 and other interventions. see https://github.com/ZhangBuDiu/WZ_COVID-19 for R code, case data, and prepared datafiles. All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.02.25.20024398 doi: medRxiv preprint A total of 434 incidence, 31 severe case, 99 hospital discharges and 5304 probable COVID-19 cases were reported before February 10, 2020, and 168 patients who visited Wuhan after the onset of the SARS-CoV-2 epidemic. The median age of persons with COVID-19 was 47 years; 48 cases (11.1%) occurred in persons 65 years of age or older, and 5 (1.2%) were in children younger than 15 years of age (Table) . The maximum number of illness onset in Wenzhou appeared on January 26 (38 cases). Since January 27, the incidence per day in Wenzhou has continued to decline is likely to be due to isolation of people return to Wenzhou, implementation of region quarantine and suspension of public transportation system. Under the current control efforts, we estimate that the daily incidence by March 3-9, 2020 will drop to 0 in Wenzhou using SEIR model. The total number of affected people is 538 (95% CI: 534-542 Although the current epidemic of SARS-CoV-2 in China is unprecedented in scale, clinical presentations greatly resemble SARS-CoV. The higher number of infections may be due to the late identification of pathogens, the host's ability to hide infection symptoms and high transport capacity of China. As we known, estimate of epidemic dynamics and predictions are of crucial importance for public health planning and control measurement 5, 6 . In this study, we provide an assessment of the transmission dynamics and predictions of the future spread of COVID-19 All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.02.25.20024398 doi: medRxiv preprint among four cities. Forward projections suggest that the Wenzhou and Shenzhen epidemic will end before Zhengzhou and Harbin, which result from substantial and draconian measures that limit population movements and drastically reduce within-population contact rates, such as greater community engagement, cancellation group gatherings, school closures, and work-fromhome arrangements. All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.02.25.20024398 doi: medRxiv preprint author/funder, who has granted medRxiv a license to display the preprint in perpetuity. author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.02.25.20024398 doi: medRxiv preprint author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org/10.1101/2020.02.25.20024398 doi: medRxiv preprint A novel coronavirus genome identified in a cluster of pneumonia cases-Wuhan A novel coronavirus from patients with pneumonia in China Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. The Lancet Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. The Lancet Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint (which was not peer-reviewed) is the