The 2019 novel coronavirus (2019-nCoV) might have infected at least 500,000 people in Wuhan, the Chinese city at the epicenter of the global outbreak, by the time it peaks in coming weeks, but most of those people are not likely to know it.
The typically bustling megacity, where the virus emerged late last year, has been in effective lockdown since Jan. 23, restricting the movement of 11 million people. Recent trends in reported cases in Wuhan broadly support the preliminary mathematical modeling the London School of Hygiene & Tropical Medicine is using to predict the epidemic’s transmission dynamics.
“Assuming current trends continue, we’re still projecting a mid-to-late-February peak” of 2019-nCoV cases in Wuhan, Adam Kucharski, an associate professor of infectious disease epidemiology at the school, said by e-mail on Sunday. “There’s a lot of uncertainty, so I’m cautious about picking out a single value for the peak, but it’s possible based on current data we might see a peak prevalence over 5 percent.”
That would potentially mean at least one in 20 people would have been infected in the city by the time the epidemic peaks, Kucharski said, adding that this might change if transmission patterns slow in coming days.
The prediction does not indicate a coming surge in cases in Wuhan, but that the current cumulative total does not reflect all infections, especially mild ones, that have occurred.
Health authorities in China and around the world are anxiously waiting to know whether the world’s largest known quarantine effort has been effective in slowing the spread of the pneumonia-causing virus in Wuhan and across other cities in Hubei Province, a landlocked region of 60 million people.
Kucharski, whose research focuses on the dynamics of infectious diseases, and colleagues have based their modeling on a range of assumptions about 2019-nCoV. These include an incubation period of 5.2 days, a delay from the onset of symptoms to confirmation of infection of 6.1 days, and about 10 million people being at risk of infection in Wuhan.
Based on that, a prevalence of 5 percent equates to about 500,000 cumulative infections. That is many times more than the 16,902 cases provincial health authorities had counted in Wuhan as of midnight on Sunday.
Researchers are to gauge the proportion of people in the population who have been infected with 2019-nCoV after a test becomes available that enables them to conduct a serosurvey to identify those whose blood contains antibodies produced in response to exposure to the virus.
By comparison, about 10 percent of the population are usually infected with influenza during severe epidemics, and typically 1 to 2 percent catch the respiratory virus in a normal year, said Ian Barr, deputy director of the WHO’s Collaborating Center for Reference and Research on Influenza in Melbourne.
Currently, the true number of people exposed to the virus in Wuhan “may be vastly underestimated,” Manuel Battegay and colleagues at the University of Basel in Switzerland said in a study published on Friday. “With a focus on thousands of serious cases, mild or asymptomatic courses that possibly account for the bulk of the 2019-nCoV infections might remain largely unrecognized, in particular during the influenza season.”
Official statistics are likely a “severe underestimate of the total,” Battegay and colleagues said, adding that “accounting for this underestimate will decrease the case fatality rate.”
Once researchers understand the full spectrum of illness associated with the virus, the overall case-fatality risk is likely to be much less than 1 percent, said Ian Lipkin, director of the Center for Infection and Immunity at Columbia University’s Mailman School of Public Health in New York.
A slowdown in the increase in reported cases over the past few days is “meaningful,” Lipkin said.
If measures taken so far to contain the outbreak are effective, some “dramatic reductions” in infections should be observed in the third or fourth weeks of February, he said.
Warmer, early-spring weather might also impede transmission, he said.
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