Name: Chico, James Knowell E.

Block: 7

Title: High Contagiousness and Rapid Spread of Severe Acute Respiratory Syndrome
Coronavirus 2

1. Research Design
The research design is of cross-sectional cohort type. The researchers aimed to
estimate key epidemiologic parameters and provide a new estimate of the early
epidemic growth rate and R0 (basic reproductive rate) in Wuhan, China.

2. Identified variables and their categories

VARIABLE SPECIFICS
Province/City/Country qualitative, nominal, independent, exposure
Age qualitative, ordinal, independent, exposure
Gender qualitative, nominal, independent, exposure
First day of exposure in Wuhan quantitative, interval, independent, exposure
Last day of exposure in Wuhan quantitative, interval, independent, exposure
[Date of] Departure from Wuhan quantitative, interval, independent, exposure
Onset date [incubation period] quantitative, interval, dependent, outcome
Hospitalization date quantitative, interval, dependent, outcome
Confirmation date quantitative, interval, dependent, outcome
Date of discharge or death quantitative, interval, dependent, outcome
Date quantitative, interval, independent, exposure
Emigration index quantitative, ratio, dependent, exposure
Immigration index quantitative, ratio, dependent, exposure
Total population size out of Wuhan quantitative, ratio, dependent, exposure
Fraction to other provinces quantitative, ratio, dependent, exposure
Population exported out of Hubei from
quantitative, ratio, dependent, exposure
Wuhan
Total population size in Wuhan quantitative, ratio, dependent, exposure
Estimated # of individuals who traveled
from Wuhan to provinces outside of quantitative, ratio, dependent, exposure
Hubei
Scenario # qualitative, ordinal, independent, exposure
Detection start quantitative, interval, independent, exposure
Detection probability (minimum,
quantitative, ratio, independent, exposure
maximum)
Total predicted infected cases (infected
quantitative, interval, dependent, outcome
individuals in Wuhan)
Growth rate of the number of daily new
quantitative, ratio, dependent, outcome
deaths (log scale)
r (exponential growth rate of the
quantitative, ratio, dependent, outcome
outbreak)
t0 (theoretical time of the exponential quantitative, ratio, dependent, outcome
 growth initiation)
l* (total infected population,
asymptomatic or symptomatic [in quantitative, ratio, dependent, outcome
Wuhan])
1/σ (mean latent period) quantitative, ratio, dependent, outcome
1/γ (mean infectious period) quantitative, ratio, dependent, outcome
R0 (basic reproductive number) quantitative, ratio, dependent, outcome

3. Statistical tests used in the study and the specific purpose of the study.
 Mann–Whitney U test
- a.k.a. Wilcoxon Rank-Sum Test or Wilcoxon Mann-Whitney Test
- used in the study to compare the time from symptom onset to hospitalization
- results showed evidence of time dependence
o before January 18, the time from symptom onset to hospitalization
was 5.5 days (95% CI 4.6–6.6 days)
o after January 18, the duration shortened significantly to 1.5 days
(95% CI 1.2–1.9 days) (p<0.001)
o The change in the distribution coincides with news reports of potential
human-to-human transmission (this was during January 2020, where
the virus was still relatively new)
 Kolmogorov-Smirnov goodness-of-fit test (GoF test p-value)
- to determine the sensitivity of the ‘first arrival model’ used in the study to
changes in surveillance intensity under two assumptions
- assumption #1: a constant fraction of infected were not detected
o under this assumption, t0 would be earlier than the researchers’
estimate [earlier than December 20, 2019 (95% Cl December 11–26)],
but r remained the same [shown in Appendix 1 Table 4].
- assumption #2: the intensity of surveillance increases over the period of data
collection
o under this assumption, the researchers would have predicted a lower
r than the estimate we just described (0.21–0.30/day across all
scenarios [shown in Appendix 1 Table 4 and Appendix B])

Notes:

 The researches aimed to estimate key epidemiologic parameters and provide a new
estimate of the early epidemic growth rate and R0 Wuhan,
 Their approaches are based on integration of high-resolution domestic travel data and
early infection data reported in Wuhan (such as analysis on collected expanded set of
case reports across China on the basis of publicly available information)
 provinces other than Hubei to infer outbreak dynamics in Wuhan
  The researches have estimated the following basic epidemiologic parameters of SARS-
CoV-2:
o the incubation period
 4.2 days
o a time-dependent duration from symptom onset to hospitalization
 from 5.5 days in early January to 1.5 days in late January outside Hubei
Province
o time from symptom onset to death
 16.1 days
 By using two distinct approaches, the researchers have estimated the growth rate of the
early outbreak in Wuhan to be 0.21–0.30 per day (a doubling time of 2.3–3.3 days),
suggesting that the rate of spread of the pathogen is much faster than initially measured
(0.1–0.14 per day with a doubling time of 6–7 days), suggesting a much faster rate of
spread than initially measured.
 Given their current state of knowledge, the researchers have found R0 is likely to be 5.7
(95% CI 3.8–8.9), which is significantly higher than initially estimated (2.2 to 2.7).
 “The lack of awareness of this new pathogen and the Lunar New Year travel and
gathering in early and mid-January 2020 might or might not play a role in the high R0.”

Reference:

Sanche S, Lin YT, Xu C, Romero-Severson E, Hengartner N, Ke R. High contagiousness and

rapid spread of severe acute respiratory syndrome coronavirus 2. Emerg Infect Dis. 2020 April
16. https://doi.org/10.3201/eid2607.200282