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2.
Med J Aust ; 216(1): 39-42, 2022 01 17.
Article in English | MEDLINE | ID: covidwho-1463976

ABSTRACT

OBJECTIVE: To estimate the numbers of COVID-19-related hospitalisations in Australia after re-opening the international border. DESIGN: Population-level deterministic compartmental epidemic modelling of eight scenarios applying various assumptions regarding SARS-CoV-2 transmissibility (baseline R0 = 3.5 or 7.0), vaccine rollout speed (slow or fast), and scale of border re-opening (mean of 2500 or 13 000 overseas arrivals per day). SETTING: Simulation population size, age structure, and age-based contact rates based on recent estimates for the Australian population. We assumed that 80% vaccination coverage of people aged 16 years or more was reached in mid-October 2021 (fast rollout) or early January 2022 (slow rollout). MAIN OUTCOME MEASURES: Numbers of people admitted to hospital with COVID-19, December 2021 - December 2022. RESULTS: In scenarios assuming a highly transmissible SARS-CoV-2 variant (R0  = 7.0), opening the international border on either scale was followed by surges in both infections and hospitalisations that would require public health measures beyond mask wearing and social distancing to avoid overwhelming the health system. Reducing the number of hospitalisations to manageable levels required several cycles of additional social and mobility restrictions. CONCLUSIONS: If highly transmissible SARS-CoV-2 variants are circulating locally or overseas, large and disruptive COVID-19 outbreaks will still be possible in Australia after 80% of people aged 16 years or more have been vaccinated. Continuing public health measures to restrict the spread of disease are likely to be necessary throughout 2022.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/statistics & numerical data , Communicable Diseases, Imported/epidemiology , Disease Outbreaks , Hospitalization/statistics & numerical data , Adolescent , Adult , Aged , Australia/epidemiology , COVID-19/prevention & control , COVID-19/virology , Communicable Disease Control/methods , Communicable Diseases, Imported/virology , Computer Simulation , Female , Humans , Male , Middle Aged , SARS-CoV-2 , Vaccination Coverage/statistics & numerical data , Young Adult
4.
J Med Virol ; 93(9): 5523-5526, 2021 09.
Article in English | MEDLINE | ID: covidwho-1363692

ABSTRACT

The appearance of new variants of SARS-CoV-2 has recently challenged public health authorities with respect to tracking transmission and mitigating the impact in the evolving pandemic across countries. B.1.525 is considered a variant under investigation since it carries specific genetic signatures present in P.1, B.1.1.7, and B.1.351. Here we report genomic evidence of the first likely imported case of the SARS-CoV-2 B.1.525 variant, isolated in a traveler returning from Nigeria.


Subject(s)
COVID-19/virology , Communicable Diseases, Imported/virology , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Aged , Brazil/epidemiology , COVID-19/diagnosis , COVID-19/epidemiology , Communicable Diseases, Imported/diagnosis , Communicable Diseases, Imported/epidemiology , Female , Genome, Viral/genetics , Humans , Mutation , Nigeria/epidemiology , Travel-Related Illness
5.
Emerg Infect Dis ; 27(4): 1249-1251, 2021 04.
Article in English | MEDLINE | ID: covidwho-1145546
6.
Emerg Infect Dis ; 27(4)2021 04.
Article in English | MEDLINE | ID: covidwho-1145545

ABSTRACT

Multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with higher transmission potential have been emerging globally, including SARS-CoV-2 variants from the United Kingdom and South Africa. We report 4 travelers from Brazil to Japan in January 2021 infected with a novel SARS-CoV-2 variant with an additional set of mutations.


Subject(s)
COVID-19/drug therapy , Communicable Diseases, Imported , SARS-CoV-2 , Adult , Basic Reproduction Number , Brazil/epidemiology , COVID-19/epidemiology , COVID-19/therapy , COVID-19/transmission , COVID-19/virology , Communicable Diseases, Imported/epidemiology , Communicable Diseases, Imported/physiopathology , Communicable Diseases, Imported/therapy , Communicable Diseases, Imported/virology , Hospitalization , Humans , Japan/epidemiology , Male , Mutation , Quarantine/methods , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Symptom Assessment/methods , Travel-Related Illness , Treatment Outcome
7.
Medicine (Baltimore) ; 100(11): e24826, 2021 Mar 19.
Article in English | MEDLINE | ID: covidwho-1138014

ABSTRACT

ABSTRACT: Wenzhou had the highest number of confirmed novel coronavirus 2019 (COVID-19) cases outside the Hubei province. The aim of this study was to identify the difference in clinical features and viral RNA shedding between the imported and local COVID-19 cases in Wenzhou.All patients with confirmed COVID-19 admitted to Wenzhou Sixth People's Hospital, Wenzhou Central Hospital Medical Group, from January 17 to February 11, 2020, were enrolled in this study. Data was analyzed and compared for the imported and local cases with regard to epidemiological, demographic, clinical, radiological features, and laboratory findings. Outcomes for the enrolled participants were followed up until May 7, 2020.Of the 136 cases, 50 were imported from Wuhan. The median age was 45 years and 73 (53.7%) were men. The most common symptoms at onset were fever (104 [76.5%]) and cough (85[62.5%]). Pleural effusion was more common among imported cases compared to local cases. The white blood cell count, neutrophil count, lymphocyte count and platelet count of the imported cases were significantly lower than those of the local cases, while the prothrombin time was significantly longer than that of the local cases. Severe and critically ill patients accounted for 15.4% and 2.9%, respectively. The median duration of SARS-CoV-2 RNA shedding from symptom onset was 26 days (IQR 17-32.3 days) and there were no significant differences in duration of viral RNA shedding between the two groups.The study findings suggest that imported cases from Wuhan were more likely to be severe compared to the local cases in Wenzhou. However, there was no difference between imported and local cases on the viral shedding among the COVID patients.


Subject(s)
COVID-19/virology , RNA, Viral , SARS-CoV-2 , Virus Shedding , Adolescent , Adult , Aged , COVID-19/diagnosis , COVID-19/epidemiology , Child , Child, Preschool , China/epidemiology , Communicable Diseases, Imported/epidemiology , Communicable Diseases, Imported/virology , Cough/virology , Critical Illness , Female , Fever/virology , Humans , Hypertension/epidemiology , Male , Middle Aged , Retrospective Studies , Young Adult
9.
Drug Discov Ther ; 15(1): 1-8, 2021 Mar 10.
Article in English | MEDLINE | ID: covidwho-1110629

ABSTRACT

Despite the high number of coronavirus disease-19 (COVID-19) cases from India, there are few reports from India describing the clinical epidemiology of COVID-19. This study aimed to describe the clinical/epidemiological characteristics and outcomes of asymptomatic vs. symptomatic COVID-19 patients. This was a retrospective chart review of all admitted patients with COVID-19 above 18 years with a history of travel within one month of the admission. The patients were categorized into asymptomatic and symptomatic. The symptomatic patients were further classified into mild, moderate and severe. The demographic profile, risk factors, clinical features, laboratory parameters, treatment details and outcome of all patients were recorded. The clinical and laboratory parameters were compared between symptomatic patients and asymptomatic patients. Of the 127 recruited patients, 75 were asymptomatic. Of the 52 symptomatic patients, 41 patients were classified as a mild illness. The mean age of the patients was 44.5 ± 15 years. A total of 73 patients had one or more risk factors. The male patients were more commonly found to be symptomatic compared to female patients. Neutrophil-lymphocyte ratio, C-reactive protein and lactate dehydrogenase were significantly elevated in symptomatic patients. A total of five individuals required supplemental oxygen therapy, and one of them required mechanical ventilation. All the patients had favourable outcomes. Asymptomatic and mild illness form a significant proportion of positive patients and have excellent outcomes without therapeutic interventions.


Subject(s)
Asymptomatic Infections/epidemiology , COVID-19/epidemiology , COVID-19/therapy , Communicable Diseases, Imported/epidemiology , Communicable Diseases, Imported/therapy , Adult , C-Reactive Protein/metabolism , COVID-19/blood , Communicable Diseases, Imported/blood , Communicable Diseases, Imported/virology , Female , Hospitalization/statistics & numerical data , Humans , India/epidemiology , L-Lactate Dehydrogenase/blood , Lymphocyte Count , Male , Middle Aged , Neutrophils/metabolism , Oxygen Inhalation Therapy , Prognosis , Respiration, Artificial , Retrospective Studies , Travel-Related Illness , Young Adult
10.
J Virol Methods ; 289: 114034, 2021 03.
Article in English | MEDLINE | ID: covidwho-1084023

ABSTRACT

As with many countries around the world, Thailand is currently experiencing restrictions to daily life as a consequence of the worldwide transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 is the third respiratory syndrome coronavirus to be introduced into Thailand, following previous importation of cases of the severe acute respiratory syndrome coronavirus (SARS) and the Middle East respiratory syndrome coronavirus (MERS). Unlike SARS and MERS, SARS-CoV-2 was able to establish local transmission in Thailand. In addition to the imported coronaviruses, Thailand has a number of endemic coronaviruses that can affect livestock and pet species, can be found in bats, as well as four human coronaviruses that are mostly associated with the common cold. This article seeks to review what is known on both the endemic and imported coronaviruses in Thailand.


Subject(s)
Coronavirus Infections , Animals , Communicable Diseases, Imported/virology , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Endemic Diseases , Humans , Thailand/epidemiology
12.
Science ; 371(6530): 708-712, 2021 02 12.
Article in English | MEDLINE | ID: covidwho-1066806

ABSTRACT

The United Kingdom's COVID-19 epidemic during early 2020 was one of world's largest and was unusually well represented by virus genomic sampling. We determined the fine-scale genetic lineage structure of this epidemic through analysis of 50,887 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes, including 26,181 from the UK sampled throughout the country's first wave of infection. Using large-scale phylogenetic analyses combined with epidemiological and travel data, we quantified the size, spatiotemporal origins, and persistence of genetically distinct UK transmission lineages. Rapid fluctuations in virus importation rates resulted in >1000 lineages; those introduced prior to national lockdown tended to be larger and more dispersed. Lineage importation and regional lineage diversity declined after lockdown, whereas lineage elimination was size-dependent. We discuss the implications of our genetic perspective on transmission dynamics for COVID-19 epidemiology and control.


Subject(s)
COVID-19/epidemiology , COVID-19/virology , Genome, Viral , SARS-CoV-2/genetics , COVID-19/prevention & control , COVID-19/transmission , Chain of Infection , Communicable Disease Control , Communicable Diseases, Imported/epidemiology , Communicable Diseases, Imported/virology , Epidemics , Humans , Phylogeny , Travel , United Kingdom/epidemiology
13.
Am J Trop Med Hyg ; 104(2): 490-495, 2020 Dec 10.
Article in English | MEDLINE | ID: covidwho-976421

ABSTRACT

As the COVID-19 pandemic continues, there is growing concordance and persisting conflicts on the virus and the disease process. We discuss limited transmissibility of the virus by asymptomatic and mild cases of COVID-19 patients in Bhutan. We followed up the secondary transmission of SARS-CoV-2 in the contacts of asymptomatic and mild COVID-19 patients in Bhutan. Bhutan had 33 confirmed COVID-19 cases in the country as of May 29, 2020. Of these, 22 (67%) were females. Except the first two cases (American tourists), the rest were Bhutanese living outside the country. The mean age of the Bhutanese patients was 26.3 (range 16-33) years. Close contacts of 27 of the 33 cases were followed up for signs and symptoms and COVID-19 positivity. The first two cases had 73 and 97 primary contacts, respectively, and equal number of secondary contacts (224). From the third case, a mandatory 21-day facility quarantine was instituted, all primary contacts were facility quarantined, and there were no secondary contacts. In total, the 27 cases had 1,095 primary contacts and 448 secondary contacts. Of these, 75 individuals were categorized as definite high-risk contacts. Secondary transmission occurred in seven high-risk contacts. Therefore, the overall secondary transmission was 9.0% (7/75) and 0.6% (7/1,095) among the high-risk and primary contacts, respectively. No transmission occurred in the secondary contacts. In contrast to several reports indicating high transmissibility of SARS-CoV-2 in contacts of confirmed cases, the mostly young, asymptomatic, and mild cases of COVID-19 in Bhutan showed limited secondary transmission.


Subject(s)
COVID-19/transmission , Carrier State/virology , Communicable Diseases, Imported/transmission , Communicable Diseases, Imported/virology , Adolescent , Adult , Aged , Bhutan/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Diseases, Imported/epidemiology , Contact Tracing , Female , Humans , Male , Middle Aged , Quarantine , Risk Factors , SARS-CoV-2/pathogenicity , Travel-Related Illness , Young Adult
14.
Nat Commun ; 11(1): 5518, 2020 11 02.
Article in English | MEDLINE | ID: covidwho-899925

ABSTRACT

Full genome sequences are increasingly used to track the geographic spread and transmission dynamics of viral pathogens. Here, with a focus on Israel, we sequence 212 SARS-CoV-2 sequences and use them to perform a comprehensive analysis to trace the origins and spread of the virus. We find that travelers returning from the United States of America significantly contributed to viral spread in Israel, more than their proportion in incoming infected travelers. Using phylodynamic analysis, we estimate that the basic reproduction number of the virus was initially around 2.5, dropping by more than two-thirds following the implementation of social distancing measures. We further report high levels of transmission heterogeneity in SARS-CoV-2 spread, with between 2-10% of infected individuals resulting in 80% of secondary infections. Overall, our findings demonstrate the effectiveness of social distancing measures for reducing viral spread.


Subject(s)
Betacoronavirus/genetics , Communicable Diseases, Imported/virology , Coronavirus Infections/transmission , Genome, Viral/genetics , Pneumonia, Viral/transmission , Adolescent , Adult , Aged , Aged, 80 and over , Base Sequence , Basic Reproduction Number/statistics & numerical data , COVID-19 , Child , Child, Preschool , Communicable Diseases, Imported/epidemiology , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Female , Humans , Infant , Infant, Newborn , Israel/epidemiology , Male , Middle Aged , Pandemics/prevention & control , Phylogeny , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Psychological Distance , RNA, Viral/genetics , SARS-CoV-2 , Sequence Analysis, RNA , United States , Young Adult
15.
Infect Dis Poverty ; 9(1): 143, 2020 Oct 19.
Article in English | MEDLINE | ID: covidwho-874089

ABSTRACT

BACKGROUND: Effective management of imported cases is an important part of epidemic prevention and control. Hainan Province, China reported 168 coronavirus disease 2019 (COVID-19), including 112 imported cases on February 19, 2020, but successfully contained the epidemic within 1 month. We described the epidemiological and clinical characteristics of COVID-19 in Hainan and compared these features between imported and local cases to provide information for other international epidemic areas. METHODS: We included 91 patients (56 imported and 35 local cases) from two designated hospitals for COVID-19 in Haikou, China, from January 20 to February 19, 2020. Data on the demographic, epidemiological, clinical and laboratory characteristics were extracted from medical records. Patients were followed until April 21, 2020, and the levels of antibodies at the follow-ups were also analysed by the Wilcoxon matched-pairs signed ranks test. RESULTS: Of the 91 patients, 78 (85.7%) patients were diagnosed within the first three weeks after the first case was identified (Day 1: Jan 22, 2020), while the number of local cases started to increase during the third week. No new cases occurred after Day 29. Fever and cough were two main clinical manifestations. In total, 15 (16.5%) patients were severe, 14 (15.4%) had complicated infections, nine (9.9%) were admitted to the intensive care unit, and three died. The median duration of viral shedding in feces was longer than that in nasopharyngeal swabs (19 days vs 16 days, P = 0.007). Compared with local cases, imported cases were older and had a higher incidence of fever and concurrent infections. There was no difference in outcomes between the two groups. IgG was positive in 92.8% patients (77/83) in the follow-up at week 2 after discharge, while 88.4% patients (38/43) had a reduction in IgG levels in the follow-up at week 4 after discharge, and the median level was lower than that in the follow-up at week 2 (10.95 S/Cut Off (S/CO) vs 15.02 S/CO, P <  0.001). CONCLUSION: Imported cases were more severe than local cases but had similar prognoses. The level of IgG antibodies declined from week 6 to week 8 after onset. The short epidemic period in Hainan suggests that the epidemic could be quickly brought under control if proper timely measures were taken.


Subject(s)
Communicable Diseases, Imported/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Adult , Aged , Betacoronavirus/isolation & purification , COVID-19 , China/epidemiology , Communicable Diseases, Imported/diagnosis , Communicable Diseases, Imported/therapy , Communicable Diseases, Imported/virology , Coronavirus Infections/virology , Feces/virology , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/virology , Retrospective Studies , SARS-CoV-2 , Thorax/diagnostic imaging , Treatment Outcome , Virus Shedding
17.
Emerg Infect Dis ; 26(9)2020 09.
Article in English | MEDLINE | ID: covidwho-625736

ABSTRACT

An asymptomatic person infected with severe acute respiratory syndrome coronavirus 2 returned to Heilongjiang Province, China, after international travel. The traveler's neighbor became infected and generated a cluster of >71 cases, including cases in 2 hospitals. Genome sequences of the virus were distinct from viral genomes previously circulating in China.


Subject(s)
Betacoronavirus , Communicable Diseases, Imported/epidemiology , Coronavirus Infections/epidemiology , Disease Outbreaks , Pneumonia, Viral/epidemiology , Adult , Aged , Asymptomatic Infections/epidemiology , COVID-19 , China/epidemiology , Communicable Diseases, Imported/transmission , Communicable Diseases, Imported/virology , Coronavirus Infections/transmission , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/transmission , SARS-CoV-2 , Travel
19.
Medicine (Baltimore) ; 99(21): e20370, 2020 May 22.
Article in English | MEDLINE | ID: covidwho-494887

ABSTRACT

To explore the discrepancy in computed tomography (CT) manifestations of the coronavirus disease 2019 (COVID-19) in patients outside the original district (Wuhan, China) between cases with imported infection and second-generation infection, 22 patients with COVID-19 from 2 hospitals in Nanchong, China, 938 km away from the original district (Wuhan, China) of this disease were enrolled. All patients underwent initial and follow-up CT after admission during the treatment, and were divided into 2 groups. Group A and B were composed of 15 patients with a history of exposure to the original district (Wuhan, China) in short-term (i.e., imported infection), and 7 with a close contact with the patients with confirmed COVID-19 or with the healthy individuals from the original district (i.e., second-generation infection), respectively. Initial CT features including extent score and density score between groups were statistically compared. We found that all patients in group A and 3 of 7 patients in group B had abnormal CT findings while 4 of 7 patients in group B had not. Patients with abnormal CT findings were more frequent in group A than in group B (P < .05). On initial CT, pure ground glass opacity (GGO), and GGO with consolidation and/or other abnormalities were found in 20% (3/15) and 80% (12/15) patients in group A, respectively, while 1 (14.3%), 2 (28.6%), and 4 (57.1%) had pure GGOs, GGO with focal consolidation, and normal CT appearances in Group B, respectively. Patients with extent and density scores of ≥5 were more frequent in group A than in group B (all P-values < .01). Additionally, 3 of 4 (75%) patients with normal initial CT findings had focal pure GGO lesions on follow-up. In conclusion, COVID-19 in patients with a history of exposure to the original district can be severer than with the second-generation infection on CT.


Subject(s)
Communicable Diseases, Imported/diagnostic imaging , Communicable Diseases, Imported/virology , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed , Adult , COVID-19 , China , Female , Humans , Male , Middle Aged , Pandemics
20.
Lancet Infect Dis ; 20(8): 920-928, 2020 08.
Article in English | MEDLINE | ID: covidwho-276988

ABSTRACT

BACKGROUND: In December, 2019, the newly identified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, causing COVID-19, a respiratory disease presenting with fever, cough, and often pneumonia. WHO has set the strategic objective to interrupt spread of SARS-CoV-2 worldwide. An outbreak in Bavaria, Germany, starting at the end of January, 2020, provided the opportunity to study transmission events, incubation period, and secondary attack rates. METHODS: A case was defined as a person with SARS-CoV-2 infection confirmed by RT-PCR. Case interviews were done to describe timing of onset and nature of symptoms and to identify and classify contacts as high risk (had cumulative face-to-face contact with a confirmed case for ≥15 min, direct contact with secretions or body fluids of a patient with confirmed COVID-19, or, in the case of health-care workers, had worked within 2 m of a patient with confirmed COVID-19 without personal protective equipment) or low risk (all other contacts). High-risk contacts were ordered to stay at home in quarantine for 14 days and were actively followed up and monitored for symptoms, and low-risk contacts were tested upon self-reporting of symptoms. We defined fever and cough as specific symptoms, and defined a prodromal phase as the presence of non-specific symptoms for at least 1 day before the onset of specific symptoms. Whole genome sequencing was used to confirm epidemiological links and clarify transmission events where contact histories were ambiguous; integration with epidemiological data enabled precise reconstruction of exposure events and incubation periods. Secondary attack rates were calculated as the number of cases divided by the number of contacts, using Fisher's exact test for the 95% CIs. FINDINGS: Patient 0 was a Chinese resident who visited Germany for professional reasons. 16 subsequent cases, often with mild and non-specific symptoms, emerged in four transmission generations. Signature mutations in the viral genome occurred upon foundation of generation 2, as well as in one case pertaining to generation 4. The median incubation period was 4·0 days (IQR 2·3-4·3) and the median serial interval was 4·0 days (3·0-5·0). Transmission events were likely to have occurred presymptomatically for one case (possibly five more), at the day of symptom onset for four cases (possibly five more), and the remainder after the day of symptom onset or unknown. One or two cases resulted from contact with a case during the prodromal phase. Secondary attack rates were 75·0% (95% CI 19·0-99·0; three of four people) among members of a household cluster in common isolation, 10·0% (1·2-32·0; two of 20) among household contacts only together until isolation of the patient, and 5·1% (2·6-8·9; 11 of 217) among non-household, high-risk contacts. INTERPRETATION: Although patients in our study presented with predominately mild, non-specific symptoms, infectiousness before or on the day of symptom onset was substantial. Additionally, the incubation period was often very short and false-negative tests occurred. These results suggest that although the outbreak was controlled, successful long-term and global containment of COVID-19 could be difficult to achieve. FUNDING: All authors are employed and all expenses covered by governmental, federal state, or other publicly funded institutions.


Subject(s)
Betacoronavirus/isolation & purification , Communicable Diseases, Imported/transmission , Coronavirus Infections/transmission , Disease Outbreaks , Disease Transmission, Infectious , Pneumonia, Viral/transmission , Travel-Related Illness , Adolescent , Adult , Betacoronavirus/classification , Betacoronavirus/genetics , COVID-19 , Child , Child, Preschool , China , Communicable Diseases, Imported/epidemiology , Communicable Diseases, Imported/pathology , Communicable Diseases, Imported/virology , Coronavirus Infections/epidemiology , Germany/epidemiology , Humans , Interviews as Topic , Middle Aged , Mutation , Pandemics , Pneumonia, Viral/epidemiology , RNA, Viral/genetics , Reverse Transcriptase Polymerase Chain Reaction , Risk Assessment , SARS-CoV-2 , Travel , Young Adult
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