First-wave COVID-19 transmissibility and severity in China outside Hubei after control measures, and second-wave scenario planning: a modelling impact assessment

By K. Leung, Joseph T. Wu, Di Liu, G. Leung. The Lancet, 2020

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Background As of March 18, 2020, 13 415 confirmed cases and 120 deaths related to coronavirus disease 2019 (COVID-19) in mainland China, outside Hubei province—the epicentre of the outbreak—had been reported. Since late January, massive public health interventions have been implemented nationwide to contain the outbreak. We provide an impact assessment of the transmissibility and severity of COVID-19 during the first wave in mainland Chinese locations outside Hubei. Methods We estimated the instantaneous reproduction number (Rt) of COVID-19 in Beijing, Shanghai, Shenzhen, Wenzhou, and the ten Chinese provinces that had the highest number of confirmed COVID-19 cases; and the confirmed case-fatality risk (cCFR) in Beijing, Shanghai, Shenzhen, and Wenzhou, and all 31 Chinese provinces. We used a susceptible–infectious–recovered model to show the potential effects of relaxing containment measures after the first wave of infection, in anticipation of a possible second wave. Findings In all selected cities and provinces, the Rt decreased substantially since Jan 23, when control measures were implemented, and have since remained below 1. The cCFR outside Hubei was 0·98% (95% CI 0·82–1·16), which was almost five times lower than that in Hubei (5·91%, 5·73–6·09). Relaxing the interventions (resulting in Rt >1) when the epidemic size was still small would increase the cumulative case count exponentially as a function of relaxation duration, even if aggressive interventions could subsequently push disease prevalence back to the baseline level. Interpretation The first wave of COVID-19 outside of Hubei has abated because of aggressive non-pharmaceutical interventions. However, given the substantial risk of viral reintroduction, particularly from overseas importation, close monitoring of Rt and cCFR is needed to inform strategies against a potential second wave to achieve an optimal balance between health and economic protection. Funding Health and Medical Research Fund, Hong Kong, China.

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Citations in the corpus

Non-pharmaceutical interventions during the COVID-19 pandemic: A review (2020, methodology): “Finally, EpiEstim has been used also to model the impact of NPIs in several cities in China [126].”
Acceptance of COVID-19 Vaccination during the COVID-19 Pandemic in China (2020, background): “To address these challenges, China has taken drastic measures and public health interventions to control the transmission of COVID-19 since the outbreak of the disease, and these actions have substantially mitigated the spread of COVID-19 [32,33,36].”
COVI White Paper (2020, background): “While these details are key in understanding general viral profile in an infected individual, the ability to understand how this information translates into real-world viral transmission is limited [37].”
Effects of temperature and humidity on the daily new cases and new deaths of COVID-19 in 166 countries (2020, unknown): “Countries must take active measures to control the first pandemic and prevent a second wave of COVID-19 (Leung et al., 2020).”