Estimating number of global importations of COVID-19 from Wuhan, risk of transmission outside mainland China and COVID-19 introduction index between countries outside mainland China
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Abstract
Background
The emergence of a novel coronavirus (SARS-CoV-2) in Wuhan, China in early December 2019 has caused widespread transmission within the country, with over 1,000 deaths reported to date. Other countries have since reported coronavirus disease 2019 (COVID-19) importation from China, with some experiencing local transmission and even case importation from countries outside China. We aim to estimate the number of cases imported from Wuhan to each country or territory outside mainland China, and with these estimates assess the risk of onward local transmission and the relative potential of case importation between countries outside China.
Methods
We used the reported number of cases imported from Wuhan and flight data to generate an uncertainty distribution for the estimated number of imported cases from Wuhan to each location outside mainland China. This uncertainty was propagated to quantify the local outbreak risk using a branching process model. A COVID-19 introduction index was derived for each pair of donor and recipient countries, accounting for the local outbreak risk in the donor country and the between- country connectivity.
Results
We identified 13 countries or territories outside mainland China that may have under-detected COVID-19 importation from Wuhan, such as Thailand and Indonesia. In addition, 16 countries had a local outbreak risk estimate exceeding 50%, including four outside Asia. The COVID-19 introduction index highlights potential locations outside mainland China from which cases may be imported to each recipient country.
Conclusions
As SARS-CoV-2 continues to spread globally, more epicentres may emerge outside China. Hence, it is important for countries to remain alert for the possibilities of viral introduction from other countries outside China, even before local transmission in a source country becomes known.
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SciScore for 10.1101/2020.02.17.20024075: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:There are other limitations to our analysis. We assume that R0 in places outside of Wuhan is similar to that estimated from early transmission in Wuhan, however we do not know how variation in climate, population structure, contact patterns, control measures such as contact tracing and quarantine, and other factors may impact …
SciScore for 10.1101/2020.02.17.20024075: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:There are other limitations to our analysis. We assume that R0 in places outside of Wuhan is similar to that estimated from early transmission in Wuhan, however we do not know how variation in climate, population structure, contact patterns, control measures such as contact tracing and quarantine, and other factors may impact transmission. This is an important area for future research based on what is observed in different places and the extension of the analysis to explicitly model transmission in each recipient country can be undertaken as more becomes known. In summary, we estimate a number of imported cases from Wuhan that were undetected. Given these importations, we estimate a high risk of onward transmission within a number of countries outside mainland China, particularly in those places where cases were not detected, as these undetected cases could not be isolated, and transmission truncated. Given our results of high risk of onward transmission we highlight the importance of wider testing to pick up community transmission as soon as possible after transmission occurs. We also highlight countries that become at increased risk of importation as transmission occurs outside China, and provide results for each country to assess the countries that pose their highest risk of importation.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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