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Article: Effect of changing case definitions for COVID-19 on the epidemic curve and transmission parameters in mainland China: a modelling study
Title | Effect of changing case definitions for COVID-19 on the epidemic curve and transmission parameters in mainland China: a modelling study |
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Authors | |
Keywords | basic reproduction number China coronavirus disease 2019 credible interval disease transmission |
Issue Date | 2020 |
Publisher | The Lancet Publishing Group. The Journal's web site is located at http://www.thelancet.com/journals/lanpub/issue/current |
Citation | The Lancet Public Health, 2020, v. 5 n. 5, p. e289-e296 How to Cite? |
Abstract | Background: When a new infectious disease emerges, appropriate case definitions are important for clinical diagnosis and for public health surveillance. Tracking case numbers over time is important to establish the speed of spread and the effectiveness of interventions. We aimed to assess whether changes in case definitions affected inferences on the transmission dynamics of coronavirus disease 2019 (COVID-19) in China.
Methods: We examined changes in the case definition for COVID-19 in mainland China during the first epidemic wave. We used exponential growth models to estimate how changes in the case definitions affected the number of cases reported each day. We then inferred how the epidemic curve would have appeared if the same case definition had been used throughout the epidemic.
Findings: From Jan 15 to March 3, 2020, seven versions of the case definition for COVID-19 were issued by the National Health Commission in China. We estimated that when the case definitions were changed, the proportion of infections being detected as cases increased by 7·1 times (95% credible interval [CrI] 4·8–10·9) from version 1 to 2, 2·8 times (1·9–4·2) from version 2 to 4, and 4·2 times (2·6–7·3) from version 4 to 5. If the fifth version of the case definition had been applied throughout the outbreak with sufficient testing capacity, we estimated that by Feb 20, 2020, there would have been 232000 (95% CrI 161000–359000) confirmed cases in China as opposed to the 55508 confirmed cases reported.
Interpretation: The case definition was initially narrow and was gradually broadened to allow detection of more cases as knowledge increased, particularly milder cases and those without epidemiological links to Wuhan, China, or other known cases. These changes should be taken into account when making inferences on epidemic growth rates and doubling times, and therefore on the reproductive number, to avoid bias.
Funding: Health and Medical Research Fund, Hong Kong |
Persistent Identifier | http://hdl.handle.net/10722/282832 |
ISSN | 2023 Impact Factor: 25.4 2023 SCImago Journal Rankings: 9.434 |
PubMed Central ID | |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Tsang, TK | - |
dc.contributor.author | Wu, P | - |
dc.contributor.author | Lin, Y | - |
dc.contributor.author | Lau, EHY | - |
dc.contributor.author | Leung, GM | - |
dc.contributor.author | Cowling, BJ | - |
dc.date.accessioned | 2020-06-05T06:22:05Z | - |
dc.date.available | 2020-06-05T06:22:05Z | - |
dc.date.issued | 2020 | - |
dc.identifier.citation | The Lancet Public Health, 2020, v. 5 n. 5, p. e289-e296 | - |
dc.identifier.issn | 2468-2667 | - |
dc.identifier.uri | http://hdl.handle.net/10722/282832 | - |
dc.description.abstract | Background: When a new infectious disease emerges, appropriate case definitions are important for clinical diagnosis and for public health surveillance. Tracking case numbers over time is important to establish the speed of spread and the effectiveness of interventions. We aimed to assess whether changes in case definitions affected inferences on the transmission dynamics of coronavirus disease 2019 (COVID-19) in China. Methods: We examined changes in the case definition for COVID-19 in mainland China during the first epidemic wave. We used exponential growth models to estimate how changes in the case definitions affected the number of cases reported each day. We then inferred how the epidemic curve would have appeared if the same case definition had been used throughout the epidemic. Findings: From Jan 15 to March 3, 2020, seven versions of the case definition for COVID-19 were issued by the National Health Commission in China. We estimated that when the case definitions were changed, the proportion of infections being detected as cases increased by 7·1 times (95% credible interval [CrI] 4·8–10·9) from version 1 to 2, 2·8 times (1·9–4·2) from version 2 to 4, and 4·2 times (2·6–7·3) from version 4 to 5. If the fifth version of the case definition had been applied throughout the outbreak with sufficient testing capacity, we estimated that by Feb 20, 2020, there would have been 232000 (95% CrI 161000–359000) confirmed cases in China as opposed to the 55508 confirmed cases reported. Interpretation: The case definition was initially narrow and was gradually broadened to allow detection of more cases as knowledge increased, particularly milder cases and those without epidemiological links to Wuhan, China, or other known cases. These changes should be taken into account when making inferences on epidemic growth rates and doubling times, and therefore on the reproductive number, to avoid bias. Funding: Health and Medical Research Fund, Hong Kong | - |
dc.language | eng | - |
dc.publisher | The Lancet Publishing Group. The Journal's web site is located at http://www.thelancet.com/journals/lanpub/issue/current | - |
dc.relation.ispartof | The Lancet Public Health | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject | basic reproduction number | - |
dc.subject | China | - |
dc.subject | coronavirus disease 2019 | - |
dc.subject | credible interval | - |
dc.subject | disease transmission | - |
dc.title | Effect of changing case definitions for COVID-19 on the epidemic curve and transmission parameters in mainland China: a modelling study | - |
dc.type | Article | - |
dc.identifier.email | Tsang, TK: matklab@hku.hk | - |
dc.identifier.email | Wu, P: pengwu@hku.hk | - |
dc.identifier.email | Lin, Y: vanialin@hku.hk | - |
dc.identifier.email | Lau, EHY: ehylau@hku.hk | - |
dc.identifier.email | Leung, GM: gmleung@hku.hk | - |
dc.identifier.email | Cowling, BJ: bcowling@hku.hk | - |
dc.identifier.authority | Tsang, TK=rp02571 | - |
dc.identifier.authority | Wu, P=rp02025 | - |
dc.identifier.authority | Lau, EHY=rp01349 | - |
dc.identifier.authority | Leung, GM=rp00460 | - |
dc.identifier.authority | Cowling, BJ=rp01326 | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.1016/S2468-2667(20)30089-X | - |
dc.identifier.pmid | 32330458 | - |
dc.identifier.pmcid | PMC7173814 | - |
dc.identifier.scopus | eid_2-s2.0-85083676940 | - |
dc.identifier.hkuros | 310172 | - |
dc.identifier.volume | 5 | - |
dc.identifier.issue | 5 | - |
dc.identifier.spage | e289 | - |
dc.identifier.epage | e296 | - |
dc.identifier.isi | WOS:000531073600022 | - |
dc.publisher.place | United Kingdom | - |
dc.identifier.issnl | 2468-2667 | - |