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

The Lancet, 8 Apr 2020

Kathy Leung, Prof Joseph T Wu, Di Liu, Prof Gabriel M Leung

Hightlights:

• Estimated the instantaneous reproduction number (R_t) 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
• In all selected cities and provinces, the R_t 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).
• The comprehensive package of non-pharmaceutical interventions China undertook, including social distancing and population behavioural change, has substantially reduced transmissibility of COVID-19 across the country.
• Early detection of cases is essential. Guangdong province did more than 320 000 RT-PCR tests on those who had attended fever clinics and hospitals over 30 days between January and February, 2020, which was about ten times baseline testing capacity for routine influenza-like illness surveillance during the influenza season of 2018.
• Keeping close watch of real-time transmissibility will also help to ensure the infection prevalence does not exceed the surge capacity of the health system.
• Fatality risks, among officially confirmed cases that are adjusted for resolution ascertainment bias, vary by several folds between provinces. The cCFR was relatively low in south and east China, and substantially higher in the north and northwest, which also correlates with provincial per capita gross domestic product.

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