PMC:6988272 / 10463-14204 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/6988272","sourcedb":"PMC","sourceid":"6988272","source_url":"https://www.ncbi.nlm.nih.gov/pmc/6988272","text":"Comparison of two hypothetical scenarios: one with large zoonotic spillover and one with small zoonotic spillover\nTo date, as at 22 January, official information has not been sufficient to determine the source of infection and risk of human-to-human transmission for the newly emerged 2019-nCoV. Two competing hypotheses are therefore proposed and compared as potential explanations for the characteristics of the current outbreak of 2019-nCoV infections within and outside mainland China. Scenario 1 comprises a large zoonotic spillover event starting in early December 2019, perhaps over a number of days or weeks, and very limited human-to-human transmission subsequently. Scenario 2 comprises a small zoonotic spillover event in early December 2019 followed by efficient human-to-human transmission. Evidence consistent or inconsistent with each of these two scenarios is outlined in the Table.\nTable Evidence on transmission dynamics of human infections with 2019-nCoV, as at 22 January 2020\nObservation Date Interpretation Supports Scenario 1?a Supports Scenario 2?b\nBy 20 January, 198 laboratory-confirmed cases, 3 fatal, 25 recovered [28] 20 Jan 2020 Fatality risk among hospitalised cases is 11%c Yes Yes\nNo infections among the more than 700 people under medical surveillance, including HCWs [28] 20 Jan 2020 Very low human-to-human transmissibility Yes No (Note: assuming adequate contact tracing and surveillance)\nOnly one likely human-to-human cluster among the first 41 cases [18] 20 Jan 2020 Very low human-to-human transmissibility (R 0 of 0.02) Yes No (Note: assuming adequate contact tracing)\nOnly approximately 70% of the first 41 cases had exposure to Southern China Seafood Wholesale Market [16] 15 Jan 2020 Low human-to-human transmissibility (R 0 of 0.3) Yes No (Note: possible selection bias towards identifying cases linked to that market)\nNew cases with a travel history to Wuhan before onset were confirmed in other cities in China [29] 20 Jan 2020 Indicative of many mild to moderate infections (not requiring hospitalisation) in Wuhan Yes Yes\nFour exported cases to other countries, all with relatively mild illness [30,31] 12–20 Jan 2020 Indicative of many mild to moderate infections not necessitating hospitalisation or outpatient medical care in Wuhan Yes Yes\nFour exported cases, at least three of whom had no contact with Southern China Seafood Wholesale Market [30,31] 12–20 Jan 2020 At least some limited human-to-human transmission (unclear R 0) Yes Yes\nTwo family clusters in Guangdong, with family members who did not visit Wuhan but were infected after the other family member(s) returning from Wuhan were confirmed with the infection [29] 20 Jan 2020 At least some limited human-to-human transmission (unclear R 0) Yes Yes\n15 HCWs confirmed with infection of 2019-nCoV (not clear whether infections were from one case or multiple cases) [20] 20 Jan 2020 Super-spreading event? Could still be consistent with limited human-to-human transmission if an isolated incident (unclear R 0) Yes Yes\nExported cases identified in Taiwan and the United States with illness onset dates on 11 and 19 January [32,33] 22 Jan 2020 Could be because of surveillance bias, but is more consistent with an increase in incidence of infections over time No (Note: possible selection bias because of enhanced surveillance towards identifying more recent cases) Yes\nHCWs: healthcare workers; nCoV: novel coronavirus; MHC: Municipal Health Commission.\na Most infections are zoonotic with limited human-to-human transmission (R 0 \u003c 1).\nb Initial zoonotic spillover with efficient human-to-human transmission (R 0 \u003e 1).\nc Estimated as (fatal cases) / (fatal cases + recovered 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