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Id Subject Object Predicate Lexical cue
T1 0-140 Sentence denotes Real-time tentative assessment of the epidemiological characteristics of novel coronavirus infections in Wuhan, China, as at 22 January 2020
T2 142-150 Sentence denotes Abstract
T3 151-257 Sentence denotes A novel coronavirus (2019-nCoV) causing severe acute respiratory disease emerged recently in Wuhan, China.
T4 258-430 Sentence denotes Information on reported cases strongly indicates human-to-human spread, and the most recent information is increasingly indicative of sustained human-to-human transmission.
T5 431-612 Sentence denotes While the overall severity profile among cases may change as more mild cases are identified, we estimate a risk of fatality among hospitalised cases at 14% (95% confidence interval:
T6 613-622 Sentence denotes 3.9–32%).
T7 624-772 Sentence denotes Four strains of coronaviruses are known to spread easily in humans, causing generally-mild acute respiratory illnesses known as the common cold [1].
T8 773-902 Sentence denotes A much larger number of coronaviruses have been detected in animals, particularly in bats, but have not been found in humans [2].
T9 903-1136 Sentence denotes Prior to December 2019 when clusters of pneumonia cases with unknown aetiology were detected in Wuhan, China, only two additional strains of coronaviruses had caused outbreaks of severe acute respiratory disease around the world [3].
T10 1137-1355 Sentence denotes In the 2003 outbreaks of severe acute respiratory syndrome coronavirus (SARS-CoV) infections in mainland China, Hong Kong and a number of other locations, there were more than 8,000 documented cases and 774 deaths [4].
T11 1356-1546 Sentence denotes Since 2012, outbreaks of Middle East respiratory syndrome coronavirus (MERS-CoV) infection have occurred in the Middle East [5], and in 2015, there was a large outbreak in South Korea [6,7].
T12 1547-1638 Sentence denotes Super-spreading events have contributed to large outbreaks of SARS-CoV and MERS-CoV [8-10].
T13 1639-1784 Sentence denotes On 9 January 2020, a novel coronavirus, 2019-nCoV, was officially identified as the cause of an outbreak of viral pneumonia in Wuhan, China [11].
T14 1785-1896 Sentence denotes Wuhan is a large city of more than 11 million people located in central China around 1,200 km south of Beijing.
T15 1897-2145 Sentence denotes As of 22 January, there have been 440 confirmed 2019-nCoV infections reported in 13 provinces and municipalities in mainland China and five other countries and regions overseas, with an increasing number of cases reported in recent days (Figure 1).
T16 2146-2375 Sentence denotes Here, we describe the preliminary epidemiological characteristics of 2019-nCoV infections based on publicly-available information (including some media reports) before an official ‘line list’ of confirmed cases becomes available.
T17 2376-2480 Sentence denotes Figure 1 Increase in laboratory-confirmed cases of 2019-nCoV infection over time, as at 21 January 2020
T18 2481-2505 Sentence denotes nCoV: novel coronavirus.
T19 2506-2562 Sentence denotes a Refers to 2019-nCov infections outside mainland China.
T20 2563-2695 Sentence denotes Figure based on the date of case announcement by the Wuhan Municipal Health Commission and then the from National Health Commission.
T21 2697-2767 Sentence denotes Early outbreak of viral pneumonia of unknown aetiology as at 9 January
T22 2768-2900 Sentence denotes On 31 December 2019, the Wuhan Municipal Health Commission announced a cluster of cases of viral pneumonia of unexplained aetiology.
T23 2901-3097 Sentence denotes The Southern China Seafood Wholesale Market in Wuhan was suspected to be related to the first 27 pneumonia cases without identified pathogenic agents that were reported in late December 2019 [12].
T24 3098-3289 Sentence denotes Most of the early cases were reportedly either shop owners, largely in the West District of the Southern China Seafood Wholesale Market, or people who visited the market before symptom onset.
T25 3290-3492 Sentence denotes This market is a large open complex of 50,000 square metres including sections selling seafood, fresh meat, produce, other perishable goods, and a very wide variety of live wild animals for consumption.
T26 3493-3631 Sentence denotes While wet markets selling such perishable food products are common in China, they usually do not sell such a wide variety of wild animals.
T27 3632-3789 Sentence denotes Environmental disinfection of the Southern China Seafood Wholesale Market was initiated on 30 December 2019 and the market was closed on 1 January 2020 [13].
T28 3790-3955 Sentence denotes Contact tracing was initiated, and by 5 January, more than 160 close contacts of these cases were under medical surveillance, and none of them had an infection [14].
T29 3957-4015 Sentence denotes Early information on 2019-nCoV infections as at 12 January
T30 4016-4144 Sentence denotes On 9 January 2020, a novel coronavirus, 2019-nCoV, was officially identified as the cause of the outbreak of pneumonia in Wuhan.
T31 4145-4330 Sentence denotes Following the official announcement of the genetic sequence of the virus, on 11 January, 41 laboratory-confirmed cases of 2019-nCov infection with pneumonia were reported in Wuhan [15].
T32 4331-4877 Sentence denotes While the case definition for laboratory-confirmed cases has not been officially published, our understanding is that the initial case definition required (i) fever, (ii) x-ray evidence of pneumonia, (iii) white blood cell count normal or low or low lymphocyte count, (iv) antibiotic treatment for 3 days without improvement, in addition to (v) one or more recent visits to Wuhan or direct or indirect exposure to a wet market in Wuhan, and (vi) a respiratory specimen positive for 2019-nCoV and confirmed as 2019-nCoV by whole genome sequencing.
T33 4878-4939 Sentence denotes The earliest known case had illness onset on 8 December 2019.
T34 4940-5145 Sentence denotes Between 10 and 12 January when there were no new cases reported, the Wuhan Municipal Health Commission announced that no new cases of 2019-nCoV infection were identified with illness onset after 3 January.
T35 5146-5315 Sentence denotes As at 11 January, more than 700 close contacts were under medical surveillance, more than half being healthcare workers (HCWs), with no infections being identified [15].
T36 5316-5440 Sentence denotes Among the first 41 confirmed cases, approximately 70% reported exposure to the Southern China Seafood Wholesale Market [16].
T37 5441-5624 Sentence denotes Using the method described by Cauchemez et al. [17], assuming that the market was the only source of zoonotic infections, we estimated R 0 to be 0.3 (95% confidence interval (95% CI):
T38 5625-5636 Sentence denotes 0.17–0.44).
T39 5638-5718 Sentence denotes Information on exported cases identified outside mainland China as at 17 January
T40 5719-5843 Sentence denotes On 13 January 2020, Thai health authorities reported an imported case in a person in their 60s who had travelled from Wuhan.
T41 5844-6007 Sentence denotes This person had onset of an upper respiratory illness on 5 January and landed in Bangkok on 8 January, and was screened out by the thermal scanners at the airport.
T42 6008-6122 Sentence denotes They did not visit the Southern China Seafood Wholesale Market, but reported visiting another wet market in Wuhan.
T43 6123-6291 Sentence denotes On 16 January, Japanese health authorities reported a confirmed imported case in a person in their 30s who had travelled from Wuhan and landed in Kanagawa on 6 January.
T44 6292-6358 Sentence denotes Illness onset was on 3 January and the person has since recovered.
T45 6359-6488 Sentence denotes The person had not visited any wet market in Wuhan, but had visited a close relative who was in hospital in Wuhan with pneumonia.
T46 6489-6556 Sentence denotes A third case was reported by Thai health authorities on 17 January.
T47 6557-6722 Sentence denotes This person was in their 70s and had landed in Bangkok on 13 January, reporting an illness onset on 6 January and unclear history of exposure to the market in Wuhan.
T48 6723-6843 Sentence denotes On 20 January, the fourth exported case from Wuhan, a person in their 30s visiting South Korea, was identified in Seoul.
T49 6844-6975 Sentence denotes This person reported no previous visit to wet markets in Wuhan nor contact with any other case within 2 weeks before illness onset.
T50 6976-7154 Sentence denotes The lack of exposure history to wet markets in Wuhan in two of four generally-mild exported cases indicated that there might be a larger number of undetected infections in Wuhan.
T51 7155-7233 Sentence denotes Two family clusters involving five people were reported from 15 to 16 January.
T52 7234-7473 Sentence denotes One cluster of three close relatives all with illness onset on the same day, were thought to have occurred through a common exposure since they all lived together and worked in the same stall in the Southern China Seafood Wholesale Market.
T53 7474-7606 Sentence denotes The other cluster involved a couple and may have occurred through human-to-human transmission with a serial interval of 5 days [18].
T54 7607-7772 Sentence denotes The basic reproduction number R 0 is defined as the expected number of secondary cases produced by a typical single infection in a completely susceptible population.
T55 7773-7936 Sentence denotes If there had been only one case infected by human-to-human transmission among the first 41 identified cases by that date, it implies R 0 was 0.02 (i.e. 1/41) [19].
T56 7938-8032 Sentence denotes Information on cases after creation of the National Health Commission task force on 18 January
T57 8033-8141 Sentence denotes On 19 January 2020, a task force under the National Health Commission, created on 18 January, visited Wuhan.
T58 8142-8315 Sentence denotes On 20 January, 136 new infections in Wuhan, including 100 mild cases, 33 severe cases and three critically ill cases, were reported by the Wuhan Municipal Health Commission.
T59 8316-8460 Sentence denotes Three traveller cases from Wuhan were also identified in Beijing and Shenzhen, possibly suggesting a large number of infections in Wuhan itself.
T60 8461-8640 Sentence denotes However, further information on the most recently confirmed 2019-nCoV infections is required to determine the transmissibility of the virus and the severity profile of infections.
T61 8641-8735 Sentence denotes On 20 January, the task force reported three possible episodes of human-to-human transmission.
T62 8736-8953 Sentence denotes This included, in two different families, family members who had not recently visited Wuhan being laboratory-confirmed with 2019-nCoV infection after other family members came back from Wuhan and were confirmed cases.
T63 8954-9114 Sentence denotes A possible super-spreading event was also speculated by the task force given that there had been 15 HCWs infected with the virus in Wuhan until 20 January [20].
T64 9115-9256 Sentence denotes On 21 January, additional exported cases were reported in Taiwan and the United States, with illness onset on 11 and 19 January respectively.
T65 9258-9299 Sentence denotes Risk of fatality among hospitalised cases
T66 9300-9583 Sentence denotes We estimated the hospital fatality risk, i.e. the risk of fatality among hospitalised cases [21] using the formula (fatal cases)/(fatal cases + recovered cases), which provides a more accurate early estimate of the hospital fatality risk compared with (fatal cases)/(all cases) [22].
T67 9584-9682 Sentence denotes We estimated the associated 95% CI for the hospital fatality risk using the binomial distribution.
T68 9683-9899 Sentence denotes According to the update on 21 January 2020 when information on deaths and recoveries were reported, four cases had died while 25 had recovered, and our estimate of the hospital fatality risk is therefore 14% (95% CI:
T69 9900-9909 Sentence denotes 3.9–32%).
T70 9910-10060 Sentence denotes The estimate of the hospital fatality risk remained fairly stable over the 10 day period since the first death was announced on 11 January (Figure 2).
T71 10061-10205 Sentence denotes If deaths continue to be reported without any corresponding increase in reported recoveries, the formula will overestimate the risk of fatality.
T72 10206-10364 Sentence denotes Figure 2 Temporal changes in estimated risk of death among laboratory-confirmed cases of 2019-nCoV admitted to hospitala, Wuhan, China, as at 21 January 2020
T73 10365-10389 Sentence denotes nCoV: novel coronavirus.
T74 10390-10461 Sentence denotes a Based on the formula (fatal cases) / (fatal cases + recovered cases).
T75 10463-10576 Sentence denotes Comparison of two hypothetical scenarios: one with large zoonotic spillover and one with small zoonotic spillover
T76 10577-10758 Sentence denotes To 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.
T77 10759-10952 Sentence denotes 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.
T78 10953-11138 Sentence denotes 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.
T79 11139-11266 Sentence denotes Scenario 2 comprises a small zoonotic spillover event in early December 2019 followed by efficient human-to-human transmission.
T80 11267-11361 Sentence denotes Evidence consistent or inconsistent with each of these two scenarios is outlined in the Table.
T81 11362-11460 Sentence denotes Table Evidence on transmission dynamics of human infections with 2019-nCoV, as at 22 January 2020
T82 11461-11540 Sentence denotes Observation Date Interpretation Supports Scenario 1?a Supports Scenario 2?b
T83 11541-11685 Sentence denotes By 20 January, 198 laboratory-confirmed cases, 3 fatal, 25 recovered [28] 20 Jan 2020 Fatality risk among hospitalised cases is 11%c Yes Yes
T84 11686-11901 Sentence denotes No 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)
T85 11902-12090 Sentence denotes Only 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)
T86 12091-12348 Sentence denotes Only 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)
T87 12349-12559 Sentence denotes New 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
T88 12560-12784 Sentence denotes Four 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
T89 12785-12987 Sentence denotes Four 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
T90 12988-13264 Sentence denotes Two 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
T91 13265-13420 Sentence denotes 15 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?
T92 13421-13535 Sentence denotes Could still be consistent with limited human-to-human transmission if an isolated incident (unclear R 0) Yes Yes
T93 13536-13889 Sentence denotes Exported 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
T94 13890-13974 Sentence denotes HCWs: healthcare workers; nCoV: novel coronavirus; MHC: Municipal Health Commission.
T95 13975-14057 Sentence denotes a Most infections are zoonotic with limited human-to-human transmission (R 0 < 1).
T96 14058-14140 Sentence denotes b Initial zoonotic spillover with efficient human-to-human transmission (R 0 > 1).
T97 14141-14204 Sentence denotes c Estimated as (fatal cases) / (fatal cases + recovered cases).
T98 14206-14216 Sentence denotes Discussion
T99 14217-14337 Sentence denotes In this article, we describe a preliminary assessment of the outbreak of infections with the newly identified 2019-nCoV.
T100 14338-14521 Sentence denotes This assessment is based on the cases of infection reported over time by health authorities in Wuhan and then at the national level, as well as the media in China and other countries.
T101 14522-14708 Sentence denotes One of the most urgent priorities is to determine the degree of human-to-human transmissibility of the novel pathogen, and accordingly, this is where information is most urgently needed.
T102 14709-15003 Sentence denotes We outline two possible scenarios in the Table and find that the early evidence was most consistent with limited human-to-human transmissibility, however more recent data seem to be increasingly more compatible with scenario 2 in which sustained human-to-human transmission has been occurring.
T103 15004-15117 Sentence denotes Determining the exposure profile among the recently confirmed cases would directly contribute to this assessment.
T104 15118-15275 Sentence denotes Additional information on approaches to case identification and laboratory testing protocols in Wuhan and in other cities in China would also be informative.
T105 15276-15438 Sentence denotes A separate priority is to identify the animal reservoir of this novel pathogen and any intermediary hosts, including potential supply chains of wild or game meat.
T106 15439-15514 Sentence denotes It is challenging to judge severity from the information available to date.
T107 15515-15596 Sentence denotes We estimated the risk of death among hospitalised cases of around 14% (Figure 2).
T108 15597-15755 Sentence denotes For both SARS-CoV and MERS-CoV infections, the risk of severe disease increases substantially with age and with the presence of underlying conditions [23-25].
T109 15756-15906 Sentence denotes One other caveat with estimating severity is that there can be long delays between hospitalisation and death for infections that are ultimately fatal.
T110 15907-16002 Sentence denotes For SARS in Hong Kong, the average time from illness to death for fatal cases was 24 days [26].
T111 16003-16187 Sentence denotes This means that early estimates of the case fatality risk that ignore the potential outcomes of cases still in hospital are typically underestimates of the final severity profile [27].
T112 16188-16310 Sentence denotes We accounted for that by only including cases that either died or recovered in our estimate of the hospital fatality risk.
T113 16311-16569 Sentence denotes Given that the cases reported outside Wuhan have mostly not been severe, it would be reasonable to infer that there might be a large number of undetected relatively mild infections in Wuhan and that the infection fatality risk is below 1% or even below 0.1%.
T114 16570-16620 Sentence denotes There are a number of limitations to our analyses.
T115 16621-16696 Sentence denotes Most importantly, they are only based on data in the public domain to date.
T116 16697-16805 Sentence denotes Detailed information has not yet been released by authoritative sources on the most recently reported cases.
T117 16806-17174 Sentence denotes In our analysis in the Table, support for scenario 2 might increase if contact tracing or medical surveillance was incomplete, if there was incomplete ascertainment of clusters or if there was an early focus in testing cases linked to the Southern China Seafood Wholesale Market that led to a selection bias in the prevalence of market exposures among the early cases.
T118 17176-17192 Sentence denotes Acknowledgements
T119 17193-17247 Sentence denotes The authors thank Julie Au for administrative support.
T120 17248-17256 Sentence denotes Funding:
T121 17257-17433 Sentence denotes This project was supported by a commissioned grant from the Health and Medical Research Fund, Food and Health Bureau, Government of the Hong Kong Special Administrative Region.
T122 17435-17534 Sentence denotes Conflict of interest: BJC reports honoraria from Sanofi Pasteur and Roche not related to this work.
T123 17535-17595 Sentence denotes The authors report no other potential conflicts of interest.
T124 17596-17619 Sentence denotes Authors’ contributions:
T125 17620-17650 Sentence denotes Conceived study: PW, BJC, GML.
T126 17651-17690 Sentence denotes Collected data: PW, XH, EHYL, KSML, QX.
T127 17691-17724 Sentence denotes Analysed data: PW, XH, EHYL, BJC.
T128 17725-17770 Sentence denotes Interpreted results: PW, EHYL, JYW, BJC, GML.
T129 17771-17797 Sentence denotes Wrote the first draft: PW.
T130 17798-17871 Sentence denotes Critically revised the draft and approved the final version: all authors.