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[Preprint]. 2020 Sep 1:2020.08.27.20183228.
doi: 10.1101/2020.08.27.20183228.

Disease burden and clinical severity of the first pandemic wave of COVID-19 in Wuhan, China

Juan Yang  1 , Xinhua Chen  1 , Xiaowei Deng  1 , Zhiyuan Chen  1 , Hui Gong  1 , Han Yan  1 , Qianhui Wu  1 , Huilin Shi  1 , Shengjie Lai  1   2 , Marco Ajelli  3 , Cecile Viboud  4 , Hongjie Yu  1
Affiliations

Disease burden and clinical severity of the first pandemic wave of COVID-19 in Wuhan, China

Juan Yang et al. medRxiv. .

Update in

Abstract

The pandemic of novel coronavirus disease 2019 (COVID-19) began in Wuhan, China, where a first wave of intense community transmission was cut short by interventions. Using multiple data source, we estimated the disease burden and clinical severity of COVID-19 by age in Wuhan from December 1, 2019 to March 31, 2020. We adjusted estimates for sensitivity of laboratory assays and accounted for prospective community screenings and healthcare seeking behaviors. Rates of symptomatic cases, medical consultations, hospitalizations and deaths were estimated at 796 (95%CI: 703-977), 489 (472-509), 370 (358-384), and 36.2 (35.0-37.3) per 100,000 persons, respectively. The COVID-19 outbreak in Wuhan had higher burden than the 2009 influenza pandemic or seasonal influenza, and that clinical severity was similar to that of the 1918 influenza pandemic. Our comparison puts the COVID-19 pandemic into context and could be helpful to guide intervention strategies and preparedness for the potential resurgence of COVID-19.

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Conflict of interest statement

Declaration of interests

H.Y. has received research funding from Sanofi Pasteur, GlaxoSmithKline, Yichang HEC Changjiang Pharmaceutical Company, and Shanghai Roche Pharmaceutical Company. None of those research funding is related to COVID-19. All other authors report no competing interests.

Figures

Figure 1.
Figure 1.. Severity levels of COVID-19 and schematic diagram of the baseline analyses.
A: Severity levels of infections with SARS-CoV-2 and parameters of interest. Each level is assumed to be a subset of the level below. sCFR: symptomatic case-fatality risk; sCHR: symptomatic case-hospitalization risk; mCFR: medically attended case-fatality risk; mCHR: medically attended case-hospitalization risk; and HFR: hospitalization-fatality risk. B: Schematic diagram of the baseline analyses. Data source of COVID-19 cases in Wuhan: D1) 32,583 laboratory-confirmed COVID-19 cases as of March 8, D2) 17,365 clinically-diagnosed COVID-19 cases during February 9–19, D3)daily number of laboratory-confirmed cases on March 9-April 24, D4) total number of COVID-19 deaths as of April 24 obtained from the Hubei Health Commission, D5) 325 laboratory-confirmed cases and D6) 1,290 deaths were added as of April 16 through a comprehensive and systematic verification by Wuhan Authorities, and D7) 16,781 laboratory-confirmed cases identified through universal screening, . Pse: RT-PCR sensitivity. Pmed.care: proportion of seeking medical assistance among patients suffering from acute respiratory infections. (Red, blue and green arrows separately denote the data flow from laboratory-confirmed cases of passive surveillance, clinically-diagnosed cases, and laboratory-confirmed cases of active screenings)
Figure 2.
Figure 2.. Rates of symptomatic cases and of medical consultation rates by age group (mean, 95%CI)
a: rates of medical consultation associated with COVID-19 in Wuhan, China b: rates of medical consultation associated with 2009 pandemic H1N1 influenza, China c: rates of medical consultation associated with 2009 pandemic H1N1 influenza, USA d: seasonal influenza-associated excess ILI outpatient consultations rates, China e: rates of medical consultation associated with seasonal influenza, USA
Figure 3.
Figure 3.. Hospitalization rates
a: rates of hospitalization associated with COVID-19 in Wuhan, China (mean, 95%CI) b: rates of hospitalization associated with 2009 pandemic H1N1 influenza, USA (median, range) c: rates of hospitalization associated with seasonal influenza related SARI in Jingzhou, Hubei province, China (median, range) d: rates of hospitalization associated with seasonal influenza, USA (mean, 95%CI),
Figure 4.
Figure 4.. Mortality rates
a: rates of mortality associated with COVID-19 in Wuhan, China (mean, 95%CI) b: rates of mortality associated with 2009 pandemic H1N1 influenza, USA (75% percentile) c: excess mortality rates associated with seasonal influenza, China (mean, 95%CI) d: excess mortality rates associated with seasonal influenza, USA (median, 95% credibility interval)
Figure 5.
Figure 5.. Clinical severity
a: symptomatic case-fatality risk (sCFR) associated with COVID-19 in Wuhan, China (mean, 95%CI) b: symptomatic case-fatality risk (sCFR) associated with 1918 pandemic H1N1 influenza in August - December 1918, USA (mean) c: symptomatic case-fatality risk (sCFR) associated with 2009 pandemic H1N1 influenza, USA (median,95%CI) d: medically attended case-fatality risk (mCFR) associated with COVID-19 in Wuhan, China (mean, 95%CI) e: hospitalization-fatality risk (HFR) associated with COVID-19 in Wuhan, China (mean, 95%CI) f: hospitalization-fatality risk (HFR) associated with 2009 pandemic H1N1 influenza, North America (mean,95%CI) g: symptomatic case-hospitalization risk (sCHR) associated with COVID-19 in Wuhan, China (mean, 95%CI) h: symptomatic case-hospitalization risk (sCHR) associated with 2009 pandemic H1N1 influenza, USA (median,95%CI) i: medically attended case-hospitalization risk (mCHR) associated with COVID-19 in Wuhan, China (mean, 95%CI)
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