Analysis of Epidemiological Characteristics of

New Coronavirus Pneumonia

• Epidemiological group of emergency response mechanism of new coronavirus pneumonia in Chinese

Center for Disease Control and Prevention

Chinese Journal of Epidemiology, 2020, 41: Pre-published online . DOI: 10.3760 / cma.j.issn.0254-

6450.2020.02.003
Summary
purpose
New coronavirus pneumonia has spread throughout the country since the outbreak in
Wuhan. Describe and analyze the epidemiological characteristics of all cases reported in Mainland
China as of February 11, 2020.
method
All the new cases of coronavirus pneumonia reported in the infectious disease reporting information
system in Mainland China as of February 11, 2020 were selected. The analysis includes: ① patient
characteristics; ② fatality rate; ③ age distribution and sex ratio; ④ spatiotemporal characteristics
of disease transmission; ⑤ epidemiological curves of all cases, cases outside Hubei Province and
cases of medical staff.
result
A total of 72 314 cases were reported in Mainland China, of which 44 672 (61.8%) were confirmed,
16 186 (22.4%) were suspected, 10 567 (14.6%) were clinically diagnosed, and 889 (1.2%) were
asymptomatic. ). The majority of confirmed cases were in the age group of 30 to 79 (86.6%), and
Hubei Province (74.7%). Mild cases were the main cause (80.9%). Of the confirmed cases, 1023
died, and the crude case fatality rate was 2.3%. The case investigation results indicate that the
outbreak spread from Hubei in December 2019. As of February 11, 2020, 1,386 counties and
districts in 31 provinces across the country were affected. The epidemic curve showed a peak
around January 23-26, and a decline in the number of cases was observed. As of February 11, a
total of 1,716 medical workers were infected, of whom 5 died, with a crude case fatality rate of
0.3%.
in conclusion
New coronavirus pneumonia spreads rapidly, spreading to 31 provinces (autonomous regions /
municipalities) from 30 days after the first reported case, the epidemic reached its first epidemic
peak on January 24-26, and a single-day outbreak was extremely high on February 1. Value and
then gradually decrease. As people return to work, they need to actively respond to a possible
rebound in the epidemic.

In late December 2019, an unexplained case of mass pneumonia occurred in Wuhan, China,
which caused the concern of the competent health department. On December 31, the Chinese Center
for Disease Control and Prevention sent a rapid response team to Wuhan. Possible causes were
excluded one by one including influenza, avian influenza, adenovirus, severe acute respiratory
syndrome coronavirus (SARS-CoV), and Middle East respiratory syndrome coronavirus (MERS-
CoV). The epidemiological investigation pointed out that the case infection may be related to Wuhan
South China Seafood Market. On January 1, the local government closed the South China Seafood
Market and disinfected the market. At the same time, active search and emergency surveillance of
cases were required [ 1 , 2 , 3 , 4 , 5 ] . On January 3, the Chinese government notified the WHO of the
epidemic situation [ 1 , 2 , 3 , 4 ] .
On January 7, 2020, the causative agent was identified as a new coronavirus (2019-nCoV),
followed by genetic sequence analysis and development of detection methods [ 2 , 3 , 4 , 5 , 6 ] . The WHO
now names the disease COVID-19. Although the virus is similar to SARS-CoV and MERS-CoV, it is quite
different [ 5 , 7 ] . Early cases suggest that it may not be as severe as SARS-CoV and MERS-
CoV. However, the rapidly increasing number of cases and increasing evidence of human-to-human
transmission suggest that the virus is more contagious than SARS-CoV and MERS-CoV [ 3 , 8 , 9 , 10 , 11 ] .
On January 20, with the approval of the State Council, the National Health and Health
Commission decided to include the new coronavirus pneumonia in the management of Class B
infectious diseases. Quarantine and infectious disease management. On January 23, the Wuhan City
Epidemic Prevention and Control Headquarters announced that the city's urban bus, subway, ferry,
and long-distance passenger transport operations were temporarily suspended, and the airport and
train station channels were temporarily closed from Han. Two days later, the Chinese government
made the highest-level commitment to mobilize every effort to stop the epidemic. Understanding the
epidemiological characteristics of COVID-19 transmission is critical to developing and implementing
effective control strategies. To this end, epidemiological characterization and analysis of all cases of
COVID-19 as of February 11, 2020 were performed.
Materials and Methods
1. Research design:
Describe and analyze the epidemiological characteristics of all COVID-19 cases reported in
Mainland China as of February 11, 2020. We used a cross-sectional study design and referenced the
STROBE guide (www.equator-network.org) to help us make an in-depth report on this observational
study.
From December 31, 2019, the CDCs at all levels across the country jointly launched the COVID-
19 investigation. We extracted all data from the case reporting system and removed personally
identifiable information from all cases during the analysis to protect personal privacy. This study
belongs to the data analysis of epidemic emergency response information, which was reviewed and
approved by China CDC Ethics Review Committee.
2. Data Sources:
COVID-19 has been classified as a Class B infectious disease. According to legal requirements,
all cases should be reported immediately through the Infectious Disease Information
System. Individual case information was entered into the system by local hospital and CDC personnel
who investigated and collected information on possible exposures. All case records contain personal
identification numbers, so all cases are not duplicated in the system. We selected all Mainland China
COVID-19 cases reported in the Infectious Disease Information System as of February 11, 2020. After
removing all personally identifiable information, we formed a separate data set for analysis. All cases
were included in this study, so no sampling of a predetermined sample size was required, and no case
inclusion criteria were considered.
3．Variable information:
Collect patient demographics, diagnosis time, epidemiological survey time, and report time to
the infectious disease information system. If the patient is engaged in any form of work in a medical
institution, classify their occupational variables as medical staff (ie, this category includes not only
doctors and nurses); if the patient has recently lived in Wuhan, traveled, or interacted with People
with close contact are classified as Wuhan-related exposures. The comorbidity condition variable was
based on a patient's self-reported medical history in an epidemiological survey, and was not verified
using medical records from all cases. Symptom severity is classified as mild, severe or critical: Mild
includes non-pneumonia and mild pneumonia; severe refers to dyspnea, and respiratory rate ≥30 /
min, blood oxygen saturation ≤93%, PaO 2 / FiO 2 The ratio is <300, and / or the lung infiltration is>
50% within 24 to 48 hours; critically ill refers to those who present with respiratory failure, septic
shock, and / or multiple organ dysfunction / failure.
Because the variables related to Wuhan exposure, comorbidity, and case severity were not
required when creating records in the infectious disease information system, data on these variables
were missing from some case information.
For the epidemiological curve, the onset date is defined as the date on which the case self-
reported fever or cough in the epidemiological investigation. The cases were classified as suspected
cases, confirmed cases, clinically diagnosed cases (only in Hubei), and asymptomatic
infection. Suspected cases are clinically diagnosed based on symptoms and exposure history; clinically
diagnosed cases are those whose suspected cases have imaging characteristics of pneumonia (only
applicable in Hubei Province); confirmed cases are those who have suspected cases with positive
results of viral nucleic acid testing; asymptomatic Infection refers to positive pathogenic detection of
new coronavirus in specimens such as the respiratory tract. The "onset day" of asymptomatic infection
is replaced by a positive laboratory test date.
4．Statistical analysis:
For confirmed cases, demographic and clinical characteristics of descriptive statistical cases are
used. The crude case fatality rate is calculated by dividing the number of confirmed cases (numerator)
by the total number of confirmed cases (denominator) and expressing it as a percentage. At the same
time, the number of person-observed days for each confirmed case is calculated, and the number of
deaths (numerator) of the confirmed cases divided by the number of person-days (denominator)
accumulated for the confirmed cases is used to obtain the mortality rate, which is expressed as the
number of deaths / 10 person-days.
Using the age at the time of diagnosis of the confirmed cases, three age distribution maps of
Wuhan, Hubei (including Wuhan), and China (including Hubei) were plotted, and the gender ratio was
calculated.
For time-space analysis, the county-level location of each case at the time of diagnosis is used
to draw a color map. According to the retrospective onset date of epidemiological investigation after
diagnosis, it is divided into December 31, 2019 and January 10, 2020. On the 5th, 20th, 31st, and
11th February, report the distribution of cases counted by province. The analysis was performed using
ArcGIS Desktop software (version 10.6; Redlands, California, USA, Environmental Systems Research
Corporation).
The epidemic curve was drawn by the number of cases (y-axis) and the self-reported onset date
(x-axis) of the earliest clinical symptoms. The onset dates of confirmed and suspected cases are
superimposed to show the total number of cases over time. At the same time, the onset date and
report date of the confirmed cases are made together, which is convenient for comparing the epidemic
curve drawn on the outbreak date with the epidemic curve drawn on the report day. The epidemic
curves of the two subpopulations were analyzed separately: confirmed cases outside Hubei Province
(whether there were Wuhan-related exposures) and medical staff cases (confirmed cases and
suspected cases).
result
1. Case:
A total of 72 314 cases were reported, of which 44 672 (61.8%) were confirmed, 16 186 (22.4%)
were suspected, 10 567 (14.6%) were clinically diagnosed, and 889 (1.2%) were asymptomatic. ).
Basic characteristics of confirmed cases (n = 44 672). Most of them were between 30 and 69
years old (77.8%), 51.4% were male, farmers or workers accounted for 22.0%, Hubei Province
accounted for 74.7%, and 80.9% were mild. See Table 1 .
Table 1
Number of cases, deaths and mortality of new coronary pneumonia nationwide.

2. Deaths, crude case fatality rate and case fatality rate:

Among the 44 672 confirmed cases, there were a total of 1023 deaths, with a crude case fatality
rate of 2.3% and a case fatality rate of 0.015 / 10 person-days, which means that the average risk of
death per patient observed for 10 days was 0.015. The highest crude case fatality rate in the age
group ≥80 years was 14.8%. The crude case fatality rate was 2.8% for men and 1.7% for women. By
occupation, the highest crude case fatality rate for retirees is 5.1%. The crude case fatality rate (2.9%)
in Hubei Province was 7.3 times higher than in other provinces (0.4%). The crude case fatality rate
for patients with no comorbidities is approximately 0.9%, and the case fatality rate is much higher for
patients with comorbidities, 10.5% for cardiovascular disease patients, 7.3% for diabetes, 6.3% for
chronic respiratory disease, and 6.3% for hypertension 6.0%, cancer was 5.6%. Severe cases
accounted for 13.8%, and critical cases accounted for 4.7%. The crude case fatality rate of critical
cases was 49%, and the case fatality rate was 0.325, which means that the average risk of death for
every 10 days observed in each case was 0.325. See Table 1 .
3．Age distribution and sex ratio:
Wuhan City, Hubei Province and the national age distribution of confirmed cases, see Figure
1 . The patients were concentrated between 30 and 79 years old. The proportion of this age group in
the total number of confirmed cases was 89.8% in Wuhan, 88.6% in Hubei (including Wuhan), and
86.6% in the country (including Hubei). The proportion of cases in the elderly group over 60 years
old was 44.1% in Wuhan, 35.1% in Hubei (including Wuhan), and 31.2% in China (including
Hubei). The male to female ratio of confirmed cases was 0.99: 1 in Wuhan, 1.04: 1 in Hubei, and
1.06: 1 in the country.

figure 1
As of February 11, 2020, the age distribution of confirmed cases of new coronavirus pneumonia in
different regions

4．Spatiotemporal distribution:
On January 19, the National Health Commission confirmed the first confirmed case of pneumonia
imported from Guangdong province with imported new coronavirus infection. This is the first
confirmed case of new coronary pneumonia reported in a province other than Hubei in China. As of
January 22, a total of 301 confirmed cases of new coronary pneumonia were reported in 83 counties
and districts in 23 provinces across the country. Tibet reported the first confirmed case of new
coronary pneumonia imported from Hubei on January 30. Outbreaks of new coronary pneumonia were
reported within two weeks in 30 additional provinces ( Figure 2 ).

figure 2
As of February 11, 2020, new coronavirus pneumonia has spread from Hubei to the country
A retrospective analysis of the reported onset dates of the reported cases restored the national
geographic distribution of confirmed cases of new coronary pneumonia over five different periods. As
of February 11, a total of 44 672 confirmed cases were reported in 1 386 counties and districts in 31
provinces across the country (74.7% in Hubei, Figure 2E ), of which 0.2% of cases had onset dates
before December 31, 2019 The cases were all in Hubei ( Figure 2A ); 1.7% of the cases had onset
dates before January 10th and were distributed in 113 counties and districts in 20 provinces, of which
88.5% were in Hubei ( Figure 2B ); there were 13.8% of the cases The onset date was January 20,
distributed in 627 counties and districts in 30 provinces, of which Hubei accounted for 77.6% ( Figure
2C ); 73.1% of cases occurred on January 31, distributed in 31 provinces 1,310 counties and districts,
of which Hubei accounted for 74.7% ( Figure 2D ).
Epidemic curves plotted by time of onset for all patients ( Figure 3A ). January 24-28 was the
first epidemic peak. On February 1, there was an abnormally high value on a single-day onset day,
and then it gradually decreased. Epidemic curves of confirmed cases according to the onset date and
the reported date ( Figure 3B ). The number of cases began to rise rapidly in early January, reached
the first epidemic peak on January 24-28, and then slowly declined, but a single-day onset day showed
an abnormally high value on February 1 and then gradually decreased. On the reporting day, the
epidemic curve showed that the number of reported cases rose rapidly after January 10, reached the
epidemic peak on February 5, and then slowly declined.

image 3
As of February 11, 2020, the date of report of confirmed cases of new coronavirus pneumonia and
the epidemic curve of onset date

5．Cases outside Hubei and cases of medical staff:

For cases reported outside Hubei Province, confirmed cases with and without Wuhan exposure
history are shown in two colors, and epidemic curves are drawn based on the date of onset of the
patient ( Figure 4A ). The peak period of cases outside Hubei Province is January 24-27. Most cases
(68.6%) reported living or going to Wuhan or had close contact with Wuhan patients within 14 days
before the onset of illness.
Figure 4
As of February 11, 2020, confirmed cases of new coronavirus pneumonia outside Hubei have no
exposure history in Wuhan and medical staff cases are distributed according to the date of onset
The peak incidence of medical staff cases may occur on January 28 ( Figure 4B ). Of the 422
medical institutions that provide diagnosis and treatment for patients with new coronary pneumonia,
a total of 3,019 medical staff were infected with the new coronavirus (1,716 confirmed cases), of
which 5 died. Among them, there may be infections caused by non-occupational exposures. An
analysis of 1 688 confirmed cases with severe disease, there were 1 080 cases in Wuhan, accounting
for 64.0% of the total incidence of medical staff in the country, 394 cases (23.3%) in Hubei other
than Wuhan, and 30 in the country except Hubei There were 214 cases (12.7%) in each province
(region / city). The proportion of severe cases was 17.7% in Wuhan, 10.4% in Hubei, and 7.0% across
Hubei. According to different time periods, the severe illness rate of Wuhan medical staff gradually
decreased from 38.9% at its peak to 12.7% in early February ( Table 2 ).

Table 2
From December 8th to February 11th, 2019, the national, Hubei, and Wuhan countries reported the
confirmed cases, severe cases, and deaths of new coronary pneumonia among medical staff.

discuss
The epidemiological characterization and exploratory analysis of 72 314 cases of new coronavirus
pneumonia reported in China, the main findings include that although the new coronavirus is highly
infectious in 2019, most patients have mild manifestations and overall crude disease The rate is
low. The majority of deaths are patients 60 years of age and older, and suffer from underlying diseases
such as hypertension, cardiovascular disease and diabetes.
Another major contribution of this study was to describe for the first time the epidemic curve of
neocoronary pneumonia in 2019. The overall curve ( Figure 3 ) shows the outbreak pattern. The cases
that occurred in December 2019 may be a small-scale exposure transmission mode; in January 2020,
it may be a diffusion transmission mode. The time trend of this outbreak is consistent with the previous
survey conclusion that the South China seafood market in Wuhan may have wild animal trading, which
makes the new coronavirus transmitted from a still unknown wild animal to humans, and its
adaptability is enhanced. Human-to-human transmission [ 3 , 8 ] .
The early outbreaks were reminiscent of SARS and MERS, and the discovery of a pathogen that
has been closely related to coronavirus and has never been described before, foreshadows potential
hospital transmissions and so-called "super communicator" events [ 8 ] , That is, a single exposure
caused more than 10 cases. Unfortunately, the new coronavirus did spread through hospitals and
infected medical staff. This study describes for the first time 1 688 confirmed cases of medical staff,
most of which are mild patients (85.4%), and the mortality rate is lower than other cases. The main
reason is related to age. Medical staff are all working staff, generally under 60 years old, and deaths
mainly occur in patients over 60 years old. As of now, there is no evidence that a super-transmitter
incident has occurred in any of the medical institutions serving patients with the new coronavirus
pneumonia.
By analyzing the epidemiological characteristics of new coronary pneumonia that has become an
"public health emergency of international concern" [ 12 ] , it is hoped that the results will be provided to
medical staff and health decision-makers who are preparing or may be experiencing a new coronary
pneumonia epidemic. Valuable reference information. This epidemiological analysis provides important
insights into several key issues in this outbreak and how to design effective control strategies [ 3 ] . For
example, severe medical staff infections have occurred in some areas in Wuhan and Hubei, but the
specific causes of medical staff infection and protection failure have yet to be investigated in depth. In
addition, the downward trend in the overall epidemic curve suggests that limiting personnel
movements, reducing exposure, transmitting critical prevention information (such as hand washing,
wearing masks, and seeking medical advice) at high frequency through multiple channels, and
mobilizing multisectoral rapid response can help Curb the epidemic.
The timely epidemic response across the country has learned the lessons and experiences of
SARS. It is also the past ten years that China has established and improved infectious disease
surveillance systems and public health infrastructure, providing a basis for early detection of epidemics
and rapid response. We must remain vigilant and adjust and improve prevention and control strategies
and measures based on the growing new understanding of new coronary pneumonia. At the same
time, emergency preparations are being made for more serious outbreaks that may occur.
A major advantage of this study is the inclusion of a large number of reported cases. The study
also has several limitations. First, a significant proportion of the cases analyzed were not diagnosed
with nucleic acid tests, because nucleic acid tests are time-consuming and labor-intensive and require
specialized equipment and technicians. However, all cases have been clinically diagnosed, and a
significant percentage of cases have been investigated by professional epidemiologists. Second, some
of the cases in the study were missing variable data that limited the conclusions of the study, such as
exposure history in Wuhan, concomitant diseases and disease severity. Third, in the case of
epidemiological investigations, there may be a problem of recall bias, especially the time of onset as
a key variable analysis may have a time bias.
In short, the epidemiological characterization and analysis of new coronary pneumonia cases
reported as of February 11, 2020 provided important new information about the epidemic situation in
China to the international community. Some important scientific questions still need to be answered,
including identification of animal hosts, determination of infectious period, identification of
transmission routes, development of effective treatment and prevention methods (including simple
detection reagent development, drug and vaccine development) [ 3 , 4 , 8 , 9 ] . China is an international
society, and we must all become responsible partners in monitoring, communicating, responding to,
researching and implementing evidence-based public health and clinical practices. China's response
measures have effectively curbed the spread of the epidemic in China and have significantly reduced
its spread to other countries.
Although the epidemic situation shown as of February 11 has tended to decline, the epidemic
situation has not ended, especially the large number of people moving and contacting after the
resumption of work, which has increased the risk of new crown pneumonia transmission. The first
case of the community and the workplace must be continued Case detection and treatment,
prevention and control of the epidemic rebound.
Epidemiology Group of Emergency Response to New Coronavirus Pneumonia of
Chinese Center for Disease Control and Prevention : Feng Zijian, Li Qun, Zhang Yanping, Wu
Zunyou, Dong Xiaoping, Ma Huilai, Yin Dapeng, Lu Ke, Wang Dayan, Zhou Lei, Xiang Nijuan, Ren
Ruiqi, Li Chao , Wang Yali, Li Dan, Zhao Jing, Li Bing, Wang Rui, Niu Yan, Wang Xiaoyu, Zhang Lijie,
Sun Jinfang, Liu Boxi, Deng Zhiqiang, Ma Zhitao, Yang Yang, Liu Hui, Shao Ge, Li Huan, Liu Yuan,
Zhang Hangjie, Qu Shuquan, Luo Wei , Dan Duo, Hu Yaohua, Hou Lei, Zhao Zhenping, Liu Jiangmei,
Wang Hongyuan, Pang Yuanjie, Han Yuting, Ma Qiuyue, Ma Yujia, Chen Si, Zhang Xueying, Li Wei,
Yang Ruotong, Li Zewu, Guo Yingnan, Liu Xinran, Bahabak, Yin Zhaoxue, Xu Juan, Wang Shuo, Xiao
Lin, Xu Tao, Wang Limin, Xi Xiao, Shi Guoqing, Tu Wenxiao, Shi Xiaoming, Su Xuemei, Li Zhongjie,
Luo Huiming, Ma Jiaqi
Zhi Xieyi pays tribute to the comrades fighting in the front line of the new coronavirus pneumonia
epidemic prevention and control! Thanks to all staff members involved in the prevention and control
of the new crown pneumonia epidemic, including treatment, detection and diagnosis,
epidemiological investigation, close contact management, etc.
Conflict of interest: All authors declare no conflict of interest
Note: In order to promptly announce the national epidemiological characteristics and data
of new-type coronavirus pneumonia to domestic and foreign countries, this report is published in
academic papers in Chinese in the Chinese Journal of Epidemiology and English in China CDC
Weekly . Medical report format, Chinese and English reports published on the website of China
Centers for Disease Control and Prevention, for professional and technical personnel at home and
abroad and interested parties to read
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