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http://conacyt.repositorioinstitucional.mx/jspui/handle/1000/386| Impact of changing case definitions for COVID-19 on the epidemic curve and transmission parameters in mainland China | |
| Tim K. Tsang Peng Wu Yun Lin Yun Lin Gabriel M. Leung Benjamin J Cowling Eric Lau | |
| Novel Coronavirus | |
| Acceso Abierto | |
| Atribución-SinDerivadas | |
| 10.1101/2020.03.23.20041319 | |
| Background: When a new infectious disease emerges, appropriate case definitions are important for clinical diagnosis and also for public health surveillance. Tracking case numbers over time allows us to determine speed of spread and the effectiveness of interventions. Changing case definitions during an epidemic can affect these inferences. Methods: We examined changes in the case definition for COVID-19 in mainland China during the first epidemic wave. We used simple models assuming exponential growth and then exponential decay to estimate how changes in the case definitions affected the numbers of cases reported each day. We then inferred how the epidemic curve would have appeared if the same case definition had been used throughout the epidemic. Findings: From January through to early March 2020, seven versions of the case definition for COVID-19 were issued by the National Health Commission in China. As of February 20, there were 55,508 confirmed cases reported in mainland China. We estimated that when the case definitions were changed from version 1 to 2, version 2 to 4 and version 4 to 5, the proportion of infections being detected as cases were increased by 7.1-fold (95% credible interval (CI): 4.8, 10.9), 2.8-fold (95% CI: 1.9, 4.2) and 4.2-fold (95% CI: 2.6, 7.3) respectively. If the fifth version of the case definition had been applied throughout the outbreak, we estimated that by February 20 there would have been 232,000 (95% CI: 161,000, 359,000) confirmed cases. Interpretation: The case definition was initially narrow, but was gradually broadened to allow detection of more cases as knowledge increased, particularly milder cases and those without epidemiological links to Wuhan or other known cases. This should be taken into account when making inferences on epidemic growth rates and doubling times, and therefore on the reproductive number, to avoid bias. Funding: Commissioned grant from the Health and Medical Research Fund, Food and Health Bureau, Government of the Hong Kong Special Administrative Region. ### Competing Interest Statement BJC reports honoraria from Sanofi Pasteur and Roche. The authors report no other potential conflicts of interest. ### Funding Statement 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. ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes We used publicly available information on confirmed case counts, and a spreadsheet can be obtained from the corresponding author on request. | |
| Cold Spring Harbor Laboratory Press | |
| 2020 | |
| Preimpreso | |
| https://www.medrxiv.org/content/10.1101/2020.03.23.20041319v1 | |
| Inglés | |
| VIRUS RESPIRATORIOS | |
| Aparece en las colecciones: | Artículos científicos |
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| Impact of changing case definitions.pdf | 1.42 MB | Adobe PDF | Visualizar/Abrir |