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Epidemiological identification of a novel infectious disease in real time: Analysis of the atypical pneumonia outbreak in Wuhan, China, 2019-20
Katsuma Hayashi
Yichi Yang
Robin N. Thompson
Ryo Kinoshita
Sung-mok Jung
Natalie M. Linton
Hiroshi Nishiura
Andrei R. Akhmetzhanov
Novel Coronavirus
Acceso Abierto
Objective: Virological tests indicate that a novel coronavirus is the most likely explanation for the 2019-20 pneumonia outbreak in Wuhan, China. We demonstrate that non-virological descriptive characteristics could have determined that the outbreak is caused by a novel pathogen in advance of virological testing. Methods: Characteristics of the ongoing outbreak were collected in real time from two medical social media sites. These were compared against characteristics of ten existing pathogens that can induce atypical pneumonia. The probability that the current outbreak is due to "Disease X" (i.e., previously unknown etiology) as opposed to one of the known pathogens was inferred, and this estimate was updated as the outbreak continued. Results: The probability that Disease X is driving the outbreak was assessed as over 32% on 31 December 2019, one week before virus identification. After some specific pathogens were ruled out by laboratory tests on 5 Jan 2020, the inferred probability of Disease X was over 59%. Conclusions: We showed quantitatively that the emerging outbreak of atypical pneumonia cases is consistent with causation by a novel pathogen. The proposed approach, that uses only routinely-observed non-virological data, can aid ongoing risk assessments even before virological test results become available. Keywords: Epidemic; Causation; Bayes' theorem; Diagnosis; Prediction; Statistical model ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement R.N.T. would like to thank Christ Church (Oxford) for funding via a Junior Research Fellowship. H.N. received funding from the Japan Agency for Medical Research and Development (AMED) [grant number: JP18fk0108050]; the Japan Society for the Promotion of Science (JSPS) KAKENHI [grant numbers, H.N.: 17H04701, 17H05808, 18H04895 and 19H01074; R.K.: 18J21587], the Inamori Foundation, and the Japan Science and Technology Agency (JST) CREST program [grant number: JPMJCR1413]. ### 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 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 Supplemetal tables are available as attached to this submission.
Cold Spring Harbor Laboratory Press
Appears in Collections:Artículos científicos

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