may 2020 • Annals of Internal Medicine

The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application

Lauer SA, Grantz KH, Bi Q, et al.

DOI: 10.7326/M20-0504

Content curation::Clara Jasmins

Key message

Em doentes por COVID-19 sintomáticos, estimou-se que o tempo médio de incubação para foi de 5.1 dias após a exposição, sendo que nas estimativas mais conservadoras, os primeiros sintomas poderiam ocorrer em média até 11.5 dias após a exposição. Através desta análise torna-se muito pouco provável que doentes de alto risco de contágio venham a ter um resultado positivo após o período de 14 dias de isolamento (1 em 10 000 pessoas). Ainda assim, este estudo não integrou doentes infectados por SARS-CoV-2 que permanecem sempre assintomáticos, pelo que a sua aplicabilidade nesse grupo é limitada.

Abstract

Background: A novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019. There is limited support for many of its key epidemiologic features, including the incubation period for clinical disease (coronavirus disease 2019 [COVID-19]), which has important implications for surveillance and control activities. Objective: To estimate the length of the incubation period of COVID-19 and describe its public health implications. Design: Pooled analysis of confirmed COVID-19 cases reported between 4 January 2020 and 24 February 2020. Setting: News reports and press releases from 50 provinces, regions, and countries outside Wuhan, Hubei province, China. Participants: Persons with confirmed SARS-CoV-2 infection outside Hubei province, China. Measurements: Patient demographic characteristics and dates and times of possible exposure, symptom onset, fever onset, and hospitalization. Results: There were 181 confirmed cases with identifiable exposure and symptom onset windows to estimate the incubation period of COVID-19. The median incubation period was estimated to be 5.1 days (95% CI, 4.5 to 5.8 days), and 97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection. These estimates imply that, under conservative assumptions, 101 out of every 10 000 cases (99th percentile, 482) will develop symptoms after 14 days of active monitoring or quarantine. Limitation: Publicly reported cases may overrepresent severe cases, the incubation period for which may differ from that of mild cases. Conclusion: This work provides additional evidence for a median incubation period for COVID-19 of approximately 5 days, similar to SARS. Our results support current proposals for the length of quarantine or active monitoring of persons potentially exposed to SARS-CoV-2, although longer monitoring periods might be justified in extreme cases.