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2/18/2020 3:15:00 PM
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First Posting 2/18/2020 3:15:00 PM  
Posting Date: 2/18/2020 3:15:00 PM

On December 31, 2019, 44 cases of pneumonia from an unknown cause were reported in China, possibly associated with one live-animal market in Wuhan, China. An epidemiological study to identify the origin of the pneumonia-like symptoms started at the same time. In the market identified, live animals—including wild animals—were held in close contact with each other and with humans. Close contact between humans and animals could have caused the viral recombination and emergence of the novel coronavirus. Available evidence at that time suggested that the novel virus was a recombinant of a coronavirus with animal origin that emerged during November or December 2019. To learn more about the novel coronavirus, please visit our In Focus blog.

By January 12, the disease agent was determined to be a previously unidentified coronavirus, and its genetic sequence was shared with researchers globally. The first imported case, in Thailand, was identified the next day and it has since spread to 28 other countries/territories. On February 11, the disease that is caused by the novel coronavirus received an official name from the World Health Organization, COVID-19, and the agent of the disease is called SARS-CoV-2.

Licensees of the AIR Pandemic Model should contact their AIR representative to receive more information to help them in their assessment of this current outbreak. Modeled projected ranges will be provided by geographic resolution at the moderate, serious, and death resolutions for the following time intervals: as of current report, 1 week, and 2 weeks out from current report date.

According to the World Health Organization (WHO) as of 10 a.m. ET on February 18, 2020, there were 73,424 confirmed cases and 1,873 deaths. Currently, the vast majority of deaths have occurred in Mainland China; additional deaths have occurred in Hong Kong, the Philippines, Japan, Taiwan, and France. Actual counts are likely to be much higher due to significant underreporting. The main country affected by the current outbreak is Mainland China. Small clusters and isolated cases have occurred (in order of the number of cases) in Singapore, Japan, Hong Kong, Thailand, South Korea, Malaysia, Taiwan, Germany, Vietnam, Australia, United States, France, Macau, United Arab Emirates, United Kingdom, Canada, Philippines, Italy, India, Russia, Spain, Egypt, Sweden, Belgium, Cambodia, Finland, Nepal, Sri Lanka. Vietnam was the first country outside of China with confirmed local transmission of the virus.

On February 4, the cruise ship Diamond Princess was put under quarantine by authorities in Japan after it docked in Yokohama and reported 10 confirmed cases of the disease. Some of the passengers and crew were evacuated from the ship on February 16. U.S. passengers face an additional two weeks of quarantine on U.S. soil. As of February 18 at 10 a.m. ET, total reported cases from the ship were 542.


There is a high level of uncertainty associated with estimating the dynamics of a disease during an ongoing outbreak. The uncertainty can be due in part to lack of reporting, and to the high speed of case transmission due to the nature of airborne diseases. Preliminary estimates from the AIR Pandemic Model suggest that the projected outbreak size varies depending on mitigation and containment measures, and their effectiveness in China and other countries. Containing the current outbreak has proven difficult. Some factors contributing to the spread of the disease are international travel, the fact that it is an airborne virus—meaning that it can be spread through respiratory droplets from the coughing and sneezing of infected individuals—and the relatively high proportion of infected individuals who may not experience severe symptoms but can play a role in disease spread.

Pathogenesis of COVID-19

Current observations suggest that a high proportion of infected individuals with the novel coronavirus, COVID-19, develop very mild and nonspecific symptoms. Therefore, they may not seek medical care and not be counted in the published figures. Moderately symptomatic individuals usually experience fever, fatigue, and dry cough, and may ask for medical care.  The current estimate of people who have developed severe symptoms ranges between 8% and 20%; these severe symptoms include pneumonia, shortness of breath and, in more complicated cases, acute respiratory distress syndrome, arrhythmia, and shock. Intensive care unit (ICU) admission has been higher among people over 60 years of age with pre-existing comorbidities. There is high uncertainty around the lethality of the disease; however, it is estimated that COVID-19 has a higher case fatality rate (CFR) compared to seasonal flu (~0.1-0.4%) and a lower CFR compared to the 2003 SARS outbreak (~5.0%-10.0%). The current estimation for CFR ranges between 0.5% and 4%.

Estimates from various sources, including academic studies published in The Lancet and from Imperial College London, have indicated that the global estimated cases could reach hundreds of thousands of cases or more before the end of February. Based on projections from the AIR Pandemic Model, we estimate that this may represent a moderately conservative projection of cases; the vast majority will be asymptomatic or have mild symptoms. AIR projections also suggest that the number of moderately symptomatic cases in China on February 18 could range between 70,000 and 165,000, and the number of severe cases in China on February 18 could range between 35,000 and 85,000, with deaths ranging from 3,000 to 7,500. For context, it is important to note that tens of millions to hundreds of millions of people contract the flu in China in any given year. Globally, hundreds of thousands of people die from flu-related complications. The risk of death varies by age, healthcare received, presence of comorbidities, and many other factors. Influenza infection shares many similarities with coronavirus infections, although coronavirus belongs to a different family of viruses (Orthomyxoviridae vs Coronaviridae). Flu infections often have milder symptoms than the virus causing this current outbreak of COVID-19, MERS, or SARS.

AIR’s model-based estimates account for uncertainty and underreporting. Mild to moderate symptoms are the types of cases most likely to not be captured in the official numbers, but even for severe cases and deaths it is likely that there will be significant underreporting. The current modeled projection does not suggest substantial transmission of the disease outside China in the coming weeks.

figure feb 18 covid 580.jpg

The AIR Pandemic Model total cases for February 18, 2020, including individuals who are mildly symptomatic or asymptomatic. This number is higher than the reported cases due to the fact that individuals with mild symptoms may not seek medical care and therefore go unreported. (Source: AIR)

The difference between the low and high end of the range is driven by a few factors. As previously discussed, uncertainty in the reported number of confirmed cases and the transmissibility of the virus play a significant role. Specifically, the lower end of the range represents a scenario where a) the true number of cases is relatively closer to what has been reported than estimated, and b) the possibility that containment measures (such as isolation and quarantine) become more successful than they have been to date. If such containment measures—driven by international and/or local authorities—are successful, this could restrict the human-to-human transmission sufficiently to bring the eventual number of cases to or even below the low end of the modeled projected range of cases.

Currently there is no specific treatment available for this disease other than supportive care. There are some antivirals and other treatments currently being tested, although it is too early to determine their effectiveness. So far, fatality is most common in older patients, with more than 80% of deaths occurring in people over 60 years of age, more than 70% of whom have one or more pre-existing co-morbidities, including cardiovascular disease, diabetes, and malignancies. It is also important to note that people who are more than 60 years old are generally at higher risk for any type of pneumonia and not just COVID-19 pneumonia.  For these reasons, an overall increase in cases of the virus does not imply a commensurate increase in fatalities.

In countries with robust healthcare systems, any imported cases would most likely be contained with few or no transmissions to additional people—provided that cases are rapidly identified and appropriate infection control protocols are followed.

AIR continues to monitor the COVID-19 outbreak and will send updates to clients as warranted. 

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