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Resurgence of Omicron BA.2 in SARS-CoV-2 infection-naive Hong Kong
Open accessAbstract
After keeping infections at bay for two years, Hong Kong experienced a surge of Omicron BA.2 infections in early 2022 that overwhelmed the health care system, isolation facilities, and contact tracing capacity, leading to one of the highest per-capita death rates of COVID-19 in early 2022. The outbreak occurred against a backdrop of a dense population with low immunity towards natural SARS-CoV-2 infection, high vaccine hesitancy in vulnerable populations, comprehensive disease surveillance and the capacity for stringent public health and social measures. Using genome sequences and epidemiological data from this time, we reconstruct the epidemic trajectory of the BA.2 wave, estimate transmission and incidence rates, and evaluate the effectiveness of policy changes. We identify an increase in the effective reproductive rate (Re) to 9.5 in mid-January 2022, which preceded real-time estimates of transmission (Rt), revealing that BA.2 community transmission was under-ascertained weeks before the epidemic appeared to surge in mid-February 2022. Due to this, public health measures were relaxed in early February (Spring Festival) while Re increased and remained > 1 throughout February. An independent estimation of point prevalence and incidence using phylodynamics also indicates extensive superspreading at this time, which likely contributed to the rapid expansion of the epidemic. This study demonstrates that relying on Rt estimation methods dependent on case reporting can misinform epidemic response planning, sometimes with substantial consequences. There is a need for future research and implementation of improved estimates of epidemic growth in near real-time that combine multiple disparate data sources to better inform outbreak response policy.
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Lau, J. J., Cheng, S. M. S., Leung, K., Lee, C. K., Hachim, A., Tsang, L. C. H., Yam, K. W. H., Chaothai, S., Kwan, K. K. H., Chai, Z. Y. H., et al. (2023) · Nature Medicine · doi:10.1038/s41591-023-02219-5 · Cited by 198
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Metadata
- Authors
- Xie, R., Edwards, K. M., Adam, D. C., Leung, K. S. M., Tsang, T. K., Gurung, S., Xiong, W., Wei, X., Ng, D. Y. M., Liu, G. Y. Z., Krishnan, P., Chang, L. D. J., Cheng, S. M. S., Gu, H., Siu, G. K. H., Wu, J. T., Leung, G. M., Peiris, M., Cowling, B. J., Poon, L. L. M., & Dhanasekaran, V.
- Affiliations
- HKU-Pasteur Research Pole (HK)
- University of Hong Kong (HK)
- The Hong Kong Polytechnic University
- Laboratory of Data Discovery for Health (HK)
- Hong Kong Science and Technology Parks Corporation (HK)
- The University of Hong Kong
- ORCID
- Venue
- Nature Communications
- Published
- 2022-09-27
- Volume
- 14
- Issue
- 1
- Pages
- 2422-2422
- ISSN
- 2041-1723 (ISSN-L)
- PMC
- PMC10134727
- OpenAlex
- W4367291784
- Cited by
- 31
- References
- 32
- Citations by year
- 2026: 2 · 2025: 10 · 2024: 13 · 2023: 6
- FWCI
- 6.53
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Nature Communications (publishedVersion, cc-by)
- Research Square (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institutes of Health (75N93021C00016)
- Research Grants Council, University Grants Committee (T11-705/21-N)
- Health and Medical Research Fund (COVID190205)
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Keywords
- Omicron BA.2, SARS-CoV-2, COVID-19 outbreak, Hong Kong, hotel quarantine, cross-infection, superspreading, public health and social measures, effective reproduction number, phylodynamics, point prevalence, epidemic trajectory, Chinese New Year, vaccine hesitancy
- MeSH terms
- COVID-19, SARS-CoV-2, Disease Outbreaks, Hong Kong, Humans, Basic Reproduction Number
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