Cited by 5,970COVID-19 epidemiological studiesSARS-CoV-2 and COVID-19 ResearchCOVID-19 Clinical Research Studies

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

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Lauer, Stephen A., Grantz, Kyra H., Bi, Qifang, Jones, Forrest K., Zheng, Qulu, Meredith, Hannah R., Azman, Andrew S., Reich, Nicholas G., Lessler, Justin·2020·Annals of Internal Medicine

DOI 10.7326/m20-0504PMC PMC7081172

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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. PRIMARY FUNDING SOURCE: U.S. Centers for Disease Control and Prevention, National Institute of Allergy and Infectious Diseases, National Institute of General Medical Sciences, and Alexander von Humboldt Foundation.

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Authors: Lauer, S. A., Grantz, K. H., Bi, Q., Jones, F. K., Zheng, Q., Meredith, H. R., Azman, A. S., Reich, N. G., & Lessler, J.
Affiliations: Johns Hopkins University (US)
University of Massachusetts Amherst (US)
Corresponding author: Lessler, Justin
ORCID: Lauer, Stephen A.
Grantz, Kyra H.
Jones, Forrest K.
Zheng, Qulu
Meredith, Hannah R.
Azman, Andrew S.
Reich, Nicholas G.
Lessler, Justin
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 2020-05-05
Volume: 172
Issue: 9
Pages: 577-582
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/m20-0504
PMC: PMC7081172
OpenAlex: W3010233963
Cited by: 5,970
References: 26
Citations by year: 2026: 64 · 2025: 131 · 2024: 249 · 2023: 453 · 2022: 938 · 2021: 1871 · 2020: 2257
FWCI: 219.21
Type: journal article
Language: en
Open access: green
doi.org
Licence: cc-by-nd
Locations: Annals of Internal Medicine (publishedVersion)
medRxiv (acceptedVersion, cc-by-nd)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
ScholarWorks@UMassAmherst (University of Massachusetts Amherst) (submittedVersion)
PUBLISSO (German National Library of Medicine) (submittedVersion)
ScholarWorks@UMassAmherst (University of Massachusetts Amherst) (submittedVersion, other-oa)
Funders: Alexander von Humboldt-Stiftung
Johns Hopkins University
National Institutes of Health
Centers for Disease Control and Prevention
National Institute of General Medical Sciences (R35GM119582)
National Institute of Allergy and Infectious Diseases
Fogarty International Center
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: COVID-19 pandemic, SARS-CoV-2, incubation period, symptom onset, quarantine duration, active monitoring, confirmed cases, disease surveillance, disease control
MeSH terms: Betacoronavirus, COVID-19, SARS-CoV-2, Adult, China, Female, Humans, Male, Middle Aged, Pneumonia, Viral, Retrospective Studies, Coronavirus Infections, Infectious Disease Incubation Period, Pandemics

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

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