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The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application
Open accessPublished version of a preprint
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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“The cumulative incidence of Covid-19 cases over time among placebo and vaccine recipients begins to diverge by 12 days after the first dose, 7 days after the estimated median viral incubation period of 5 days,10 indicating the early onset of a partially protective effect of immunization.”
From Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine (2020) · cites this paper as [10]
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Metadata
- 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
- 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
- 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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