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Contact: PANTHR@HQ.DHS.GOV DISTRIBUTION STATEMENT A: Approved for Public Release; Distribution Is Unlimited REQUIRED INFORMATION FOR EFFECTIVE INFECTIOUS DISEASE OUTBREAK RESPONSE SARS-CoV-2 (COVID-19) Updated 3/4/2020 Transmissibility – How does it spread Host range – how many species does it Incubation period – how long after SARS-CoV-2 Infectious dose – how much agent will from one host to another? How easily infect? Can it transfer from species to infection do symptoms appear? Are make a normal individual ill? (COVID-19) is it spread? species? people infectious during this time? What do we know? • The human infectious dose for novel • The WHO has declared SARS-CoV-2 a • Early genomic analysis indicates • A study of 1,099 COVID-19 patients Wuhan coronavirus (SARS-CoV-2), Public Health Emergency of similarity to SARS,132 with a found a median incubation period of which causes coronavirus disease 19 International Concern116 with 95,124 suggested bat origin.5,42, 132 3 days, with a range from 0 to 24 68 57 (COVID-19) is currently unknown via cases and 3,254 deaths in 75 • Analysis of SARS-CoV-2 genomes days. 22, 96, 114 all exposure routes. Severe acute countries (as of 3/4/2020). suggests that a non-bat intermediate • Earlier estimates of the incubation respiratory syndrome (SARS) and • High-quality estimates of human species is responsible for the period from confirmed cases were 92 Middle East respiratory syndrome transmissibility (R0) range from 2.2 to beginning of the outbreak. higher; 5.8 days with a range from (MERS) coronaviruses (CoV) are used 3.180, 86, 91, 120, 128 Although the identity of the 1.3 to 11.3 days,9 and 5.2 days with as surrogates. • Large outbreaks are occurring in intermediate species remains an upper bound of 9.2-18 days.75 • The infectious dose for SARS in mice Japan, Italy, Iran, South Korea, unconfirmed, pangolins may be a • CDC estimates that the incubation is estimated to be between 67-540 Germany France, and Spain.110 natural host of related viruses period is between 2 and 14 days 27, 31 PFU (average 240 PFU, intranasal • There are 153 SARS-CoV-2 cases possibly including SARS-CoV-2.76-77 • Asymptomatic infection has been route).50-51 across 15 US states, with 11 deaths. • Positive samples from the South documented, where individuals do • Genetically modified mice exposed (as of 3/4/2020).68 China Seafood Market strongly not present with clinical symptoms intranasally to doses of MERS virus • Sustained transmission may have suggests a wildlife source,32 though it but are found positive via diagnostic between 100 and 500,000 PFU show been occurring in the US (Seattle) for is possible that the virus was assay.10, 34, 57, 101, 130 signs of infection. Infection with up to 5 or 6 weeks.14 circulating in humans before the • Individuals can be infectious while higher doses result in severe • SARS-CoV-2 transmission has disease was associated with the asymptomatic,30, 93, 101, 130 and syndromes.5, 41, 73, 129 occurred in hospitals inside108 and seafood market.15, 43, 122, 126 asymptomatic individuals have about • Initial experiments suggest that SARS- outside of China,58 including the US.17 • Experiments suggest that SARS-CoV- the same amount of virus in their CoV-2 can infect genetically modified • Pre-symptomatic130 or 2 Spike (S) receptor-binding domain nose and throat as symptomatic mice containing the human ACE2 cell asymptomatic10 patients in China can binds the human cell receptor (ACE2) individuals.133 entry receptor. Infection via the transmit SARS-CoV-2; the degree of stronger than SARS,119 potentially • Infectious period is unknown, but 5 intranasal route (dose: 10 TCID50) asymptomatic transmission is still explaining its high transmissibility; possibly up to 10-14 days 4, 96 causes light infection, however no unknown. the same work suggests that • On average, there are 7.5 days virus was isolated from infected • SARS-CoV-2 is believed to spread differences between SARS-CoV-2 and between symptom onset in animals, and PCR primers used in the through close contact and droplet SARS-CoV Spike proteins may limit successive cases of a single study do not align well with SARS- transmission.30 the therapeutic ability of SARS transmission chain (i.e., the serial 11 119 CoV-2, casting doubt on this study. • Viable SARS-CoV-2 has been isolated antibody treatments. interval).75 from human feces; fecal-oral • Modeling between SARS-CoV-2 Spike • The average time for individuals to transmission is possible.81, 124, 127 and ACE2 proteins suggests that first seek medical care decreased • Transmission via fomites has not SARS-CoV-2 can bind and infect from 5.8 days after symptom onset been confirmed for SARS-CoV-2, but human, bat, civet, monkey and swine to 4.6 days before and after January 107 occurred in prior SARS40, 121 and cells. 1st, 2020, respectively, indicating an 75 MERS70 outbreaks increase in seeking care behavior. • SARS-CoV-2 is consistently present in • China recommends 14 quarantine for infected patient saliva104 recovered patients due to positive • Infants have been diagnosed with genetic tests days after leaving the COVID-19, but no evidence exists for hospital, raising the possibility of vertical transmission via intrauterine continued transmission after infection or through breastmilk.38, 109 symptoms subside.64 • China reports no evidence of super- spreading events (SSEs) within hospital patients or staff.101 Contact: [email protected] DISTRIBUTION STATEMENT A: Approved for public release; distribution is unlimited. 1 REQUIRED INFORMATION FOR EFFECTIVE INFECTIOUS DISEASE OUTBREAK RESPONSE SARS-CoV-2 (COVID-19) Updated 3/4/2020 Transmissibility – How does it spread Host range – how many species does it Incubation period – how long after SARS-CoV-2 Infectious dose – how much agent will from one host to another? How easily infect? Can it transfer from species to infection do symptoms appear? Are make a normal individual ill? (COVID-19) is it spread? species? people infectious during this time? What do we need • Human infectious dose by aerosol • Capability of SARS-CoV-2 to be • What is the intermediate host(s)? • How early does asymptomatic to know? route transmitted by contact with fomites • What are the mutations in SARS-CoV- transmission begin? • Human infectious dose by surface (doorknobs, surfaces, clothing, etc.) 2 that allowed human infection and • What is the average infectious period contact (fomite) – see also Experimental Stability transmission? during which individuals can transmit • Human infectious dose by fecal-oral • Superspreading capacity needs to be • What animals can SARS-CoV-2 infect the disease? route refined (e.g., pet dogs, potential wildlife • How long do patients continue to • Where does SARS-CoV-2 replicate in • Updated person to person reservoirs)? shed infectious virus after physical the respiratory tract? transmission rates (e.g., R0) as recovery? control measures take effect • Can individuals become re-infected • Tendency for ill individuals to seek after recovery? If so, how long after? medical care due to symptoms • What is the underreporting rate?67 • Can individuals become re-infected with SARS-CoV-2? • What is the difference in transmissibility among countries? • Is the R0 estimate higher in healthcare or long-term care facilities? • How effective are social distancing measures at reducing spread? Who is doing Capable of performing work Performing work: Capable of performing work: Performing work: experiments/has - DHS National Biodefense Analysis and - Christian Althaus (Bern) - Vincent Munster (Rocky Mountain - Chaolin Huang (Jin Yin-tan Hospital, capabilities in this Countermeasures Center (NBACC) - Neil Ferguson (MRC) National Laboratory) Wuhan, China) area? - Gabriel Leung, Joseph Wu (University - Matthew Frieman (University of - The Novel Coronavirus Pneumonia of Hong Kong) Maryland Baltimore) Emergency Response Epidemiology - Sara Del Valle (Los Alamos) - Ralph Baric (University of North Team - Maimuna Majumder (Boston Carolina) Children’s Hospital) - Stanley Perlman (University of Iowa) - Trevor Bedford (Fred Hutchinson - Susan Baker (Loyola University Cancer Center) Chicago) - Sang Woo Park (Princeton) - Mark Denison (Vanderbilt University) - Vineet Menachery (University of Texas Medical Branch) - Jason McLellan, Daniel Wrapp, Nianshuang Wang (University of Texas) - David O’Conner (U. Wisconsin, Madison) Contact: [email protected] DISTRIBUTION STATEMENT A: Approved for public release; distribution is unlimited. 2 REQUIRED INFORMATION FOR EFFECTIVE INFECTIOUS DISEASE OUTBREAK RESPONSE SARS-CoV-2 (COVID-19) Updated 3/4/2020 Clinical presentation – what are the Clinical diagnosis – are there tools to SARS-CoV-2 Medical treatment – are there effective Environmental stability – how long does signs and symptoms of an infected diagnose infected individuals? When treatments? Vaccines? the agent live in the environment? (COVID-19) person? during infection are they effective? What do we know? • The majority of COVID-19 cases are • Updated tests from the US CDC are • Treatment for COVID-19 is primarily • No information yet exists regarding the mild (81%, N = 44,000 cases)101 available to states.21, 30 supportive care including oxygen and environmental stability of SARS-CoV-2; • Initial COVID-19 symptoms include • The FDA released an Emergency Use mechanical ventilation,29 though China SARS and MERS coronaviruses are used fever (87.9% overall, but only 43.8% Authorization describing an has released a treatment plan8; over as surrogates instead. present with fever initially57), cough accelerated policy enabling 80 clinical trials are set to run on • Studies
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