Transmission of corona virus disease 2019 during the incubation period may lead to a quarantine loophole

Xia, Wei; Liao, Jiaqiang; Li, Chunhui; Li, Yuanyuan; Qian, Xi; Sun, Xiaojie; Xu, Hongbo; Mahai, Gaga; Zhao, Xin; Shi, Lisha; Liu, Juan; Yu, Ling; Wang, Meng; Wang, Qianqian; Namat, Asmagvl; Li, Ying; Qu, Jingyu; Liu, Qi; Lin, Xiaofang; Cao, Shuting; Huan, Shu; Xiao, Jiying; Ruan, Fengyu; Wang, Hanjin; Xu, Qing; Ding, Xingjuan; Fang, Xingjie; Qiu, Feng; Ma, Jiaolong; Zhang, Yu; Wang, Aizhen; Xing, Yuling; Xu, Shunqing

Background: The ongoing outbreak of novel corona virus disease 2019 (COVID-19) in Wuhan, China, is arousing international concern. This study evaluated whether and when the infected but asymptomatic cases during the incubation period could infect others. Methods: We collected data on demographic characteristics, exposure history, and symptom onset day of the confirmed cases, which had been announced by the Chinese local authorities. We evaluated the potential of transmission during the incubation period in 50 infection clusters, including 124 cases. All the secondary cases had a history of contact with their first-generation cases prior to symptom onset. Results: The estimated mean incubation period for COVID-19 was 4.9 days (95% confidence interval [CI], 4.4 to 5.4) days, ranging from 0.8 to 11.1 days (2.5th to 97.5th percentile). The observed mean and standard deviation (SD) of serial interval was 4.1±3.3 days, with the 2.5th and 97.5th percentiles at -1 and 13 days. The infectious curve showed that in 73.0% of the secondary cases, their date of getting infected was before symptom onset of the first-generation cases, particularly in the last three days of the incubation period. Conclusions: The results indicated the transmission of COVID-9 occurs among close contacts during the incubation period, which may lead to a quarantine loophole. Strong and effective countermeasures should be implemented to prevent or mitigate asymptomatic transmission during the incubation period in populations at high risk.