Passengers' destinations from China: low risk of Novel Coronavirus (2019-nCoV) transmission into Africa and South America

Abstract

Novel Coronavirus (2019-nCoV [SARS-COV-2]) was detected in humans during the last week of December 2019 at Wuhan city in China, and caused 24 554 cases in 27 countries and territories as of 5 February 2020. The objective of this study was to estimate the risk of transmission of 2019-nCoV through human passenger air flight from four major cities of China (Wuhan, Beijing, Shanghai and Guangzhou) to the passengers' destination countries. We extracted the weekly simulated passengers' end destination data for the period of 1-31 January 2020 from FLIRT, an online air travel dataset that uses information from 800 airlines to show the direct flight and passengers' end destination. We estimated a risk index of 2019-nCoV transmission based on the number of travellers to destination countries, weighted by the number of confirmed cases of the departed city reported by the World Health Organization (WHO). We ranked each country based on the risk index in four quantiles (4th quantile being the highest risk and 1st quantile being the lowest risk). During the period, 388 287 passengers were destined for 1297 airports in 168 countries or territories across the world. The risk index of 2019-nCoV among the countries had a very high correlation with the WHO-reported confirmed cases (0.97). According to our risk score classification, of the countries that reported at least one Coronavirus-infected pneumonia (COVID-19) case as of 5 February 2020, 24 countries were in the 4th quantile of the risk index, two in the 3rd quantile, one in the 2nd quantile and none in the 1st quantile. Outside China, countries with a higher risk of 2019-nCoV transmission are Thailand, Cambodia, Malaysia, Canada and the USA, all of which reported at least one case. In pan-Europe, UK, France, Russia, Germany and Italy; in North America, USA and Canada; in Oceania, Australia had high risk, all of them reported at least one case. In Africa and South America, the risk of transmission is very low with Ethiopia, South Africa, Egypt, Mauritius and Brazil showing a similar risk of transmission compared to the risk of any of the countries where at least one case is detected. The risk of transmission on 31 January 2020 was very high in neighbouring Asian countries, followed by Europe (UK, France, Russia and Germany), Oceania (Australia) and North America (USA and Canada). Increased public health response including early case recognition, isolation of identified case, contract tracing and targeted airport screening, public awareness and vigilance of health workers will help mitigate the force of further spread to naïve countries.

Keywords: 2019-nCoV; Africa; COVID-19; China; SARS-COV-2; Wuhan; risk map; transmission.

Fig. 1.

The map with the risk index of countries or territories with 2019-nCoV (SARS-COV-2) infection (0-1). The darker colour indicates higher risk and light blue colour indicates the absence of data. In general, China and neighbouring countries have a higher risk of transmission of 2019-nCoV infection. Africa and South America generally have a low risk of transmission. Ethiopia, South Africa, Egypt, Mauritius and Brazil have a similar risk of transmission to countries where at least one case has been detected. For example, the risk index of 0.1 for Thailand indicates that based on travel patterns observed during 1–31 January 2020 from four major cities of China, Thailand has 10% risk of importing a 2019-nCoV-infected person from China.

Fig. 2.

Chart showing the relative risk of countries outside China being exposed to coronavirus ( SARS-COV-2) transmission. The second Y-axis indicates the number of confirmed COVID-19 cases reported by the WHO as of 5 February 2020. Twenty-one of the top 25 at-risk countries (except Indonesia, Turkey, Pakistan and Qatar) reported at least one COVID-19 case by 5 February 2020.