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Meta-Analysis
. 2020 Jun 29:148:e130.
doi: 10.1017/S0950268820001430.

Epidemiological characteristics of COVID-19: a systematic review and meta-analysis

Malahat Khalili  1   2 , Mohammad Karamouzian  1   3 , Naser Nasiri  1   2 , Sara Javadi  2   4 , Ali Mirzazadeh  1   5 , Hamid Sharifi  1   2
Affiliations
Meta-Analysis

Epidemiological characteristics of COVID-19: a systematic review and meta-analysis

Malahat Khalili et al. Epidemiol Infect. .

Abstract

Our understanding of the Coronavirus disease 2019 (COVID-19) continues to evolve and there are many unknowns about its epidemiology. This study aims to synthesise case fatality rate (CFR) among confirmed COVID-19 patients, incubation period and time from onset of COVID-19 symptoms to first medical visit, intensive care unit (ICU) admission, recovery, and death. We searched MEDLINE, Embase, Google Scholar, and bibliographies of relevant articles from 01 December 2019 to 11 March 2020 without any language restrictions. Quantitative studies that recruited people with confirmed COVID-19 diagnosis were included. Two independent reviewers extracted the data. Out of 1675 non-duplicate studies, 43 were included in the meta-analysis. The pooled mean incubation period was 5.68 (99% confidence interval [CI]: 4.78, 6.59) days. The pooled mean number of days from the onset of COVID-19 symptoms to first clinical visit was 4.92 (95% CI: 3.95, 5.90), ICU admission was 9.84 (95% CI: 8.78, 10.90), recovery was 18.55 (95% CI: 13.69, 23.41), and death was 15.93 (95% CI: 13.07, 18.79). Pooled CFR among confirmed COVID-19 patients was 0.02 (95% CI: 0.02, 0.03). We found that the incubation period and lag between the onset of symptoms and first clinical visit for COVID-19 are longer than other respiratory viral infections including Middle East respiratory syndrome and severe acute respiratory syndrome; however, the current policy of 14 days of mandatory quarantine for everyone potentially exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might be too conservative. Longer quarantine periods might be more justified for extreme cases.

Keywords: COVID-19; Coronavirus; epidemiology; pandemic.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1.
Fig. 1.
PRISMA flowchart of screened and included studies.
Fig. 2.
Fig. 2.
Incubation period of COVID-19.
Fig. 3.
Fig. 3.
Time from onset of symptoms to first clinical visit for COVID-19 patients.
Fig. 4.
Fig. 4.
Time from onset of symptoms to ICU admission for COVID-19 patients.
Fig. 5.
Fig. 5.
Time from onset of symptoms to recovery for COVID-19 patients.
Fig. 6.
Fig. 6.
Time from onset of symptoms to death for COVID-19.
Fig. 7.
Fig. 7.
Crude fatality rate among COVID-19 patients.
See this image and copyright information in PMC

References

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    1. World Health Organization (2020) Coronavirus Disease (COVID-19) Pandemic. Geneva: World Health Organization.
    1. Daga MK et al. (2019) From SARS-CoV to coronavirus disease 2019 (COVID-19)-A brief review. Journal of Advanced Research in Medicine 6, 1–9.
    1. Centers for Disease Control and Prevention (2004) SARS Basics Fact Sheet. USA: Centers for Disease Control and Prevention.
    1. World Health Organization. SARS (Severe Acute Respiratory Syndrome). Geneva: World Health Organization.

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MeSH terms