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Coronavirus symptoms start about five days after exposure, Johns Hopkins study finds

Menstrual Conditions | Johns Hopkins Medicine

A new study led by researchers at Johns Hopkins Bloomberg School of Public Health suggests that the median incubation period for SARS-CoV-2—the new coronavirus that causes the respiratory illness COVID-19—is 5.1 days.

This median time from exposure to onset of symptoms suggests that the 14-day quarantine period used by the U.S. Centers for Disease Control and Prevention for individuals with ly exposure to the coronavirus is a reasonable amount of time to monitor individuals for development of the disease.

The analysis suggests that about 97.5% of people who develop symptoms of SARS-CoV-2 infection will do so within 11.5 days of exposure. The researchers estimated that for every 10,000 individuals quarantined for 14 days, only about 101 would develop symptoms after being released from quarantine.

The findings were published online today in the journal Annals of Internal Medicine.

For the study, the researchers analyzed 181 cases from China and other countries that were detected prior to Feb. 24, were reported in the media, and included ly dates of exposure and symptom onset. Most of the cases involved travel to or from Wuhan, China, the city at the center of the epidemic, or exposure to individuals who had been to Hubei, the province for which Wuhan is the capital.

The CDC and many other public health authorities around the world have been using a 14-day quarantine or active-monitoring period for individuals who are known to be at high risk of infection due to contact with known cases or travel to a heavily affected area.

” our analysis of publicly available data, the current recommendation of 14 days for active monitoring or quarantine is reasonable, although with that period some cases would be missed over the long-term,” says study senior author Justin Lessler, an associate professor in the Bloomberg School's Department of Epidemiology.

The global outbreak of SARS-CoV-2 infection emerged in December 2019 in Wuhan, a city of 11 million people in central China, and has resulted in more than 113,000 confirmed cases around the world and nearly 4,000 deaths from pneumonia caused by the virus, according to the COVID-19 tracker map developed by engineers at Johns Hopkins University. The majority of the cases are from Wuhan and the surrounding Hubei province, although dozens of other countries have been affected, including the U.S., but chiefly South Korea, Iran, and Italy to date.

An accurate estimate of the disease incubation period for a new virus makes it easier for epidemiologists to gauge the ly dynamics of the outbreak.

It also allows public health officials to design effective quarantine and other control measures.

Quarantines typically slow and may ultimately stop the spread of infection, even if there are some outlier cases with incubation periods that exceed the quarantine period.

/ The Wall Street Journal

Lessler notes that sequestering people in a way that prevents them from working has both personal and societal costs, which is perhaps made most obvious when health care workers and first responders firefighters are quarantined.

The new estimate of 5.1 days for the median incubation period of SARS-CoV-2 is similar to estimates from the earliest studies of this new virus, which were fewer cases.

This incubation period for SARS-CoV-2 is in the same range as SARS-CoV, a different human-infecting coronavirus that caused a major outbreak centered in southern China and Hong Kong from 2002-04.

For MERS-CoV, a coronavirus that has caused hundreds of cases in the Middle East, with a relatively high fatality rate, the estimated mean incubation period is 5–7 days.

Human coronaviruses that cause common colds have mean illness-incubation periods of about three days.

Lessler and colleagues have published an online tool that allows public health officials and members of the public to estimate how many cases would be caught and missed under different quarantine periods.

Source: https://hub.jhu.edu/2020/03/09/coronavirus-incubation-period/

5.1 days incubation period for COVID-19

Menstrual Conditions | Johns Hopkins Medicine

Summary: Researchers report the median time from exposure to symptoms for the COVID-19 virus is 5.1 days. 97.5% of people who develop symptoms of coronavirus will do so within 11.5 days of exposure. For every 10,000 people quarantined for 14 days, an estimated 101 would develop symptoms after release.

Source: Johns Hopkins University

An analysis of publicly available data on infections from the new coronavirus, SARS-CoV-2, that causes the respiratory illness COVID-19 yielded an estimate of 5.

1 days for the median disease incubation period, according to a new study led by researchers at Johns Hopkins Bloomberg School of Public Health. This median time from exposure to onset of symptoms suggests that the 14-day quarantine period used by the U.S.

Centers for Disease Control and Prevention for individuals with ly exposure to the coronavirus is reasonable.

The analysis suggests that about 97.5 percent of people who develop symptoms of SARS-CoV-2 infection will do so within 11.5 days of exposure. The researchers estimated that for every 10,000 individuals quarantined for 14 days, only about 101 would develop symptoms after being released from quarantine.

The findings will be published online March 9 in the journal Annals of Internal Medicine.

For the study, the researchers analyzed 181 cases from China and other countries that were detected prior to February 24, were reported in the media, and included ly dates of exposure and symptom onset. Most of the cases involved travel to or from Wuhan, China, the city at the center of the epidemic, or exposure to individuals who had been to Hubei, the province for which Wuhan is the capital.

The CDC and many other public health authorities around the world have been using a 14-day quarantine or active-monitoring period for individuals who are known to be at high risk of infection due to contact with known cases or travel to a heavily affected area.

“ our analysis of publicly available data, the current recommendation of 14 days for active monitoring or quarantine is reasonable, although with that period some cases would be missed over the long-term,” says study senior author Justin Lessler, an associate professor in the Bloomberg School’s Department of Epidemiology.

The global outbreak of SARS-CoV-2 infection emerged in December 2019 in Wuhan, a city of 11 million in central China, and has resulted in 95,333 officially confirmed cases around the world and 3,282 deaths from pneumonia caused by the virus, according to the World Health Organization’s March 5 Situation Report. The majority of the cases are from Wuhan and the surrounding Hubei province, although dozens of other countries have been affected, including the U.S., but chiefly South Korea, Iran, and Italy.

An accurate estimate of the disease incubation period for a new virus makes it easier for epidemiologists to gauge the ly dynamics of the outbreak, and allows public health officials to design effective quarantine and other control measures. Quarantines typically slow and may ultimately stop the spread of infection, even if there are some outlier cases with incubation periods that exceed the quarantine period.

Lessler notes that sequestering people in a way that prevents them from working has costs, both personal and societal, which is perhaps most obvious when health care workers and first responders firefighters are quarantined.

The CDC and many other public health authorities around the world have been using a 14-day quarantine or active-monitoring period for individuals who are known to be at high risk of infection due to contact with known cases or travel to a heavily affected area. The image is credited to the US State Department.

The new estimate of 5.1 days for the median incubation period of SARS-CoV-2 is similar to estimates from the earliest studies of this new virus, which were fewer cases.

This incubation period for SARS-CoV-2 is in the same range as SARS-CoV, a different human-infecting coronavirus that caused a major outbreak centered in southern China and Hong Kong from 2002-04.

For MERS-CoV, a coronavirus that has caused hundreds of cases in the Middle East, with a relatively high fatality rate, the estimated mean incubation period is 5-7 days.

Human coronaviruses that cause common colds have mean illness-incubation periods of about three days.

Lessler and colleagues have published an online tool that allows public health officials and members of the public to estimate how many cases would be caught and missed under different quarantine periods.

“The incubation period of COVID-19 from publicly reported confirmed cases: estimation and application” was written by co-first authors Stephen Lauer and Kyra Grantz, and Qifang Bi, Forrest Jones, Qulu Zheng, Hannah Meredith, Andrew Azman, Nicholas Reich, and Justin Lessler.

Funding: Support for the research was provided by CDC (NU2GGH002000), the National Institute of Allergy and Infectious Diseases (R01 AI135115), the National Institute of General Medical Sciences (R35 GM119582), and the Alexander von Humboldt Foundation.

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Source:
Johns Hopkins University
Media Contacts: Barbara Benham – Johns Hopkins University

Image Source:

The image is credited to the US State Department.

Original Research: Open access
“The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application”. Stephen A.

Lauer, MS, PhD; Kyra H. Grantz, BA; Qifang Bi, MHS; Forrest K. Jones, MPH; Qulu Zheng, MHS; Hannah R. Meredith, PhD; Andrew S. Azman, PhD; Nicholas G. Reich, PhD; Justin Lessler, PhD.

Annals of Internal Medicine doi:10.7326/M20-0504.

Abstract

The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application

See also

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 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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Source: https://neurosciencenews.com/covid-19-incubation-period-15883/

Gianna Pomata, PhD

Menstrual Conditions | Johns Hopkins Medicine

Phone: 410-955-3037
E-mail: gpomata1@jhmi.edu

Research Interests

I was educated and trained in Italy, but for the last twenty five years my professional life as a historian has been divided almost equally between Europe and the United States. Before joining Johns Hopkins University in 2007, I have taught for many years at the Universities of Bologna and Minnesota.

I have also held fellowships at the National Humanities Center (North Carolina), the Max Planck Institut für Wissenschaftsgeschichte in Berlin, the European University Institute in Florence, the University of Cambridge, the École des Hautes Études en Sciences Sociales and Centre Koyré in Paris, the Ruhr Universität in Bochum, and the Maison de l’Histoire at the University of Geneva.

In the academic year 2016-17 I'll be a Fellow of the Wissenschaftskolleg in Berlin. 

My research interests include early modern European social and cultural history, with a main focus on the history of medicine. I have always been fascinated by the history of the doctor/patient relationship, and particularly by those aspects of medical knowledge that deal with the patient as an individual human being.

This is why I have developed a research interest in the medical case narrative — casuistry being an aspect of medicine where the focus on patient’s individuality is uppermost.

Ever since coming to Hopkins, where I have the privilege of working as a historian within the environment of an intellectually vibrant Medical School, this has blossomed into an interest in the history of “individualized medicine” – a fascinating aspect of contemporary biomedicine whose story, I would contend, has important pre-modern intellectual roots.

In 2014, I have organized a conference on this topic, Individualized Medicine in Historical Perspective: from Antiquity to the Genome Age, with my Hopkins colleague Nathaniel Comfort, and I keep pursuing research on this topic.  I am also interested in medical casuistry from the viewpoint of a comparative history of medical genres.

Textual forms —  or,  as I would call them, “epistemic genres” — such as the case narrative, the recipe, the commentary, the treatise and the textbook, can be found in various medical traditions, and they offer an ideal framework for the comparative study of medical ways of knowing.

With another Hopkins colleague, Marta Hanson, a specialist of early modern Chinese medicine, I have started a collaborative study of Specimen Medicinae Sinicae (1682), the first book that offered a translation of Chinese pulse medicine, with related pharmaceutical recipes, for European Latin readers.  A cross-cultural approach to the history of medical genres and epistemologies is a central feature of my current research work. 

I am currently writing a book titled The Case Narrative in Pre-modern Medicine: A History Across Cultures, for which I have been awarded a NIH three-year grant, and which I intend to finish during my stay at the Wissenschaftskolleg in Berlin in 2016-17.

In this book, I study the development of the medical case history in a long-term perspective by tracing its antecedents in ancient Greek, medieval European and medieval Arabic medicine. I compare the early-modern European collections of case narratives with the case collections that developed in early modern Chinese medicine.

This project combines my long-standing engagement with the history of the doctor/patient relationship with my more recent interest in individualized medicine.

In the past, I have worked on the history of scientific observation, with particular attention to the role of early modern medicine in the rise of scientific empiricism.

I have written on the early modern genre of historia and its significance in medicine and anatomy, showing how the early modern historia straddled the distinction between the natural and the human sciences. I have also studied concepts and rules of evidence as they developed at the intersection of early modern medicine and religion.

I have contributed to the history of the healer/patient relationship by reconstructing the long-forgotten custom of contractual agreements between practitioners and patients. 

I keep pursuing a long-standing interest in women’s history, gender history, and the history of the body, to which I have contributed with various essays on women healers and women patients, the history of menstruation and lactation, the cult of holy bodies and relics, the understanding of sexual difference in early modern medicine, and the impact of medical thought on early modern proto-feminism. A recent contributions to this field is my critical edition and translation of Oliva Sabuco’s The True Medicine, one of the very few medical books published under a woman’s name in early modern Europe. Finally, I should mention that, as a woman historian, I have great interest in those women scholars who pursued the study of history outside or on the margins of academia in the late 19th and early 20th century, when the universities started, somewhat reluctantly, to admit female students. It is a labor of love for me to write an occasional essay to pay homage to the memory of these women. Their dedication to independent scholarship is my model of the values and passions that should lie at the heart of the historian’s craft.

 As you can see from this rather heterogeneous list of research interests, of the two kinds of intellectuals described by Isaiah Berlin, the hedgehog and the fox, I definitely belong to the fox tribe.

But I have great respect for hedgehogs, and whenever focusing on a specific research project I try to restrain my vulpine propensities.

It is nice to be a fox, but in issues of scholarship the hedgehog is probably the one who has the final word.

Recent Publications

Books
Oliva Sabuco de Nantes Barrera, The True Medicine, edited and translated by Gianna Pomata (Toronto: Center for Reformation and Renaissance Studies, 2010).

Historia: Empiricism and Erudition in Early Modern Europe (Cambridge, Mass.: MIT Press, 2005, co-edited with Nancy G. Siraisi).

I monasteri femminili come centri di cultura fra Rinascimento e Barocco (Rome: Edizioni di Storia e Letteratura, 2005, co-edited with Gabriella Zarri).

The Faces of Nature in Enlightenment Europe (Berlin: Berliner Wissenschafts-Verlag, 2003, co-edited with Lorraine Daston)

Contracting a Cure: Patients, Healers, and the Law in Early Modern Bologna (Baltimore & London: Johns Hopkins University Press, 1998); Italian edition: La promessa di guarigione: malati e curatori in antico regime, Bologna, secoli XVI-XVIII (Rome-Bari: Laterza, 1994)

Articles
“The Medical Case Narrative : Distant Reading of an Epistemic Genre,, in Literature and Medicine, 32 :1 (2014),1-23.

“Was there a Querelle des femmes in early modern medicine?” Arenal. Revista de Historia de las Mujeres, 20:3 (2013), 213-41.

“Amateurs by Choice: Women and the Pursuit of independent Scholarship in Twentieth-Century Historical Writing”, in “Beyond the Academy: Histories of Gender and Knowledge”, special issue of Centaurus. An International Journal of the History of Science and its Cultural Aspects, 55:2 (May 2013), 196-219.

“A Word of the Empirics: The Ancient Concept of Observation and its Recovery in Early Modern Medicine”, Annals of Science, 68:1 (2011), 1-26.

“Sharing Cases: the Observationes in Early Modern Medicine”, Early Science and Medicine, 15:3 (2010), 193-236; German translation: “Fälle mitteilen: die Observationes in der Medizin der frühen Neuzeit”, in Krankheit Schreiben: Aufzeichnungsverfahren in Medizin und Literatur, ed.

Yvonne Wübben and Carsten Zelle, Göttingen: Wallstein Verlag, 2013, 20-63; Italian translation: “Un archivio di casi: le Observationes nella medicina della prima età moderna”, in Interpretare e curare. Medicina e salute nel Rinascimento, ed.

Andrea Carlino, Antonio Clericuzio and Maria Conforti, Rome: Carocci, 2013, 249-68, 385-400.

“Dalla biografia alla storia e ritorno: Iris Origo tra Bloomsbury e Toscana”, Genesis, Rivista della Società Italiana delle Storiche, 6:1 (2008), 117-157.

“Malpighi and the Holy Body: Medical Experts and Miraculous Evidence in Seventeenth-Century Italy”, Renaissance Studies, 21:4 (2007), 568-586. Also published in Sandra Cavallo and David Gentilcore, eds., Spaces, Objects and Identities in Early Modern Italian Medicine, Oxford: Blackwell, 2008.

“Rejoinder to Pygmalion: the origins of women’s history at the London School of Economics” in History of Historiography, 46 (2004), 79-104.

“Fatti: storie dell’evidenza empirica”, Quaderni Storici, 108:3 (2001) (co-editor and co-author of Introduction with Simona Cerutti).

“Practicing Between Earth and Heaven: Women Healers in Early Modern Bologna” in Dynamis, 19 (1999), 119-143. Also published in Spanish as “Entre el cielo y la tierra: las sanadoras en la Bolonia del siglo XVII” in Montserrat Cabré i Pairet and Teresa Ortiz Gómez, eds., Sanadoras, Matronas y Médicas en Europa, siglos XII-XX, Barcelona: Icaria, 2001.

Chapters
“The Devil’s Advocate among the Physicians: What Prospero Lambertini learned from Medical Sources”, in Benedict XIV and the Enlightenment: Art, Science, and Spirituality,  ed. Rebecca Messbarger, Christopher M.S. Johns, and Philip Gavitt, Toronto: University of Toronto Press, 2016, 120-150.

 “The Recipe and the Case: Epistemic Genres and the Dynamics of Cognitive Practices” in Wissenschaftsgeschichte und Geschichte des Wissens im Dialog/Connecting Science and Knowledge, ed. Kaspar von Greyerz, Silvia Flubacher, and Philipp Senn, Göttingen: Vanderhoeck & Ruprecht, 2013, 131-154.

“Observation Rising: Birth of an Epistemic Genre, ca. 1500-1650” in Histories of Scientific Observation, eds Lorraine Daston and Elizabeth Lunbeck, Chicago: University of Chicago Press, 2011, 45-80.

“Feminism as Integral to the History of Humanism” in Humanism in Intercultural Perspective: Experiences and Expectations, ed. Jörn Rüsen and Henner Laass, Bielefeld: Transcript Verlag, 2009, vol. 1, 167-176.

“Praxis historialis: the uses of historia in early modern medicine” in Historia: Empiricism and Erudition in Early Modern Europe, eds Gianna Pomata and Nancy Siraisi, Cambridge, Mass.: MIT University Press, 2005, 105-146.

“Medicina delle monache: pratiche terapeutiche nei monasteri femminili a Bologna in età moderna” in I monasteri femminili come centri di cultura fra Rinascimento e Barocco, eds Gianna Pomata e Gabriella Zarri, Rome: Edizioni di Storia e Letteratura, 2005, 329-363.

“Medicine for the poor: health care and poor relief in 18th and 19th- century Bologna”, in Health Care and Poor Relief in 18th and 19th century Southern Europe, eds, Andrew Cunningham and Ole Grell, Aldershot: Ashgate, 2005, 229-243.

“Gender and the Family” in Short Oxford History of Italy: Early Modern Italy 1550-1796, ed. John Marino, Oxford: Oxford University Press, 2002, 69-86.

“Knowledge-freshening Wind: Gender and the Renewal of Renaissance Studies”, in The Italian Renaissance in the Twentieth Century, eds. Allan Grieco and Michael Rocke, Florence: Olschki, 2002, 173-192.

 “A Christian Utopia of the Renaissance: Elena Duglioli’s Spiritual and Physical Motherhood (ca. 1510-1520)” in Von der dargestellten Person zum erinnerten Ich: Europäische Selbstzeugnisse als historische Quellen (1500-1850), ed. Kaspar von Greyerz, Hans Medick, Patrice Veit, Cologne: Böhlau Verlag, 2001, 323-353.

“Menstruating Men: Similarity and Difference of the Sexes in Early Modern Medicine” in Generation and Degeneration: Tropes of Reproduction in Literature and History from Antiquity to Early Modern Europe,  eds Valeria Finucci and Kevin Brownlee, Durham and London: Duke Univ. Press, 2001, 109-152.

Teaching
140.105 History of Medicine: Antiquity to the Scientific Revolution.

140.418 Medicine for and by Women in Pre-Modern Europe.

140.425 Individualized Medicine from Antiquity to the Genome Age (co-taught with Nathaniel Comfort)

140.601. History of Science, Medicine and Technology: An Introduction to Historical Methods (co-taught with Lawrence Principe)

Graduate Section150. 701 History of Medicine: Antiquity to the Scientific Revolution.150. 813 Medicine and Science in History. A Survey of Historiography (co-taught with Marta Hanson).

Cross-Cultural Histories of Medicine (co-taught with Marta Hanson)

Source: https://hopkinshistoryofmedicine.org/content/gianna-pomata