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A novel coronavirus (2019-nCoV) causing severe acute respiratory disease emerged recently in Wuhan, China. Information on reported cases strongly indicates human-to-human spread, and the most recent information is increasingly indicative of sustained human-to-human transmission. While the overall severity profile among cases may change as more mild cases are identified, we estimate a risk of fatality among hospitalised cases at 14% (95% confidence interval: 3.9–32%).


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  1. Su S, Wong G, Shi W, Liu J, Lai ACK, Zhou J, et al. Epidemiology, Genetic Recombination, and Pathogenesis of Coronaviruses. Trends Microbiol. 2016;24(6):490-502.  https://doi.org/10.1016/j.tim.2016.03.003  PMID: 27012512 
  2. Fan Y, Zhao K, Shi ZL, Zhou P. Bat Coronaviruses in China. Viruses. 2019;11(3):E210.  https://doi.org/10.3390/v11030210  PMID: 30832341 
  3. Hui DS. Epidemic and Emerging Coronaviruses (Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome). Clin Chest Med. 2017;38(1):71-86.  https://doi.org/10.1016/j.ccm.2016.11.007  PMID: 28159163 
  4. Guan Y, Peiris JS, Zheng B, Poon LL, Chan KH, Zeng FY, et al. Molecular epidemiology of the novel coronavirus that causes severe acute respiratory syndrome. Lancet. 2004;363(9403):99-104.  https://doi.org/10.1016/S0140-6736(03)15259-2  PMID: 14726162 
  5. World Health Organization Regional Office for the (WHO/Eastern Mediterranean). MERS Situation Update. Cairo: WHO/Eastern Mediterranean; Nov2019. [Accessed 11 Jan 2020]. Available from: http://applications.emro.who.int/docs/EMRPUB-CSR-241-2019-EN.pdf?ua=1&ua=1
  6. Cowling BJ, Park M, Fang VJ, Wu P, Leung GM, Wu JT. Preliminary epidemiological assessment of MERS-CoV outbreak in South Korea, May to June 2015. Euro Surveill. 2015;20(25):7-13.  https://doi.org/10.2807/1560-7917.ES2015.20.25.21163  PMID: 26132767 
  7. Kim KH, Tandi TE, Choi JW, Moon JM, Kim MS. Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak in South Korea, 2015: epidemiology, characteristics and public health implications. J Hosp Infect. 2017;95(2):207-13.  https://doi.org/10.1016/j.jhin.2016.10.008  PMID: 28153558 
  8. Wong G, Liu W, Liu Y, Zhou B, Bi Y, Gao GF. MERS, SARS, and Ebola: The Role of Super-Spreaders in Infectious Disease. Cell Host Microbe. 2015;18(4):398-401.  https://doi.org/10.1016/j.chom.2015.09.013  PMID: 26468744 
  9. Kucharski AJ, Althaus CL. The role of superspreading in Middle East respiratory syndrome coronavirus (MERS-CoV) transmission. Euro Surveill. 2015;20(25):14-8.  https://doi.org/10.2807/1560-7917.ES2015.20.25.21167  PMID: 26132768 
  10. Amer H, Alqahtani AS, Alzoman H, Aljerian N, Memish ZA. Unusual presentation of Middle East respiratory syndrome coronavirus leading to a large outbreak in Riyadh during 2017. Am J Infect Control. 2018;46(9):1022-5.  https://doi.org/10.1016/j.ajic.2018.02.023  PMID: 29661625 
  11. World Health Organization (WHO). WHO Statement Regarding Cluster of Pneumonia Cases in Wuhan, China. Beijing: WHO; 9 Jan 2020. [Accessed 11 Jan 2020]. https://www.who.int/china/news/detail/09-01-2020-who-statement-regarding-cluster-of-pneumonia-cases-in-wuhan-china
  12. Wuhan Municipal Health Commission. [Update on outbreak of pneumonia cases in Wuhan]. 31 Dec 2019. [Accessed 13 Jan 2020]. Chinese. Available from: http://wjw.wuhan.gov.cn/front/web/showDetail/2019123108989
  13. Beijing News. [Southern China Seafood Market linked to unexplained pneumonia outbreak]. 2 Jan 2020. [Accessed 13 Jan 2020]. Chinese. Available from: http://epaper.bjnews.com.cn/html/2020-01/02/content_775695.htm
  14. Wuhan Municipal Health Commission. [Report on unexplained viral pneumonia]. 5 Jan 2020. [Accessed 21 Jan 2020]. Chinese. Available from: http://wjw.wuhan.gov.cn/front/web/showDetail/2020010509020
  15. Wuhan Municipal Health Commission. [Report on unexplained viral pneumonia]. 11 Jan 2020. [Accessed 21 Jan 2020]. Chinese. Available from: http://wjw.wuhan.gov.cn/front/web/showDetail/2020011109035
  16. Cheung J. Ill husband and wife add to Wuhan riddle. Hong Kong; The Standard; 16 Jan 2020. [Accessed 20 Jan 2020]. Available from: https://www.thestandard.com.hk/sections-news-print/215457/Ill-husband-and-wife--add-to-Wuhan-riddle
  17. Cauchemez S, Epperson S, Biggerstaff M, Swerdlow D, Finelli L, Ferguson NM. Using routine surveillance data to estimate the epidemic potential of emerging zoonoses: application to the emergence of US swine origin influenza A H3N2v virus. PLoS Med. 2013;10(3):e1001399.  https://doi.org/10.1371/journal.pmed.1001399  PMID: 23472057 
  18. Wuhan Municipal Health Commission. [Questions and answers on pneumonia due to novel coronavirus infection]. 14 Jan 2020. [Accessed 20 Jan 2020]. Chinese. Available from: http://wjw.wuhan.gov.cn/front/web/showDetail/2020011509040
  19. Cauchemez S, Van Kerkhove MD, Riley S, Donnelly CA, Fraser C, Ferguson NM. Transmission scenarios for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and how to tell them apart. Euro Surveill. 2013;18(24):20503. PMID: 23787162 
  20. World Health Organization Regional Office for the Western Pacific (WHO/Pacific). World Health Organization Western Pacific Twitter Feed. Manila: WHO/Pacific; 8:35 PM 20 Jan 2020. Available from: https://twitter.com/WHOWPRO
  21. Yu H, Cowling BJ, Feng L, Lau EH, Liao Q, Tsang TK, et al. Human infection with avian influenza A H7N9 virus: an assessment of clinical severity. Lancet. 2013;382(9887):138-45.  https://doi.org/10.1016/S0140-6736(13)61207-6  PMID: 23803487 
  22. Ghani AC, Donnelly CA, Cox DR, Griffin JT, Fraser C, Lam TH, et al. Methods for estimating the case fatality ratio for a novel, emerging infectious disease. Am J Epidemiol. 2005;162(5):479-86.  https://doi.org/10.1093/aje/kwi230  PMID: 16076827 
  23. Cowling BJ, Muller MP, Wong IO, Ho LM, Lo SV, Tsang T, et al. Clinical prognostic rules for severe acute respiratory syndrome in low- and high-resource settings. Arch Intern Med. 2006;166(14):1505-11.  https://doi.org/10.1001/archinte.166.14.1505  PMID: 16864761 
  24. Lau EH, Hsiung CA, Cowling BJ, Chen CH, Ho LM, Tsang T, et al. A comparative epidemiologic analysis of SARS in Hong Kong, Beijing and Taiwan. BMC Infect Dis. 2010;10(1):50.  https://doi.org/10.1186/1471-2334-10-50  PMID: 20205928 
  25. Hui DS, Azhar EI, Kim YJ, Memish ZA, Oh MD, Zumla A. Middle East respiratory syndrome coronavirus: risk factors and determinants of primary, household, and nosocomial transmission. Lancet Infect Dis. 2018;18(8):e217-27.  https://doi.org/10.1016/S1473-3099(18)30127-0  PMID: 29680581 
  26. Leung GM, Hedley AJ, Ho LM, Chau P, Wong IO, Thach TQ, et al. The epidemiology of severe acute respiratory syndrome in the 2003 Hong Kong epidemic: an analysis of all 1755 patients. Ann Intern Med. 2004;141(9):662-73.  https://doi.org/10.7326/0003-4819-141-9-200411020-00006  PMID: 15520422 
  27. Jewell NP, Lei X, Ghani AC, Donnelly CA, Leung GM, Ho LM, et al. Non-parametric estimation of the case fatality ratio with competing risks data: an application to Severe Acute Respiratory Syndrome (SARS). Stat Med. 2007;26(9):1982-98.  https://doi.org/10.1002/sim.2691  PMID: 16981181 
  28. Chinese National Health Commission (NHC). [Experts answer reporters' questions on pneumonia outbreak of new coronavirus infection]. Beijing: NHC; 20 Jan 2020. [Accessed 20 Jan 2020]. Chinese http://www.nhc.gov.cn/xcs/s7847/202001/8d735f0bb50b45af928d9944d16950c8.shtml
  29. Chinese National Health Commission (NHC). [Press conference in response to the outbreak of pneumonia caused by 2019-nCoV]. Beijing: NHC; 21 Jan 2020. [Accessed 21 Jan 2020]. Chinese. Available from: http://www.nhc.gov.cn/xcs/s7847/202001/8d735f0bb50b45af928d9944d16950c8.shtml
  30. World Health Organization (WHO). Novel Coronavirus – Thailand (ex-China). Geneva: WHO: 14 Jan 2020. Available from: https://www.who.int/csr/don/14-january-2020-novel-coronavirus-thailand/en/
  31. World Health Organization (WHO). Novel Coronavirus – Japan (ex-China). Geneva: WHO; 16 Jan 2020. Available from: https://www.who.int/csr/don/16-january-2020-novel-coronavirus-japan-ex-china/en/
  32. Centers for Disease Control and Prevention (CDC). First Travel-related Case of 2019 Novel Coronavirus Detected in United States. Atlanta: CDC; 21 Jan 2020. Available from: https://www.cdc.gov/media/releases/2020/p0121-novel-coronavirus-travel-case.html
  33. Taiwan Centers for Disease Control (CDC). Taiwan timely identifies first imported case of severe special infectious pneumonia from Wuhan, China through onboard quarantine; Central Epidemic Command Center (CECC) raises travel notice level for Wuhan, China to Level 3: Warning. Taipei City: CDC; 21 Jan 2020. Available from: https://www.cdc.gov.tw/En/Bulletin/Detail/pVg_jRVvtHhp94C6GShRkQ?typeid=158

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