Abstract
BackgroundFollowing an outbreak of coronavirus disease 2019 (COVID-19) on the cruise ship Diamond Princess, passengers and crew were followed-up to determine prognosis. This study examined the epidemiological determinants of COVID-19 natural history using these follow-up data.MethodsInfection status, diagnosis, clinical symptoms and prognosis were analysed for all passengers and crew members on the Diamond Princess. In addition, the risk of infection associated with exposure within cabin rooms, as well as the risks of various clinical manifestations of disease, along with their epidemiological determinants, were analysed.ResultsThe adjusted odds ratio (aOR) of infection for individuals tested by polymerase chain reaction on or after 12 February 2020 compared with individuals tested before this date was 0.53 [95% confidence interval (CI) 0.39–0.72], reflecting decreased transmission during onboard quarantine. Among infected individuals, older age was associated with elevated odds of symptomatic illness (aOR 1.01, 95% CI 1.00–1.02), severe disease (aOR 1.08, 95% CI 1.05–1.12) and death (aOR 1.12, 95% CI 1.05–1.21).ConclusionsSevere COVID-19 disease, death and symptomatic illness were more frequent among older individuals on the Diamond Princess. Older elderly cases (age ≥80 years) had the highest risks of severe disease and death. Inter-room transmission was prevented successfully by the onboard quarantine.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic has engulfed all regions of the world very swiftly, and has yet to be brought under control in many nations (World Health Organization, 2020)
Men accounted for 40.2% of passenger cases, and sex was not associated with in-room transmission (P=0.79)
Older age of exposed individuals was marginally associated with increased odds of infection
Summary
The coronavirus disease 2019 (COVID-19) pandemic has engulfed all regions of the world very swiftly, and has yet to be brought under control in many nations (World Health Organization, 2020). Epidemiological studies aiming to better characterize heterogeneous COVID-19 outcomes have not yet quantified the unconditional risk of transmission (e.g. secondary attack rate measured in confined spaces, such as households). These elements of disease heterogeneity can be clarified only by observing transmission and disease course over time in a substantial number of exposed and infected individuals of different ages.
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