Abstract
BackgroundUnderstanding the epidemiological parameters that determine the transmission dynamics of COVID-19 is essential for public health intervention. Globally, a number of studies were conducted to estimate the average serial interval and incubation period of COVID-19. Combining findings of existing studies that estimate the average serial interval and incubation period of COVID-19 significantly improves the quality of evidence. Hence, this study aimed to determine the overall average serial interval and incubation period of COVID-19.MethodsWe followed the PRISMA checklist to present this study. A comprehensive search strategy was carried out from international electronic databases (Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library) by two experienced reviewers (MAA and DBK) authors between the 1st of June and the 31st of July 2020. All observational studies either reporting the serial interval or incubation period in persons diagnosed with COVID-19 were included in this study. Heterogeneity across studies was assessed using the I2 and Higgins test. The NOS adapted for cross-sectional studies was used to evaluate the quality of studies. A random effect Meta-analysis was employed to determine the pooled estimate with 95% (CI). Microsoft Excel was used for data extraction and R software was used for analysis.ResultsWe combined a total of 23 studies to estimate the overall mean serial interval of COVID-19. The mean serial interval of COVID-19 ranged from 4. 2 to 7.5 days. Our meta-analysis showed that the weighted pooled mean serial interval of COVID-19 was 5.2 (95%CI: 4.9–5.5) days. Additionally, to pool the mean incubation period of COVID-19, we included 14 articles. The mean incubation period of COVID-19 also ranged from 4.8 to 9 days. Accordingly, the weighted pooled mean incubation period of COVID-19 was 6.5 (95%CI: 5.9–7.1) days.ConclusionsThis systematic review and meta-analysis showed that the weighted pooled mean serial interval and incubation period of COVID-19 were 5.2, and 6.5 days, respectively. In this study, the average serial interval of COVID-19 is shorter than the average incubation period, which suggests that substantial numbers of COVID-19 cases will be attributed to presymptomatic transmission.
Highlights
Understanding the epidemiological parameters that determine the transmission dynamics of COVID19 is essential for public health intervention
Previous studies reported that the average serial interval of COVID-19 is shorter than the average incubation period, which suggests that a substantial proportion of presymptomatic transmission [8, 9]
The following searching terms are used from the above databases: “serial interval” OR “generation time” AND “incubation period” OR “infectious period” AND “COVID-19” OR “SARS-CoV-2” OR “novel coronavirus”
Summary
Understanding the epidemiological parameters that determine the transmission dynamics of COVID19 is essential for public health intervention. A number of studies were conducted to estimate the average serial interval and incubation period of COVID-19. Combining findings of existing studies that estimate the average serial interval and incubation period of COVID-19 significantly improves the quality of evidence. This study aimed to determine the overall average serial interval and incubation period of COVID-19. Effective treatment to block the spread of COVID19 is not developed yet, countries implement non-treatment intervention such as social distancing, isolation, face mask and quarantine to reduce its rapid transmission [4, 5]. Serial interval and incubation period are the two main epidemiological parameters that determine the transmission dynamics of infectious diseases [7]. Serial interval is defined as the time from illness onset in the primary case to illness onset in the secondary case, while incubation period is the time from infection occurred to the onset of signs and symptoms
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