Objective: To estimate the potential risk and geographic range of Wuhan novel coronavirus (2019-nCoV) spread within and beyond China from January through to April, 2020. Design: Travel network-based modelling study. Setting and participants: General population travelling from Wuhan and other high-risk cities in China. Main outcome measures: Based on de-identified and aggregated mobile phone data, air passenger itinerary data, and case reports, we defined the relative importation risk and internal and international destinations of 2019-nCoV from Wuhan and other high-risk cities in China. Results: The cordon sanitaire of Wuhan is likely to have occurred during the latter stages of peak population numbers leaving the city before Lunar New Year (LNY), with travellers departing into neighbouring cities and other megacities in China, and a high proportion of cases likely travelled with symptoms at the early stage of the outbreak. Should secondary outbreaks occur in 17 high-risk secondary cities, they could contribute to seeding the virus in other highly connected cities within and beyond China after the LNY holiday. We estimated that 59,912 air passengers, of which 834 (95% UI: 478 - 1349) had 2019-nCoV infection, travelled from Wuhan to 382 cities outside of mainland China during the two weeks prior to the lockdown of Wuhan. The majority of these cities were in Asia, but major hubs in Europe, the US and Australia were also prominent, with strong correlation seen between predicted importation risks and reported cases seen. Because significant spread has already occurred, a large number of airline travellers (3.3 million under the scenario of 75% travel reduction from normal volumes) may be required to be screened at origin high-risk cities in China and destinations across the globe for the following three months of February to April, 2020 to effectively limit spread beyond its current extent. Conclusion: Further spread of 2019-nCoV within China and international exportation is likely to occur. All countries, especially vulnerable regions, should be prepared for efforts to contain the 2019-nCoV infection.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis study was supported by the grants from the Bill & Melinda Gates Foundation (OPP1134076); the European Union Horizon 2020 (MOOD 874850); the National Natural Science Fund of China (81773498, 71771213, 91846301); National Science and Technology Major Project of China (2016ZX10004222-009, 2018ZX10201001-010, 2018ZX10713001-007, 2017ZX10103009-005); Program of Shanghai Academic/Technology Research Leader (18XD1400300); Hunan Science and Technology Plan Project (2017RS3040, 2018JJ1034). AJT is supported by funding from the Bill & Melinda Gates Foundation (OPP1106427, OPP1032350, OPP1134076, OPP1094793), the Clinton Health Access Initiative, the UK Department for International Development (DFID) and the Wellcome Trust (106866/Z/15/Z, 204613/Z/16/Z). HY is supported by funding from the National Natural Science Fund for Distinguished Young Scholars of China (No. 81525023); Program of Shanghai Academic/Technology Research Leader (No. 18XD1400300); and the United States National Institutes of Health (Comprehensive International Program for Research on AIDS grant U19 AI51915). The research team members were independent from the funding agencies. The funders had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; and the preparation, review, or approval of the manuscript. Author DeclarationsAll relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.YesAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I onfirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesThe datasets on monthly air passenger data in February April, 2018 used in this study are available from Dr. Kamran Khan (Kamran@bluedot.global). The case data are available from Dr. Shengjie Lai (Shengjie.Lai@soton.ac.uk). The datasets on holidays and air travel statistics from 2010 through 2018 used for validation are available on the WorldPop website (www.worldpop.org). The mobile phone datasets analysed during the current study are not publicly available since this would compromise the agreement with the data provider, but information on the process of requesting access to the data that support the findings of this study are available from Dr. Shengjie Lai (Shengjie.Lai@soton.ac.uk).
Lai Shengjie, Bogoch Isaac, Ruktanonchai Nick, Watts Alexander, Li Yu, Yu Jianzing, Lv Xin, Yang Weizhong, Yu Hongjie, Khan Kamran, Li Zhongjie, Tatem Andrew J. (2020). Assessing spread risk of Wuhan novel coronavirus within and beyond China, January-April 2020: a travel network-based modelling study