{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T07:08:11Z","timestamp":1774595291535,"version":"3.50.1"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2020,5,15]],"date-time":"2020-05-15T00:00:00Z","timestamp":1589500800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100014219","name":"National Science Fund for Distinguished Young Scholars","doi-asserted-by":"publisher","award":["81525023"],"award-info":[{"award-number":["81525023"]}],"id":[{"id":"10.13039\/501100014219","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018537","name":"National Science and Technology Major Project","doi-asserted-by":"publisher","award":["2018ZX10201001-010"],"award-info":[{"award-number":["2018ZX10201001-010"]}],"id":[{"id":"10.13039\/501100018537","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018537","name":"National Science and Technology Major Project","doi-asserted-by":"publisher","award":["2018ZX10713001-007"],"award-info":[{"award-number":["2018ZX10713001-007"]}],"id":[{"id":"10.13039\/501100018537","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018537","name":"National Science and Technology Major Project","doi-asserted-by":"publisher","award":["2017ZX10103009-005"],"award-info":[{"award-number":["2017ZX10103009-005"]}],"id":[{"id":"10.13039\/501100018537","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To assess the case fatality risk (CFR) of COVID-19 in mainland China, stratified by region and clinical category, and estimate key time-to-event intervals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We collected individual information and aggregated data on COVID-19 cases from publicly available official sources from 29 December 2019 to 17 April 2020. We accounted for right-censoring to estimate the CFR and explored the risk factors for mortality. We fitted Weibull, gamma, and log-normal distributions to time-to-event data using maximum-likelihood estimation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We analyzed 82\u2005719 laboratory-confirmed cases reported in mainland China, including 4632 deaths and 77\u2005029 discharges. The estimated CFR was 5.65% (95% confidence interval [CI], 5.50\u20135.81%) nationally, with the highest estimate in Wuhan (7.71%) and lowest in provinces outside Hubei (0.86%). The fatality risk among critical patients was 3.6 times that of all patients and 0.8\u201310.3-fold higher than that of mild-to-severe patients. Older age (odds ratio [OR], 1.14 per year; 95% CI, 1.11\u20131.16) and being male (OR, 1.83; 95% CI, 1.10\u20133.04) were risk factors for mortality. The times from symptom onset to first healthcare consultation, to laboratory confirmation, and to hospitalization were consistently longer for deceased patients than for those who recovered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our CFR estimates based on laboratory-confirmed cases ascertained in mainland China suggest that COVID-19 is more severe than the 2009 H1N1 influenza pandemic in hospitalized patients, particularly in Wuhan. Our study provides a comprehensive picture of the severity of the first wave of the pandemic in China. Our estimates can help inform models and the global response to COVID-19.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaa578","type":"journal-article","created":{"date-parts":[[2020,5,12]],"date-time":"2020-05-12T15:09:52Z","timestamp":1589296192000},"page":"e79-e85","source":"Crossref","is-referenced-by-count":40,"title":["Case Fatality Risk of the First Pandemic Wave of Coronavirus Disease 2019 (COVID-19) in China"],"prefix":"10.1093","volume":"73","author":[{"given":"Xiaowei","family":"Deng","sequence":"first","affiliation":[{"name":"School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiling","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiaxin","family":"Zhou","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiyuan","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yinzi","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Han","family":"Yan","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juanjuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongli","family":"Zhang","sequence":"additional","affiliation":[{"name":"Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"Qiu","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Gong","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xianglin","family":"Wei","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lili","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaiyuan","family":"Sun","sequence":"additional","affiliation":[{"name":"Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peng","family":"Wu","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Ajelli","sequence":"additional","affiliation":[{"name":"Bruno Kessler Foundation, Trento, Italy"},{"name":"Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, Indiana, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin J","family":"Cowling","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cecile","family":"Viboud","sequence":"additional","affiliation":[{"name":"Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongjie","family":"Yu","sequence":"additional","affiliation":[{"name":"School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,5,15]]},"reference":[{"key":"2021070111225476200_CIT0001","author":"National Health Commission of the People\u2019s Republic of China"},{"key":"2021070111225476200_CIT0002","author":"National Health Commission of the People\u2019s Republic of China","year":"2020"},{"key":"2021070111225476200_CIT0003","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1126\/science.abb6105","article-title":"An investigation of transmission","volume":"368","author":"Tian","year":"2020","journal-title":"Science"},{"key":"2021070111225476200_CIT0004","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1016\/S0140-6736(20)30746-7","article-title":"First-wave COVID-19 transmissibility and severity in China outside Hubei after control measures, and second-wave scenario planning: a modelling impact assessment","volume":"395","author":"Leung","year":"2020","journal-title":"Lancet"},{"key":"2021070111225476200_CIT0005","first-page":"w20203","article-title":"2019-novel coronavirus (2019-nCoV): estimating the case fatality rate\u2014 a word of caution","volume":"150","author":"Battegay","year":"2020","journal-title":"Swiss Med Wkly"},{"key":"2021070111225476200_CIT0006","first-page":"1775","article-title":"Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy","volume":"323","author":"Onder","year":"2020","journal-title":"JAMA"},{"key":"2021070111225476200_CIT0007","doi-asserted-by":"crossref","first-page":"523","DOI":"10.3390\/jcm9020523","article-title":"Real-time estimation","volume":"9","author":"Jung","year":"2020","journal-title":"J Clin Med"},{"key":"2021070111225476200_CIT0008","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.3201\/eid2606.200233","article-title":"Estimating risk for death from 2019 novel coronavirus disease, China, January-February 2020","volume":"26","author":"Mizumoto","year":"2020","journal-title":"Emerg Infect Dis"},{"key":"2021070111225476200_CIT0009","doi-asserted-by":"crossref","first-page":"2000256","DOI":"10.2807\/1560-7917.ES.2020.25.12.2000256","article-title":"Estimating the infection and case fatality ratio for coronavirus disease (COVID-19) using age-adjusted data from the outbreak on the Diamond Princess cruise ship, February 2020","volume":"25","author":"Russell","year":"2020","journal-title":"Euro Surveill"},{"key":"2021070111225476200_CIT0010","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.ijid.2020.03.031","article-title":"Transmission potential and severity of COVID-19 in South Korea","volume":"93","author":"Shim","year":"2020","journal-title":"Int J Infect Dis"},{"key":"2021070111225476200_CIT0011","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.3201\/eid2606.200320","article-title":"Case-fatality risk estimates for COVID-19 calculated by using a lag time for fatality","volume":"26","author":"Wilson","year":"2020","journal-title":"Emerg Infect Dis"},{"key":"2021070111225476200_CIT0012","doi-asserted-by":"crossref","first-page":"2000044","DOI":"10.2807\/1560-7917.ES.2020.25.3.2000044","article-title":"Real-time tentative assessment of the epidemiological characteristics of novel coronavirus infections in Wuhan, China, as at 22 January 2020","volume":"25","author":"Wu","year":"2020","journal-title":"Euro Surveill"},{"key":"2021070111225476200_CIT0013","author":"WHO Collaborating Centre for Infectious Disease Modelling and Imperial College London."},{"key":"2021070111225476200_CIT0014","author":"National Health Commission of the People\u2019s Republic of China"},{"key":"2021070111225476200_CIT0015","doi-asserted-by":"crossref","DOI":"10.1016\/S1473-3099(20)30230-9","article-title":"Evolving epidemiology and transmission dynamics of novel coronavirus disease 2019 outside Hubei Province in China: a descriptive and modeling study","author":"Zhang","year":"2020","journal-title":"Lancet Infect Dis"},{"key":"2021070111225476200_CIT0016","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1056\/NEJMoa2001316","article-title":"Early transmission dynamics in Wuhan, China, of novel coronavirus\u2013infected pneumonia","volume":"382","author":"Li","year":"2020","journal-title":"N Engl J Med"},{"key":"2021070111225476200_CIT0017","doi-asserted-by":"crossref","DOI":"10.1016\/S1473-3099(20)30243-7","article-title":"Estimates of the severity of coronavirus disease 2019: a model-based analysis","author":"Verity","year":"2020","journal-title":"Lancet Infect Dis"},{"key":"2021070111225476200_CIT0018","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1038\/s41591-020-0822-7","article-title":"Estimating clinical severity of COVID-19 from the transmission dynamics in Wuhan, China","volume":"26","author":"Wu","year":"2020","journal-title":"Nat Med"},{"key":"2021070111225476200_CIT0019","doi-asserted-by":"crossref","first-page":"2000310","DOI":"10.1183\/13993003.00310-2020","article-title":"Epidemiological characteristics of 2019-ncoV infections in Shaanxi, China by February 8, 2020","volume":"55","author":"Yao","year":"2020","journal-title":"Eur Respir J"},{"key":"2021070111225476200_CIT0020","author":"World Health Organization"},{"key":"2021070111225476200_CIT0021","author":"Chinese Center for Disease Control and Prevention"},{"key":"2021070111225476200_CIT0022","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/S1473-3099(10)70120-1","article-title":"Case fatality ratio of pandemic influenza","volume":"10","author":"Nishiura","year":"2010","journal-title":"Lancet Infect Dis"},{"key":"2021070111225476200_CIT0023","doi-asserted-by":"crossref","first-page":"e10896","DOI":"10.1371\/journal.pone.0010896","article-title":"Low clinical burden of 2009 pandemic influenza A (H1N1) infection during pregnancy on the island of La R\u00e9union","volume":"5","author":"G\u00e9rardin","year":"2010","journal-title":"PLoS One"},{"key":"2021070111225476200_CIT0024","author":"The Paper"},{"key":"2021070111225476200_CIT0025","doi-asserted-by":"crossref","first-page":":20596","DOI":"10.2807\/1560-7917.ES2013.18.39.20596","article-title":"Taking stock of the first 133 MERS coronavirus cases globally\u2014is the epidemic changing?","volume":"18","author":"Penttinen","year":"2013","journal-title":"Euro Surveill"},{"key":"2021070111225476200_CIT0026","first-page":"533","article-title":"An outbreak of SARS in Dongcheng District, Beijing during March to June 2003","volume":"25","author":"Wang","year":"2003","journal-title":"Zhongguo Yi Xue Ke Xue Yuan Xue Bao"},{"key":"2021070111225476200_CIT0027","doi-asserted-by":"crossref","first-page":"b2840","DOI":"10.1136\/bmj.b2840","article-title":"Assessing the severity of the novel influenza A\/H1N1 pandemic","volume":"339","author":"Garske","year":"2009","journal-title":"BMJ"},{"key":"2021070111225476200_CIT0028","author":"World Health Organization\u2013China Joint Mission"},{"key":"2021070111225476200_CIT0029","author":"Wuhan Municipal Health Commission"},{"key":"2021070111225476200_CIT0030","author":"Health Commission of Guangdong Province"},{"key":"2021070111225476200_CIT0031","doi-asserted-by":"crossref","DOI":"10.1016\/S1473-3099(20)30244-9","article-title":"The many estimates of the COVID-19 case fatality rate","author":"Rajgor","year":"2020","journal-title":"Lancet Infect Dis"},{"key":"2021070111225476200_CIT0032","author":"World Health Organization"},{"key":"2021070111225476200_CIT0033","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S2213-2600(20)30079-5","article-title":"Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study","volume":"8","author":"Yang","year":"2020","journal-title":"Lancet Respir Med"},{"key":"2021070111225476200_CIT0034","doi-asserted-by":"crossref","first-page":"e147","DOI":"10.1016\/j.lpm.2010.03.009","article-title":"Outbreak of influenza pandemic virus A(H1N1) 2009 infections in emergency department, Saint-Pierre, Reunion Island","volume":"39","author":"Staikowsky","year":"2010","journal-title":"Presse Medicale"},{"key":"2021070111225476200_CIT0035","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1111\/j.1365-3156.2009.02300.x","article-title":"No evidence of over-reporting of SARS in mainland China","volume":"14(Suppl 1)","author":"Liu","year":"2009","journal-title":"Trop Med Int Health"},{"key":"2021070111225476200_CIT0036","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1016\/j.jtbi.2006.09.015","article-title":"Impact of quarantine on the 2003 SARS outbreak: a retrospective modeling study","volume":"244","author":"Hsieh","year":"2007","journal-title":"J Theor Biol"},{"key":"2021070111225476200_CIT0037","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1093\/aje\/kwv054","article-title":"Hospitalization fatality risk of influenza A(H1N1)pdm09: a systematic review and meta-analysis","volume":"182","author":"Wong","year":"2015","journal-title":"Am J Epidemiol"}],"container-title":["Clinical Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/cid\/advance-article-pdf\/doi\/10.1093\/cid\/ciaa578\/34032585\/ciaa578.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/73\/1\/e79\/38846734\/ciaa578.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/cid\/article-pdf\/73\/1\/e79\/38846734\/ciaa578.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T08:01:10Z","timestamp":1625126470000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cid\/article\/73\/1\/e79\/5837356"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,15]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,5,15]]},"published-print":{"date-parts":[[2021,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/cid\/ciaa578","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2020.03.04.20031005","asserted-by":"object"}]},"ISSN":["1058-4838","1537-6591"],"issn-type":[{"value":"1058-4838","type":"print"},{"value":"1537-6591","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,7,1]]},"published":{"date-parts":[[2020,5,15]]}}}