The incubation period of COVID-19 – A rapid systematic review and meta-analysis of observational research

Abstract

ABSTRACTBackgroundReliable estimates of the incubation period are important for decision making around the control of infectious diseases. Knowledge of the incubation period distribution can be used directly to inform decision-making or as inputs into mathematical models.ObjectivesThe aim of this study was to conduct a rapid systematic review and meta-analysis of estimates of the incubation periods of COVID-19.DesignRapid systematic review and meta-analysis of observational researchData sourcesPublications on the electronic databases PubMed, Google Scholar, MedRxiv and BioRxiv were searched. The search was not limited to peer-reviewed published data, but also included pre-print articles.Study appraisal and synthesis methodsStudies were selected for meta-analysis if they reported either the parameters and confidence intervals of the distributions fit to the data, or sufficient information to facilitate calculation of those values. The majority of studies suitable for inclusion in the final analysis modelled incubation period as a lognormal distribution. We conducted a random effects meta-analysis of the parameters of this distribution.ResultsThe incubation period distribution may be modelled with a lognormal distribution with pooled mu and sigma parameters of 1.63 (1.51, 1.75) and 0.50 (0.45, 0.55) respectively. The corresponding mean was 5.8 (5.01, 6.69 days). It should be noted that uncertainty increases towards the tail of the distribution: the pooled parameter estimates resulted in a median incubation period of 5.1 (4.5, 5.8) days, whereas the 95th percentile was 11.6 (9.5, 14.2) days.Conclusions and implicationsThe choice of which parameter values are adopted will depend on how the information is used, the associated risks and the perceived consequences of decisions to be taken. These recommendations will need to be revisited once further relevant information becomes available. Finally, we present an RShiny app that facilitates updating these estimates as new data become available.ARTICLE SUMMARYStrengths and limitations of this studyThis study provides a pooled estimate of the distribution of incubation periods which may be used in subsequent modelling studies or to inform decision-makingThis estimate will need to be revisited as subsequent data become available. We present an RShiny app to allow the meta-analysis to be updated with new estimates