The novel coronavirus infection pneumonia in Zhejiang province, China: early transmission dynamics, the government measures, and current situation of diagnosis and treatment CURRENT STATUS: UNDER REVIEW

Objective: to analyze the early transmission dynamics, the government measures, and current Methods: We collected the daily number of newly confirmed novel coronavirus infection pneumonia (NCP) patients and the number of discharge patients by February 8 in Zhejiang province. We analyzed the characteristics, exposure history, and the clinical symptoms of NCP patients. Results: there were 1075 confirmed NCP patients and 173 discharge patients in Zhejiang province by February 8. The daily number of newly confirmed NCP patients got decreased since January 29 (27 patients on February 8), while the daily number of newly discharge NCP patients was increasing (46 patients on February 8). Before February 1, the imported NCP patients contained the most significant part of total NCP patients. And the local infection of NCP patients occupied the main reason. 77 patients needed to stay in ICU. 26 of 77 patients had greater life danger. Fortunately, no patient was dead, and no health care worker got the infection. At the same time, the government of Zhejiang province strictly restricted the movement of people to prevent the NCP from further spread. Conclusion: The early spread of NCP in Zhejiang province was speedy. After the government of Zhejiang province took strict measures to restrict the movement of people, the difficult situation of NCP got noticeable relief in Zhejiang province since February 1.


Introduction
The novel coronavirus infection pneumonia (2019-nCOV) was reported to appear in the city of Wuhan, the provincial city of Hubei province, in December 2019 (1,2) . A few early kinds of research pointed out that the basic reproductive number of NCIP was more significant than 2 (3,4) . And another study of 41 confirmed 2019-nCOV patients revealed the clinical symptom of the 2019-nCOV, and the fatality rate of the 2019-nCOV was 15% in this research (5) . At the same time, Italy, Germany, and the united states had found the 2019-nCOV patients in January 2020 (6,7) . The information represented the strong infectivity of 2019-nCOV.
The Chinese government took the emergency response level 1 to the 2019-nCOV on January 15 and named this novel coronavirus infection pneumonia as NCP. Every district of china, including the Zhejiang province, had emergency measures in the following days. Since February 8, there were 33738 confirmed NCP patients in china and 1075 confirmed NCP patients in Zhejiang province. The number of confirmed NCP patients in Zhejiang province was second to the Hubei province in China.
To analyze the early transmission dynamics of NCP, the government measures for NCP, and the current situation of treatment for NCP patients in Zhejiang province, we did the research and wrote this paper.

Methods sources of data
We obtained the number of NCP patients' data released by the Zhejiang health commission from January 20 to February 8 (Zhejiang province found the first confirmed NCP patients on January 20).
And we collected the government response measures to the disease of NCP from the Zhejiang government's announcement. diagnostic criteria for NCP patients A confirmed NCP patient was diagnosed with respiratory or blood specimens that tested positive for NCP by at least one of the following two methods: 1.at least two positive results by real-time reversetranscription-polymerase chain-reaction (RT-PCR) assay for NCP; 2. a genetic sequence that matches NCP (8) . The above standard confirmed all the NCP patients in Zhejiang province. And Zhejiang health commission released the daily new diagnosis of NCP patients.

the collection information and criteria
We collected the government response measures to the disease of NCP through the Zhejiang government's announcement from January 20 to February 8. And we would arrange the detail of actions in the part of the results. The value of steps was analyzed in the part of the discussion.
We recorded the details of NCP patients in Zhejiang province that were released by the Zhejiang health commission from January 20 to February 8.
We recorded the number of accumulative confirmed NCP patients, the daily number of newly diagnosed NCP patients, the accumulated amount of discharge NCP patients, the daily number of discharge NCP patients. The patients staying in ICU were paid more attention.
We recorded the epidemiological history of all the confirmed NCP patients. We divided the patients' epidemiological history into four types: 1. from Hubei province: the patients travel from the Hubei We recorded the clinical symptoms of all the confirmed NCP patients. According to the announcement of Zhejiang health commission, we recorded the following clinical symptoms: fever, respiratory symptoms (it contained cough, expectoration, and pharyngalgia), digestive tract symptoms (it contained stomachache, diarrhea, nausea, and emesis), muscle and neurological symptoms (it contained headache, muscular soreness, and lacked in strength), abnormal changes in chest CT, or without clinical symptoms. The number of the above symptoms was counted. And we would show the data in the part of the results.
We recorded the time from clinical signs to NCP diagnosis for every confirmed NCP patient from the announcement of the Zhejiang health commission. For example, zero-day might mean that this patient's time from clinical symptoms to NCP diagnosis was less than 24 hours. And two days might suggest that this patient's time from clinical signs to NCP diagnosis was less than 72 hours but more massive than 48 hours. the number of patients who needed to stay in ICU was still increasing; 2. the number of NCP patients whose life danger in ICU was also growing. Although there was no dead patient in the Zhejiang province right now, those NCP patients in ICU were still facing the threat of death.
According to the government circular of Zhejiang province, we could get 982 of 1075 NCP patients' epidemiological history (part patients' epidemiological history was not released before January 28). According to the government circular of Zhejiang province, we could get 982 of 1075 NCP patients' age, sexy, clinical symptoms, and the time from clinical signs to NCP diagnosis (part patients' information were not released before January 28). There were 492 male patients and 490 female patients. There were 3 patients whose birth time was smaller than 12 months. And there were 15 patients whose ages were older than 80 years.   What is the next challenge for preventing the NCP from spreading? Firstly, the NCP patients with unknown epidemiological history need to pay more attention. Those patients stood for the invisible and hidden spreading of NCP. Secondly, the super spreader is a significant threat to the Zhejiang province. And we did not forget the lessons of SARS (11,12) . we should maintain vigilance for the super patients were presumed to get infected in the hospital. 40 of 57 patients were health care workers ( 13) . There was no health care worker with confirmed or suspected NCP in Zhejiang province till February 8 , and we can't ignore the risk.
What is the problem for the NCP's detection at present? Some researchers suggested us to use chest CT for early diagnosis criteria. Prof Xie pointed out that the NCP patients had typical imaging findings, including the ground-glass opacity in chest CT (14) . And the staff doctors can get the results half an hour after the patients had finished the chest CT. While the PR-PCR assay would take at least one day to get the results. And the results of the PR-PCR assay might be a false negative. To prevent falsenegative effects, we had to test at least two times of PR-PCR assay for suspected NCP patients (15) .
And our data showed that average patients need more 5 days from having the symptom of confirming the NCP. Although we still used the positive results of PR-PCR assay or matching genetic sequence as the detection criteria, we need more efficient diagnosis criteria and methods.
Fever and cough were the most common early clinical symptoms for NCP patients in our research.
Similar results also appeared in other studies (16,17) . The fatality rate in Zhejiang province was much lower. There were 1075 confirmed NCP patients in Zhejiang province without one patient dead on

Conclusion
The early spread of NCP in Zhejiang province was speedy. After the government of Zhejiang province took strict measures to restrict the movement of people, the serious situation of NCP got noticeable relief in Zhejiang province since February 1. The potential risk of NCP in Zhejiang province was huge, and especially the government takes off the restriction of the movement of people in the future.

Declarations
The statement we confirmed that our study was carried out in accordance with relevant guidelines.

Supplementary Files
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