Epidemiology of Coronavirus Disease in Gansu Province, China, 2020

Jingchun Fan; Xiaodong Liu; Weimin Pan; Mark W. Douglas; Shisan Bao


Emerging Infectious Diseases. 2020;26(6):1257-1265. 

In This Article

Abstract and Introduction


To determine the epidemiology of coronavirus disease (COVID-19) in a remote region of China, far from Wuhan, we analyzed the epidemiology of COVID-19 in Gansu Province. From January 23 through February 3, 2020, a total of 35 (64.8%) of 54 reported cases were imported from COVID-19–epidemic areas. Characteristics that differed significantly during the first and second waves of illness in Gansu Province were mean patient age, occupation, having visited epidemic areas, and mode of transportation. Time from infection to illness onset for family clusters was shorter in Gansu Province than in Wuhan, consistent with shortened durations from onset to first medical visit or hospitalization. Spatial distribution pattern analysis indicated hot spots and spatial outliers in Gansu Province. As a result of adequate interventions, transmission of the COVID-19 virus in Gansu Province is decreasing.


The outbreak of coronavirus disease (COVID-19) was first reported on December 31, 2019, in Wuhan, China.[1] Within a few weeks, the virus had spread rapidly throughout China and within 1 month to several other countries, including Italy,[2] the United States,[3] and Germany.[4] Difficulty controlling such aggressive spread resulted partly from the size of Wuhan, which has a full-time population of >9 million and a transient population of an additional 5.10 million, for a total population of ≈14 million.[5,6] Wuhan is located in central China and has a wide range of transportation links, including airplanes, trains, interstate buses, and private transportation. In an attempt to reduce virus transmission, on January 23, 2020, authorities locked down Wuhan, but by that time, ≈5 million persons had already left.[7] Reasons for leaving included returning to hometowns for the Chinese New Year (most persons) or leaving for holidays, but some left because of fear of COVID-19.[7] Consequently, COVID-19 has now been identified in every province or autonomous region in China, although the highest number of cases is still in Wuhan.[7]

Gansu Province is located in northwestern China, and as of February 3, 2020, the number of COVID-19 cases identified has been small, most in persons coming from Wuhan. As of January 23, the date of the Wuhan lockdown, the Gansu Provincial Centre for Disease Control and Prevention (Lanzhou, China) had identified only 2 cases of COVID-19 in Lanzhou, the capital of Ganzu Province: 1 patient had traveled from Wuhan and another had been in contact with persons from Wuhan.[8] Within 2 weeks, however, 54 cases of COVID-19 in Gansu Province were confirmed, indicating the seriousness of this outbreak and triggering the alarm for the Gansu Province government to make it mandatory that face masks be worn in public places from January 28 until further notice.[9] From a public health point of view, the epidemiology of the COVID-19 event in Lanzhou,[10] a relatively remote region of China, may provide critical information to help control the spread of this disease to other provinces and countries. We therefore explored the epidemiology of COVID-19 in Gansu Province, remote from the outbreak epicenter in Wuhan.