Long Diagnostic Delay with Unknown Transmission Route Inversely Correlates with the Subsequent Doubling Time of Coronavirus Disease 2019 in Japan, February-March 2020.

Long diagnostic delays (LDDs) may decrease the effectiveness of patient isolation in reducing subsequent transmission of coronavirus disease 2019 (COVID-19). This study aims to investigate the correlation between the proportion of LDD of COVID-19 patients with unknown transmission routes and the subsequent doubling time. LDD was defined as the duration between COVID-19 symptom onset and confirmation ≥6 days. We investigated the geographic correlation between the LDD proportion among 369 confirmed COVID-19 patients with symptom onset between the 9th and 11th week and the subsequent doubling time for 717 patients in the 12th-13th week among the six prefectures. The doubling time on March 29 (the end of the 13th week) ranged from 4.67 days in Chiba to 22.2 days in Aichi. Using a Pearson's product-moment correlation (p-value = 0.00182) and multiple regression analyses that were adjusted for sex and age (correlation coefficient -0.729, 95% confidence interval: -0.923--0.535, p-value = 0.0179), the proportion of LDD for unknown exposure patients was correlated inversely with the base 10 logarithm of the subsequent doubling time. The LDD for unknown exposure patients was correlated significantly and inversely with the subsequent doubling time.