Abstract
INTRODUCTION: Minimizing the importation and exportation risks of coronavirus disease 2019 (COVID-19) is a primary concern for sustaining the "Dynamic COVID-zero" strategy in China. Risk estimation is essential for cities to conduct before relaxing border control measures. METHODS: Informed by the daily number of passengers traveling between 367 prefectures (cities) in China, this study used a stochastic metapopulation model parameterized with COVID-19 epidemic characteristics to estimate the importation and exportation risks. RESULTS: Under the transmission scenario (R(0) =5.49), this study estimated the cumulative case incidence of Changchun City, Jilin Province as 3,233 (95% confidence interval: 1,480, 4,986) before a lockdown on March 14, 2022, which is close to the 3,168 cases reported in real life by March 16, 2022. In a total of 367 prefectures (cities), 127 (35%) had high exportation risks according to the simulation and could transmit the disease to 50% of all other regions within a period from 17 to 94 days. The average time until a new infection arrives in a location in 1 of the 367 prefectures (cities) ranged from 26 to 101 days. CONCLUSIONS: Estimating COVID-19 importation and exportation risks is necessary for preparedness, prevention, and control measures of COVID-19 - especially when new variants emerge.