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Abstract

Background

Estimating key infectious disease parameters from the coronavirus disease (COVID-19) outbreak is essential for modelling studies and guiding intervention strategies.

Aim

We estimate the generation interval, serial interval, proportion of pre-symptomatic transmission and effective reproduction number of COVID-19. We illustrate that reproduction numbers calculated based on serial interval estimates can be biased.

Methods

We used outbreak data from clusters in Singapore and Tianjin, China to estimate the generation interval from symptom onset data while acknowledging uncertainty about the incubation period distribution and the underlying transmission network. From those estimates, we obtained the serial interval, proportions of pre-symptomatic transmission and reproduction numbers.

Results

The mean generation interval was 5.20 days (95% credible interval (CrI): 3.78–6.78) for Singapore and 3.95 days (95% CrI: 3.01–4.91) for Tianjin. The proportion of pre-symptomatic transmission was 48% (95% CrI: 32–67) for Singapore and 62% (95% CrI: 50–76) for Tianjin. Reproduction number estimates based on the generation interval distribution were slightly higher than those based on the serial interval distribution. Sensitivity analyses showed that estimating these quantities from outbreak data requires detailed contact tracing information.

Conclusion

High estimates of the proportion of pre-symptomatic transmission imply that case finding and contact tracing need to be supplemented by physical distancing measures in order to control the COVID-19 outbreak. Notably, quarantine and other containment measures were already in place at the time of data collection, which may inflate the proportion of infections from pre-symptomatic individuals.

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/content/10.2807/1560-7917.ES.2020.25.17.2000257
2020-04-30
2020-10-22
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2020.25.17.2000257
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References

  1. Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020 Feb 19.  PMID: 32087114 
  2. Held L, Hens N, O’Neill PD, Wallinga J. Handbook of infectious disease data analysis. 1st ed. New York: Chapman and Hall/CRC;2019.
  3. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020;382(13):1199-207.  https://doi.org/10.1056/NEJMoa2001316  PMID: 31995857 
  4. Backer JA, Klinkenberg D, Wallinga J. Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20-28 January 2020. Euro Surveill. 2020;25(5).  https://doi.org/10.2807/1560-7917.ES.2020.25.5.2000062  PMID: 32046819 
  5. Linton NM, Kobayashi T, Yang Y, Hayashi K, Akhmetzhanov AR, Jung SM, et al. Incubation period and other epidemiological characteristics of 2019 novel coronavirus infections with right truncation: A statistical analysis of publicly available case data. J Clin Med. 2020;9(2):538.  https://doi.org/10.3390/jcm9020538  PMID: 32079150 
  6. Zhang J, Litvinova M, Wang W, Wang Y, Deng X, Chen X, et al. Evolving epidemiology of novel coronavirus diseases 2019 and possible interruption of local transmission outside Hubei Province in China: a descriptive and modeling study. medRxiv. 2020;20026328: (Preprint). Available from: https://doi.org/10.1101/2020.02.21.20026328
  7. Liu T, Hu J, Kang M, Lin L, Zhong H, Xiao J, et al. Transmission dynamics of 2019 novel coronavirus (2019-nCoV). SSRN. 2020;3526307: (Preprint). Available from: https://doi.org/10.2139/ssrn.3526307
  8. Britton T, Scalia Tomba G. Estimation in emerging epidemics: biases and remedies. J R Soc Interface. 2019;16(150):20180670.  https://doi.org/10.1098/rsif.2018.0670  PMID: 30958162 
  9. Wallinga J, Teunis P. Different epidemic curves for severe acute respiratory syndrome reveal similar impacts of control measures. Am J Epidemiol. 2004;160(6):509-16.  https://doi.org/10.1093/aje/kwh255  PMID: 15353409 
  10. Hens N, Calatayud L, Kurkela S, Tamme T, Wallinga J. Robust reconstruction and analysis of outbreak data: influenza A(H1N1)v transmission in a school-based population. Am J Epidemiol. 2012;176(3):196-203.  https://doi.org/10.1093/aje/kws006  PMID: 22791742 
  11. te Beest DE, Wallinga J, Donker T, van Boven M. Estimating the generation interval of influenza A (H1N1) in a range of social settings. Epidemiology. 2013;24(2):244-50.  https://doi.org/10.1097/EDE.0b013e31827f50e8  PMID: 23337238 
  12. Mood AM, Graybill FA, Boes DC. Introduction to the Theory of Statistics. McGraw-Hill; 1950.
  13. Robert CP, Casella G. Monte Carlo Statistical Methods. New York: Springer; 2004.
  14. Wallinga J, Lipsitch M. How generation intervals shape the relationship between growth rates and reproductive numbers. Proc Biol Sci. 2007;274(1609):599-604.  https://doi.org/10.1098/rspb.2006.3754  PMID: 17476782 
  15. Tindale LC, Coombe M, Stockdale JE, Garlock E, Lau WYV, Saraswat M, et al. Transmission interval estimates suggest pre-symptomatic spread of COVID-19. medRxiv. 2020;20029983: (Preprint). Available from: https://doi.org/10.1101/2020.03.03.20029983
  16. Du Z, Xu X, Wu Y, Wang L, Cowling BJ, Meyers LA. Serial interval of COVID-19 among publicly reported confirmed cases. Emerg Infect Dis. 2020;26(6).  https://doi.org/10.3201/eid2606.200357  PMID: 32191173 
  17. Bell DM, World Health Organization Working Group on International and Community Transmission of SARS. Public health interventions and SARS spread, 2003. Emerg Infect Dis. 2004;10(11):1900-6.  https://doi.org/10.3201/eid1011.040729  PMID: 15550198 
  18. Hellwell J, Abbott S, Gimma A, Bosse NI, Jarvis CI, Russell TW, et al. Feasibility of controlling 2019-nCoV outbreaks by isolation of cases and contacts. medRxiv. 2020;20021162: (Preprint). Available from: https://doi.org/10.1101/2020.02.08.20021162
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