The contribution of asymptomatic sars-cov-2 infections to transmission on the diamond princess cruise ship

CMMID COVID-19 Working Group

doi:10.7554/ELIFE.58699

The contribution of asymptomatic sars-cov-2 infections to transmission on the diamond princess cruise ship

CMMID COVID-19 Working Group

Global Public Health

Research output: Contribution to journal › Article › peer-review

Abstract

A key unknown for SARS-CoV-2 is how asymptomatic infections contribute to transmission. We used a transmission model with asymptomatic and presymptomatic states, calibrated to data on disease onset and test frequency from the Diamond Princess cruise ship outbreak, to quantify the contribution of asymptomatic infections to transmission. The model estimated that 74% (70-78%, 95% posterior interval) of infections proceeded asymptomatically. Despite intense testing, 53% (51-56%) of infections remained undetected, most of them asymptomatic. Asymptomatic individuals were the source for 69% (20-85%) of all infections. The data did not allow identification of the infectiousness of asymptomatic infections, however low ranges (0-25%) required a net reproduction number for individuals progressing through presymptomatic and symptomatic stages of at least 15. Asymptomatic SARS-CoV-2 infections may contribute substantially to transmission. Control measures, and models projecting their potential impact, need to look beyond the symptomatic cases if they are to understand and address ongoing transmission.

Original language	English (US)
Article number	e58699
Pages (from-to)	1-68
Number of pages	68
Journal	eLife
Volume	9
DOIs	https://doi.org/10.7554/ELIFE.58699
State	Published - Aug 2020

ASJC Scopus subject areas

General Neuroscience
General Biochemistry, Genetics and Molecular Biology
General Immunology and Microbiology

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10.7554/ELIFE.58699

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@article{787e31716bda49148fa06fac83fa9076,

title = "The contribution of asymptomatic sars-cov-2 infections to transmission on the diamond princess cruise ship",

abstract = "A key unknown for SARS-CoV-2 is how asymptomatic infections contribute to transmission. We used a transmission model with asymptomatic and presymptomatic states, calibrated to data on disease onset and test frequency from the Diamond Princess cruise ship outbreak, to quantify the contribution of asymptomatic infections to transmission. The model estimated that 74% (70-78%, 95% posterior interval) of infections proceeded asymptomatically. Despite intense testing, 53% (51-56%) of infections remained undetected, most of them asymptomatic. Asymptomatic individuals were the source for 69% (20-85%) of all infections. The data did not allow identification of the infectiousness of asymptomatic infections, however low ranges (0-25%) required a net reproduction number for individuals progressing through presymptomatic and symptomatic stages of at least 15. Asymptomatic SARS-CoV-2 infections may contribute substantially to transmission. Control measures, and models projecting their potential impact, need to look beyond the symptomatic cases if they are to understand and address ongoing transmission.",

author = "{CMMID COVID-19 Working Group} and Emery, {Jon C.} and Russell, {Timothy W.} and Yang Liu and Joel Hellewell and Pearson, {Carl A.B.} and Knight, {Gwenan M.} and Eggo, {Rosalind M.} and Kucharski, {Adam J.} and Sebastian Funk and Stefan Flasche and Houben, {Rein M.G.J.} and Atkins, {Katherine E.} and Petra Klepac and Akira Endo and Jarvis, {Christopher I.} and Davies, {Nicholas G.} and Rees, {Eleanor M.} and Meakin, {Sophie R.} and Alicia Rosello and {van Zandvoort}, Kevin and Munday, {James D.} and Edmunds, {W. John} and Thibaut Jombart and Megan Auzenbergs and Nightingale, {Emily S.} and Mark Jit and Sam Abbott and David Simons and Bosse, {Nikos I.} and Leclerc, {Quentin J.} and Procter, {Simon R.} and Villabona-Arenas, {C. Julian} and Tully, {Damien C.} and Deol, {Arminder K.} and Sun, {Fiona Yueqian} and St{\'e}phane Hu{\'e} and Foss, {Anna M.} and Kiesha Prem and Graham Medley and Amy Gimma and Rachel Lowe and Samuel Clifford and Matthew Quaife and Charlie Diamond and Gibbs, {Hamish P.} and Quilty, {Billy J.} and Kathleen O{\textquoteright}reilly",

year = "2020",

month = aug,

doi = "10.7554/ELIFE.58699",

language = "English (US)",

volume = "9",

pages = "1--68",

journal = "eLife",

issn = "2050-084X",

publisher = "eLife Sciences Publications",

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T1 - The contribution of asymptomatic sars-cov-2 infections to transmission on the diamond princess cruise ship

AU - CMMID COVID-19 Working Group

AU - Emery, Jon C.

AU - Russell, Timothy W.

AU - Liu, Yang

AU - Hellewell, Joel

AU - Pearson, Carl A.B.

AU - Knight, Gwenan M.

AU - Eggo, Rosalind M.

AU - Kucharski, Adam J.

AU - Funk, Sebastian

AU - Flasche, Stefan

AU - Houben, Rein M.G.J.

AU - Atkins, Katherine E.

AU - Klepac, Petra

AU - Endo, Akira

AU - Jarvis, Christopher I.

AU - Davies, Nicholas G.

AU - Rees, Eleanor M.

AU - Meakin, Sophie R.

AU - Rosello, Alicia

AU - van Zandvoort, Kevin

AU - Munday, James D.

AU - Edmunds, W. John

AU - Jombart, Thibaut

AU - Auzenbergs, Megan

AU - Nightingale, Emily S.

AU - Jit, Mark

AU - Abbott, Sam

AU - Simons, David

AU - Bosse, Nikos I.

AU - Leclerc, Quentin J.

AU - Procter, Simon R.

AU - Villabona-Arenas, C. Julian

AU - Tully, Damien C.

AU - Deol, Arminder K.

AU - Sun, Fiona Yueqian

AU - Hué, Stéphane

AU - Foss, Anna M.

AU - Prem, Kiesha

AU - Medley, Graham

AU - Gimma, Amy

AU - Lowe, Rachel

AU - Clifford, Samuel

AU - Quaife, Matthew

AU - Diamond, Charlie

AU - Gibbs, Hamish P.

AU - Quilty, Billy J.

AU - O’reilly, Kathleen

PY - 2020/8

Y1 - 2020/8

N2 - A key unknown for SARS-CoV-2 is how asymptomatic infections contribute to transmission. We used a transmission model with asymptomatic and presymptomatic states, calibrated to data on disease onset and test frequency from the Diamond Princess cruise ship outbreak, to quantify the contribution of asymptomatic infections to transmission. The model estimated that 74% (70-78%, 95% posterior interval) of infections proceeded asymptomatically. Despite intense testing, 53% (51-56%) of infections remained undetected, most of them asymptomatic. Asymptomatic individuals were the source for 69% (20-85%) of all infections. The data did not allow identification of the infectiousness of asymptomatic infections, however low ranges (0-25%) required a net reproduction number for individuals progressing through presymptomatic and symptomatic stages of at least 15. Asymptomatic SARS-CoV-2 infections may contribute substantially to transmission. Control measures, and models projecting their potential impact, need to look beyond the symptomatic cases if they are to understand and address ongoing transmission.

AB - A key unknown for SARS-CoV-2 is how asymptomatic infections contribute to transmission. We used a transmission model with asymptomatic and presymptomatic states, calibrated to data on disease onset and test frequency from the Diamond Princess cruise ship outbreak, to quantify the contribution of asymptomatic infections to transmission. The model estimated that 74% (70-78%, 95% posterior interval) of infections proceeded asymptomatically. Despite intense testing, 53% (51-56%) of infections remained undetected, most of them asymptomatic. Asymptomatic individuals were the source for 69% (20-85%) of all infections. The data did not allow identification of the infectiousness of asymptomatic infections, however low ranges (0-25%) required a net reproduction number for individuals progressing through presymptomatic and symptomatic stages of at least 15. Asymptomatic SARS-CoV-2 infections may contribute substantially to transmission. Control measures, and models projecting their potential impact, need to look beyond the symptomatic cases if they are to understand and address ongoing transmission.

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JO - eLife

JF - eLife

M1 - e58699

ER -

The contribution of asymptomatic sars-cov-2 infections to transmission on the diamond princess cruise ship

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ASJC Scopus subject areas

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