Control of COVID-19

Coronavirus

Early dynamics of transmission and control of COVID-19: a mathematical modelling study

 

 

An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to 95 333 confirmed cases as of March 5, 2020. Understanding the early transmission dynamics of the infection and evaluating the effectiveness of control measures is crucial for assessing the potential for sustained transmission to occur in new areas. Combining a mathematical model of severe SARS-CoV-2 transmission with four datasets from within and outside Wuhan, we estimated how transmission in Wuhan varied between December, 2019, and February, 2020. We used these estimates to assess the potential for sustained human-to-human transmission to occur in locations outside Wuhan if cases were introduced.
Methods
We combined a stochastic transmission model with data on cases of coronavirus disease 2019 (COVID-19) in Wuhan and international cases that originated in Wuhan to estimate how transmission had varied over time during January, 2020, and February, 2020. Based on these estimates, we then calculated the probability that newly introduced cases might generate outbreaks in other areas. To estimate the early dynamics of transmission in Wuhan, we fitted a stochastic transmission dynamic model to multiple publicly available datasets on cases in Wuhan and internationally exported cases from Wuhan. The four datasets we fitted to were: daily number of new internationally exported cases (or lack thereof), by date of onset, as of Jan 26, 2020; daily number of new cases in Wuhan with no market exposure, by date of onset, between Dec 1, 2019, and Jan 1, 2020; daily number of new cases in China, by date of onset, between Dec 29, 2019, and Jan 23, 2020; and proportion of infected passengers on evacuation flights between Jan 29, 2020, and Feb 4, 2020. We used an additional two datasets for comparison with model outputs: daily number of new exported cases from Wuhan (or lack thereof) in countries with high connectivity to Wuhan (ie, top 20 most at-risk countries), by date of confirmation, as of Feb 10, 2020; and data on new confirmed cases reported in Wuhan between Jan 16, 2020, and Feb 11, 2020.
Findings
We estimated that the median daily reproduction number (Rt) in Wuhan declined from 2·35 (95% CI 1·15–4·77) 1 week before travel restrictions were introduced on Jan 23, 2020, to 1·05 (0·41–2·39) 1 week after. Based on our estimates of Rt, assuming SARS-like variation, we calculated that in locations with similar transmission potential to Wuhan in early January, once there are at least four independently introduced cases, there is a more than 50% chance the infection will establish within that population.
Interpretation
Our results show that COVID-19 transmission probably declined in Wuhan during late January, 2020, coinciding with the introduction of travel control measures. As more cases arrive in international locations with similar transmission potential to Wuhan before these control measures, it is likely many chains of transmission will fail to establish initially, but might lead to new outbreaks eventually.
Funding
Wellcome Trust, Health Data Research UK, Bill & Melinda Gates Foundation, and National Institute for Health Research.
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Introduction
As of Feb 13, 2020, an outbreak of coronavirus disease 2019 (COVID-19) has resulted in 46 997 confirmed cases.1
The outbreak was first identified in Wuhan, China, in December, 2019, with most early cases being reported in the city. Most internationally exported cases reported to date have history of travel to Wuhan.2
In the early stages of a new infectious disease outbreak, it is crucial to understand the transmission dynamics of the infection. Estimation of changes in transmission over time can provide insights into the epidemiological situation3
and identify whether outbreak control measures are having a measurable effect.4
,  5
Such analysis can inform predictions about potential future growth,6
help estimate risk to other countries,7
and guide the design of alternative interventions.8
However, there are several challenges to such analyses, particularly in real time. There can be a delay to symptom appearance resulting from the incubation period and delay to confirmation of cases resulting from detection and testing capacity.9
Modelling approaches can account for such delays and uncertainty by explicitly incorporating delays resulting from the natural history of infection and reporting processes.10
Additionally, individual data sources might be biased, incomplete, or only capture certain aspects of the outbreak dynamics. Evidence synthesis approaches, which fit to multiple data sources rather than a single dataset (or datapoint) can enable more robust estimation of the underlying dynamics of transmission from noisy data.11
,  12
Combining a mathematical model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission with four datasets from within and outside Wuhan, we estimated how transmission in Wuhan varied between December, 2019, and February, 2020. We used these estimates to assess the potential for sustained human-to-human transmission to occur in locations outside Wuhan if cases were introduced.

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