The contribution of asymptomatic SARS-CoV-2 infections to transmission on the Diamond Princess cruise ship

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 asy...

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Bibliographic Details
Published in:eLife 2020-08, Vol.9
Main Authors: Emery, Jon C, Russell, Timothy W, Liu, Yang, Hellewell, Joel, Pearson, Carl Ab, Knight, Gwenan M, Eggo, Rosalind M, Kucharski, Adam J, Funk, Sebastian, Flasche, Stefan, Houben, Rein Mgj
Format: Article
Language:English
Subjects:
Analysis
Asymptomatic Diseases
asymptomatic infections
Betacoronavirus - isolation & purification
Calibration
Coronavirus Infections - epidemiology
Coronavirus Infections - therapy
Coronavirus Infections - transmission
COVID-19
Cruise ships
Disease transmission
Epidemiology and Global Health
Health aspects
Humans
Incidence
Infection
Medical research
Microbiology and Infectious Disease
Models, Statistical
Pandemics
Pneumonia, Viral - epidemiology
Pneumonia, Viral - therapy
SARS-CoV-2
Ships - statistics & numerical data
subclinical infections
transmission
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Summary: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.
ISSN:2050-084X
2050-084X
DOI:10.7554/ELIFE.58699