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

CMMID COVID-19 Working Group

Research output: Contribution to journalArticlepeer-review

36 Citations (Scopus)

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 languageEnglish
Article numbere58699
Pages (from-to)1-68
Number of pages68
JournaleLife
Volume9
DOIs
Publication statusPublished - Aug 2020

Bibliographical note

Funding Information:
The authors would like to thank Dr Taichi Kidani for help in translating primary data sources. The following funding sources are acknowledged as providing funding for the named authors. This research was partly funded by the Bill & Melinda Gates Foundation (INV-003174: YL; NTD Modelling Consortium OPP1184344: CABP). DFID/Wellcome Trust (Epidemic Preparedness Coronavirus research programme 221303/Z/20/Z: CABP). ERC Starting Grant (#757699: JCE, RMGJH). This project has received funding from the European Union?s Horizon 2020 research and innovation programme-project EpiPose (101003688: YL). HDR UK (MR/S003975/1: RME). This research was partly funded by the National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care (16/137/109: YL). UK MRC (MC_PC 19065: RME; MR/P014658/1: GMK). Wellcome Trust (206250/Z/17/Z: AJK, TWR; 208812/Z/17/Z: SFlasche; 210758/Z/18/Z: JH, SFunk). The following funding sources are acknowledged as providing funding for the CMMID COVID-19 working group. Alan Turing Institute (AE). BBSRC LIDP (BB/M009513/1: DS). This research was partly funded by the Bill & Melinda Gates Foundation (INV-003174: KP, MJ; NTD Modelling Consortium OPP1184344: GM; OPP1180644: SRP; OPP1183986: ESN; OPP1191821: KO?R, MA). DFID/Wellcome Trust (Epidemic Preparedness Coronavirus research programme 221303/Z/20/Z: KvZ). Elrha R2HC/UK DFID/Wellcome Trust/This research was partly funded by the National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care (KvZ). ERC Starting Grant (#757699: MQ). This project has received funding from the European Union?s Horizon 2020 research and innovation programme-project EpiPose (101003688: KP, MJ, PK, WJE). This research was partly funded by the Global Challenges Research Fund (GCRF) project ?RECAP? managed through RCUK and ESRC (ES/P010873/1: AG, CIJ, TJ). Nakajima Foundation (AE). NIHR (16/137/109: BJQ, CD, FYS, MJ; Health Protection Research Unit for Modelling Methodology HPRU-2012-10096: NGD, TJ; PR-OD-1017-20002: AR). Royal Society (Dorothy Hodgkin Fellowship: RL; RP\EA\180004: PK). UK DHSC/UK Aid/NIHR (ITCRZ 03010: HPG). UK MRC (LID DTP MR/N013638/1: EMR, QJL). Authors of this research receive funding from UK Public Health Rapid Support Team funded by the United Kingdom Department of Health and Social Care (TJ). Wellcome Trust (208812/Z/17/Z: SC; 210758/Z/18/Z: JDM, NIB, SA, SRM). No funding (AKD, AMF, DCT, SH).

Funding Information:
The following funding sources are acknowledged as providing funding for the CMMID COVID-19 working group. Alan Turing Institute (AE). BBSRC LIDP (BB/M009513/1: DS). This research was partly funded by the Bill & Melinda Gates Foundation (INV-003174: KP, MJ; NTD Modelling Consortium OPP1184344: GM; OPP1180644: SRP; OPP1183986: ESN; OPP1191821: KO’R, MA). DFID/Wellcome Trust (Epidemic Preparedness Coronavirus research programme 221303/Z/20/Z: KvZ). Elrha R2HC/UK DFID/Wellcome Trust/This research was partly funded by the National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care (KvZ). ERC Starting Grant (#757699: MQ). This project has received funding from the European Union’s Horizon 2020 research and innovation programme - project EpiPose (101003688: KP, MJ, PK, WJE). This research was partly funded by the Global Challenges Research Fund (GCRF) project ‘RECAP’ managed through RCUK and ESRC (ES/P010873/1: AG, CIJ, TJ). Nakajima Foundation (AE). NIHR (16/137/109: BJQ, CD, FYS, MJ; Health Protection Research Unit for Modelling Methodology HPRU-2012-10096: NGD, TJ; PR-OD-1017-20002: AR). Royal Society (Dorothy Hodgkin Fellowship: RL; RP\EA\180004: PK). UK DHSC/UK Aid/NIHR (ITCRZ 03010: HPG). UK MRC (LID DTP MR/N013638/1: EMR, QJL). Authors of this research receive funding from UK Public Health Rapid Support Team funded by the United Kingdom Department of Health and Social Care (TJ). Wellcome Trust (208812/Z/17/Z: SC; 210758/Z/18/Z: JDM, NIB, SA, SRM). No funding (AKD, AMF, DCT, SH).

Funding Information:
The following funding sources are acknowledged as providing funding for the named authors. This research was partly funded by the Bill & Melinda Gates Foundation (INV-003174: YL; NTD Modelling Consortium OPP1184344: CABP). DFID/Wellcome Trust (Epidemic Preparedness Coronavirus research programme 221303/Z/20/Z: CABP). ERC Starting Grant (#757699: JCE, RMGJH). This project has received funding from the European Union’s Horizon 2020 research and innovation programme - project EpiPose (101003688: YL). HDR UK (MR/S003975/1: RME). This research was partly funded by the National Institute for Health Research (NIHR) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care (16/137/109: YL). UK MRC (MC_PC 19065: RME; MR/P014658/1: GMK). Wellcome Trust (206250/Z/17/Z: AJK, TWR; 208812/Z/17/Z: SFlasche; 210758/Z/18/Z: JH, SFunk).

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