Correlation between times to SARS-CoV-2 symptom onset and secondary transmission undermines epidemic control efforts

Abstract

Severe acute respiratory coronavirus 2 (SARS-CoV-2) infections have been associated with substantial presymptomatic transmission, which occurs when the generation interval--the time between infection of an individual with a pathogen and transmission of the pathogen to another individual--is shorter than the incubation period--the time between infection and symptom onset. We collected a dataset of 257 SARS-CoV-2 transmission pairs in Japan and jointly estimated the mean generation interval (3.7-5.1 days) and mean incubation period (4.4-5.7 days) as well as measured their dependence (Kendall's tau of 0.4-0.6), taking into consideration demographic and epidemiological characteristics of the pairs. The positive correlation between the two parameters demonstrates that reliance on isolation of symptomatic COVID-19 cases as a focal point of control efforts is insufficient to address the challenges posed by SARS-CoV-2 transmission dynamics. Accounting for this dependence within SARS-CoV-2 epidemic models can also improve model estimates.

When Do Epidemics End? Scientific Insights from Mathematical Modelling Studies

“…Later investigated in greater detail by Kenah, Lipsitch, & Robins (2008), as well as Nishiura (2020). Analyses considering COVID-19 include Ali et al (2020) and Linton, Akhmetzhanov, & Nishiura (2021a); Hart, Abbott, et al (2022);. Davies, Klepac, et al (2020); Teunis, Le Guyader, Liu, Ollivier, & Moe (2020).…”