This time is different: model-based evaluation of the implications of SARS-CoV-2 infection kinetics for disease control

  1. Kaitlyn E. Johnson
  2. Madison Stoddard
  3. Ryan P. Nolan
  4. Douglas E. White
  5. Natasha Hochberg
  6. Arijit Chakravarty

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Abstract

As the ongoing COVID-19 pandemic passes from an acute to a chronic situation, countries and territories are grappling with the issue of how to reopen safely. The unique kinetics of infectivity of SARS-CoV-2, with its significant presymptomatic transmission, presents an unprecedented challenge to our intuitions. In this context, a generalizable quantitative understanding of the impact of SARS-CoV-2 infectivity on disease control strategies is vital. We used a previously published time-dependent model of SARS-CoV-2 infectivity (He et al ., 2020) to parameterize an epidemiological model of transmission, which was then used to explore the effect of various disease control measures. Our analysis suggests that using symptom-based isolation alone as a control strategy is ineffective in limiting the spread of COVID-19, in contrast to its effectiveness in other diseases, such as SARS and influenza. Additionally, timeliness of testing and tracing strategies to reduce time to isolation, along with widespread adoption of measures to limit transmission are critical for any containment strategy. Our findings suggest that for symptom-based isolation and testing strategies to be effective, reduced transmission is required, reinforcing the importance of measures to limit transmission. From a public health strategy perspective, our findings lend support to the idea that symptomatic isolation should not form the primary basis for COVID-19 disease control.

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    SciScore for 10.1101/2020.08.19.20177550: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    While it is unlikely that any one measure will be implemented in isolation, resource limitations can sometimes lead organizations and territories to rely more heavily on one measure than others. Therefore, it is important to understand the impact of individual NPI measures separately, in order to tease out the contribution that each measure makes to COVID-19 disease control. In this work, we have used a model-based approach to identify generalizable principles for COVID-19 public health strategy. Testing for symptoms and isolating individuals is an intuitive and easily implemented strategy for public health authorities during an outbreak or epidemic. The concept of quarantine is an ancient one, with an etymology rooted in the Black Death and references dating back to the Bible (Leviticus 13:4). In recent times, SARS in particular was very effectively controlled through public health interventions. Our work suggests that this may have happened in some measure through symptomatic isolation, although studies have raised questions about the cost-benefit of temperature screening in that context (Chng et al., 2004; St John et al., 2005; Mouchtouri et al., 2019). For the current pandemic, many territories and organizations have made symptomatic testing and isolation an integral part of their strategy for disease control. For example, Walt Disney World in Florida uses temperature checks on all guests and employees and uses a cutoff of two consecutive temperature readings of 100.4 F t...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: Please consider improving the rainbow (“jet”) colormap(s) used on pages 10, 11, 12 and 14. At least one figure is not accessible to readers with colorblindness and/or is not true to the data, i.e. not perceptually uniform.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  2. Version published to 10.1101/2020.08.19.20177550v2 on medRxiv
  3. Version published to 10.1101/2020.08.19.20177550v1 on medRxiv