Taking account of asymptomatic infections: A modeling study of the COVID-19 outbreak on the Diamond Princess cruise ship
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Abstract
The COVID-19 outbreak on the Diamond Princess (DP) cruise ship has provided empirical data to study the transmission potential of COVID-19 with the presence of pre/asymptomatic cases. We studied the changes in R 0 on DP from January 21 to February 19, 2020 based on chain binomial models under two scenarios: no quarantine assuming a random mixing condition, and quarantine of passengers in cabins—passengers may get infected either by an infectious case in a shared cabin or by pre/asymptomatic crew who continued to work. Estimates of R 0 at the beginning of the epidemic were 3.27 (95% CI, 3.02–3.54) and 3.78 (95% CI, 3.49–4.09) respectively for serial intervals of 5 and 6 days; and when quarantine started, with the reported asymptomatic ratio 0.505, R 0 rose to 4.18 (95%CI, 3.86–4.52) and 4.73 (95%CI, 4.37–5.12) respectively for passengers who might be exposed to the virus due to pre/asymptomatic crew. Results confirm that the higher the asymptomatic ratio is, the more infectious contacts would happen. We find evidence to support a US CDC report that “a high proportion of asymptomatic infections could partially explain the high attack rate among cruise ship passengers and crew.” Our study suggests that if the asymptomatic ratio is high, the conventional quarantine procedure may not be effective to stop the spread of virus.
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SciScore for 10.1101/2020.04.22.20074286: (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:However, there are also limitations. First, due to inadequate data on the time course of infection cases among crew and passengers, assumption (d) (i) assumes a constant proportion, which may vary with time in practice. Second, the values of the parameter rp assumed in the present study may not be sufficiently large. Third, the …
SciScore for 10.1101/2020.04.22.20074286: (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:However, there are also limitations. First, due to inadequate data on the time course of infection cases among crew and passengers, assumption (d) (i) assumes a constant proportion, which may vary with time in practice. Second, the values of the parameter rp assumed in the present study may not be sufficiently large. Third, the assumptions (a)-(d) under chain-binomial models may not be sufficient to capture the complexity of the COVID-19 epidemics. Fuller data reporting is important for researchers to develop statistical methodology to help combat this pandemic. Almost all of the passengers on DP were tested before they were evacuated. However, it is impractical to test everyone in the real world, especially for those asymptomatic cases. On DP, crew members continued to perform service unless they showed symptoms. This provides a parallel to people doing “essential work” in society and thus exempt from shelter-in-place rules. Our study suggests that if the asymptomatic ratio is high, the conventional quarantine might not be sufficient to reduce R0 to below 1, implying that a combination of preventive measures is needed to stop the spread of virus. When DP was docked in Taiwan for a 1-day tour on January 31, 2020, “big data analytics” was used to contain the spread of virus [27]. The low incidences in Taiwan strongly suggest that the virus can be contained with early and appropriate measures.
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: We did not find any issues relating to colormaps.
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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SciScore for 10.1101/2020.04.22.20074286: (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
Results from OddPub: We did not find a statement about open data. We also did not find a statement about open code. Researchers are encouraged to share open data when possible (see Nature blog).
About SciScore
SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. …
SciScore for 10.1101/2020.04.22.20074286: (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
Results from OddPub: We did not find a statement about open data. We also did not find a statement about open code. Researchers are encouraged to share open data when possible (see Nature blog).
About SciScore
SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, please follow this link.
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