The contribution of asymptomatic SARS-CoV-2 infections to transmission on the Diamond Princess cruise ship
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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.
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SciScore for 10.1101/2020.05.07.20093849: (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: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:(31,38–40) Limitations: Additional data, in particular on the distribution of asymptomatic infections across crew and passengers, by age and shared quarantine environments would have benefited the model and potentially enable us to estimate a range for the relative infectiousness of asymptomatic infections. Also, a serological survey of the population, and the date and testing history of individuals who developed symptoms …
SciScore for 10.1101/2020.05.07.20093849: (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: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:(31,38–40) Limitations: Additional data, in particular on the distribution of asymptomatic infections across crew and passengers, by age and shared quarantine environments would have benefited the model and potentially enable us to estimate a range for the relative infectiousness of asymptomatic infections. Also, a serological survey of the population, and the date and testing history of individuals who developed symptoms post-disembarkation would have likely informed more precise model estimates. In addition, better evidence on performance of the test used, and the associated likelihood of false-negative or false-positive results would help refine estimates. As more data becomes available, future model analyses of SARS-CoV dynamics in closed populations should further inform the key questions we have looked to address here.
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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