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The implications of silent transmission for the control of COVID-19 outbreaks.
Proc Natl Acad Sci U S A. 2020 07 28; 117(30):17513-17515.PN

Abstract

Since the emergence of coronavirus disease 2019 (COVID-19), unprecedented movement restrictions and social distancing measures have been implemented worldwide. The socioeconomic repercussions have fueled calls to lift these measures. In the absence of population-wide restrictions, isolation of infected individuals is key to curtailing transmission. However, the effectiveness of symptom-based isolation in preventing a resurgence depends on the extent of presymptomatic and asymptomatic transmission. We evaluate the contribution of presymptomatic and asymptomatic transmission based on recent individual-level data regarding infectiousness prior to symptom onset and the asymptomatic proportion among all infections. We found that the majority of incidences may be attributable to silent transmission from a combination of the presymptomatic stage and asymptomatic infections. Consequently, even if all symptomatic cases are isolated, a vast outbreak may nonetheless unfold. We further quantified the effect of isolating silent infections in addition to symptomatic cases, finding that over one-third of silent infections must be isolated to suppress a future outbreak below 1% of the population. Our results indicate that symptom-based isolation must be supplemented by rapid contact tracing and testing that identifies asymptomatic and presymptomatic cases, in order to safely lift current restrictions and minimize the risk of resurgence.

Authors+Show Affiliations

Agent-Based Modelling Laboratory, York University, Toronto, ON M3J 1P3, Canada.Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510. Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD 21201.Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510.Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510.Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510.Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610 bhsinger@epi.ufl.edu alison.galvani@yale.edu.Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510; bhsinger@epi.ufl.edu alison.galvani@yale.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

32632012

Citation

Moghadas, Seyed M., et al. "The Implications of Silent Transmission for the Control of COVID-19 Outbreaks." Proceedings of the National Academy of Sciences of the United States of America, vol. 117, no. 30, 2020, pp. 17513-17515.
Moghadas SM, Fitzpatrick MC, Sah P, et al. The implications of silent transmission for the control of COVID-19 outbreaks. Proc Natl Acad Sci U S A. 2020;117(30):17513-17515.
Moghadas, S. M., Fitzpatrick, M. C., Sah, P., Pandey, A., Shoukat, A., Singer, B. H., & Galvani, A. P. (2020). The implications of silent transmission for the control of COVID-19 outbreaks. Proceedings of the National Academy of Sciences of the United States of America, 117(30), 17513-17515. https://doi.org/10.1073/pnas.2008373117
Moghadas SM, et al. The Implications of Silent Transmission for the Control of COVID-19 Outbreaks. Proc Natl Acad Sci U S A. 2020 07 28;117(30):17513-17515. PubMed PMID: 32632012.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The implications of silent transmission for the control of COVID-19 outbreaks. AU - Moghadas,Seyed M, AU - Fitzpatrick,Meagan C, AU - Sah,Pratha, AU - Pandey,Abhishek, AU - Shoukat,Affan, AU - Singer,Burton H, AU - Galvani,Alison P, Y1 - 2020/07/06/ PY - 2020/7/8/pubmed PY - 2020/8/11/medline PY - 2020/7/8/entrez KW - COVID-19 KW - case isolation KW - contact tracing SP - 17513 EP - 17515 JF - Proceedings of the National Academy of Sciences of the United States of America JO - Proc Natl Acad Sci U S A VL - 117 IS - 30 N2 - Since the emergence of coronavirus disease 2019 (COVID-19), unprecedented movement restrictions and social distancing measures have been implemented worldwide. The socioeconomic repercussions have fueled calls to lift these measures. In the absence of population-wide restrictions, isolation of infected individuals is key to curtailing transmission. However, the effectiveness of symptom-based isolation in preventing a resurgence depends on the extent of presymptomatic and asymptomatic transmission. We evaluate the contribution of presymptomatic and asymptomatic transmission based on recent individual-level data regarding infectiousness prior to symptom onset and the asymptomatic proportion among all infections. We found that the majority of incidences may be attributable to silent transmission from a combination of the presymptomatic stage and asymptomatic infections. Consequently, even if all symptomatic cases are isolated, a vast outbreak may nonetheless unfold. We further quantified the effect of isolating silent infections in addition to symptomatic cases, finding that over one-third of silent infections must be isolated to suppress a future outbreak below 1% of the population. Our results indicate that symptom-based isolation must be supplemented by rapid contact tracing and testing that identifies asymptomatic and presymptomatic cases, in order to safely lift current restrictions and minimize the risk of resurgence. SN - 1091-6490 UR - https://www.unboundmedicine.com/medline/citation/32632012/The_implications_of_silent_transmission_for_the_control_of_COVID_19_outbreaks_ DB - PRIME DP - Unbound Medicine ER -