Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing
Luca Ferretti, Chris Wymant, Michelle Kendall, Lele Zhao, Anel Nurtay, Lucie Abeler-Dörner, Michael Parker, David Bonsall, Christophe Fraser, Luca Ferretti, Chris Wymant, Michelle Kendall, Lele Zhao, Anel Nurtay, Lucie Abeler-Dörner, Michael Parker, David Bonsall, Christophe Fraser
Abstract
The newly emergent human virus SARS-CoV-2 (severe acute respiratory syndrome-coronavirus 2) is resulting in high fatality rates and incapacitated health systems. Preventing further transmission is a priority. We analyzed key parameters of epidemic spread to estimate the contribution of different transmission routes and determine requirements for case isolation and contact tracing needed to stop the epidemic. Although SARS-CoV-2 is spreading too fast to be contained by manual contact tracing, it could be controlled if this process were faster, more efficient, and happened at scale. A contact-tracing app that builds a memory of proximity contacts and immediately notifies contacts of positive cases can achieve epidemic control if used by enough people. By targeting recommendations to only those at risk, epidemics could be contained without resorting to mass quarantines ("lockdowns") that are harmful to society. We discuss the ethical requirements for an intervention of this kind.
Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.
Figures
References
- World Health Organization, Coronavirus Disease 2019 (COVID-19): Situation Report – 36 (25 February 2020); .
- Guan W.-J., Ni Z.-Y., Hu Y., Liang W.-H., Ou C.-Q., He J.-X., Liu L., Shan H., Lei C.-L., Hui D. S. C., Du B., Li L.-J., Zeng G., Yuen K.-Y., Chen R.-C., Tang C.-L., Wang T., Chen P.-Y., Xiang J., Li S.-Y., Wang J.-L., Liang Z.-J., Peng Y.-X., Wei L., Liu Y., Hu Y.-H., Peng P., Wang J.-M., Liu J.-Y., Chen Z., Li G., Zheng Z.-J., Qiu S.-Q., Luo J., Ye C.-J., Zhu S.-Y., Zhong N.-S., China Medical Treatment Expert Group for Covid-19 , Clinical Characteristics of Coronavirus Disease 2019 in China. N. Engl. J. Med. 10.1056/NEJMoa2002032 (2020). 10.1056/NEJMoa2002032
- H. Li, S. Wang, F. Zhong, W. Bao, Y. Li, L. Liu, H. Wang, Y. He, Age-dependent risks of Incidence and Mortality of COVID-19 in Hubei Province and Other Parts of China. medRxiv [preprint]. 6 March 2020.
- N. Ferguson, D. Laydon, G. Nedjati-Gilani, N. Imai, K. Ainslie, M. Baguelin, S. Bhatia, A. Boonyasiri, Z. Cucunubá, G. Cuomo-Dannenburg, A. Dighe, I. Dorigatti, H. Fu, K. Gaythorpe, W. Green, A. Hamlet, W. Hinsley, L. Okell, S. van Elsland, H. Thompson, R. Verity, E. Volz, H. Wang, Y. Wang, P. Walker, C. Walters, P. Winskill, C. Whittaker, C. Donnelly, S. Riley, A. Ghani, Impact of Non-Pharmaceutical Interventions (NPIs) to Reduce COVID-19 Mortality and Healthcare Demand (16 March 2020); .
- Yu I. T. S., Sung J. J. Y., The epidemiology of the outbreak of severe acute respiratory syndrome (SARS) in Hong Kong—What we do know and what we don’t. Epidemiol. Infect. 132, 781–786 (2004). 10.1017/S0950268804002614
- Li Y., Huang X., Yu I. T. S., Wong T. W., Qian H., Role of air distribution in SARS transmission during the largest nosocomial outbreak in Hong Kong. Indoor Air 15, 83–95 (2005). 10.1111/j.1600-0668.2004.00317.x
- Otter J. A., Donskey C., Yezli S., Douthwaite S., Goldenberg S. D., Weber D. J., Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: The possible role of dry surface contamination. J. Hosp. Infect. 92, 235–250 (2016). 10.1016/j.jhin.2015.08.027
- Ong S. W. X., Tan Y. K., Chia P. Y., Lee T. H., Ng O. T., Wong M. S. Y., Marimuthu K., Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient. JAMA 10.1001/jama.2020.3227 (2020). 10.1001/jama.2020.3227
- Fraser C., Riley S., Anderson R. M., Ferguson N. M., Factors that make an infectious disease outbreak controllable. Proc. Natl. Acad. Sci. U.S.A. 101, 6146–6151 (2004). 10.1073/pnas.0307506101
- Peak C. M., Childs L. M., Grad Y. H., Buckee C. O., Comparing nonpharmaceutical interventions for containing emerging epidemics. Proc. Natl. Acad. Sci. U.S.A. 114, 4023–4028 (2017). 10.1073/pnas.1616438114
- Hellewell J., Abbott S., Gimma A., Bosse N. I., Jarvis C. I., Russell T. W., Munday J. D., Kucharski A. J., Edmunds W. J., Funk S., Eggo R. M., Sun F., Flasche S., Quilty B. J., Davies N., Liu Y., Clifford S., Klepac P., Jit M., Diamond C., Gibbs H., van Zandvoort K., Centre for the Mathematical Modelling of Infectious Diseases COVID-19 Working Group , Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts. Lancet Glob. Health 8, e488–e496 (2020). 10.1016/S2214-109X(20)30074-7
- Li Q., Guan X., Wu P., Wang X., Zhou L., Tong Y., Ren R., Leung K. S. M., Lau E. H. Y., Wong J. Y., Xing X., Xiang N., Wu Y., Li C., Chen Q., Li D., Liu T., Zhao J., Liu M., Tu W., Chen C., Jin L., Yang R., Wang Q., Zhou S., Wang R., Liu H., Luo Y., Liu Y., Shao G., Li H., Tao Z., Yang Y., Deng Z., Liu B., Ma Z., Zhang Y., Shi G., Lam T. T. Y., Wu J. T. K., Gao G. F., Cowling B. J., Yang B., Leung G. M., Feng Z., Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N. Engl. J. Med. 382, 1199–1207 (2020). 10.1056/NEJMoa2001316
- Tong Z.-D., Tang A., Li K.-F., Li P., Wang H.-L., Yi J.-P., Zhang Y.-L., Yan J.-B., Potential Presymptomatic Transmission of SARS-CoV-2, Zhejiang Province, China, 2020. Emerg. Infect. Dis. 26, 10.3201/eid2605.200198 (2020). 10.3201/eid2605.200198
- Bai Y., Yao L., Wei T., Tian F., Jin D.-Y., Chen L., Wang M., Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA 10.1001/jama.2020.2565 (2020). 10.1001/jama.2020.2565
- Channel News Asia , ; .
- Q. Bi, Y. Wu, S. Mei, C. Ye, X. Zou, Z. Zhang, X. Liu, L. Wei, S. A. Truelove, T. Zhang, W. Gao, C. Cheng, X. Tang, X. Wu, Y. Wu, B. Sun, S. Huang, Y. Sun, J. Zhang, T. Ma, J. Lessler, T. Feng, Epidemiology and Transmission of COVID-19 in Shenzhen China: Analysis of 391 cases and 1,286 of their close contacts. medRxiv [preprint]. 27 March 2020.
- Mizumoto K., Kagaya K., Zarebski A., Chowell G., Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Euro Surveill. 25, 2000180 (2020). 10.2807/1560-7917.ES.2020.25.10.2000180
- R. Verity, L. C. Okell, I. Dorigatti, P. Winskill, C. Whittaker, N. Imai, G. Cuomo-Dannenburg, H. Thompson, P. Walker, H. Fu, A. Dighe, J. Griffin, A. Cori, M. Baguelin, S. Bhatia, A. Boonyasiri, Z. M. Cucunuba, R. Fitzjohn, K. A. M. Gaythorpe, W. Green, A. Hamlet, W. Hinsley, D. Laydon, G. Nedjati-Gilani, S. Riley, S. van-Elsand, E. Volz, H. Wang, Y. Wang, X. Xi, C. Donnelly, A. Ghani, N. Ferguson, Estimates of the severity of COVID-19 disease. medRxiv [preprint]. 13 March 2020.
- Liu Y., Yan L.-M., Wan L., Xiang T.-X., Le A., Liu J.-M., Peiris M., Poon L. L. M., Zhang W., Viral dynamics in mild and severe cases of COVID-19. Lancet Infect. Dis. S1473-3099(20)30232-2 (2020). 10.1016/S1473-3099(20)30232-2
- I. Dorigatti, L. Okell, A. Cori, N. Imai, M. Baguelin, S. Bhatia, A. Boonyasiri, Z. Cucunubá, G. Cuomo-Dannenburg, R. FitzJohn, H. Fu, K. Gaythorpe, A. Hamlet, W. Hinsley, N. Hong, M. Kwun, D. Laydon, G. Nedjati-Gilani, S. Riley, S. van Elsland, E. Volz, H. Wang, R. Wang, C. Walters, X. Xi, C. Donnelly, A. Ghani, N. Ferguson, Report 4: Severity of 2019-Novel Coronavirus (nCoV) (10 February 2020); .
- S. A. Lauer, K. H. Grantz, Q. Bi, F. K. Jones, Q. Zheng, H. Meredith, A. S. Azman, N. G. Reich, J. Lessler, The incubation period of 2019-nCoV from publicly reported confirmed cases: Estimation and application. medRxiv [preprint]. 4 February 2020.
- H. Nishiura, N. M. Linton, A. R. Akhmetzhanov, Serial interval of novel coronavirus (2019-nCoV) infections. medRxiv [preprint]. 17 February 2020.
- Grassly N. C., Fraser C., Mathematical models of infectious disease transmission. Nat. Rev. Microbiol. 6, 477–487 (2008). 10.1038/nrmicro1845
- BDI Pathogen Dynamics Group, Digital contact tracing for SARS-COV-2 (2020); .
- P. Mozur, R. Zhong, A. Krolik, “In Coronavirus Fight, China Gives Citizens a Color Code, With Red Flags.” New York Times (1 March 2020); .
- Chen S., Yang J., Yang W., Wang C., Bärnighausen T., COVID-19 control in China during mass population movements at New Year. Lancet 395, 764–766 (2020). 10.1016/S0140-6736(20)30421-9
- Nuffield Council on Bioethics, Research in Global Health Emergencies: Ethical Issues (28 January 2020); .
- Zhao S., Lin Q., Ran J., Musa S. S., Yang G., Wang W., Lou Y., Gao D., Yang L., He D., Wang M. H., Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak. Int. J. Infect. Dis. 92, 214–217 (2020). 10.1016/j.ijid.2020.01.050
- Zhou T., Liu Q., Yang Z., Liao J., Yang K., Bai W., Lu X., Zhang W., Preliminary prediction of the basic reproduction number of the Wuhan novel coronavirus 2019-nCoV. J. Evid. Based Med. 13, 3–7 (2020). 10.1111/jebm.12376
- T. Ganyani, C. Kremer, D. Chen, A. Torneri, C. Faes, J. Wallinga, N. Hens, Estimating the generation interval for COVID-19 based on symptom onset data. medRxiv [preprint]. 8 March 2020.
- X. He, E. H. Y. Lau, P. Wu, X. Deng, J. Wang, X. Hao, Y. C. Lau, J. Y. Wong, Y. Guan, X. Tan, X. Mo, Y. Chen, B. Liao, W. Chen, F. Hu, Q. Zhang, M. Zhong, Y. Wu, L. Zhao, F. Zhang, B. J. Cowling, F. Li, G. M. Leung, Temporal dynamics in viral shedding and transmissibility of COVID-19. medRxiv [preprint]. 18 March 2020.
- Klinkenberg D., Fraser C., Heesterbeek H., The effectiveness of contact tracing in emerging epidemics. PLOS ONE 1, e12 (2006). 10.1371/journal.pone.0000012
- Salathé M., Kazandjieva M., Lee J. W., Levis P., Feldman M. W., Jones J. H., A high-resolution human contact network for infectious disease transmission. Proc. Natl. Acad. Sci. U.S.A. 107, 22020–22025 (2010). 10.1073/pnas.1009094108
- Yoneki E., Crowcroft J., EpiMap: Towards quantifying contact networks for understanding epidemiology in developing countries. Ad Hoc Netw. 13, 83–93 (2014). 10.1016/j.adhoc.2012.06.003
- K. A. Nguyen, Z. Luo, C. Watkins, in Progress in Location-Based Services 2014, G. Gartner, H. Huang, Eds. (Springer, 2015), pp. 63–78.
- Leung G. M., Chung P.-H., Tsang T., Lim W., Chan S. K. K., Chau P., Donnelly C. A., Ghani A. C., Fraser C., Riley S., Ferguson N. M., Anderson R. M., Law Y.-L., Mok T., Ng T., Fu A., Leung P.-Y., Peiris J. S. M., Lam T.-H., Hedley A. J., SARS-CoV antibody prevalence in all Hong Kong patient contacts. Emerg. Infect. Dis. 10, 1653–1656 (2004). 10.3201/eid1009.040155
- Kam K.-Q., Yung C. F., Cui L., Tzer Pin Lin R., Mak T. M., Maiwald M., Li J., Chong C. Y., Nadua K., Tan N. W. H., Thoon K. C., A Well Infant with Coronavirus Disease 2019 with High Viral Load. Clin. Infect. Dis. ciaa201 (2020). 10.1093/cid/ciaa201
- Lu X., Zhang L., Du H., Zhang J., Li Y. Y., Qu J., Zhang W., Wang Y., Bao S., Li Y., Wu C., Liu H., Liu D., Shao J., Peng X., Yang Y., Liu Z., Xiang Y., Zhang F., Silva R. M., Pinkerton K. E., Shen K., Xiao H., Xu S., Wong G. W. K., SARS-CoV-2 Infection in Children. N. Engl. J. Med. NEJMc2005073 (2020). 10.1056/NEJMc2005073
- Kampf G., Todt D., Pfaender S., Steinmann E., Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J. Hosp. Infect. 104, 246–251 (2020). 10.1016/j.jhin.2020.01.022
- The code used for our analyses is available at .
- L. Ferretti, C. Wymant, M. Kendall, L. Zhao, A. Nurtay, D. G. Bonsall, C. Fraser, Quantifying dynamics of SARS-CoV-2 transmission suggests that epidemic control and avoidance is feasible through instantaneous digital contact tracing. medRxiv [preprint]. 12 March 2020.
- China Centre for Disease Control, Distribution of New Coronavirus Pneumonia; .
- Phan L. T., Nguyen T. V., Luong Q. C., Nguyen T. V., Nguyen H. T., Le H. Q., Nguyen T. T., Cao T. M., Pham Q. D., Importation and Human-to-Human Transmission of a Novel Coronavirus in Vietnam. N. Engl. J. Med. 382, 872–874 (2020). 10.1056/NEJMc2001272
- Ki M., Task Force for 2019-nCoV , Epidemiologic characteristics of early cases with 2019 novel coronavirus (2019-nCoV) disease in Republic of Korea. Epidemiol. Health 42, e2020007 (2020). 10.4178/epih.e2020007
- Rothe C., Schunk M., Sothmann P., Bretzel G., Froeschl G., Wallrauch C., Zimmer T., Thiel V., Janke C., Guggemos W., Seilmaier M., Drosten C., Vollmar P., Zwirglmaier K., Zange S., Wölfel R., Hoelscher M., Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. N. Engl. J. Med. 382, 970–971 (2020). 10.1056/NEJMc2001468
Source: PubMed