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Science. 2020 Mar 16. pii: eabb3221. doi: 10.1126/science.abb3221. [Epub ahead of print]

Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2).

Author information

1
MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, London W2 1PG, UK.
2
Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA. sp3449@cumc.columbia.edu jls106@cumc.columbia.edu.
3
Department of Land, Air and Water Resources, University of California, Davis, Davis, CA 95616, USA.
4
Department of Urban Planning and Design, The University of Hong Kong, Hong Kong.
5
Ministry of Education Key Laboratory for Earth System Modeling, Department of Earth System Science, Tsinghua University, Beijing 10084, P. R. China.
6
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Contributed equally

Abstract

Estimation of the prevalence and contagiousness of undocumented novel coronavirus (SARS-CoV2) infections is critical for understanding the overall prevalence and pandemic potential of this disease. Here we use observations of reported infection within China, in conjunction with mobility data, a networked dynamic metapopulation model and Bayesian inference, to infer critical epidemiological characteristics associated with SARS-CoV2, including the fraction of undocumented infections and their contagiousness. We estimate 86% of all infections were undocumented (95% CI: [82%-90%]) prior to 23 January 2020 travel restrictions. Per person, the transmission rate of undocumented infections was 55% of documented infections ([46%-62%]), yet, due to their greater numbers, undocumented infections were the infection source for 79% of documented cases. These findings explain the rapid geographic spread of SARS-CoV2 and indicate containment of this virus will be particularly challenging.

PMID:
32179701
DOI:
10.1126/science.abb3221

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