Reconstruction of the full transmission dynamics of COVID-19 in Wuhan

Xingjie Hao, Shanshan Cheng, Degang Wu, Tangchun Wu (), Xihong Lin () and Chaolong Wang ()
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Xingjie Hao: Huazhong University of Science and Technology
Shanshan Cheng: Huazhong University of Science and Technology
Degang Wu: Huazhong University of Science and Technology
Tangchun Wu: Huazhong University of Science and Technology
Xihong Lin: Harvard T. H. Chan School of Public Health
Chaolong Wang: Huazhong University of Science and Technology

Nature, 2020, vol. 584, issue 7821, 420-424

Abstract: Abstract As countries in the world review interventions for containing the pandemic of coronavirus disease 2019 (COVID-19), important lessons can be drawn from the study of the full transmission dynamics of its causative agent—severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)— in Wuhan (China), where vigorous non-pharmaceutical interventions have suppressed the local outbreak of this disease1. Here we use a modelling approach to reconstruct the full-spectrum dynamics of COVID-19 in Wuhan between 1 January and 8 March 2020 across 5 periods defined by events and interventions, on the basis of 32,583 laboratory-confirmed cases1. Accounting for presymptomatic infectiousness2, time-varying ascertainment rates, transmission rates and population movements3, we identify two key features of the outbreak: high covertness and high transmissibility. We estimate 87% (lower bound, 53%) of the infections before 8 March 2020 were unascertained (potentially including asymptomatic and mildly symptomatic individuals); and a basic reproduction number (R0) of 3.54 (95% credible interval 3.40–3.67) in the early outbreak, much higher than that of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS)4,5. We observe that multipronged interventions had considerable positive effects on controlling the outbreak, decreasing the reproduction number to 0.28 (95% credible interval 0.23–0.33) and—by projection—reducing the total infections in Wuhan by 96.0% as of 8 March 2020. We also explore the probability of resurgence following the lifting of all interventions after 14 consecutive days of no ascertained infections; we estimate this probability at 0.32 and 0.06 on the basis of models with 87% and 53% unascertained cases, respectively—highlighting the risk posed by substantial covert infections when changing control measures. These results have important implications when considering strategies of continuing surveillance and interventions to eventually contain outbreaks of COVID-19.

Date: 2020
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DOI: 10.1038/s41586-020-2554-8

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