Cryptic transmission of SARS-CoV-2 and the first COVID-19 wave

Jessica T. Davis, Matteo Chinazzi, Nicola Perra, Kunpeng Mu, Ana Pastore y Piontti, Marco Ajelli, Natalie E. Dean, Corrado Gioannini, Maria Litvinova, Stefano Merler, Luca Rossi, Kaiyuan Sun, Xinyue Xiong, Ira M. Longini, M. Elizabeth Halloran, Cécile Viboud and Alessandro Vespignani ()
Additional contact information
Jessica T. Davis: Northeastern University
Matteo Chinazzi: Northeastern University
Nicola Perra: Northeastern University
Kunpeng Mu: Northeastern University
Ana Pastore y Piontti: Northeastern University
Marco Ajelli: Indiana University School of Public Health
Natalie E. Dean: Emory University
Corrado Gioannini: ISI Foundation
Maria Litvinova: Indiana University School of Public Health
Stefano Merler: Bruno Kessler Foundation
Luca Rossi: ISI Foundation
Kaiyuan Sun: National Institutes of Health
Xinyue Xiong: Northeastern University
Ira M. Longini: University of Florida
M. Elizabeth Halloran: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center
Cécile Viboud: National Institutes of Health
Alessandro Vespignani: Northeastern University

Nature, 2021, vol. 600, issue 7887, 127-132

Abstract: Abstract Considerable uncertainty surrounds the timeline of introductions and onsets of local transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) globally1–7. Although a limited number of SARS-CoV-2 introductions were reported in January and February 2020 (refs.8,9), the narrowness of the initial testing criteria, combined with a slow growth in testing capacity and porous travel screening10, left many countries vulnerable to unmitigated, cryptic transmission. Here we use a global metapopulation epidemic model to provide a mechanistic understanding of the early dispersal of infections and the temporal windows of the introduction of SARS-CoV-2 and onset of local transmission in Europe and the USA. We find that community transmission of SARS-CoV-2 was likely to have been present in several areas of Europe and the USA by January 2020, and estimate that by early March, only 1 to 4 in 100 SARS-CoV-2 infections were detected by surveillance systems. The modelling results highlight international travel as the key driver of the introduction of SARS-CoV-2, with possible introductions and transmission events as early as December 2019 to January 2020. We find a heterogeneous geographic distribution of cumulative infection attack rates by 4 July 2020, ranging from 0.78% to 15.2% across US states and 0.19% to 13.2% in European countries. Our approach complements phylogenetic analyses and other surveillance approaches and provides insights that can be used to design innovative, model-driven surveillance systems that guide enhanced testing and response strategies.

Date: 2021
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DOI: 10.1038/s41586-021-04130-w

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