Super-spreading events initiated the exponential growth phase of COVID-19 with ℛ ₀ higher than initially estimated

Abstract

The basic reproduction number <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:msub><mml:mrow><mml:mi>R</mml:mi></mml:mrow> <mml:mrow><mml:mn>0</mml:mn></mml:mrow> </mml:msub> </mml:math> of the coronavirus disease 2019 has been estimated to range between 2 and 4. Here, we used an SEIR model that properly accounts for the distribution of the latent period and, based on empirical estimates of the doubling time in the near-exponential phases of epidemic progression in China, Italy, Spain, France, UK, Germany, Switzerland and New York State, we estimated that <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:msub><mml:mrow><mml:mi>R</mml:mi></mml:mrow> <mml:mrow><mml:mn>0</mml:mn></mml:mrow> </mml:msub> </mml:math> lies in the range 4.7-11.4. We explained this discrepancy by performing stochastic simulations of model dynamics in a population with a small proportion of super-spreaders. The simulations revealed two-phase dynamics, in which an initial phase of relatively slow epidemic progression diverts to a faster phase upon appearance of infectious super-spreaders. Early estimates obtained for this initial phase may suggest lower <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:msub><mml:mrow><mml:mi>R</mml:mi></mml:mrow> <mml:mrow><mml:mn>0</mml:mn></mml:mrow> </mml:msub> </mml:math> .