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Wrong person, place and time: viral load and contact network structure predict SARS-CoV-2 transmission and
Ashish Goyal1, Daniel B Reeves1, E Fabian Cardozo-Ojeda1
1Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center.
Abstract:
SARS-CoV-2 is difficult to contain because many transmissions occur during the pre-symptomatic phase of infection. Moreover, in contrast to influenza, while most SARS-CoV-2 infected people do not transmit the virus to anybody, a small percentage secondarily infect large numbers of people. We designed mathematical models of SARS-CoV-2 and influenza which link observed viral shedding patterns with key epidemiologic features of each virus, including distributions of the number of secondary cases attributed to each infected person (individual R0) and the duration between symptom onset in the transmitter and secondarily infected person (serial interval). We identify that people with SARS-CoV-2 or influenza infections are usually contagious for fewer than one day congruent with peak viral load several days after infection, and that transmission is unlikely below a certain viral load. SARS-CoV-2 super-spreader events with over 10 secondary infections occur when an infected person is briefly shedding at a very high viral load and has a high concurrent number of exposed contacts. The higher predisposition of SARS-CoV-2 towards super-spreading events is not due to its 1-2 additional weeks of viral shedding relative to influenza. Rather, a person infected with SARS-CoV-2 exposes more people within equivalent physical contact networks than a person infected with influenza, likely due to aerosolization of virus. Our results support policies that limit crowd size in indoor spaces and provide viral load benchmarks for infection control and therapeutic interventions intended to prevent secondary transmission.
Insights
Super-spreading events for SARS-CoV-2 are driven by brief, high viral load shedding and more exposed contacts, unlike influenza. This highlights the importance of limiting indoor crowds and monitoring viral load for infection control.
Area of Science:
- Epidemiology
- Infectious Disease Modeling
Background:
- SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is challenging to control due to pre-symptomatic transmission and super-spreading events.
- Understanding viral shedding patterns and transmission dynamics is crucial for effective public health interventions.
Approach:
- Developed mathematical models comparing SARS-CoV-2 and influenza.
- Linked viral shedding patterns with epidemiologic features like individual R0 and serial interval.
- Analyzed factors contributing to super-spreading events.
Key Points:
- Transmission is linked to peak viral load; shedding is typically brief for both viruses.
- SARS-CoV-2 super-spreading events result from high viral load shedding and numerous contacts.
- SARS-CoV-2's higher predisposition to super-spreading is linked to increased exposure via aerosolization, not prolonged shedding.
Conclusions:
- Policies limiting indoor crowd sizes are supported by findings.
- Viral load benchmarks are proposed for infection control and therapeutic strategies.
- Aerosolization plays a key role in SARS-CoV-2's enhanced transmission potential.
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