A comparative analysis of epidemiological characteristics of MERS-CoV and SARS-CoV-2 in Saudi Arabia

In this study, we determine and compare the incubation duration, serial interval, pre-symptomatic transmission, and case fatality rate of MERS-CoV and COVID-19 in Saudi Arabia based on contact tracing data we acquired in Saudi Arabia. The date of infection and infector-infectee pairings are deduced from travel history to Saudi Arabia or exposure to confirmed cases. The incubation times and serial intervals are estimated using parametric models accounting for exposure interval censoring. Our estimations show that MERS-CoV has a mean incubation time of 7.21 (95% CI: 6.59-7.85) days, whereas COVID-19 (for the circulating strain in the study period) has a mean incubation period of 5.43(95% CI: 4.81-6.11) days. MERS-CoV has an estimated serial interval of 14.13(95% CI: 13.9-14.7) days, while COVID-19 has an estimated serial interval of 5.1(95% CI: 5.0-5.5) days. The COVID-19 serial interval is found to be shorter than the incubation time, indicating that pre-symptomatic transmission may occur in a significant fraction of transmission events. We conclude that during the COVID-19 wave studied, at least 75% of transmission happened prior to the onset of symptoms. The CFR for MERS-CoV is estimated to be 38.1% (95% CI: 36.8-39.5), while the CFR for COVID-19 1.67% (95% CI: 1.63-1.71). This work is expected to help design future surveillance and intervention program targeted at specific respiratory virus outbreaks, and have implications for contingency planning for future coronavirus outbreaks.