The timing of COVID-19 transmission
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The timing of SARS-CoV-2 transmission is a critical factor to understand the epidemic trajectory and the impact of isolation, contact tracing and other non-pharmaceutical interventions on the spread of COVID-19 epidemics. We examined the distribution of transmission events with respect to exposure and onset of symptoms. We show that for symptomatic individuals, the timing of transmission of SARS-CoV-2 is more strongly linked to the onset of clinical symptoms of COVID-19 than to the time since infection. We found that it was approximately centered and symmetric around the onset of symptoms, with three quarters of events occurring in the window from 2-3 days before to 2-3 days after. However, we caution against overinterpretation of the right tail of the distribution, due to its dependence on behavioural factors and interventions. We also found that the pre-symptomatic infectious period extended further back in time for individuals with longer incubation periods. This strongly suggests that information about when a case was infected should be collected where possible, in order to assess how far into the past their contacts should be traced. Overall, the fraction of transmission from strictly pre-symptomatic infections was high (41%; 95%CI 31-50%), which limits the efficacy of symptom-based interventions, and the large fraction of transmissions (35%; 95%CI 26-45%) that occur on the same day or the day after onset of symptoms underlines the critical importance of individuals distancing themselves from others as soon as they notice any symptoms, even if they are mild. Rapid or at-home testing and contextual risk information would greatly facilitate efficient early isolation.
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The generation time distribution has a mean of 5.5 days.
“using the generation time distribution in 28 with mean 5.5 days”
From The epidemiological impact of the NHS COVID-19 app (2021) · cites this paper as [28]
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The epidemiological impact of the Canadian COVID Alert app
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Feasibility of a High-Volume Filter Sampler for Detecting SARS-CoV-2 RNA in COVID-19 Patient Rooms
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Testing for COVID-19 is Much More Effective When Performed Immediately Prior to Social Mixing
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Semi-parametric estimation of incubation and generation times by means of Laguerre polynomials
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Estimating event ban effects on COVID-19 outbreak in JapanPreprint
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- Authors
- Ferretti, L., Ledda, A., Wymant, C., Zhao, L., Ledda, V., Abeler-Dörner, L., Kendall, M., Nurtay, A., Cheng, H.-Y., Ng, T.-C., Lin, H.-H., Hinch, R., Masel, J., Kilpatrick, A. M., & Fraser, C.
- Affiliations
- Imperial College London (GB)
- University of Oxford (GB)
- Liverpool University Hospitals NHS Foundation Trust (GB)
- Taiwan Centers for Disease Control (TW)
- National Taiwan University (TW)
- University of California, Santa Cruz (US)
- Corresponding author
- Fraser, Christophe
- ORCID
- Venue
- medRxiv
- Publisher
- openRxiv
- Published
- 2020-09-07
- OpenAlex
- W3083050273
- Cited by
- 112
- References
- 52
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 6 · 2023: 17 · 2022: 30 · 2021: 44 · 2020: 9
- Type
- posted content
- Language
- en
- Open access
- green
- doi.org
- Locations
- medRxiv (acceptedVersion)
- SSRN Electronic Journal (acceptedVersion)
- Funders
- Li Ka Shing Foundation
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 detection and testing
- Keywords
- SARS-CoV-2, pre-symptomatic transmission, incubation period, symptom onset, infectious period, contact tracing, isolation, non-pharmaceutical interventions, rapid testing
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