PreprintCited by 113COVID-19 epidemiological studiesSARS-CoV-2 and COVID-19 ResearchSARS-CoV-2 detection and testing

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The timing of COVID-19 transmission

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Ferretti, Luca, Ledda, Alice, Wymant, Chris, Zhao, Lele, Ledda, Virginia, Abeler-Dörner, Lucie, Kendall, Michelle, Nurtay, Anel, Cheng, Hao-Yuan, Ng, Ta-Chou, Lin, Hsien-Ho, Hinch, Rob, Masel, Joanna, Kilpatrick, A. Marm, Fraser, Christophe·2020·medRxiv

DOI 10.1101/2020.09.04.20188516

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Abstract

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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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: Ferretti, Luca
Ledda, Alice
Wymant, Chris
Zhao, Lele
Ledda, Virginia
Abeler-Dörner, Lucie
Kendall, Michelle
Nurtay, Anel
Cheng, Hao-Yuan
Ng, Ta-Chou
Lin, Hsien-Ho
Masel, Joanna
Kilpatrick, A. Marm
Fraser, Christophe
Venue: medRxiv
Publisher: openRxiv
Published: 2020-09-07
DOI: 10.1101/2020.09.04.20188516
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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