Temporal dynamics in viral shedding and transmissibility of COVID-19

We report temporal patterns of viral shedding in 94 patients with laboratory-confirmed COVID-19 and modeled COVID-19 infectiousness profiles from a separate sample of 77 infector–infectee transmission pairs. We observed the highest viral load in throat swabs at the time of symptom onset, and inferre...

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Published in	Nature medicine Vol. 26; no. 5; pp. 672 - 675
Main Authors	He, Xi, Lau, Eric H. Y., Wu, Peng, Deng, Xilong, Wang, Jian, Hao, Xinxin, Lau, Yiu Chung, Wong, Jessica Y., Guan, Yujuan, Tan, Xinghua, Mo, Xiaoneng, Chen, Yanqing, Liao, Baolin, Chen, Weilie, Hu, Fengyu, Zhang, Qing, Zhong, Mingqiu, Wu, Yanrong, Zhao, Lingzhai, Zhang, Fuchun, Cowling, Benjamin J., Li, Fang, Leung, Gabriel M.
Format	Journal Article
Language	English
Published	New York Nature Publishing Group US 01.05.2020 Nature Publishing Group
Subjects	692/308/174 692/699/255 692/700/459 692/700/478 Analysis Betacoronavirus - physiology Biomedical and Life Sciences Biomedicine Brief Communication Cancer Research Clustering Confidence intervals Coronavirus Infections - epidemiology Coronavirus Infections - transmission Coronaviruses COVID-19 Disease control Disease transmission Humans Infectious Diseases Measurement Metabolic Diseases Molecular Medicine Neurosciences Pandemics Pneumonia, Viral - epidemiology Pneumonia, Viral - transmission SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Viral diseases Viremia Virus Shedding China
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Abstract	We report temporal patterns of viral shedding in 94 patients with laboratory-confirmed COVID-19 and modeled COVID-19 infectiousness profiles from a separate sample of 77 infector–infectee transmission pairs. We observed the highest viral load in throat swabs at the time of symptom onset, and inferred that infectiousness peaked on or before symptom onset. We estimated that 44% (95% confidence interval, 30–57%) of secondary cases were infected during the index cases’ presymptomatic stage, in settings with substantial household clustering, active case finding and quarantine outside the home. Disease control measures should be adjusted to account for probable substantial presymptomatic transmission. Presymptomatic transmission of SARS-CoV-2 is estimated to account for a substantial proportion of COVID-19 cases.
AbstractList	We report temporal patterns of viral shedding in 94 patients with laboratory-confirmed COVID-19 and modeled COVID-19 infectiousness profiles from a separate sample of 77 infector-infectee transmission pairs. We observed the highest viral load in throat swabs at the time of symptom onset, and inferred that infectiousness peaked on or before symptom onset. We estimated that 44% (95% confidence interval, 25-69%) of secondary cases were infected during the index cases' presymptomatic stage, in settings with substantial household clustering, active case finding and quarantine outside the home. Disease control measures should be adjusted to account for probable substantial presymptomatic transmission. We report temporal patterns of viral shedding in 94 patients with laboratory-confirmed COVID-19 and modeled COVID-19 infectiousness profiles from a separate sample of 77 infector-infectee transmission pairs. We observed the highest viral load in throat swabs at the time of symptom onset, and inferred that infectiousness peaked on or before symptom onset. We estimated that 44% (95% confidence interval, 25-69%) of secondary cases were infected during the index cases' presymptomatic stage, in settings with substantial household clustering, active case finding and quarantine outside the home. Disease control measures should be adjusted to account for probable substantial presymptomatic transmission. Presymptomatic transmission of SARS-CoV-2 is estimated to account for a substantial proportion of COVID-19 cases. We report temporal patterns of viral shedding in 94 patients with laboratory-confirmed COVID-19 and modeled COVID-19 infectiousness profiles from a separate sample of 77 infector–infectee transmission pairs. We observed the highest viral load in throat swabs at the time of symptom onset, and inferred that infectiousness peaked on or before symptom onset. We estimated that 44% (95% confidence interval, 30–57%) of secondary cases were infected during the index cases’ presymptomatic stage, in settings with substantial household clustering, active case finding and quarantine outside the home. Disease control measures should be adjusted to account for probable substantial presymptomatic transmission.Presymptomatic transmission of SARS-CoV-2 is estimated to account for a substantial proportion of COVID-19 cases. We report temporal patterns of viral shedding in 94 patients with laboratory-confirmed COVID-19 and modeled COVID-19 infectiousness profiles from a separate sample of 77 infector-infectee transmission pairs. We observed the highest viral load in throat swabs at the time of symptom onset, and inferred that infectiousness peaked on or before symptom onset. We estimated that 44% (95% confidence interval, 25-69%) of secondary cases were infected during the index cases' presymptomatic stage, in settings with substantial household clustering, active case finding and quarantine outside the home. Disease control measures should be adjusted to account for probable substantial presymptomatic transmission.We report temporal patterns of viral shedding in 94 patients with laboratory-confirmed COVID-19 and modeled COVID-19 infectiousness profiles from a separate sample of 77 infector-infectee transmission pairs. We observed the highest viral load in throat swabs at the time of symptom onset, and inferred that infectiousness peaked on or before symptom onset. We estimated that 44% (95% confidence interval, 25-69%) of secondary cases were infected during the index cases' presymptomatic stage, in settings with substantial household clustering, active case finding and quarantine outside the home. Disease control measures should be adjusted to account for probable substantial presymptomatic transmission. We report temporal patterns of viral shedding in 94 patients with laboratory-confirmed COVID-19 and modeled COVID-19 infectiousness profiles from a separate sample of 77 infector–infectee transmission pairs. We observed the highest viral load in throat swabs at the time of symptom onset, and inferred that infectiousness peaked on or before symptom onset. We estimated that 44% (95% confidence interval, 30–57%) of secondary cases were infected during the index cases’ presymptomatic stage, in settings with substantial household clustering, active case finding and quarantine outside the home. Disease control measures should be adjusted to account for probable substantial presymptomatic transmission. Presymptomatic transmission of SARS-CoV-2 is estimated to account for a substantial proportion of COVID-19 cases.
Audience	Academic
Author	Guan, Yujuan Wang, Jian He, Xi Li, Fang Zhong, Mingqiu Zhang, Fuchun Zhao, Lingzhai Hu, Fengyu Tan, Xinghua Wu, Yanrong Chen, Yanqing Cowling, Benjamin J. Liao, Baolin Lau, Eric H. Y. Mo, Xiaoneng Chen, Weilie Hao, Xinxin Deng, Xilong Lau, Yiu Chung Leung, Gabriel M. Wu, Peng Wong, Jessica Y. Zhang, Qing
Author_xml	– sequence: 1 givenname: Xi surname: He fullname: He, Xi organization: Guangzhou Eighth People’s Hospital, Guangzhou Medical University – sequence: 2 givenname: Eric H. Y. orcidid: 0000-0002-6688-9637 surname: Lau fullname: Lau, Eric H. Y. email: ehylau@hku.hk organization: World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, University of Hong Kong – sequence: 3 givenname: Peng surname: Wu fullname: Wu, Peng organization: World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, University of Hong Kong – sequence: 4 givenname: Xilong surname: Deng fullname: Deng, Xilong organization: Guangzhou Eighth People’s Hospital, Guangzhou Medical University – sequence: 5 givenname: Jian surname: Wang fullname: Wang, Jian organization: Guangzhou Eighth People’s Hospital, Guangzhou Medical University – sequence: 6 givenname: Xinxin surname: Hao fullname: Hao, Xinxin organization: World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, University of Hong Kong – sequence: 7 givenname: Yiu Chung surname: Lau fullname: Lau, Yiu Chung organization: World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, University of Hong Kong – sequence: 8 givenname: Jessica Y. surname: Wong fullname: Wong, Jessica Y. organization: World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, University of Hong Kong – sequence: 9 givenname: Yujuan surname: Guan fullname: Guan, Yujuan organization: Guangzhou Eighth People’s Hospital, Guangzhou Medical University – sequence: 10 givenname: Xinghua surname: Tan fullname: Tan, Xinghua organization: Guangzhou Eighth People’s Hospital, Guangzhou Medical University – sequence: 11 givenname: Xiaoneng surname: Mo fullname: Mo, Xiaoneng organization: Guangzhou Eighth People’s Hospital, Guangzhou Medical University – sequence: 12 givenname: Yanqing surname: Chen fullname: Chen, Yanqing organization: Guangzhou Eighth People’s Hospital, Guangzhou Medical University – sequence: 13 givenname: Baolin surname: Liao fullname: Liao, Baolin organization: Guangzhou Eighth People’s Hospital, Guangzhou Medical University – sequence: 14 givenname: Weilie surname: Chen fullname: Chen, Weilie organization: Guangzhou Eighth People’s Hospital, Guangzhou Medical University – sequence: 15 givenname: Fengyu surname: Hu fullname: Hu, Fengyu organization: Guangzhou Eighth People’s Hospital, Guangzhou Medical University – sequence: 16 givenname: Qing surname: Zhang fullname: Zhang, Qing organization: Guangzhou Eighth People’s Hospital, Guangzhou Medical University – sequence: 17 givenname: Mingqiu surname: Zhong fullname: Zhong, Mingqiu organization: Guangzhou Eighth People’s Hospital, Guangzhou Medical University – sequence: 18 givenname: Yanrong surname: Wu fullname: Wu, Yanrong organization: Guangzhou Eighth People’s Hospital, Guangzhou Medical University – sequence: 19 givenname: Lingzhai surname: Zhao fullname: Zhao, Lingzhai organization: Guangzhou Eighth People’s Hospital, Guangzhou Medical University – sequence: 20 givenname: Fuchun surname: Zhang fullname: Zhang, Fuchun organization: Guangzhou Eighth People’s Hospital, Guangzhou Medical University – sequence: 21 givenname: Benjamin J. orcidid: 0000-0002-6297-7154 surname: Cowling fullname: Cowling, Benjamin J. organization: World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, University of Hong Kong – sequence: 22 givenname: Fang surname: Li fullname: Li, Fang organization: Guangzhou Eighth People’s Hospital, Guangzhou Medical University – sequence: 23 givenname: Gabriel M. orcidid: 0000-0002-2503-6283 surname: Leung fullname: Leung, Gabriel M. organization: World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, University of Hong Kong
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/32296168$$D View this record in MEDLINE/PubMed
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Snippet	We report temporal patterns of viral shedding in 94 patients with laboratory-confirmed COVID-19 and modeled COVID-19 infectiousness profiles from a separate...
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SubjectTerms	692/308/174 692/699/255 692/700/459 692/700/478 Analysis Betacoronavirus - physiology Biomedical and Life Sciences Biomedicine Brief Communication Cancer Research Clustering Confidence intervals Coronavirus Infections - epidemiology Coronavirus Infections - transmission Coronaviruses COVID-19 Disease control Disease transmission Humans Infectious Diseases Measurement Metabolic Diseases Molecular Medicine Neurosciences Pandemics Pneumonia, Viral - epidemiology Pneumonia, Viral - transmission SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Viral diseases Viremia Virus Shedding
Title	Temporal dynamics in viral shedding and transmissibility of COVID-19
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