Lovell-Read, Francesca A., Funk, Sebastian, Obolski, Uri, Donnelly, Christl A. and Thompson, Robin N. (2021) Interventions targeting nonsymptomatic cases can be important to prevent local outbreaks : SARS-CoV-2 as a case-study. Journal of The Royal Society Interface, 18 (178). 20201014. doi:10.1098/rsif.2020.1014 ISSN 1742-5689.

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Abstract

During infectious disease epidemics, an important question is whether cases travelling to new locations will trigger local outbreaks. The risk of this occurring depends on the transmissibility of the pathogen, the susceptibility of the host population and, crucially, the effectiveness of surveillance in detecting cases and preventing onward spread. For many pathogens, transmission from pre-symptomatic and/or asymptomatic (together referred to as non-symptomatic) infectious hosts can occur, making effective surveillance challenging. Here, by using SARS-CoV-2 as a case study, we show how the risk of local outbreaks can be assessed when non-symptomatic transmission can occur. We construct a branching process model that includes non-symptomatic transmission and explore the effects of interventions targeting non-symptomatic or symptomatic hosts when surveillance resources are limited. We consider whether the greatest reductions in local outbreak risks are achieved by increasing surveillance and control targeting non-symptomatic or symptomatic cases, or a combination of both. We find that seeking to increase surveillance of symptomatic hosts alone is typically not the optimal strategy for reducing outbreak risks. Adopting a strategy that combines an enhancement of surveillance of symptomatic cases with efforts to find and isolate non-symptomatic infected hosts leads to the largest reduction in the probability that imported cases will initiate a local outbreak.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Science > Mathematics
Library of Congress Subject Headings (LCSH):	COVID-19 (Disease) , COVID-19 (Disease) -- Prevention, COVID-19 (Disease) -- Prevention -- Mathematical models, Communicable diseases -- Epidemiology -- Mathematical models, COVID-19 (Disease) -- Etiology, Diseases -- Causes and theories of causation
Journal or Publication Title:	Journal of The Royal Society Interface
Publisher:	The Royal Society Publishing
ISSN:	1742-5689
Official Date:	2021
Dates:	Date Event 2021 Published 19 May 2021 Available 20 April 2021 Accepted
Volume:	18
Number:	178
Article Number:	20201014
DOI:	10.1098/rsif.2020.1014
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Copyright Holders:	© 2021 The Authors
Date of first compliant deposit:	22 April 2021
Date of first compliant Open Access:	23 April 2021
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID BB/M011224/1 [BBSRC] Biotechnology and Biological Sciences Research Council http://dx.doi.org/10.13039/501100000268 210758/Z/18/Z Wellcome Trust http://dx.doi.org/10.13039/100010269 Junior Research Fellowship Christ Church (University of Oxford) http://viaf.org/viaf/140757625 MR/R015600/1 [MRC] Medical Research Council http://dx.doi.org/10.13039/501100000265 MR/R015600/1 Foreign, Commonwealth and Development Office UNSPECIFIED EDCTP2 programme European Commission http://dx.doi.org/10.13039/501100000780
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