Abstract
BackgroundAs of March 31, 2020, the ongoing COVID-19 epidemic that started in China in December 2019 is now generating local transmission around the world. The geographic heterogeneity and associated intervention strategies highlight the need to monitor in real time the transmission potential of COVID-19. Singapore provides a unique case example for monitoring transmission, as there have been multiple disease clusters, yet transmission remains relatively continued.MethodsHere we estimate the effective reproduction number, Rt, of COVID-19 in Singapore from the publicly available daily case series of imported and autochthonous cases by date of symptoms onset, after adjusting the local cases for reporting delays as of March 17, 2020. We also derive the reproduction number from the distribution of cluster sizes using a branching process analysis that accounts for truncation of case counts.ResultsThe local incidence curve displays sub-exponential growth dynamics, with the reproduction number following a declining trend and reaching an estimate at 0.7 (95% CI 0.3, 1.0) during the first transmission wave by February 14, 2020, while the overall R based on the cluster size distribution as of March 17, 2020, was estimated at 0.6 (95% CI 0.4, 1.02). The overall mean reporting delay was estimated at 6.4 days (95% CI 5.8, 6.9), but it was shorter among imported cases compared to local cases (mean 4.3 vs. 7.6 days, Wilcoxon test, p < 0.001).ConclusionThe trajectory of the reproduction number in Singapore underscores the significant effects of successful containment efforts in Singapore, but it also suggests the need to sustain social distancing and active case finding efforts to stomp out all active chains of transmission.
Highlights
As of March 31, 2020, the ongoing COVID-19 epidemic that started in China in December 2019 is generating local transmission around the world
Rapid human-to-human transmission of the disease was confirmed in January 2020, and the etiological agent was identified as severe acute respiratory syndromerelated coronavirus 2 (SARS-CoV-2) due to its genetic similarity to the SARS-CoV discovered in 2003 [4, 5]
We found that imported cases tend to have shorter reporting delays compared to local cases, as imported cases tend to be identified more quickly
Summary
As of March 31, 2020, the ongoing COVID-19 epidemic that started in China in December 2019 is generating local transmission around the world. Singapore provides a unique case example for monitoring transmission, as there have been multiple disease clusters, yet transmission remains relatively continued. The ongoing Coronavirus Disease 2019 (COVID-19) pandemic started with a cluster of pneumonia cases of unknown etiology in Wuhan, China, back in December 2019 [1, 2]. The COVID19 case incidence in China has substantially declined, active transmission is occurring in multiple countries around the world [2]. Epidemiological data from these countries can help to monitor transmission potential of SARS-CoV-2 in near real time
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