Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the etiological agent of the Coronavirus Disease 2019 (COVID-19) disease, has moved rapidly around the globe, infecting millions and killing hundreds of thousands. The basic reproduction number, which has been widely used—appropriately and less appropriately—to characterize the transmissibility of the virus, hides the fact that transmission is stochastic, often dominated by a small number of individuals, and heavily influenced by superspreading events (SSEs). The distinct transmission features of SARS-CoV-2, e.g., high stochasticity under low prevalence (as compared to other pathogens, such as influenza), and the central role played by SSEs on transmission dynamics cannot be overlooked. Many explosive SSEs have occurred in indoor settings, stoking the pandemic and shaping its spread, such as long-term care facilities, prisons, meat-packing plants, produce processing facilities, fish factories, cruise ships, family gatherings, parties, and nightclubs. These SSEs demonstrate the urgent need to understand routes of transmission, while posing an opportunity to effectively contain outbreaks with targeted interventions to eliminate SSEs. Here, we describe the different types of SSEs, how they influence transmission, empirical evidence for their role in the COVID-19 pandemic, and give recommendations for control of SARS-CoV-2.
Highlights
While Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has moved swiftly around the globe, causing millions of Coronavirus Disease 2019 (COVID-19) cases, much attention has been given to the basic reproduction number (R0), estimated to be roughly between 1.5 and 4 [1]
It has become clear that relying on a single value to characterize the number of secondary infections—and estimates of the transmissibility of this virus—is inadequate to capture the true transmission dynamics and subsequent risk to humanity [2]
Earliest notable examples include a Briton who returned from a Singapore conference and infected 13 other people in a ski resort in the Alps [3], more than 70 cases were linked to a Boston Biogen conference within 2 weeks [4], and the most extreme example so far is South Korea “Patient 31” who caused an superspreading event (SSE) that eventually resulted in a cluster of more than 5,000 cases in Daegu [5]
Summary
Data Availability Statement: Code necessary to generate all figures is included as supplementary material. The funders had no role in study design, Benjamin M. ScarpinoID5,6,7,8,9,10, Antoine AllardID11,12, Laurent Hebert-Dufresne, Hao Hu15☯
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