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Volume 26, Number 7—July 2020
Online Report

Evidence Supporting Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 While Presymptomatic or Asymptomatic

Nathan W. FurukawaComments to Author , John T. Brooks, and Jeremy Sobel
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Main Article

Table 3

Summary of modeling reports supporting transmission of severe acute respiratory syndrome coronavirus 2 while asymptomatic and presymptomatic*

Reference Data source Model findings Limitations
(29)
 Confirmed case-patients from 18 provincial health departments in China
 The mean serial interval was 4 d, and symptoms developed in 13% of secondary case-patients before primary case-patients, suggesting presymptomatic transmission.
 Data limited to reports of confirmed cases early in the outbreak; recall bias may attribute infection to recent exposures and falsely lower the serial interval.
(30)
 Published articles and case investigation reports.
 The median serial interval was 4–5 d, depending on the reports analyzed.
 Recall bias may attribute infection to recent exposures and falsely lower the serial interval.
(32)
 Spatiotemporal data and reports on infections of 375 persons during Spring Festival, China
 An estimated 86% of all infections were asymptomatic or mild and not reported; up to 79% of reported cases may have originated from these unreported asymptomatic or mild cases.
 Data limited to China early in the outbreak; several assumptions built into a complex model.
(33) Reports of 40 manually selected transmission pairs from China On the basis of generation times and serial intervals, the authors estimated that one third to one half of transmission occurred from presymptomatic persons. Data limited for reports of confirmed cases early in the outbreak; recall bias may attribute infection to recent exposures and falsely lower the serial interval.

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