Consistent Pattern of Epidemic Slowing Across Many Geographies Led to Longer, Flatter Initial Waves of the COVID-19 Pandemic

Abstract

AbstractTo define appropriate planning scenarios for future pandemics of respiratory pathogens, it is important to understand the initial transmission dynamics of COVID-19 during 2020. Here, we fit an age-stratified compartmental model with a flexible underlying transmission term to daily COVID-19 death data from states in the contiguous U.S. and to national and sub-national data from around the world. The daily death data of the first months of the COVID-19 pandemic was categorized into one of four main types: “spring single-peak profile”, “summer single-peak profile”, “spring/summer two-peak profile” and “broad with shoulder profile”. We estimated a reproduction number R as a function of calendar time tc and as a function of time since the first death reported in that population (local pandemic time, tp). Contrary to the multiple categories and range of magnitudes in death incidence profiles, the R(tp) profiles were much more homogeneous. We find that in both the contiguous U.S. and globally, the initial value of both R(tc) and R(tp) was substantial: at or above two. However, during the early months, pandemic time R(tp) decreased exponentially to a value that hovered around one. This decrease was accompanied by a reduction in the variance of R(tp). For calendar time R(tc), the decrease in magnitude was slower and non-exponential, with a smaller reduction in variance. Intriguingly, similar trends of exponential decrease and reduced variance were not observed in raw death data. Our findings suggest that the combination of specific government responses and spontaneous changes in behaviour ensured that transmissibility dropped, rather than remaining constant, during the initial phases of a pandemic. Future pandemic planning scenarios should be based on models that assume similar decreases in transmissibility, which lead to longer epidemics with lower peaks when compared with models based on constant transmissibility.Author summaryIn planning for a future novel respiratory pandemic, or the next variant of SARS-Cov-2, it is important to characterize and understand the observed epidemic patterns during the first months of the COVID-19 outbreak. Here, we describe COVID-19 epidemic patterns observed in the U.S. and globally in terms of patterns of the basic reproduction number, R(t), using an age-stratified compartmental model. We find that daily death data of the first months of the COVID-19 pandemic can be classified into one of four types: “spring single-peak profile”, “summer single-peak profile”, “spring/summer two-peak profile” and “broad with shoulder profile”. Using the concept of local pandemic time, tp, we show a consistent pattern on four continents of an initial large magnitude and variance in reproductive number R(tp) that decreases monotonically and hovers around one for many days, regardless of specific intervention measures imposed by local authorities and without an accompanying decrease in daily death prevalence. We attribute this to significant behavior changes in populations in response to the perceived risk of COVID-19.