The basic reproduction number of SARS-CoV-2: a scoping review of available evidence

Abstract

ABSTRACTBackgroundThe transmissibility of SARS-CoV-2 determines both the ability of the virus to invade a population and the strength of intervention that would be required to contain or eliminate the spread of infection. The basic reproduction number, R0, provides a quantitative measure of the transmission potential of a pathogen.ObjectiveConduct a scoping review of the available literature providing estimates of R0 for SARS-CoV-2, provide an overview of the drivers of variation in R0 estimates and the considerations taken in the calculation of the parameter.DesignScoping review of available literature between the 01 December 2019 and 07 May 2020.Data sourcesBoth peer-reviewed and pre-print articles were searched for on PubMed, Google Scholar, MedRxiv and BioRxiv.Selection criteriaStudies were selected for review if (i) the estimation of R0 for SARS-CoV-2 represented either the initial stages of the outbreak or the initial stages of the outbreak prior to the onset of widespread population restriction (“lockdown”), (ii) the exact dates of the study period were provided and (iii) the study provided primary estimates of R0.ResultsA total of 20 R0 for SARS-CoV-2 estimates were extracted from 15 studies. There was substantial variation in the estimates reported. Estimates derived from mathematical models fell within a wider range of 1.94-6.94 than statistical models which fell between the range of 2.2 to 4.4. Several studies made assumptions about the length of the infectious period which ranged from 5.8-20 days and the serial interval which ranged from 4.41-14 days. For a given set of parameters a longer duration of infectiousness or a longer serial interval equates to a higher R0. Several studies took measures to minimise bias in early case reporting, to account for the potential occurrence of super-spreading events, and to account for early sub-exponential epidemic growth.ConclusionsThe variation in reported estimates of R0 reflects the complex nature of the parameter itself, including the context (i.e. social/spatial structure), the methodology used to estimate the parameter, and model assumptions. R0 is a fundamental parameter in the study of infectious disease dynamics, however it provides limited practical applicability outside of the context in which it was estimated, and should be calculated and interpreted with this in mind.STRENGTHS AND LIMITATIONS OF THE SCOPING REVIEWThis study provides an overview of basic reproduction number estimates for SARS-CoV-2 across a range of settings, a fundamental parameter in gauging the transmissibility of an emerging infectious disease.The key drivers of variation in R0 estimates and considerations in the calculation of the parameter highlighted across the reviewed studies are discussed.This evidence may be used to help inform modelling studies and intervention strategies.Given the need for rapid dissemination of information on a newly emerging infectious disease, several of the reviewed papers were in the pre-print phase yet to be peer-reviewed.