Importation, Local Transmission, and Model Selection in Estimating the Transmissibility of COVID-19: The Outbreak in Shaanxi Province of China as a Case Study.

ABSTRACT

Background: Since the emergence of the COVID-19 pandemic, many models have been applied to understand its epidemiological characteristics. However, the ways in which outbreak data were used in some models are problematic, for example, importation was mixed up with local transmission. Methods: In this study, five models were proposed for the early Shaanxi outbreak in China. We demonstrated how to select a reasonable model and correctly use the outbreak data. Bayesian inference was used to obtain parameter estimates. Results: Model comparison showed that the renewal equation model generates the best model fitting and the Susceptible-Exposed-Diseased-Asymptomatic-Recovered (SEDAR) model is the worst; the performance of the SEEDAR model, which divides the exposure into two stages and includes the pre-symptomatic transmission, and SEEDDAAR model, which further divides infectious classes into two equally, lies in between. The Richards growth model is invalidated by its continuously increasing prediction. By separating continuous importation from local transmission, the basic reproduction number of COVID-19 in Shaanxi province ranges from 0.45 to 0.61, well below the unit, implying that timely interventions greatly limited contact between people and effectively contained the spread of COVID-19 in Shaanxi. Conclusions: The renewal equation model provides the best modelling; mixing continuous importation with local transmission significantly increases the estimate of transmissibility.