As countries in the world review interventions for containing the COVID-19 pandemic, important lessons can be drawn by studying the full transmission dynamics of SARS-CoV-2 in Wuhan, China, where vigorous non-pharmaceutical interventions have suppressed the local COVID-19 outbreak1. Here, we use a modelling approach to reconstruct the full-spectrum dynamics of COVID-19 between January 1, 2020 and March 8, 2020 across five periods marked by events and interventions based on 32,583 laboratory-confirmed cases1. Accounting for presymptomatic infectiousness2, time-varying ascertainment rates, transmission rates and population movements3, we identify two key features of the outbreak: high covertness and high transmissibility. We estimate 87% (lower bound 53%) of the infections before March 8 were unascertained, potentially including asymptomatic and mild-symptomatic cases; and a basic reproduction number R0 of 3.54 (95% credible interval [CrI]: 3.40-3.67) in the early outbreak, much higher than for SARS and MERS4,5. We observe that multi-pronged interventions had considerable positive effects on controlling the outbreak, decreasing the reproduction number to 0.28 (0.23-0.33) and by projection reducing the total infections in Wuhan by 96.0% as of March 8. We furthermore explore the probability of resurgence following lifting of all interventions after 14 days of no ascertained infections, estimating it at 0.32 and 0.06 based on models with 87% and 53% unascertained infections, respectively, highlighting the risk posed by unascertained cases in changing intervention strategies. These results provide important implications for continuing surveillance and interventions to eventually contain COVID-19 outbreaks.
Reconstruction of the full transmission dynamics of COVID-19 in Wuhan.