How Asymptomatic Transmission Influences Mitigation and Suppression Strategies during a Pandemic.

Asymptomatic transmission complicates any public health strategies to combat a pandemic, which proved especially accurate in the case of COVID-19. Although asymptomatic cases are not unique to COVID-19, the high asymptomatic case rate raised many problems for developing effective public health interventions. The current modeling effort explored how asymptomatic transmission might impact pandemic responses in four key areas: isolation procedures, changes in reproduction rate, the potential for reduced transmission from asymptomatic cases, and social adherence to public health measures. A high rate of asymptomatic cases effectively requires large-scale public health suppression and mitigation procedures given that quarantine procedures alone could not prevent an outbreak for a virus such as SARS-CoV-2. This problem only becomes worse without lowering the effective reproduction rate, and even assuming the potential for reduced transmission, any virus with a high degree of asymptomatic transmission will likely produce a pandemic. Finally, there is a concern that asymptomatic individuals will also refuse to adhere to public health guidance. Analyses indicate that, given certain assumptions, even half of the population adhering to public health guidance could reduce the peak and flatten the curve by over 90%. Taken together, these analyses highlight the importance of taking asymptomatic cases into account when modeling viral spread and developing public health intervention strategies.