A comprehensive estimation of country-level basic reproduction numbers R0 for COVID-19: Regime regression can automatically estimate the end of the exponential phase in epidemic data.

Abstract

In a compartmental epidemic model, the initial exponential phase reflects a fixed interaction between an infectious agent and a susceptible population in steady state, so it determines the basic reproduction number R0 on its own. After the exponential phase, dynamic complexities like societal responses muddy the practical interpretation of many estimated parameters. The computer program ARRP, already available from sequence alignment applications, automatically estimated the end of the exponential phase in COVID-19 and extracted the exponential growth rate r for 160 countries. By positing a gamma-distributed generation time, the exponential growth method then yielded R0 estimates for COVID-19 in 160 countries. The use of ARRP ensured that the R0 estimates were largely freed from any dependency outside the exponential phase. The Prem matrices quantify rates of effective contact for infectious disease. Without using any age-stratified COVID-19 data, but under strong assumptions about the homogeneity of susceptibility, infectiousness, etc., across different age-groups, the Prem contact matrices also yielded theoretical R0 estimates for COVID-19 in 152 countries, generally in quantitative conflict with the R0 estimates derived from the exponential growth method. An exploratory analysis manipulating only the Prem contact matrices reduced the conflict, suggesting that age-groups under 20 years did not promote the initial exponential growth of COVID-19 as much as other age-groups. The analysis therefore supports tentatively and tardily, but independently of age-stratified COVID-19 data, the low priority given to vaccinating younger age groups. It also supports the judicious reopening of schools. The exploratory analysis also supports the possibility of suspecting differences in epidemic spread among different age-groups, even before substantial amounts of age-stratified data become available.