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REVIEW ARTICLE
Year : 2020  |  Volume : 64  |  Issue : 6  |  Page : 139-141  

Significance of super spreader events in COVID-19


1 Chair, Indian Public Health Academy, All India Institute of Medical Sciences, New Delhi, India
2 Consultant, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
3 Professor, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Submission04-May-2020
Date of Decision05-May-2020
Date of Acceptance11-May-2020
Date of Web Publication2-Jun-2020

Correspondence Address:
Shreya Jha
Room No. 26, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_495_20

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   Abstract 


The number of secondary cases from each primary case determines how fast an epidemic grows. It is known that all cases do not spread the infection equally; super spreaders play an important role as they contribute disproportionately to a much larger number of cases including in the ongoing COVID-19 pandemic. Super spreaders have been reported for more than a century, but limited information is available in scientific literature. An epidemic containment strategy needs to include early identification of super spreaders to limit an explosive growth. Super spreaders tend to get stigmatized, resulting in late reporting and hiding of cases. It is important for program managers to be sensitive to the manner in which related information is shared with media and general public.

Keywords: COVID-19, infection, super spreader


How to cite this article:
Kumar S, Jha S, Rai SK. Significance of super spreader events in COVID-19. Indian J Public Health 2020;64, Suppl S2:139-41

How to cite this URL:
Kumar S, Jha S, Rai SK. Significance of super spreader events in COVID-19. Indian J Public Health [serial online] 2020 [cited 2020 Oct 25];64, Suppl S2:139-41. Available from: https://www.ijph.in/text.asp?2020/64/6/139/285614




   Introduction Top


COVID-19 is a highly contagious disease and spreads rapidly overwhelming the best health systems in the world and devastating the best performing economies. Super spreader events (SSEs) play an important role in accelerating the spread of the epidemic. A better understanding of SSE will help improve evidence-based control measures and deal with anticipated waves of the current pandemic and future epidemics. The super spreaders have been reported in literature for over a century, the first one being Typhoid Mary. The city of Zamora, Spain, had a religious event of nine days to honor Saint Rocco (Saint of Plague) during Spanish flu. The city reported a large number of deaths and one of the highest case fatality rates.[1] SSEs have been reported for many infectious disease outbreaks such as measles,[2] tuberculosis,[3] Ebola,[4] and severe acute respiratory syndrome.[5] There is a lack of consistent and generally accepted definitions.[6] The criteria of SSEs and their impact on outbreak control measures are still unclear.[7] This paper reviews the role of SSE in spreading COVID 19 with examples from across the world.


   Role of Super Spreader Events in Spreading Infection Top


In any population, there can be a small proportion of individuals who mix freely with others while the efforts are made to isolate them. A bartender super spreader in a skiing resort in Austria infected more than a thousand persons that eventually spread to at least five countries across Europe.[8] [Table 1] shows some examples of COVID-19 SSE to illustrate the importance of super spreaders.
Table 1: Summary of some super spreader events

Click here to view


It is important to note that religious teachers and religious gathering contributed a lot to SSEs across the world. The religious gatherings must also be stopped when academic institutions are closed. Mobilizing religious leaders should be included as a priority in an epidemic containment plan from early stages.


   Characteristics of Super Spreaders Top


Most of the SSEs are identified in hindsight as it is not possible to know in advance. Some characteristics of super spreaders include the following.

Clinical characteristics

  • Heavy dose of infection and shed more virus
  • May have more severe cough, thereby more likely to spread infection
  • In most instances, have spread infection before they even know that they are infected.


Social characteristics

  • Work in or visit crowded places often
  • Travel to many places because of nature of work such as religious leaders, restaurant, hotel, or hospital staff
  • Work or live in a confined space which increases the possibility of transmission
  • Risk takers may willfully disregard instructions to quarantine or intention to harm others
  • Public gathering, often religious gatherings.


A super spreader may have more than one of the above characteristics.


   Integrating Super Spreaders Identification and Control Top


It is important to study super spreaders and prepare to deal with these as an integral part of an epidemic control and management strategy. Identification of potential super spreader in media is likely to create strong stigma attached to not only individuals and communities involved against those from disease but also their families, neighbors, and health-care providers. Typhoid Mary spent rest of her remaining life, about 30 years, in hospital in isolation after detection. Some examples from the ongoing phase in India include a hearing and speech impaired suspected case abandoned by family in AIIMS Raipur who tested negative; a 35-year-old suspect case in Kerala suspected found dead but later tested negative; and a 36-year-old woman in Agra was shot dead when her family reported a visitor in neighborhood.

It is important that both health authorities and media are sensitive about details of super spreaders and SSE; else, it will not only push the super spreaders but also other cases and contacts into hiding limiting the containment efforts. A study on SSE in Middle East respiratory syndrome (MERS) in Korea concluded that understanding of SSE is tremendously important to make prediction models and plan prevention and control strategies. We can gain a better understanding of heterogeneity parameters and their associated factors by analyzing and modeling the epidemic data of the MERS outbreak in Korea.[7]

The Pareto Principe in spread of infection, i.e., 20% of cases responsible for 80% of spread, has been applied to other infectious diseases.[18] Super spreaders are certainly among these 20%. Heterogeneity in transmission is a challenge for infectious disease dynamics and control. An 80–20 “Pareto” rule may be applicable to spread of infection in COVID 19 pandemic as well, and requires validation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Trilla A, Trilla G, Daer C. The 1918 “Spanish flu” in Spain. Clin Infect Dis 2008;47:668-73. doi:10.1086/590567.  Back to cited text no. 1
    
2.
De Serres G, Markowski F, Toth E, Landry M, Auger D, Mercier M, et al. Largest measles epidemic in North America in a decade – Quebec, Canada, 2011: Contribution of susceptibility, serendipity, and super spreading events. J Infect Dis 2013;207:990-8.  Back to cited text no. 2
    
3.
Kline SE, Hedemark LL, Davies SF. Outbreak of tuberculosis among regular patrons of a neighborhood bar. N Engl J Med 1995;333:222-7.  Back to cited text no. 3
    
4.
Althaus CL. Ebola superspreading. Lancet Infect Dis 2015;15:507-8.  Back to cited text no. 4
    
5.
Li Y, Yu IT, Xu P, Lee JH, Wong TW, Ooi PL, et al. Predicting super spreading events during the 2003 severe acute respiratory syndrome epidemics in Hong Kong and Singapore. Am J Epidemiol 2004;160:719-28.  Back to cited text no. 5
    
6.
Shen Z, Ning F, Zhou W, He X, Lin C, Chin DP, et al. Superspreading SARS events, Beijing, 2003. Emerg Infect Dis 2004;10:256-60.  Back to cited text no. 6
    
7.
Chun BC. Understanding and modeling the super-spreading events of the Middle East respiratory syndrome Outbreak in Korea. Infect Chemother 2016;48:147-9.  Back to cited text no. 7
    
8.
9.
10.
11.
12.
13.
14.
15.
Available from: https://www.youtube.com/watch?v=Xdu-7_OvfXY. [Last accessed on 2020 May 05].  Back to cited text no. 15
    
16.
17.
Available from: https://en.qantara.de/content/covid-19-epidemic-in- iran-faith-and-the-coronavirus. [Last accessed on 2020 May 05].  Back to cited text no. 17
    
18.
Cooper L, Kang SY, Bisanzio D, Maxwell K, Rodriguez-Barraquer I, Greenhouse B, et al. Pareto rules for malaria super-spreaders and super-spreading. Nat Commun 2019;10:3939.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1]



 

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