Combined Transmission From Individuals Who Are Presymptomatic and Those Who Never Have Symptoms

            Uncertainty remains regarding the magnitude of both presymptomatic and never symptomatic transmission. Therefore, we analyzed a wider range of each of these components, with peak infectiousness varying between 2 days before (more presymptomatic transmission) to 2 days after (less presymptomatic transmission) median symptom onset and with never symptomatic transmission ranging from 0% to 70% (Figure 2).

            Under this broader range of scenarios, most combined assumptions of peak infectiousness timing and transmission from individuals who never have symptoms indicated that at least 50% of new SARS-CoV-2 infections likely originated from individuals without symptoms at the time of transmission. If more than 30% of transmission was from individuals who never have symptoms, total asymptomatic transmission was higher than 50% with any value of peak infectiousness, up to 2 days after the median time of symptom onset. If peak infectiousness was at any point approximately 6 hours before median symptom onset time, more than 50% of transmission was from individuals without symptoms, regardless of the proportion from those who never have symptoms. Even a very conservative assumption of peak infectiousness 2 days.