COVID-19: does the infectious inoculum dose-response relationship contribute to understanding heterogeneity in disease severity and transmission dynamics?

Wim Van Damme, Ritwik Dahake, Remco van de Pas, Guido Vanham, Yibeltal Assefa

Research output: Contribution to journalA1: Web of Science-article

Abstract

The variation in the speed and intensity of SARS-CoV-2 transmission and severity of the resulting COVID-19 disease are still imperfectly understood. We postulate a dose-response relationship in COVID-19, and that "the dose of virus in the initial inoculum" is an important missing link in understanding several incompletely explained observations in COVID-19 as a factor in transmission dynamics and severity of disease. We hypothesize that: (1) Viral dose in inoculum is related to severity of disease, (2) Severity of disease is related to transmission potential, and (3) In certain contexts, chains of severe cases can build up to severe local outbreaks, and large-scale intensive epidemics. Considerable evidence from other infectious diseases substantiates this hypothesis and recent evidence from COVID-19 points in the same direction. We suggest research avenues to validate the hypothesis. If proven, our hypothesis could strengthen the scientific basis for deciding priority containment measures in various contexts in particular the importance of avoiding super-spreading events and the benefits of mass masking.

Original languageEnglish
Article number110431
JournalMedical Hypotheses
Volume146
Number of pages8
ISSN0306-9877
DOIs
Publication statusPublished - 2021

Keywords

  • Adaptive Immunity
  • COVID-19/immunology
  • Host Microbial Interactions/immunology
  • Humans
  • Immunity, Innate
  • Models, Biological
  • Pandemics
  • SARS-CoV-2/immunology
  • Severity of Illness Index
  • Viral Load/physiology

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