Estimating the Instantaneous Asymptomatic Proportion With a Simple Approach: Exemplified With the Publicly Available COVID-19 Surveillance Data in Hong Kong.

Abstract Background: The asymptomatic proportion is a critical epidemiological characteristic that modulates the pandemic potential of emergent respiratory virus, which may vary depending on the nature of the disease source, population characteristics, source-host interaction, and environmental factors. Methods: We developed a simple likelihood-based framework to estimate the instantaneous asymptomatic proportion of infectious diseases. Taking the COVID-19 epidemics in Hong Kong as a case study, we applied the estimation-framework to estimate the reported asymptomatic proportion using the publicly available surveillance data. We divided the time series of daily cases into four stages of epidemics in Hong Kong by examining the persistency of the epidemic, and compared the reported asymptomatic proportions of imported cases and local cases at different stages. Results: As of July 31, 2020, there were two intermittent epidemics in Hong Kong. The first one is dominated by imported cases, accounting for 63.2% of the total cases, and the second one is dominated by local cases, accounting for 86.5% of the total cases. The reported asymptomatic proportion (rAP) was estimated at 23.1% (95%CI: 10.8-39.7) from January 23 to July 31, and the rAPs were estimated at 22.6% (95%CI: 11.1-38.9) among local cases and 38.7% (95%CI: 9.0-72.0) among imported cases. Our results show that the rAPs of local cases were not significantly different between the two epidemics, but increased gradually during the first epidemic period. In contrast, the rAP of imported cases in the latter epidemic period was significantly higher than that in the previous epidemic period. Conclusion: Hong Kong has a high rAP of imported COVID-19 cases and should continue to strengthen the detection and isolation of imported individuals to prevent the resurgence of the disease.