Evaluating the trade-off between transmissibility and virulence of SARS-CoV-2 by mathematical modeling

Background: At the beginning of 2020, SARS-CoV-2 spread to all continents, and since then, mutations have appeared in different regions of the world. The appearance of more virulent mutations leads to asseverate that they are also more transmissible. We analyzed the lower and higher virulent SARS-CoV-2 epidemics to establish a relationship between transmissibility and virulence based on a mathematical model. Methods: A compartmental mathematical model based on the CoViD-19 natural history encompassing the age-dependent fatality was applied to evaluate the SARS-CoV-2 transmissibility and virulence. The transmissibility was measured by the basic reproduction number R0 and the virulence by the proportion of asymptomatic individuals. The model parameters were fitted considering the observed data from Sao Paulo State. Results: The numbers of severe CoViD-19 and deaths are three times higher, but R0 is 25% lower in more virulent SARS-CoV-2 transmission than in a less virulent one. However, the number of more virulent SARS-CoV-2 transmitting individuals is 25% lower, mainly due to symptomatic individuals' isolation, explaining the increased transmission in lower virulence. Conclusions: The quarantine study in Sao Paulo State showed that the more virulent SARS-CoV-2 resulted in a higher number of fatalities but less transmissible than the less virulent one. One possible explanation for the number of deaths surpassing that predicted by the low virulent SARS-CoV-2 infection could be the transmission of more virulent variant(s).