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 Chaos, Solitons and Fractals 135 (2020) 109846

Contents lists available at ScienceDirect

Chaos, Solitons and Fractals

Nonlinear Science, and Nonequilibrium and Complex Phenomena
journal homepage: www.elsevier.com/locate/chaos

Mathematical modeling of COVID-19 transmission dynamics with a

case study of Wuhan
Faïçal Ndaïrou a,b, Iván Area b, Juan J. Nieto c, Delfim F.M. Torres a,∗
a
Center for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics, University of Aveiro, Aveiro 3810-193,
Portugal
b
Departamento de Matemática Aplicada II, E. E. Aeronáutica e do Espazo, Campus de Ourense, Universidade de Vigo, Ourense 32004, Spain
c
Instituto de Matematicas, Universidade de Santiago de Compostela, Santiago de Compostela 15782, Spain

a r t i c l e i n f o a b s t r a c t

Article history: We propose a compartmental mathematical model for the spread of the COVID-19 disease with special
Received 18 April 2020 focus on the transmissibility of super-spreaders individuals. We compute the basic reproduction number
Accepted 22 April 2020
threshold, we study the local stability of the disease free equilibrium in terms of the basic reproduction
Available online 27 April 2020
number, and we investigate the sensitivity of the model with respect to the variation of each one of its
2010 MSC: parameters. Numerical simulations show the suitability of the proposed COVID-19 model for the outbreak
34D05 that occurred in Wuhan, China.
92D30
© 2020 Elsevier Ltd. All rights reserved.
Keywords:
Mathematical modeling of COVID-19
pandemic
Wuhan case study
Basic reproduction number
Stability
Sensitivity analysis
Numerical simulations

1. Introduction 1,353,361 confirmed cumulative cases with 79,235 deaths, accord-

ing to the report dated by April 8, 2020, by the Word Health
Mathematical models of infectious disease transmission dynam- Organization.
ics are now ubiquitous. Such models play an important role in The global problem of the outbreak has attracted the interest of
helping to quantify possible infectious disease control and mitiga- researchers of different areas, giving rise to a number of proposals
tion strategies [1–3]. There exist a number of models for infectious to analyze and predict the evolution of the pandemic [6,7]. Our
diseases; as for compartmental models, starting from the very clas- main contribution is related with considering the class of super-
sical SIR model to more complex proposals [4]. spreaders, which is now appearing in medical journals (see, e.g.,
Coronavirus disease 2019 (COVID-19) is an infectious disease [8,9]). This new class, as added to any compartmental model, im-
caused by severe acute respiratory syndrome coronavirus 2 (SARS- plies a number of analysis about disease free equilibrium points,
CoV-2). The disease was first identified December 2019 in Wuhan, which is also considered in this work.
the capital of Hubei, China, and has since spread globally, re- The manuscript is organized as follows. In Section 2, we pro-
sulting in the ongoing 2020 pandemic outbreak [5]. The COVID- pose a new model for COVID-19. A qualitative analysis of the
19 pandemic is considered as the biggest global threat world- model is investigated in Section 3: in Section 3.1, we compute the
wide because of thousands of confirmed infections, accompanied basic reproduction number R0 of the COVID-19 system model; in
by thousands deaths over the world. Notice, by March 26, 2020, Section 3.2, we study the local stability of the disease free equi-
report 503,274 confirmed cumulative cases with 22,342 deaths. librium in terms of R0 . The sensitivity of the basic reproduction
At the time of this revision, the numbers have increased to number R0 with respect to the parameters of the system model is
given in Section 4. The usefulness of our model is then illustrated
∗ in Section 5 of numerical simulations, where we use real data from
Corresponding author.
E-mail addresses: faical@ua.pt (F. Ndaïrou), area@uvigo.es (I. Area),
Wuhan. We end with Section 6 of conclusions, discussion, and fu-
juanjose.nieto.roig@usc.es (J.J. Nieto), delfim@ua.pt (D.F.M. Torres). ture research.

https://doi.org/10.1016/j.chaos.2020.109846
0960-0779/© 2020 Elsevier Ltd. All rights reserved.
2 F. Ndaïrou, I. Area and J.J. Nieto et al. / Chaos, Solitons and Fractals 135 (2020) 109846

Fig. 1. Flowchart of model (1).

2. The proposed COVID-19 compartment model the disease induced death rates due to infected, super-spreaders,
and hospitalized individuals, respectively. At each instant of time,
Based on a 2016 model [10], and taking into account the ex-
dF (t )
istence of super-spreaders in the family of corona virus [11], we D(t ) := δi I (t ) + δ p P (t ) + δh H (t ) = (2)
propose a new epidemiological compartment model that takes dt
into account the super-spreading phenomenon of some individu- gives the number of death due to the disease. The transmissibility
als. Moreover, we consider a fatality compartment, related to death from asymptomatic individuals has been modeled in this way since
due to the virus infection. In doing so, the constant total popula- it was not apparent their behavior. Indeed, at present, this question
tion size N is subdivided into eight epidemiological classes: sus- is a controversial issue for epidemiologists. A flowchart of model
ceptible class (S), exposed class (E), symptomatic and infectious (1) is presented in Fig. 1.
class (I), super-spreaders class (P), infectious but asymptomatic
class (A), hospitalized (H), recovery class (R), and fatality class (F). 3. Qualitative analysis of the model
The model takes the following form:
One of the most significant thresholds when studying infectious
⎧ dS
⎪
⎪ = −β NI S − l β HN S − β
 P
S, disease models, which quantifies disease invasion or extinction in
⎪
⎪ dt N
a population, is the basic reproduction number [12]. In this section
⎪
⎪
⎪
⎪ dE 
β NI S + l β HN S + β NP S − κ E,
we obtain the basic reproduction number for our model (1) and
⎪
⎪ =
⎪ dt
⎪
study the locally asymptotically stability of its disease free equilib-
⎪
⎪ rium (see Theorem 1).
⎪ dI
⎪ = κρ1 E − (γa + γi )I − δi I,
⎪
⎪ dt
⎪
⎪ 3.1. The basic reproduction number
⎪
⎪ dP
⎨ = κρ2 E − (γa + γi )P − δ p P,
dt (1) The basic reproduction number, as a measure for disease spread
⎪
⎪ dA
⎪
⎪ = κ (1 − ρ1 − ρ2 )E, in a population, plays an important role in the course and control
⎪
⎪ dt of an ongoing outbreak. It can be understood as the average num-
⎪
⎪
⎪
⎪
dH
= γa (I + P ) − γr H − δh H, ber of cases one infected individual generates, over the course of
⎪
⎪ dt
⎪
⎪ its infectious period, in an otherwise uninfected population. Using
⎪
⎪ dR the next generation matrix approach outlined in van den Driess-
⎪
⎪ = γi (I + P ) + γr H,
⎪
⎪ dt che and Watmough [13] to our model (1), the basic reproduction
⎪
⎪
⎩ dF number can be computed by considering the below generation ma-
= δi I + δ p P + δh H, trices F and V, that is, the Jacobian matrices associated to the rate
dt
of appearance of new infections and the net rate out of the corre-
with β quantifying the human-to-human transmission coefficient
 sponding compartments, respectively,
per unit time (days) per person, β quantifies a high transmis- ⎡  ⎤
sion coefficient due to super-spreaders, and l quantifies the rela- 0 β βl β
tive transmissibility of hospitalized patients. Here κ is the rate at ⎢0 0 0 0⎥
JF = ⎣
0⎦
and
which an individual leaves the exposed class by becoming infec- 0 0 0
tious (symptomatic, super-spreaders or asymptomatic); ρ 1 is the 0 0 0 0
⎡ ⎤
proportion of progression from exposed class E to symptomatic in- κ 0 0 0
fectious class I; ρ 2 is a relative very low rate at which exposed in- ⎢−κρ1 i 0 0 ⎥
dividuals become super-spreaders while 1 − ρ1 − ρ2 is the progres- JV = ⎣ ⎦,
−κρ2 0 p 0
sion from exposed to asymptomatic class; γ a is the average rate at 0 −γa −γa h
which symptomatic and super-spreaders individuals become hos-
pitalized; γ i is the recovery rate without being hospitalized; γ r is where
the recovery rate of hospitalized patients; and δ i , δ p , and δ h are i = γa + γi + δi ,  p = γa + γi + δ p and h = γr + δh . (3)
 F. Ndaïrou, I. Area and J.J. Nieto et al. / Chaos, Solitons and Fractals 135 (2020) 109846 3

Table 1
Values of the model parameters corresponding to the situation of Wuhan, as discussed in Section 5, for which
R0 = 0.945.

Name Description Value Units

β Transmission coefficient from infected individuals 2.55 day−1

l Relative transmissibility of hospitalized patients 1.56 dimensionless

β Transmission coefficient due to super-spreaders 7.65 day−1
κ Rate at which exposed become infectious 0.25 day−1
ρ1 Rate at which exposed people become infected I 0.580 dimensionless
ρ2 Rate at which exposed people become super-spreaders 0.001 dimensionless
γa Rate of being hospitalized 0.94 day−1
γi Recovery rate without being hospitalized 0.27 day−1
γr Recovery rate of hospitalized patients 0.5 day−1
δi Disease induced death rate due to infected class 3.5 day−1
δp Disease induced death rate due to super-spreaders 1 day−1
δh Disease induced death rate due to hospitalized class 0.3 day−1

The basic reproduction number R0 is obtained as the spectral

radius of F · V −1 , precisely, Next, by using the Liénard–Chipard test [14,15], all the roots of
 Z(λ) are negative or have negative real part if, and only if, the fol-
βρ1 (γa l + h ) (βγa l + β h )ρ2
R0 = + . (4) lowing conditions are satisfied:
i h  p h
1. ai > 0, i = 1, 2, 3, 4;
For the parameters used in our simulations (see Table 1), one 2. a1 a2 > a3 .
computes this basic reproduction number to obtain R0 = 0.945.
This means that the epidemic outbreak that has occurred in In order to check these conditions of the Liénard–Chipard test,
Wuhan was well controlled by the Chinese authorities. we rewrite the coefficients a1 , a2 , a3 , and a4 of the characteristic
polynomial in terms of the basic reproduction number given by
3.2. Local stability in terms of the basic reproduction number (4):
a1 = κ + h + i +  p ,
Noting that the two last equations and the fifth of system 
βρ1 β ρ2
(1) are uncoupled to the remaining equations of the system, we a2 = (1 − R0 )(κi + κ p ) + κ p + κi
can easily obtain, by direct integration, the following analytical re- i p
 
sults: 1 p  1 i
⎧ +βγa l ρ1 κ + + βγa l ρ2 κ +
h h i h h  p
⎨A(t ) = κ (1 − ρ1 − ρ2 ) 0E (s )ds
⎪ t

R(t ) = γi 0 I (s ) + P (s ) ds + γr 0 H (s )ds
t t
(5) + ( κ + i )h + ( h + i ) p ,
⎪
⎩ βρ1 h
F (t ) = δi 0 I (s )ds + δ p 0 P (s )ds + δh 0 H (s )ds.
t t t
a3 = κ (1 − R0 )(h  p + h i + i  p ) + κ p
i
Furthermore, since the total population size N is constant, one 
β ρ2  h 1 1

has +κi + κ p βγa l ρ1 +
p h i
S(t ) = N − [E (t ) + I (t ) + P (t ) + A(t ) + H (t ) + R(t ) + F (t )]. (6)  
1 1
+κi βγa l ρ2 + + i h  p ,
Therefore, the local stability of model (1) can be studied h  p
through the remaining coupled system of state variables, namely,
a4 = κi h  p (1 − R0 ).
the variables E, I, P, and H in (1). The Jacobian matrix associated to
these variables of (1) is the following one:
⎡  ⎤ Moreover, we also compute, in terms of R0 , the following ex-
−κ β lβ β pression:
⎢κρ1 −i 0 0 ⎥
JM = ⎣ ⎦, (7) a1 a2 − a3 = (1 − R0 )(κ + i )κi + (1 − R0 )(κ + h +  p )κ p
κρ2 0 − p 0
0 γa γa −h βρ1 βγa l ρ1 
+ ( κ +  p + i ) + κ p
where ϖi , ϖp , and ϖh are defined in (3). The eigenvalues of the ma- p i
β ρ2 βγa l ρ2 

trix JM are the roots of the following characteristic polynomial:
+ ( κ +  p + i ) + κi
Z (λ ) = λ4 + a1 λ3 + a2 λ2 + a1 λ + a4 , p p
βγa l ρ1 κ βγa l ρ2 κ
where + ( κ + h + i ) + ( κ + h +  p )
h h
a1 = κ + h + i +  p , + ( κ + i )h + ( h + i ) p .

a2 = −βκρ1 − β κρ2 + κh + κi + h i + κ p
+ h  p + i  p , From these previous expressions, it is clear that if R0 < 1, then
 the conditions of the Liénard–Chipard test are satisfied and, as a
a3 = −βγa κ l ρ1 − βγa κ l ρ2 − βκρ1 h − β κρ2 h − βκρ1  p
consequence, the disease free equilibrium is stable. In the case

−β κρ2 i + κh i + κh  p + κi  p + h i  p , when R0 > 1, we have that a4 < 0 and, by using Descartes’ rule
 of signs, we conclude that at least one of the eigenvalues is posi-
a4 = −βγa κ l ρ2 i − βγa κ l ρ1  p − β κρ2 i h
tive. Therefore, the system is unstable. In conclusion, we have just
− βκρ1 h  p + κh i  p . proved the following result:
4 F. Ndaïrou, I. Area and J.J. Nieto et al. / Chaos, Solitons and Fractals 135 (2020) 109846

Table 2 because a small perturbation in that parameter leads to small

Sensitivity of R0 evaluated for the
changes.
parameter values given in Table 1.
From Table 2, we conclude that the most sensitive parameters
Parameter Sensitivity index to the basic reproduction number R0 of the COVID-19 model (1) are
β 0.963 β , ρ 1 and δ i . In concrete, an increase of the value of β will in-
l

0.631 crease the basic reproduction number by 96.3% and this happens,
β 0.366 in a similar way, for the parameter ρ 1 . In contrast, an increase of
κ 0.000
the value of δ i will decrease R0 by 69.9%.
ρ1 0.941
ρ2 0.059
γa 0.418 5. Numerical simulations: the case study of Wuhan
γi −0.061
γr −0.395 We perform numerical simulations to compare the results of
δi −0.699
δp −0.027
our model with the real data obtained from several reports pub-
δh −0.238 lished by WHO [20,21] and worldometer [5].
The starting point of our simulations is 4 January 2020 (day 0),
when the Chinese authorities informed about the new virus [20],
with already 6 confirmed cases in one day. From this period up to
Theorem 1. The disease free equilibrium of system (1), that is, (N, 0,
January 19, there is less information about the number of people
0, 0, 0, 0, 0, 0), is locally asymptotically stable if R0 < 1 and unstable
contracting the disease. Only on January 20, we have the report
if R0 > 1.
[21], with 1460 new reported cases in that day and 26 the dead.
Next we investigate the sensitiveness of the COVID-19 model Thus, the infection gained much more attention from 21 January
(1), with respect to the variation of each one of its parameters, for 2020, with 1739 confirmed cases and 38 the dead, up to 4 March
the endemic threshold (4). 2020, when the numbers in that day were as low as 11 and 7, re-
spectively infected and dead, after a pick of 3892 confirmed cases
4. Sensitivity analysis on 27 January 2020 and a pick of 254 dead on 4 February 2020.
Here we follow the data of the daily reports published by [5]. We
As we saw in Section 3, the basic reproduction number for the show that our COVID-19 model describes well the real data of daily
COVID-19 model (1), which we propose in Section 2, is given by confirmed cases during the 2 months outbreak (66 days to be pre-
(4). The sensitivity analysis for the endemic threshold (4) tells us cise, from January 4 to March 9, 2020).
how important each parameter is to disease transmission. This in- The total population of Wuhan is about 11 million. During the
formation is crucial not only for experimental design, but also to COVID-19 outbreak, there was a restriction of movements of in-
data assimilation and reduction of complex models [16]. Sensi- dividuals due to quarantine in the city. As a consequence, there
tivity analysis is commonly used to determine the robustness of was a limitation on the spread of the disease. In agreement, in
model predictions to parameter values, since there are usually er- our model we consider, as the total population under study, N =
rors in collected data and presumed parameter values. It is used 110 0 0 0 0 0/250. This denominator has been determined in the first
to discover parameters that have a high impact on the threshold days of the outbreak and later has been proved to be a correct
R0 and should be targeted by intervention strategies. More accu- value: according to the real data published by the WHO, it is an
rately, sensitivity indices’ allows us to measure the relative change appropriate value for the restriction of movements of individu-
in a variable when a parameter changes. For that purpose, we use als. As for the initial conditions, the following values have been
the normalized forward sensitivity index of a variable with respect fixed: S0 = N − 6, E0 = 0, I0 = 1, P0 = 5, A0 = 0, H0 = 0, R0 = 0,
to a given parameter, which is defined as the ratio of the relative and F0 = 0.
change in the variable to the relative change in the parameter. If We would like to mention that there exist gaps in the reports of
such variable is differentiable with respect to the parameter, then the WHO at the beginning of the outbreak. For completeness, we
the sensitivity index is defined as follows. give here the list LC of the number of confirmed cases in Wuhan
per day, corresponding to the green line of Fig. 2, and the list LD of
Definition 1.1 (See [17,18]). The normalized forward sensitivity in- the number of dead individuals in Wuhan per day, corresponding
dex of R0 , which is differentiable with respect to a given parameter to the red line of Fig. 3:
θ , is defined by
LC = [6, 12, 19, 25, 31, 38, 44, 60, 80, 131, 131, 259, 467, 688, 776,
∂ R0 θ
ϒθR0 = . 1776, 1460, 1739, 1984, 2101, 2590, 2827, 3233, 3892, 3697, 3151,
∂θ R0
3387, 2653, 2984, 2473, 2022, 1820, 1998, 1506, 1278, 2051, 1772,
The values of the sensitivity indices for the parameters values
1891, 399, 894, 397, 650, 415, 518, 412, 439, 441, 435, 579, 206,
of Table 1, are presented in Table 2.
These values have been determined experimentally in such a 130, 120, 143, 146, 102, 46, 45, 20, 31, 26, 11, 18, 27, 29, 39, 39],
way the mathematical model describes well the real data, giving
rise to Figs. 2 and 3. Other values for the parameters can be found,
e.g., in Aguilar et al. [19]. LD = [0, 0, 0, 0, 0, 0, 0, 0, 4, 4, 4, 8, 15, 15, 25, 26, 26, 38, 43, 46, 45,
Note that the sensitivity index may depend on several param- 57, 64, 66, 73, 73, 86, 89, 97, 108, 97, 254, 121, 121, 142, 106, 106,
eters of the system, but also can be constant, independent of any 98, 115, 118, 109, 97, 150, 71, 52, 29, 44, 37, 35, 42, 31, 38, 31, 30,
R
parameter. For example, ϒθ 0 = +1 means that increasing (decreas-
28, 27, 23, 17, 22, 11, 7, 14, 10, 14, 13, 13].
ing) θ by a given percentage increases (decreases) always R0 by
that same percentage. The estimation of a sensitive parameter Lists LC and LD have 66 numbers, where LC (0) represents the
should be carefully done, since a small perturbation in such pa- number of confirmed cases 04 January 2020 (day 0) and LC (65)
rameter leads to relevant quantitative changes. On the other hand, the number of confirmed cases 09 March 2020 (day 65) and, anal-
the estimation of a parameter with a rather small value for the ogously, LD (0) represents the number of dead on January 4, and
sensitivity index does not require as much attention to estimate, LD (65) the number of dead on March 9, 2020.
 F. Ndaïrou, I. Area and J.J. Nieto et al. / Chaos, Solitons and Fractals 135 (2020) 109846 5

Fig. 2. Number of confirmed cases per day. The green line corresponds to the real data obtained from reports [5,20,21] while the black line (I + P + H) has been obtained
by solving numerically the system of ordinary differential Eq. (1), by using the Matlab code ode45. (For interpretation of the references to color in this figure legend, the
reader is referred to the web version of this article.)

Fig. 3. Number of confirmed deaths per day. The red line corresponds to the real data obtained from reports [5,20,21] while the black line has been obtained by solving
numerically, using the Matlab code ode45, our system of ordinary differential Eq. (1) to derive D(t) given in (2). (For interpretation of the references to color in this figure
legend, the reader is referred to the web version of this article.)

6. Conclusions and discussion reality of the Wuhan outbreak (see Fig. 2) and predicting a di-
minishing on the daily number of confirmed cases of the disease.
Classical models consider SIR populations. Here we have taken This is in agreement with our computations of the basic reproduc-
into consideration the super-spreaders (P), hospitalized (H), and fa- tion number in Section 4 that, surprisingly, is obtained less than 1.
tality class (F), so that its derivative (see formula (2)) gives the Moreover, it is worth to mention that our model fits also enough
number of deaths (D). Our model is an ad hoc compartmental well the real data of daily confirmed deaths, as shown in Fig. 3.
model of the COVID-19, taking into account its particularities, some Our theoretical findings and numerical results adapt well to the
of them still not well-known, giving a good approximation of the real data and it reflects or reflected the reality in Wuhan, China.
6 F. Ndaïrou, I. Area and J.J. Nieto et al. / Chaos, Solitons and Fractals 135 (2020) 109846

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Nieto also thanks partial financial support by Xunta de Galicia un-
[20] de la Salud O.P.. Alerta epidemiológica nuevo coronavirus (ncov).
der grant ED431C 2019/02. 2020a. https://www.paho.org/hq/index.php?option=com_docman&view=
download&category_slug=coronavirus- alertas- epidemiologicas&alias=
Declaration of Competing Interest 51351- 16- de- enero- de- 2020- nuevo- coronavirus- ncov- alerta- epidemiologica- 1
&Itemid=270&lang=es, accessed on January 16.
[21] de la Salud O.P.. Actualización epidemiológica nuevo coronavirus (2019-ncov).
The authors declare that they have no known competing finan- 2020b. https://www.paho.org/hq/index.php?option=com_docman&view=
cial interests or personal relationships that could have appeared to download&category_slug=coronavirus- alertas- epidemiologicas&alias=
51355- 20- de- enero- de- 2020- nuevo- coronavirus- ncov-actualizacion-
influence the work reported in this paper. epidemiologica-1&Itemid=270&lang=es, accessed on January 20.

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