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<front>
<?covid-19-tdm?>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Phys.</journal-id>
<journal-title>Frontiers in Physics</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Phys.</abbrev-journal-title>
<issn pub-type="epub">2296-424X</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="publisher-id">683364</article-id>
<article-id pub-id-type="doi">10.3389/fphy.2021.683364</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Physics</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Inhomogeneous Transmission and Asynchronic Mixing in the Spread of COVID-19 Epidemics</article-title>
<alt-title alt-title-type="left-running-head">Mendoza</alt-title>
<alt-title alt-title-type="right-running-head">Inhomogeneous Mixing in COVID-19 Spread</alt-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Mendoza</surname>
<given-names>Carlos I.</given-names>
</name>
<xref ref-type="corresp" rid="c001">&#x2a;</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1274735/overview"/>
</contrib>
</contrib-group>
<aff>Instituto de Investigaciones en Materiales, Universidad Nacional Aut&#xf3;noma de M&#xe9;xico, <addr-line>Mexico</addr-line>, <country>Mexico</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>
<bold>Edited by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/797979/overview">Hui-Jia Li</ext-link>, Beijing University of Posts and Telecommunications (BUPT), China</p>
</fn>
<fn fn-type="edited-by">
<p>
<bold>Reviewed by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/101109/overview">Chengyi Xia</ext-link>, Tianjin University of Technology, China</p>
<p>
<ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/825631/overview">Gui-Quan Sun</ext-link>, North University of China, China</p>
</fn>
<corresp id="c001">&#x2a;Correspondence: Carlos I. Mendoza, <email>cmendoza@materiales.unam.mx</email>
</corresp>
<fn fn-type="other">
<p>This article was submitted to Social Physics, a section of the journal Frontiers in Physics</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>15</day>
<month>06</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="collection">
<year>2021</year>
</pub-date>
<volume>9</volume>
<elocation-id>683364</elocation-id>
<history>
<date date-type="received">
<day>20</day>
<month>03</month>
<year>2021</year>
</date>
<date date-type="accepted">
<day>24</day>
<month>05</month>
<year>2021</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2021 Mendoza.</copyright-statement>
<copyright-year>2021</copyright-year>
<copyright-holder>Mendoza</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these&#x20;terms.</p>
</license>
</permissions>
<abstract>
<p>The ongoing epidemic of COVID-19 first found in China has reinforced the need to develop epidemiological models capable of describing the progression of the disease to be of use in the formulation of mitigation policies. Here, this problem is addressed using a metapopulation approach to consider the inhomogeneous transmission of the spread arising from a variety of reasons, like the distribution of local epidemic onset times or of the transmission rates. We show that these contributions can be incorporated into a susceptible-infected-recovered framework through a time-dependent transmission rate. Thus, the reproduction number decreases with time despite the population dynamics remaining uniform and the depletion of susceptible individuals is small. The obtained results are consistent with the early subexponential growth observed in the cumulated number of confirmed cases even in the absence of containment measures. We validate our model by describing the evolution of COVID-19 using real data from different countries, with an emphasis in the case of Mexico, and show that it also correctly describes the longtime dynamics of the spread. The proposed model yet simple is successful at describing the onset and progression of the outbreak, and considerably improves the accuracy of predictions over traditional compartmental models. The insights given here may prove to be useful to forecast the extent of the public health risks of the epidemics, thus improving public policy-making aimed at reducing such&#x20;risks.</p>
</abstract>
<kwd-group>
<kwd>COVID-19</kwd>
<kwd>SARS-CoV-2</kwd>
<kwd>mathematical modeling</kwd>
<kwd>compartmental models</kwd>
<kwd>susceptible-infected-recovered model</kwd>
<kwd>forecasting</kwd>
</kwd-group>
<contract-num rid="cn001">IN-103419</contract-num>
<contract-sponsor id="cn001">Direcci&#xf3;n General de Asuntos Del Personal Acad&#xe9;mico, Universidad Nacional Aut&#xf3;noma de M&#xe9;xico<named-content content-type="fundref-id">10.13039/501100006087</named-content>
</contract-sponsor>
</article-meta>
</front>
<body>
<sec id="s1">
<title>1 Introduction</title>
<p>First detected in December 2019 in the city of Wuhan in Hubei Province, China, the COVID-19 outbreak, caused by the newly identified coronavirus SARS-CoV-2, has spread around the globe and reached the status of a pandemic on March 11th, 2020. Due to the severity of the damages it may cause to health and its ease of transmission, a number of different strategies have been implemented by the authorities of different countries to block or reduce the spread of the virus. In some cases like China, Italy, or Spain, strict quarantine measures have been adopted [<xref ref-type="bibr" rid="B1">1</xref>&#x2013;<xref ref-type="bibr" rid="B3">3</xref>]. However, strict lockdown in many cases has been impossible due to prevailing economic and social factors. In such cases, the authorities aimed for less strict mitigation policies [<xref ref-type="bibr" rid="B4">4</xref>], including social distancing and individual non-pharmaceutical interventions [<xref ref-type="bibr" rid="B5">5</xref>]. Nonetheless, an accurate description of the progression of an epidemic is of fundamental importance in helping to decide public policies to reduce its impact, especially to stay below a fixed healthcare capacity and delaying the peak of the epidemic so that the healthcare capacity can be expanded to support patients.</p>
<p>In Mexico, the first detected case of COVID-19 was registered on February 27th, 2020 and corresponded to an imported case from Italy. This marks the start of what was called phase 1 of the epidemic, characterized by imported cases only, with no local contagion. Mexican health authorities identified a total of three epidemiological phases, according to the degree of transmission of the disease. Phase 2 of the coronavirus pandemic was characterized by cases of the local contagion between people who have not had contact with foreigners; it was declared on March 24th, and the actions comprised primarily the suspension of certain economic activities, the suspension of lessons at schools, the restriction of mass congregations, and the recommendation of domiciliary protection for the general population. As a consequence of the evolution of confirmed cases and deaths from the disease in the country, on March 30th, a &#x201c;health emergency due to force majeure&#x201d; was declared, which led to the execution of additional actions for its prevention and control; the most conspicuous was the generalized voluntary quarantine of the population (the so-called Jornada Nacional de Sana Distancia). Eventually, on April 21st, phase 3, characterized by thousands of cases disseminated in all the country, was declared.</p>
<p>Interventional measures adopted with the intention to mitigate the spread are normally based on estimates of the progression of the outbreak. Mathematical models of infectious diseases are important tools for assessing the threat of a novel pathogen and offer the best information for mitigating an outbreak [<xref ref-type="bibr" rid="B6">6</xref>, <xref ref-type="bibr" rid="B7">7</xref>], hence the need for epidemiological models that are able to estimate with some degree of accuracy the evolution of the outbreak to help to evaluate the impact of interventions [<xref ref-type="bibr" rid="B2">2</xref>, <xref ref-type="bibr" rid="B8">8</xref>&#x2013;<xref ref-type="bibr" rid="B11">11</xref>]. The paradigmatic approach traditionally used to model the dynamics of an epidemic is the well-known SIR (susceptible, infectious, and removed) compartmental model [<xref ref-type="bibr" rid="B12">12</xref>, <xref ref-type="bibr" rid="B13">13</xref>]. In this model, the group <italic>S</italic> represents individuals who are susceptible to the disease and can become infected, the group <italic>I</italic> represents individuals who are infectious and can infect susceptible individuals, and the group <italic>R</italic> represents removed individuals who either gained life-long immunity at recovery or died; in either case, removed individuals cannot infect or be infected anymore. Although this model was successfully applied to describe the spread of an infectious agent in a <italic>well-mixed</italic> population [<xref ref-type="bibr" rid="B14">14</xref>], this same simplifying assumption prevents its successful application in many other cases [<xref ref-type="bibr" rid="B15">15</xref>], such as the recent outbreak of COVID-19 which shows an early subexponential growth [<xref ref-type="bibr" rid="B16">16</xref>, <xref ref-type="bibr" rid="B17">17</xref>]. In a well-mixed population, a homogeneous distribution of the susceptible-infectious contacts such that any susceptible individual may be infected by any infectious individual in the whole population is assumed. However, pathogens affect populations in an uneven way [<xref ref-type="bibr" rid="B18">18</xref>]; there are many heterogeneities in human populations that influence virus transmission [<xref ref-type="bibr" rid="B19">19</xref>], for example, variability in the risk experienced by age [<xref ref-type="bibr" rid="B20">20</xref>], comorbidities, or other factors (e.g., behavior and nutrition); the presence of individuals that propagates the virus more efficiently (super-spreader individuals) [<xref ref-type="bibr" rid="B21">21</xref>]; and the limited transmission between geographically distant populations. Thus, any realistic epidemic model should take them into account to some extent.</p>
<p>Given that the subexponential growth seems to be a generic characteristic of the COVID-19 outbreak, independent of the suppression strategies implemented to mitigate the temporal evolution of the epidemic process, it is suggested that the existence of an underlying mechanism is responsible for this temporal behavior. The purpose of the present study is to show that the inhomogeneous transmission of the epidemics of component subpopulations may be the source of this behavior. It is also shown that the standard SIR model can be extended to include the abovementioned inhomogeneities and that the resulting model correctly captures not only the short time but also the longtime dynamics of the COVID-19 outbreaks.</p>
</sec>
<sec id="s2">
<title>2 Incorporating Inhomogeneous Transmission in a Susceptible-Infected-Recovered Framework</title>
<p>A natural way to incorporate population heterogeneities or spatial structure into an infectious disease model is by means of metapopulation models [<xref ref-type="bibr" rid="B6">6</xref>, <xref ref-type="bibr" rid="B22">22</xref>&#x2013;<xref ref-type="bibr" rid="B24">24</xref>]. Let us assume a cross-coupled metapopulation approach [<xref ref-type="bibr" rid="B24">24</xref>] in which the total population is considered as if it were formed by <italic>n</italic> subpopulations or patches connected to each other with transmission lines, and no explicit mobility among subpopulations is included. In each subpopulation, an infectious agent spread is described by a standard SIR model with coupling terms.<disp-formula id="e1">
<mml:math id="m1">
<mml:mrow>
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<label>(1)</label>
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<p>where <inline-formula id="inf1">
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</inline-formula>, <inline-formula id="inf2">
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</inline-formula>, and <inline-formula id="inf3">
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</inline-formula> are the fractional representations of susceptible, infectious, and removed individuals of subpopulation <italic>i</italic> that has <inline-formula id="inf4">
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</inline-formula>. No human birth and death rates are being considered, and as stated above, neither the immigration nor emigration effects [<xref ref-type="bibr" rid="B2">2</xref>]. Although it is known that COVID-19 has a mean incubation period of about five days [<xref ref-type="bibr" rid="B25">25</xref>], in order to maintain the number of parameters and equations to a minimum, we are going to ignore it, and therefore, there is no compartment of exposed individuals. In <xref ref-type="disp-formula" rid="e1">Eqs 1</xref>&#x2013;<xref ref-type="disp-formula" rid="e3">3</xref>, <inline-formula id="inf6">
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</mml:mrow>
</mml:math>
</inline-formula> represents the elements of a matrix that describes the transmission between and within patches, the recovery rate <italic>&#x3b3;</italic> is common to all subpopulations, and, as in traditional SIR, all these quantities are time independent. The transmission rate <inline-formula id="inf7">
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</inline-formula> captures the rate of flow from group <inline-formula id="inf8">
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</inline-formula> to group <inline-formula id="inf9">
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</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula>, while the recovering rate <italic>&#x3b3;</italic> indicates that infectious individuals get recovered or die at a fixed average rate <italic>&#x3b3;</italic>. If subpopulations are independent from each other, then <inline-formula id="inf10">
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</inline-formula> grows exponentially during the early epidemic phase [<xref ref-type="bibr" rid="B26">26</xref>], that is, <inline-formula id="inf20">
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<p>As mentioned before, it is unusual for a naturally occurring disease emergence to occur simultaneously at many locations and to propagate at a uniform rate. This means that at least during the initial phase of transmission, infectious individuals are clustered [<xref ref-type="bibr" rid="B8">8</xref>]. The presence of the subpopulations can be thought as clustered regions in space where a given individual spent most of his time. Clusters exchange pathogens with each other through infected or susceptible individuals traveling among them during the period of infectiousness. Thus, spatial inhomogeneities lead naturally to outbreaks that do not occur simultaneously in all subpopulations. Even if they are governed by the same dynamical equations, they are asynchronic, which means that the onset of the outbreaks in the subpopulations are not necessarily simultaneous [<xref ref-type="bibr" rid="B27">27</xref>&#x2013;<xref ref-type="bibr" rid="B29">29</xref>]. In a similar way, different individuals may propagate the pathogen at different rates, and one can also consider groups of individuals with similar transmission rates as distinct subpopulations even if not geographically remote. Adding the corresponding differential equations of all subpopulations, one gets the following equations:<disp-formula id="e4">
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<label>(4)</label>
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</mml:mrow>
<mml:mo>&#x2261;</mml:mo>
<mml:mrow>
<mml:mrow>
<mml:mi>I</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
<mml:mo>/</mml:mo>
<mml:mi>N</mml:mi>
</mml:mrow>
<mml:mo>&#x3d;</mml:mo>
<mml:mstyle displaystyle="true">
<mml:mo>&#x2211;</mml:mo>
<mml:mrow>
<mml:mrow>
<mml:mrow>
<mml:msub>
<mml:mi>i</mml:mi>
<mml:mi>i</mml:mi>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
<mml:mo>/</mml:mo>
<mml:mi>n</mml:mi>
</mml:mrow>
</mml:mrow>
</mml:mstyle>
</mml:mrow>
</mml:math>
</inline-formula>, and <inline-formula id="inf23">
<mml:math id="m29">
<mml:mrow>
<mml:mi>r</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x2261;</mml:mo>
<mml:mrow>
<mml:mrow>
<mml:mi>R</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
<mml:mo>/</mml:mo>
<mml:mi>N</mml:mi>
</mml:mrow>
<mml:mo>&#x3d;</mml:mo>
<mml:mstyle displaystyle="true">
<mml:mo>&#x2211;</mml:mo>
<mml:mrow>
<mml:mrow>
<mml:mrow>
<mml:msub>
<mml:mi>r</mml:mi>
<mml:mi>i</mml:mi>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
<mml:mo>/</mml:mo>
<mml:mi>n</mml:mi>
</mml:mrow>
</mml:mrow>
</mml:mstyle>
</mml:mrow>
</mml:math>
</inline-formula> are the fractional representations of susceptible, infectious, and removed individuals of the total population with <italic>N</italic> individuals, and <inline-formula id="inf24">
<mml:math id="m30">
<mml:mrow>
<mml:mi>N</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mi>n</mml:mi>
<mml:msub>
<mml:mi>N</mml:mi>
<mml:mi>i</mml:mi>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> relates to the total population with that of each subpopulation <inline-formula id="inf25">
<mml:math id="m31">
<mml:mrow>
<mml:msub>
<mml:mi>N</mml:mi>
<mml:mi>i</mml:mi>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> which is assumed to be the same for all subpopulations. To obtain the final relations in <xref ref-type="disp-formula" rid="e4">Eqs (4</xref>&#x2013;<xref ref-type="disp-formula" rid="e6">6)</xref>, we have defined a time-dependent transmission rate by the following equation:<disp-formula id="e7">
<mml:math id="m32">
<mml:mrow>
<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x3d;</mml:mo>
<mml:msub>
<mml:mi>&#x3b2;</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
<mml:mfrac>
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mi>e</mml:mi>
<mml:mi>f</mml:mi>
<mml:mi>f</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
<mml:mrow>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:mfrac>
<mml:mo>,</mml:mo>
</mml:mrow>
</mml:math>
<label>(7)</label>
</disp-formula> with<disp-formula id="e8">
<mml:math id="m33">
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mi>e</mml:mi>
<mml:mi>f</mml:mi>
<mml:mi>f</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x2261;</mml:mo>
<mml:mstyle displaystyle="true">
<mml:munderover>
<mml:mo>&#x2211;</mml:mo>
<mml:mrow>
<mml:mi>i</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>1</mml:mn>
</mml:mrow>
<mml:mi>n</mml:mi>
</mml:munderover>
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mi>i</mml:mi>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:mstyle>
<mml:mrow>
<mml:mo>[</mml:mo>
<mml:mrow>
<mml:mfrac>
<mml:mrow>
<mml:mfrac>
<mml:mn>1</mml:mn>
<mml:mi>n</mml:mi>
</mml:mfrac>
<mml:mstyle displaystyle="true">
<mml:msubsup>
<mml:mo>&#x2211;</mml:mo>
<mml:mrow>
<mml:mi>j</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>1</mml:mn>
</mml:mrow>
<mml:mi>n</mml:mi>
</mml:msubsup>
<mml:mrow>
<mml:msub>
<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mi>i</mml:mi>
<mml:mi>j</mml:mi>
</mml:mrow>
</mml:msub>
<mml:msub>
<mml:mi>i</mml:mi>
<mml:mi>j</mml:mi>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:mstyle>
</mml:mrow>
<mml:mrow>
<mml:mi>n</mml:mi>
<mml:msub>
<mml:mi>&#x3b2;</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
<mml:mi>i</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:mfrac>
</mml:mrow>
<mml:mo>]</mml:mo>
</mml:mrow>
<mml:mo>.</mml:mo>
</mml:mrow>
</mml:math>
<label>(8)</label>
</disp-formula>
</p>
<p>If all the subpopulations were synchronic and had the same transmission rate, then <inline-formula id="inf26">
<mml:math id="m34">
<mml:mrow>
<mml:msub>
<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mi>i</mml:mi>
<mml:mi>j</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mo>&#x3d;</mml:mo>
<mml:msub>
<mml:mi>&#x3b2;</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula>, and we can recover the standard SIR result <inline-formula id="inf27">
<mml:math id="m35">
<mml:mrow>
<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x3d;</mml:mo>
<mml:msub>
<mml:mi>&#x3b2;</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> and <inline-formula id="inf28">
<mml:math id="m36">
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mi>e</mml:mi>
<mml:mi>f</mml:mi>
<mml:mi>f</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x3d;</mml:mo>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula>. However, in general, <inline-formula id="inf29">
<mml:math id="m37">
<mml:mrow>
<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x3c;</mml:mo>
<mml:msub>
<mml:mi>&#x3b2;</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> for inhomogeneous systems with a distribution of onset times and transmission rates. This means that <inline-formula id="inf30">
<mml:math id="m38">
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mi>e</mml:mi>
<mml:mi>f</mml:mi>
<mml:mi>f</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x3c;</mml:mo>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula>. In other words, the fact that the population is not homogeneous (in contrast to the <italic>well-mixed</italic> assumption of standard SIR) implies that <inline-formula id="inf31">
<mml:math id="m39">
<mml:mrow>
<mml:mi>d</mml:mi>
<mml:mi>s</mml:mi>
<mml:mo>/</mml:mo>
<mml:mi>d</mml:mi>
<mml:mi>t</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula> is not proportional to the product of the total number of susceptible individuals in the population times the total number of infectious individuals as in the traditional SIR model. On the contrary, these inhomogeneities (the population is not <italic>well-mixed</italic>) make <inline-formula id="inf32">
<mml:math id="m40">
<mml:mrow>
<mml:mi>d</mml:mi>
<mml:mi>s</mml:mi>
<mml:mo>/</mml:mo>
<mml:mi>d</mml:mi>
<mml:mi>t</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula> proportional (with the same proportionality constant <inline-formula id="inf33">
<mml:math id="m41">
<mml:mrow>
<mml:msub>
<mml:mi>&#x3b2;</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula>) to the product of the number of infectious individuals multiplied by a smaller number of susceptible individuals, <inline-formula id="inf34">
<mml:math id="m42">
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mi>e</mml:mi>
<mml:mi>f</mml:mi>
<mml:mi>f</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula>. Such <italic>effective</italic> number would represent a subset of the susceptible individuals who are able to <italic>mix</italic> with the infectious population. The exact expression for <inline-formula id="inf35">
<mml:math id="m43">
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mi>i</mml:mi>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula> appearing in <xref ref-type="disp-formula" rid="e8">Eq. (8)</xref> in principle could be obtained from the solution of <xref ref-type="disp-formula" rid="e1">Eqs (1</xref>, <xref ref-type="disp-formula" rid="e2">2)</xref>; however, the quantities <inline-formula id="inf36">
<mml:math id="m44">
<mml:mrow>
<mml:msub>
<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mi>i</mml:mi>
<mml:mi>j</mml:mi>
</mml:mrow>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> are unknown. Here, we propose to approximate <inline-formula id="inf37">
<mml:math id="m45">
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mi>i</mml:mi>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula> in <xref ref-type="disp-formula" rid="e8">Eq. (8)</xref> by the solution of a standard SIR model, <inline-formula id="inf38">
<mml:math id="m46">
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mi>S</mml:mi>
<mml:mi>I</mml:mi>
<mml:mi>R</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mrow>
<mml:mi>t</mml:mi>
<mml:mo>&#x2b;</mml:mo>
<mml:msub>
<mml:mi>t</mml:mi>
<mml:mi>i</mml:mi>
</mml:msub>
</mml:mrow>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula>, evaluated at time <inline-formula id="inf39">
<mml:math id="m47">
<mml:mrow>
<mml:mi>t</mml:mi>
<mml:mo>&#x2b;</mml:mo>
<mml:msub>
<mml:mi>t</mml:mi>
<mml:mi>i</mml:mi>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> that depends on the subpopulation <italic>i</italic>. The onset times <inline-formula id="inf40">
<mml:math id="m48">
<mml:mrow>
<mml:mi>t</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mo>&#x2212;</mml:mo>
<mml:msub>
<mml:mi>t</mml:mi>
<mml:mi>i</mml:mi>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> of the local epidemics can be different (they are asynchronic) from one subpopulation to the other, and transmission rates <inline-formula id="inf41">
<mml:math id="m49">
<mml:mrow>
<mml:msub>
<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mi>i</mml:mi>
<mml:mi>j</mml:mi>
</mml:mrow>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> can also be different. The initial conditions <inline-formula id="inf42">
<mml:math id="m50">
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mi>S</mml:mi>
<mml:mi>I</mml:mi>
<mml:mi>R</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mn>0</mml:mn>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>1</mml:mn>
<mml:mo>&#x2212;</mml:mo>
<mml:mn>1</mml:mn>
<mml:mo>/</mml:mo>
<mml:msub>
<mml:mi>N</mml:mi>
<mml:mi>i</mml:mi>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula>, <inline-formula id="inf43">
<mml:math id="m51">
<mml:mrow>
<mml:msub>
<mml:mi>i</mml:mi>
<mml:mrow>
<mml:mi>S</mml:mi>
<mml:mi>I</mml:mi>
<mml:mi>R</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mn>0</mml:mn>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>1</mml:mn>
<mml:mo>/</mml:mo>
<mml:msub>
<mml:mi>N</mml:mi>
<mml:mi>i</mml:mi>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula>, and <inline-formula id="inf44">
<mml:math id="m52">
<mml:mrow>
<mml:msub>
<mml:mi>r</mml:mi>
<mml:mrow>
<mml:mi>S</mml:mi>
<mml:mi>I</mml:mi>
<mml:mi>R</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mn>0</mml:mn>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>0</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> are assumed. Then, <inline-formula id="inf45">
<mml:math id="m53">
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mi>i</mml:mi>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x2243;</mml:mo>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mi>S</mml:mi>
<mml:mi>I</mml:mi>
<mml:mi>R</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mrow>
<mml:mi>t</mml:mi>
<mml:mo>&#x2b;</mml:mo>
<mml:msub>
<mml:mi>t</mml:mi>
<mml:mi>i</mml:mi>
</mml:msub>
</mml:mrow>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula> can be directly substituted into <xref ref-type="disp-formula" rid="e8">Eq. (8)</xref> to obtain<disp-formula id="e9">
<mml:math id="m54">
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mi>e</mml:mi>
<mml:mi>f</mml:mi>
<mml:mi>f</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x2243;</mml:mo>
<mml:mstyle displaystyle="true">
<mml:munderover>
<mml:mo>&#x2211;</mml:mo>
<mml:mrow>
<mml:mi>i</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>1</mml:mn>
</mml:mrow>
<mml:mi>n</mml:mi>
</mml:munderover>
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mi>S</mml:mi>
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<label>(9)</label>
</disp-formula>
</p>
<p>Summarizing, inhomogeneous transmission has been incorporated in an SIR framework through a time-dependent transmission rate, <inline-formula id="inf46">
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</mml:mrow>
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</inline-formula>. As we will show below, a time-dependent transmission rate may be used to explain the early subexponential growth of the spread, even in the absence of susceptible depletion or interventional measures. Let us stress that other SIR models also consider time-dependent transmission rates, but in those cases, it is introduced externally and mainly to model the reactive behavior of the population in response to containment measures [<xref ref-type="bibr" rid="B14">14</xref>, <xref ref-type="bibr" rid="B18">18</xref>, <xref ref-type="bibr" rid="B30">30</xref>, <xref ref-type="bibr" rid="B31">31</xref>]. In contrast, in the present model, <inline-formula id="inf47">
<mml:math id="m56">
<mml:mrow>
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<mml:mrow>
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</mml:mrow>
</mml:math>
</inline-formula> is obtained as part of the solution of the dynamic equations, and its time-dependence appears even if the population contact dynamics is uniform and the depletion of susceptible individuals is negligible.</p>
</sec>
<sec id="s3">
<title>3 A Time-Dependent Transmission Rate That Describes Correctly the Spread of COVID-19 and Leads to Early Algebraic Growth</title>
<p>The calculation of <inline-formula id="inf48">
<mml:math id="m57">
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</inline-formula> in <xref ref-type="disp-formula" rid="e9">Eq. 9</xref> would depend on the distribution of subpopulation onset times, <inline-formula id="inf49">
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<mml:mi>t</mml:mi>
<mml:mi>i</mml:mi>
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</inline-formula>, and transmission rates, <inline-formula id="inf50">
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</mml:math>
</inline-formula>, and is influenced by the amount of contacts among the individuals of different populations. The effective fractional susceptibility <inline-formula id="inf51">
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</inline-formula> can be thought as a weighted average over subpopulations, with the quantity in square brackets in <xref ref-type="disp-formula" rid="e9">Eq. 9</xref> playing the role of a weight factor. Assuming that we can transform the average over subpopulations into a time average and making a continuous approximation, we propose to transform <xref ref-type="disp-formula" rid="e9">Eq. 9</xref> into the following equation:<disp-formula id="e10">
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<label>(10)</label>
</disp-formula>with <inline-formula id="inf52">
<mml:math id="m62">
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</inline-formula> as a weight function that plays the role of the quantity in square brackets in <xref ref-type="disp-formula" rid="e9">Eq. 9</xref>. Lacking additional information about the distribution of onset times, population sizes, transmission rates, or mixture rules, here we make the parsimonious assumption that <inline-formula id="inf53">
<mml:math id="m63">
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</mml:mrow>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x3d;</mml:mo>
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</inline-formula>, with <inline-formula id="inf54">
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</mml:mrow>
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</inline-formula> as the Heaviside step function and <italic>a</italic> as a constant. In other words, the effective susceptible population, intervening in the transmission rate given by the average in <xref ref-type="disp-formula" rid="e10">Eq. 10</xref>, has been approximated by a set of independent SIR subsystems with a uniform distribution of onset times, between an initial time <inline-formula id="inf55">
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</inline-formula> and a final time <inline-formula id="inf56">
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</inline-formula>:<disp-formula id="e11">
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<label>(11)</label>
</disp-formula>
</p>
<p>Approximation (<xref ref-type="disp-formula" rid="e11">Eq. 11</xref>), together with <xref ref-type="disp-formula" rid="e4">Eqs 4&#x2013;6</xref>, pretends to describe the effects that the inhomogeneous transmission between subpopulations have on the epidemic propagation. The lower limit of the integral appearing in <xref ref-type="disp-formula" rid="e11">Eq. 11</xref> is chosen so that in the average, there will always be contributions from subpopulations that evolve more slowly than the nominal subpopulation, defined as the one with <inline-formula id="inf57">
<mml:math id="m68">
<mml:mrow>
<mml:mi>t</mml:mi>
<mml:mo>&#x2032;</mml:mo>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>0</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula>, that is, <inline-formula id="inf58">
<mml:math id="m69">
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mi>S</mml:mi>
<mml:mi>I</mml:mi>
<mml:mi>R</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
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<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula>. On the other hand, the upper limit is chosen to allow subpopulations that evolve more rapidly. More precisely, the interval <inline-formula id="inf59">
<mml:math id="m70">
<mml:mrow>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mrow>
<mml:msub>
<mml:mi>t</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
<mml:mo>,</mml:mo>
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<mml:mi>t</mml:mi>
</mml:mrow>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula> corresponds to subpopulations that have not started their local outbreaks at time <italic>t</italic>, as can be the case of segments of the population or regions where the pathogen is not present at time <italic>t</italic>. The interval <inline-formula id="inf60">
<mml:math id="m71">
<mml:mrow>
<mml:mrow>
<mml:mo>(</mml:mo>
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<mml:mo>&#x2212;</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>,</mml:mo>
<mml:mn>0</mml:mn>
</mml:mrow>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula> corresponds to subpopulations with delayed outbreaks, and finally, the interval <inline-formula id="inf61">
<mml:math id="m72">
<mml:mrow>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mrow>
<mml:mn>0</mml:mn>
<mml:mo>,</mml:mo>
<mml:mi>a</mml:mi>
<mml:mi>t</mml:mi>
</mml:mrow>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula> corresponds to outbreaks apparently in advance to the nominal one. Since the upper limit <inline-formula id="inf62">
<mml:math id="m73">
<mml:mrow>
<mml:mi>a</mml:mi>
<mml:mi>t</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula> is chosen to consider subpopulations where the pathogen propagates more rapidly than the average, this would imply that for those subpopulations, their local transmission rates <inline-formula id="inf63">
<mml:math id="m74">
<mml:mrow>
<mml:msub>
<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mi>i</mml:mi>
<mml:mi>j</mml:mi>
</mml:mrow>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> would be larger than the nominal value <inline-formula id="inf64">
<mml:math id="m75">
<mml:mrow>
<mml:msub>
<mml:mi>&#x3b2;</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> and their evolution equations should be written in terms of those transmission rates. Correspondingly, the number of susceptible individuals at time <italic>t</italic> has evolved more rapidly than that in subpopulations with smaller values of <inline-formula id="inf65">
<mml:math id="m76">
<mml:mrow>
<mml:msub>
<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mi>i</mml:mi>
<mml:mi>j</mml:mi>
</mml:mrow>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula>. Here, however, we have described the evolution of all the subpopulations using the same nominal value <inline-formula id="inf66">
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<mml:mrow>
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<mml:mi>&#x3b2;</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> for the transmission rates. This means that the evolution of those populations with <inline-formula id="inf67">
<mml:math id="m78">
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<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mi>i</mml:mi>
<mml:mi>j</mml:mi>
</mml:mrow>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> larger than <inline-formula id="inf68">
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<mml:mrow>
<mml:msub>
<mml:mi>&#x3b2;</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> has been approximated by populations evolving with <inline-formula id="inf69">
<mml:math id="m80">
<mml:mrow>
<mml:msub>
<mml:mi>&#x3b2;</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> but evaluated at latter times (<inline-formula id="inf70">
<mml:math id="m81">
<mml:mrow>
<mml:mi>a</mml:mi>
<mml:mo>&#x3e;</mml:mo>
<mml:mn>0</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula>). As a consequence of the distribution of transmission rates, the time dispersion of the local outbreaks increases with time. This is reflected in the time dependence of the limits of the integral in <xref ref-type="disp-formula" rid="e11">Eq. 11</xref>. The value of the parameters <inline-formula id="inf72">
<mml:math id="m83">
<mml:mrow>
<mml:msub>
<mml:mi>t</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> and <italic>a</italic> is obtained from the fitting to the data points of the epidemic curve for a given population. The parameter <italic>a</italic> is a measure of the <italic>strength</italic> of the asynchronicity in the sense that the larger the distribution of transmission rates, the larger the parameter&#x20;<italic>a</italic>.</p>
<p>To examine the validity of the proposed approximation, we apply it to the COVID-19 epidemics in different countries starting with the case of Mexico. <xref ref-type="fig" rid="F1">Figure&#x20;1</xref> (top panel) shows a semilogarithmic plot of <inline-formula id="inf73">
<mml:math id="m84">
<mml:mrow>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula> and <inline-formula id="inf74">
<mml:math id="m85">
<mml:mrow>
<mml:mi>i</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula>, as obtained from <xref ref-type="disp-formula" rid="e4">Eqs (4</xref>, <xref ref-type="disp-formula" rid="e5">5)</xref>, and compares it with the observed data (by confirmation date) [<xref ref-type="bibr" rid="B32">32</xref>] for both the total number of infected (cumulative cases), <inline-formula id="inf75">
<mml:math id="m86">
<mml:mrow>
<mml:mn>1</mml:mn>
<mml:mo>&#x2212;</mml:mo>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula>, and infectious individuals (active cases), <inline-formula id="inf76">
<mml:math id="m87">
<mml:mrow>
<mml:mi>i</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula>, for the case of Mexico. In practice, active cases correspond to individuals whose symptoms started within the previous 14&#x20;days from the day a given data point was released. Let us stress that identifying the measured active cases with the number of infectious individuals is only an approximation. There is some uncertainty on the number of days an infected individual remains infectious, and also, there is some variability in the degree of infectiousness at different days. Nonetheless, here we are going to consider that the active cases correspond to infectious individuals. An initial basic reproduction number <inline-formula id="inf77">
<mml:math id="m88">
<mml:mrow>
<mml:msub>
<mml:mi>R</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>2.2</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> and recovery rate <inline-formula id="inf78">
<mml:math id="m89">
<mml:mrow>
<mml:mi>&#x3b3;</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>1</mml:mn>
<mml:mo>/</mml:mo>
<mml:mn>6</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> were used as parameters for phase 1, that is, before containment measures were adopted. After <italic>t</italic>&#x20;&#x3d; 20 days, once containment measures were adopted and their effects started to be noticeable, the initial reproduction number was changed to <inline-formula id="inf79">
<mml:math id="m90">
<mml:mrow>
<mml:msub>
<mml:mi>R</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>1.7</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula>. The data have been plotted from March 9th, which corresponds to <italic>t</italic>&#x20;&#x3d; 0, where the data points show the beginning of a regular behavior (see Materials and Methods). The bottom panel shows the empirical new daily cases and the model fit. Remarkably, the model is able to correctly reproduce the empirical infectious cases (yellow line) and the new daily cases data, considering that the fitting was performed only for the total number of infected (blue line), and no independent fittings for each curve were required. We did not exclude the possibility that the other set of parameters (using a different value for <italic>&#x3b3;</italic>) corresponds better to real values even if the yellow curve would not be as accurately fit. The inset in the first panel shows that traditional SIR using the same set of parameters fails to reproduce the epidemic curves. The exponential growth and characteristics of traditional SIR makes the comparison with real data, which shows algebraic growth, to eventually differ largely. <xref ref-type="fig" rid="F2">Figure&#x20;2</xref> shows the early growth of the total number of cases. After a first short exponential growth, an algebraic dependence with scaling law <inline-formula id="inf80">
<mml:math id="m91">
<mml:mrow>
<mml:mo>&#x2243;</mml:mo>
<mml:msup>
<mml:mi>t</mml:mi>
<mml:mrow>
<mml:mn>3.4</mml:mn>
</mml:mrow>
</mml:msup>
</mml:mrow>
</mml:math>
</inline-formula> follows. Let us stress that, in contrast to other approaches [<xref ref-type="bibr" rid="B16">16</xref>, <xref ref-type="bibr" rid="B17">17</xref>], this scaling law appears exclusively due to the time-dependence of the transmission rate <inline-formula id="inf81">
<mml:math id="m92">
<mml:mrow>
<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula>, arising from the assumption of inhomogeneous transmission even without reactive population behavioral changes and before the susceptible depletion sets in. <xref ref-type="fig" rid="F3">Figure&#x20;3</xref> shows with lines the behavior of <inline-formula id="inf82">
<mml:math id="m93">
<mml:mrow>
<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula> as obtained from the model, <xref ref-type="disp-formula" rid="e7">Eq. 7</xref> with the approximation given by <xref ref-type="disp-formula" rid="e11">Eq. 11</xref>. The first section of this curve (blue line) corresponds to the beginning of the outbreak, when propagation was free, without containment measures. The second section of the curve (yellow line) corresponds to days after containment measures were implemented. In both cases, the transmission rate decreases with time. The data points are obtained solving for <inline-formula id="inf83">
<mml:math id="m94">
<mml:mrow>
<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula> from <xref ref-type="disp-formula" rid="e4">Eq. 4</xref>, employing real data for Mexico [<xref ref-type="bibr" rid="B32">32</xref>]. We used the fact that the measured new daily cases equal <inline-formula id="inf84">
<mml:math id="m95">
<mml:mrow>
<mml:mo>&#x2212;</mml:mo>
<mml:mi>d</mml:mi>
<mml:mi>s</mml:mi>
<mml:mo>/</mml:mo>
<mml:mi>d</mml:mi>
<mml:mi>t</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula>, that the cumulative cases equal <inline-formula id="inf85">
<mml:math id="m96">
<mml:mrow>
<mml:mn>1</mml:mn>
<mml:mo>&#x2212;</mml:mo>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula>, and that the infectious cases are the measured active cases. The gray vertical line signals the end of the generalized voluntary quarantine (&#x201c;Jornada Nacional de Sana Distancia&#x201d;), and mitigation measures started to be released locally, depending on the strength of the epidemic in each state of the country. Accordingly, rebounds are verified after this date. Other approaches [<xref ref-type="bibr" rid="B14">14</xref>, <xref ref-type="bibr" rid="B31">31</xref>, <xref ref-type="bibr" rid="B34">34</xref>] attributed the time-dependence of <inline-formula id="inf86">
<mml:math id="m97">
<mml:mrow>
<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula> to the reactive behavior of the population in response to the non-pharmaceutical mitigation measures and are introduced externally to the model. Even if no centralized information is provided about the presence of a disease, the impact of information diffusion, through first-hand observation and word of mouth, on the epidemic propagation can also be incorporated in a time-dependent basic reproductive number [<xref ref-type="bibr" rid="B35">35</xref>&#x2013;<xref ref-type="bibr" rid="B37">37</xref>]. In contrast, in the present model, the temporal variation of <inline-formula id="inf87">
<mml:math id="m98">
<mml:mrow>
<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula> is attributed to the inhomogeneous transmission arising from a distribution of transmission rates and of onset times of the local outbreaks, even if the behavior of the population remains unaltered and is obtained from the model dynamical equations. The right axis shows the corresponding values of the time-dependent basic reproduction number defined as [<xref ref-type="bibr" rid="B30">30</xref>], <inline-formula id="inf88">
<mml:math id="m99">
<mml:mrow>
<mml:msub>
<mml:mi>R</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x2261;</mml:mo>
<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>/</mml:mo>
<mml:mi>&#x3b3;</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula>.</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption>
<p>Number of cases in Mexico compared to model predictions. The total number of cases (blue line) is obtained from fits of the model defined by <xref ref-type="disp-formula" rid="e4">Eqs 4</xref>&#x2013;<xref ref-type="disp-formula" rid="e11">11</xref> to real data for Mexico. The prediction of the number of infectious individuals and of the new daily cases is obtained as a consequence; no independent fittings are required. The model predicts that the peak time for the number of infectious cases is around July 29, 2020, whereas that for the new daily cases is around July 22, 2020. The number of total infected saturates at around 850,000. Note that it is a common trend in epidemiological models to fail longtime predictions [<xref ref-type="bibr" rid="B18">18</xref>, <xref ref-type="bibr" rid="B33">33</xref>], and many cases tend to underestimate final observations. Predictions improve as the number of data points considered in the fitting increases. The inset shows the results of a traditional SIR model. The green symbols in the second panel correspond to seven-day averages of the new daily cases data represented by the yellow bars. The green line is the prediction of the&#x20;model.</p>
</caption>
<graphic xlink:href="fphy-09-683364-g001.tif"/>
</fig>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption>
<p>Early subexponential growth of the total number of cases compared to model predictions. The model captures both well: the initial exponential rise of total infected and the subsequent algebraic growth with scaling <inline-formula id="inf89">
<mml:math id="m100">
<mml:mrow>
<mml:mo>&#x2243;</mml:mo>
<mml:msup>
<mml:mi>t</mml:mi>
<mml:mrow>
<mml:mn>3.4</mml:mn>
</mml:mrow>
</mml:msup>
</mml:mrow>
</mml:math>
</inline-formula>. An example of exponential growth is shown for comparison.</p>
</caption>
<graphic xlink:href="fphy-09-683364-g002.tif"/>
</fig>
<fig id="F3" position="float">
<label>FIGURE 3</label>
<caption>
<p>Transmission rate, <inline-formula id="inf90">
<mml:math id="m101">
<mml:mrow>
<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula>, and time-dependent basic reproduction number <inline-formula id="inf91">
<mml:math id="m102">
<mml:mrow>
<mml:msub>
<mml:mi>R</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x2261;</mml:mo>
<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>/</mml:mo>
<mml:mi>&#x3b3;</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula>. Two different sections of the transmission rate as a direct consequence of containment policies are obtained. The initial blue section corresponds to a situation in which no specific policy was considered and the spread proceeds without restrictions. The yellow line is the result of the containment measures, consisting in the closure of nonessential activities and the suggestion to stay at home starting from April 1st. The time-dependence of <inline-formula id="inf92">
<mml:math id="m103">
<mml:mrow>
<mml:mi>&#x3b2;</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula> is not due to the containment policies but is a natural consequence of the asynchronicity of the subpopulation spreads. However, once containment measures were adopted, the basic initial reproduction number decreased from <inline-formula id="inf93">
<mml:math id="m104">
<mml:mrow>
<mml:msub>
<mml:mi>R</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>0</mml:mn>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>2.2</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> to around <inline-formula id="inf94">
<mml:math id="m105">
<mml:mrow>
<mml:msub>
<mml:mi>R</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>0</mml:mn>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x2243;</mml:mo>
<mml:mn>1.7</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula>. The symbols are obtained from <xref ref-type="disp-formula" rid="e4">Eq. 4</xref> using real data for Mexico. The dashed vertical line marks the end of the generalized voluntary quarantine of the population on May 31st. The recovery rate was <inline-formula id="inf95">
<mml:math id="m106">
<mml:mrow>
<mml:mi>&#x3b3;</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>1</mml:mn>
<mml:mo>/</mml:mo>
<mml:mn>6</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula>.</p>
</caption>
<graphic xlink:href="fphy-09-683364-g003.tif"/>
</fig>
<p>Since the first outbreak of COVID-19 in Mexico remains in progress (at the time of writing this manuscript), it is interesting to evaluate the performance of the model in countries where the first outbreak has nearly ended. We have chosen the eight European countries with the largest number of COVID-19 cases to further validate the model [<xref ref-type="bibr" rid="B38">38</xref>]. <xref ref-type="fig" rid="F4">Figure&#x20;4</xref> shows the epidemic curves for Belgium, Italy, France, Germany, Netherlands, Spain, Sweden, and United&#x20;Kingdom. The model-fits capture the epidemic progression surprisingly well in all cases in spite of the different mitigation strategies applied by each country [<xref ref-type="bibr" rid="B39">39</xref>, <xref ref-type="bibr" rid="B40">40</xref>]. Note that the fit starts to fail around <inline-formula id="inf96">
<mml:math id="m107">
<mml:mrow>
<mml:mi>t</mml:mi>
<mml:mo>&#x3e;</mml:mo>
<mml:mn>80</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> particularly in the case of Sweden where a second wave is already apparent. This is due to the fact that we have not taken into consideration the progressive release of the containment measures once the first outbreak has mostly finished. If a larger value for <inline-formula id="inf97">
<mml:math id="m108">
<mml:mrow>
<mml:msub>
<mml:mi>R</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> is used around <inline-formula id="inf98">
<mml:math id="m109">
<mml:mrow>
<mml:mi>t</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>80</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula>, then an increase of the epidemic curve can be obtained again, giving rise to a second wave. In <xref ref-type="fig" rid="F4">Figure&#x20;4,</xref> we have used the present model to fit only the first wave in all&#x20;cases.</p>
<fig id="F4" position="float">
<label>FIGURE 4</label>
<caption>
<p>Epidemic curves for various countries. We plot the data and model fits for the new daily cases for the eight European countries with the largest number of cases. The model fits correctly capture the epidemic progression in all cases. The green symbols correspond to seven-day averages of the data represented by the yellow bars. Note that the second wave (already apparent in the case of Sweden) could also be fit by considering a third regime with an increased value of <inline-formula id="inf99">
<mml:math id="m110">
<mml:mrow>
<mml:msub>
<mml:mi>R</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> due to the gradual release of containment measures starting around <inline-formula id="inf100">
<mml:math id="m111">
<mml:mrow>
<mml:mi>t</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>80</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula>&#x20;days.</p>
</caption>
<graphic xlink:href="fphy-09-683364-g004.tif"/>
</fig>
<p>
<xref ref-type="table" rid="T1">Table&#x20;1</xref> shows the parameters used to fit the model in <xref ref-type="fig" rid="F4">Figure&#x20;4</xref>. In most of these countries, containment measures were taken at about 20&#x2013;40&#x20;days after time <inline-formula id="inf101">
<mml:math id="m112">
<mml:mrow>
<mml:mi>t</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>0</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> days, and thus, the epidemic curve can be divided into two sections, one before and one after the containment measures were adopted. The negative values of <inline-formula id="inf102">
<mml:math id="m113">
<mml:mrow>
<mml:msub>
<mml:mi>t</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> found in the first section, before mitigation measures were adopted, reflect the fact that a fraction of the subpopulations whose local outbreaks had not started contributes to the average in <xref ref-type="disp-formula" rid="e11">Eq. 11</xref>. On the other hand, the positive values of <inline-formula id="inf103">
<mml:math id="m114">
<mml:mrow>
<mml:msub>
<mml:mi>t</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> in the second section reflect the fact that when confinement measures were adopted, there were already a considerable number of infected individuals. Since the local epidemics in this second section evolve with an assumed attenuated value <inline-formula id="inf104">
<mml:math id="m115">
<mml:mrow>
<mml:msub>
<mml:mi>R</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula>, then, in order to produce the same number of initial cases (which in reality were obtained with the original larger value <inline-formula id="inf105">
<mml:math id="m116">
<mml:mrow>
<mml:msub>
<mml:mi>R</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula>), larger times (<inline-formula id="inf106">
<mml:math id="m117">
<mml:mrow>
<mml:msub>
<mml:mi>t</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
<mml:mo>&#x3e;</mml:mo>
<mml:mn>0</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula>) are needed in the SIR subsystems appearing in <xref ref-type="disp-formula" rid="e11">Eq. 11</xref>. In contrast, the case of Mexico shows a negative value of <inline-formula id="inf107">
<mml:math id="m118">
<mml:mrow>
<mml:msub>
<mml:mi>t</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> after the containment measures were adopted, reflecting the fact that the measures were taken very soon in the epidemic progression, when very few cases were present. This is also consistent with the fact that the evolution of the outbreak is taking considerably longer in Mexico than in most of the other countries analyzed. In most cases, the value <inline-formula id="inf108">
<mml:math id="m119">
<mml:mrow>
<mml:mi>&#x3b3;</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>1</mml:mn>
<mml:mo>/</mml:mo>
<mml:mn>6</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> was used as a parameter and the rest of the parameters were obtained by a least-squares fit. We cannot disregard that other choices for the parameter <italic>&#x3b3;</italic> could also produce good fits but with different values for the rest of the fit parameters. Additionally, the fact that we are ignoring the incubation time of the disease may give rise to modified fit parameters; thus, they should be considered only as rough estimates.</p>
<table-wrap id="T1" position="float">
<label>TABLE 1</label>
<caption>
<p>Fitting parameters used in <xref ref-type="fig" rid="F4">Figure&#x20;4</xref>. The effects of containment measures were started to be observed at times <inline-formula id="inf109">
<mml:math id="m120">
<mml:mrow>
<mml:mi>t</mml:mi>
<mml:mo>&#x2243;</mml:mo>
<mml:mn>20</mml:mn>
<mml:mo>&#x2212;</mml:mo>
<mml:mn>40</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> days (labeled transition day). Parameters are rough estimates and should not be considered as accurate values.</p>
</caption>
<table>
<thead valign="top">
<tr>
<th rowspan="2" align="left">Country</th>
<th rowspan="2" align="left">
<italic>&#x3b3;</italic> (1/days)</th>
<th colspan="3" align="center">Before containment</th>
<th rowspan="2" align="left">Transition day</th>
<th colspan="3" align="center">After containment</th>
</tr>
<tr>
<td align="left">
<inline-formula id="inf110">
<mml:math id="m121">
<mml:mrow>
<mml:msub>
<mml:mi>R</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula>
</td>
<td align="left">
<inline-formula id="inf111">
<mml:math id="m122">
<mml:mrow>
<mml:msub>
<mml:mi>t</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> (days)</td>
<td align="center">
<italic>a</italic>
</td>
<td align="left">
<inline-formula id="inf112">
<mml:math id="m123">
<mml:mrow>
<mml:msub>
<mml:mi>R</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula>
</td>
<td align="left">
<inline-formula id="inf113">
<mml:math id="m124">
<mml:mrow>
<mml:msub>
<mml:mi>t</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> (days)</td>
<td align="center">
<italic>a</italic>
</td>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left">Belgium</td>
<td align="center">1/6</td>
<td align="char" char=".">2.5</td>
<td align="left">&#x2212;106.8</td>
<td align="center">5.88</td>
<td align="char" char=".">20</td>
<td align="char" char=".">2.0</td>
<td align="center">50.5</td>
<td align="left">3.05</td>
</tr>
<tr>
<td align="left">Italy</td>
<td align="center">1/6</td>
<td align="char" char=".">2.5</td>
<td align="left">&#x2212;49.8</td>
<td align="center">4.48</td>
<td align="char" char=".">29</td>
<td align="char" char=".">1.7</td>
<td align="center">97.0</td>
<td align="left">4.01</td>
</tr>
<tr>
<td align="left">France</td>
<td align="center">1/6</td>
<td align="char" char=".">2.8</td>
<td align="left">&#x2212;74.1</td>
<td align="center">4.47</td>
<td align="char" char=".">21</td>
<td align="char" char=".">1.8</td>
<td align="center">113.5</td>
<td align="left">2.50</td>
</tr>
<tr>
<td align="left">Germany</td>
<td align="center">1/6.5</td>
<td align="char" char=".">2.6</td>
<td align="left">&#x2212;43.7</td>
<td align="center">3.59</td>
<td align="char" char=".">21</td>
<td align="char" char=".">2.5</td>
<td align="center">63.1</td>
<td align="left">1.54</td>
</tr>
<tr>
<td align="left">Netherlands</td>
<td align="center">1/6</td>
<td align="char" char=".">2.7</td>
<td align="left">&#x2212;34.4</td>
<td align="center">4.01</td>
<td align="char" char=".">17</td>
<td align="char" char=".">2.0</td>
<td align="center">62.2</td>
<td align="left">2.4</td>
</tr>
<tr>
<td align="left">Spain</td>
<td align="center">1/7.5</td>
<td align="char" char=".">3.7</td>
<td align="left">&#x2212;7.7</td>
<td align="center">2.52</td>
<td align="char" char=".">29</td>
<td align="char" char=".">2.15</td>
<td align="center">96.9</td>
<td align="left">2.37</td>
</tr>
<tr>
<td align="left">Sweden</td>
<td align="center">1/6</td>
<td align="char" char=".">2.5</td>
<td align="left">&#x2212;46.4</td>
<td align="center">4.07</td>
<td align="char" char=".">42</td>
<td align="char" char=".">1.8</td>
<td align="center">34.9</td>
<td align="left">4.22</td>
</tr>
<tr>
<td align="left">United&#x20;Kingdom</td>
<td align="center">1/8</td>
<td align="char" char=".">2.9</td>
<td align="left">&#x2212;142.4</td>
<td align="center">3.87</td>
<td align="char" char=".">36</td>
<td align="char" char=".">1.9</td>
<td align="center">86.9</td>
<td align="left">3.27</td>
</tr>
</tbody>
</table>
</table-wrap>
<p>The effect of the strength of asynchronicity is shown in <xref ref-type="fig" rid="F5">Figure&#x20;5</xref>, which shows the evolution of the total number of infected, considering different values for the parameter <italic>a</italic>, for a given <inline-formula id="inf114">
<mml:math id="m125">
<mml:mrow>
<mml:msub>
<mml:mi>R</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula>. We observe that the longtime total number of infected individuals will be highly dependent on <italic>a</italic>. The blue line corresponds to the fitted value of <italic>a</italic> for the case of Mexico, while the yellow and green lines are the predictions for a smaller (smaller <italic>a</italic>) or a larger (larger <italic>a</italic>) asynchronicity.</p>
<fig id="F5" position="float">
<label>FIGURE 5</label>
<caption>
<p>Progression of the spread assuming different asynchronicities. Blue line: The observed data points for the total number of cases in Mexico with the fitted model. Yellow line: The predicted evolution for subpopulations with a smaller asynchronicity (<inline-formula id="inf115">
<mml:math id="m126">
<mml:mrow>
<mml:mi>a</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>9</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula>). Green line: The predicted evolution for subpopulations with a larger asynchronicity (<inline-formula id="inf116">
<mml:math id="m127">
<mml:mrow>
<mml:mi>a</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>15</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula>). In all cases, <inline-formula id="inf117">
<mml:math id="m128">
<mml:mrow>
<mml:msub>
<mml:mi>R</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>1.7</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> and <inline-formula id="inf118">
<mml:math id="m129">
<mml:mrow>
<mml:mi>&#x3b3;</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>1</mml:mn>
<mml:mo>/</mml:mo>
<mml:mn>6</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula>.</p>
</caption>
<graphic xlink:href="fphy-09-683364-g005.tif"/>
</fig>
</sec>
<sec id="s4">
<title>4 Discussion and Conclusion</title>
<p>Summarizing, we have shown that the spread of the local outbreak onset times and transmission rates can be incorporated in an SIR formulation through the use of a time-dependent basic reproduction number. This quantity is obtained as a solution of the dynamical equations and not introduced externally. Thus, its time-dependence does not arise as a result of changes in the social behavior in response to containment measures or of the depletion of susceptible individuals. Instead, it is the result of an inhomogeneous transmission expressed as a time-dependent average of asynchronic SIR subpopulations (<xref ref-type="disp-formula" rid="e11">Eq. 11</xref>). We have shown that a simple assumption for the distribution of onset times and transmission rates can be at the origin of the algebraic growth observed at the early stages of the COVID-19 outbreak. This contradicts the common assumption that the early growth phase should be exponential in the absence of susceptible depletion or interventional measures. In the present model, containment measures contribute by decreasing the initial reproduction number or equivalently, the initial transmission rate. Other epidemic outbreaks also show early subexponential growth, and a number of potential mechanisms have been proposed to explain it. Among them are the spatial heterogeneity and clustering of contacts arising from the fact that the number of noninfected individuals in the immediate neighborhood of infecting agents is strongly constrained [<xref ref-type="bibr" rid="B41">41</xref>, <xref ref-type="bibr" rid="B42">42</xref>]. Reactive population behavior has also been proposed to explain the changes that can gradually mitigate the transmission rate [<xref ref-type="bibr" rid="B16">16</xref>, <xref ref-type="bibr" rid="B26">26</xref>, <xref ref-type="bibr" rid="B31">31</xref>, <xref ref-type="bibr" rid="B35">35</xref>&#x2013;<xref ref-type="bibr" rid="B37">37</xref>, <xref ref-type="bibr" rid="B43">43</xref>]. Related to these mechanisms, a range of mechanistic models that can reproduce the subexponential growth dynamics before susceptible depletion sets in have been proposed. These include models with gradually declining contact rate over time [<xref ref-type="bibr" rid="B14">14</xref>] and spatially structured models such as household-community networks [<xref ref-type="bibr" rid="B26">26</xref>], among others. However, for real epidemics, the underlying mechanisms governing the subexponential growth have been difficult to disentangle, and the matter remains debated [<xref ref-type="bibr" rid="B26">26</xref>, <xref ref-type="bibr" rid="B41">41</xref>,&#x20;<xref ref-type="bibr" rid="B44">44</xref>].</p>
<p>The model predicts a final number of cumulated cases that is substantially smaller than that predicted for homogenous well-mixed populations in agreement with models that predict smaller disease-induced herd immunity when population heterogeneity is taken into account&#x20;[<xref ref-type="bibr" rid="B19">19</xref>].</p>
<p>The present model was validated using the case of the COVID-19 outbreak in different countries, with an emphasis in the case of Mexico. As of the origin of the inhomogeneities in the transmission rates and onset times, one can propose different underlying mechanisms, including the transmission between geographical dispersal subpopulations as individuals travel among them [<xref ref-type="bibr" rid="B6">6</xref>, <xref ref-type="bibr" rid="B8">8</xref>, <xref ref-type="bibr" rid="B15">15</xref>]. Another possible source of inhomogeneities is the existence of different social cohorts, with transmission rates between them that are lower than those between individuals of the same cohort [<xref ref-type="bibr" rid="B19">19</xref>, <xref ref-type="bibr" rid="B45">45</xref>]. In general, the overall connectivity between subpopulations will determine to a large extent the rate of propagation of the viral agent and the final number of cases. Subpopulations more efficiently connected between them will have smaller dispersion of onset times and transmission&#x20;rates.</p>
<p>The model is consistent with mitigation strategies, consisting in the design of containment mechanisms oriented to increase inhomogeneities, for example, imposing travel restrictions for long-distance routes, partially isolating subpopulations from each other [<xref ref-type="bibr" rid="B46">46</xref>, <xref ref-type="bibr" rid="B47">47</xref>], or by increasing the time an individual takes to move from one subpopulation to the other. Furthermore, travel restrictions could be targeted to highly connected individuals. The reason is that the effective number of susceptible individuals, <inline-formula id="inf119">
<mml:math id="m130">
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mi>e</mml:mi>
<mml:mi>f</mml:mi>
<mml:mi>f</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula>, that are the responsible for the rate of change of <inline-formula id="inf120">
<mml:math id="m131">
<mml:mrow>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula>, decreases with the implementation of such mitigation mechanisms. For countries where a strict quarantine is impracticable, this could be a more realistic alternative. We believe that the insight obtained from the present model may be useful for planning non-pharmaceutical responses to better mitigate or block the overall spread of an epidemic outbreak.</p>
</sec>
<sec id="s5">
<title>5 Materials and Methods</title>
<p>Identifying the first infectious case is a difficult task, so considering <inline-formula id="inf121">
<mml:math id="m132">
<mml:mrow>
<mml:mi>t</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>0</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> days as the day the first case was reported, does not seem to be appropriate. For this reason, before trying to fit the original data points, we first shifted them in time so that the time <inline-formula id="inf122">
<mml:math id="m133">
<mml:mrow>
<mml:mi>t</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>0</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> days corresponds to the point where a discernible regular behavior starts to appear. This is shown in <xref ref-type="sec" rid="s1">Supplementary Figure S1</xref> where the data for Mexico that were disregarded for fitting purposes correspond to dates ranging from February 27th, the day of the first detected case, until March 9th. Those data show an irregular behavior probably due to the fewer number of cases and large relative fluctuations.</p>
<p>From a practical point of view, it is numerically easier to approximate <inline-formula id="inf123">
<mml:math id="m134">
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mi>S</mml:mi>
<mml:mi>I</mml:mi>
<mml:mi>R</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula> in <xref ref-type="disp-formula" rid="e11">Eq. 11</xref> by the function<disp-formula id="e12">
<mml:math id="m135">
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mi>S</mml:mi>
<mml:mi>I</mml:mi>
<mml:mi>R</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x2243;</mml:mo>
<mml:mn>1</mml:mn>
<mml:mo>&#x2212;</mml:mo>
<mml:mfrac>
<mml:mn>1</mml:mn>
<mml:mrow>
<mml:msup>
<mml:mrow>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mrow>
<mml:mi>c</mml:mi>
<mml:mo>&#x2b;</mml:mo>
<mml:mi>q</mml:mi>
<mml:msup>
<mml:mi>e</mml:mi>
<mml:mrow>
<mml:mo>&#x2212;</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>/</mml:mo>
<mml:mi>&#x3c4;</mml:mi>
</mml:mrow>
</mml:msup>
</mml:mrow>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
<mml:mrow>
<mml:mn>1</mml:mn>
<mml:mo>/</mml:mo>
<mml:mi>&#x3bd;</mml:mi>
</mml:mrow>
</mml:msup>
</mml:mrow>
</mml:mfrac>
<mml:mo>,</mml:mo>
</mml:mrow>
</mml:math>
<label>(12)</label>
</disp-formula>where the parameters <italic>c</italic>, <italic>q</italic>, <italic>&#x3bd;</italic>, and <italic>&#x3c4;</italic> are obtained from the fitting to the exact form for <inline-formula id="inf124">
<mml:math id="m136">
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mi>S</mml:mi>
<mml:mi>I</mml:mi>
<mml:mi>R</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula> once <inline-formula id="inf125">
<mml:math id="m137">
<mml:mrow>
<mml:msub>
<mml:mi>&#x3b2;</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> and <italic>&#x3b3;</italic> are known. The initial conditions <inline-formula id="inf126">
<mml:math id="m138">
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mi>S</mml:mi>
<mml:mi>I</mml:mi>
<mml:mi>R</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mn>0</mml:mn>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>1</mml:mn>
<mml:mo>&#x2212;</mml:mo>
<mml:mn>1</mml:mn>
<mml:mo>/</mml:mo>
<mml:msub>
<mml:mi>N</mml:mi>
<mml:mi>i</mml:mi>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula>, <inline-formula id="inf127">
<mml:math id="m139">
<mml:mrow>
<mml:msub>
<mml:mi>i</mml:mi>
<mml:mrow>
<mml:mi>S</mml:mi>
<mml:mi>I</mml:mi>
<mml:mi>R</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mn>0</mml:mn>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>1</mml:mn>
<mml:mo>/</mml:mo>
<mml:msub>
<mml:mi>N</mml:mi>
<mml:mi>i</mml:mi>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula>, and <inline-formula id="inf128">
<mml:math id="m140">
<mml:mrow>
<mml:msub>
<mml:mi>r</mml:mi>
<mml:mrow>
<mml:mi>S</mml:mi>
<mml:mi>I</mml:mi>
<mml:mi>R</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mn>0</mml:mn>
<mml:mo>)</mml:mo>
</mml:mrow>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>0</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> were assumed. <xref ref-type="sec" rid="s2">Supplementary Figure S2</xref> shows an example for <inline-formula id="inf129">
<mml:math id="m141">
<mml:mrow>
<mml:msub>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mi>S</mml:mi>
<mml:mi>I</mml:mi>
<mml:mi>R</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula> as obtained from the standard SIR model (solid line) and its approximation <xref ref-type="disp-formula" rid="e12">Eq. 12</xref> (dashed line). By incorporating <xref ref-type="disp-formula" rid="e12">Eq. 12</xref> into <xref ref-type="disp-formula" rid="e11">Eq. 11</xref> and the last result into <xref ref-type="disp-formula" rid="e4">Eqs 4&#x2013;7</xref>, the evolution of <inline-formula id="inf130">
<mml:math id="m142">
<mml:mrow>
<mml:mi>s</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula>, <inline-formula id="inf131">
<mml:math id="m143">
<mml:mrow>
<mml:mi>i</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula>, and <inline-formula id="inf132">
<mml:math id="m144">
<mml:mrow>
<mml:mi>r</mml:mi>
<mml:mrow>
<mml:mo>(</mml:mo>
<mml:mi>t</mml:mi>
<mml:mo>)</mml:mo>
</mml:mrow>
</mml:mrow>
</mml:math>
</inline-formula> for the whole population is finally obtained.</p>
<p>The fitting of the model to the data, before containment measures were taken, was done choosing the value of a spline function that softens the data taken arbitrarily at time <inline-formula id="inf133">
<mml:math id="m145">
<mml:mrow>
<mml:mi>t</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>4</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> days as an initial condition, as shown in <xref ref-type="sec" rid="s3">Supplementary Figure S3</xref>. In this way, possible misfitting due to fluctuations of the data at the very first data points is minimized. The fitting of the second section of the model, that is, once containment measures were taken at day 20 in the case of Mexico, considered as initial values of the model, the values obtained from the first section evaluated at day 20.</p>
<p>For the case of Mexico, the parameters used were <inline-formula id="inf134">
<mml:math id="m146">
<mml:mrow>
<mml:msub>
<mml:mi>R</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>2.2</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> and <inline-formula id="inf135">
<mml:math id="m147">
<mml:mrow>
<mml:mi>&#x3b3;</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>1</mml:mn>
<mml:mo>/</mml:mo>
<mml:mn>6</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula>, values generally accepted for the initial regime without containment measures, and <inline-formula id="inf136">
<mml:math id="m148">
<mml:mrow>
<mml:msub>
<mml:mi>R</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>1.7</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> for the second regime after containment measures were adopted. The first fitting process considered the first data points up to <inline-formula id="inf137">
<mml:math id="m149">
<mml:mrow>
<mml:mi>t</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>20</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> days with obtained fitting parameters <inline-formula id="inf138">
<mml:math id="m150">
<mml:mrow>
<mml:msub>
<mml:mi>t</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
<mml:mo>&#x2243;</mml:mo>
<mml:mo>&#x2212;</mml:mo>
<mml:mn>26.8</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> days and <inline-formula id="inf139">
<mml:math id="m151">
<mml:mrow>
<mml:mi>a</mml:mi>
<mml:mo>&#x2243;</mml:mo>
<mml:mn>6.5</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula>. Analogously, the fitting for the second regime consisted of data from <inline-formula id="inf140">
<mml:math id="m152">
<mml:mrow>
<mml:mi>t</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>21</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> days to the last data point available. For this second regime, the obtained fitting values were <inline-formula id="inf141">
<mml:math id="m153">
<mml:mrow>
<mml:msub>
<mml:mi>t</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
<mml:mo>&#x2243;</mml:mo>
<mml:mo>&#x2212;</mml:mo>
<mml:mn>896</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula> days and <inline-formula id="inf142">
<mml:math id="m154">
<mml:mrow>
<mml:mi>a</mml:mi>
<mml:mo>&#x2243;</mml:mo>
<mml:mn>11</mml:mn>
</mml:mrow>
</mml:math>
</inline-formula>. The results were largely insensitive to variations in the exact day of transition between the two regimes.</p>
</sec>
</body>
<back>
<sec id="s6">
<title>Data Availability Statement</title>
<p>Publicly available datasets were analyzed in this study. These data can be found here: Mexican Government data files. <ext-link ext-link-type="uri" xlink:href="https://covid19.sinave.gob.mx">https://covid19.sinave.gob.mx</ext-link> Our World in Data. <ext-link ext-link-type="uri" xlink:href="https://ourworldindata.org/coronavirus">https://ourworldindata.org/coronavirus</ext-link>.</p>
</sec>
<sec id="s7">
<title>Author Contributions</title>
<p>CM conceived the research, developed the mathematical model, wrote the manuscript, and approved the submitted version.</p>
</sec>
<sec id="s8">
<title>Funding</title>
<p>Partial financial support was provided by DGAPA-UNAM through grant DGAPA IN-103419.</p>
</sec>
<sec sec-type="COI-statement" id="s9">
<title>Conflict of Interest</title>
<p>The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<ack>
<p>The author thanks Oleg Kogan, David Reguera, and Juan Adri&#xe1;n Reyes for their fruitful discussions and helpful comments.</p>
</ack>
<sec id="s10">
<title>Supplementary Material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fphy.2021.683364/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fphy.2021.683364/full&#x23;supplementary-material</ext-link>
</p>
<supplementary-material xlink:href="DataSheet1.PDF" id="SM1" mimetype="application/PDF" xmlns:xlink="http://www.w3.org/1999/xlink"/>
</sec>
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