How contact patterns destabilize and modulate epidemic outbreaks

The spread of a contagious disease clearly depends on when infected individuals come into contact with susceptible ones. Such effects, however, have remained largely unexplored in the study of epidemic outbreaks. In particular, it remains unclear how the timing of contacts interacts with the latent and infectious stages of the disease. Here, we use real-world physical proximity data to study this interaction and find that the temporal statistics of actual human contact patterns (i) destabilize epidemic outbreaks and (ii) modulate the basic reproduction number R 0. We explain both observations by distinct aspects of the observed contact patterns. On the one hand, we find the destabilization of outbreaks to be caused by the temporal clustering of contacts leading to over-dispersed offspring distributions and increased probabilities of otherwise rare events (zero- and super-spreading). Notably, our analysis enables us to disentangle previously elusive sources of over-dispersion in empirical offspring distributions. On the other hand, we find the modulation of R 0 to be caused by a periodically varying contact rate. Both mechanisms are a direct consequence of the memory in contact behavior, and we showcase a generative process that reproduces these non-Markovian statistics. Our results point to the importance of including non-Markovian contact timings into studies of epidemic outbreaks.