Is it growing exponentially fast? -- Impact of assuming exponential growth for characterizing and forecasting epidemics with initial near-exponential growth dynamics.

The increasing use of mathematical models for epidemic forecasting has highlighted the importance of designing models that capture the baseline transmission characteristics in order to generate reliable epidemic forecasts. Improved models for epidemic forecasting could be achieved by identifying signature features of epidemic growth, which could inform the design of models of disease spread and reveal important characteristics of the transmission process. In particular, it is often taken for granted that the early growth phase of different growth processes in nature follow early exponential growth dynamics. In the context of infectious disease spread, this assumption is often convenient to describe a transmission process with mass action kinetics using differential equations and generate analytic expressions and estimates of the reproduction number. In this article, we carry out a simulation study to illustrate the impact of incorrectly assuming an exponential-growth model to characterize the early phase (e.g., 3-5 disease generation intervals) of an infectious disease outbreak that follows near-exponential growth dynamics. Specifically, we assess the impact on: 1) goodness of fit, 2) bias on the growth parameter, and 3) the impact on short-term epidemic forecasts. Designing transmission models and statistical approaches that more flexibly capture the profile of epidemic growth could lead to enhanced model fit, improved estimates of key transmission parameters, and more realistic epidemic forecasts.