Can people with asymptomatic or pre-symptomatic COVID-19 infect others: a systematic review of primary data

Aguirre-Duarte, Nelson Alberto

doi:10.1101/2020.04.08.20054023

Cited by 15 publications

(14 citation statements)

References 28 publications

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“…Asymptomatic cases with COVID-19 are of great concern. They contribute to the spread of SARS-CoV-2, 23 with similar transmission rates as symptomatic patients, 24 while the virus replicates in their lower respiratory tract resulting in radiological evidence of infection. 25 Reports show that asymptomatic cases with normal chest CT have shorter periods from diagnosis to being SARS-CoV-2 negative than asymptomatic cases with positive chest CT. 26 COVID-19 should be considered among cases with CT abnormalities even when there are no other symptoms.…”

Section: Discussionmentioning

confidence: 99%

Chest CT findings in asymptomatic cases with COVID-19: a systematic review and meta-analysis

et al. 2020

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To determine the overall rate of chest imaging findings in asymptomatic cases, describe the most common patterns found, and determine the rate of later symptom development in these initially asymptomatic cases. MATERIALS AND METHODS: The PubMed and EMBASE databases were searched until 1 May 2020, for studies examining the proportion of positive chest imaging findings in asymptomatic cases diagnosed with COVID-19 and a random-effects meta-analysis of proportions was performed. Heterogeneity was assessed using the I 2 statistic. RESULTS: Among 858 non-duplicate studies, seven studies with a total of 231 asymptomatic cases met the inclusion criteria. In the primary analysis, the pooled estimate of the overall rate of positive chest computed tomography (CT) findings among asymptomatic cases was 63% (95% confidence interval [CI]: 44e78%). Among 155/231 cases that were followed up for later symptom development, 90/155 remained asymptomatic and 65/155 developed symptoms during the study period (that ranged between seven and 30 days of follow-up). The pooled estimate of the rate of positive chest CT findings was 62% (95% CI: 38e81%) in cases that remained asymptomatic, while it was 90% (95% CI: 49e99%) in cases that developed symptoms. Among CT findings, the pooled estimate of the overall rate of ground-glass opacities (GGO) at CT alone was 71% (95% CI: 50e86%). Among other CT findings reported, 22/231 patients had GGO with consolidation, 7/231 patients had stripe shadows with or without GGO, and 8/231 patients had GGO with interlobular septal thickening. Among initially asymptomatic cases with positive CT findings, the pooled estimate of the overall rate of later symptom development was 26% (95% CI: 14e43%). CONCLUSION: In COVID-19, asymptomatic cases can have positive chest CT findings, and COVID-19 should be considered among cases with CT abnormalities even when there are no other symptoms. There is a need for close clinical monitoring of asymptomatic cases with radiographic findings as a significant percentage will develop symptoms.

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Section: Discussionmentioning

confidence: 99%

Chest CT findings in asymptomatic cases with COVID-19: a systematic review and meta-analysis

et al. 2020

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“…It is known that an infected person begins to shed significant amounts of virus from 3 days before of becoming symptomatic, with the maximum peak of viral load found throughout the 24 hours prior to clinical manifestations [11]. In asymptomatic people, it is estimated that the contagion period would be about 8 to 15 days after infection [12,13].…”

Section: Methodsmentioning

confidence: 99%

Recommendations for use of antigenic tests in the diagnosis of acute SARS-CoV-2 infection in the second pandemic wave: attitude in different clinical settings

Candel

Barreiro²,

Román³

et al. 2020

Rev Esp Quimioter

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The high transmissibility of SARS-CoV-2 before and shortly after the onset of symptoms suggests that only diagnosing and isolating symptomatic patients may not be sufficient to interrupt the spread of infection; therefore, public health measures such as personal distancing are also necessary. Additionally, it will be important to detect the newly infected individuals who remain asymptomatic, which may account for 50% or more of the cases. Molecular techniques are the “gold standard” for the diagnosis of SARS-CoV-2 infection. However, the massive use of these techniques has generated some problems. On the one hand, the scarcity of resources (analyzers, fungibles and reagents), and on the other the delay in the notification of results. These two facts translate into a lag in the application of isolation measures among cases and contacts, which favors the spread of the infection. Antigen detection tests are also direct diagnostic methods, with the advantage of obtaining the result in a few minutes and at the very “pointof-care”. Furthermore, the simplicity and low cost of these tests allow them to be repeated on successive days in certain clinical settings. The sensitivity of antigen tests is generally lower than that of nucleic acid tests, although their specificity is comparable. Antigenic tests have been shown to be more valid in the days around the onset of symptoms, when the viral load in the nasopharynx is higher. Having a rapid and real-time viral detection assay such as the antigen test has been shown to be more useful to control the spread of the infection than more sensitive tests, but with greater cost and response time, such as in case of molecular tests. The main health institutions such as the WHO, the CDC and the Ministry of Health of the Government of Spain propose the use of antigenic tests in a wide variety of strategies to respond to the pandemic. This document aims to support physicians involved in the care of patients with suspected SC2 infection, in the context of a growing incidence in Spain since September 2020, which already represents the second pandemic wave of COVID-19.

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“…Development of these diagnostic tools is a result of a partnership between Mologic (UK), a biotechnology company committed to developing tests for low resource settings at cost of goods in line with Global Access Policy 8 Our aim is to develop COVID-19 RDTs to meet the WHO provisional target product profiles (TPP) for point-of-need tests for antigen and antibody assays 9 . Antigen assays, could be used for the rapid triage of patients with presumptive COVID-19, to detect asymptomatic or presymptomatic carriers and mild infections for isolation 10 .…”

Section: Introductionmentioning

confidence: 99%

Rapid development of COVID-19 rapid diagnostics for low resource settings: accelerating delivery through transparency, responsiveness, and open collaboration

Adams

Augustin

Byrne

et al. 2020

Preprint

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Here we describe an open and transparent consortium for the rapid development of COVID-19 rapid diagnostics tests. We report diagnostic accuracy data on the Mologic manufactured IgG COVID-19 ELISA on known positive serum samples and on a panel of known negative respiratory and viral serum samples pre-December 2019. : medRxiv preprint In January, Mologic, embarked on a product development pathway for COVID-19 diagnostics focusing on ELISA and rapid diagnostic tests (RDTs), with anticipated funding from Wellcome Trust and DFID. 834 clinical samples from known COVID-19 patients and hospital negative controls were tested on Mologic's IgG ELISA. The reported sensitivity on 270 clinical samples from 124 prospectively enrolled patients was 94% (95% CI: 89.60% -96.81%) on day 10 or more post laboratory diagnosis, and 96% (95% CI: 84.85% -99.46%) between 14-21 days post symptom onset. A specificity panel comprising 564 samples collected pre-December 2019 were tested to include most common respiratory pathogens, other types of coronavirus, and flaviviruses. Specificity in this panel was 97% (95% CI: 95.65% -98.50%).This is the first in a series of Mologic products for COVID-19, which will be deployed for COVID-19 diagnosis, contact tracing and sero-epidemiological studies to estimate disease burden and transmission with a focus on ensuring access, affordability, and availability to low-resource settings.

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Can people with asymptomatic or pre-symptomatic COVID-19 infect others: a systematic review of primary data

Cited by 15 publications

References 28 publications

Chest CT findings in asymptomatic cases with COVID-19: a systematic review and meta-analysis

Chest CT findings in asymptomatic cases with COVID-19: a systematic review and meta-analysis

Recommendations for use of antigenic tests in the diagnosis of acute SARS-CoV-2 infection in the second pandemic wave: attitude in different clinical settings

Rapid development of COVID-19 rapid diagnostics for low resource settings: accelerating delivery through transparency, responsiveness, and open collaboration

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