Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2)

Abstract

Estimation of the prevalence and contagiousness of undocumented novel coronavirus [severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2)] infections is critical for understanding the overall prevalence and pandemic potential of this disease. Here, we use observations of reported infection within China, in conjunction with mobility data, a networked dynamic metapopulation model, and Bayesian inference, to infer critical epidemiological characteristics associated with SARS-CoV-2, including the fraction of undocumented infections and their contagiousness. We estimate that 86% of all infections were undocumented [95% credible interval (CI): 82–90%] before the 23 January 2020 travel restrictions. The transmission rate of undocumented infections per person was 55% the transmission rate of documented infections (95% CI: 46–62%), yet, because of their greater numbers, undocumented infections were the source of 79% of the documented cases. These findings explain the rapid geographic spread of SARS-CoV-2 and indicate that containment of this virus will be particularly challenging.

Ad hoc laboratory-based surveillance of SARS-CoV-2 by real-time RT-PCR using minipools of RNA prepared from routine respiratory samples

“…Early case detection is crucial to contain the pandemic and symptom-based case definitions have been set up in many countries worldwide. However, there is evidence that transmission chains can be initiated by asymptomatic cases or only mildly diseased COVID-19 patients (2). These cases will be missed by currently recommended symptom-based case definitions and may lead to unrecognized local spread, which has been seen in Italy, Iran and more recently in the US.…”

Impacto de la pandemia por SARS-CoV-2 sobre la actividad y profesionales de un Servicio de Cirugía General y del Aparato Digestivo en un hospital terciario

“…No podemos concluir que la infección por COVID-19 haya sido el elemento diferencial entre ambos grupos de pacientes, ya que la edad media de cada grupo (81 vs 59,5 años) y la gravedad clínica que presentaba no nos permiten comparar ambos grupos.La indicación de cirugía (tanto por patología urgente como programada) en la situación en la que nos encontramos de pandemia por SARS-CoV-2, debe valorarse individualmente sopesando el beneficio de la cirugía respecto a las alternativas existentes (antibioterapia, drenaje percutáneo, colecistostomía, colocación de stent o retraso de la cirugía hasta que la enfermedad sea menos prevalente)(11) .En los hospitales que atienden un área con alta incidencia de casos con COVID-19 parece aconsejable el screening preoperatorio de todos los pacientes que vayan a ser intervenidos quirúrgicamente (12) (mediante RT-PCR y/o TAC de tórax) con el objetivo de seleccionar el mejor tratamiento disponible para el paciente, así como la vía de abordaje en caso de cirugía (laparoscopia o laparotomía) y para que el personal sanitario tome las medidas de protección necesarias (equipo de protección individual) (8)(7)(13)(14) .En todo caso, el objetivo fundamental en cuanto a seguridad del paciente se sustenta en dos acciones: por un lado, evitar intervenir pacientes ya infectados que pueden presentar un agravamiento de su situación respiratoria debido a la intubación y a la agresión quirúrgica, y por otro evitar el contagio intrahospitalario de pacientes no COVID-19 durante el postoperatorio(15) .…”

COVID-19 in a patient with long-term use of glucocorticoids: A study of a familial cluster

“…The ongoing outbreak of COVID-19, starting in December 2019, has quickly become a sweeping and unprecedented global challenge. Because COVID-19 can spread from person to person [10,11], a major challenge in controlling the disease is recognizing and quarantining potential infectious sources as soon as possible [12].…”