The epidemiological and radiographical characteristics of asymptomatic infections with the novel coronavirus (COVID-19): A systematic review and meta-analysis

Abstract

The role of asymptomatic infections in the transmission of COVID-19 have drawn considerable attention. Here, we performed a meta-analysis to summarize the epidemiological and radiographical characteristics of asymptomatic infections associated with COVID-19. Methods: Data on the epidemiological and radiographical characteristics of asymptomatic infections were extracted from the existing literature. Pooled proportions with 95% confidence intervals were then calculated using a random effects model. Results: A total of 104 studies involving 20,152 cases were included. The proportion of asymptomatic individuals among those with COVID-19 was 13.34% (10.86%-16.29%), among which presymptomatic and covert infections accounted for 7.64% (4.02%-14.04%) and 8.44% (5.12%-13.62%), respectively. The proportions of asymptomatic infections among infected children and healthcare workers were 32.24% (23.08%-42.13%) and 36.96% (18.51%-60.21%), respectively. The proportion of asymptomatic infections was significantly higher after 2020/02/29 than before (33.53% vs 10.19%) and in non-Asian regions than in Asia (28.76% vs 11.54%). The median viral shedding duration of asymptomatic infections was 14.14 days (11.25-17.04). A total of 47.62% (31.13%-72.87%) of asymptomatic infections showed lung abnormalities, especially ground-glass opacity (41.11% 19.7%-85.79%). Conclusions: Asymptomatic infections were more commonly found in infected children and healthcare workers and increased after 2020/02/29 and in non-Asian regions. Chest radiographical imaging could be conducive to the early identification of asymptomatic infections.

COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection

“…This was misconstrued across scientific papers and social networks as ASI being responsible for the majority of SARS-CoV-2 infections [ 216 ]. Another unconventional and unnecessary term is “covert infection” [ 217 ], which was used in place of ASI in a systematic review [ 218 ]. Further, in a modeling study, researchers used the term “silent infections” to merge presymptomatic and asymptomatic infections [ 219 ].…”

“…Despite the scientific rigor of the articles cited above, generalizability is unclear and the wide prediction intervals of their pooled estimates reflect the considerable methodological and clinical heterogeneity among the studies included. Other systematic reviews with problematic inclusion criteria and definitions published much lower or higher estimates (e.g., 8% [ 218 ], 31% [ 227 ], 39% [ 228 ]) or did not meta-analyze data yet concluded that the proportion of ASI was “at least one third” [ 212 ] or was “not negligible in any population” [ 229 ].…”

“…Pooled estimates of the proportion of presymptomatic SARS-CoV-2 infection published in three systematic reviews are dissimilar (8% [ 218 ], 15% [ 228 ], 49% [ 223 ]). This raises several concerns.…”

SARS-CoV-2 Infection in Spondyloarthritis Patients Treated With Biotechnological Drugs: A Study on Serology

“…Our findings highlight that serology is useful to detect previous contact with COVID-19 and could help estimate the extent of asymptomatic spread of the virus (10). Of course, the performances of SARS-CoV-2 serological tests also depend on sensitivity and specificity.…”

Characteristics and Outcomes of Pediatric COVID-19 Patients in Osaka, Japan

“…Previous studies from China, the United States, and European countries reported that the common symptoms of COVID-19 among pediatric patients were fever, cough, and nausea/vomiting [ 4 ], although most of them were asymptomatic [ 4 , 7 , 8 ]. Additionally, many pediatric patients were infected in their homes [ 8 , 9 , 10 ].…”