Towards an accurate and systematic characterisation of persistently asymptomatic infection with SARS-CoV-2

Meyerowitz, Eric A.; Richterman, Aaron; Bogoch, Isaac I.; Low, Nicola; Çevik, Müge

doi:10.1016/s1473-3099(20)30837-9

Cited by 157 publications

(168 citation statements)

References 49 publications

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“…On the other hand, although there is no optimal strategy to precisely identify asymptomatic SARS-CoV-2 infected individuals, our study complies with most of the recommended methods proposed by Meyerowitz et al [29]. Firstly, our survey was performed among trustful University members who may recall COVID-19-related symptoms reliably.…”

Section: Discussionmentioning

confidence: 62%

SARS-CoV-2 Infection Is Asymptomatic in Nearly Half of Adults with Robust Anti-Spike Protein Receptor-Binding Domain Antibody Response

Tsitsilonis

Paraskevis²,

Lianidou³

et al. 2021

Vaccines

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Between June and November 2020, we assessed plasma antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid protein in 4996 participants (aged 18–82 years, 34.5% men) from the National and Kapodistrian University of Athens. The weighted overall prevalence was 1.6% and monthly prevalence correlated with viral RNA-confirmed SARS-CoV-2 infections in Greece, in the same period. Notably, 49% of seropositive cases reported no history of SARS-CoV-2 infection-related clinical symptoms and 33% were unsuspected of their previous infection. Additionally, levels of anti-SARS-CoV-2 antibodies against the spike-protein receptor-binding domain were similar between symptomatic and asymptomatic individuals, irrespective of age and gender. Using Food and Drug Administration Emergency Use Authorization-approved assays, these results support the need for such studies on pandemic evaluation and highlight the development of robust humoral immune responses even among asymptomatic individuals. The high percentage of unsuspected/asymptomatic active cases, which may contribute to community transmission for more days than that of cases who are aware and self-isolate, underscores the necessity of measures across the population for the efficient control of the pandemic.

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Section: Discussionmentioning

confidence: 62%

SARS-CoV-2 Infection Is Asymptomatic in Nearly Half of Adults with Robust Anti-Spike Protein Receptor-Binding Domain Antibody Response

Tsitsilonis

Paraskevis²,

Lianidou³

et al. 2021

Vaccines

View full text Add to dashboard Cite

show abstract

“…The proportion of infectious cases without or with only mild symptoms was set to 65%. However, a correct estimate of this proportion is subject to several methodological limitations that make interpretation of the reported frequencies of symptoms among SARS-CoV-2 cases difficult [14]. Additionally, we assume that the remaining 35% of cases are recognized by a health care system and they contribute to the observed incidence at population level.…”

Section: Discussionmentioning

confidence: 99%

Negative SARS-CoV-2 PCR or rapid antigen test result and the subsequent risk of being infectious: a mathematical simulation study

Krumkamp

Kreuels

Jaeger

et al. 2021

Preprint

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Background. A considerable proportion of SARS-CoV-2 transmission occurs from asymptomatic and pre-symptomatic cases. Therefore, different polymerase chain reaction (PCR)- or rapid antigen test (RAT)-based approaches are being discussed and applied to identify infectious cases that would have gone undetected (e.g., in nursing homes). In this article, we provide a framework to estimate the time-dependent risk of being infectious after a negative SARS-CoV-2 test and we simulate the number of expected cases over time in populations of individuals who initially tested negative. Methods. A Monte Carlo approach is used to simulate infections that occurred over a one-week period in populations with 1,000 individuals following a negative SARS-Cov-2 test. Parameters representing the application of PCR tests or RATs are utilized, and SARS-CoV-2 7-day incidences between 25 and 200 per 100,000 people are considered. Simulation results are compared to case numbers predicted via a mathematical equation. Results. The simulations showed a linear increase in cases over time in populations of individuals who initially tested SARS-CoV-2 negative. The different false negative rates of PCR tests and RATs have a strong impact on the number of simulated cases. The simulated and the mathematically predicted case numbers were comparable. However, Monte Carlo simulations highlight that, due to random effects, infectious cases can exceed predicted case numbers even shortly after a test was conducted. Conclusions. The analysis demonstrates that the number of infectious cases in a population can be effectively reduced by the screening of asymptomatic individuals. However, the time since the negative test and the underlying SARS-CoV-2 incidence are critical parameters in determining the observed subsequent number of cases in tested populations.

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“…Yet, transmission modeling suggests that asymptomatic individuals have represented the major source of infections so far (51,52). However, this has to be viewed in the light of the methodological challenges in the estimation of asymptomatic spread (53). Transmission in the absence of symptoms, whether asymptomatic or pre-symptomatic, has been coined silent transmission (54).…”

Section: Sars-cov-2 Transmission Vs Clearancementioning

confidence: 99%

Lung Protection vs. Infection Resolution: Interleukin 10 Suspected of Double-Dealing in COVID-19

et al. 2021

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The pathological processes by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that make the virus a major threat to global health are insufficiently understood. Inefficient viral clearance at any stage is a hallmark of coronavirus disease 2019 (COVID-19). Disease severity is associated with increases in peripheral blood cytokines among which interleukin 10 (IL-10) increases particularly early and independent of patient age, which is not seen in active SARS-CoV infection. Here, we consider the known multi-faceted immune regulatory role of IL-10, both in protecting the lung from injury and in defense against infections, as well as its potential cellular source. While the absence of an IL-10 response in SARS is thought to contribute to early deterioration, we suspect IL-10 to protect the lung from early immune-mediated damage and to interfere with viral clearance in COVID-19. This may further both viral spread and poor outcome in many high-risk patients. Identifying the features of the viral genotype, which specifically underlie the different IL-10 dynamics as an etiological endotype and the different viral load kinetics and outcomes as clinical phenotype, may unveil a new immune evasive strategy of SARS-CoV-2.

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Towards an accurate and systematic characterisation of persistently asymptomatic infection with SARS-CoV-2

Cited by 157 publications

References 49 publications

SARS-CoV-2 Infection Is Asymptomatic in Nearly Half of Adults with Robust Anti-Spike Protein Receptor-Binding Domain Antibody Response

SARS-CoV-2 Infection Is Asymptomatic in Nearly Half of Adults with Robust Anti-Spike Protein Receptor-Binding Domain Antibody Response

Negative SARS-CoV-2 PCR or rapid antigen test result and the subsequent risk of being infectious: a mathematical simulation study

Lung Protection vs. Infection Resolution: Interleukin 10 Suspected of Double-Dealing in COVID-19

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