Prevalence of Asymptomatic SARS-CoV-2 Infection
Authors: N. Belgin Akilli, Ramazan Koylu
Journal: Annals of Internal Medicine (2021)

LettersFebruary 2021Prevalence of Asymptomatic SARS-CoV-2 InfectionFREEN. Belgin Akilli, MD, Ramazan Koylu, MDN. Belgin Akilli, MDKonya Research and Education Hospital, Konya, Turkey, Ramazan Koylu, MDKonya Research and Education Hospital, Konya, TurkeyAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1280 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I read Oran and Topol's narrative review with interest (1). The world is facing a problem that is very rare to date. Since COVID-19 was first diagnosed in December 2019, a total of 8 860 331 persons have been infected worldwide and 465 740 persons have died as of 22 June 2020 (2). Many issues related to this disease have yet to be clarified. Oran and Topol analyzed 16 studies on patients with positive results for SARS-CoV-2 infection by RT-PCR testing and suggest that this disease may be asymptomatic in 40% of 45% of infected persons (1).Although the evidence level of their included studies is low, we believe that Oran and Topol's review makes a remarkable point that may affect the daily functioning of health institutions and public health professionals in pandemic conditions. However, the sensitivity of RT-PCR testing may be low because of such factors as suboptimal clinical sampling, variability in viral load, and sensitivity of the manufacturer test kit (3). The false-negative rate for SARS-CoV-2 was reported to be between 2% and 29% (3). In a study of 205 patients, the sensitivity of RT-PCR testing was 93% for bronchoalveolar lavage, 72% for sputum, 63% for nasal swabs, and 32% for throat specimens (4).The sensitivity is uncertain for asymptomatic persons. Woloshin and colleagues (5) state that determining the test sensitivity in this population is an urgent priority. They also state that, even in a highly sensitive test, negative results cannot exclude infection if the probability of pretesting is high (5). We believe that the rate of asymptomatic persons in society may be higher because of the lack of a gold standard for the diagnosis of COVID-19.Despite the World Health Organization report that caused confusion about the contagiousness of asymptomatic COVID-19 cases, we believe the number of asymptomatic cases in the community may be higher than expected. We further contend that public health policies for controlling infection should be developed accordingly.References1. Oran DP, Topol EJ. Prevalence of asymptomatic SARS-CoV-2 infection. A narrative review. Ann Intern Med. 2020;173:362-7. doi:10.7326/M20-3012 LinkGoogle Scholar2. World Health Organization. WHO coronavirus disease (COVID-19) dashboard. 2020. Accessed at https://covid19.who.int on 22 June 2020. Google Scholar3. Watson J, Whiting PF, Brush JE. Interpreting a COVID-19 test result. BMJ 2020;369:m1808 doi:10.1136/bmj.m1808 Google Scholar4. Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA. 2020;323:1843-4. [PMID: 32159775] doi:10.1001/jama.2020.3786 MedlineGoogle Scholar5. Woloshin S, Patel N, Kesselheim AS. False negative tests for SARS-CoV-2 infection—challenges and implications. N Engl J Med. 2020;383:e38. [PMID: 32502334] doi:10.1056/NEJMp2015897 CrossrefMedlineGoogle Scholar Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: N. Belgin Akilli, MD; Ramazan Koylu, MDAffiliations: Konya Research and Education Hospital, Konya, TurkeyDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-1280. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPrevalence of Asymptomatic SARS-CoV-2 Infection Daniel P. Oran and Eric J. Topol Prevalence of Asymptomatic SARS-CoV-2 Infection Daniel T. Halperin Prevalence of Asymptomatic SARS-CoV-2 Infection Muge Cevik , Isaac I. Bogoch , Gail Carson , Eric D’Ortenzio , Krutika Kuppalli Prevalence of Asymptomatic SARS-CoV-2 Infection Dongsheng Han , Jinming Li Prevalence of Asymptomatic SARS-CoV-2 Infection Andrew N. Cohen , Bruce Kessel Prevalence of Asymptomatic SARS-CoV-2 Infection Daniel P. Oran , Eric J. Topol Prevalence of Asymptomatic SARS-CoV-2 Infection Charles Elder Metrics Cited byThe Implementation and Role of Antigen Rapid Test for COVID-19 in Hemodialysis Units February 2021Volume 174, Issue 2 Page: 286 Keywords COVID-19 Disclosure Global health Infectious diseases Pharynx Prevention, policy, and public health Public policy Reverse transcriptase polymerase chain reaction Sputum Viral load ePublished: 16 February 2021 Issue Published: February 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...