Prevalence of Asymptomatic SARS-CoV-2 Infection
Authors: Charles Elder
Journal: Annals of Internal Medicine (2021)

LettersFebruary 2021Prevalence of Asymptomatic SARS-CoV-2 InfectionFREECharles Elder, MD, MPHCharles Elder, MD, MPHKaiser Permanente Center for Health Research, Portland, OregonSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1279 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Oran and Topol's narrative review (1) catalogs the existing evidence on the prevalence of asymptomatic SARS-CoV-2 infection and thus provides a useful resource for clinicians and policymakers. However, they draw several provocative conclusions that are not supported by the data.The authors accurately report that after 2 weeks of quarantine, some sailors on the U.S.S. Theodore Roosevelt continued to test positive for SARS-CoV-2. In their discussion, the authors state that “the experience aboard the U.S.S. Theodore Roosevelt suggests that they might be able to transmit the virus for longer than 14 days.” However, results of the RT-PCR assays that are commonly used to diagnose COVID-19 can remain positive for weeks after the onset of symptoms. This does not imply that such patients remain infectious; instead, data suggest that it would be unusual to detect infectious viral particles more than 10 days after illness onset where symptoms have resolved (2). The authors' key summary point stating that “asymptomatic persons can transmit SARS-CoV-2 to others for an extended period, perhaps longer than 14 days” does not follow from the U.S.S. Theodore Roosevelt experience and thus seems misleading.The authors cite data from Vo’, Italy, in support of the idea that asymptomatic persons can transmit SARS-CoV-2. That such asymptomatic transmission can take place is widely accepted; however, the extent to which this is so and the contribution that this phenomenon makes to the spread of the pandemic remain uncertain. In 1 analysis from Singapore, presymptomatic transmission was implicated in only 6.4% of cases (3). In any case, Oran and Topol's review adds no new information to this discussion. The statement in their concluding paragraph that “the early data that we have assembled on the prevalence of asymptomatic SARS-CoV-2 infection suggest that this is a significant factor in the rapid progression of the COVID-19 pandemic” likewise seems exaggerated and premature.Much about SARS-CoV-2 remains unknown. The narrative review by Oran and Topol will serve as a helpful reference. However, scientists can help to balance a public environment already saturated with disinformation and media hype by modeling accurate reporting, prudence, and restraint.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. Bullard J, Dust K, Funk D, et al. Predicting infectious SARS-CoV-2 from diagnostic samples. Clin Infect Dis. 2020. [PMID: 32442256] doi:10.1093/cid/ciaa638 CrossrefMedlineGoogle Scholar3. Wei WE, Li Z, Chiew CJ, et al. Presymptomatic transmission of SARS-CoV-2—Singapore, January 23-March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:411-5. [PMID: 32271722] doi:10.15585/mmwr.mm6914e1 CrossrefMedlineGoogle Scholar Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Charles Elder, MD, MPHAffiliations: Kaiser Permanente Center for Health Research, Portland, OregonDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-1279. 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 N. Belgin Akilli , Ramazan Koylu Prevalence of Asymptomatic SARS-CoV-2 Infection Daniel P. Oran , Eric J. Topol Metrics Cited byCOVID-19-Omics Report: From Individual Omics Approaches to Precision MedicineCharacterization of Specific Humoral Immunity in Asymptomatic SARS-CoV-2 Infection February 2021Volume 174, Issue 2 Page: 285-286 Keywords Armed forces COVID-19 Disclosure Quarantines Reverse transcriptase polymerase chain reaction Scientists ePublished: 16 February 2021 Issue Published: February 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...