One in five people could be walking around with “silent” COVID-19, according to a study published in the journal Thorax, leading researchers to suggest these people may act as an important driver of viral spread in the community.
Lead author Sung-Han Kim, from the Department of Infectious Diseases at Asan Medical Center in Seoul, South Korea, said the findings add further support to the use of face masks by the general public.
He also said the scope of testing for COVID-19 should be expanded to include asymptomatic individuals in high-risk settings, such as nursing homes or healthcare facilities.
The Centers for Disease Control and Prevention recently U-turned on its advice around testing asymptomatic people and now stresses the need to test asymptomatic and pre-symptomatic people, including close contacts of a person with confirmed COVID-19.
What exactly did the new study on silent COVID find?
The new study found those with asymptomatic COVID-19 cases appear to have similar viral loads to those with symptoms, echoing the results of past studies. Viral load refers to the total amount of virus a person has inside them. In theory: the higher the viral load, the more infectious someone is likely to be.
Researchers looked at a large cluster outbreak of COVID-19 in Daegu City, South Korea, early on in the pandemic. The close contacts of the cluster were traced and more than 3,000 cases of COVID-19 were uncovered, ranging from people having no symptoms at all to severe effects.
Those with mild or no symptoms were admitted to dedicated care facilities for isolation and monitoring. The 213 participants involved in this study had been admitted to one such facility.
People were classified as symptomless if they had none of the following: fever; chills; muscle pain (myalgia); fatigue; runny nose (rhinorrhea); blocked nose; loss of taste or smell; sore throat; swallowing difficulties; cough; phlegm production; coughing up blood; headache; dizziness; loss of appetite; nausea; vomiting, abdominal pain; and diarrhea.
In 213 patients with the virus, 41 (19%) remained asymptomatic. Of them, 39 (95%) underwent follow-up testing after an average of 13 days, while in 172 patients with mild symptoms, 144 (84%) underwent follow-up testing.
The follow-up testing is important as it showed those with silent COVID didn’t then develop symptoms, which would’ve meant they were pre-symptomatic.
A large proportion of mildly symptomatic patients with COVID-19 and asymptomatic individuals showed persistent positive upper respiratory RT-PCR results at follow-up. Asymptomatic individuals and symptomatic patients also had very similar viral loads.
Researchers said further studies are needed to clarify whether the persistence of viral DNA in people without any symptoms warrants precautionary quarantine measures. They added that most of the participants were in their 20s and 30s, so the findings might not apply to other age groups.
Nevertheless, they pointed out: “Considering that most asymptomatic individuals with COVID-19 are likely to go unnoticed by healthcare workers and continue to reside within communities, such individuals may act as an essential driving force for the community spread of COVID-19 and the ongoing pandemic state.”
So, what does this mean?
Until we know how long, and to what extent, asymptomatic people might be infectious, testing should be extended to certain groups as a precautionary measure, the researchers recommended.
While we don’t know exactly how many people tend to be asymptomatic, we do know that the number could range from 20-50%.
A study from Italy published at the end of June found that of residents who tested positive for COVID-19 in the municipality of Vo’, a small town near Padua, 42% were asymptomatic. Another study of 9,000 people selected to take a coronavirus test in Iceland found 50% of them tested positive for COVID-19, but didn’t have any symptoms.
Most recently, a review of 94 studies concluded that the proportion of people who catch COVID-19 and remain asymptomatic throughout infection is somewhere around 20%.
The secondary attack rate – meaning the rate of infection among close contacts – was lower in contacts of people with asymptomatic infection than those with symptomatic infection.
A higher proportion of infections resulted from transmission from pre-symptomatic individuals than from asymptomatic individuals, the study found.
This story originally appeared in HuffPost UK.
Experts are still learning about COVID-19. The information in this story is what was known or available as of publication, but guidance can change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.