Towards an Accurate and Systematic Characterization of Persistently Asymptomatic Infection with SARS-CoV-2

24 Pages Posted: 20 Aug 2020 Last revised: 19 Oct 2020

See all articles by Eric Meyerowitz

Eric Meyerowitz

Montefiore Medical Center, Albert Einstein College of Medicine

Aaron Richterman

University of Pennsylvania - Hospital of the University of Pennsylvania

Isaac Bogoch

University of Toronto

Nicola Low

University of Bern - Institute of Social and Preventive Medicine

Muge Cevik

University of St. Andrews - Division of Infection and Global Health

Date Written: August 10, 2020

Abstract

People with persistently asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection experience no symptoms throughout the course of infection, while pre-symptomatic individuals report symptoms attributable to the virus. Transmission of SARS-CoV-2 from individuals without symptoms contributes to pandemic spread, but the extent of transmission from persistently asymptomatic individuals remains unknown. We describe three methodological issues that hinder attempts to estimate this proportion. First, incomplete symptom assessment likely overestimates the asymptomatic fraction. Second, studies with inadequate follow-up misclassify pre-symptomatic individuals. Third, serological studies may identify people with previously unrecognized infection, but reliance on poorly defined antibody responses and retrospective symptom assessment may result in misclassification. We provide recommendations regarding definitions, detection, documentation and follow-up to improve the identification and evaluation of people with persistently asymptomatic SARS-CoV-2 infection and their contacts. Accurate characterisation of the persistently asymptomatic fraction may shed light on COVID-19 pathogenesis, transmission dynamics, and inform public health responses.

Note: Funding: No funding was received for this work.

Conflict of Interest: IIB has consulted for BlueDot, a social benefit corporation that tracks the spread of emerging infectious diseases. EAM,AR, NL and MCreport no conflicts of interest.

Keywords: SARS-CoV-2, COVID-19, asymptomatic infection, pre-symptomatic infection

Suggested Citation

Meyerowitz, Eric and Richterman, Aaron and Bogoch, Isaac and Low, Nicola and Cevik, Muge, Towards an Accurate and Systematic Characterization of Persistently Asymptomatic Infection with SARS-CoV-2 (August 10, 2020). Available at SSRN: https://ssrn.com/abstract=3670755 or http://dx.doi.org/10.2139/ssrn.3670755

Eric Meyerowitz (Contact Author)

Montefiore Medical Center, Albert Einstein College of Medicine ( email )

111 East 210th Street
Bronx, NY 10467
United States

Aaron Richterman

University of Pennsylvania - Hospital of the University of Pennsylvania ( email )

Philadelphia, PA
United States

Isaac Bogoch

University of Toronto

105 St George Street
Toronto, Ontario M5S 3G8
Canada

Nicola Low

University of Bern - Institute of Social and Preventive Medicine ( email )

Bern
Switzerland

Muge Cevik

University of St. Andrews - Division of Infection and Global Health ( email )

The Gateway
North Haugh
St Andrews, Fife KY16 9RJ
United Kingdom

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