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A Cohort of SARS-CoV-2 Infected Asymptomatic and Pre-Symptomatic Contacts from COVID-19 Contact Tracing in Hubei Province, China: Short-Term Outcomes

32 Pages Posted: 12 Oct 2020

See all articles by Peng Zhang

Peng Zhang

Hubei Provincial Center for Disease Control and Prevention - Institute of Preventive Medicine Information

Fei Tian

Sun Yat-Sen University (SYSU) - Department of Epidemiology

Yuan Wan

Hubei Provincial Center for Disease Control and Prevention - Institute of Preventive Medicine Information

Jing Cai

Hubei Provincial Center for Disease Control and Prevention - Institute of Preventive Medicine Information

Zhengmin Qian

Saint Louis University - Department of Epidemiology and Biostatistics

Ran Wu

Independent

Yunquan Zhang

Wuhan University of Science and Technology - Department of Department of Epidemiology and Biostatistics

Shiyu Zhang

Sun Yat-Sen University (SYSU) - Department of Epidemiology

Huan Li

Sun Yat-Sen University (SYSU) - Department of Epidemiology

Mingyan Li

Hubei Provincial Center for Disease Control and Prevention - Institute of Preventive Medicine Information

Edwin Trevathan

Vanderbilt University - Department of Pediatrics; Vanderbilt University - Department of Neurology; Vanderbilt University - Vanderbilt Institute for Global Health

Hualiang Lin

Sun Yat-Sen University (SYSU) - Department of Epidemiology

More...

Abstract

Background: Contact tracing with quarantine of SARS-CoV-2 positive contacts is required on an unprecedented scale worldwide.

Methods: During February 1-March 25, 2020, COVID-19 cases in Hubei province were traced by more than 1800 teams. PCR positive contacts without COVID-19 symptoms with two or more consecutive positive tests for SARS-CoV-2 were categorized as: (a) asymptomatic SARS-CoV-2 if without COVID-19 symptoms throughout the > 14 days of quarantine, (b) pre-symptomatic SARS-CoV-2 if COVID-19 symptoms started during the quarantine, and (c) false positive contacts if two consecutive follow-up qRT-PCRs were negative after an initial positive SARS-CoV-2 test.

Findings: 48,944 COVID-19 patients identified 277,066 contacts who were tested for SARS-CoV-2; upon ascertainment, 3,152 contacts without symptoms were SARS-CoV-2 PCR positive without symptoms, and 50 contacts were false positives. After quarantine, 2928 were classified as asymptomatic and 174 were pre-symptomatic SARS-CoV-2 contacts, with a pre-symptomatic case fatality (11/174) of 6.3%. The average interval between the initial SARS-CoV-2 PCR positive and onset of COVID-19 symptoms was 9.7 days, and the average time from onset of symptoms to death for deceased pre-symptomatic cases was 6.3 days (range = 1 - 35 days).

Interpretation: Contact tracing of COVID-19 cases required many contact tracing teams, testing all contacts without COVID-19 symptoms, and quarantine of asymptomatic SARS-CoV-2 positive contacts. Countries with limited contact tracing, testing and quarantine of asymptomatic SARS-CoV-2 infected contacts under-estimate the number of infected asymptomatic SARS-CoV-2 contacts, and their contribution to COVID-19 spread.

Funding Statement: National Natural Science Foundation of China (82041021), Bill & Melinda Gates Foundation (INV-006371).

Declaration of Interests: The authors declare they have no conflict of interest.

Ethics Approval Statement: This study was approved by the Medical Research Ethics Review Committee of Sun Yat-sen University School of Public Health (No.: 2020016). Consistent with public health regulations the informed consent was waived because data were collected as part of public health practice associated with the COVID-19 outbreak investigation and response.

Keywords: SARS-CoV-2, Covid-19, Asymptomatic SARS-CoV-2, Asymptomatic SARS-CoV-2, Pre-symptomatic SARS-CoV-2, Pre-symptomatic SARS-CoV-2, contrat tracing, contrat tracing

Suggested Citation

Zhang, Peng and Tian, Fei and Wan, Yuan and Cai, Jing and Qian, Zhengmin and Wu, Ran and Zhang, Yunquan and Zhang, Shiyu and Li, Huan and Li, Mingyan and Trevathan, Edwin and Lin, Hualiang, A Cohort of SARS-CoV-2 Infected Asymptomatic and Pre-Symptomatic Contacts from COVID-19 Contact Tracing in Hubei Province, China: Short-Term Outcomes. Available at SSRN: https://ssrn.com/abstract=3678556 or http://dx.doi.org/10.2139/ssrn.3678556

Peng Zhang

Hubei Provincial Center for Disease Control and Prevention - Institute of Preventive Medicine Information

China

Fei Tian

Sun Yat-Sen University (SYSU) - Department of Epidemiology

China

Yuan Wan

Hubei Provincial Center for Disease Control and Prevention - Institute of Preventive Medicine Information

China

Jing Cai

Hubei Provincial Center for Disease Control and Prevention - Institute of Preventive Medicine Information

China

Zhengmin Qian

Saint Louis University - Department of Epidemiology and Biostatistics

220 North Grand Boulevard
St. Louis, MO 63103
United States

Ran Wu

Independent

Yunquan Zhang

Wuhan University of Science and Technology - Department of Department of Epidemiology and Biostatistics ( email )

947 Heping Avenue,Qingshan District
null
Wuhan, Hubei 430081
China

Shiyu Zhang

Sun Yat-Sen University (SYSU) - Department of Epidemiology

China

Huan Li

Sun Yat-Sen University (SYSU) - Department of Epidemiology

China

Mingyan Li

Hubei Provincial Center for Disease Control and Prevention - Institute of Preventive Medicine Information

China

Edwin Trevathan (Contact Author)

Vanderbilt University - Department of Pediatrics ( email )

TN
United States

Vanderbilt University - Department of Neurology ( email )

Nashville, TN
United States

Vanderbilt University - Vanderbilt Institute for Global Health ( email )

NashvilleTN
United States

Hualiang Lin

Sun Yat-Sen University (SYSU) - Department of Epidemiology ( email )

China

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