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Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: A systematic review and meta-analysis

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  • Mercedes Yanes-Lane
  • Nicholas Winters
  • Federica Fregonese
  • Mayara Bastos
  • Sara Perlman-Arrow
  • Jonathon R Campbell
  • Dick Menzies

Abstract

Background: The study objective was to conduct a systematic review and meta-analysis on the proportion of asymptomatic infection among coronavirus disease 2019 (COVID-19) positive persons and their transmission potential. Methods: We searched Embase, Medline, bioRxiv, and medRxiv up to 22 June 2020. We included cohorts or cross-sectional studies which systematically tested populations regardless of symptoms for COVID-19, or case series of any size reporting contact investigations of asymptomatic index patients. Two reviewers independently extracted data and assessed quality using pre-specified criteria. Only moderate/high quality studies were included. The main outcomes were proportion of asymptomatic infection among COVID-19 positive persons at testing and through follow-up, and secondary attack rate among close contacts of asymptomatic index patients. A qualitative synthesis was performed. Where appropriate, data were pooled using random effects meta-analysis to estimate proportions and 95% confidence intervals (95% CI). Results: Of 6,137 identified studies, 71 underwent quality assessment after full text review, and 28 were high/moderate quality and were included. In two general population studies, the proportion of asymptomatic COVID-19 infection at time of testing was 20% and 75%, respectively; among three studies in contacts it was 8.2% to 50%. In meta-analysis, the proportion (95% CI) of asymptomatic COVID-19 infection in obstetric patients was 95% (45% to 100%) of which 59% (49% to 68%) remained asymptomatic through follow-up; among nursing home residents, the proportion was 54% (42% to 65%) of which 28% (13% to 50%) remained asymptomatic through follow-up. Transmission studies were too heterogenous to meta-analyse. Among five transmission studies, 18 of 96 (18.8%) close contacts exposed to asymptomatic index patients were COVID-19 positive. Conclusions: Despite study heterogeneity, the proportion of asymptomatic infection among COVID-19 positive persons appears high and transmission potential seems substantial. To further our understanding, high quality studies in representative general population samples are required.

Suggested Citation

  • Mercedes Yanes-Lane & Nicholas Winters & Federica Fregonese & Mayara Bastos & Sara Perlman-Arrow & Jonathon R Campbell & Dick Menzies, 2020. "Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-21, November.
    • Handle: RePEc:plo:pone00:0241536
    DOI: 10.1371/journal.pone.0241536
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    References listed on IDEAS

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    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
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    1. Christian Moser & Pierre Yared, 2022. "Pandemic Lockdown: The Role of Government Commitment," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 46, pages 27-50, October.
    2. Sara Barsanti & Virginia Sommati & Giulia Colombini, 2022. "Il vissuto degli operatori e l?emergenza Covid-19 nelle Residenze Sanitarie Assistenziali," MECOSAN, FrancoAngeli Editore, vol. 2022(122), pages 7-28.
    3. Holly Blake & Holly Knight & Ru Jia & Jessica Corner & Joanne R. Morling & Chris Denning & Jonathan K. Ball & Kirsty Bolton & Grazziela Figueredo & David E. Morris & Patrick Tighe & Armando Mendez Vil, 2021. "Students’ Views towards Sars-Cov-2 Mass Asymptomatic Testing, Social Distancing and Self-Isolation in a University Setting during the COVID-19 Pandemic: A Qualitative Study," IJERPH, MDPI, vol. 18(8), pages 1-19, April.
    4. Shoaib, Mohd & Mustafee, Navonil & Madan, Karan & Ramamohan, Varun, 2023. "Leveraging multi-tier healthcare facility network simulations for capacity planning in a pandemic," Socio-Economic Planning Sciences, Elsevier, vol. 88(C).
    5. Christian Moser & Pierre Yared, 2022. "Pandemic Lockdown: The Role of Government Commitment," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 46, pages 27-50, October.
    6. Michal Brzoza-Brzezina & Marcin Kolasa & Krzysztof Makarski, 2022. "Monetary Policy and COVID-19," International Journal of Central Banking, International Journal of Central Banking, vol. 18(1), pages 41-80, March.

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