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Magnitude of asymptomatic COVID-19 cases throughout the course of infection: A systematic review and meta-analysis

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  • Muluneh Alene
  • Leltework Yismaw
  • Moges Agazhe Assemie
  • Daniel Bekele Ketema
  • Belayneh Mengist
  • Bekalu Kassie
  • Tilahun Yemanu Birhan

Abstract

Background: Asymptomatic SARS-CoV-2 infections are responsible for potentially significant transmission of COVID-19. Worldwide, a number of studies were conducted to estimate the magnitude of asymptomatic COVID-19 cases. However, there is a need for more robust and well-designed studies to have a relevant public health intervention. Synthesis of the available studies significantly strengthens the quality of evidences for public health practice. Thus, this systematic review and meta-analysis aimed to determine the overall magnitude of asymptomatic COVID-19 cases throughout the course of infection using available evidences. Methods: We followed the PRISMA checklist to present this study. Two experienced review authors (MA and DBK) were systematically searched international electronic databases for studies. We performed meta-analysis using R statistical software. The overall weighted proportion of asymptomatic COVID-19 cases throughout the course infection was computed. The pooled estimates with 95% confidence intervals were presented using forest plot. Egger’s tests were used to assess publication bias, and primary estimates were pooled using a random effects model. Furthermore, a sensitivity analysis was conducted to assure the robustness of the result. Results: A total of 28 studies that satisfied the eligibility criteria were included in this systematic review and meta-analysis. Consequently, in the meta-analysis, a total of 6,071 COVID-19 cases were included. The proportion of asymptomatic infections among the included studies ranged from 1.4% to 78.3%. The findings of this meta-analysis showed that the weighted pooled proportion of asymptomatic COVID-19 cases throughout the course of infection was 25% (95%CI: 16–38). The leave-one out result also revealed that the weighted pooled average of asymptomatic SARS-CoV-2 infection was between 28% and 31.4%. Conclusions: In conclusion, one-fourth of SARS-CoV-2 infections are remained asymptomatic throughout the course infection. Scale-up of testing, which targeting high risk populations is recommended to tackle the pandemic.

Suggested Citation

  • Muluneh Alene & Leltework Yismaw & Moges Agazhe Assemie & Daniel Bekele Ketema & Belayneh Mengist & Bekalu Kassie & Tilahun Yemanu Birhan, 2021. "Magnitude of asymptomatic COVID-19 cases throughout the course of infection: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 16(3), pages 1-11, March.
    • Handle: RePEc:plo:pone00:0249090
    DOI: 10.1371/journal.pone.0249090
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    References listed on IDEAS

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    1. Muluneh Alene & Leltework Yismaw & Yebelay Berelie & Bekalu Kassie & Reta Yeshambel & Moges Agazhe Assemie, 2020. "Prevalence and determinants of unintended pregnancy in Ethiopia: A systematic review and meta-analysis of observational studies," PLOS ONE, Public Library of Science, vol. 15(4), pages 1-15, April.
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    1. Jun Wei Ng & Eric Tzyy Jiann Chong & Yee Ann Tan & Heng Gee Lee & Lan Lan Chan & Qin Zhi Lee & Yen Tsen Saw & Yiko Wong & Ahmad Aizudeen Bin Zakaria & Zarina Binti Amin & Ping-Chin Lee, 2022. "Prevalence of Coronavirus Disease 2019 (COVID-19) in Different Clinical Stages before the National COVID-19 Vaccination Programme in Malaysia: A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 19(4), pages 1-12, February.

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