ABSTRACT
Background Global evidence on the transmission of asymptomatic SARS-CoV-2 infection needs to be synthesized. Methods A search of 4 electronic databases (PubMed, EMBASE, Cochrane Library, and Web of Science databases) as of January 24, 2021 was performed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Studies which reported the transmission rate among close contacts with asymptomatic SARS-CoV-2 cases were included, and transmission activities occurred were considered. The transmission rates were pooled by zero-inflated beta distribution. The risk ratios (RRs) were calculated using random-effects models. Results Of 4923 records retrieved and reviewed, 15 studies including 3917 close contacts with asymptomatic indexes were eligible. The pooled transmission rates were 1.79 per 100 person-days (or 1.79%, 95% confidence interval [CI] 0.41%–3.16%) by asymptomatic index, which is significantly lower than by presymptomatic (5.02%, 95% CI 2.37%–7.66%;P<.001), and by symptomatic (5.27%, 95% CI 2.40%–8.15%;P<.001). Subgroup analyses showed that the household transmission rate of asymptomatic index was (4.22%, 95% CI 0.91%–7.52%), four times significantly higher than non-household transmission (1.03%, 95% CI 0.73%–1.33%;P=.03), and the asymptomatic transmission rate in China (1.82%, 95% CI 0.11%–3.53%) was lower than in other countries (2.22%, 95% CI 0.67%–3.77%;P=.01). Conclusions People with asymptomatic SARS-CoV-2 infection are at risk of transmitting the virus to their close contacts, particularly in household settings. The transmission potential of asymptomatic infection is lower than symptomatic and presymptomatic infections. This meta-analysis provides evidence for predicting the epidemic trend and promulgating vaccination and other control measures. Trial Registration Registered with PROSPERO International Prospective Register of Systematic Reviews, CRD42021269446;https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=269446
ABSTRACT
BACKGROUND: Anxiety is one of the psychological problems being experienced by the general population during the current coronavirus disease 2019 (COVID-19) pandemic. Health literacy, such as infectious-disease-specific health literacy, is associated with anxiety, but the mechanism of such association is not clear. This study explored the relationship between infectious-disease-specific health literacy and anxiety. METHODS: We conducted an online survey in Hubei province, the early epicenter of the COVID-19 pandemic. A total of 1038 COVID-19-negative participants accomplished a battery of online survey tools determining their sociodemographic characteristics, perceived risk of acquiring COVID-19, infectious-disease-specific health literacy, resilience, and anxiety symptoms. We examined the moderated mediation models, in which the mediator was resilience and the moderator was gender. RESULTS: Most (63%) of the study participants experienced at least mild anxiety. The indirect effect of infectious-disease-specific health literacy on anxiety through resilience was -0.282 (95% confidence interval [CI] = [-0.511, -0.083]), contributing to 32.7% of the total effect of health literacy on anxiety. Resilience fully mediated the association. The mediation effect of resilience tended to be stronger for the male participants than for the female participants as the moderation effect of gender remained until we included perceived risk of acquiring COVID-19 in the model. CONCLUSION: Resilience was found to mediate the association between infectious-disease-specific health literacy and anxiety. Individuals with good infectious-disease-specific health literacy are more likely to acquire higher resilience, which may in turn decrease their anxiety level. Males may benefit more from the mediation effect of resilience during the current pandemic. Infectious-disease-specific health literacy programs may help reduce the anxiety of the program participants by enhancing their resilience during a pandemic.
ABSTRACT
The COVID-19 outbreak in China was devastating, and spread throughout the country before being contained. Stringent physical distancing recommendations and shelter-in-place were first introduced in the hardest-hit provinces, and by March, these recommendations were uniform throughout the country. In the presence of an evolving and deadly pandemic, we sought to investigate the impact of this pandemic on individual well-being and prevention practices among Chinese urban residents. From March 2-11, 2020, 4,607 individuals were recruited from 11 provinces with varying numbers of COVID-19 casers using the social networking app WeChat to complete a brief, anonymous, online survey. The analytical sample was restricted to 2,551 urban residents. Standardized scales measured generalized anxiety disorder (GAD), the primary outcome. Multiple logistic regression was conducted to identify correlates of GAD alongside assessment of community practices in response to the COVID-19 pandemic. We found that during the COVID-19 pandemic, recommended public health practices significantly (p <0.001) increased, including wearing facial mask, practicing physical distancing, handwashing, decreased public spitting, and going outside in urban communities. Overall, 40.3% of participants met screening criteria for GAD and 49.3%, 62.6%, and 55.4% reported that their work, social life, and family life were interrupted by anxious feelings, respectively. Independent correlates of having anxiety symptoms included being a healthcare provider (aOR=1.58, p <0.01), living in regions with a higher density of COVID-19 cases (aOR=2.13, p <0.01), having completed college (aOR=1.38, p =0.03), meeting screening criteria for depression (aOR=6.03, p <0.01) and poorer perceived health status (aOR=1.54, p <0.01). COVID-19 had a profound impact on the health of urban dwellers throughout China. Not only did they markedly increase their self- and community-protective behaviors, but they also experienced high levels of anxiety associated with a heightened vulnerability like depression, having poor perceived health, and the potential of increased exposure to COVID-19 such as living closer to the epicenter of the pandemic.