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The Lancet Psychiatry ; 8(5):e14-e15, 2021.
Article in English | APA PsycInfo | ID: covidwho-1340924


The current article discusses an efficient way to assess the effect of COVID-19 on mental health in the general population. It is maintained tat a meta-ecological study is needed to explore te effect of geograpically and temporally different pandemic characteristics o npopulations;mental health. Despite their potential shortcomings due to confounding and aggregation bias, meta-ecological study designs have successfully answered similar global questions, such as the role of air pollution on morbidity. In a meta-ecological study, a systematic review of prevalence before and during the pandemic in various locations with different responses to the pandemic should shed light on changes in mental health problems. It is concluded that because a meta-ecological study uses published and regularly updated information, it does not require expensive or time-consuming data collection. The crowdsourcing approach will speed up the process and could be the way forward to do large-scale research in times of social isolation. Investment in methods for harnessing information in a reliable and rapid way will enable decision makers worldwide to integrate a mental health science perspective into their response to the pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

PLoS Med ; 17(9): e1003346, 2020 09.
Article in English | MEDLINE | ID: covidwho-788852


BACKGROUND: There is disagreement about the level of asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We conducted a living systematic review and meta-analysis to address three questions: (1) Amongst people who become infected with SARS-CoV-2, what proportion does not experience symptoms at all during their infection? (2) Amongst people with SARS-CoV-2 infection who are asymptomatic when diagnosed, what proportion will develop symptoms later? (3) What proportion of SARS-CoV-2 transmission is accounted for by people who are either asymptomatic throughout infection or presymptomatic? METHODS AND FINDINGS: We searched PubMed, Embase, bioRxiv, and medRxiv using a database of SARS-CoV-2 literature that is updated daily, on 25 March 2020, 20 April 2020, and 10 June 2020. Studies of people with SARS-CoV-2 diagnosed by reverse transcriptase PCR (RT-PCR) that documented follow-up and symptom status at the beginning and end of follow-up or modelling studies were included. One reviewer extracted data and a second verified the extraction, with disagreement resolved by discussion or a third reviewer. Risk of bias in empirical studies was assessed with an adapted checklist for case series, and the relevance and credibility of modelling studies were assessed using a published checklist. We included a total of 94 studies. The overall estimate of the proportion of people who become infected with SARS-CoV-2 and remain asymptomatic throughout infection was 20% (95% confidence interval [CI] 17-25) with a prediction interval of 3%-67% in 79 studies that addressed this review question. There was some evidence that biases in the selection of participants influence the estimate. In seven studies of defined populations screened for SARS-CoV-2 and then followed, 31% (95% CI 26%-37%, prediction interval 24%-38%) remained asymptomatic. The proportion of people that is presymptomatic could not be summarised, owing to heterogeneity. The secondary attack rate was lower in contacts of people with asymptomatic infection than those with symptomatic infection (relative risk 0.35, 95% CI 0.10-1.27). Modelling studies fit to data found a higher proportion of all SARS-CoV-2 infections resulting from transmission from presymptomatic individuals than from asymptomatic individuals. Limitations of the review include that most included studies were not designed to estimate the proportion of asymptomatic SARS-CoV-2 infections and were at risk of selection biases; we did not consider the possible impact of false negative RT-PCR results, which would underestimate the proportion of asymptomatic infections; and the database does not include all sources. CONCLUSIONS: The findings of this living systematic review suggest that most people who become infected with SARS-CoV-2 will not remain asymptomatic throughout the course of the infection. The contribution of presymptomatic and asymptomatic infections to overall SARS-CoV-2 transmission means that combination prevention measures, with enhanced hand hygiene, masks, testing tracing, and isolation strategies and social distancing, will continue to be needed.

Asymptomatic Infections/epidemiology , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Asymptomatic Diseases/epidemiology , Betacoronavirus , COVID-19 , Coronavirus Infections/physiopathology , Coronavirus Infections/transmission , Disease Progression , Humans , Mass Screening , Pandemics , Pneumonia, Viral/physiopathology , Pneumonia, Viral/transmission , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2