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2.
JAMA ; 328(15): 1523-1533, 2022 10 18.
Article in English | MEDLINE | ID: covidwho-2074838

ABSTRACT

Importance: Data on the epidemiology of mild to moderately severe COVID-19 are needed to inform public health guidance. Objective: To evaluate associations between 2 or 3 doses of mRNA COVID-19 vaccine and attenuation of symptoms and viral RNA load across SARS-CoV-2 viral lineages. Design, Setting, and Participants: A prospective cohort study of essential and frontline workers in Arizona, Florida, Minnesota, Oregon, Texas, and Utah with COVID-19 infection confirmed by reverse transcriptase-polymerase chain reaction testing and lineage classified by whole genome sequencing of specimens self-collected weekly and at COVID-19 illness symptom onset. This analysis was conducted among 1199 participants with SARS-CoV-2 from December 14, 2020, to April 19, 2022, with follow-up until May 9, 2022, reported. Exposures: SARS-CoV-2 lineage (origin strain, Delta variant, Omicron variant) and COVID-19 vaccination status. Main Outcomes and Measures: Clinical outcomes included presence of symptoms, specific symptoms (including fever or chills), illness duration, and medical care seeking. Virologic outcomes included viral load by quantitative reverse transcriptase-polymerase chain reaction testing along with viral viability. Results: Among 1199 participants with COVID-19 infection (714 [59.5%] women; median age, 41 years), 14.0% were infected with the origin strain, 24.0% with the Delta variant, and 62.0% with the Omicron variant. Participants vaccinated with the second vaccine dose 14 to 149 days before Delta infection were significantly less likely to be symptomatic compared with unvaccinated participants (21/27 [77.8%] vs 74/77 [96.1%]; OR, 0.13 [95% CI, 0-0.6]) and, when symptomatic, those vaccinated with the third dose 7 to 149 days before infection were significantly less likely to report fever or chills (5/13 [38.5%] vs 62/73 [84.9%]; OR, 0.07 [95% CI, 0.0-0.3]) and reported significantly fewer days of symptoms (10.2 vs 16.4; difference, -6.1 [95% CI, -11.8 to -0.4] days). Among those with Omicron infection, the risk of symptomatic infection did not differ significantly for the 2-dose vaccination status vs unvaccinated status and was significantly higher for the 3-dose recipients vs those who were unvaccinated (327/370 [88.4%] vs 85/107 [79.4%]; OR, 2.0 [95% CI, 1.1-3.5]). Among symptomatic Omicron infections, those vaccinated with the third dose 7 to 149 days before infection compared with those who were unvaccinated were significantly less likely to report fever or chills (160/311 [51.5%] vs 64/81 [79.0%]; OR, 0.25 [95% CI, 0.1-0.5]) or seek medical care (45/308 [14.6%] vs 20/81 [24.7%]; OR, 0.45 [95% CI, 0.2-0.9]). Participants with Delta and Omicron infections who received the second dose 14 to 149 days before infection had a significantly lower mean viral load compared with unvaccinated participants (3 vs 4.1 log10 copies/µL; difference, -1.0 [95% CI, -1.7 to -0.2] for Delta and 2.8 vs 3.5 log10 copies/µL, difference, -1.0 [95% CI, -1.7 to -0.3] for Omicron). Conclusions and Relevance: In a cohort of US essential and frontline workers with SARS-CoV-2 infections, recent vaccination with 2 or 3 mRNA vaccine doses less than 150 days before infection with Delta or Omicron variants, compared with being unvaccinated, was associated with attenuated symptoms, duration of illness, medical care seeking, or viral load for some comparisons, although the precision and statistical significance of specific estimates varied.


Subject(s)
COVID-19 Vaccines , COVID-19 , Vaccination , Viral Load , Adult , Female , Humans , Male , COVID-19/diagnosis , COVID-19/genetics , COVID-19/prevention & control , COVID-19/virology , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/therapeutic use , Prospective Studies , RNA, Viral/analysis , RNA, Viral/genetics , RNA-Directed DNA Polymerase , SARS-CoV-2/genetics , Vaccination/statistics & numerical data , United States/epidemiology , Viral Load/drug effects , Viral Load/genetics , Viral Load/statistics & numerical data , Whole Genome Sequencing , Asymptomatic Infections/epidemiology , Asymptomatic Infections/therapy , Time Factors , Patient Acceptance of Health Care/statistics & numerical data
3.
PLoS One ; 17(3): e0264901, 2022.
Article in English | MEDLINE | ID: covidwho-1742010

ABSTRACT

BACKGROUND: The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the possible development of serious illness, and the possibility of severe obstetric outcomes highlight the importance of addressing SARS-CoV-2 infection in obstetric management. METHODS AND FINDINGS: A cross-sectional study of pregnant women assisted in a high-risk maternity hospital in Brazil in 2020. All patients admitted for delivery or miscarriage care were tested for SARS-CoV-2 using polymerase chain reaction (PCR) and for immunoglobulin (I)gM, and/or IgG by immunochromatography. Clinical aspects and obstetric outcomes were analyzed. A total of 265 pregnant women were included in the study. There were 38 (14.4%) PCR positive cases during pregnancy, 12 (31.6%) on admission screening, and 71(27.2%) patients were IgM- and/or IgG-positive. Among the participants, 86 (32.4%) had at least one positive test during pregnancy. SARS-CoV-2 positive patients had greater contact with known positive patients (p = 0.005). The most frequently reported symptoms were runny nose, cough, loss of smell and taste, headache, and fever. There was also a 35% rate of asymptomatic infections and a 4.6% rate of severe or critical infections. Patients exposed or infected with SARS-CoV-2 had a higher incidence of preterm delivery, cesarean section, need for resuscitation in the delivery room, Apgar score <7 at 5 min, admission to the neonatal intensive care unit, and jaundice. Newborns with at least one positive test had a significantly greater need for phototherapy after delivery (p = 0.05). The results showed a high rate of positive tests among newborns (37.5%), which seems to be compatible with both neonatal and perinatal infection. CONCLUSIONS: It is important to further investigate SARS-CoV-2 infection during pregnancy, including the clinical course and the possibility of adverse outcomes with impact on maternal and fetal health, regardless of the development of symptoms.


Subject(s)
COVID-19/epidemiology , Hospitals, Maternity , Pregnancy Complications, Infectious/epidemiology , Pregnancy Outcome , Prenatal Care , SARS-CoV-2 , Adolescent , Adult , Asymptomatic Infections/epidemiology , Asymptomatic Infections/therapy , Brazil/epidemiology , COVID-19/therapy , Cross-Sectional Studies , Female , Humans , Pregnancy , Pregnancy Complications, Infectious/therapy
5.
Int J Biol Sci ; 17(4): 1119-1124, 2021.
Article in English | MEDLINE | ID: covidwho-1181770

ABSTRACT

With ongoing research, it was found that asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was widespread in coronavirus disease 2019 (COVID-19) populations. Studies have confirmed asymptomatic patients with COVID-19 have potential infectivity, and most of the transmission occurred before symptoms appear. Asymptomatic infection rates varied widely in different countries and regions. Identifying the asymptomatic infected persons and cutting off the infection source is an effective way to prevent the spread of this disease. However, asymptomatic patients have hidden clinical symptoms, and screening based only on the clinical symptoms of COVID-19 can easily lead to a missed diagnosis. Therefore, determining asymptomatic infection patients by SARS-CoV-2 nucleic acid testing is the gold standard. A series of prevention and control measures adopted by the Chinese government, especially the "Four Early" policy, have achieved outstanding achievements, which are worth learning from by other countries.


Subject(s)
Asymptomatic Infections/epidemiology , COVID-19/epidemiology , Asymptomatic Infections/therapy , COVID-19/transmission , COVID-19/virology , China/epidemiology , Humans , SARS-CoV-2/isolation & purification , SARS-CoV-2/pathogenicity
6.
Elife ; 102021 04 08.
Article in English | MEDLINE | ID: covidwho-1173059

ABSTRACT

The BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech) is being utilised internationally for mass COVID-19 vaccination. Evidence of single-dose protection against symptomatic disease has encouraged some countries to opt for delayed booster doses of BNT162b2, but the effect of this strategy on rates of asymptomatic SARS-CoV-2 infection remains unknown. We previously demonstrated frequent pauci- and asymptomatic SARS-CoV-2 infection amongst healthcare workers (HCWs) during the UK's first wave of the COVID-19 pandemic, using a comprehensive PCR-based HCW screening programme (Rivett et al., 2020; Jones et al., 2020). Here, we evaluate the effect of first-dose BNT162b2 vaccination on test positivity rates and find a fourfold reduction in asymptomatic infection amongst HCWs ≥12 days post-vaccination. These data provide real-world evidence of short-term protection against asymptomatic SARS-CoV-2 infection following a single dose of BNT162b2 vaccine, suggesting that mass first-dose vaccination will reduce SARS-CoV-2 transmission, as well as the burden of COVID-19 disease.


Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Asymptomatic Infections/therapy , BNT162 Vaccine , COVID-19/diagnosis , COVID-19 Vaccines/administration & dosage , Health Personnel , Humans , Immunization Schedule , Immunization, Secondary , SARS-CoV-2/isolation & purification , Vaccination
7.
Travel Med Infect Dis ; 41: 102058, 2021.
Article in English | MEDLINE | ID: covidwho-1171219

ABSTRACT

BACKGROUND: COVID-19 can be asymptomatic in a substantial proportion of patients. The assessment and management of these patients constitute a key element to stop dissemination. AIM: To describe the assessment and treatment of asymptomatic infection in patients with a confirmed diagnosis of COVID-19. METHODS: We searched five databases and search engines for preprints/preproofs, up to August 22, 2020. We included cohort, cross-sectional, and case series studies, reporting the assessment and management of asymptomatic individuals. We extracted data on total discharges with negative PCR, length of hospitalization, treatment, and number of patients who remained asymptomatic. A random-effects model with inverse variance method was used to calculate the pooled prevalence. RESULTS: 41 studies (nine cross-sectional studies, five retrospective studies and 27 reports/case series; 647 asymptomatic individuals), were included, of which 47% were male (233/501). The age of patients was between 1month and 73 years. In patients who became symptomatic, length of hospitalization mean was 13.6 days (SD 6.4). Studies used lopinavir/ritonavir, hydroxychloroquine plus ritonavir/lopinavir, hydroxychloroquine with and without azithromycin, ribavirin plus interferon and interferon alfa. The proportion of individuals who remained asymptomatic was 91% (463/588 patients; 95%CI: 78.3%-98.7%); and asymptomatic individuals discharged with negative PCR was 86% (102/124 individuals; 95%CI: 58.4%-100%). CONCLUSIONS: There is no standard treatment for asymptomatic COVID-19 individuals. There are no studies of adequate design to make this decision. It has been shown that most asymptomatic individuals who were followed have recovered, but this cannot be attributed to standard treatment.


Subject(s)
Asymptomatic Infections/therapy , COVID-19 Drug Treatment , COVID-19/diagnosis , Adolescent , Adult , Aged , Anti-Bacterial Agents/therapeutic use , Antiviral Agents/therapeutic use , Azithromycin/therapeutic use , COVID-19 Nucleic Acid Testing/methods , Child , Child, Preschool , Drug Therapy, Combination , Female , Hospitalization , Humans , Hydroxychloroquine/therapeutic use , Infant , Lopinavir/therapeutic use , Male , Middle Aged , Reverse Transcriptase Polymerase Chain Reaction/methods , Ritonavir/therapeutic use , SARS-CoV-2/isolation & purification , Young Adult
8.
Cancer Treat Res Commun ; 27: 100346, 2021.
Article in English | MEDLINE | ID: covidwho-1108205

ABSTRACT

OBJECTIVE: Several factors raise concern for increased risk of COVID-19 in cancer patients. While there is strong support for testing symptomatic patients. The benefit of routine testing of asymptomatic patients remains contentious. We aim to evaluate the prevalence of asymptomatic COVID-19 infection in cancer patients. METHODS: Between June 1 and September 3, 2020, we obtained nasopharyngeal swab from asymptomatic cancer patients who were visiting a single tertiary-care cancer center, and tested the specimen for the presence or absence of SARS-CoV-2 RNA. We performed a descriptive statistic of data RESULTS: We tested a total of 80 patients, of which 3 (3.75%) were found positive for COVID-19. A significant proportion of the tested patients were on active immunosuppressive or immunomodulatory treatment, cytotoxic chemotherapy (n = 34), and immunotherapy (n = 16). However, all three COVID-19 positive patients were only actively on hormonal therapy. All three patients observed a minimum of 2 weeks home quarantine. None of the patients developed symptoms upon follow up and no changes were required to their treatment plan. CONCLUSIONS: Despite published evidence that cancer patients may be at increased risk of severe COVID -19 infection, our data suggest that some infected cancer patients are asymptomatic. The overall prevalence of asymptomatic COVID-19 infection in this population of cancer patients was similar to that in the general population. Therefore, since asymptomatic infections are not uncommon in patients with cancer, we recommend universal COVID-19 testing to help guide treatment decisions and prevent the spread of the disease.


Subject(s)
Asymptomatic Infections/therapy , COVID-19/prevention & control , Neoplasms/therapy , SARS-CoV-2/isolation & purification , Tertiary Care Centers , Adult , Aged , Aged, 80 and over , Asymptomatic Infections/epidemiology , COVID-19/diagnosis , COVID-19/virology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Neoplasms/diagnosis , Neoplasms/epidemiology , New York City/epidemiology , Pandemics , Prevalence , Prospective Studies , RNA, Viral/analysis , RNA, Viral/genetics , SARS-CoV-2/genetics , SARS-CoV-2/physiology
10.
Medicine (Baltimore) ; 99(51): e23547, 2020 Dec 18.
Article in English | MEDLINE | ID: covidwho-1010676

ABSTRACT

ABSTRACT: This study aims to investigate the clinical characteristics and viral shedding kinetics of asymptomatic patients with coronavirus disease 2019 (COVID-19).The data of 38 asymptomatic patients positive for SARS-CoV-2 nucleic acid were collected from February to March 2020 in Tuanfeng County, Huanggang, Hubei, China. The epidemiology, laboratory examination, chest imaging, viral nucleic acid test results, clinical characteristics, and viral shedding time were summarized in this retrospective study.The study included 20 family members of patients with COVID-19, 10 medical personnel participating in COVID-19 treatment or working in a fever clinic, 6 personnel from quarantine places, 1 individual with a close contact history with confirmed patients, and 1 local epidemic prevention personnel. All were positive for SARS-CoV-2 nucleic acid. The white blood cell (WBC) count, the absolute value of lymphocytes, C-reactive protein (CRP), and D-dimer were normal. Pneumonia manifestations were not found in the chest computed tomography (CT) scan of 36 patients; the remaining 2 cases included a 1-year-old child and a pregnant woman, and they did not undergo chest CT. The viral shedding time was 6 days.All asymptomatic patients with COVID-19 had a history of close contact or exposure. Laboratory tests were normal. Chest imaging did not show any pneumonia manifestation. The viral shedding time was <10 days, which is shorter than that of patients with COVID-19. A timely discovery of such asymptomatic infections is crucial for blocking the spread of the virus and strengthening the prevention and control measures.


Subject(s)
Asymptomatic Infections/epidemiology , COVID-19/virology , SARS-CoV-2 , Virus Shedding , Adolescent , Adult , Asymptomatic Infections/therapy , COVID-19/blood , COVID-19/diagnostic imaging , COVID-19/epidemiology , Child , China/epidemiology , Female , Humans , Indoles/therapeutic use , Infant , Male , Medicine, Chinese Traditional , Middle Aged , Radiography, Thoracic , Retrospective Studies , Young Adult
11.
Trials ; 21(1): 892, 2020 Oct 27.
Article in English | MEDLINE | ID: covidwho-895025

ABSTRACT

OBJECTIVES: The primary objectives of this study are to determine efficacy of Siddha medicine, Kabasura kudineer in reduction of SARS-CoV-2 viral load and reducing the onset of symptoms in asymptomatic COVID-19 when compared to Vitamin C and Zinc (CZ) supplementation. In addition, the trial will examine the changes in the immunological markers of the Siddha medicine against control. The secondary objectives of the trial are to evaluate the safety of the Siddha medicine and to document clinical profile of asymptomatic COVID-19 as per principles of Siddha system of Medicine. TRIAL DESIGN: A single centre, open-label, parallel group (1:1 allocation ratio), exploratory randomized controlled trial. PARTICIPANTS: Cases admitted at non-hospital settings designated as COVID Care Centre and managed by the State Government Stanley Medical College, Chennai, Tamil Nadu, India will be recruited. Eligible participants will be those tested positive for COVID-19 by Reverse Transcriptase Polymerase Chain reaction (RT-PCR) aged 18 to 55 years without any symptoms and co-morbidities like diabetes mellitus, hypertension and bronchial asthma. Those pregnant or lactating, with severe respiratory disease, already participating in COVID trials and with severe illness like malignancy will be excluded. INTERVENTION AND COMPARATOR: Adopting traditional methods, decoction of Kabasura kudineer will be prepared by boiling 5g of KSK powder in 240 ml water and reduced to one-fourth (60ml) and filtered. The KSK group will receive a dose of 60ml decoction, orally in the morning and evening after food for 14 days. The control group will receive Vitamin C (60000 IU) and Zinc tablets (100mg) orally in the morning and evening respectively for 14 days. MAIN OUTCOMES: The primary outcomes are the reduction in the SARS-CoV-2 load [as measured by cyclic threshold (CT) value of RT-PCR] from the baseline to that of seventh day of the treatment, prevention of progression of asymptomatic to symptomatic state (clinical symptoms like fever, cough and breathlessness) and changes in the immunity markers [Interleukins (IL) 6, IL10, IL2, Interferon gamma (IFNγ) and Tumor Necrosis Factor (TNF) alpha]. Clinical assessment of COVID-19 as per standard Siddha system of medicine principles and the occurrence of adverse effects will be documented as secondary outcomes. RANDOMISATION: The assignment to the study or control group will be allocated in equal numbers through randomization using random number generation in Microsoft Excel by a statistician who is not involved in the trial. The allocation scheme will be made by an independent statistician using a sealed envelope. The participants will be allocated immediately after the eligibility assessment and informed consent procedures. BLINDING (MASKING): This study is unblinded. The investigators will be blinded to data analysis, which will be carried out by a statistician who is not involved in the trial. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): Sample size could not be calculated, as there is no prior trial on KSK. This trial will be a pilot trial. Hence, we intend to recruit 60 participants in total using a 1:1 allocation ratio, with 30 participants randomised into each arm. TRIAL STATUS: Protocol version 2.0 dated 16th May 2020. Recruitment is completed. The trial started recruitment on the 25th May 2020. We anticipate study including data analysis will finish on November 2020. We also stated that protocol was submitted before the end of data collection TRIAL REGISTRATION: The study protocol was registered with clinical trial registry of India (CTRI) with CTRI/2020/05/025215 on 16 May 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).


Subject(s)
Ascorbic Acid , Betacoronavirus , Coronavirus Infections , Medicine, Ayurvedic/methods , Pandemics , Pneumonia, Viral , Zinc , Adult , Ascorbic Acid/administration & dosage , Ascorbic Acid/adverse effects , Asymptomatic Infections/therapy , Betacoronavirus/drug effects , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Dietary Supplements , Drug Monitoring/methods , Female , Humans , India , Male , Pneumonia, Viral/diagnosis , Pneumonia, Viral/drug therapy , Randomized Controlled Trials as Topic , SARS-CoV-2 , Treatment Outcome , Viral Load/methods , Zinc/administration & dosage , Zinc/adverse effects
12.
Cancer Med ; 9(21): 8020-8028, 2020 11.
Article in English | MEDLINE | ID: covidwho-838604

ABSTRACT

Oncologic patients are regarded as the population most at risk of developing a severe course of COVID-19 due to the fact that malignant diseases and chemotherapy often weaken the immune system. In the face of the ongoing SARS-CoV-2 pandemic, how particular patients deal with this infection remains an important question. In the period between the 15 and 26 April 2020, a total of 1227 patients were tested in one of seven oncologic outpatient clinics for SARS-CoV-2, regardless of symptoms, employing RT-qPCR. Of 1227 patients, 78 (6.4%) were tested positive of SARS-CoV-2. Only one of the patients who tested positive developed a severe form of COVID-19 with pneumonia (CURB-65 score of 2), and two patients showed mild symptoms. Fourteen of 75 asymptomatic but positively tested patients received chemotherapy or chemo-immunotherapy according to their regular therapy algorithm (±4 weeks of SARS-CoV-2 test), and 48 of 78 (61.5%) positive-tested patients received glucocorticoids as co-medication. None of the asymptomatic infected patients showed unexpected complications due to the SARS-CoV-2 infection during the cancer treatment. These data clearly contrast the view that patients with an oncologic disease are particularly vulnerable to SARS-CoV-2 and suggest that compromising therapies could be continued or started despite the ongoing pandemic. Moreover the relatively low appearance of symptoms due to COVID-19 among patients on chemotherapy and other immunosuppressive co-medication like glucocorticoids indicate that suppressing the response capacity of the immune system reduces disease severity.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Asymptomatic Infections/therapy , Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Neoplasms/drug therapy , Outpatients/statistics & numerical data , Pneumonia, Viral/epidemiology , COVID-19 , Coronavirus Infections/transmission , Coronavirus Infections/virology , Female , Germany/epidemiology , Humans , Male , Middle Aged , Neoplasms/virology , Pandemics , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Prognosis , SARS-CoV-2
14.
Cochrane Database Syst Rev ; 9: CD013628, 2020 09 16.
Article in English | MEDLINE | ID: covidwho-774574

ABSTRACT

BACKGROUND: COVID-19 infection poses a serious risk to patients and - due to its contagious nature - to those healthcare workers (HCWs) treating them. The risks of transmission of infection are greater when a patient is undergoing an aerosol-generating procedure (AGP). Not all those with COVID-19 infection are symptomatic, or suspected of harbouring the infection. If a patient who is not known to have or suspected of having COVID-19 infection is to undergo an AGP, it would nonetheless be sensible to minimise the risk to those HCWs treating them. If the mouth and nose of an individual undergoing an AGP are irrigated with antimicrobial solutions, this may be a simple and safe method of reducing the risk of any covert infection being passed to HCWs through droplet transmission or direct contact. Alternatively, the use of antimicrobial solutions by the HCW may decrease the chance of them acquiring COVID-19 infection. However, the use of such antimicrobial solutions may be associated with harms related to the toxicity of the solutions themselves or alterations in the natural microbial flora of the mouth or nose. OBJECTIVES: To assess the benefits and harms of antimicrobial mouthwashes and nasal sprays administered to HCWs and/or patients when undertaking AGPs on patients without suspected or confirmed COVID-19 infection. SEARCH METHODS: Information Specialists from Cochrane ENT and Cochrane Oral Health searched the Central Register of Controlled Trials (CENTRAL 2020, Issue 6); Ovid MEDLINE; Ovid Embase and additional sources for published and unpublished trials. The date of the search was 1 June 2020.  SELECTION CRITERIA: This is a question that urgently requires evidence, however at the present time we did not anticipate finding many completed RCTs. We therefore planned to include the following types of studies: randomised controlled trials (RCTs); quasi-RCTs; non-randomised controlled trials; prospective cohort studies; retrospective cohort studies; cross-sectional studies; controlled before-and-after studies. We set no minimum duration for the studies.   We sought studies comparing any antimicrobial mouthwash and/or nasal spray (alone or in combination) at any concentration, delivered to the patient or HCW before and/or after an AGP. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures. Our primary outcomes were: 1) incidence of symptomatic or test-positive COVID-19 infection in HCWs or patients; 2) significant adverse event: anosmia (or disturbance in sense of smell). Our secondary outcomes were: 3) COVID-19 viral content of aerosol (when present); 4) change in COVID-19 viral load at site(s) of irrigation; 5) other adverse events: changes in microbiome in oral cavity, nasal cavity, oro- or nasopharynx; 6) other adverse events: allergy, irritation/burning of nasal, oral or oropharyngeal mucosa (e.g. erosions, ulcers, bleeding), long-term staining of mucous membranes or teeth, accidental ingestion. We planned to use GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS: We found no completed studies to include in this review.   AUTHORS' CONCLUSIONS: We identified no studies for inclusion in this review, nor any ongoing studies. The absence of completed studies is not surprising given the relatively recent emergence of COVID-19 infection. However, we are disappointed that this important clinical question is not being addressed by ongoing studies.


Subject(s)
Anti-Infective Agents/administration & dosage , Betacoronavirus , Coronavirus Infections/transmission , Health Personnel , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Mouthwashes/administration & dosage , Nasal Sprays , Pneumonia, Viral/transmission , Administration, Intranasal , Air Microbiology , Anti-Infective Agents/adverse effects , Asymptomatic Infections/therapy , COVID-19 , Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Humans , Mouth/virology , Mouthwashes/adverse effects , Nose/virology , Occupational Diseases/etiology , Occupational Diseases/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/therapy , SARS-CoV-2
16.
Medicine (Baltimore) ; 99(35): e21927, 2020 Aug 28.
Article in English | MEDLINE | ID: covidwho-740206

ABSTRACT

BACKGROUND: The number of patients infected with novel coronavirus disease (COVID-19) has exceeded 10 million in 2020, and a large proportion of them are asymptomatic. At present, there is still no effective treatment for this disease. Traditional Chinese medicine (TCM) shows a good therapeutic effect on COVID-19, especially for asymptomatic patients. According to the search results, we found that although there are many studies on COVID-19, there are no studies targeting asymptomatic infections. Therefore, we design a network meta-analysis (NMA) to evaluate the therapeutic effect of TCM on asymptomatic COVID-19. METHODS: We will search Chinese and English databases to collect all randomized controlled trials (RCTs) of TCM combined with conventional western medicine or using only TCM to treat asymptomatic COVID-19 from December 2019 to July 2020. Then, two investigators will independently filter the articles, extract data, and evaluate the risk of bias. We will conduct a Bayesian NMA to evaluate the effects of different therapies. All data will be processed by Stata 16.0 and WinBUGS. RESULTS: This study will evaluate the effectiveness of various treatments for asymptomatic COVID-19. The outcome indicators include the time when the nucleic acid turned negative, the proportion of patients with disease progression, changes in laboratory indicators, and the side effects of drugs. CONCLUSION: This analysis will further improve the treatment of asymptomatic COVID-19. INPLASY REGISTRATION NUMBER: INPLASY202070022.


Subject(s)
Combined Modality Therapy/methods , Coronavirus Infections/therapy , Medicine, Chinese Traditional/methods , Pneumonia, Viral/therapy , Asymptomatic Infections/therapy , Bayes Theorem , Betacoronavirus/drug effects , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/drug therapy , Humans , Network Meta-Analysis , Pandemics , Research Design , SARS-CoV-2 , Treatment Outcome , COVID-19 Drug Treatment
18.
JAMA Intern Med ; 180(11): 1447-1452, 2020 Nov 01.
Article in English | MEDLINE | ID: covidwho-696078

ABSTRACT

IMPORTANCE: There is limited information about the clinical course and viral load in asymptomatic patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). OBJECTIVE: To quantitatively describe SARS-CoV-2 molecular viral shedding in asymptomatic and symptomatic patients. DESIGN, SETTING, AND PARTICIPANTS: A retrospective evaluation was conducted for a cohort of 303 symptomatic and asymptomatic patients with SARS-CoV-2 infection between March 6 and March 26, 2020. Participants were isolated in a community treatment center in Cheonan, Republic of Korea. MAIN OUTCOMES AND MEASURES: Epidemiologic, demographic, and laboratory data were collected and analyzed. Attending health care personnel carefully identified patients' symptoms during isolation. The decision to release an individual from isolation was based on the results of reverse transcription-polymerase chain reaction (RT-PCR) assay from upper respiratory tract specimens (nasopharynx and oropharynx swab) and lower respiratory tract specimens (sputum) for SARS-CoV-2. This testing was performed on days 8, 9, 15, and 16 of isolation. On days 10, 17, 18, and 19, RT-PCR assays from the upper or lower respiratory tract were performed at physician discretion. Cycle threshold (Ct) values in RT-PCR for SARS-CoV-2 detection were determined in both asymptomatic and symptomatic patients. RESULTS: Of the 303 patients with SARS-CoV-2 infection, the median (interquartile range) age was 25 (22-36) years, and 201 (66.3%) were women. Only 12 (3.9%) patients had comorbidities (10 had hypertension, 1 had cancer, and 1 had asthma). Among the 303 patients with SARS-CoV-2 infection, 193 (63.7%) were symptomatic at the time of isolation. Of the 110 (36.3%) asymptomatic patients, 21 (19.1%) developed symptoms during isolation. The median (interquartile range) interval of time from detection of SARS-CoV-2 to symptom onset in presymptomatic patients was 15 (13-20) days. The proportions of participants with a negative conversion at day 14 and day 21 from diagnosis were 33.7% and 75.2%, respectively, in asymptomatic patients and 29.6% and 69.9%, respectively, in symptomatic patients (including presymptomatic patients). The median (SE) time from diagnosis to the first negative conversion was 17 (1.07) days for asymptomatic patients and 19.5 (0.63) days for symptomatic (including presymptomatic) patients (P = .07). The Ct values for the envelope (env) gene from lower respiratory tract specimens showed that viral loads in asymptomatic patients from diagnosis to discharge tended to decrease more slowly in the time interaction trend than those in symptomatic (including presymptomatic) patients (ß = -0.065 [SE, 0.023]; P = .005). CONCLUSIONS AND RELEVANCE: In this cohort study of symptomatic and asymptomatic patients with SARS-CoV-2 infection who were isolated in a community treatment center in Cheonan, Republic of Korea, the Ct values in asymptomatic patients were similar to those in symptomatic patients. Isolation of asymptomatic patients may be necessary to control the spread of SARS-CoV-2.


Subject(s)
Asymptomatic Infections , Hospitals, Isolation , Patient Isolation/methods , SARS-CoV-2 , Viral Load/methods , Virus Shedding , Adult , Asymptomatic Infections/epidemiology , Asymptomatic Infections/therapy , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Epidemiological Monitoring , Female , Hospitals, Isolation/methods , Hospitals, Isolation/statistics & numerical data , Humans , Male , Public Health/statistics & numerical data , Republic of Korea/epidemiology , Retrospective Studies , SARS-CoV-2/isolation & purification , SARS-CoV-2/physiology , Symptom Assessment/methods , Symptom Assessment/statistics & numerical data
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