Rates of Asymptomatic COVID-19 Infection and Associated Factors in Olmsted County, MN in the Pre-Vaccination Era

ABSTRACT

Objective To estimate rates and identify factors associated with asymptomatic COVID-19 in the population of Olmsted County during the pre-vaccination era. Patients and Methods We screened first responders (N=191) and Olmsted County employees (N=564) for antibodies to SARS-CoV-2 from November 2020 to February 2021 to estimate seroprevalence and asymptomatic infection. Second, we retrieved all PCR confirmed COVID-19 diagnoses in Olmsted County from March 2020 through January 2021, ed symptom information, estimated rates of asymptomatic infection and examined related factors. Results Twenty (10.5%;95%CI 6.9%-15.6%) first responders and thirty-eight (6.7%;95% CI 5.0%-9.1%) county employees had positive antibodies;an additional 5 (2.6%) and 10 (1.8%) had prior positive PCR tests per self-report or medical record, but no antibodies detected. Of persons with symptom information, 4/20, (20%, 95% CI 3.0%-37.0%) of first responders and 10/39 (26%, 95% CI 12.6%-40.0%) county employees, were asymptomatic. Of 6,020 positive PCR tests in Olmsted County with symptom information between March 1, 2020, and January 31, 2021, 6% (n=385;95% CI 5.8%-7.1%) were asymptomatic. Factors associated with asymptomatic disease included age [0-18 years (OR=2.3, 95% CI 1.7-3.1) and 65+ years (OR=1.40, 95% CI 1.0-2.0) compared to ages 19-44 years], body-mass-index [overweight OR=0.58, 95% CI 0.44-0.77) or obese (OR=0.48, 95% CI 0.57-0.62) compared to normal or underweight] and tests after November 20, 2020 [(OR=1.35;95% CI 1.13-1.71) compared to prior dates]. Conclusion Asymptomatic rates in Olmsted County prior to vaccine rollout ranged from 6-25%, and younger age, normal weight, and later tests dates were associated with asymptomatic infection.