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Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: A systematic review and meta-analysis.
Yanes-Lane, Mercedes; Winters, Nicholas; Fregonese, Federica; Bastos, Mayara; Perlman-Arrow, Sara; Campbell, Jonathon R; Menzies, Dick.
  • Yanes-Lane M; Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.
  • Winters N; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada.
  • Fregonese F; Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.
  • Bastos M; Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.
  • Perlman-Arrow S; Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.
  • Campbell JR; Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.
  • Menzies D; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada.
PLoS One ; 15(11): e0241536, 2020.
Article in English | MEDLINE | ID: covidwho-902054
ABSTRACT

BACKGROUND:

The study objective was to conduct a systematic review and meta-analysis on the proportion of asymptomatic infection among coronavirus disease 2019 (COVID-19) positive persons and their transmission potential.

METHODS:

We searched Embase, Medline, bioRxiv, and medRxiv up to 22 June 2020. We included cohorts or cross-sectional studies which systematically tested populations regardless of symptoms for COVID-19, or case series of any size reporting contact investigations of asymptomatic index patients. Two reviewers independently extracted data and assessed quality using pre-specified criteria. Only moderate/high quality studies were included. The main outcomes were proportion of asymptomatic infection among COVID-19 positive persons at testing and through follow-up, and secondary attack rate among close contacts of asymptomatic index patients. A qualitative synthesis was performed. Where appropriate, data were pooled using random effects meta-analysis to estimate proportions and 95% confidence intervals (95% CI).

RESULTS:

Of 6,137 identified studies, 71 underwent quality assessment after full text review, and 28 were high/moderate quality and were included. In two general population studies, the proportion of asymptomatic COVID-19 infection at time of testing was 20% and 75%, respectively; among three studies in contacts it was 8.2% to 50%. In meta-analysis, the proportion (95% CI) of asymptomatic COVID-19 infection in obstetric patients was 95% (45% to 100%) of which 59% (49% to 68%) remained asymptomatic through follow-up; among nursing home residents, the proportion was 54% (42% to 65%) of which 28% (13% to 50%) remained asymptomatic through follow-up. Transmission studies were too heterogenous to meta-analyse. Among five transmission studies, 18 of 96 (18.8%) close contacts exposed to asymptomatic index patients were COVID-19 positive.

CONCLUSIONS:

Despite study heterogeneity, the proportion of asymptomatic infection among COVID-19 positive persons appears high and transmission potential seems substantial. To further our understanding, high quality studies in representative general population samples are required.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Asymptomatic Infections Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study / Qualitative research / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2020 Document Type: Article Affiliation country: Journal.pone.0241536

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Coronavirus Infections / Asymptomatic Infections Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study / Qualitative research / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Limits: Humans Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2020 Document Type: Article Affiliation country: Journal.pone.0241536