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Real Asymptomatic SARS-CoV-2 Infection Might Be Rare: Importance of Careful Interviews and Follow-up.
J Korean Med Sci. 2020 Sep 21; 35(37):e333.JK

Abstract

BACKGROUND

There is limited information on the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) who are asymptomatic or have mild symptoms.

METHODS

We performed a retrospective case series of patients with COVID-19 enrolled from February 22 to March 26, 2020. Forty cases of COVID-19 were confirmed using real-time reverse-transcription polymerase chain reaction among patients who underwent screening tests and were consecutively hospitalized at Ulsan University Hospital, Ulsan, Korea. The final follow-up date was May 19, 2020. All COVID-19 cases in Ulsan were included. Demographic and epidemiological information, comorbidities, clinical signs and symptoms, laboratory and radiologic findings, medications, treatments, outcomes, and main durations of patients with COVID-19 were compared according to supplemental oxygen requirement.

RESULTS

Forty patients were included (median age, 30 years; interquartile range [IQR], 25-57 years; 58% female). Six (15%) patients required supplemental oxygen. The prevalence of asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection was 5% and that of presymptomatic infection was 13%. Cough, fever, myalgia, rhinorrhea or nasal congestion, and diarrhea were the screening criteria for diagnosing symptomatic and presymptomatic SARS-CoV-2 infections. Sputum production, chest discomfort, a large number of symptoms, abnormal procalcitonin and C-reactive protein levels, and abnormal chest X-ray or chest computed tomography findings were more common in patients requiring supplemental oxygen than in those not requiring supplemental oxygen. Overall mortality rate was 3% (1/40). Four patients (10%) were readmitted after testing positive by reverse-transcription polymerase chain reaction again. Incubation period was 5 days (IQR, 4-6 days), and the duration of viral shedding was 21 days (IQR, 14-28 days; maximum, 51 days).

CONCLUSION

The prevalence of asymptomatic SARS-CoV-2 infection was 5%, which is much lower than that previously reported. This finding suggests that careful interviews and follow-ups should be performed to identify SARS-CoV-2 infections. Cough, fever, myalgia, rhinorrhea or nasal congestion, and diarrhea are adequate screening criteria for covering all symptoms of SARS-CoV-2 infection. Further evaluation is required to create representative screening criteria for COVID-19.

Authors+Show Affiliations

Department of Family Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea. jeongth@uuh.ulsan.kr.Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.Department of Family Medicine, Daegu Medical Center, Daegu, Korea.Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.Department of Family Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32959547

Citation

Jeong, Tae Heum, et al. "Real Asymptomatic SARS-CoV-2 Infection Might Be Rare: Importance of Careful Interviews and Follow-up." Journal of Korean Medical Science, vol. 35, no. 37, 2020, pp. e333.
Jeong TH, Pak C, Ock M, et al. Real Asymptomatic SARS-CoV-2 Infection Might Be Rare: Importance of Careful Interviews and Follow-up. J Korean Med Sci. 2020;35(37):e333.
Jeong, T. H., Pak, C., Ock, M., Lee, S. H., Son, J. S., & Jeon, Y. J. (2020). Real Asymptomatic SARS-CoV-2 Infection Might Be Rare: Importance of Careful Interviews and Follow-up. Journal of Korean Medical Science, 35(37), e333. https://doi.org/10.3346/jkms.2020.35.e333
Jeong TH, et al. Real Asymptomatic SARS-CoV-2 Infection Might Be Rare: Importance of Careful Interviews and Follow-up. J Korean Med Sci. 2020 Sep 21;35(37):e333. PubMed PMID: 32959547.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Real Asymptomatic SARS-CoV-2 Infection Might Be Rare: Importance of Careful Interviews and Follow-up. AU - Jeong,Tae Heum, AU - Pak,Chuiyong, AU - Ock,Minsu, AU - Lee,Seock Hwan, AU - Son,Joung Sik, AU - Jeon,Young Jee, Y1 - 2020/09/21/ PY - 2020/08/20/received PY - 2020/08/31/accepted PY - 2020/9/22/entrez PY - 2020/9/23/pubmed PY - 2020/10/6/medline KW - Asymptomatic KW - COVID-19 KW - Korea KW - Prevalence KW - SARS-CoV-2 SP - e333 EP - e333 JF - Journal of Korean medical science JO - J Korean Med Sci VL - 35 IS - 37 N2 - BACKGROUND: There is limited information on the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) who are asymptomatic or have mild symptoms. METHODS: We performed a retrospective case series of patients with COVID-19 enrolled from February 22 to March 26, 2020. Forty cases of COVID-19 were confirmed using real-time reverse-transcription polymerase chain reaction among patients who underwent screening tests and were consecutively hospitalized at Ulsan University Hospital, Ulsan, Korea. The final follow-up date was May 19, 2020. All COVID-19 cases in Ulsan were included. Demographic and epidemiological information, comorbidities, clinical signs and symptoms, laboratory and radiologic findings, medications, treatments, outcomes, and main durations of patients with COVID-19 were compared according to supplemental oxygen requirement. RESULTS: Forty patients were included (median age, 30 years; interquartile range [IQR], 25-57 years; 58% female). Six (15%) patients required supplemental oxygen. The prevalence of asymptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection was 5% and that of presymptomatic infection was 13%. Cough, fever, myalgia, rhinorrhea or nasal congestion, and diarrhea were the screening criteria for diagnosing symptomatic and presymptomatic SARS-CoV-2 infections. Sputum production, chest discomfort, a large number of symptoms, abnormal procalcitonin and C-reactive protein levels, and abnormal chest X-ray or chest computed tomography findings were more common in patients requiring supplemental oxygen than in those not requiring supplemental oxygen. Overall mortality rate was 3% (1/40). Four patients (10%) were readmitted after testing positive by reverse-transcription polymerase chain reaction again. Incubation period was 5 days (IQR, 4-6 days), and the duration of viral shedding was 21 days (IQR, 14-28 days; maximum, 51 days). CONCLUSION: The prevalence of asymptomatic SARS-CoV-2 infection was 5%, which is much lower than that previously reported. This finding suggests that careful interviews and follow-ups should be performed to identify SARS-CoV-2 infections. Cough, fever, myalgia, rhinorrhea or nasal congestion, and diarrhea are adequate screening criteria for covering all symptoms of SARS-CoV-2 infection. Further evaluation is required to create representative screening criteria for COVID-19. SN - 1598-6357 UR - https://www.unboundmedicine.com/medline/citation/32959547/Real_Asymptomatic_SARS_CoV_2_Infection_Might_Be_Rare:_Importance_of_Careful_Interviews_and_Follow_up_ L2 - https://jkms.org/DOIx.php?id=10.3346/jkms.2020.35.e333 DB - PRIME DP - Unbound Medicine ER -