24 April 2020

Asymptomatic carriers of coronavirus are the problem

Excerpts from an article in today's New England Journal of Medicine:
When Covid-19 burst onto the global scene, public health officials initially deployed interventions that were used to control severe acute respiratory syndrome (SARS) in 2003, including symptom-based case detection and subsequent testing to guide isolation and quarantine. This initial approach was justified by the many similarities between SARS-CoV-1 and SARS-CoV-2, including high genetic relatedness, transmission primarily through respiratory droplets, and the frequency of lower respiratory symptoms (fever, cough, and shortness of breath) with both infections developing a median of 5 days after exposure.

However, despite the deployment of similar control interventions, the trajectories of the two epidemics have veered in dramatically different directions. Within 8 months, SARS was controlled after SARS-CoV-1 had infected approximately 8100 persons in limited geographic areas. Within 5 months, SARS-CoV-2 has infected more than 2.6 million people and continues to spread rapidly around the world.

What explains these differences in transmission and spread? A key factor in the transmissibility of Covid-19 is the high level of SARS-CoV-2 shedding in the upper respiratory tract, even among presymptomatic patients, which distinguishes it from SARS-CoV-1, where replication occurs mainly in the lower respiratory tract...

An important finding of this report is that more than half the residents of this skilled nursing facility (27 of 48) who had positive tests were asymptomatic at testing. Moreover, live coronavirus clearly sheds at high concentrations from the nasal cavity even before symptom development...

Asymptomatic transmission of SARS-CoV-2 is the Achilles’ heel of Covid-19 pandemic control through the public health strategies we have currently deployed. Symptom-based screening has utility, but epidemiologic evaluations of Covid-19 outbreaks within skilled nursing facilities such as the one described by Arons et al. strongly demonstrate that our current approaches are inadequate...
More at the link.


  1. This comment has been removed by a blog administrator.

  2. This is the nail on the head. We don't know what we don't measure. It appears that active non-measurement is a tool used by some states. So it appears. The second bite at the apple is covid 19 Relapse or Reinfection. This interview with a South Korean epidemiologist gives, in my opinion, some pretty good information in this interview.


  3. the system works quite well where it is implemented. i live in Australia, and both us and our neighbor New Zealand went early with border closures lock downs and contact tracing. countries run by poor leaders talked about hoaxes and herd immunity and the economy. don't blame basic pandemic procedures for your tens of thousands of dead, blame your countries leadership or rather the lack of it


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