Thread by @ErinSandersNP, THREAD: 1/ Given my interactions with @ASlavitt and @jeremyfaust yesterday, I decided [...]

THREAD:
1/ Given my interactions with @ASlavitt and @jeremyfaust yesterday, I decided to make a compiled list of data on asymptomatic transmission. This is not complete, but the most striking data I have seen on #COVID19 and #SARSCoV2 worldwide. https://twitter.com/ASlavitt/status/1249914030267019264

https://twitter.com/ASlavitt/status/1249914030267019264

2/ A nice summary published in @TIME yesterday:

Covert coronavirus infections could be seeding new outbreaks
https://www.nature.com/articles/d41586-020-00822-x

3/ USA (NY) #usaCoronavirus #NewYork

Universal Screening for #SARSCoV2 in Women Admitted for Delivery @ColumbiaWomens @NB83
- 33 positive cases, 29 (87%) asymptomatic
- https://www.nejm.org/doi/full/10.1056/NEJMc2009316

Universal Screening for SARS-CoV-2 in Women Admitted for Delivery | NEJM

Correspondence from The New England Journal of Medicine — Universal Screening for SARS-CoV-2 in Women Admitted for Delivery

https://www.nejm.org/doi/full/10.1056/NEJMc2009316

4/ USA (MA) #usaCoronavirus

#SARSCoV2 titers in wastewater are higher than expected from clinically confirmed cases
- #viral titer in feces to be about 3000 times higher than that in sampled raw sewage
- https://www.medrxiv.org/content/10.1101/2020.04.05.20051540v1.full.pdf

5/ #CHINA:

Covid-19: 4/5 of cases are #asymptomatic, #CHINA figures
- Found 43 000 cases of asymptomatic infection through contact tracing
- 166 new infections, 130 (78%) asymptomatic identified in the 24 hours to the afternoon of Wednesday 1 April
- https://bmj.com/content/369/bmj.m1375?=&utm_source=adestra&utm_medium=email&utm_campaign=usage&utm_content=daily&utm_term=text…

Covid-19: four fifths of cases are asymptomatic, China figures indicate

New evidence has emerged from China indicating that the large majority of coronavirus infections do not result in symptoms. Chinese authorities began publishing daily figures on 1 April on the number...

https://bmj.com/content/369/bmj.m1375?=&utm_source=adestra&utm_medium=email&utm_campaign=usage&utm_content=daily&utm_term=text

6/ #CHINA:

Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus ( #SARSCoV2 )
undocumented infections was 55% of documented infections https://science.sciencemag.org/content/early/2020/03/24/science.abb3221

Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus...

Estimation of the prevalence and contagiousness of undocumented novel coronavirus (SARS-CoV2) infections is critical for understanding the overall prevalence and pandemic potential of this disease....

https://science.sciencemag.org/content/early/2020/03/24/science.abb3221

7/ #CHINA:

A familial cluster of pneumonia associated with the 2019 novel #coronavirus indicating person-to-person transmission: a study of a family cluster
- Reports of #asymptomatic infected children
- https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/fulltext

A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-p...

Our findings are consistent with person-to-person transmission of this novel coronavirus in hospital and family settings, and the reports of infected travellers in other geographical regions.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/fulltext

8/ #DIAMONDPRINCESS ( #JAPAN):

Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020
- 634 confirmed cases, 328 (51.7%) were reported to be asymptomatic.
- https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180

9/ #ICELAND:

- Iceland countrywide data
- 0.3%-0.8% of Iceland's population is infected with the respiratory illness, about 50% of those who test positive for the virus are #asymptomatic when they are tested
- https://covid.is/data
- https://www.marketwatch.com/story/iceland-finds-that-half-its-citizens-with-coronavirus-have-shown-no-symptoms-2020-04-10

Iceland finds that half its citizens with coronavirus have shown no symptoms

The island has tested more of its population for COVID-19 than any other country.

https://covid.is/data

10/ #JAPAN

Estimation of the asymptomatic ratio of novel coronavirus infections (COVID-19)
- Among the Japanese patients evacuated from Wuhan, the center of the coronavirus outbreak, 30.8% were asymptomatic.
- https://www.ijidonline.com/article/S1201-9712(20)30139-9/pdf

11/ #SOUTHKOREA:

- “Korea currently has a significantly higher rate of asymptomatic cases than other countries, perhaps due to our extensive testing," said Jeong Eun-kyeong, director of KCDC, at a press briefing on 03/16/2020.
- https://www.dw.com/en/up-to-30-of-coronavirus-cases-asymptomatic/a-52900988

A third of coronavirus cases asymptomatic

In South Korea, nationwide testing, comprehensive isolation of Covid-19 patients and strict rules on social interaction have shown results. The measures have proved effective in slowing the spread of...

https://www.dw.com/en/up-to-30-of-coronavirus-cases-asymptomatic/a-52900988

12/ OTHER HELPFUL ARTICLES:

Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany
- https://www.nejm.org/doi/full/10.1056/NEJMc2001468

Coronavirus: Why it’s so deadly in Italy
- Demographics and why they are a warning to other countries
- https://medium.com/@andreasbackhausab/coronavirus-why-its-so-deadly-in-italy-c4200a15a7bf

Coronavirus: Why it’s so deadly in Italy

Demographics and why they are a warning to other countries

https://www.nejm.org/doi/full/10.1056/NEJMc2001468

13/ Of additional concern is prolonged asymptomatic viral shedding:

A special case of COVID-19 with long duration of viral shedding for 49 days (CHINA) https://www.medrxiv.org/content/10.1101/2020.03.22.20040071v1

A special case of COVID-19 with long duration of viral shedding for 49 days

Prolonged viral shedding is associated with severe status and poor prognosis of COVID-19 patients. Unexpectedly, here we report a non-severe patient with the longest duration of viral shedding....

https://www.medrxiv.org/content/10.1101/2020.03.22.20040071v1

14/ PROLONGED VIRAL SHEDDING

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study (CHINA)
- Viral shedding of survivors can occur on average for 20 days, at max 37 days. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a...

The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding...

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext

15/ I hope no one believes that I am an expert on #SARSCoV2 or believes that *I* think I am an expert on #COVID19

My role has been asking questions, synthesizing ideas, and hoping to catalyze discussion amongst colleagues.

More thinking, more questions…
@ScottGottliebMD

16/ If you are also curious or interested in my late night medical #COVID19 and #SARSCOV2 queries please check out my other 3 threads:

THREAD 1: Hypercoagulable State in COVID19 https://threadreaderapp.com/thread/1248512794749739008.html

Thread by @ErinSandersNP: 1/ #Frontline clinicians across the world are observing a #hypercoagula...

Thread by @ErinSandersNP: 1/ #Frontline clinicians across the world are observing a #hypercoagulable state in patients with #COVID19. Could td varied effects of the disease on multiple organ systems...

https://threadreaderapp.com/thread/1248512794749739008.html

17/ THREAD 2: COVID19 as a Biphasic Disease of Hypercoagulable State and Endothelial Damage Followed by Immune Response
https://threadreaderapp.com/thread/1249236555962646528.html

THREAD 3: Eyes, ENT, Neuro, and #SARSCoV2 https://threadreaderapp.com/thread/1249790563991400450.html

Thread by @ErinSandersNP: THREAD 1/ I hope no one believes that I am an expert on #SARSCoV2 or...

Thread by @ErinSandersNP: THREAD 1/ I hope no one believes that I am an expert on #SARSCoV2 or believes that “I” think I am an expert on #COVffort to contribute to the greater good of this #pandemic...

https://threadreaderapp.com/thread/1249236555962646528.html

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@threadreaderapp please unroll

#USA #usaCoronavirus

4800 sailors on aircraft carrier
>600 sailors (12.5%) tested positive for #SARSCoV2
~360 sailors (~60%) who tested positive have no symptoms https://www.reuters.com/article/us-health-coronavirus-usa-military-sympt-idUSKCN21Y2GB

Coronavirus clue? Most cases aboard U.S. aircraft carrier are symptom-free

Sweeping testing of the entire crew of the coronavirus-stricken U.S. aircraft carrier Theodore Roosevelt may have revealed a clue about the pandemic: The majority of the positive cases so far are...

https://www.reuters.com/article/us-health-coronavirus-usa-military-sympt-idUSKCN21Y2GB

Yet another data point to add to the amassing pile of ASYMPTOMATIC TRANSMISSION:

#Boston #homeless shelter #USA #usaCoronavirus
397 people tested
146 people (36.7%) tested positive for #SARSCoV2
146 people (100%) who tested positive have no symptoms https://www.boston25news.com/news/cdc-reviewing-stunning-universal-testing-results-boston-homeless-shelter/Z253TFBO6RG4HCUAARBO4YWO64/

CDC reviewing ‘stunning’ universal testing results from Boston homeless shelter

The Centers for Disease Control and Prevention is now “actively looking into” results from universal COVID-19 testing at Pine Street Inn homeless shelter.

https://www.boston25news.com/news/cdc-reviewing-stunning-universal-testing-results-boston-homeless-shelter/Z253TFBO6RG4HCUAARBO4YWO64/

#SantaClara County
- 3,330 individuals tested
- 50 tested positive (1.5%)

Seroprevalence of antibodies to #SARSCoV2 is 2.49%-4.16%, with uncertainty bounds ranging from 1.80%-5.70%.

#COVID19 cases likely 40-84 fold higher than currently reported

https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1.full.pdf

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