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Real Asymptomatic SARS-CoV-2 Infection Might Be Rare: Importance of Careful Interviews and Follow-up

Journal of Korean Medical Science 2020년 35권 37호 p.333 ~ 333
정태흠, Pak Chuiyong, 옥민수, 이석환, 손정식, 전영지,
소속 상세정보
정태흠 ( Jeong Tae-Heum ) - University of Ulsan College of Medicine Ulsan University Hospital Department of Family Medicine
 ( Pak Chuiyong ) - University of Ulsan College of Medicine Ulsan University Hospital Department of Internal Medicine
옥민수 ( Ock Min-Su ) - University of Ulsan College of Medicine Ulsan University Hospital Department of Preventive Medicine
이석환 ( Lee Seock-Hwan ) - Daegu Medical Center Department of Family Medicine
손정식 ( Son Joung-Sik ) - Seoul National University Hospital Department of Family Medicine
전영지 ( Jeon Young-Jee ) - University of Ulsan College of Medicine Ulsan University Hospital Department of Family Medicine

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.

키워드

Prevalence; Asymptomatic; COVID-19; SARS-CoV-2; Korea

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