Relative infectiousness of asymptomatic SARS-CoV-2 infected persons compared with symptomatic individuals: a rapid scoping review

• Published in: BMJ open Vol. 11; no. 5; p. e042354
• Main Authors: McEvoy, David, McAloon, Conor, Collins, Aine, Hunt, Kevin, Butler, Francis, Byrne, Andrew, Casey-Bryars, Miriam, Barber, Ann, Griffin, John, Lane, Elizabeth Ann, Wall, Patrick, More, Simon John
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 04.05.2021; BMJ Publishing Group
• Series: Original research
• Subjects: Asymptomatic; Bias; Clinical decision making; Cohort Studies; Contact Tracing; Coronaviruses; COVID-19; Decision making; Disease transmission; Epidemics; Epidemiology; Estimates; Humans; Infections; Mass Screening; Methods; Pandemics; Public health; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Systematic review; COVID-19; epidemiology; infectious diseases
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-042354

ObjectivesThe aim of this study was to determine the relative infectiousness of asymptomatic SARS-CoV-2 infected persons compared with symptomatic individuals based on a scoping review of available literature.DesignRapid scoping review of peer-reviewed literature from 1 January to 5 December 2020 using the LitCovid database and the Cochrane library.SettingInternational studies on the infectiousness of individuals infected with SARS-CoV-2.ParticipantsStudies were selected for inclusion if they defined asymptomatics as a separate cohort distinct from presymptomatics and if they provided a quantitative measure of the infectiousness of asymptomatics relative to symptomatics.Primary outcome measuresPCR result (PCR studies), the rate of infection (mathematical modelling studies) and secondary attack rate (contact tracing studies) - in each case from asymptomatic in comparison with symptomatic individuals.ResultsThere are only a limited number of published studies that report estimates of relative infectiousness of asymptomatic compared with symptomatic individuals. 12 studies were included after the screening process. Significant differences exist in the definition of infectiousness. PCR studies in general show no difference in shedding levels between symptomatic and asymptomatic individuals; however, the number of study subjects is generally limited. Two modelling studies estimate relative infectiousness to be 0.43 and 0.57, but both of these were more reflective of the infectiousness of undocumented rather than asymptomatic cases. The results from contact tracing studies include estimates of relative infectiousness of 0, but with insufficient evidence to conclude that it is significantly different from 1.ConclusionsThere is considerable heterogeneity in estimates of relative infectiousness highlighting the need for further investigation of this important parameter. It is not possible to provide any conclusive estimate of relative infectiousness, as the estimates from the reviewed studies varied between 0 and 1.