COVID-19 causes lung damage in patients who do not present with fever
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Available literature acknowledges that COVID-19 can be asymptomatic or present with minimal signs, but the retrieved evidence only partially covers asymptomatic presentation and does not establish the specific causal link to lung damage in patients presenting without a fever.
Since the outbreak of coronavirus disease 2019 (COVID-19) in late December 2019, it has brought significant harm and challenges to over 200 countries and regions around the world. However, there is increasing evidence that many patients with COVID-19 are asymptomatic or have only mild symptoms, but they are able to transmit the virus to others. There are difficulties in screening for asymptomatic infections, which makes it more difficult for national prevention and control of this epidemic. This article reviews the characteristics, treatment, and outcomes of asymptomatic infections with COVID-19, hoping it would be helpful for early prevention and control of this severe public health threat worldwide.
These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. Abstract Since the outbreak of coronavirus disease 2019 (COVID-19) in late December 2019, it has brought significant harm and challenges to over 200 countries and regions around the world. However, there is increasing evidence that
3 However, with the global outbreak of coronavirus, there is increasing evidence that many infections of COVID-19 are asymptomatic, but they can transmit the virus to others. Asymptomatic infections refer to the positive detection of nucleic acid of SARS-CoV-2 in patient samples by reverse transcriptase-polymerase chain reaction (RT-PCR), but have no typical clinical symptoms or signs, and no apparent abnormalities in images, including lung computed tomography (CT). 4 The clinical characteristics of asymptomatic infections and other types of COVID-19 are shown in Table 1 . Early recognition of an infected person and cutting off the route of transmission are key points to control COVID-19.
However, most asymptomatic infections do not seek medical assistance due to no obvious clinical signs and poor prevention awareness, which contribute to the rapid spread of COVID-19. Therefore, it is a great challenge to prevent and control this specific type of patient globally, which requires more attention worldwide. Table 1 Clinical characteristics of asymptomatic infections and other types of COVID-19. 2 , 3 Table 1 Type Clinical characteristics RT-PCR test for COVID-19 Asymptomatic No clinical symptoms and chest imaging findings. Positive Mild Mild clinical symptoms, such as fever, fatigue, cough, anorexia, malaise, muscle pain, sore throat, dyspnea, nasal congestion, headache.
Positive RT-PCR, reverse transcriptase-polymerase chain reaction; RR, respiratory rate; Pa0 2, arterial partial pressure of oxygen; Fi0 2, oxygen concentration; ICU, intensive care unit. Infectivity Asymptomatic infections have the same infectivity as symptomatic infections. 5 It has been reported that a 53-year-old UK patient with an asymptomatic COVID-19 infection may cause 11 infections. 6 A report pointed out that one asymptomatic person who experienced 19 days from contact with the source of infection to RT-PCR confirmation may have infected 5 people. 7 These asymptomatic cases may play a role in the transmission and therefore pose a significant challenge to infection control.
One case in Wuhan tracked the prevalence of 1391 children under 15 years old who had been in close contact with infected or suspected cases. 13 The incidence of asymptomatic infections in the children is lower than that of the whole population, we propose that it is related to the special immune response and ACE2 level in the children's bodies. 14 According to these studies, the ability of asymptomatic infections to spread the virus is not low, and these patients are likely to cause a new round of outbreaks. Therefore, finding asymptomatic infections is the key point for early prevention and control of COVID-19 worldwide.
17 That is, sometimes, despite ongoing high viral loads, no live virus can be isolated, which means that viral nucleic acid positivity does not indicate infectivity. 18 It is also proved by a clinical study in which the recovered COVID-19 patients who had no obvious clinical symptoms were detected to be positive for SARS-CoV-2 by hyper-sensitive viral nucleic acid re-examination methods, but these patients had not caused new infections. 19 Due to the limited data from current studies, we think that it is necessary for us to be highly vigilant to asymptomatic infections.
Also, colleagues, friends, and people who coincide with the trajectories of diagnosed or suspected patients are all regarded as high-risk populations. Familial cluster has made the epidemic challenging to prevent and control. Some family members do not have any clinical manifestations, but the nucleic acid test result is positive, and this has become a major difficulty in the prevention and treatment of COVID-19. In one case report, all three of the family members were diagnosed with COVID-19, and only one family member had clinical symptoms.
24 Family members of COVID-19 patients, even without any symptoms, should be closely monitored and examined to rule out infection. These cases also highlight the need for a close epidemiological investigation to prevent the omission of possible sources of contamination. Different individuals may have different clinical signs. Studies have shown that asymptomatic infections are more common in populations of young and middle-aged individuals with functional performance status without underlying diseases.
26 Because ACE2-mediated angiotensin II (Ang ll) degradation plays an important role in the pathogenesis of severe lung failure after a viral infection, the severity of the virus infection is closely related to the maturity and binding capacity of ACE2. 27 Therefore, we supposed that a lower level of ACE2 and weaker binding capacity with SARS-CoV-2 should be a major factor that leads to the absence of any clinical manifestations for asymptomatic infections. It has been reported that only a specific mild immune response is caused by the SARS-CoV-2 invasion in asymptomatic patients.
Presently, coronavirus disease-19 (COVID-19) is spreading worldwide without an effective treatment method. For COVID-19, which is often asymptomatic, it is essential to adopt a method that does not cause aggravation, as well as a method to prevent infection. Whether aggravation can be predicted by analyzing the extent of lung damage on chest computed tomography (CT) scans was examined. The extent of lung damage on pre-intubation chest CT scans of 277 patients with COVID-19 was assessed. It was observed that aggravation occurred when the CT scan showed extensive damage associated with ground-gl
For COVID-19, which is often asymptomatic, it is essential to adopt a method that does not cause aggravation, as well as a method to prevent infection. Whether aggravation can be predicted by analyzing the extent of lung damage on chest computed tomography (CT) scans was examined. The extent of lung damage on pre-intubation chest CT scans of 277 patients with COVID-19 was assessed. It was observed that aggravation occurred when the CT scan showed extensive damage associated with ground-glass opacification and/or consolidation ( p < 0.0001). The extent of lung damage was similar across the upper, middle, and lower fields.
status released display-pdf yes is-olf no is-manuscript no is-preprint no is-journal-matter no is-scanned no is-retracted no Received 2021 Nov 29; Accepted 2022 Oct 12; Collection date 2022. Introduction Coronavirus disease-19 (COVID-19) that broke out in 2019 in Wuhan, Hubei Province, China, has spread worldwide [ 1 ]. At present, the disease lacks an effective treatment method [ 2 ]. As a result, most patients with COVID-19 develop pneumonia, which aggravates in some and becomes life-threatening. Moreover, this troublesome virus often causes an asymptomatic infection and is therefore difficult to prevent [ 3 ].
Additionally, in patients with COVID-19, consolidation is observed only in some areas, and the significance of consolidation is unclear. Therefore, since our institution accepts patients with moderate to severe pneumonia by COVID-19, we investigated what predictors of severe disease were present in patients who consequently transitioned from moderate to severe disease. Particularly, whether chest CT scans can predict the aggravation of pneumonia was examined. Additionally, if aggravation can be predicted, how soon it can be predicted after the appearance of symptoms was examined.
In the analysis according to the various time periods, as per the tendency for all age groups, it was found that on chest CTs taken early after onset from the T2 period onwards, the area of damage correlated with severe pneumonia ( Fig 5C ). Discussion Presently, COVID-19 is spreading worldwide without an effective treatment method. COVID-19 is often asymptomatic; therefore, it is challenging to prevent actual infection [ 3 ]. The problem is that some patients with COVID-19 show aggravation of the condition, whereas the condition becomes fatal in some.
Therefore, it is believed that individuals with COVID-19 infection should be identified and that it is crucial to adopt an approach that prevents aggravation. Whether aggravation could be predicted by focusing on the extent of lung damage on CT was examined. It was found that aggravation occurred when there was extensive damage associated with GGO and/or consolidation on chest CT scans with a significant difference as previously reported. Upon comparing the extent of the lung damage according to the regions, comparable results were obtained for the upper, middle, and lower regions.
Additionally, on evaluating the extent of lung damage at several days after onset, a significant
An insignificant difference in age and underlying disease was found between the SPG and NSPG, consistent with previous reports [ 10 , 13 ]. A previous report showed that advanced age (≥65 years) correlated with the deterioration of the clinical outcomes of patients with COVID-19 [ 14 ]; therefore, the extent of lung damage on CT according to age was evaluated. Linear regression was observed on the evaluation of all the age groups, especially in those aged ≥65 years.
It has been highlighted that COVID-19 is often asymptomatic and is difficult to control. Therefore, it is vital to prevent its aggravation. For patients with risk factors for aggravation, it is particularly imperative to evaluate chest CT scans as an indicator of aggravation. Patients whose condition aggravated demonstrated an increase in the extent of lung damage on chest CT scans obtained early after onset. Early CT findings can predict and improve prognosis through rapid and appropriate management. Supporting information S1 Checklist (DOCX) Click here for additional data file. S1 Data (CSV) Click here for additional data file.
The Role of Chest Imaging in Patient Management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society. Radiology 2020; 296:172–180. (3) Line 202-224 : “Analysis according to site”, “…..in terms of the area with damage combining GGO and consolidation in the upper, middle, and lower lobes (Fig 3A).” -----According to your methodology the so called “the upper, middle, and lower lobes” in this study actually are not the same the terminology of upper, middle, and lower lobes in lung anatomy. Readers will get confused if your “lobe” is actually not a lobe, but a region in the lung.
⇒In 126, we added “Therefore, since our institution accepts patients with moderate to severe pneumonia by COVID-19, we investigated what predictors of severe disease were present in patients who consequently transitioned from moderate to severe disease.” Line 98 : “was qualitatively examined.” ----- qualitatively or quantitatively or semi-quantitatively examined in this study? In line132, we changed as “was examined qualitatively and quantitatively.”migi Line 123 : “KL6 levels” ----- KL6 is not a popular abbreviation. Please provide full name in front of abbreviation.
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