Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Facts and myths

Chih-Cheng Lai, Yen Hung Liu, Cheng-Yi Wang, Ya-Hui Wang, Shun-Chung Hsueh, Muh-Yen Yen, Wen-Chien Ko, Po-Ren Hsueh, Chih-Cheng Lai, Yen Hung Liu, Cheng-Yi Wang, Ya-Hui Wang, Shun-Chung Hsueh, Muh-Yen Yen, Wen-Chien Ko, Po-Ren Hsueh

Abstract

Since the emergence of coronavirus disease 2019 (COVID-19) (formerly known as the 2019 novel coronavirus [2019-nCoV]) in Wuhan, China in December 2019, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), more than 75,000 cases have been reported in 32 countries/regions, resulting in more than 2000 deaths worldwide. Despite the fact that most COVID-19 cases and mortalities were reported in China, the WHO has declared this outbreak as the sixth public health emergency of international concern. The COVID-19 can present as an asymptomatic carrier state, acute respiratory disease, and pneumonia. Adults represent the population with the highest infection rate; however, neonates, children, and elderly patients can also be infected by SARS-CoV-2. In addition, nosocomial infection of hospitalized patients and healthcare workers, and viral transmission from asymptomatic carriers are possible. The most common finding on chest imaging among patients with pneumonia was ground-glass opacity with bilateral involvement. Severe cases are more likely to be older patients with underlying comorbidities compared to mild cases. Indeed, age and disease severity may be correlated with the outcomes of COVID-19. To date, effective treatment is lacking; however, clinical trials investigating the efficacy of several agents, including remdesivir and chloroquine, are underway in China. Currently, effective infection control intervention is the only way to prevent the spread of SARS-CoV-2.

Keywords: 2019-nCoV; Acute respiratory disease; Asymptomatic carrier; COVID-19; Coronavirus; SARS-CoV-2; Wuhan pneumonia.

Conflict of interest statement

Declaration of competing interest The author declares no conflict of interests.

Copyright © 2020. Published by Elsevier B.V.

References

    1. WHO. . [Accessed on 21 February 2020].
    1. Lee P.I., Hsueh P.R. Emerging threats from zoonotic coronaviruses-from SARS and MERS to 2019-nCoV. J Microbiol Immunol Infect. 2020;53:365–367. doi: 10.1016/j.jmii.2020.02.001.
    1. Huang W.H., Teng L.C., Yeh T.K., Chen Y.J., Lo W.J., Wu M.J. 2019 novel coronavirus disease (COVID-19) in Taiwan: reports of two cases from Wuhan, China. J Microbiol Immunol Infect. 2020;53:481–484. doi: 10.1016/j.jmii.2020.02.009.
    1. Liu Y.C., Liao C.H., Chang C.F., Chou C.C., Lin Y.R. A locally transmitted case of SARS-CoV-2 infection in Taiwan. N Engl J Med. 2020 Feb 12 doi: 10.1056/NEJMc2001573.
    1. Gorbalenya A.E., Baker S.C., Baric R.S., de Groot R.J., Drosten C., Gulyaeva A.A. 2020. Severe acute respiratory syndrome-related coronavirus: the species and its viruses – a statement of the Coronavirus Study Group. 2020.02.07.937862.
    1. Lai C.C., Shih T.P., Ko W.C., Tang H.J., Hsueh P.R. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and corona virus disease-2019 (COVID-19): the epidemic and the challenges. Int J Antimicrob Agents. 2020 Feb 17 doi: 10.1016/j.ijantimicag.2020.105924.
    1. Bai Y., Yao L., Wei T., Tian F., Jih D.Y., Chen L. Presumed asymptomatic carrier transmission of COVID-19. J Am Med Assoc. 2020 Feb 21 doi: 10.1001/jama.2020.2565.
    1. The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team . China CDC Weekly; 2020. The epidemiological characteristics of an outbreak of 2019 novel coronavirus disease (COVID-19) – China.
    1. Rothe C., Schunk M., Sothmann P., Bretzel G., Froeschl G., Wallrauch C. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med. 2020 Jan 30 doi: 10.1056/NEJMc2001468.
    1. Yu P., Zhu J., Zhang Z., Han Y., Huang L. A familial cluster of infection associated with the 2019 novel coronavirus indicating potential person-to-person transmission during the incubation period. J Infect Dis. 2020 Feb 18 doi: 10.1093/infdis/jiaa077. pii: jiaa077.
    1. Guan W.J., Ni Z.Y., Hu Y., Laing W.H., Ou C.Q., He J.X. Clinical characteristics of 2019 novel coronavirus infection in China. medRxiv. 2020 Feb 9 doi: 10.1101/2020.02.06.20020974. preprint.
    1. Chen N., Zhou M., Dong X., Qu J., Gong F., Han Y. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507–513. doi: 10.1016/S0140-6736(20)30211-7.
    1. Huang C., Wang Y., Li X., Ren L., Zhao J., Hu Y. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. doi: 10.1016/S0140-6736(20)30183-5.
    1. Wang D., Hu B., Hu C., Zhu F., Liu X., Zhang J. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. J Am Med Assoc. 2020 Feb 7 doi: 10.1001/jama.2020.1585.
    1. Yang Y., Lu Q., Liu M., Wang Y., Zhang A., Jalali N. Epidemiological and clinical features of the 2019 novel coronavirus outbreak in China. medRxiv. 2020 Feb 11 doi: 10.1101/2020.02.10.20021675.
    1. Ryu S., Chun B.C. An interim review of the epidemiological characteristics of 2019 novel coronavirus. Epidemiol Health. 2020;42:e2020006.
    1. Nishiura H., Linton N.M., Akhmetzhanov A.R. Initial cluster of novel coronavirus (2019-nCoV) infections in Wuhan, China is consistent with substantial human-to-human transmission. J Clin Med. 2020;9:E488. doi: 10.3390/jcm9020488.
    1. Chen H., Guo J., Wang C., Luo F., Yu X., Zhang W. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020 Feb 12 doi: 10.1016/S0140-6736(20)30360-3.
    1. Chan J.F., Yuan S., Kok K.H., To K.K., Chu H., Yang J. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;395:514–523. doi: 10.1016/S0140-6736(20)30154-9.
    1. Li Q., Guan X., Wu P., Wang X., Zhou L., Tong Y. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020 Jan 29 doi: 10.1056/NEJMoa2001316.
    1. Backer J.A., Klinkenberg D., Wallinga J. Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20-28 January 2020. Euro Surveill. 2020;25(5) doi: 10.2807/1560-7917.
    1. Chang Xu H., Rebaza A., Sharma L., Dela Cruz C.S. Protecting health-care workers from subclinical coronavirus infection. Lancet Respir Med. 2020 Feb 13 doi: 10.1016/S2213-2600(20)30066-7. pii: S2213-2600(20)30066-30067.
    1. Liu J., Liu Y., Xiang P., Pu L., Xiong H., Li C. Neutrophil-to-lymphocyte ratio predicts severe illness patients with 2019 novel coronaviruse in the early stage. medRxiv. 2020 Feb 12 doi: 10.1101/2020.02.10.20021584.
    1. Chung M., Bernheim A., Mei X., Zhang N., Huang M., Zeng X. CT imaging features of 2019 novel coronavirus (2019-nCoV) Radiology. 2020 Feb 4:200230. doi: 10.1148/radiol.2020200230.
    1. Lei J., Li J., Li X., Qi X. CT Imaging of the 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology. 2020 Jan 31:200236. doi: 10.1148/radiol.2020200236.
    1. Pan Y., Guan H. Imaging changes in patients with 2019-nCov. Eur Radiol. 2020 Feb 6 doi: 10.1007/s00330-020-06713-z.
    1. Kanne J.P. Chest CT findings in 2019 novel coronavirus (2019-nCoV) infections from Wuhan, China: key points for the radiologist. Radiology. 2020 Feb 4:200241. doi: 10.1148/radiol.2020200241.
    1. Pan Y., Guan H., Zhou S., Wang Y., Li Q., Zhu T. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol. 2020 Feb 13 doi: 10.1007/s00330-020-06731-x.
    1. Duan Y.N., Qin J. Pre- and posttreatment chest CT findings: 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology. 2020 Feb 12:200323. doi: 10.1148/radiol.2020200323.
    1. Lu H. Drug treatment options for the 2019-new coronavirus (2019-nCoV) Biosci Trends. 2020 Jan 28 doi: 10.5582/bst.2020.01020.
    1. Wang M., Cao R., Zhang L., Yang X., Liu J., Xu M. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020 Feb 4 doi: 10.1038/s41422-020-0282-0.
    1. Liu W., Morse J.S., Lalonde T., Xu S. Learning from the past: possible urgent prevention and treatment options for severe acute respiratory infections caused by 2019-nCoV. ChemBioChem. 2020 Feb 4 doi: 10.1038/s41422-020-0282-0.
    1. Holshue M.L., DeBolt C., Lindquist S., Lofy K.H., Wiesman J., Bruce H. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020 Jan 31 doi: 10.1056/NEJMoa2001191.
    1. Ko W.C., Rolain J.M., Lee N.Y., Chen P.L., Huang C.T., Lee P.I. Arguments in favor of remdesivir for treating SARS-CoV-2 infections. Int J Antimicrob Agents. 2020 Mar 6 doi: 10.1016/j.ijantimicag.2020.105933.
    1. Colson P., Rolain J.M., Raoult D. Chloroquine for the 2019 novel coronavirus. Int J Antimicrob Agents. 2020 Feb 17 doi: 10.1016/j.ijantimicag.2020.105923.
    1. Multicenter collaboration group of Department of Science and Technology of Guangdong Province and Health Commission of Guangdong Province for chloroquine in the treatment of novel coronavirus pneumonia. [Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia] Zhonghua Jie He He Hu Xi Za Zhi. 2020 Feb 20;43(0):E019. doi: 10.3760/cma.j.issn.1001-0939.2020.0019.
    1. Szűcs Z., Kelemen V., Le Thai S., Csávás M., Rőth E., Batta G. Structure-activity relationship studies of lipophilic teicoplanin pseudoaglycon derivatives as new anti-influenza virus agents. Eur J Med Chem. 2018;157:1017–1030.
    1. Zhou N., Pan T., Zhang J., Li Q., Zhang X., Bai C. Glycopeptide antibiotics potently inhibit cathepsin L in the late endosome/lysosome and block the entry of Ebola virus, middle east respiratory syndrome coronavirus (MERS-CoV), and severe acute respiratory syndrome coronavirus (SARS-CoV) J Biol Chem. 2016;291:9218–9232.
    1. Balzarini J., Keyaerts E., Vijgen L., Egberink H., De Clercq E., Van Ranst M. Inhibition of feline (FIPV) and human (SARS) coronavirus by semisynthetic derivatives of glycopeptide antibiotics. Antivir Res. 2006;72:20–33.
    1. Arabi Y.M., Mandourah Y., Al-Hameed F., Sindi A.A., Almekhlafi G.A., Hussein M.A. Corticosteroid therapy for critically ill patients with middle east respiratory syndrome. Am J Respir Crit Care Med. 2018;197:757–767.
    1. Lee N., Allen Chan K.C., Hui D.S., Ng E.K., Wu A., Chiu R.W. Effects of early corticosteroid treatment on plasma SARS-associated coronavirus RNA concentrations in adult patients. J Clin Virol. 2004;31:304–309.
    1. Lee D.T., Wing Y.K., Leung H.C., Sung J.J., Ng Y.K., Yiu G.C. Factors associated with psychosis among patients with severe acute respiratory syndrome: a case-control study. Clin Infect Dis. 2004;39:1247–1249.
    1. Xiao J.Z., Ma L., Gao J., Yang Z.J., Xing X.Y., Zhao H.C. Glucocorticoid-induced diabetes in severe acute respiratory syndrome: the impact of high dosage and duration of methylprednisolone therapy. Zhonghua Nei Ke Za Zhi. 2004;43:179–182.
    1. Russell C.D., Millar J.E., Baillie J.K. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020;395:473–475.
    1. Li G., Fan Y., Lai Y., Han T., Li Z., Zhou P. Coronavirus infections and immune responses. J Med Virol. 2020;92:424–432. doi: 10.1002/jmv.25685.
    1. Guo L., Wei D., Zhang X., Wu Y., Li Q., Zhou M. Clinical features predicting mortality risk in patients with viral pneumonia: the MuLBSTA score. Front Microbiol. 2019;10:2752. doi: 10.3389/fmicb.2019.02752.
    1. Patel A., Jernigan D.B. 2019-nCoV CDC Response Team. Initial public health response and interim clinical guidance for the 2019 novel coronavirus outbreak – United States, December 31, 2019-February 4, 2020. MMWR – Morb Mortal Wkly Rep. 2020;69:140–146.
    1. Yen M.Y., Schwartz J., Wu J.S., Hsueh P.R. Controlling Middle East respiratory syndrome: lessons learned from severe acute respiratory syndrome. Clin Infect Dis. 2015;61:1761–1762.
    1. Lee P.I., Hu Y.L., Chen P.Y., Huang Y.C., Hsueh P.R. Are children less susceptible to COVID-19? J Microbiol Immunol Infect. 2020 Feb 25 doi: 10.1016/j.jmii.2020.02.011.
    1. Zou L., Ruan F., Huang M., Liang L., Huang H., Hong Z. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020 Feb 19 doi: 10.1056/NEJMc2001737.

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