COVID-19 update: viral shedding in asymptomatic persons is possible

  • Hoehl S, et al
  • NEJM
  • 19 Feb 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Shedding of potentially infectious 2019 novel coronavirus (COVID-2019) may occur in individuals without fever and with few or no signs of infection.

Why this matters

  • It is unclear if COVID-19 viral shedding in asymptomatic persons implies transmission risk.
  • Testing may be warranted in all persons with possible COVID-19 exposure, regardless of symptoms. 

Key points

  • 126 German nationals staying in Hubei Province were evacuated from the area on February 1 and transferred to Germersheim, Germany, to be quarantined for 14 days.
  • 10 passengers were isolated during the flight: 2 had had contact with 1 person who had a confirmed COVID-19 infection, 6 showed symptoms, and 2 had been exposed to isolated family members; all 10 tested negative upon arrival.
  • 116 passengers (ages 5 months to 68 years; 23 children) were screened upon landing; 1 had fever and cough but tested negative for COVID-19.
  • 114 of the remaining 115 who passed triage consented to a throat swab.
  • 1.8% (2/114) of this group were positive for the COVID-19-causative virus on RT-PCR (cycle threshold values for each were 24.39 and 30.25, respectively).
    • Testing in culture with colon tumor epithelial cells indicated potential infectivity.
  • Both patients were transferred to an infectious disease unit for evaluation/observation.
    • 1 patient had faint rash, minimal pharyngitis.
    • The other is reported to have remained symptom-free.
  • At 7 days postadmission, both were well and afebrile.