Abstract
The coronavirus disease 2019 (COVID-19) cases could be symptomatic or asymptomatic. We (1) characterized and analyzed data collected from the first cohort of reverse transcriptase polymerase chain reaction (RT-PCR)-confirmed COVID-19 cases reported in the Emirate of Abu Dhabi, United Arab Emirates, according to the symptomatic state, and (2) identified factors associated with the symptomatic state. The association between the symptomatic state and testing positive in three subsequent RT-PCR testing rounds was also quantified. Between February 28 and April 8, 2020, 1,249 cases were reported. Sociodemographic characteristics, working status, travel history, and chronic comorbidities of 791 cases were analyzed according to the symptomatic state (symptomatic or asymptomatic). After the first confirmatory test, the results of three subsequent tests were analyzed. The mean age of the 791 cases was 35.6 ± 12.7 years (range: 1–81). Nearly 57.0% of cases were symptomatic. The two most frequent symptoms were fever (58.0%) and cough (41.0%). Symptomatic cases (mean age 36.3 ± 12.6 years) were significantly older than asymptomatic cases (mean age 34.5 ± 12.7 years). Compared with nonworking populations, working in public places (adjusted odds ratio (aOR), 1.76, 95% confidence interval (95% CI): 1.11–2.80), healthcare settings (aOR, 2.09, 95% CI: 1.01–4.31), or in the aviation and tourism sectors (aOR, 2.24, 95% CI: 1.14–4.40) was independently associated with the symptomatic state. Reporting at least one chronic comorbidity was also associated with symptomatic cases (aOR, 1.76, 95% CI: 1.03–3.01). Compared with asymptomatic cases, symptomatic cases had a prolonged duration of viral shedding and consistent odds of ≥2 positive COVID-19 tests result out of the three subsequent testing rounds. A substantial proportion of the diagnosed COVID-19 cases in the Emirate of Abu Dhabi were asymptomatic. Quarantining asymptomatic cases, implementing prevention measures, and raising awareness among populations working in high-risk settings are warranted.
Highlights
Coronavirus disease 2019 (COVID-19) emerged in Wuhan, China, in December 2019 [1]
We reviewed the first cohort of 1,249 reverse transcriptase polymerase chain reaction (RT-PCR)-confirmed COVID-19 cases that were passively or actively identified and reported to health authorities in the Emirate of Abu Dhabi, United Arab Emirates, up to April 8, 2020
Our study provided empirical evidence on the positive association between symptomatic state and delays in testing negative compared with asymptomatic COVID-19 cases
Summary
Coronavirus disease 2019 (COVID-19) emerged in Wuhan, China, in December 2019 [1]. Due to sustained human-to-human transmission, COVID-19 has rapidly spread globally in >215 countries, affecting over 77 million people and causing over 1.7 million deaths, as of December 22, 2020 [2]. 80% of COVID-19 cases are asymptomatic or mild, 15% are severe and require oxygen, and 5% are critical infections that require ventilation [3]. Asymptomatic infection refers to the identification of viral nucleic acid by reverse transcriptase polymerase chain reaction (RT-PCR) in patients not displaying typical clinical symptoms. Asymptomatic COVID-19 infections reported having a similar viral load as those of symptomatic infections [4,5]. In Boston, 88% of COVID19 positive cases were asymptomatic [6]. In Japan, 30.8% of Japanese citizens evacuated from Wuhan [7] and 51.7% of COVID-19 cases from the “Diamond Princess” cruise [8] were asymptomatic. A mild or asymptomatic COVID-19 case can potentially transmit the virus to other people without any awareness
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