Asymptomatic COVID-19 Patients Research Articles

Asymptomatic infection and disappearance of clinical symptoms of COVID-19 infectors in China 2022–2023: a cross-sectional study

To explore the clinical characteristics of patients infected with SARS-CoV-2 nationwide, especially the effect factors of asymptomatic infection and disappearance of clinical symptoms. A total of 66,448 COVID-19 patients in China who have been diagnosed by nucleic acid test or rapid antigen test were surveyed online (December 24, 2022 to January 16, 2023). Our cross-sectional study used descriptive analyses and binary Logistics regression model to assess the correlation between the clinical characteristics and relative factors, including age, gender, pre-existing conditions, reinfection, vaccination and treatment. A total of 64,515 valid questionnaires were collected. Among included participants, 5969 of which were asymptomatic. The symptoms were mainly upper respiratory symptoms, including dry and itchy throat (64.16%), sore throat (59.95%), hoarseness (57.90%), nasal congestion (53.39%). In binary Logistics regression model, we found that male, no pre-existing conditions, reinfection and vaccination have positive correlations with the appearance of asymptomatic COVID-19 patients. In Cox proportional-hazards regression model, considering all clinical symptoms disappeared in 14 days as outcome, we found that ≤ 60 years old, male, no pre-existing conditions, vaccination and adopted treatment have positive correlations with rapid amelioration of clinical symptoms in COVID-19 patients. The clinical symptoms of the participants were mainly upper respiratory symptoms which were according with the infection of Omicron variant. Factors including age, gender, pre-existing conditions and reinfection could influence the clinical characteristics and prognosis of COVID-19 patients. Importantly, vaccination has positive significance for the prevention and treatment of COVID-19. Lastly, the use of Chinese medicine maybe beneficial to COVID-19 patients, however, reasonable guidance is necessary.

Immune Cells Quantitative Abnormalities Associated with Symptomatic COVID-19

COVID-19 spread to countries around the world. It is essential to set up suspected biomarkers for rapid management of the disease. This study aimed to determine quantitative abnormalities of peripheral blood immune cells associated with COVID-19 and establish those associated with the severity of COVID-19 in Togo. In a retrospective analytical study from May to September 2022; 851 symptomatic and 194 asymptomatic COVID-19 patients medical records were recovered. Their complete blood count data were analyzed using Chi-square test, Mann-Whitney U test, univariate and multivariate binary logistic regression analysis. Symptomatic COVID-19 patients had low and high platelets count, high white blood count, high neutrophils, low and high lymphocytes count and high eosinophils count compared to asymptomatic ones (p < 0.0001). Complete blood count anomalies as low platelets count [OR = 2.75; 95% CI (1.55-4.88)] or high platelets count [OR = 3.12; 95% CI (1.23-7.91)], high neutrophils count [OR = 9.91; 95% CI (4.81-20.45)] and low lymphocytes count [OR = 3.83; 95% CI (2.20-6.65)] were associated with COVID-19 severity. Low or high platelets count, high neutrophils count, low lymphocytes were associated with severe COVID-19. It is important to consider immune cells profile for the diagnosis and follow-up of COVID-19 patients in Togo.

Immune Cells Quantitative Abnormalities Associated with Symptomatic COVID-19

COVID-19 spread to countries around the world. It is essential to set up suspected biomarkers for rapid management of the disease. This study aimed to determine quantitative abnormalities of peripheral blood immune cells associated with COVID-19 and establish those associated with the severity of COVID-19 in Togo. In a retrospective analytical study from May to September 2022; 851 symptomatic and 194 asymptomatic COVID-19 patients medical records were recovered. Their complete blood count data were analyzed using Chi-square test, Mann-Whitney U test, univariate and multivariate binary logistic regression analysis. Symptomatic COVID-19 patients had low and high platelets count, high white blood count, high neutrophils, low and high lymphocytes count and high eosinophils count compared to asymptomatic ones (p < 0.0001). Complete blood count anomalies as low platelets count [OR = 2.75; 95% CI (1.55-4.88)] or high platelets count [OR = 3.12; 95% CI (1.23-7.91)], high neutrophils count [OR = 9.91; 95% CI (4.81-20.45)] and low lymphocytes count [OR = 3.83; 95% CI (2.20-6.65)] were associated with COVID-19 severity. Low or high platelets count, high neutrophils count, low lymphocytes were associated with severe COVID-19. It is important to consider immune cells profile for the diagnosis and follow-up of COVID-19 patients in Togo.

Development of “eIndianMedicine” App for subclinical infection of COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of the coronavirus disease (COVID-19) pandemic and has infected more than 561M people worldwide. The World Health Organization (WHO) has declared it an international public health concern. Approximately 80% of subclinical COVID-19 cases continue to rapidly spread in India. Consequently, the Indian Government urges the scientific community to control its transmission by developing self-assessed mobile apps and searching for Indian systems of medicine. The Ministry of Ayush, Government of India, recently recommended Ayurvedic medicine for the treatment of COVID-19 subclinical infection. However, awareness of Indian systems of medicine is not yet popularized because of low consumer perception and ignorance of scientific facts in India. This study provides a perspective on the design and development of a mobile app “eIndianMedicine for COVID-19” with a self-assessment tool. The abstraction of scientific facts regarding Indian systems of medicine is important for the development of such information tools in India. It can gather information from any patient to stop the spread of a silent carrier and to start treatment immediately. This can reduce mass testing costs and awareness of the Indian systems of medicine. Hence, current progress in information technology can increase the mobilization of International Trade in Indian traditional medicine to treat asymptomatic COVID-19 patients worldwide.

Comparison of time to negative conversion of SARS-CoV-2 between young and elderly among asymptomatic and mild COVID-19 patients: a cohort study from a national containment center.

We aimed to study the relationship between age and time to negative conversion of SARS-CoV-2 in patients with asymptomatic and mild forms of COVID-19. We conducted a cohort study including all patients diagnosed with COVID-19 from the national COVID-19 containment center of Tunisia. Patients were subdivided into two cohorts: (under 60 years) and (over 60 years) and were followed up until PCR negativization. Log rank test and Cox regression were applied to compare time to negative conversion between the old group and the young group. The study included 289 patients with non-severe forms of COVID-19. Age over 60 was significantly associated with delayed negative conversion in male sex (Hazard ratio (HR): 1.9; 95% CI: 1.2-3.07) and among patients with morbid conditions (HR:1.68; 95% CI: 1.02-2.75) especially diabetics (HR: 2.06; 95% CI: 1.01-4.21). This association increased to (HR:2.3; 95% CI: 1.13-4.66) when male sex and comorbidities were concomitantly present and rose to (HR: 2.63; 95% CI: 1.02-6.80) for men with diabetes. Cox regression analysis revealed a significantly delayed negative conversion in symptomatic patients. Significant interaction was observed between gender and age and between age and chronic conditions. Age is associated with delayed negative conversion of viral RNA in certain subgroups. Identifying these subgroups is crucial to know how prioritize preventive strategies in elderly.

Postoperative Evolution of Asymptomatic Covid-19 Patients Not Recognized Preoperatively: A Case Report of 12 Patients

Background: In order to ensure better management of patients with coronavirus disease 2019 and to reduce disease transmission, all scheduled surgeries were postponed. However, with the flattening of the epidemiological curve, surgical activity was gradually resumed which was responsible for increasing the rate of postoperative complications and mortality for undiagnosed asymptomatic patients operated on during the incubation period. The aim of our study was to evaluate the postoperative evolution of asymptomatic undiagnosed patients who developed COVID-19 after scheduled surgery. Materials and Methods: This is a retrospective monocentric observational study of 12 initially asymptomatic patients who were operated on during their COVID-19 incubation period in the operating theatres of Mohamed V military training hospital of rabat during the period from April 1 to September 30, 2020. Results: 4638 patients were operated on. Only 12 patients developed COVID-19 infection after confirmation by a reverse transcriptase Polymerase Chain Reaction test postoperatively. The most common symptom was fever (91.6%). The postoperative course was marked by the development of several complications such as secondary superinfection (66.6%), acute respiratory distress syndrome (58.3%), and shock (50%). Seven of the 12 (58.3%) patients were admitted to intensive care and 5/12 (41.6%) required invasive ventilation and subsequently died. Acute respiratory distress syndrome was the main complication in all patients who died. Conclusion: Many challenges are encountered when performing surgical activity during the pandemic period. Nevertheless, knowledge of the patient’s COVID-19 status prior to any surgical procedure should be considered in order to reduce and control the risk of postoperative morbidity and mortality.

Diagnostic Performance of Saliva Samples in Asymtomatic COVID-19 Infected Patients in Kakamega Kenya

The pandemic coronavirus SARS‐CoV‐2 in the world has caused a large infected population suffering from COVID‐19. To curb the spreading of the virus, WHO urgently demanded an extension of screening and testing; thus, a rapid and simple diagnostic method is needed which is non-invasive. Use of self-collected saliva can minimize healthcare worker exposure and expand testing capabilities for symptomatic and asymptomatic patients. The main aim of this study was to document the ability of patients to self-collect sufficient saliva specimens for SARS-CoV-2 in the quantitative detection by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) in asymptomatic patients by themselves under observation by a healthcare provider. The researcher recorded whether the patients were confident and the suitability of the specimen for laboratory testing that would inform clinical decision making. Seventy-one patients aged from 13 years and above were included between December 2020 and July, 2021. Saliva samples and Nasopharyngeal samples were taken from each patient. Quantitative PCR was performed to detect SARS-CoV-2 viral load in the nasopharyngeal samples and qualitative Reverse Transcriptase Loop-mediated isothermal amplification (RT-LAMP) was used to detect the presence of the virus in saliva samples. Results of saliva vs. nasopharyngeal samples testing using the two different methods were compared. Statistical analyses were performed. Out of the 350 samples tested, 314 samples were found to be Covid 19 positive. Result of the test was validated by the RT-PCR test. This showed that only 314 samples were tested both by saliva rapid test and PCR test while the rest 36 samples were not tested using RT-PCR method but were tested using saliva test. Thus, the salivary test based on pure oral saliva samples easily obtained by noninvasive techniques using RT-LAMP has the same agreement with the nasopharyngeal technique using RT-PCR one in asymptomatic COVID-19 patients.

EFFECTIVE BIOMEDICAL SYSTEM FOR DETECTING, TRACKING, AND PREVENTING ASYMPTOMATIC COVID-19 PATIENTS NON-INVASIVELY USING IoT AND MIXED REALITY

This article proposes a novel biomedical system integrating internet of things (IoT) and mixed reality (MR) technologies for detecting, tracking, and preventing asymptomatic corona virus disease (COVID) patients from entering into public places which prevents the further spread of COVID-19 infection. Asymptomatic patients are the very active carriers for virus transmission, and the most challenging conditions in mitigating the virus transmission are contact tracking and contact tracing of asymptomatic patients. The proposed system can be implemented in public places such as theaters, malls, railway stations, airport, markets, conferences, and other gatherings for screening people to detect asymptomatic COVID patients and restrict them from entry. The arrest or decrease in spread of COVID infection during pandemic situation is the most challenging factor around the globe. However, with the proposed system, detection and prevention of asymptomatic COVID patients will result in drastic decrease in the spread of COVID infection during pandemic situation. The proposed system comprises an IoT-based sensing system to get the current sensor values and an MR vision software system to retrieve the pre-saved sensor values from the server. The MR vision system compares the present sensor values and the server values of the human and displays accurately with green MR images for permitted persons and red MR images for restricted asymptomatic COVID patients.

Steroid prescribing practices for mildly symptomatic and asymptomatic COVID-19 patients, among doctors of selected Sri Lankan hospitals

Introduction: Effects of infection by SARS-COV-2 virus (COVID-19) range from asymptomatic infection to respiratory failure with multi-organ dysfunction. Steroids are indicated in patients with severe pneumonia, who require oxygen supplementation. There is evidence of harm if steroids are given for asymptomatic or mildly symptomatic patients.Objectives: This study assesses the steroid prescribing practices among Sri Lankan doctors for mildly symptomatic and asymptomatic COVID-19 patients.Methodology: This clinical survey was conducted during 20/11/2021 to 15/03/2022 using an electronic questionnaire, sent to doctors in 16 hospitals, representing all provinces of Sri Lanka. Doctors who have not treated nor advised patients with COVID-19 were excluded.Results: Hundred and thirty-five participants were incorporated into the study. The mean age was 33.7 years (SD=7.82). The majority did not prescribe steroids routinely for asymptomatic (n=132, 97.8%) and mildly symptomatic (n=124, 91.9%) COVID-19. Dexamethasone was the most prescribed steroid. Doctors who treated COVID-19 patients in the private sector were more likely to prescribe steroids for mild symptoms (p=0.016). The majority (n=101, 81.5%) identified a decrease of oxygen saturation to below 94% on room air as an indication to start steroids.Conclusions: Most of the study participants adhered to the recommended guidelines and refrained from prescribing steroids in mildly symptomatic and asymptomatic COVID-19 patients.

A Monitored Self-isolation Model for Asymptomatic COVID-19 Patients to Prevent the Family-based Transmission

Background: Systematic effort and sustainable systems are highly suggested to avoid new family clusters of COVID-19 in a community. It was challenging that self-isolation should be monitored and evaluated to prevent the transmission. Purpose: This study aimed to develop and evaluate a monitored self-isolation model, named the “Reni-Model,” for asymptomatic COVID-19 patients to prevent family-based transmission. Methods: A mixed-methods approach with an embedded design was employed. The Reni-Model incorporated a moderating factor of patient empowerment through education, participatory discussions, and training. The model was developed through an analysis, design, development, implementation, and evaluation process. The study population was COVID-19 patients, their family members, healthcare workers, and the community in Deli Serdang Regency, North Sumatra Province, Indonesia, in 2022. The respondent characteristics correlated to the self-isolation model's success are gender, education, occupation, and income. Results: Data implied several determinant factors, including patient knowledge, attitudes, actions, perceptions, family support, healthcare worker involvement, and collective behaviour, significantly influencing the success of monitored self-isolation. The Reni-Model demonstrated significant effectiveness in preventing the transmission of COVID-19 within families. Conclusion: This study emphasises the importance of prioritising and taking concrete actions to implement monitored self-isolation, drawing valuable lessons from the COVID-19 pandemic.

Cost-effectiveness analysis of isolation strategies for asymptomatic and mild symptom COVID-19 patients

BackgroundManagement of COVID-19 patients with mild and moderate symptoms could be isolated at home isolation (HI), community isolation (CI) or hospitel. However, it was still unclear which strategy was more cost-effective. Therefore, this study was conducted to evaluate this.MethodsThis study used data from patients who initially stayed at HI, CI, and hospitel under supervision of Ramathibodi Hospital between April and October 2021. Outcomes of interest were hospitalisation and mortality. An incremental cost-effectiveness ratios (ICER) was calculated based on hospital perspective using home isolation as the reference.ResultsFrom 7,077 patients, 4,349 2,356, and 372 were admitted at hospitel, HI, and CI, respectively. Most patients were females (57.04%) and the mean age was 40.42 (SD = 16.15). Average durations of stay were 4.47, 3.35, and 3.91 days for HI, CI, and hospitel, respectively. The average cost per day for staying in these corresponding places were 24.22, 63.69, and 65.23 US$. For hospitalisation, the ICER for hospitel was at 41.93 US$ to avoid one hospitalisation in 1,000 patients when compared to HI, while CI had more cost, but less cases avoided. The ICER for hospitel and CI were at 46.21 and 866.17 US$ to avoid one death in 1,000 patients.ConclusionsHI may be cost-effective isolated strategy for preventing hospitalisation and death in developing countries with limited resources.

Positivity Rate of Universal PCR Screening for COVID-19 Pre-Endoscopy and its Impact on Diagnosis and Management of New Cancer Patients at a Cancer Centre in Pakistan

Objective: To determine the positivity rate of COVID-19 on pre-procedure screening and its impact on diagnosis and management of new cancer patients. Study Design: Cross-sectional study. Place and Duration of Study: Shaukat Khanum Memorial Cancer Hospital, Lahore Pakistan, from Sep 2020 to Aug 2021. Methodology: Data was retrospectively collected from electronic medical records of the patients, including their age, gender, PCR test result, date of first visit to the gastroenterology clinic, date of multidisciplinary team meeting and any adverse event reported due to delay in endoscopy procedure. Results: A total of 1273 patients underwent endoscopy procedures in the study period. Fifty-two patients were found to be COVID-positive (4.1%), and only one was symptomatic. The percentage of positivity in newly diagnosed 22 cancer patients was 1.72%. Of 52 patients, 31 were male (59.61%), and 21 were female (40.39%). Only 1 patient was presented with abdominal pain and revealed concealed perforation. No other adverse event was reported in any patient, and no new imaging was required before discussion in a multidisciplinary team meeting. Conclusion: The hospital policy of COVID PCR test 48 hours before the endoscopy procedure effectively isolates the asymptomatic positive COVID-19 patients. The two-week delay due to COVID-PCR positivity in newly diagnosed cancer patients was not associated with any adverse event, and no new imaging was required.

A Successful Pyloromyotomy In A Child With COVID-19 Infection

Infantile Hypertrophic Pyloric Stenosis (IHPS) is the most common cause of gastric outlet obstruction in children, usually manifesting between 2 and 6 weeks of age by non-bilious vomiting. Although the COVID-19 pandemic has dominated the world since the beginning of 2020 causing the restructuring of healthcare delivery, patients still require high-quality medical care concerning other diseases. We report a 6-week infant with confirmed COVID-19 infection, who developed mild symptoms after a successful pyloromyotomy. Our aim is to encourage other professionals not to delay the necessary treatment in asymptomatic COVID-19 patients, considering the proper use of personal protective equipment, as it may worsen the course of the underlying disease.

Comparison of plasma mitochondrial DNA copy number in asymptomatic and symptomatic COVID-19 patients.

Since the beginning of the COVID-19 pandemic, a wide clinical spectrum, from asymptomatic infection to mild or severe disease and death, have been reported in COVID-19 patients. Studies have suggested several possible factors, which may affect the clinical outcome of COVID-19. A pro-inflammatory state and impaired antiviral response have been suggested as major contributing factors in severe COVID-19. Considering that mitochondria have an important role in regulating the immune responses to pathogens, pro-inflammatory signaling, and cell death, it has received much attention in SARS-CoV-2 infection. Recent studies have demonstrated that high levels of cell-free mitochondrial DNA (cf-mtDNA) are associated with an increased risk of COVID-19 intensive care unit (ICU) admission and mortality. However, there have been few studies on cf-mtDNA in SARS-CoV-2 infection, mainly focusing on critically ill COVID-19 cases. In the present study, we investigated cf-mtDNA copy number in COVID-19 patients and compared between asymptomatic and symptomatic cases, and assessed the clinical values. We also determined the cf-nuclear DNA (cf-nDNA) copy number and mitochondrial transcription factor A (TFAM) mRNA level in the studied groups. Plasma and buffy coat samples were collected from 37 COVID-19 patients and 33 controls. Briefly, after total DNA extraction, plasma cf-mtDNA, and cf-nDNA copy numbers were measured by absolute qPCR using a standard curve method. Furthermore, after total RNA extraction from buffy coat and cDNA synthesis, TFAM mRNA levels were evaluated by qPCR. The results showed that cf-mtDNA levels in asymptomatic COVID-19 patients were statistically significantly higher than in symptomatic cases (p value = 0.01). However, cf-nDNA levels were higher in symptomatic patients than in asymptomatic cases (p value = 0.00). There was no significant difference between TFAM levels in the buffy coat of these two groups (p value > 0.05). Also, cf-mtDNA levels showed good diagnostic potential in COVID-19 subgroups. cf-mtDNA is probably important in the outcome of SARS-CoV-2 infection due to its role in inflammation and immune response. It can also be a promising candidate biomarker for the diagnosis of COVID-19 subgroups. Further investigation will help understanding the COVID-19 pathophysiology and effective diagnostic and therapeutic strategies.

Monitoring Prevalence and Persistence of Environmental Contamination by SARS-CoV-2 RNA in a Makeshift Hospital for Asymptomatic and Very Mild COVID-19 Patients.

Objective: To investigate the details of environmental contamination status by SARS-CoV-2 in a makeshift COVID-19 hospital. Methods: Environmental samples were collected from a makeshift hospital. The extent of contamination was assessed by quantitative reverse transcription polymerase chain reaction (RT-qPCR) for SARS-CoV-2 RNA from various samples. Results: There was a wide range of total collected samples contaminated with SARS-CoV-2 RNA, ranging from 8.47% to 100%. Results revealed that 70.00% of sewage from the bathroom and 48.19% of air samples were positive. The highest rate of contamination was found from the no-touch surfaces (73.07%) and the lowest from frequently touched surfaces (33.40%). The most contaminated objects were the top surfaces of patient cubic partitions (100%). The median Ct values among strongly positive samples were 33.38 (IQR, 31.69-35.07) and 33.24 (IQR, 31.33-34.34) for ORF1ab and N genes, respectively. SARS-CoV-2 relic RNA can be detected on indoor surfaces for up to 20days. Conclusion: The findings show a higher prevalence and persistence in detecting the presence of SARS-CoV-2 in the makeshift COVID-19 hospital setting. The contamination mode of droplet deposition may be more common than contaminated touches.

A cross-sectional study on the nasopharyngeal microbiota of individuals with SARS-CoV-2 infection across three COVID-19 waves in India.

Multiple variants of the SARS-CoV-2 virus have plagued the world through successive waves of infection over the past three years. Independent research groups across geographies have shown that the microbiome composition in COVID-19 positive patients (CP) differs from that of COVID-19 negative individuals (CN). However, these observations were based on limited-sized sample-sets collected primarily from the early days of the pandemic. Here, we study the nasopharyngeal microbiota in COVID-19 patients, wherein the samples have been collected across the three COVID-19 waves witnessed in India, which were driven by different variants of concern. The nasopharyngeal swabs were collected from 589 subjects providing samples for diagnostics purposes at the Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, India and subjected to 16s rRNA gene amplicon - based sequencing. We found variations in the microbiota of symptomatic vs. asymptomatic COVID-19 patients. CP showed a marked shift in the microbial diversity and composition compared to CN, in a wave-dependent manner. Rickettsiaceae was the only family that was noted to be consistently depleted in CP samples across the waves. The genera Staphylococcus, Anhydrobacter, Thermus, and Aerococcus were observed to be highly abundant in the symptomatic CP patients when compared to the asymptomatic group. In general, we observed a decrease in the burden of opportunistic pathogens in the host microbiota during the later waves of infection. To our knowledge, this is the first analytical cross-sectional study of this scale, which was designed to understand the relation between the evolving nature of the virus and the changes in the human nasopharyngeal microbiota. Although no clear signatures were observed, this study shall pave the way for a better understanding of the disease pathophysiology and help gather preliminary evidence on whether interventions to the host microbiota can help in better protection or faster recovery.

1057 Fournier’s Gangrene Caused by Porphyromonas Asaccharolytica; a New Bug in the Block?

Abstract Introduction Fournier’s gangrene (FG) is a urological emergency characterised by a destructive inflammation of the genital and perineal area typically forming necrotising fasciitis that affects the external genitalia and the perineum resulting in the gangrene of infected tissues as well as generalised systemic deterioration in its severest form. Although FG is typically polymicrobial, we found it can very rarely be mono-microbial and caused by Porphyromonas asaccharolytica, an obligate anaerobic gram-negative rod. Case presentation We present a case of a 44-year-old man seen in the emergency department with bilateral scrotal swelling, redness, and pain. A diagnosis of acute epididymo-orchitis (on a background of chronic severe phimosis) was made. Ultrasound imaging of the testes was consistent with features suggestive of epididymo-orchitis and reactive hydrocoele. The patient also tested positive for the SARS-Cov-2 virus but had no respiratory symptoms. Empirical treatment, as per Trust antimicrobial policy, was initiated with intravenous Flucloxacillin which was changed, following the results of blood culture growth of Porphyromonas asaccharolytica, to Meropenem, Vancomycin and Clindamycin. On day 3 of admission, an ulcer was noticed at the base of the scrotum which progressed rapidly into a fulminant Fournier's gangrene. He was treated radically with urgent debridement and direct closure of the wounds and was discharged after 2 weeks on admission. Conclusions We report a case of Fournier’s gangrene caused by a rare gram-negative organism in an asymptomatic unvaccinated COVID-19 patient. Clinicians need to have a high index of suspicion that this organism can also be a cause of Fournier’s gangrene.

Comparing SARS-CoV-2 Viral Load in Human Saliva to Oropharyngeal Swabs, Nasopharyngeal Swabs, and Sputum: A Systematic Review and Meta-Analysis.

A systematic review and meta-analysis were conducted to investigate the SARS-CoV-2 viral load in human saliva and compared it with the loads in oropharyngeal swabs, nasopharyngeal swabs, and sputum. In addition, the salivary viral loads of symptomatic and asymptomatic COVID-19 patients were compared. Searches were conducted using four electronic databases: PubMed, Embase, Scopus, and Web of Science, for studies published on SARS-CoV-2 loads expressed by CT values or copies/mL RNA. Three reviewers evaluated the included studies to confirm eligibility and assessed the risk of bias. A total of 37 studies were included. Mean CT values in saliva ranged from 21.5 to 39.6 and mean copies/mL RNA ranged from 1.91 × 101 to 6.98 × 1011. Meta-analysis revealed no significant differences in SARS-CoV-2 load in saliva compared to oropharyngeal swabs, nasopharyngeal swabs, and sputum. In addition, no significant differences were observed in the salivary viral load of symptomatic and asymptomatic COVID-19 patients. We conclude that saliva specimen can be used as an alternative for SARS-CoV-2 detection in oropharyngeal swabs, nasopharyngeal swabs, and sputum.

Clinical Characteristics of 6102 Asymptomatic and Mild Cases for Patients with COVID-19 in Indonesia.

The COVID-19 pandemic has led to a rise in confirmed cases, making epidemiological studies crucial for identifying the source of transmission and developing effective treatment methods. We conducted a study on the clinical characteristics of patients with asymptomatic and mild symptoms of COVID-19 at a rescue hospital in Indonesia. This is an epidemiological study involving 6102 patients who were admitted to the Indrapura forefront hospital in Surabaya from May 2020 to February 2021. We described demographic data, clinical signs and symptoms, laboratory data, therapy, and clinical outcomes. A total of 6102 patients were involved in this study, with 3664 (60.04%) being male and 2438 (39.95%) being female. The age range of 21-30 years was the most prevalent, accounting for 31.1% (1898 patients). The population had 1476 patients (24.2%) with comorbid conditions. The most prevalent comorbidity observed among these patients was hypertension, affecting 1015 individuals (16.6%). Out of the total 6006 patients observed, 40.7% (n = 2486) were asymptomatic, 54.6% (n = 3329) had mild symptoms, and 3.1% (n = 191) had moderate symptoms. All patients were administered supportive therapy without the use of antiviral medication. Out of the 6102 patients included in the study, 5923 patients (97.1%) achieved a cure, 36 patients (0.6%) are currently undergoing treatment, 142 patients (2.3%) were referred for desaturation indications (SpO2 < 94%), and one patient died due to a suspected cardiovascular event. Out of the total number of patients, 74.5% (4529 patients) had an average length of stay (LOS) of less than 10 days, while 25.6% (1563 patients) had an average length of stay of more than 10 days. The clinical presentation of asymptomatic and mild COVID-19 patients at a rescue hospital varies significantly based on the age and sex of patients. Cough and hyposmia are commonly observed symptoms. Supportive therapy is effective, and strict implementation of social distancing is crucial in preventing the spread of this disease from individuals who are asymptomatic or have mild symptoms.

A burns and COVID-19 shared stress responding gene network deciphers CD1C-CD141- DCs as the key cellular components in septic prognosis

Differential body responses to various stresses, infectious or noninfectious, govern clinical outcomes ranging from asymptoma to death. However, the common molecular and cellular nature of the stress responsome across different stimuli is not described. In this study, we compared the expression behaviors between burns and COVID-19 infection by choosing the transcriptome of peripheral blood from related patients as the analytic target since the blood cells reflect the systemic landscape of immune status. To this end, we identified an immune co-stimulator (CD86)-centered network, named stress-response core (SRC), which was robustly co-expressed in burns and COVID-19. The enhancement of SRC genes (SRCs) expression indicated favorable prognosis and less severity in both conditions. An independent whole blood single-cell RNA sequencing of COVID-19 patients demonstrated that the monocyte-dendritic cell (Mono-DC) wing was the major cellular source of SRC, among which the higher expression of the SRCs in the monocyte was associated with the asymptomatic COVID-19 patients, while the quantity-restricted and function-defected CD1C-CD141-DCs were recognized as the key signature which linked to bad consequences. Specifically, the proportion of the CD1C-CD141-DCs and their SRCs expression were step-wise reduced along with worse clinic conditions while the subcluster of CD1C-CD141-DCs from the critical COVID-19 patients was characterized of IFN signaling quiescence, high mitochondrial metabolism and immune-communication inactivation. Thus, our study identified an expression-synchronized and function-focused gene network in Mono-DC population whose expression status was prognosis-related and might serve as a new target of diagnosis and therapy.