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Can I get COVID-19 from an asymptomatic patient?

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WHO defines an asymptomatic case as a laboratory-confirmed infected person without overt symptoms.1It remains to be established how thoroughly such a person needs to be examined clinically. Furthermore, there is a distinction between asymptomatic and presymptomatic individuals which can currently be made onlyretrospectively, after the occurrence or non-occurrence of clinical symptoms.

Recent evidence suggests that elevated serum/plasma lactate dehydrogenase levels may, already in the early stages, be indicative of presymptomatic infections and, thus, facilitate early differentiation.2 However, it is these asymptomatic individuals carrying SARS-CoV-2 that are hidden drivers of the pandemic, and infectivity studies confirm the existence of transmission by asymptomatic individuals.Younger age correlates strongly with asymptomatic and mild infections and children as hidden drivers. The estimated proportion of asymptomatic infections ranges from 18% to 81%,3 however, the transmission risk from these asymptomatic individuals remains low as per reports and analysis published in the world’s no. 1 journal Nature, because scientists they are not coughing or sneezing as much. 4

Nevertheless, there are many accounts of SARS‐CoV‐2 spreading by proximity with asymptomatic individuals who do not know they are infected; these could be the individuals that may notbe coughing or sneezing. On almost a daily basis, scientists from the CDC and the National Institutes of Health (NIH) discuss the importance of curbing transmission from asymptomatic individuals, few of which we have covered in this report.5

Early on, when the main geographical regions with cases of COVID‐19 were in China, there were reports in the press regarding asymptomatic transmission suggesting that coughing and sneezing might not be the only important means of spreading active virus, leading to hypothesized pathways such as touching of surfaces and shedding of particles in the process of normal breathing.

Researchers in China had indicated early on that asymptomatic transmission was a possibility after studying five family members who became symptomatic after contact with an asymptomatic family member who was visiting from Wuhan.6Similarly, other researchers identified viral loads in an asymptomatic subject, with unremarkable CT scans, that were similar to the symptomatic subjects.7Wei et al. investigated all 243 cases of COVID‐19 reported in Singapore between January 23 and March 168and were able to identify presymptomatic transmission as the most likely explanation in seven clusters of cases in the analysis.

Therefore, it is definitely a good idea to follow precautions irrespective of the individual or group around you being symptomatic or not. Universal use of masks can prevent inadvertent spread by an asymptomatic person who is not aware of his/her positive status. It is also important to maintain a distance of at least six feet from any individual, apart from handwashing or use of sanitizers, and maintenance of personal hygiene. At home, it is best to wear a mask, especially if there are elderly people in the house. but if that is not possible, it is advisable to cover one’s mouth when coughing or sneezing or to do so into one’s elbow. In public transports or in closed settings, such as office spaces, it is recommended to wear masks – even if they are just multi-layered fabric masks, to prevent the spread of active transmission to the maximum.

Source:

1 WHO defines an asymptomatic case as a laboratory-confirmed infected person without overt symptoms
2 Ooi EE, et al. Asymptomatic SARS-CoV-2 infection. Lancet Infect Dis. 2020 doi: 10.1016/S1473-3099(20)30460-6.
3 Nikolai LA, et al. Asymptomatic SARS Coronavirus 2 infection: Invisible yet invincible. Int J Infect Dis. 2020;100:112–16. doi: 10.1016/j.ijid.2020.08.076
4 Nogardy B. What the data say about asymptomatic COVID infections. Nature 2020;587:534.
5 Anderson EL, et al. Consideration of the Aerosol Transmission for COVID‐19 and Public Health. Risk Anal. 2020;40(5):902–07.  doi: 10.1111/risa.13500
6 Bai Y, et al. Presumed asymptomatic carrier transmission of COVID‐19. JAMA 2020:323(14):1406–07. 
7 Zou L, et al. SARS‐CoV‐2 viral load in upper respiratory specimens of infected patients. New Engl J Med 2020;382(12):1177–79.
8 Wei WE, et al.Presymptomatic transmission of SARS‐CoV‐2—Singapore, January 23–March 16, 2020. Morbidity and Mortality Weekly Report, 69(14), 411.

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Coronavirus

Dos and don’ts for vacay activities

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It is not a one size fits all when it comes to vacations or holidays because every family has a different demographic – some may have small kids who need to be taken to a washroom very often, some may have elderly who cannot sit too long during road trips. Therefore, every family should decide based on their own family size, needs and facilities. Traveling will inevitably lead to exposures to unvaccinated kids and adults. But the risk will be decided based on the extent of that exposure.

Masks reduce transmission and have been proven to be an effective tool with vaccination. Wearing a mask indoors and in public spaces further cuts down on risk considerably.

Before you travel:

  1. Get your RTPCR test done

While traveling:

  1. Wear a mask covering your nose and mouth at all times when you are in public places or around individuals that cannot maintain a safe distance of 6 feet away from you.
  2. Avoid crowds and stay at least 6 feet/2 meters from anyone who you do not know personally with their health history.
  3. Wash your hands often or use hand sanitizer (with at least 60% alcohol).

When you return from your vacation:

  1. If you see any signs of COVID, get tested and isolate yourself from other family members as well.
  2. Even if you test negative, stay home and self-quarantine for the full 7 days.
  3. If you don’t get tested, stay home and self-quarantine for 10 days after travel.
  4. Self-monitor for COVID-19 symptoms; isolate and get tested if you develop symptoms.

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Coronavirus

It hasn’t affected kids till now – it won’t affect them ever

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Schools reopening across the globe has brought about a sense of panic in some parents and a sense of confidence in others because vaccination for children is yet to come and unvaccinated children are both at direct risk for COVID as well as at risk of transmitting the virus to others.

According to the World Health Organisation (WHO), data suggests that children under the age of 18 years represent about 8.5% of reported cases, with relatively few deaths compared to other age groups and usually mild disease. However, cases of critical illness have been reported. As with adults, pre-existing medical conditions have been suggested as a risk factor for severe disease and intensive care admission in children. Further studies are underway to assess the risk of infection in children and to better understand transmission in this age group.

Although research has shown that children develop severe disease from COVID-19 far less commonly than adults, and therefore, the risk of death due to severity of COVID-19 is also much lower in children. However, they are not immune. There are reports of children dying due to COVID-19.  But even when children do not get seriously ill with COVID-19 or show symptoms, they can still transmit the virus to other children and adults. The rate of child-to-adult transmission of SARS-CoV-2 is roughly half the rate of adult-to-child transmission. So even when the risk is low for children, transmission to other unvaccinated kids and adults is still a serious concern.

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Coronavirus

Vaccination can help us tide over the third wave

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The  second wave is declining, although up to 30-40,000 daily new cases continue to be recorded. India is far from being a COVID-19 free nation. Moreover, the looming third wave and alerts released by different State heads to be prepared for a third wave or to make adequate arrangements for the third wave in terms of oxygen cylinders, beds, critical care wards, etc. has kept us all on our toes and inside homes for fear of expediting the arrival of the third wave.

Eminent virologist and retired professor (CMC Vellore), Dr. T Jacob John, in a recent media interview said if the Government can do justice to the vaccination, in terms of making it available in abundance and everywhere, even the unlikely probability of a third wave can be mitigated, adding that in other words, the third wave can be and must be prevented with vaccination. Dr. John also believes that the two strong waves of COVID-19 pandemic in India would have created high herd-immunity, which is why even a moderate level of vaccination will surely avert the third wave.

We should continue to follow physical distancing protocols and avoid crowding indoors or outdoors as much as possible.

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Coronavirus

Complete vaccinated individuals three times less likely to get COVID-19

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In what comes as more evidence to back completing the (two-dose or one-dose) mandated course for vaccinations for COVID-19, a recent update published by the Imperial College London has shown that people who have received both doses of their coronavirus vaccine are three times less likely to get infected with COVID-19. These results from the 13th round of the Imperial-led REACT-1 study, a major coronavirus monitoring programme, are based on swab tests taken by almost 100,000 people in England between 24 June and 12 July. 

According to their website, REACT (REal-time Assessment of Community Transmission) is a series of studies that are using home testing to improve the understanding of how the COVID-19 pandemic is progressing across England. This major research programme was commissioned by the Department of Health and Social Care (DHSC) and is being carried out by Imperial College London in partnership with Ipsos MORI and Imperial College Healthcare NHS Trust.

The analysis by Imperial College London and Ipsos MORI, which had almost 100,000 volunteers taking part in the study in England between June 24 and July 12, suggests that double vaccinated people are also less likely to pass on the virus to others. Results have also indicated that people who were fully vaccinated were less likely to be carriers of infection to pass the virus on to others, because they have a lower viral load on average and therefore shed less virus. 

In his statement to the Press post release of study results, the UK Vaccines Minister Mr. Nadhim Zahawi also stated, “these results show the positive impact of the vaccination program with those who are double jabbed three times less likely than unvaccinated people to get the virus and less likely to pass on this awful disease to those around them”.

It is important to note that no vaccine has 100% efficacy but benefits outweigh the risks and therefore vaccination is an important step towards curbing the pandemic. Vaccination however, must also be complemented by COVID appropriate behavior.

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Coronavirus

Breastfeeding post vaccination can kill your baby

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There isn’t any research to support this claim, and based on how vaccines work, there is no reason to believe that the vaccine could harm mom or baby. In fact studies support the fact that the vaccines are not excreted into the breast milk, but antibodies produced by mothers in response to the COVID-19 vaccine do — providing hope that breastfed babies might have some level of protection.

A report published in the journal Nature states that COVID-19 vaccines do not carry a risk of igniting an active infection and that they are extremely unlikely to cross into breast milk. The report further elaborates how the fragile messenger RNA used in the Pfizer–BioNTech and Moderna vaccines, is designed to break down so quickly that it should never leave the cells where it was injected. Therefore, it cannot get into the bloodstream and then the breast. In fact, experts believe none of the current vaccines will be excreted into breast milk.

The World Health Organisation (WHO) Strategic Advisory Group of Experts on Immunization (SAGE) Guidance also recommends that mothers continue to breastfeed after vaccination. The Centre for Disease Control (CDC) and the UK Joint Committee on Vaccination and Immunisation issued statements shortly after the first vaccines were authorized in both countries recommending COVID-19 vaccination for breastfeeding women.

Australia’s Department of Health has indicated that breastfeeding women can get an approved COVID-19 vaccine and don’t need to stop breastfeeding before or after. 

Therefore, in conclusion, no safety concerns have been identified in lactating women who have been vaccinated. Women can continue to breastfeed pre and post COVID-19 vaccination.

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