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- Page navigation anchor for RE: Strategically sequence asymptomatic COVID-19 patientsRE: Strategically sequence asymptomatic COVID-19 patients
An editorial call was published recently for aggressive testing on asymptomatic as well as symptomatic COVID-19 patients1. This prudential rallying cry should be carried further, amplified by strategic asymptomatic patient genome sequencing.
The current pandemic has spawned tremendous research on SARS-CoV-2 and its clinical manifestations. Patients can be categorised into at least three groups on the basis of pathogenic effects. Some patients follow the stereotypical, severe path, predominantly involving respiratory trauma and ultimately arrest; these patients often are high-risk members in populations, elderly, frail or immunocompromised individuals. Some patients are asymptomatic, experiencing no maladies despite having tested positive; these patients often are low-risk members in populations, young, healthy individuals. Some patients follow an atypical, milder path, involving less common symptoms, such as nosmia1,2, ageusia2 or paresthesia; scant data are available about these individuals, although olfactory and gustatory dysfunction prevalence is greater in young-age cohorts and, so, low-risk patients2.
Asymptomatic and atypical-course patients warrant investigation1. Asymptomatic health care providers particularly should be studied to determine why they seem to be resistant despite ample opportunity for SARS-CoV-2 infection or, for those that tested positive, what halted the viral perpetration to COVID-19. Asymptomatic patients provided the first fundame...
Show MoreCompeting Interests: None declared.References
- Larissa M. Matukas, Irfan A. Dhalla, Andreas Laupacis. Aggressively find, test, trace and isolate to beat COVID-19. CMAJ 2020;192:E1164-E1165.
- Yan CH, Faraji F, Prajapati DP, Ostrander BT, DeConde AS. Self-reported olfactory loss associates with outpatient clinical course in COVID-19. Int. Forum Allergy Rhinol 2020;10:821-31.
- Agyeman AA, Chin KL, Landersdorfer CB, Liew D, Ofori-Asenso R. Smell and taste dysfunction in patients with COVID-19: a systematic review and meta-analysis. Mayo Clin Proc 2020;95:1621-31.
- Page navigation anchor for 7,000 active COVID cases in Canada is the spark that could ignite the second wave7,000 active COVID cases in Canada is the spark that could ignite the second wave
While we were caught off guard in March when COVID cases spiked in Canada, there is no excuse this time around. We are far from COVID herd immunity, antibody tests are not reliable indicators of protection, approval of a vaccine is months away, so we are left with the same arsenal of public health measures to prevent and protect us from the second wave, which may be even bigger and longer as our Canadian winter approaches.
To prevent outbreaks that can lead to the second wave, each new diagnosis of COVID (i.e. index case) requires rapid intervention and containment at the source since up to 1 in 5 secondary cases may have no symptoms leading to undetected ongoing spread. All close contacts of the index case must therefore isolate for 14 days and ideally should be tested for COVID (i.e. “Ring Testing”). In school settings, for instance, isolating for 14 days and immediately testing all household members of the index case is important to identify secondary cases among siblings or parents to identify other classrooms and/or workplaces at risk. For each classroom exposed, isolating for 14 days and testing all teachers and students on day 5-7 post-exposure (i.e. the peak incubation period) will further identify secondary cases but even those with a negative test still need to complete the 14-days and be retested if symptoms develop. Due to ongoing exposure to the index case, at the end of the 10-14 days isolation period (or longer if the case remains symptomatic), the en...
Show MoreCompeting Interests: None declared.References
- Larissa M. Matukas, Irfan A. Dhalla, Andreas Laupacis. Aggressively find, test, trace and isolate to beat COVID-19. CMAJ 2020;10.1503/cmaj.202120.