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BREAKING: study shows ‘silent’ COVID-19 infections more widespread than expected
A recently peer-reviewed study published in *Thorax* today reveals that being asymptomatic with COVID-19 might be much more common than previously anticipated. According to the data, over 80% of cruise ship passengers who tested positive for the virus showed no symptoms. One researcher involved in the study stated that these findings have significant implications for decisions regarding the easing of lockdown restrictions. In essence, it means we need to continue being extremely vigilant about social interactions and public outings.
This particular study is notable as it marks the first time comprehensive testing of all passengers and crew members was conducted on a completely isolated cruise ship during the ongoing pandemic.
The setting for this research was an expedition cruise ship that set sail from Argentina just as the World Health Organization declared the virus a global pandemic. Over a span of a month, from mid-March to mid-April, the ship functioned as its own self-contained environment, with no interaction with the outside world. The researchers were not external observers but were part of the ship's community, with two Australian doctors, Alvin J. Ing and Christine Cocks, serving as passengers, and Jeffery Peter Green acting as the ship's medical officer.
The initial plan was to embark on a 21-day journey around the Antarctic Peninsula and Elephant Island. Before boarding, all passengers were screened for symptoms of COVID-19, and anyone who had traveled through regions with high infection rates, such as China, Macau, Hong Kong, Taiwan, Japan, South Korea, or Iran, was barred from joining. However, by day three, international borders began closing, prompting the cruise organizers to cut the trip short. For the first week, things seemed under control. Regular temperature checks were performed, and hand sanitizers were readily available throughout the ship.
On the eighth day, however, the first case of fever emerged. Immediately, the entire ship was placed under quarantine, masks were handed out, and meals were delivered directly to passengers' cabins. The outbreak had officially begun.
By day 14, when the ship reached Montevideo, Uruguay, six passengers and crew members exhibited fever symptoms and were tested for COVID-19 antibodies using the VivaDiag qSARS-CoV-2 IgM/IgG test. All results came back negative. Nevertheless, Uruguay insisted that every individual on board be tested before allowing the ship to dock. On day 20, the Uruguayan Ministry of Health provided the CDC 2019-nCoV Real-Time RT-PCR Diagnostic Panel for testing. Out of 217 passengers and crew members, 128 tested positive for COVID-19, representing 59% of the ship's population.
Of these 128 positive cases:
- Only 16 (12.5%) showed mild symptoms or had fevers.
- Eight additional individuals (6.2% of total) required medical evacuation.
- Four of them (3.1% of total) needed to be intubated and placed on ventilators.
- One patient (0.8% of total) unfortunately passed away.
- In 10 instances where passengers shared cabins, one tested positive while the other tested negative.
In summary, out of the 128 confirmed COVID-19 cases, only 24 exhibited symptoms. This indicates that **81% of those who tested positive were asymptomatic**.
There's an important distinction between the two tests used. The VivaDiag qSARS-CoV-2 IgM/IgG test is an antibody test approved for use in Australia in late March and granted Emergency Use Authorization by the FDA in early April. The CDC 2019-nCoV Real-Time RT-PCR Diagnostic Panel, which received Emergency Use Authorization from the FDA in early February, is not an antibody test. Instead, it uses nasal or oral swabs to detect active coronavirus in a patient's respiratory system.
Interestingly, some participants tested negative with the antibody test yet positive with the RT-PCR test, suggesting that antibody tests might not be entirely reliable. The CDC recently noted that more than half of positive antibody tests could be inaccurate.
This study provides critical insights into the silent spread of the virus within a confined environment. It highlights the limitations of our current testing methods and underscores the importance of immediate isolation and RT-PCR testing for everyone to fully understand the virus's reach.
The doctors concluded:
1. Silent infections suggest that the actual prevalence of COVID-19 is likely much higher than reported.
2. Rapid antibody tests may yield unreliable results.
3. The majority (81%) of cases went unnoticed.
4. The RT-PCR tests may have a high false-negative rate, given differing results among cabin-mates.
5. Some passengers tested positive after the typical incubation period, indicating potential cross-contamination post-isolation.
In the U.S., widespread testing for all citizens seems unlikely anytime soon, and many states are already easing restrictions. Therefore, individuals must take responsibility for their own safety amidst the presence of silent carriers.
For further information on protection strategies, consider reviewing our coverage on preparing for the next phase of the pandemic, the proper use of personal protective equipment, safer cleaning alternatives, and innovative mask-making techniques.