"Study claiming new coronavirus can be transmitted by people without symptoms was flawed" https://t.co/ltccgJ3mAi— Ron Coleman (@RonColeman) May 17, 2020
ScienceMag.org
written by Kai Kupferschmidt
February 3, 2020
A paper published on 30 January in The New England Journal of Medicine (NEJM) about the first four people in Germany infected with a novel coronavirus made many headlines because it seemed to confirm what public health experts feared: that someone who has no symptoms from infection with the virus, named 2019-nCoV, can still transmit it to others. That might make controlling the virus much harder.
Chinese researchers had previously suggested asymptomatic people might transmit the virus but had not presented clear-cut evidence. “There’s no doubt after reading [the NEJM] paper that asymptomatic transmission is occurring,” Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, told journalists. “This study lays the question to rest.”
But now, it turns out that information was wrong. The Robert Koch Institute (RKI), the German government’s public health agency, has written a letter to NEJM to set the record straight, even though it was not involved in the paper.
The letter in NEJM described a cluster of infections that began after a businesswoman from Shanghai visited a company near Munich on 20 and 21 January, where she had a meeting with the first of four people who later fell ill. Crucially, she wasn’t sick at the time: “During her stay, she had been well with no sign or symptoms of infection but had become ill on her flight back to China,” the authors wrote. “The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak.”
But the researchers didn’t actually speak to the woman before they published the paper. The last author, Michael Hoelscher of the Ludwig Maximilian University of Munich Medical Center, says the paper relied on information from the four other patients: “They told us that the patient from China did not appear to have any symptoms.” Afterward, however, RKI and the Health and Food Safety Authority of the state of Bavaria did talk to the Shanghai patient on the phone, and it turned out she did have symptoms while in Germany. According to people familiar with the call, she felt tired, suffered from muscle pain, and took paracetamol, a fever-lowering medication. (An RKI spokesperson would only confirm to Science that the woman had symptoms.)
Hoelscher was not on the call, he says. “I asked the Bavarian Health and Food Safety Authority whether the information from that phone conversation called for a correction and I was told that is not the case,” he says. (The Bavarian ministry of health, of which the agency is part, has not responded to a request for information from ScienceInsider.) But RKI disagreed. The agency’s spokesperson confirms that a letter about the error has been submitted to NEJM. RKI also informed the World Health Organization (WHO) and European partner agencies about the new information.
“I feel bad about how this went, but I don’t think anybody is at fault here,” says virologist Christian Drosten of the Charitรฉ University Hospital in Berlin, who did the lab work for the study and is one of its authors. “Apparently the woman could not be reached at first and people felt this had to be communicated quickly.”
Marc Lipsitch, an epidemiologist at the Harvard T.H. Chan School of Public Health, says calling a case asymptomatic without talking to the person is problematic. “In retrospect, it sounds like this was a poor choice,” he says. However, “In an emergency setting, it’s often not possible to talk to all the people,” he adds. “I’m assuming that this was an overstretched group trying to get out their best idea of what the truth was quickly rather than somebody trying to be careless.”
The Public Health Agency of Sweden reacted less charitably. “The sources that claimed that the coronavirus would infect during the incubation period lack scientific support for this analysis in their articles,” says a document with frequently asked questions the agency posted on its website yesterday. “This applies, among other things, to an article in [NEJM] that has subsequently proven to contain major flaws and errors.” Even if the patient’s symptoms were unspecific, it wasn’t an asymptomatic infection, says Isaac Bogoch, an infectious disease specialist at the University of Toronto. “Asymptomatic means no symptoms, zero. It means you feel fine. We have to be careful with our words.”
Hoelscher agrees that the paper should have been clearer about the origin of the information about the woman’s health. “If I was writing this today, I would phrase that differently,” he says. The need to share information as fast as possible, along with NEJM’s push to publish early, created a lot of pressure, he says.
Given how fast data are coming out amid the growing global crisis, it’s good to read even peer-reviewed papers with some extra caution at the moment, Lipsitch says: “I think peer review is lighter in the middle of an epidemic than it is at normal speed, and also the quality of the data going into the papers is necessarily more uncertain.”
The fact that the paper got it wrong doesn’t mean transmission from asymptomatic people doesn’t occur. Fauci, for one, still believes it does. "This evening I telephoned one of my colleagues in China who is a highly respected infectious diseases scientist and health official," he says. "He said that he is convinced that there is asymptomatic infection and that some asymptomatic people are transmitting infection." But even if they do, asymptomatic transmission likely plays a minor role in the epidemic overall, WHO says. People who cough or sneeze are more likely to spread the virus, the agency wrote in a situation report on Saturday. “More data may come out soon. We will just have to wait,” Lipsitch says.
The German cluster does reveal another interesting aspect about the new virus, Drosten says. So far most attention has gone to patients who get seriously ill, but all four cases in Germany had a very mild infection. That may be true for many more patients, Drosten says, which may help the virus spread. “There is increasingly the sense that patients may just experience mild cold symptoms, while already shedding the virus,” he says. “Those are not symptoms that lead people to stay at home.”
UPDATE 5/19/20 at 3:50am: Added info below.Governement study about COVID-19 seroprevalence in Spain: among workers, those who had an "essential profession" and continued working were less infected than those staying at home. This should lead to a reflection on the role of general confinement. https://t.co/rMaFSLH8eR pic.twitter.com/4pvoTGPiaz— Didier Raoult (@raoult_didier) May 14, 2020
In January WHO and even Dr Fauci told the world because China Communist government told them coronavirus COULD NOT be transmitted person-to-person.— Global Awareness 101 (@Mononoke__Hime) April 21, 2020
President Trump launched coronavirus task force January 29 and declared China travel ban January 31.https://t.co/wJYPGwZu87
In Jan Dr Fauci said "Interesting thing about the current virus that we're seeing in Wuhan, China does not appear to spread certainly not readily and maybe NOT AT ALL from human-to-human because there have been no cases of infection of healthcare workershttps://t.co/tmjYzCKPFb— Global Awareness 101 (@Mononoke__Hime) April 10, 2020
But just last year, the National Institute for Allergy and Infectious Diseases, the organization led by Dr. Fauci, funded scientists at the Wuhan Institute of Virology and other institutions for work on gain-of-function research on bat coronaviruses.https://t.co/JVkLu66eFR— Global Awareness 101 (@Mononoke__Hime) April 30, 2020
Explain to me why the media takes their masks off when they think the cameras are off? Is it all for show? #fakenews #LamestreamMedia looks like the rules only apply to us peasants. #obamagate #qanon pic.twitter.com/rlET581ytJ— Mateusz Zawadzki (@Matt_Zawadzki) May 12, 2020
The mask is for show? pic.twitter.com/XnRLiEJ1L5— Power Tie (@realPowerTie) May 15, 2020
You didn't wear a mask on Cinco de Mayo to pick up your tacos from Mi Vida. Why not? Is there a different standard for the media? Are there some places we have to wear masks and others we don't? pic.twitter.com/nA8L69TsEj— Luke Mahoney (@LukeRMahoney) May 11, 2020
And here’s @jdawsey1 sitting on his porch with friends drinking & smoking — no mask. He’s not even wearing shoes. #gross pic.twitter.com/vEYeTO1S8c— Arthur Schwartz (@ArthurSchwartz) May 11, 2020
UPDATE 5/19/20 at 4:22pm: Added info below.Please read and retweet.The Surgeon General is trying to get this out.They held a press conference to get this out but none of the mainstream media is putting it up for people to see it.If you are healthy you should not wear the mask. It can make you sick. https://t.co/uZPwkd6ppd— Teresa Sprague⭐⭐⭐ (@TVSprague) May 8, 2020
This is the supercut video President Trump just played during the coronavirus briefing. It includes clips of MSNBC and CNN pundits downplaying coronavirus, @maggieNYT defending his China travel ban, and Govs. Cuomo and Newsom praising his administration's response. pic.twitter.com/W6O1oEQuso— Daily Caller (@DailyCaller) April 13, 2020
What is @jonkarl insinuating right now because President Trump's administration created an informational video setting the record straight after journalists spread fake smear news?— Global Awareness 101 (@Mononoke__Hime) April 13, 2020
Jonathan Karl is Chief White House Correspondent for ABC sitting in the Brady Press Briefing room.
Communist China government quarantined Wuhan domestically BUT allowed International flights to continue during Chinese New Year.— Global Awareness 101 (@Mononoke__Hime) May 13, 2020
China destroyed nations and destroyed lives BECAUSE CHINA Communist cared more about China commerce.
China & WHO warned nations not to close borders.
CHINE LIED, PEOPLE DIED.
WHO LIED, PEOPLE DIED.
DEMOCRATS LIED, PEOPLE DIED.
DEMOCRATS LIED, PEOPLE DIED.
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