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Up to 45 percent of SARS-CoV-2 infections may be asymptomatic

高達45%的SARS-CoV-2感染病例可能并未出現任何癥狀

上海譯銳翻譯       2020-6-16     09:46 a.m.

An extraordinary percentage of people infected by the virus behind the ongoing deadly COVID-19 pandemic never show symptoms of the disease, according to the results of a Scripps Research analysis of public datasets on asymptomatic infections.

根據斯科瑞普斯研究所（Scripps Research）對無癥狀感染公共數據的分析結果，在目前感染有致命風險的COVID-19傳染病病毒的人群中，有很大一部分感染者并未出現任何感染癥狀。

asymptomatic infection：無癥狀感染

The findings, published in Annals of Internal Medicine, suggest that asymptomatic infections may account for as much as 45 percent of all COVID-19 cases, playing a significant role in the early and ongoing spread of COVID-19. The report highlights the need for expansive testing and contact tracing to mitigate the pandemic.

研究結果刊登于《內科醫(yī)學年監(jiān)》(Annals of Internal Medicine)。根據研究報告，在所有的COVID-19病例中，無癥狀感染者的比例大概高達45%。如此高的比例在COVID-19早期以及持續(xù)傳播方面具有重要的推動作用。報告強調，延緩疾病傳播需要進行大規(guī)模的檢測以及接觸人群追蹤。

"The silent spread of the virus makes it all the more challenging to control," says Eric Topol, MD, founder and director of the Scripps Research Translational Institute and professor of Molecular Medicine at Scripps Research. "Our review really highlights the importance of testing. It's clear that with such a high asymptomatic rate, we need to cast a very wide net, otherwise the virus will continue to evade us."

Eric Topol，醫(yī)學博士，斯科瑞普斯研究所轉化研究所創(chuàng)始人兼所長、斯科瑞普斯分子藥物教授表示：“悄無聲息地傳播使病毒更加難以控制。我們的報告強調了檢測的重要性。面對如此高比例的無癥狀感染，顯然我們需要布下天羅地網，否則病毒還會繼續(xù)和我們玩捉迷藏。”

Together with behavioral scientist Daniel Oran, Topol collected information from testing studies on 16 diverse cohorts from around the world. These datasets -- gathered via keyword searches of PubMed, bioRxiv and medRxiv, as well as Google searches of relevant news reports -- included data on nursing home residents, cruise ship passengers, prison inmates and various other groups.

Topol和行為學家Daniel Oran一道從世界各地16個分散的人群的測試研究中收集信息。這些數據集來自于通過關鍵詞“PubMed、bioRxiv和medRxiv”搜索以及通過Google搜索相關新聞報道，包括養(yǎng)老院人群、郵輪乘客、監(jiān)獄罪犯以及各種其他群體的數據搜索結果。

cohort：（有共同特點或舉止類同的）一群人

"What virtually all of them had in common was that a very large proportion of infected individuals had no symptoms," says Oran. "Among more than 3,000 prison inmates in four states who tested positive for the coronavirus, the figure was astronomical: 96 percent asymptomatic."

Oran表示：“所有人群的一個共同點是很大一部分感染患者沒有任何癥狀。在四個州超過3000名檢測結果呈陽性的服刑人員中，無癥狀的數據比例是非常龐大的：96%的感染者沒有任何癥狀。”

The review further suggests that asymptomatic individuals are able to transmit the virus for an extended period of time, perhaps longer than 14 days. The viral loads are very similar in people with or without symptoms, but it remains unclear whether their infectiousness is of the same magnitude. To resolve that issue, we'll need large-scale studies that include sufficient numbers of asymptomatic people.

報告進一步表明，無癥狀感染者能夠在更長的時間內傳播病毒，也許不止14天。有癥狀感染者或無癥狀感染者身體中的病毒載量非常相似，但是其感染程度是否具有相同等級則仍不明確。為了解決這一問題，我們需要展開大規(guī)模的研究，其中包括足夠多的無癥狀感染者 。

viral load：病毒載量/病毒負荷

The authors also conclude that the absence of symptoms may not imply an absence of harm. CT scans conducted on 54 percent of 76 asymptomatic individuals on the Diamond Princess cruise ship, appear to show significant subclinical lung abnormalities raising the possibility of SARS-CoV-2 infection impacting lung function that might not be immediately apparent. The scientists say further research is needed to confirm the potential significance of this finding.

論文作者總結表示，無癥狀并不意味著無傷害。在對鉆石公主號郵輪上的76名無癥狀感染中的部分人群（54%）進行CT掃描發(fā)現，明顯的亞臨床肺部異常使SARS-CoV-2感染影響肺功能的可能性增加，而肺功能受影響也許不會立刻顯現。科學家們表示，需要進一步研究來證實該結果的潛在影響。

subclinical:無明顯臨床癥候

The authors also acknowledge that the lack of longitudinal data makes distinguishing between asymptomatic and presymptomatic individuals difficult. An asymptomatic individual is someone who is infected with SARS-CoV-2, but never develops symptoms of COVID-19, while a presymptomatic person is similarly infected, but will eventually develop symptoms. Longitudinal testing, which refers to repeated testing of individuals over time, would help differentiate between the two.

作者還承認，缺乏縱向運動數據使得區(qū)分無癥狀和發(fā)病前人群困難重重。無癥狀人群是指感染了SARS-CoV-2，但是不會出現COVID-19癥狀的人群，而發(fā)病前感染者會出現類似的感染情況，但是最終會出現COVID-19的癥狀。縱向運動數據（即在一段時間內不斷對個人進行重復測試），也許對區(qū)分兩者有所幫助。

"Our estimate of 40 to 45 percent asymptomatic means that, if you're unlucky enough to get infected, the probability is almost a flip of a coin on whether you're going to have symptoms. So to protect others, we think that wearing a mask makes a lot of sense," Oran concludes.

我們對40%-45%無癥狀感染病例的估計意味著，如果你不幸被感染，那么是否出現感染癥狀的概率相當于拋擲硬幣。對于保護其他人，我們認為戴口罩是非常明智的舉措，Oran總結表示。

來源：科學日報     編輯：質控部