Volume 93, Issue 2 p. 820-830
RESEARCH ARTICLE

Proportion of asymptomatic coronavirus disease 2019: A systematic review and meta-analysis

Jingjing He

Jingjing He

Department of Infection Disease, Huashan Hospital, Fudan University, Shanghai, China

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Yifei Guo

Yifei Guo

Department of Infection Disease, Huashan Hospital, Fudan University, Shanghai, China

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Richeng Mao MD, PhD

Corresponding Author

Richeng Mao MD, PhD

Department of Infection Disease, Huashan Hospital, Fudan University, Shanghai, China

Correspondence

Jiming Zhang MD, PhD and Richeng Mao MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, 200040 Shanghai, China. Email: [email protected] (J. Z.) and [email protected] (R. M.)

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Jiming Zhang MD, PhD

Corresponding Author

Jiming Zhang MD, PhD

Department of Infection Disease, Huashan Hospital, Fudan University, Shanghai, China

Correspondence

Jiming Zhang MD, PhD and Richeng Mao MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, 200040 Shanghai, China. Email: [email protected] (J. Z.) and [email protected] (R. M.)

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First published: 21 July 2020
Citations: 245

Abstract

We aim to systematically review the characteristics of asymptomatic infection in the coronavirus disease 2019 (COVID-19). PubMed and EMBASE were electronically searched to identify original studies containing the rate of asymptomatic infection in COVID-19 patients before 20 May 2020. Then mate-analysis was conducted using R version 3.6.2. A total of 50 155 patients from 41 studies with confirmed COVID-19 were included. The pooled percentage of asymptomatic infection is 15.6% (95% CI, 10.1%-23.0%). Ten included studies contain the number of presymptomatic patients, who were asymptomatic at screening point and developed symptoms during follow-up. The pooled percentage of presymptomatic infection among 180 initially asymptomatic patients is 48.9% (95% CI, 31.6%-66.2%). The pooled proportion of asymptomatic infection among 1152 COVID-19 children from 11 studies is 27.7% (95% CI, 16.4%-42.7%), which is much higher than patients from all aged groups. Abnormal CT features are common in asymptomatic COVID-19 infection. For 36 patients from 4 studies that CT results were available, 15 (41.7%) patients had bilateral involvement and 14 (38.9%) had unilateral involvement in CT results. Reduced white blood cell count, increased lactate dehydrogenase, and increased C-reactive protein were also recorded. About 15.6% of confirmed COVID-19 patients are asymptomatic. Nearly half of the patients with no symptoms at detection time will develop symptoms later. Children are likely to have a higher proportion of asymptomatic infection than adults. Asymptomatic COVID-19 patients could have abnormal laboratory and radiational manifestations, which can be used as screening strategies to identify asymptomatic infection.

Highlights

By systematically reviewing the proportion and clinical features of asymptomatic infection in COVID-19, our study provides a useful quantity to understand the true burden of this disease.

CONFLICT OF INTERESTS

The authors declare that there are no conflict of interests.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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