Science: Asymptomatic infection of the new coronavirus? The paper is basically factually incorrect

On January 30th a paper published in the New England Journal of Medicine (NEJM) looked at four patients in Germany who were among the first to contract the new coronavirus, some of which raised widespread concerns that infected people could still be infected with the virus even if they had not shown symptoms of a new coronavirus infection. However, the information in this paper is not accurate.

Science: Asymptomatic infection of the new coronavirus? The paper is basically factually incorrect

The paper, published in an authoritative journal, sends a message that worries public opinion. Because, if there is a symptomatic spread, then the spread of the virus will be more difficult to control. In fact, researchers in China have previously made the assumption that asymptomatic people may spread the virus, but there is no clear evidence. And the emergence of this article undoubtedly sat down this assumption. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, confirmed the article’s huge role in the spread of public opinion: “After reading the Article in the New England Journal of Medicine, there is no doubt that asymptomatic transmission is taking place. “

However, it is now found that the information in this article is not accurate, and its conclusions are therefore hugely flawed.

From January 20 to 21, a businesswoman visiting from Shanghai arrived near Munich, the paper said. She visited a local company and caused subsequent infections. There, she met the first of four infected cases, the latter of which later became ill.

The businesswoman did not show symptoms at the time, the paper said, “and she felt well and did not experience any symptoms of discomfort while she was in Germany.” But on the flight back to China, it went off. The authors therefore reasoned: “Asymptomatic groups may also be a potential source of new coronavirus infections.” Based on this fact, one may have to reestimate the current spread of the epidemic. “

However, until the publication of the paper, the researchers did not communicate directly with the Shanghai businesswoman mentioned above. The author said the woman’s message in Germany “without any symptoms” was from the mouths of four infected cases. “They told us that the Chinese patient did not seem to have any symptoms at the time,” said Michael Hoelscher of the University Of Munich Medical Center, one of the authors of the paper. “

However, the Robert Koch Institute (RKI) and the Bavarian Health and Food Safety Authority subsequently called the woman and were informed that the symptoms did occur during her stay in Germany. This is seriously inconsistent with the facts on which the conclusion sits in the paper. It is reported that at that time, the woman felt tired abnormal, and there are muscle soreness and other symptoms, she immediately used drugs to hypothered pain.

The Robert Koch Institute has sent a letter to the New England Journal of Medicine clarifying this important fact, although the agency is not the responsible unit for the paper. In addition, it updated WHO and other European partner agencies with this latest news.

This paper with the nature of oolong has aroused a broader discussion in the academic circles. In the tension of the epidemic storm, the accuracy and timeliness of information transmission constitute a pair of contradictory propositions. Christian Drosten, a virologist at the University of Berlin’s Chalet Hospital and one of the authors of the paper, responded: “I regret the direction of the incident, but I don’t think anyone in the event acted wrong.” It is clear that the woman was not in a position to contact in the first place, but people should also know the information as soon as possible, even if it was a possibility. “

Harvard T. H. Marc Lipsitch, an epidemiologist at the Chan School of Public Health, commented that it is problematic to draw conclusions without talking to patients. “Looking back, this choice doesn’t sound very clever. However, it is often not realistic to communicate with everyone in an emergency. “

He added: “I tend to think that the authors are overreacting, they just want to make their best ideas about the truth about the incident public in the first place, rather than saying that someone is sloppy.” “

By contrast, the response of the Swedish Public Health Agency has been less than overreach. “This paper, which claims that the new coronavirus will infect others during the incubation period, lacks scientific support,” the agency said in a statement. “The document it published is a regular document, with more severe wording. The last time it was used as a response was to criticize an article that proved to contain significant flaws and errors.

In addition, Isaac Bogoch, an infectious disease expert at the University of Toronto, criticized: “Even if a patient’s symptoms are unclear or mild, they cannot be called asymptomatic.” Asymptomatic means no symptoms at all, zero symptoms, which is very different. Researchers must be careful with their words. “

Hoelscher accepted the criticism, admitting that the paper should have been more clearly verified about the woman’s health. “On the one hand, it’s about sharing information as quickly as possible, and on the other hand, the new-England medical journal’s request for a draft puts a lot of pressure on me, ” he explains. “

It is worth noting that this paper went through a normal peer review process. Therefore, this incident is worth reflecting on, in the context of the crisis of the epidemic storm, peer review will also be open to the green light. Lipsitch argues that people should take this into account when reading papers, saying: “In the course of the epidemic, I think peer review is faster than normal, and the quality of the data in the paper is therefore more difficult to guarantee.” “

But it is worth noting that although the information in this paper is not accurate, it is not possible to conclude that the new coronavirus is asymptomatic. Fauci, for example, believes this may exist. “I called a colleague in China who is a respected infectious disease expert and health official, ” he said. He said he was convinced there was a symptomatic infection and that some asymptomatic people were spreading the virus. “

But WHO says that even if there is asymptomatic transmission, the effect of this mode of transmission should be secondary. People who cough or sneeze are more likely to spread the virus, according to a recent WHO report. “More data will come out soon,” Lipsitch said. We just have to wait. “