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The authors report the results of two surveys taken in the Italian municipality of Vo’ conducted at the beginning of the 14-day city-wide lockdown for COVID-19 and at the end of the lockdown. The results give insight into the dynamics of the transmission of the virus. For example, the authors found that 42.5% of all of the confirmed infections across both surveys were asymptomatic and found a decreasing trend in the viral load following the onset of symptoms, which indicates that presymptomatic contact may play a critical role in transmission of the virus.
In the absence of strict social distancing and ongoing surveillance in the way of testing, tracing, and isolating, the authors conclude that the presymptomatic and asymptomatic transmission of the virus pose a formidable challenge to controlling its spread. They emphasize the need for enhanced community surveillance, early detection of transmission, and timely intervention to reduce the substantial burden of COVID-19.
This abstract is available on the publisher's site.
On the 21st of February 2020 a resident of the municipality of Vo', a small town near Padua, died of pneumonia due to SARS-CoV-2 infection1. This was the first COVID-19 death detected in Italy since the emergence of SARS-CoV-2 in the Chinese city of Wuhan, Hubei province2. In response, the regional authorities imposed the lockdown of the whole municipality for 14 days3. We collected information on the demography, clinical presentation, hospitalization, contact network and presence of SARS-CoV-2 infection in nasopharyngeal swabs for 85.9% and 71.5% of the population of Vo' at two consecutive time points. On the first survey, which was conducted around the time the town lockdown started, we found a prevalence of infection of 2.6% (95% confidence interval (CI) 2.1-3.3%). On the second survey, which was conducted at the end of the lockdown, we found a prevalence of 1.2% (95% Confidence Interval (CI) 0.8-1.8%). Notably, 42.5% (95% CI 31.5-54.6%) of the confirmed SARS-CoV-2 infections detected across the two surveys were asymptomatic (i.e. did not have symptoms at the time of swab testing and did not develop symptoms afterwards). The mean serial interval was 7.2 days (95% CI 5.9-9.6). We found no statistically significant difference in the viral load of symptomatic versus asymptomatic infections (p-values 0.62 and 0.74 for E and RdRp genes, respectively, Exact Wilcoxon-Mann-Whitney test). This study sheds new light on the frequency of asymptomatic SARS-CoV-2 infection, their infectivity (as measured by the viral load) and provides new insights into its transmission dynamics and the efficacy of the implemented control measures.
Suppression of a SARS-Cov-2 Outbreak in the Italian Municipality of Vo'
Nature 2020 Jun 30;[EPub Ahead of Print], E Lavezzo, E Franchin, C Ciavarella, G Cuomo-Dannenburg, L Barzon, C Del Vecchio, L Rossi, R Manganelli, A Loregian, N Navarin, D Abate, M Sciro, S Merigliano, E De Canale, MC Vanuzzo, V Besutti, F Saluzzo, F Onelia, M Pacenti, S Parisi, G Carretta, D Donato, L Flor, S Cocchio, G Masi, A Sperduti, L Cattarino, R Salvador, M Nicoletti, F Caldart, G Castelli, E Nieddu, B Labella, L Fava, M Drigo, KAM Gaythorpe, , AR Brazzale, S Toppo, M Trevisan, V Baldo, CA Donnelly, NM Ferguson, I Dorigatti, A Crisanti