MMWR Morb Mortal Wkly Rep. 2020 Apr 10;69(14):411-415. doi: 10.15585/mmwr.mm6914e1.
Presymptomatic transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), might pose challenges for disease control. The first case of COVID-19 in Singapore was detected on January 23, 2020, and by March 16, a total of 243 cases had been confirmed, including 157 locally acquired cases. Clinical and epidemiologic findings of all COVID-19 cases in Singapore through March 16 were reviewed to determine whether presymptomatic transmission might have occurred. Presymptomatic transmission was defined as the transmission of SARS-CoV-2 from an infected person (source patient) to a secondary patient before the source patient developed symptoms, as ascertained by exposure and symptom onset dates, with no evidence that the secondary patient had been exposed to anyone else with COVID-19. Seven COVID-19 epidemiologic clusters in which presymptomatic transmission likely occurred were identified, and 10 such cases within these clusters accounted for 6.4% of the 157 locally acquired cases. In the four clusters for which the date of exposure could be determined, presymptomatic transmission occurred 1-3 days before symptom onset in the presymptomatic source patient. To account for the possibility of presymptomatic transmission, officials developing contact tracing protocols should strongly consider including a period before symptom onset. Evidence of presymptomatic transmission of SARS-CoV-2 underscores the critical role social distancing, including avoidance of congregate settings, plays in controlling the COVID-19 pandemic.
新冠病毒(SARS-CoV-2)可引发 2019 冠状病毒病(COVID-19),这种病毒可能会给疾病防控带来挑战。新加坡于 2020 年 1 月 23 日确诊首例 COVID-19 病例,截至 3 月 16 日,共确诊 243 例病例,其中 157 例为本地感染病例。本研究回顾了截至 3 月 16 日新加坡所有 COVID-19 病例的临床和流行病学特征,以确定是否存在无症状传播。无症状传播是指感染者(源患者)在出现症状之前将 SARS-CoV-2 传播给二级患者,这是通过接触和症状发作日期来确定的,没有证据表明二级患者曾接触过其他 COVID-19 患者。本研究共确定了 7 个可能发生无症状传播的 COVID-19 流行病学聚集性事件,这些聚集性事件中有 10 例无症状传播病例,占 157 例本地感染病例的 6.4%。在可确定接触日期的 4 个聚集性事件中,无症状源患者在出现症状前 1-3 天发生了无症状传播。为了考虑无症状传播的可能性,制定接触者追踪方案的官员应强烈考虑将症状发作前的时段纳入其中。SARS-CoV-2 无症状传播的证据突出表明,社交隔离(包括避免聚集场所)对于控制 COVID-19 大流行至关重要。