On April 12, the Chinese Center for Disease Control and Prevention released the protocol for the management of asymptomatic carriers of COVID-19. This comes just a few days after China lifted the lockdown in Wuhan, the former epicentre of the coronavirus outbreak.
Meanwhile, cases in other countries are going up, with millions of people confined to their homes. What China does next and if there is a resurgence of cases in the country will help in shaping the response of the rest of the world in mitigating the disease outbreak.
Asymptomatic carriers of infectious diseases pose a significant challenge in mitigation efforts, since they display no symptoms but can still be contagious and pass on the disease to other people.
A 2018 article published in the Royal Society Open Science states, “These asymptomatic carriers contribute to the spread of disease but go largely undetected and can, therefore, undermine efforts to control transmission.”
The protocol identifies two types of asymptomatic people — those who have no self-perceived symptoms or clinically detectable signs throughout the 14 days of quarantine; and those who are asymptomatic during the incubation period (the time period between getting infected and showing symptoms).
To strengthen the monitoring and detection of asymptomatic persons, the protocol recommends actively testing close contacts of COVID-19 patients during their medical observation period, actively testing during cluster investigations, actively testing people with exposure during tracing the infection source, actively testing people with travel or residential history in areas abroad with sustained COVID-19 transmission, and detecting cases during the epidemiological investigation and opportunistic screening.
How will asymptomatic cases be reported?
It calls for standardised reporting of asymptomatic cases, which means that all healthcare facilities should report an asymptomatic case detected by them within two hours through direct online reporting. After the report of such a person has been received, the county-level CDCs will be required to carry out their investigation within 24 hours and report all the close contacts of the case. All the close contacts will be put under a 14-day medical observation.
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The protocol also advises scaling up of targeted screening efforts by testing close contacts of detected and asymptomatic cases.
Will asymptomatic cases be counted as COVID-19 cases?
Not all asymptomatic cases will be counted as COVID-19 cases. China does not want to classify asymptomatic cases as COVID-19 cases until they show symptoms of the disease during the 14-day period of medical observation. Therefore, only those asymptomatic cases who develop clinical symptoms during this period will be reclassified as confirmed cases.
Those who test negative for the disease twice during the 14-day quarantine period will be lifted from medical observation and those who show no symptoms and still test positive will be kept under centralised medical observation and given standard treatment.
What happens after an asymptomatic case develops symptoms?
If such a person starts developing symptoms during the period of centralised medical observation, they will be transferred to a health facility and will be reclassified after their diagnosis has been confirmed.
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Further, once an asymptomatic person is lifted from the centralised medical observation of 14 days, they will still be under medical observation for another two weeks and will be required to make follow-up visits to the designated health facilities in the second and fourth week after the centralised observation is lifted.
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