Potential SARS-CoV-2 infectiousness among asymptomatic healthcare workers

PLoS One. 2021 Dec 17;16(12):e0260453. doi: 10.1371/journal.pone.0260453. eCollection 2021.

Abstract

A majority of SARS-CoV-2 infections are transmitted from a minority of infected subjects, some of which may be symptomatic or pre-symptomatic. We aimed to quantify potential infectiousness among asymptomatic healthcare workers (HCWs) in relation to prior or later symptomatic disease. We previously (at the onset of the SARS-CoV-2 epidemic) performed a cohort study of SARS-CoV-2 infections among 27,000 healthcare workers (HCWs) at work in the capital region of Sweden. We performed both SARS-CoV-2 RT-PCR and serology. Furthermore, the cohort was comprehensively followed for sick leave, both before and after sampling. In the present report, we used the cohort database to quantify potential infectiousness among HCWs at work. Those who had sick leave either before or after sampling were classified as post-symptomatic or pre-symptomatic, whereas the virus-positive subjects with no sick leave were considered asymptomatic. About 0.2% (19/9449) of HCW at work were potentially infectious and pre-symptomatic (later had disease) and 0.17% (16/9449) were potentially infectious and asymptomatic (never had sick leave either before nor after sampling). Thus, 33% and 28% of all the 57 potentially infectious subjects were pre-symptomatic or asymptomatic, respectively. When a questionnaire was administered to HCWs with past infection, only 10,5% of HCWs had had no indication at all of having had SARS-CoV-2 infection ("truly asymptomatic"). Our findings provide a unique quantification of the different groups of asymptomatic, potentially infectious HCWs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Asymptomatic Infections / epidemiology*
  • COVID-19 / epidemiology*
  • Cohort Studies
  • Female
  • Health Personnel / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Sick Leave / statistics & numerical data*
  • Sweden / epidemiology

Grants and funding

This work was supported by the Karolinska University Hospital (KUH); the County Council of Stockholm; Erling-Persson family foundation; KTH Royal Institute of Technology; Creades and SciLifeLab. We also wish to thank the Science for Life Laboratory for the antibody testing, the National Pandemic Center of Sweden for the PCR testing and the Karolinska University Hospital for important contributions towards the inception of this study. There were no roles for the funders in design or execution of the study, in analysis and interpretation of data or in the decision to submit for publication.