Factors Associated with Asymptomatic COVID-19 Patients in Petaling District, Selangor, Malaysia
AbstractIntroduction: The rapid spread of the COVID-19 worldwide has led the World Health Organization (WHO) to declare COVID-19 outbreak as a pandemic on March 11, 2020. This study aims to determine the factors associated with asymptomatic COVID-19 patients in Petaling District, Selangor, Malaysia. Methods: Data on COVID-19 patients were extracted from the database of confirmed cases in Petaling District Health Office, Selangor, Malaysia from 3rd February 2020 to 30th April 2020. An asymptomatic laboratory-confirmed case is a person infected with COVID-19 who does not develop any symptoms. The study included socio-demographic variables, the detailed information on clinical manifestations and co-morbidity of the patients. Descriptive and multivariable logistic regression analyses were conducted to determine the factors associated with asymptomatic patients. Results: The overall COVID-19 patients in Petaling District were 434. Approximately 70% (N = 292) of the patients were symptomatic while 32.7% (N = 142) were asymptomatic. Multivariable logistic regression analyses revealed that factors significantly associated with asymptomatic patients were age below 40 years old (aOR: 1.79, 95% CI 1.11, 2.86), non-Malaysians (aOR: 3.22, 95% CI 1.44, 7.19) and local cases (aOR: 2.51, 95% CI 1.42, 4.42). Gender, ethnicity, co-morbidity and township were not significantly associated with asymptomatic patients. Conclusion: Approximately one-third of COVID-19 patients were asymptomatic and the risk factors identified were younger age, non-Malaysians and local cases. Rigorous epidemiological investigation and laboratory examinations are helpful in identifying COVID-19 cases among these group of people who are asymptomatic. Keywords: COVID-19 - asymptomatic - pandemic - Malaysia
Shigemura J, Ursano RJ, Morganstein JC, Kurosawa M, Benedek DM. Public responses to the novel 2019 coronavirus (2019-nCoV) in Japan: Mental health consequences and target populations. Psychiatry and Clinical Neurosciences. Psychia Clin Neuros. 2020; 74: 277-83.
Hussin AR, Siddappa NB. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020; 109: 1024-33.
Wang YX, Wang YY, Chen Y, Qin QS. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID‐19) implicate special control measures. J Med Virol. 2020; 92: 568–76.
World Health Organization. WHO Director-General’s Remarks at the Media Briefing on 2019-nCoV on 11 February 2020. 2020. [cited 2020 May 28]. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-remarks- at-the-media-briefing-on-2019-ncov-on-11-february-2020.
World Health Organization. Novel Coronavirus (2019-nCoV): Situation Report. [Internet]. 2019 [cited 2020 May 28]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
Fairoza Amira H, Cher Hl, Hafeez N, Dominic VL, Guanhua L, Cheng LT, et al. CoronaTracker: World-wide COVID-19 Outbreak Data Analysis and Prediction. Bull World Health Organ. E-pub: 19 March 2020. [cited 2020 May 28]. Available from: https://www.who.int/bulletin/online_first/20-255695.pdf
Nash C. Mediaite. Harvard Professor Sounds Alarm on ‘Likely’ Coronavirus Pandemic: 40% to 70% of World Could Be Infected This Year. 2020 [cited 2020 May 28]. Available from: https://www.mediaite.com/news/harvard-professor-sounds-alarm-on-likely-coronavirus-pandemic-40-to-70-of-world-could-be-infected-this-year/.
World Health Organization, WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. 2020. [cited 2020 May 28]. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-COVID-19---11-march-2020.
Catrin S, Zaid A, Niamh ON, Mehdi K, Ahmed K, Ahmed AJ, Christos L, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surgery. 2020; 76: 71-76.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y et al., Epidemiological and clinical characteristics of 99 patients of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study, Lancet. 2020; 395: 507–13.
Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Patients from the Chinese Center for Disease Control and Prevention. J Am Med Assoc. 2020; 323.
Graham L. You’re only as young as your immune system. New Scientist. 2020. New Scientist Ltd, England. 44-48.
Hiroshi N, Tetsuro K, Takeshi M, Ayako S, Sung MJ, Katsuma H. Et al. Estimation of the asymptomatic ratio of novel coronavirus infections (COVID-19). Int J Infec Dis. 2020; 94: 154-55.
World Health Organization (WHO). Q&A on coronaviruses (COVID-19). 2020 [cited 2020 May 26]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question- and-answers-hub/q-a-detail/q-a-coronaviruses.
Kim GU, Kim MJ, Ra SH, Lee J, Bae S, Jung J, et al. Clinical characteristics of asymptomatic and symptomatic patients with mild COVID-19. Clin Microb Infec. 2020; 26(7): 948.e1-948.e3.
Carl H, Jon B, Tom J. COVID-19: What proportion are asymptomatic? Centre for Evidence-Based Medicine, University of Oxford, 2020 [cited 2020 May 28]. Available from https://www.cebm.net/COVID-19/COVID-19-what-proportion-are-asymptomatic/.
Kimball A, Hatfield KM, Arons M, James A, Taylor J, Spicer K et al. Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020. MMWR Morb Mortal Wkly Rep 2020; 69: 377–381.
Zhou L, Ruan F, Huang M. SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. N Engl J Med 2020; 382(12): 1177-79.
WHO. Coronavirus disease (COVID-19) in Malaysia. 2020 [cited 2020 May 26]. Available from: https://www.who.int/malaysia/emergencies/coronavirus-disease-(COVID-19)-in-Malaysia.
Li, Q., Guan, X., Wu, P., Wang, X., Zhou, L., Tong, Y, Feng, Z. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. New Eng J Medic. 2020; 382(13): 1199–1207.
Mei X, Zhang Y, Zhu H, Ling Y, Zou Y, Zhang Z, et al.Observations about symptomatic and asymptomatic infections of 494 patients with COVID-19 in Shanghai,China. American J Infect Control. 2020. (In press).
Samrah SM, Al-Mistarehi AH, Ibnian AM, Raffee LA, Momany SM., Al-Ali M et al. COVID-19 outbreak in Jordan: Epidemiological features, clinical characteristics, and laboratory findings. Annals Medic Surg. 2020; 57: 103–108.
Kronbichler A, Kresse D, Yoon S, Lee KH, Effenberger M, Shin JI. Asymptomatic patients as a source of COVID-19 infections:A systematic review and meta-analysis. Int J Infect Diseases. 2020; 98: 180–186.
Patel AB, Verma A. Nasal ACE2 Levels and COVID-19 in Children. JAMA. 2020; 323(23): 2386-87.
Nadim Mahmud SM. How has Bangladesh remained immune to COVID-19? https://tbsnews.net/thoughts/how-has-bangladesh-remained-immune-COVID-19-50419
Forster P, Forster L, Renfrew C, Forster M. Phylogenetic network analysis of SARS-CoV-2 genomes. Proc Natl Acad Sci USA. 2020; 117(17): 9241-43.
Lanese N. Could genetics explain why some COVID-19 patients worse than others. Life Science. 2020 [cited 2020 May 26]. Available from:https://www.livescience.com/genetics-could-explain-extreme-covid19-coronavirus-infections.html
Vijay KJ, Karthikeyan I, Abhishek V, Raju V. Differential mortality in COVID-19 patients from India and western countries. Diabetes & Metabolic Syndrome: Clin Res Rev. 2020; 14: 1037-41.
Liu Y-C, Kuo R-L, Shih S-R. COVID-19: The first documented coronavirus pandemic in history, Biomed J, https://doi.org/10.1016/j.bj.2020.04.007
Achenbach J, Akiko Kashiwagi Chris Mooney. The Washington Post. Researchers ponder why COVID-19 appears deadlier in the U.S. and Europe than in Asia. 2020 [cited 2020 May 26]. Available from:https://www.washingtonpost.com/world/researchers-ponder-why-covid-appears-more-deadly-in-the-us-and-europe-than-in-asia/2020/05/26/81889d06-8a9f-11ea-9759-6d20ba0f2c0e_story.html
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