How many #COVID19 cases are asymptomatic? The *incorrect* 40% figure keeps being repeated (such as claim below in 21 Oct NEJM Perspective), but best estimates are now closer to 17% based on systematic reviews of valid studies.
2/ There are 13 reasonably good studies of asymptomatic rates (checked everyone in a well-defined at-risk group & > 7 days follow up) when combined suggest a rate of around 17% - jammi.utpjournals.press/doi/pdf/10.313…
3/ Note that we need to separate (a) the pre-symptomatic (= every infected person before symptoms!) from (b) the asymptomatic throughout infection (so need follow up to check if symptoms develop - many studies don't) - which some commentary & reviews don't do.
4/ Transmission rates are also lower by about 42% for asymptomatic cf symptomatic cases (p=0.047); 5 of 13 studies assessed this). Why? Could be less time infectious or that not coughing – less droplets, less environment contamination.
5/ Combined this means < 10% of transmissions likely to be from asymptomatic cases - so uncommon and chains of asymptomatic transmission are unlikely - but small enough that good #TestTraceIsolate can pick up most, and cut the chain links.
6/ IMPLICATIONS: Good #TestTraceIsolate finds many of both pre-symptomatic & asymptomatic folk - Iceland find 50% folk diagnosed in quarantine - but asymptomatic can only be isolated by contact tracing; pre-symptomatic can be isolated by contact tracing or becoming symptomatic.

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More from @PaulGlasziou

12 Jun
Asymptomatic #COVID19 has seen a lot of  disagreement this week: is it 15% or 40%? Is the transmission from asymptomatic people "very rare"? Some comments in this thread. @sophiescott2 @MelissaLDavey
1/ Important to separate (a) pre-symptomatic (= every infected person before symptoms!) from (b) asymptomatic throughout infection (so need follow up to check if symptoms develop - many studies don't) - which some commentary & reviews don't do.
2/ There are 9 reasonably good studies of asymptomatic rates (checked everyone in a well-defined at-risk group & > 7 days follow up) when combined suggest a rate of around 15% medrxiv.org/content/10.110…
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