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Muge Cevik Profile picture
@mugecevik
Dec 4, 2020 • 9 tweets • 3 min read • Read on X
A great article summarising our current understanding about asymptomatic infections

About 1 in 5 people w/#COVID19 will experience no symptoms whatsoever, they have shorter viral shedding & will transmit to significantly fewer ppl than someone w/symptoms

nature.com/articles/d4158…
Our new paper on asymptomatic infections is published in @TheLancetInfDis - we discuss why persistently asymptomatic infections have been overestimated and describe major methodological issues that hinder attempts to estimate this fraction. #COVID19 1/
thelancet.com/journals/lanin…
People w/persistently asymptomatic infection experience no symptoms throughout the infection, pre-symptomatic individuals become infectious days before symptom onset & there are also individuals w/ mild symptoms who otherwise feel well. But these often get mixed up. 2/
Incomplete symptom assessment misclassifies people w/ mild or atypical symptoms as asymptomatic. Studies with inadequate follow-up misclassify pre-symptomatic individuals. Serological studies rely on poorly defined antibody responses & retrospective symptom assessment. 3/
It is now becoming clear that truly asymptomatic infections make up smaller % of infections. Two systematic reviews that only included studies w/ sufficient follow up have estimated the proportion to be 20% (95% CI 17–25%) and 17% (95% CI 14–20%). 4/ journals.plos.org/plosmedicine/a…
Evidence is starting to emerge about the influence of individuals' infectiousness on transmission. While asymptomatic individuals can transmit the virus to others, they seem to be 1/3 infectious compared to symptomatic individuals. 5/

This may be due to shorter duration of infectiousness. While asymptomatic individuals have similar initial viral loads when compared with people w/ symptoms, asymptomatic people seem to clear the virus faster and are infectious for a shorter period. 6/
thelancet.com/journals/lanmi…
So, misclassification of asymptomatic fraction precludes our understanding of COVID19. Overestimation limits our ability to identify the best strategies for controlling the epidemic and obscures other mitigation measures that are important in preventing onward transmission. 7/
In this article, we make six recommendations to accurately define and report truly asymptomatic infections going forward. This was a fantastic collaboration h/t @EricMeyerowitz @AaronRichterman @BogochIsaac @nicolamlow 8/ thelancet.com/journals/lanin…

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More from @mugecevik

Muge Cevik Profile picture
Jul 20, 2022
It has been 2 months since the first cases were reported in the MPX multi-country outbreak, & the # of cases has now crossed 14k globally. While accurate information is critical to staying ahead, there is so much misinformation. An update on the current status of #monkeypox.🧵
Epidemiology:
Overall, over 14k MPX cases have been detected in 70 countries. 7 African countries have reported ~1400 cases this year. Some “non-endemic” countries are seeing cases w/o travel links or exporting cases, indicating ongoing community transmission. (n/1) Image
• 99.5% of cases are among men (where data available) 
• The mean age is 37
• Evidence continues to suggest community transmission with a disproportionate incidence among gay, bisexual and other men who have sex with men (GBMSM) gov.uk/government/pub…  (n/2) Image
Read 31 tweets
Muge Cevik Profile picture
May 21, 2022
As the monkeypox virus (MPX) outbreak continues, a lot of data emerging in real-time & being rapidly disseminated (as well as misinformation). I complied the unfolding scientific data (with direct links to papers and threads) on what we (don’t) know so far. #IDTwitter 🧵(1/n)
First, MPXV is not a novel virus. It is a viral zoonosis first discovered in 1958, with the first human infection reported in 1970. It is classified as a high priority pathogen by WHO, cases mostly identified in central & western Africa until now. (2/n) (who.int/news-room/fact…\)
Confirmed and suspected cases of #MonkeyPox now reached 145 among 13 countries with 20 cases in the UK. The main concern is that there are non-travel associated cases in Europe, meaning there is likely unnoticed community transmission. (3/n)
Read 29 tweets
Muge Cevik Profile picture
Apr 25, 2022
Late breaker session at #ECCMID2022 on acute hepatitis cases of unknown origin in children.
So far, 169 cases have been reported from 11 countries since first case was identified in 31 March. 17 have required liver transplant & at least one death has been reported. #IDTwitter
Almost all cases had high transaminases, majority of children have been hospitalised. No common exposure has been identified, no link to COVID19 vaccination. Adenovirus F41 was identified in several cases, but it doesn’t fully explain the clinical severity observed. #ECCMID2022
But there are still many uncertainties about acute hepatitis cases observed. Especially the # of cases, exact age group, clinical presentation, uncertain test results as not all cases were tested for adenovirus, risk factors and transmission routes remain unclear. #ECCMID2022
Read 15 tweets
Muge Cevik Profile picture
Dec 15, 2021
Very interesting analyses about the virology of #Omicron, which may explain the faster spread of this variant.

According to a new lab study, Omicron infects & multiplies ~70x faster than the Delta variant and the wild type SARS-CoV-2 in the human bronchus, but not in the lung.
In this ex vivo study (press release), Michael Chan, Malik Peiris & John Nicholls et al. @hkumed show that at 24h after infection Omicron replicated ~70x faster than Delta in bronchus. Interestingly, it replicated ~10x less efficiently in the lung tissue. hkumed.hk/96b127/
Another analysis by @BalazsLab also supports these findings. In this lab study w/ pseudoviruses, Omicron showed greater ability to infect cells than other variants, which was ~ 4 times more infectious than the original strain, also more than Delta. medrxiv.org/content/10.110…
Read 8 tweets
Muge Cevik Profile picture
Dec 7, 2021
Important preliminary data from SA looking at whether vaccine elicited antibodies are still effective against #Omicron.

Good & bad news: There is a big drop in neutralisation activity, but it's partial & hybrid (vax + infection) holds fairly well. 🧵

This is a live virus neutralisation assay. Neutralisation studies can tell us whether levels of Ab in the blood (convalescent and vaccinated plasma) are high enough to prevent the virus from infecting cells in the lab.

.@sigallab & colleagues tested plasma from those who received vax only (orange) & those who had vax + previous infection (green) and showed a significant (~40x) decline in neutralisation activity, but this was not a complete escape & reduction was less in hybrid anti-sera.
Read 15 tweets
Muge Cevik Profile picture
Dec 3, 2021
🦠 There’s a lot we don’t yet understand about Omicron, including its impact on immunity and what it means for vaccines. New data will be emerging over the next few wks, which could be misinterpreted w/o context. What we might expect & how to interpret the emerging data? 🧵(1/n)
1- Genomic data:
The biggest concern with omicron is that it contains >30 mutations in just the spike protein, the part which helps it enter human cells and the target for vaccines. This mutation profile is very different than other VOCs. (2/n) Image
There are plausible biological consequences of some of these mutations, but we don't really know the combined effect of all these mutations, so full significance of omicron is uncertain. (3/n) Image
Read 37 tweets

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