A new study released by the Centers for Disease Control and Prevention (CDC) reports that presymptomatic transmission is responsible for some of the spread of COVID-19.

Conducted by researchers in Singapore, the study examined 243 confirmed cases of the coronavirus reported there from Jan. 19 to March 12. This included 157 cases that were determined to be “locally acquired,” or cases confirmed in patients that haven’t traveled. The patients with confirmed COVID-19 were interviewed for information about their activity over the previous two weeks to determine how they may have become infected.

The researchers further identified seven clusters of individuals where presymptomatic transmission was likely to have occurred. Here, presymptomatic is defined as “the transmission of SARS-CoV-2 from an infected person (source patient) to a secondary patient before the source patient developed symptoms, as ascertained by exposure and symptom onset dates, with no evidence that the secondary patient had been exposed to anyone else with COVID-19.”

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The clusters were composed of two to five patients each, totaling 18 cases between the seven clusters.

Researchers discovered that 10 cases within these clusters were attributed to presymptomatic transmission of the virus between people. This accounts for approximately 6.4 percent of all locally acquired cases, meaning that seemingly healthy people are responsible for a portion of the virus spread.

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Symptoms that were monitored included fever, respiratory and gastrointestinal issues.

For patients in four of the clusters, transmission exposure occurred approximately one to three days before the source patient developed symptoms.

Presymptomatic transmission may occur through respiratory droplets or indirect transmission. Interestingly, the report highlighted presymptomatic spread of the virus during singing and vocal activities.

This supports other reports suggesting coronavirus spread occurred during a choir rehearsal in Washington state, resulting in about 45 COVID-19 diagnoses and two fatalities.

Respiratory droplets may contain coronavirus particles, the report states. Objects that might be contaminated directly by droplets or through contact with an infected individual’s hands are also possible vehicles for transmission.

This result highlights the importance of early detection and social distancing measures as part of the containment strategy, regardless of whether an individual is displaying symptoms.

“Evidence of presymptomatic transmission of SARS-CoV-2 underscores the critical role social distancing, including avoidance of congregate settings, plays in controlling the COVID-19 pandemic,” the study concludes.

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