key: cord-1045977-csu84tpe authors: Bi, Jianping; Lin, Yongping; Zhong, Ran; Jiang, Guowu; Verma, Vivek; Shi, Hongwei; Li, Jianfu; Tong, Xianli; Li, Yanping; Hu, Desheng; Liang, Wenhua; Han, Guang; He, Jianxing title: Prevalence and Clinical Characterization of Cancer Patients with Asymptomatic SARS-CoV-2 Infection History date: 2020-07-22 journal: J Infect DOI: 10.1016/j.jinf.2020.07.018 sha: c680f502628e50dbda3264404ca9d5827b916c32 doc_id: 1045977 cord_uid: csu84tpe • We retrospectively studied the prevalence and clinical characterization of cancer patients with asymptomatic SARS-CoV-2 infection history in the only cancer hospital in Wuhan. • Serosurvey of SARS-CoV-2 among hospital visitors from two hospitals, one at the epicenter in Wuhan, and one outside the epicenter, in Guangzhou. • Cancer patients are more likely to develop asymptomatic COVID-19 infection than persons with similar exposure history. • Transmissibility of asymptomatic cases is relatively low, even in vulnerable populations such as cancer patients. 1. We retrospectively studied the prevalence and clinical characterization of cancer patients with asymptomatic SARS-CoV-2 infection history in the only cancer hospital in Wuhan. 2. Serosurvey of SARS-CoV-2 among hospital visitors from two hospitals, one at the epicenter in Wuhan, and one outside the epicenter, in Guangzhou. 3 . Cancer patients are more likely to develop asymptomatic COVID-19 infection than persons with similar exposure history. 4 . Transmissibility of asymptomatic cases is relatively low, even in vulnerable populations such as cancer patients. We read with the interest the recent paper by Minotti asymptomatic SARS-CoV-2 infected caregivers also remained uninfected. Nucleic acid testing for SARS-CoV-2 was the standard for COVID-19 diagnosis at the beginning of the epidemic. However, this has many limitations: 1) RT-PCR testing generally takes several hours for results. 2) RT-PCR requires certified laboratories, expensive equipment, and trained technicians to operate. 3) RT-PCR can cause false negatives for COVID-19. Therefore, given the urgent need for a rapid, simple, sensitive, and accurate test to quickly identify infected patients, antibody testing has been largely implemented for these purposes. 6 In our study, 82(2.5%) asymptomatic SARS-CoV-2 infections were detected in 3261 individuals who visited Hubei Cancer Hospital, which is higher than the 1.2% asymptomatic COVID-19 cases from the report by the China CDC. 7 This is likely related to the high (64.2%) of cancer patients herein, which is consistent with literature showing that the infection rate tends to be higher in cancer patients as compared to non-cancer patients 2 . We extend the results of prior studies by showing that the rate of asymptomatic disease in cancer patients is higher than that of persons with similar history of exposure (e.g. caregivers). Though asymptomatic COVID-19 cases with potential to spread the virus have been reported, 8, 9 we found that paired caregivers of 51 asymptomatic SARS-CoV-2 infected cancer patients were not infected as well as paired cancer patients of 15 asymptomatic SARS-CoV-2 infected caregivers. Thus, asymptomatic infected patients should ideally be treated similar to those with subclinical infection given the very weak transmission ability. This study has several limitations. First, we did not collect a clear exposure history to COVID-19, so it was difficult to clarify how they got infected. Second, according to the updated COVID-19 Diagnostic Criteria (7th Edition), 4 the viral serum antibody is indeed valid for diagnosis; however, false positives and false negatives can still occur. Third, we cannot address the effect of oncologic therapy on re-activation of the virus (or lack thereof). In conclusion, this experience from the only cancer hospital in Wuhan, China, shows that asymptomatic manifestations of COVID-19 are more likely to occur in cancer patients as compared to non-cancer-afflicted caregivers located in a similar exposure environment. However, transmission of asymptomatic COVID-19 is relatively weak, which is novel information of utility for other nations in preparation for the "second wave" of the pandemic thought to occur later this year. All other authors declare no competing interests. How is immunosuppressive status affecting children and adults in SARS-CoV-2 infection? A systematic review Clinical characteristics of COVID-19-infected cancer patients: A retrospective case study in three hospitals within Wuhan, China Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China New coronavirus pneumonia prevention and control program CT imaging and clinical course of asymptomatic cases with COVID-19 pneumonia at admission in Wuhan Development and clinical application of a rapid IgM-IgG combined antibody test for SARS-CoV-2 infection diagnosis Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China Serial Interval of COVID-19 among Publicly Reported Confirmed Cases. Emerg Infect Dis Online ahead of print Early transmission dynamics in wuhan, china, of novel coronavirus-infected pneumonia