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Fact Check: What did WHO say about asymptomatic transmission of Covid-19?
A video clip of a WHO official saying that asymptomatic coronavirus patients do not need to isolate at a press conference is circulating on social media with the claim that the global health body has taken a “complete U-turn”.



Chayan Kundu
New Delhi
June 14, 2020
UPDATED: June 14, 2020 21:31 IST



On June 8, WHO technical lead Maria Van Kerkhove said, “We are constantly looking at this data and we’re trying to get more information from countries to truly answer this question. It still appears to be rare that an asymptomatic individual actually transmits onward.” (AFP photo)

Did the World Health Organization (WHO) say that asymptomatic Covid-19 patients need no isolation as they rarely spread the disease? A video clip of a WHO official saying exactly that in a press conference is circulating on social media with the claim that the global health body has taken a “complete U-turn”.
In the viral clip, epidemiologist and WHO technical lead on the coronavirus pandemic Maria Van Kerkhove is heard saying, “From the data we have, it seems to be rare that an asymptomatic person actually transmits onward to a second individual.”
The clip of the WHO press briefing and subsequent TV discussion was a part of an American news programme “Greg Kelly Reports” on Newsmax TV. Anchor Greg Kelly was also astonished at the statement. The video started circulating on Twitter and Facebook with the caption, “Big Story: Unbelievable! Asymptomatic patients need no isolation ... A complete U-turn by WHO. After destroying the economy of the world now a complete U-turn!!”


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Big Story: Unbelievable! Asymptomatic patients need no isolation ... A complete U turn by WHO. After destroying the economy of the world now a complete U turn!!

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India Today Anti Fake News War Room (AFWA) has found that the viral clip is genuine and WHO did indeed say that asymptomatic spread of Covid-19 seems to be rare. However, it later clarified that it does not have the data to back it up as scientists are still determining the intensity of spread by asymptomatic Covid-19 patients.


The archived version of the viral clip is saved here. Many Facebook users have shared the video.



What triggered the controversy?
In a press briefing on June 8, in an answer to a question on the asymptomatic spread of Covid-19, Kerkhove said, “We are constantly looking at this data and we’re trying to get more information from countries to truly answer this question. It still appears to be rare that an asymptomatic individual actually transmits onward.”
The remark caused an uproar as it contradicts many public health experts who have been talking about the asymptomatic spread of coronavirus.

WHO clarifies
The following day, the WHO clarified that it still does not have the answer to the intensity of spread caused by asymptomatic patients.
“The majority of transmission that we know about is that people who have symptoms transmit the virus to other people through infectious droplets. But there is a subset of people who don’t develop symptoms and to truly understand how many people don’t have symptoms, we don’t actually have that answer yet,” Kerkhove said.

Expert speak
Dr Anthony Fauci, the top infectious diseases expert in the US, said the WHO’s statement on asymptomatic spread “was not correct”. At the “ABC News” programme “Good Morning America”, Fauci said according to “CNN”, evidence shows 25-45 per cent of infected people do not likely have symptoms.
“And we know from epidemiological studies they can transmit to someone who is uninfected even when they’re without symptoms,” said Fauci, director of the National Institute of Allergy and Infectious Diseases.
“Asymptomatic spread is Achille’s heel of this outbreak,” tweeted Ashish K Jha, director of Harvard Global Health Institute. Reacting to WHO’s comments on the asymptomatic spread, Jha posted a twitter thread saying, “Both asymptomatic AND pre-symptomatic spread huge problem for controlling the disease. Because folks shedding virus while asymptomatic. Pre-symptomatic has one advantage: you can use contact tracing to find folks they infected. But that doesn’t help prevent the presymptomatic spread”.

Number of asymptomatic cases
Asymptomatic cases are challenging to identify because individuals do not know they are infected unless they are tested, typically as part of a scientific study. Therefore, various studies and their findings vary in this aspect.
The Centers for Disease Control and Prevention estimates that 35 per cent of all people with Covid-19 are asymptomatic, but they are just as infectious as those with symptoms. As per the CDC, 40 per cent transmissions take place before people feel sick.


Conclusion
The WHO has indeed said that asymptomatic spread of the new coronavirus is rare. But it later clarified that it does not have enough data about the asymptomatic spread of the disease, as scientists are still determining the intensity of Covid-19 spread by asymptomatic cases.


Fact Check: What did WHO say about asymptomatic transmission of Covid-19?
 

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WHO Says Covid-19 Asymptomatic Transmission Is ‘Very Rare’
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Jun.08 -- Maria Van Kerkhove, head of the World Health Organization’s emerging diseases and zoonosis unit, says transmission of the coronavirus by people who aren’t showing symptoms is "very rare.” She spoke Monday at a briefing in Geneva. (Excerpt)
 

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Glenmark Launches Covid-19 Drug At Rs 103 A Tablet

PTI @PTI_News
Jun 20 2020, 5:11 PM
Jun 20 2020, 8:39 PM

Glenmark Pharmaceuticals Ltd. on Saturday said it has launched antiviral drug Favipiravir, under the brand name FabiFlu, for the treatment of patients with mild to moderate Covid-19 at a price of about Rs 103 per tablet. The drug will be available as a 200 mg tablet at a maximum retail pric

 

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Compulsory 5-day institutional quarantine order for all Covid-19 cases in Delhi withdrawn

Earlier today, chief minister Arvind Kejriwal met Baijal during a meeting of the Delhi Disaster Management Authority and requested the L-G to revoke the order.







 

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Contact tracing now mandatory for all Covid-19 patients in Delhi: MHA

There will be fresh delineation of containment zones in Delhi and a serological survey will be carried out from June 27 till July 10 on 20,000 samples to ascertain the scale of the spread of the infectious Covid-19 disease in the national capital, the MHA said in a statement.

INDIA Updated: Jun 21, 2020 23:50 IST
hindustantimes.com | Edited by Sohini Sarkar

hindustantimes.com | Edited by Sohini Sarkar
Hindustan Times, New Delhi


Home Minister Amit Shah during a meeting on strengthening the Covid-19 response in the National Capital Territory (NCT) of Delhi on Sunday.


Home Minister Amit Shah during a meeting on strengthening the Covid-19 response in the National Capital Territory (NCT) of Delhi on Sunday.(PTI PHOTO.)

The Ministry of Home Affairs (MHA) on Sunday said that contact tracing would be scaled up in the national capital and would be diligently followed for all Covid-19 positive patients in Delhi using the Aarogya Setu app. The national capital has witnessed a surge in coronavirus cases this month, soon after lockdown restrictions were eased by the Centre from June 1.
There will be fresh delineation of containment zones in Delhi and a serological survey will be carried out from June 27 till July 10 on 20,000 samples to ascertain the scale of the spread of the infectious Covid-19 disease in the national capital, the MHA said in a statement.
The announcement came soon after Union Home Minister Amit Shah on Sunday evening chaired a review meeting to discuss the Covid-19 crisis in Delhi, a week after he held a series of meetings with top Delhi government officials, including chief minister Arvind Kejriwal and L-G Anil Baijal.


According to a timeline suggested by the Dr VK Paul committee, the Delhi government has been directed to prepare a strategy by Monday, form district-level teams by Tuesday and prepare to rework the delineation of the capital’s containment zones by June 26.
A total survey of such containment zones has to be completed by June 30 and by July 6, a survey has to be carried out on the whole of Delhi, the MHA has indicated.
Home minister Amit Shah, according to a statement by the home ministry, has further directed that there should be an analysis pertaining to every deceased person, including the number of days he was in hospital and his place of residence; whether the person was in home isolation or being treated in a hospital. The reasons for not taking a victim of the infectious disease to a designated Covid Care facility also needed to be mapped by the government, according to the new guidelines.


Shah also said that all Covid-19 positive cases will have to go to hospital, except those who have enough space in their homes and have no co-morbidities.
Shah has been regularly holding meetings over the coronavirus health crisis in the national capital amid a sudden spike in the number of Covid-19 positive cases. Delhi on Saturday witnessed the highest single-day spike of 3,630 Covid-19 cases. The numbers, however, dipped a little with the capital city reporting 3,000 fresh Covid-19 cases on Sunday, according to latest health department data.

The health bulletin issued by the Delhi government today indicated that there are 59,746 positive cases in the national capital.


Contact tracing now mandatory for all Covid-19 patients in Delhi: MHA
 

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Gurugram ‘undertesting’ for Covid-19, say experts

GURUGRAM Updated: Jun 22, 2020 00:04 IST
Prayag Arora-Desai

Prayag Arora-Desai



Even with a recent upgrade in testing capacity, Gurugram is not testing enough to reign in the spread of COVID-19, leading to a recent uptick in mortality in the district, according to experts who reviewed an analysis of the health department data. They added that this data point was an indicator of the district’s test positivity rate (TPR, or the number of positive results per test expressed in percentage), which of late has surged in Gurugram.
In April, Gurugram was testing an average of 192 samples per day (total tests 4789) and clocked an average TPR of 1 percent. While the samples increased to 257 per day in May (total tests 7958), TPR grew to 9 percent. The number of samples tested, however, need not necessarily equate to the actual number of individuals being tested, as some patients may have given multiple samples to be tested.

By May 31, Gurugram had 774positive cases and 3 deaths. In June, like the rest of the country, these numbers surged and the city had 4427 positive cases and 64 deaths on June 21.

While an average of 414 samples per day were tested in June thus far, the TPR has surged to 42.7 percent. Gurugram’s doubling-rate (about 13 days) is among the quickest of India’s 20 worst affected districts.

“With rising positivity, one can say that transmission of the virus has not been curbed,” said Dr Lalit Kant, an independent public health consultant and former head of the ICMR’s epidemiology division. Kant added that there is no set benchmark for how many tests need to be conducted in a given region, “You want a lower percentage of the tests to come back positive. If you are seeing positivity at 60, 70, even 80 percent, (either) you simply aren’t testing enough.” Kant, and other experts, also said that rising test positivity may indicate a high, if not increasing, prevalence of the disease within a community.

Dheeraj Singh, a Gurugram-based data scientist who has been tracking Covid-19 data in Haryana, drew attention to the World Health Organization (WHO) recommended benchmark -- a sustained TPR of 5 percent over two weeks, at which point lockdown restrictions may be eased in a given region. “Assuming that there is already a high incidence of unreported cases within Gurugram, an increase in testing is the most viable way of lowering the TPR, and widening surveillance to find unreported cases,” Singh explained.

Thus, going by the current numbers and assuming that the number of new positive cases detected each day remains the same, the district should have conducted at least tested 3100 samples per day to achieve a TPR of 5 percent. “Similarly, by the same extrapolation, a TPR of 10 percent would require 1353 tests per day, while 15 percent would require 764 tests per day,” Singh added.
Evidence of Singh’s projections can found in more granular, daily data. “On June 19, when we tested 790 samples, the TPR was 18 percent. The previous day, with 686 samples tested, the positivity rate was 19 percent,” pointed out Dr Virender Yadav, chief medical officer, Gurugram. However, on June 20, when only 590 tests were conducted, the positivity rate rose again, touching 33 percent.
Dr Rajib Dasgupta, associate professor at the Centre of Social Medicine and Community Health, Jawaharlal Nehru University, who reviewed the district health bulletin data, agreed that there is a shortfall in the number of tests being conducted daily. However, he added a caveat to Singh’s projections. “Calculating the shortfall in testing is tricky, because you are making the assumption that the number of new daily positives will remain the same. It would be more correct to assume that the number of new positives being detected every day will increase, so these calculations are conservative estimates, at best,” Dasgupta cautioned.

A senior surveillance officer in Haryana’s Integrated Disease Surveillance Program (IDSP), who requested anonymity, said this is indeed the case in Gurugram. “To say that we have been effective in controlling the spread, we would need to lower the TPR down to about 10 percent. This was the case in May, when we were seeing less deaths,” said the officer, cautioning that the district will likely see an increase in patients requiring intensive care, or succumbing to the disease, in coming weeks.
To increase testing would mean casting a wider net, bringing unreported cases onto the health department’s radar, and enabling the contact tracing effort to catch up with some of those it hasn’t reached yet.
Officials in the health department said that Gurugram’s testing capabilities are being upgraded to meet these projected capacities. “We have started RT-PCR tests in Civil Hospital. We are conducting about 50 tests per day there, but we are soon going to adopt automatic RNA extraction protocols which will increase the capacity to at least 200 to 300 new tests per day.” The surge in testing numbers on June 19 and 20, Yadav added, were a result of private labs accepting more samples, and not entirely due to an increase in government testing.
With Gurugram’s first public testing facility expected to process at least 200 new samples, the district’s daily average should touch between 600 to 700 tests per day. This is about half the required number (to bring TPR down to 10 percent). Haryana’s additional chief secretary (health), Rajeev Arora, however, added that Gurugram would, by the end of the month, “Conduct close to 1000 tests per day.” Yadav, too, said, “Our target is 1000 tests a day in the foreseeable future.”


Gurugram ‘undertesting’ for Covid-19, say experts
 

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WHO changes guidelines on masks, says wear them when social distancing not possible

WHO earlier said "there is limited evidence that wearing a medical mask by healthy individuals...may be beneficial as a preventive measure".

ANGANA CHAKRABARTI 6 June, 2020 5:05 pm IST


Three masks, belonging to three members of a family travelling to Vijaywada, hanging from hooks would hold curtains in the AC compartment | Manisha Mondal | ThePrint


Three masks, belonging to three members of a family travelling to Vijaywada, hanging from hooks that would otherwise hold curtains in the AC compartment | Manisha Mondal | ThePrint



New Delhi: Wear masks in areas where social distancing is not possible, the World Health Organization has advised in its updated guidelines, issued Friday, on the use of masks.
WHO Director-General Tedros Adhanom Ghebreyesus announced the changes in a media briefing. “In areas with community transmission, people aged 60 years or over or those with underlying conditions, should wear a medical mask in situations where physical distancing is not possible,” Tedros said.


World Health Organization (WHO)
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· Jun 5, 2020
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"That means, for example, that when a doctor is doing a ward round on the cardiology or palliative care units where there are no confirmed #COVID19 patients, they should still wear a medical mask"-@DrTedros

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"Second, in areas with community transmission, we advise that 60 , or those with underlying conditions, should wear a medical mask in situations where physical distancing is not possible"-@DrTedros #COVID19
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The new advisory, he added, is based on “evolving evidence” and was developed after “extensive consultation with international experts and civil society groups”.

The updated guidelines come four days after a review of 172 observational studies across 16 countries and six continents funded by the WHO found that the use of both N95 or similar respirators or face masks was linked to a major reduction in the risk of infection.
The Covid-19 virus is known to be transmitted through respiratory droplets from an infected person. Research has shown that those who are in close contact (1m or less) from the infected person are at greater risk of contracting the infection.


What has changed
The WHO had earlier taken a more conservative stance on the effectiveness of face masks in arresting the spread of the infection. “There is limited evidence that wearing a medical mask by healthy individuals in the households or among contacts of a sick patient, or among attendees of mass gatherings may be beneficial as a preventive measure,” the guidelines from 6 April stated.

It further noted that “the use of medical masks may create a false sense of security” and lead to the neglect of other preventive measures. The WHO had recommended the compulsory use of masks for healthcare workers while advising decision-makers to make the rationale clear behind any directive that prescribed its usage for healthy people.
In its updated advisory, the WHO endorsed the wearing of non-medical masks by everyone in public and semi-public settings like shops, offices, social gatherings, schools and places of worship. The same should also be followed in places with high population density or in settings where physical distancing is difficult, such as in public transport.
More importantly, medical masks have to be worn by people who are 60 years or above or those with comorbidities in settings where physical distancing isn’t possible. The guidelines state that the use of masks by healthy people reduces “potential exposure risk” and “potential stigmatization of individuals”, makes “people feel they can play a role” and reminds “people to be compliant with other measures”.

What kind of masks should be worn
The two types of masks mentioned in the WHO’s guidelines are a medical and non-medical mask. According to the WHO, “medical masks should be reserved for health workers and at-risk individuals”. These masks should be certified as per international and national standards and must stop at least 95 per cent droplets while remaining breathable.
Non-medical masks “are made from a variety of woven and non-woven fabrics, such as polypropylene”. The advisory states materials for these masks should be chosen based on filtration or the capture of droplets and the fabric’s breathability. Also, stretchy material should be avoided so as to prevent the filtration from decreasing as the pore sizes increase.

“A minimum of three layers is required for non-medical masks, depending on the fabric used,” the advisory states.



WHO changes guidelines on masks, says wear them when social distancing not possible
 

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Antibodies in Covid recovered patients last only 2-3 months, finds Nature study
The Chinese study also found that asymptomatic individuals have less antibodies than symptomatic ones, a fact that could have significant bearing on vaccines.

SANDHYA RAMESH 19 June, 2020 6:06 pm IST


The novel coronavirus


Bengaluru: People who have recovered from Covid-19 may have antibodies only for two to three months, said a study published Thursday in Nature Medicine.
However, the conclusions might not necessarily mean that a recovered person can get reinfected, stated the authors.

The limited findings offer clues to one of the biggest questions about Covid recovery, vaccination, and serological surveys.

The study is the first to determine the existence of antibodies in asymptomatic patients and characterise them. Previous studies have shown that infected patients who display symptoms do develop antibodies as well, but it remained unclear how long these lasted.
Another paper published in Nature Medicine, also released Thursday, found that even small amounts of antibodies could work to protect against the virus.


Asymptomatic vs symptomatic

The new study compared 37 asymptomatic patients with 37 symptomatic patients who had all been quarantined after testing positive in the Wanzhou People’s Hospital in China.

The authors found that the immune response in asymptomatic people was weaker as compared to those who showed symptoms. They also found that antibody levels started falling much faster in asymptomatic patients than in symptomatic ones.
Antibodies reduced in 40 per cent of the asymptomatic group as compared to 12.9 per cent in the symptomatic group during the early convalescent or recovery stage ⁠— about eight weeks after individuals were discharged from the hospital.

IgM, the antibodies produced during the preliminary stages of the infection, were found to last longer in symptomatic patients. When tested for IgM antibodies three to four weeks after falling sick, it was found in 78.4 per cent of the symptomatic people and 62.2 per cent of the asymptomatic group.


Body response during the infection
During the acute phase of the coronavirus infection, which is defined as when nasal swabs test positive for the virus, asymptomatic patients displayed lower levels of IgG antibodies, those produced in the later stages of the infection that help carry an individual to recovery.

However, during the early convalescent phase, the IgG count dropped in 93.3 per cent of asymptomatic individuals, lower that the 96.8 per cent of the symptomatic group.
Neutralising antibodies, which deactivate the spike protein the coronavirus uses to gain entry into cells, decreased in 81.1 per cent in the asymptomatic group and in 62.2 per cent in the symptomatic during recovery.
Asymptomatic people also displayed lower levels of pro- and anti- inflammatory cytokines, which are proteins responsible for transmitting signals between immune system cells. Cytokine levels found in asymptomatic individuals were comparable to completely healthy individuals.

Antibodies to other coronaviruses such as SARS and MERS are thought to last at least a year. Some SARS antibodies in individuals have lasted for two years, while some MERS antibodies have been detected 34 months after recovering from the infection.


Shedding factor
The study also found that asymptomatic people were shedding the virus, i.e., releasing a replicated virus to the environment, for far longer than symptomatic people did.
Symptomatic people shed the virus for 14 days while asymptomatic people did so for 19. However, it is unclear if the virus being shed at later stages is capable of infecting others or is just viral RNA remnants.
Viral shedding data also varies across studies; previous studies have shown viral shedding occurring for up to 24 days after the onset of symptoms.
“Measurable virus shedding does not equate with viral infectivity, and further evaluation is needed,” wrote the authors of the paper.
The findings have implications for vaccine and serological surveys. The authors recommend that RT-PCR and serological testing should be used in conjunction to determine accurately the extent of asymptomatic transmission.


Antibodies in Covid recovered patients last only 2-3 months, finds Nature study
 
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