At the outset of the COVID-19 pandemic, the presumed telltale signs of infection were obvious: fever, respiratory distress, chills. Then more subtle symptoms like diminished senses of loss and smell became more apparent. Eventually, we understood that some people developed few (or even no) symptoms—but that they could still infect others and be “sick” for months themselves. Unfortunately, the learning curve continues as an article just published by JAMA Network reveals that the proportion of people who’ve been infected with COVID-19 but are asymptomatic is much higher than previously thought. Researchers conducted a meta-analysis of 95 studies reflecting 29.8 million individuals who had undergone testing for the virus. While only 0.25% of the whole tested population were found to have the virus, over 40% of those known to have COVID-19 were asymptomatic. And this was in February 2021, well before the emergence of the Delta and Omicron variants. The message for urgent care providers is clear: Merely considering presenting symptoms as a basis for testing patients for COVID-19 is woefully insufficient. Broader testing of patients across the board, resources permitting, with recommendations to quarantine as needed may be the most effective means of containing the latest surge—especially with so many people gathering in large numbers during this holiday season.

Asymptomatic COVID-19 Cases Are Higher Than Previously Known. We Need to Test More