Mayo Clinic Proceedings: Innovations, Quality & Outcomes (Dec 2022)

Rates of Asymptomatic COVID-19 Infection and Associated Factors in Olmsted County, Minnesota, in the Prevaccination Era

  • Celine M. Vachon, PhD,
  • Aaron D. Norman, MPH,
  • Kavita Prasad, MD,
  • Dan Jensen, MPH,
  • Gavin M. Schaeferle, BA,
  • Kristy L. Vierling, MA,
  • Meaghan Sherden, MPH,
  • Michelle R. Majerus, MBA, FACHE,
  • Katherine A. Bews, BA,
  • Ethan P. Heinzen, MS,
  • Amy Hebl, BS,
  • Kathleen J. Yost, PhD,
  • Richard B. Kennedy, PhD,
  • Elitza S. Theel, PhD,
  • Aditya Ghosh, MD,
  • Meghan Fries,
  • Chung-Il Wi, MD,
  • Young J. Juhn, MD,
  • Priya Sampathkumar, MD,
  • William G. Morice, II, MD, PHD,
  • Walter A. Rocca, MD, MPH,
  • Aaron J. Tande, MD,
  • James R. Cerhan, MD, PhD,
  • Andrew H. Limper, MD,
  • Henry H. Ting, MD,
  • Gianrico Farrugia, MD,
  • Rickey E. Carter, PhD,
  • Lila J. Finney Rutten, PhD,
  • Robert M. Jacobson, MD,
  • Jennifer St. Sauver, PhD

Journal volume & issue
Vol. 6, no. 6
pp. 605 – 617

Abstract

Read online

Objective: To estimate rates and identify factors associated with asymptomatic COVID-19 in the population of Olmsted County during the prevaccination era. Patients and Methods: We screened first responders (n=191) and Olmsted County employees (n=564) for antibodies to SARS-CoV-2 from November 1, 2020 to February 28, 2021 to estimate seroprevalence and asymptomatic infection. Second, we retrieved all polymerase chain reaction (PCR)-confirmed COVID-19 diagnoses in Olmsted County from March 2020 through January 2021, abstracted symptom information, estimated rates of asymptomatic infection and examined related factors. Results: Twenty (10.5%; 95% CI, 6.9%-15.6%) first responders and 38 (6.7%; 95% CI, 5.0%-9.1%) county employees had positive antibodies; an additional 5 (2.6%) and 10 (1.8%) had prior positive PCR tests per self-report or medical record, but no antibodies detected. Of persons with symptom information, 4 of 20 (20%; 95% CI, 3.0%-37.0%) first responders and 10 of 39 (26%; 95% CI, 12.6%-40.0%) county employees were asymptomatic. Of 6020 positive PCR tests in Olmsted County with symptom information between March 1, 2020, and January 31, 2021, 6% (n=385; 95% CI, 5.8%-7.1%) were asymptomatic. Factors associated with asymptomatic disease included age (0-18 years [odds ratio {OR}, 2.3; 95% CI, 1.7-3.1] and >65 years [OR, 1.40; 95% CI, 1.0-2.0] compared with ages 19-44 years), body mass index (overweight [OR, 0.58; 95% CI, 0.44-0.77] or obese [OR, 0.48; 95% CI, 0.57-0.62] compared with normal or underweight) and tests after November 20, 2020 ([OR, 1.35; 95% CI, 1.13-1.71] compared with prior dates). Conclusion: Asymptomatic rates in Olmsted County before COVID-19 vaccine rollout ranged from 6% to 25%, and younger age, normal weight, and later tests dates were associated with asymptomatic infection.