Asymptomatic COVID-19 transmission revealed by study of 2000 marine recruits

Recruits with India Company, 3rd Recruit Training Battalion, prepare and practice for their initial drilling evaluation on Peatross Parade Deck on Parris Island, SC Credit: U.S. Marine Corps photo by Sgt. Dana Beesley

A study of nearly 2,000 marine recruits who went under quarantine supervision before starting basic training led to several cases of asymptomatic transmission of EARS-CoV-2, the virus that causes COVID-19, despite the quarantine measures.

The findings have important implications for the effectiveness of public health measures to suppress the transmission of COVID-19 among young adults, whether in military training, schools or other aspects of the pandemic.

Researchers from the Icahn School of Medicine at Mount Sinai and the Naval Medical Research Center studied new marine recruits while in a two-week supervised quarantine. The results of the study will be published on 11 November The New England Journal of Medicine, showed that few infected recruits had symptoms before the diagnosis of SARS-CoV-2 infection, that the transmission occurred despite the implementation of many public health measures for best practice, and that diagnoses were made only by scheduled tests, not by tests performed in response to symptoms.

Stuart Sealfon

Stuart C. Sealfon, MD, professor of neurology at the Icahn School of Medicine at Mount Sinai and senior author of the article. Credit: Mount Sinai Health System

“We are honored that the U.S. Navy has given us the opportunity to collaborate on the study of SARS-CoV-2 in marine recruits,” said Stuart Sealfon, MD, Sara B. and Seth M. Glickenhaus, professor of neurology. at the Icahn School of Medicine. at Mount Sinai. ‘It is a difficult infection to oppress young people, even under the supervision of wearing their mask, social distance and other mitigation measures. We find that regular tests, not dependent on symptoms, identify carriers that can transmit SARS-CoV-2. We hope this information helps to develop more effective measures to keep military installations and schools safe. ”

The study showed that the virus spread asymptomatically, even under strict military mandates for quarantine and public health measures that were likely to comply better than would be possible in other youth institutions such as college campuses. The researchers noted that daily temperature and symptom checks did not detect infections in the recruits, and that the virus was largely transmitted within a particular group of groups, where pupils tended to be close to each other.

The study focused on 1848 participants in the study enrolled between May 15 and the end of July from nine different marine site classes, each containing 350 to 450 recruits. The participants were offered to enroll in a prospective, longitudinal study after returning home to basic training two weeks before their arrival. After arriving there, they had to follow strict group quarantine measures with double rooms for two weeks, during the study period, before starting the actual training. The supervised group quarantine took place in a college used for this purpose only. Each recruitment class was housed in different buildings and had different meal times and training schedules so that the classes did not interact.

Each weekly class was further divided into peloton of 50-60. During the study period, all recruits wore cloth masks, practiced social distance of at least six feet, and washed their hands regularly, and each recruit had only one roommate. Most of their instructions, including the practice and learning of military customs and traditions, were done outside. After each class had completed quarantine, a deep cleaning using bleach on surfaces in all rooms and common areas of the dormitories took place before the next class.

To determine asymptomatic and symptomatic SARS-CoV-2 occurrence and transmission during quarantine under supervision, participants were tested within two days of arrival, at 7 days and at 14 days using a nose swab (PCR) test that was allowed Is for emergency use by the U.S. Food and Drug Administration. Analysis of viral genomes of infected recruits identified several clusters that were temporally, spatially, and epidemiologically linked, revealing several local transmission events during quarantine.

“The identification of six independent transmission groups defined by different mutations indicates that there were several independent SARS-CoV-2 introductions and outbreaks during the quarantine under supervision,” said Harm van Bakel, PhD, assistant professor of genetics and genomic sciences at the Icahn School, said. medicine on Mount Sinai. “The data from this large study indicate that, in order to limit coronavirus transmission in group settings and prevent it from spreading to the wider community, we need to institute widespread initial and repeated surveillance tests of all individuals, regardless of symptoms.”

Insight into COVID-19 features and SARS-CoV-2 transfer in military personnel is important for the development of safer approaches for related institutions consisting primarily of young adults such as schools, sports and camps.

‘Our study highlights the power of Navy Medicine research to deploy and overcome many logistical barriers during a pandemic and to quickly compile an approved study by Institutional Review Board. These results will improve the medical readiness of our marines and should help inform the health policy of the Navy, the Department of Defense and the wider society to reduce the spread of SARS CoV-2, ”said Cmdr. Andrew Letizia, managing director, deputy director of the board of directors for infectious diseases of the Naval Medical Research Center and principal investigator for the study.

Reference: “SARS-CoV-2 Transmission Among Marine Recruits During Quarantine” by Andrew G. Letizia, MD, Irene Ramos, Ph.D., Ajay Obla, Ph.D., Carl Goforth, Ph.D., Dawn L Weir, Ph.D., Yongchao Ge, Ph.D., Marcas M. Bamman, Ph.D., Jayeeta Dutta, MBA, Ethan Ellis, BS, Luis Estrella, Ph.D., Mary-Catherine George, Ph.D. . D., Ana S. Gonzalez-Reiche, Ph.D., William D. Graham, Ph.D., Adriana van de Guchte, MS, Ramiro Gutierrez, MD, Franca Jones, Ph.D., Aspasia Kalomoiri, Ph.D. D., Rhonda Lizewski, MD, Stephen Lizewski, Ph.D., Jan Marayag, BA, Nada Marjanovic, MS, Eugene V. Millar, Ph.D., Venugopalan D. Nair, Ph.D., German Noodleman, Ph.D. .D., Edgar Nunez, AS, Brian L. Pike, Ph.D., Chad Porter, Ph.D., James Regeimbal, Ph.D., Stas Rirak, MS, Ernesto Santa Ana, AS, Rachel SG Sealfon, Ph.D., Robert Sebra, Ph.D., Mark P. Simons, Ph.D., Alessandra Soares-Schanoski, Ph.D., Victor Sugiharto, Ph.D., Michael Termini, MD, Sindhu Vangeti, Ph.D. .D., Carlos Williams, MD, Olga G. Troyanskaya, Ph.D., Harm van Bakel, Ph.D., and Stuart C. Sealfon, Managing Director, 11 November 2020, New England Journal of Medicine.
DOI: 10.1056 / NEJMoa2029717

This work was supported by the Defense Health Agency through the Naval Medical Research Center and the Defense Advanced Research Projects Agency.

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