Asymptomatic COVID-19 Transmission Revealed Through Study of 2,000 Marine Recruits

US Marine Corp Recruits

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Recruits with India Company, 3rd Recruit Training Battalion, prepare and practice for their preliminary drill assessment on Peatross Parade Deck on Parris Island, S.C. Credit: U.S. Marine Corps picture by Sgt. Dana Beesley

A research study of almost 2,000 Marine hires who went through monitored quarantine prior to beginning standard training exposed numerous circumstances of asymptomatic transmission of SARS-CoV-2, the infection that triggers COVID-19, in spite of the quarantine procedures.

The findings have essential ramifications for the efficiency of public health procedures to reduce transmission of COVID-19 amongst young people, whether in basic training, schools, or other elements of the pandemic.

The scientists from the Icahn School of Medicine at Mount Sinai and the Naval Medical Research Center studied brand-new Marine hires while they remained in a two-week monitored quarantine. The research study results, publishing November 11 in The New England Journal of Medicine, revealed that couple of contaminated employees had signs prior to medical diagnosis of SARS-CoV-2 infection, that transmission happened in spite of carrying out numerous best-practice public health procedures, which medical diagnoses were made just by arranged tests, not by tests carried out in reaction to signs.

Stuart Sealfon

Stuart C. Sealfon, MD, Professor of Neurology at the Icahn School of Medicine at Mount Sinai and senior author of the paper. Credit: Mount Sinai Health System

“We were honored that the U.S. Navy gave us the opportunity to collaborate on studying SARS-CoV-2 in Marine recruits,” states Stuart Sealfon, MD, the Sara B. and Seth M. Glickenhaus Professor of Neurology at the Icahn School of Medicine at Mount Sinai. “This is a difficult infection to suppress in young people, even with close supervision of their mask wearing, social distancing, and other mitigation measures. We find that regular testing not dependent on symptoms identifies carriers who can transmit SARS-CoV-2. We hope this information helps in developing more effective measures to keep military installations and schools safe.”

The research study information exposed asymptomatic spread of the infection even under stringent military orders for quarantine and public health procedures that more than likely knowledgeable much better compliance than what would be possible in other youth settings like college schools. The scientists kept in mind that day-to-day temperature level and sign checks did not discover infections amongst the employees which the infection was mostly transferred within a provided squad group where students tended to be near one another.

The research study concentrated on 1,848 research study individuals who were registered from 9 various Marine hire classes, each consisting of 350 to 450 hires, in between May 15 and completion of July. The individuals were used registration in a potential, longitudinal research study after self-quarantining in the house for 2 weeks prior to arrival at standard training. Once they showed up, they were needed to follow stringent group quarantine procedures with two-person spaces for 2 weeks–the period of the research study duration–prior to the start of the real training. The monitored group quarantine happened at a college utilized just for this function. Each hire class was housed in various structures and had various dining times and training schedules, so the classes did not connect.

Each weekly class was additional divided into squads of 50-60. During the research study duration, all employees used fabric masks, practiced social distancing of a minimum of 6 feet, and frequently cleaned their hands, and each hire had simply one roomie. Most of their direction, consisting of working out and discovering military customizeds and customs, was done outdoors. After each class completed quarantine, a deep cleansing, utilizing bleach on surface areas, happened in all spaces and typical locations of the dorm rooms prior to the arrival of the next class.

To figure out asymptomatic and symptomatic SARS-CoV-2 frequency and transmission throughout monitored quarantine, individuals were evaluated within 2 days of arrival, at 7 days, and at 14 days utilizing a nasal swab (PCR) test licensed for emergency situation usage by the U.S. Food and Drug Administration. Analysis of viral genomes from contaminated employees recognized numerous clusters that were temporally, spatially, and epidemiologically connected, exposing numerous regional transmission occasions throughout quarantine.

“The identification of six independent transmission clusters defined by distinct mutations indicates that there were multiple independent SARS-CoV-2 introductions and outbreaks during the supervised quarantine,” stated Harm van Bakel, PhD, Assistant Professor of Genetics and Genomic Sciences at the Icahn School of Medicine at Mount Sinai. “The data from this large study indicates that in order to curtail coronavirus transmission in group settings and prevent spill-over to the wider community, we need to establish widespread initial and repeated surveillance testing of all individuals regardless of symptoms.”

Insight into COVID-19 qualities and SARS-CoV-2 transmission in military workers has importance to establishing much safer techniques for associated settings made up mostly of young people such as schools, sports, and camps.

“Our study highlights the power of Navy Medicine research to deploy and overcome many logistical hurdles during a pandemic and quickly stand up an institutional review board-approved study. These results will improve the medical readiness of our Marines and should help inform public health policy across the Navy, Department of Defense, and society at large to decrease transmission of SARS CoV-2,” stated Cmdr. Andrew Letizia, MD, Deputy Director of the Naval Medical Research Center’s infection illness directorate and lead scientist for the research study.

Reference: “SARS-CoV-2 Transmission among Marine Recruits during Quarantine” by Andrew G. Letizia, M.D., 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, M.B.A., Ethan Ellis, B.S., Luis Estrella, Ph.D., Mary-Catherine George, Ph.D., Ana S. Gonzalez-Reiche, Ph.D., William D. Graham, Ph.D., Adriana van de Guchte, M.S., Ramiro Gutierrez, M.D., Franca Jones, Ph.D., Aspasia Kalomoiri, Ph.D., Rhonda Lizewski, M.D., Stephen Lizewski, Ph.D., Jan Marayag, B.A., Nada Marjanovic, M.S., Eugene V. Millar, Ph.D., Venugopalan D. Nair, Ph.D., German Nudelman, Ph.D., Edgar Nunez, A.S., Brian L. Pike, Ph.D., Chad Porter, Ph.D., James Regeimbal, Ph.D., Stas Rirak, M.S., Ernesto Santa Ana, A.S., Rachel S.G. Sealfon, Ph.D., Robert Sebra, Ph.D., Mark P. Simons, Ph.D., Alessandra Soares-Schanoski, Ph.D., Victor Sugiharto, Ph.D., Michael Termini, M.D., Sindhu Vangeti, Ph.D., Carlos Williams, M.D., Olga G. Troyanskaya, Ph.D., Harm van Bakel, Ph.D., and Stuart C. Sealfon, M.D., 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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