Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: A systematic review and meta-analysis

Mercedes Yanes-Lane; Nicholas Winters; Federica Fregonese; Mayara Bastos; Sara Perlman-Arrow; Jonathon R. Campbell; Dick Menzies

doi:10.1371/journal.pone.0241536

Peer Review History

Original SubmissionSeptember 23, 2020
12 Oct 2020 Decision Letter - Raffaele Serra, Editor PONE-D-20-29770 Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: a systematic review and meta-analysis PLOS ONE Dear Dr. Yanes Lane, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. The reviewers have commented on your above paper. They have suggested that this manuscript be revised according to the reviewers suggestions and resubmitted. Provided you address the changes recommended, the manuscript will be accepted for publication. Please submit your revised manuscript by Nov 26 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Prof. Raffaele Serra, M.D., Ph.D Academic Editor PLOS ONE Additional Editor Comments: The reviewers have commented on your above paper. They have suggested that this manuscript be revised according to the reviewers suggestions and resubmitted. Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. In the Discussion section, please discuss how results can be interpreted given the quality of the included studies. 3. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors conducted a systematic review and meta-analysis to critically evaluate the literature on the proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential. The article is well written and in my opinion is very informative and important for scientific community. Well done! Reviewer #2: This systematic review and meta-analysis was rigorously executed and described in this well-written paper. The design was appropriate for the question addressed. Although the review was limited by the heterogeneity of the publications included, the authors were careful to minimize bias by selecting papers that met clearly described criteria, and their conclusions are supported by their findings. I found no major concerns in this paper. The following minor suggestions are offered to strengthen the paper overall. 1. Since the authors mention in the Discussion that data were inadequate to draw conclusions regarding asymptomatic infection and age, a sentence or two in the Introduction summarizing the current state of knowledge regarding symptoms by age would be appropriate. 2. Line 218 - Superscript the "2" in I2. 3. Line 301 - I believe that "COVID-19" should be replaced with "SARS-CoV-2" since the virus is being transmitted, rather than the disease. 4. Line 309 - the list of high risk populations that require asymptomatic screening could also include younger people in congregate settings where safety precautions are not strictly followed (i.e., college students). ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** Nicola Ielapi Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0241536.r001
Revision 1
16 Oct 2020 Author Response PLOS ONE Dear Dr. Serra, Many thanks to you and the reviewers for your time in reviewing our manuscript. We have revised the paper in light of the comments received and provided a point-by-point response, where necessary. We have provided a track changes and a clean version of the manuscript. In our responses below, when we refer to line numbers, these refer to line numbers in the clean version. We appreciate the opportunity to revise our manuscript. We look forward to hearing from you. Yours very truly, Dick Menzies and Mercedes Yanes Lane, On behalf of all authors Editor comments: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Response: We followed the formatting guidelines and updated as necessary. 2. In the Discussion section, please discuss how results can be interpreted given the quality of the included studies. Response: This is a helpful comment. We have added the following text to the discussion “We excluded studies assessed to be of low quality, as these did not include information on the population tested, methods for ascertaining the presence of symptoms or definition of asymptomatic”, which we deemed to be important for reducing bias. By including studies that had rigorous methodologies as well as complete reporting, we were able to provide more accurate estimates, however, considerations need to be taken regarding the generalizability of results.” This revision can be found on lines 323 to 328. 3. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Response: We have added captions for the Supporting Information to the end of the manuscript. Reviewer comments: 1. Since the authors mention in the Discussion that data were inadequate to draw conclusions regarding asymptomatic infection and age, a sentence or two in the Introduction summarizing the current state of knowledge regarding symptoms by age would be appropriate. Response: The following statement (with the appropriate references) has been added to the introduction “observational studies have found that younger patients are less likely to present with severe forms of the disease.” This revision can be found on lines 49 to 50. 2. Line 218 - Superscript the "2" in I2. Response: We have corrected the superscript. 3. Line 301 - I believe that "COVID-19" should be replaced with "SARS-CoV-2" since the virus is being transmitted, rather than the disease. Response: Thank you for flagging this. We have changed accordingly. 4. Line 309 - the list of high risk populations that require asymptomatic screening could also include younger people in congregate settings where safety precautions are not strictly followed (i.e., college students). Response: This is a helpful suggestion. We have updated the list to include populations in congregate settings. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0241536.r002
19 Oct 2020 Decision Letter - Raffaele Serra, Editor Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: a systematic review and meta-analysis PONE-D-20-29770R1 Dear Dr. Yanes Lane, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Prof. Raffaele Serra, M.D., Ph.D Academic Editor PLOS ONE Additional Editor Comments (optional): amended manuscript is acceptable Reviewers' comments: https://doi.org/10.1371/journal.pone.0241536.r003
Formally Accepted
22 Oct 2020 Acceptance Letter - Raffaele Serra, Editor PONE-D-20-29770R1 Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: a systematic review and meta-analysis Dear Dr. Yanes Lane: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Prof. Raffaele Serra Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0241536.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .