ASYMPTOMATIC COVID-19 CARRIERS: A QUANDARY FOR FAMILY PHYSICIAN

The current COVID-19 pandemic that started in Wuhan, China, in December 2019, infect millions globally so far. The disease is caused by an RNA virus called severe acute respiratory syndrome corona virus-2 (SARS CoV-2).The common presenting symptoms include dry cough, fever, sore throat, and malaise. A proportion of patients remain asymptomatic throughout infection. Likewise, pre-symptomatic, asymptomatic patients act as carriers that can infect others.These patients pose a management challenge for family physicians working at the primary care level.Herein we report an asymptomatic carrier of COVID-19 who presented to the primary care center for routine follow-upthat confirmed by RT-PCR test.

The current COVID-19 pandemic that started in Wuhan, China, in December 2019, infect millions globally so far. The disease is caused by an RNA virus called severe acute respiratory syndrome corona virus-2 (SARS CoV-2).The common presenting symptoms include dry cough, fever, sore throat, and malaise. A proportion of patients remain asymptomatic throughout infection. Likewise, pre-symptomatic, asymptomatic patients act as carriers that can infect others.These patients pose a management challenge for family physicians working at the primary care level.Herein we report an asymptomatic carrier of COVID-19 who presented to the primary care center for routine followupthat confirmed by RT-PCR test.

Introduction:-
The ongoing pandemic of COVID-19caused by SARS-CoV-2 affects millions globally. As of December1, 2020, worldwide confirmed infections are over 63millionin 218 countries, territories, and two international conveyances 1 .The disease brought unprecedented challenges to the healthcare sector. The presentation of COVID-19 clinical manifestations varies among individuals ranging from pre to symptomatic or asymptomatic at all. Presymptomatic or asymptomatic patients are considered as the main source of COVID-19 transmission. Not only these individuals are a silent source of disease transmission but it is a great challenge for healthcare workers in their day-to-day clinical practice.Due to their asymptomatic nature of the disease, these individuals either don't seek healthcare servicesor if they seek medical advice for any other health-related issue, they un-intentionally not bring in the notice of the treating physician unless asked otherwise.Herein, we report a case of COVID-19 that remained asymptomatic during his course of illness and consequently infect his family.

Case Presentation:
A 45years old male, a known patient of hypertension, presented to the primary care clinic for routine follow-up. There was no history of any other illness. An in-depth history of the patient revealed a friend visit, a week ago that was positive for COVID-19 which he knew latter by RT-PCR during screening. Clinical evaluationunder COVID-19 protocol was insignificant. The patient vitals were: Temp. 37.2C pulse 81/min, BP 148/90mmHg. Laboratory workup was within normal limits except for lipid profile: total cholesterol 245mg/dL, LDL 169mg/ dL, HDL 65mg/ dL. The requested chest x-ray shows no abnormal findings (Fig-1) Corresponding Author:-Liaqat Ali Khan Address:-General Directorate of Health Jazan, Kingdom of Saudi Arabia. Email: drliaqatalikhan@yahoo.com The patient was advised for nasopharyngeal swab sample for RT-PCR and home isolation. Upon a positive result of RT-PCR for the patient, his wife and children were asked for the COVID-19 test. His wife'snasopharyngeal swab result confirmed SARS CoV-2 infection and children's were negative at this point.Tele-advicehas given to the patient, to quarantine his family, and to callif any symptom arises. The patient was followed frequently via teleconsultation for the next ten days. Fortunately, the patient remained asymptomatic throughout the infection.
The publication of this case highlights the notion that asymptomatic and patients with pre-symptomatic COVID-19 may pose a management quandary for primary care physicians working at the primary level. Therefore, physicians should focus on an in-depth interview of each visiting patient specifically focusing on any history of contact and follow the standard operating guidelines. .3% of the studied population which is less than the asymptomatic patients on Diamond Princes Cruise in Japan, where 50% of the patients were asymptomaticinastudy by Kenji and colleagues. 6 Another study in a hemodialysis unit in Germanyby Albalate et al 7 .found 40.5% of their patients were asymptomatic and stressed the need for early detection of asymptomatic patients.According to a recent review by Oran & Topol 8 , the prevalence of asymptomatic carriers accounts for 40-45% and could transmit infection beyond 14 days. In light of the COVID-19 pandemic and constrain on hospitals, most of the healthcare services are directed to primary care that in turn encounter more over the desk consultations andincreases the risk of exposure to pre-or asymptomatic patients.

Conclusion:-
In the current pandemic of COVID-19, Family Physicians should be vigilant and to be focused on taking in-depth history including history of contact from each patient irrespective of the presenting symptoms to pick and screen patients of asymptomatic COVID-19.

Ethical approval
Not applicable