A letter published in the NEJM made Fauci reveal to the world the radical change in position, which he had reinforced two days earlier, that asymptomatic people always played a secondary role in epidemics.
However, that study was based only on one case of transmission by an asymptomatic person, when in the end she had symptoms. Nonetheless, the article has not been withdrawn, nor amended, and continues to be shared as evidence.
A letter published on January 30, 2020, addressed to the editors and published in the New England Journal of Medicine (NEJM), reports a case of transmission by an asymptomatic individual.
Despite being an unreviewed study and only one case, it had a huge influence on the perception of SARS-COV-2 transmission and on future measures adopted.
One of the main reasons was the fact that Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and one of the main members of the White House Coronavirus team, took the study as the decisive proof of asymptomatic transmission.
Fauci stated :
“There is no doubt after reading the [NEJM] article that asymptomatic transmission is occurring” (…) “This study sheds light on the issue.”
This statement comes just two days after having downplayed the importance of these cases. He said at the time (January 29):
“The driver of outbreaks is always a symptomatic person. Even if there is a rare asymptomatic person who can transmit it, an epidemic is not caused by asymptomatic carriers.”
However, the study in which Fauci justified his change of position was wrong. It was based on a false asymptomatic case.
The study “Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany” was based on the alleged contagion from a Chinese businesswoman visiting Germany. In the letter, the study authors stated:
“During her stay, she was fine, with no signs or symptoms of infection, but fell ill on the flight back to China.”
That information turned out to be false. As reported by Science , a few days after the article was published, the Robert Koch Institute (RKI), the German government’s public health agency, and the Bavarian State Health and Food Safety Authority contacted the Chinese woman after the publication of the NEJM article.
It turns out that the Chinese citizen had symptoms during her stay in Germany, when she came into contact with the German who fell ill.
No tests were carried out in Germany to confirm whether she was infected with the virus. She was only tested for the coronavirus in China after her return from Germany and tested positive for the virus.
Confirmation and justification of errors by the authors
The researchers never even spoke to the woman before publishing the article.
The last author, Michael Hoelscher of the Ludwig Maximilian University Medical Center in Munich, said the document was based on information from four other patients:
“They told us that the patient from China did not appear to have any symptoms.”
Virologist Christian Drosten of Charité University Hospital in Berlin, who did the lab work for the study and is one of the authors, told Science:
“I feel bad about what happened, but I don’t think anyone is to blame here.”
“Apparently, the woman could not be reached at first and people felt that this should be communicated quickly.”
Shortly before the episode – January 21 – Drosten had been one of the two lead authors of the article “ Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR ,” . It was accepted for publication the next day, 22 January, and published on Eurosurveillance .
The work presents an RT-PCR protocol for the detection of SARS-CoV-2 and a methodology for diagnosing the disease. This test was presented as being of particular importance for the detection of infected people, namely asymptomatic ones, given the hypothesis that they have a strong role in transmission.
Action by the NEJM after learning that the study was based on a wrong assumption
Instead of withdrawing and publishing an editorial note to rectify the error in the publication, the journal only placed the information with the mention of the error in a Supplementary Appendix referenced in the text of the letter.
In it, the authors acknowledge that the businesswoman reported experiencing mild symptoms at the end of the first day and on the remaining days of meetings.
“Noticed a slight pain “in some muscles and bones of the chest”…” (22 January 2020)
“She mentioned that she felt a little chilly in the morning when wearing light business attire.”
However, the article remains active, with the title and content unchanged.
Article citations
Thus, the article continues to be cited, including by the American CDC .
CNN keeps study online
Despite recognized flaws, the study continues to be disseminated in the media as well.
CNN, for example, keeps the news online, the Fauci quote, and the (admittedly wrong) timeline.
The role of asymptomatic patients is still far from being clarified. Several referenced studies have important limitations, a low level of evidence and have shown contradictory results.
However, it is now recognized that its importance is far from that advanced in some of the initial studies and more in line with what was known about other respiratory infections .
Editorial Note: We contacted NEJM to ask for a justification for the article to remain unchanged. We received confirmation of receipt of our email about two weeks ago, but we have not received any response to date.
