Sir, with the increased success of identifying symptomatic COVID-19 cases followed by self-isolation, the main mode of transmission is going to be increasingly through asymptomatic spread.1 We are not routinely testing patients who have been selected for an aerosol generating procedure (AGP) and this is based (in Scotland) on the low prevalence of infective cases in the community. In fact, the modelling used suggests that 5,000 tests would need to be performed to identify one asymptomatic infective case.
There is an opportunity here to perform a prospective study by testing patients who have been selected for an AGP, to assess this model/hypothesis. Recruiting practices from various geographical locations would be necessary to attempt to catch any local variations but if one or two thousand consecutive cases came back negative, how reassuring that would be?
Reference
Gillespie C. What's the difference between asymptomatic and presymptomatic spread of COVID-19? Explore Health 11 June 2020. Available at: https://www.health.com/condition/infectious-diseases/coronavirus/asymptomatic-vs-presymptomatic (accessed 12 July 2020).
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Malden, N. An opportunity. Br Dent J 229, 70–71 (2020). https://doi.org/10.1038/s41415-020-1934-7
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DOI: https://doi.org/10.1038/s41415-020-1934-7
