An open letter to Oran and Topol, and the Annals of Internal Medicine

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An open letter to Oran and Topol, authors of “Presence of Asymptomatic SARS-CoV-2 Infection: A Narrative Review” Annals of Internal Medicine. 2020 June 3. https://doi.org/10.7326/M20-3012 and Christine Laine (editor-in-chief The Annals of Internal Medicine) There is a need to better understand the contribution of asymptomatic SARS-CoV-2 infections (those with no symptoms at all throughout the infection) in driving the current pandemic. However, there are caveats that in our opinion are pertinent when interpreting the reported findings of this review, including the lack of a clear definition of asymptomatic infection and selective inclusion of cross-sectional studies. In addition, there is a problematic interpretation of a narrative review containing a dearth of poor-quality evidence resulting in an overestimate of asymptomatic infections, which might misinform policy response.