Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causes a spectrum of clinical manifestations, ranging from asymptomatic to mild, moderate, or severe illness with multi-organ failure and death. Using a new machine learning algorithm developed by us, we have reported a significantly higher number of predicted COVID-19 cases than the documented counts across the world. The sole reliance on confirmed symptomatic cases overlooking the symptomless COVID-19 infections and the dynamics of waning immunity may not provide ‘true’ spectrum of infection proportion, a key element for an effective planning and implementation of protection and prevention strategies. We and others have previously shown that strategic orthogonal testing and leveraging systematic data-driven modeling approach to account for asymptomatics and waning cases may situationally have a compelling role in informing efficient vaccination strategies beyond prevalence reporting. However, currently Centers for Disease Control and Prevention (CDC) does not recommend serological testing either before or after vaccination to assess immune status. Given the 27% occurrence of breakthrough infections in fully vaccinated (FV) group with many being asymptomatics and still a larger fraction of the general mass remaining unvaccinated, the relaxed mask mandate and distancing by CDC can drive resurgence. Thus, we believe it is a key time to focus on asymptomatics (no symptoms) and oligosymptomatics (so mild that the symptoms remain unrecognized) as they can be silent reservoirs to propagate the infection. This perspective thus highlights the need for proactive efforts to reevaluate the current variables/strategies in accounting for symptomless and waning fractions.

严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 病毒可引起一系列临床表现，从无症状到轻度、中度或重度疾病，并伴有多器官衰竭和死亡。使用我们开发的新机器学习算法，我们报告的预测 COVID-19 病例数明显高于全球记录的病例数。仅仅依赖有症状的确诊病例，而忽视无症状的 COVID-19 感染和免疫力减弱的动态，可能无法提供“真实”的感染比例谱，而这是有效规划和实施保护和预防策略的关键要素。我们和其他人之前已经表明，战略正交测试和利用系统数据驱动的建模方法来解释无症状和逐渐减少的病例可能在流行率报告之外的有效疫苗接种策略方面发挥着令人信服的作用。然而，目前美国疾病控制与预防中心 (CDC) 不建议在接种疫苗之前或之后进行血清学检测来评估免疫状态。鉴于在完全接种疫苗 (FV) 的人群中，突破性感染的发生率为 27%，其中许多人没有症状，而且仍有很大一部分人未接种疫苗，因此 CDC 放松的口罩要求和疏远措施可能会推动疫情卷土重来。因此，我们认为现在是关注无症状者（没有症状）和寡症状者（症状轻微以致于症状仍未被识别）的关键时刻，因为它们可能是传播感染的无声宿主。因此，这一观点强调需要积极主动地重新评估当前的变量/策略，以解释无症状和逐渐减弱的比例。