June 16, 2020
Finally, Some Good…Nevermind
- The word on the street was that the spread of coronavirus by asymptomatic people was highly unlikely.
- According to some experts, we should be using pre-symptomatic instead of asymptomatic.
- Van Kerkhove said she did not mean to suggest that asymptomatic people cannot spread COVID-19.
The World Health Organization (WHO) may have inadvertently raised hopes around the world only to dash them, or at least, put them on hold for further study.
The word on the street was that the spread of coronavirus by asymptomatic people was highly unlikely. For the sake of argument, let’s assume this information is essentially correct. That still leaves a lot to unpack. First, what exactly does it mean to be asymptomatic? Does it mean a person is not infected? Because technically, an uninfected person is unlikely to have symptoms of whatever disease is in question. But that of course, is not what we mean when we say asymptomatic. We mean infected, but showing no visible signs.
This brings us to a metaphorical fork in the road. To paraphrase Inigo Montoya, we continue to employ a word that is incorrect for this context, leading to confusion regarding the message. In other words, according to some experts, we should be using pre-symptomatic instead of asymptomatic. “Regarding the shifting thinking on symptoms and transmission of the novel coronavirus, when it comes to pre-symptomatic or asymptomatic, ‘pre’ is really the right terminology, Carlos del Rio, MD, professor of medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, said during the briefing, because it’s not that people are asymptomatic but that they develop symptoms later and start transmitting the virus 24 to 48 hours before they develop symptoms.”
For up to two days, contagious people could potentially be shedding viral particles and contributing to the spread of the coronavirus pandemic. Of course, there will still be variations between individuals regarding the severity of symptoms. So, while one COVID-19 patient may look less ill, does that mean they are somehow less infected? Do lesser symptoms equal a lesser viral load? The answer is a resounding maybe.
We know that the general health, or lack thereof, of a person can be a significant factor in susceptibility to coronavirus, to any illness in fact. But where exactly does that come into play? If patient A is healthy in every way, but contracts the virus anyway, should we expect that A will have a mild case? Or, once infected, is A just as vulnerable to the ravages of the disease as is patient B who was high risk to begin with?
It could depend on factors such as viral dose and viral load. The viral dose is the amount of coronavirus it takes to infect a person. This dose varies depending on the virus, but like everything else concerning COVID-19, we have not had time to learn everything we need to know. We do not know exactly how many viral particles are needed to initiate infection. However, greater exposure can mean a higher viral dose. More viral particles entering the body can translate to the virus spreading more rapidly and effectively. A virus that is more firmly established can cause more havoc in its host. The viral load is the amount of virus found in an infected patient.
A study published in the New England Journal of Medicine found evidence that could provide some guidance. “The viral load that was detected in the asymptomatic patient was similar to that in the symptomatic patients, which suggests the transmission potential of asymptomatic or minimally symptomatic patients.” The take-away is that more exposure could lead to more viral particles in the body, which could in turn mean more severe illness. That possibility makes it tempting to freely disregard safety protocols, because who among us doesn’t consider themselves a good judge of their own health? Or of the health of loved ones? But that confidence is false. Whatever we call it, it is possible for the virus to spread silently.
It seems clear that pre-symptomatic transmissions must play some role in the spread of coronavirus. Because realistically, people who have continued to socialize, or are just getting back to it, are not hanging out with their hacking, phlegmy cohorts, they are spending time with others who believe they are not infected. Others who they believe are not infected.
The World Health Organization later clarified. “In an interview with TIME following the press briefing, Van Kerkhove said she did not mean to suggest that asymptomatic people cannot spread COVID-19. ‘I did not say that asymptomatic cases cannot transmit; they can,’ Van Kerkhove says. ‘The question is, do they? And if they do, how often is that happening?’”
The answers are not yet known. Even if it happens rarely, how wise are we to behave as though rarely is equivalent to never? That answer is: not particularly.