COVID Transmissions for 8-7-2020

Aug 07, 2020

Greetings from an undisclosed location in my hotel room. Last day here!

It has been 264 days since the first documented human case of COVID-19.

Housekeeping note:

Yesterday I received an email from a reader asking for an in-depth on subgenomic RNAs, and I think that’s a great request. I will plan to walk through some aspects of what these RNAs are—and also what we detect when we perform COVID tests—in an in-depth piece for next week.

Another topic that I’m planning to do an in-depth on is teased by a headline in today’s edition—how assumptions based on our understanding of human coronaviruses and influenza virus pandemics hurt our response to the COVID-19 pandemic.

Both of these topics are rather involved, and in order to do them complete justice, I will need to be back at my home computer setup where I can work on them in better detail and at greater length, but I wanted to let everyone know what to look out for next week.

However, I did write at length about some of the headlines today because I think we’ve had some very important news.

Glossary terms are bolded words with links to the running newsletter glossary.

If you like what you see—or what you might see in the future—tell others about it so the newsletter continues to grow:

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Now, let’s talk COVID.

Asymptomatic spread

Since the beginning of the pandemic, there has been a serious debate over whether people who have not yet experienced symptoms are able to transmit the virus. For many respiratory viruses, it has long been thought that transmission is minimal without symptoms. This makes some sense—if you aren’t feeling sick yet, then maybe the virus hasn’t replicated enough to be transmitted.

However, early efforts to control this virus focused on isolating sick people only, and clearly, those efforts were not successful. It has become apparent that this virus can be transmitted before victims are aware that they are sick, if only because of the facts we have observed on the ground. Eventually, most authorities accepted that obviously the virus is able to transmit before people show symptoms.

Yet there was still another big question—what about those who never get sick? Are they able to spread the virus? My gut feeling has been yes for much of the pandemic, and anecdotal evidence has supported this view…but anecdotes are not data.

That is why I am glad that a new paper in JAMA Internal Medicine demonstrates that in hundreds of South Korean patients, symptomatic status did not impact the amount of viral genomic RNA detected. This strongly suggests that asymptomatic patients will be able to transmit virus nearly as well, if not equally as well, as those who experience symptoms. The paper can be found here: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2769235

The New York Times covered this as well: https://www.nytimes.com/2020/08/06/health/coronavirus-asymptomatic-transmission.html

I’m not entirely certain that this means asymptomatic patients will transmit as well as symptomatic patients; asymptomatic patients do not cough like symptomatic patients. This isn’t a transmission study and didn’t look at the ability to recover live virus from each type of patient, so we can’t be sure. But I think it’s best to be cautious.

Also, this study suggested that as many as 30% of people who are infected never show any symptoms at all. Others have made higher estimates, and this may be on the low end, but I think it gives us something of a ballpark estimate. I recognize this may be hard to square with estimates that 20 to 25% of the NYC population may have been affected, when only a few hundred thousand cases were detected, so I want to emphasize a couple of things here: asymptomatic means truly zero-symptom cases. This does not include cases that had mild symptoms and did not trigger the patient’s suspicions enough to try and get tested, or patients whose cases were too low-risk to allow them to even get a test. These groups likely were present in quite large numbers in notable outbreaks around the world as well.

What all this really means to every individual person is this: you can’t know for sure that you are safe to be exposed to other people. You could be infected, and you could be dangerous to them. That’s why it’s important to wear a mask and maintain appropriate distancing, even if you don’t feel sick. This is how we keep each other safe.

Superspreading at religious services

The government of Ohio—where Governor Mike DeWine just tested positive for SARS-CoV-2 infection—released some information today about a cluster of infections that happened in a church congregation. In that instance, 91 people got infected when one person attended a church service while infected with the virus. Here’s a graphic shared by the governor describing the infection cluster:

Church and other religious services are particularly risky because they involve communal social behavior, loud singing, and speaking in unison. All of these things can contribute to spread of the virus, as we have learned from stories like this one.

This case study began with a transmission event on June 14th; at that time, a universal masking law had not been implemented in Ohio. Since then, such a law has been implemented and will hopefully prevent situations like this in the future.

Again, this story underscores the importance of vigilance against spreading this virus. While it is not clear if the individual source of these infections was wearing a mask at the time, he wasn’t required to and this narrative does not look like one where the person would have been masked.

It’s important that as we return to religious services and other gatherings we adopt disease control measures that prevent our places of religious worship and solace becoming sources of infection and danger. I serve on the planning committee of my own synagogue, and we have adopted several measures that I think help to minimize risk of transmission. Hopefully this story serves to convince other houses of worship that they must do the same.

Journalist coverage of this story here: https://www.businessinsider.com/coronavirus-ohio-91-sick-after-infected-man-attends-church-service-2020-8

What am I doing to cope with the pandemic? This:

Vacation

Today we went to Grist Iron brewery and took a bike ride along the Cayuga waterfront trail. Both things that work well with social distance but still allow for relaxation.

Image depicts a tasting board of beer glasses, on a picnic table overlooking a view that includes a small pond in the middle distance, and a large lake farther in the background. A blue sky with scattered clouds is shown, and reflected in the pond.

Image shows two people, wearing bicycle helmets and masks, on the verdant bank of a small body of water, with trees on the shore across the water visible in the background.

Again, I want to use this opportunity to say that I really recommend getting away or finding other change-of-pace activities as may be safely possible for you. This pandemic is a long disaster and you need to take care of yourselves in both mind and body to the extent that you are able.

Join the conversation, and what you say will impact what I talk about in the next issue.

Also, I welcome any feedback on structure and content. I want this to be as useful as possible, and I can only make that happen with constructive comments.

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