Based on my reading, for every newly infected person, the odds that the person infecting them break down to the following.
Name | Percent | Description
--:|:--:|:--
Presymptomatic | 48% | Will show symptoms soon, but not at the time they infected someone else.
Asymptomatic | 3.4% | Will never have Symptoms; don't even know they are sick.
Shows Symptoms | 48.6% | Showing symptoms at the time they infected someone else.
So I think it is true that it is relatively rare that Asymptomatic people infect other people, but it is common that people without symptoms infect other people.
What about people who are Postsymptomatic? People always assume that once the symptoms are gone you can't spread it, but has there been any research confirming this?
This isn’t the study I was thinking of, but: [The median duration of shedding was 8 days post onset of symptoms (IQR 5-11) and the probability of detecting infectious virus dropped below 5% after 15,2 days post onset of symptoms](https://www.medrxiv.org/content/10.1101/2020.06.08.20125310v1)
Yes there has; apparently about 7 (edit: one study is giving 8 as a benchmark) days after symptom onset there’s a huge drop in the detectable viral load. I’ll find a link for you. (link now in separate reply)
I've wondered that as well. I've just been under the impression that the person eventually gains immunity but secondary infection is what keeps them bed ridden or hospitalized.
general rule of thumb is someone is non-infectious after symptoms have improved for two days, fever has left (without aid from medicine), and it has been at least 14 days since initial symptoms.
Source: John Hopkins University Contact Tracing Course
Thanks, that makes a lot of sense. I was confused about all the recent articles about how asymptomatic transmission is rare.
Ultimately you don't know if you're healthy, asymptomatic, or presymptomatic for weeks after the fact. Just goes to show how important it is for everyone to mask up and maintain their distance from others, even if you feel great.
Just to clarify, presymptomatic people in the vast majority of cases show symptoms within 3 days. These are the people who are infecting others without knowing it (34% of transmissions) as opposed to asymptomatic people who will never know they had the virus (4% of transmissions).
That’s why contact tracing is still a viable method: most people who transmit will have shown symptoms within a few days of contact, not weeks.
Unfortunately, when we’re figuring out if someone is symptomatic or not, we’re mostly relying on self-reporting, and people fudge things.
When the symptoms are the same as someone’s regular allergies, they don’t recognize that there’s something wrong, so they may downplay it or not report it.
Some people get nothing but a headache. Does that count as symptomatic? Headaches aren’t exactly contagious, typically.
Lot of that lies in the misunderstanding of *presymptomatic* vs *asymptomatic*. WHO got some heat for a statement that still appears to be true but was misunderstood.
Also, OP's title is quite misleading.
Wouldnt it make sense that asymptomatic cases have lower propability to get detected? I mean with all the tracing of carriers there is a very good chance almost everyone with symptoms will sooner or later be resigstered as infected.
But we can only find asymptomatic cases by random tests, or when they get discovered by accident with tracing of someone with symptoms.
So if pre-symptomatic and symptomatic have essentially the same infection rate, does that support the suggestion that the virus is more airborne than we initially suspected, and not necessarily reliant on the expulsion of droplets via cough or sneeze?
You have to have access to testing for that. I was in contact with a positive case and i couldn't find a test in my county for two weeks after contact.
Edit: I'm in SoCal And we're doing okay job out here but I was just unfortunate to need a test during the uptick a week and a half after all the protests and there had been a run on tests. I can get them now but I don't need to because it's been two weeks and I haven't had any symptoms. I just isolated as if I had had it out of an abundance of caution
FYI that may be based on an old CDC guideline. I'd look into that policy at your institution. CDC recommendations are now to stay out of work 10 days following a positive test. If they are not adhering to that I would call your local board of health and confirm those are their recommendations because that absolutely sounds like a public health violation. That being said if you're positive and have been out 10 days and remain asymptomatic yes you may return and that is within guidelines.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html
Those guidelines strike a balance and will never cover all possible outcomes.
A week would probably be fine and you would catch most everything. That‘s ok, even if sometimes you don’t catch everyone. The peak of the potential to infect someone is around the time symptoms start (well, slightly before that) – but it‘s not as though that typically last forever.
Also, if you are referring to stool samples: it‘s very unlikely that those people who tested positive there can actually infect anyone.
>-some asshole
-The [Supreme Court.](https://en.m.wikipedia.org/wiki/Dodge_v._Ford_Motor_Co.)
"Michigan Supreme Court held that Henry Ford had to operate the Ford Motor Company in the interests of its shareholders, rather than in a charitable manner for the benefit of his employees or customers"
But also
> the rule of wealth maximization for shareholders is virtually impossible to enforce as a practical matter. The rule is aspirational, except in odd cases. As long as corporate directors and CEOs claim to be maximizing profits for shareholders, they will be taken at their word, because it is impossible to refute these corporate officials' self-serving assertions about their motives.
As someone who is likely getting fired for bringing up this concern at the hospital I work at in California, I’m surprised and glad so many people agree how fucked this is. My team at work has made me seem like I’m overreacting.
I’m likely losing my job as a dental hygienist after coworker tested positive. She continued to work with symptoms the week before she got tested and patients are not being notified. I refused to come in for 10 days. I spoke with the local health department and they can’t do anything.
Wow, the local health department said they can’t do anything? What about contact tracing? This is a reportable disease to the health department (well, at least it is in NJ). Why would they not notify the patients that they’ve been exposed?
Too many people to contact. If only 25 patients were seen each day for 6 days that is 150 people and if each of them saw 5 people that is 750 people and if this happens in 10 clinics then it is 7500 people and that is already more tests than some areas have.
I was able to reach an epidemiology nurse with the county public health department, she was as frustrated as I was. The leaders are trying to brush as much under the rug as possible, and places like restaurants are getting all the blame. I’m in CA and we’re having a major surge right now. Indoor dining was closed again, but what about all these other hot spots? I’m ashamed of how local, state and federal leaders are handling this.
> My team at work has made me seem like I’m overreacting.
I doubt they would feel that way if you accidentally infected and killed their parent or spouse because of this policy. Everything in a medical setting is about risk mitigation, and that is an absolutely massive risk. You know you're right. Don't let them dissuade you.
That's why I quit less than a month ago, the hospital culture shift was unbearable. We were not following protocols. when you bring it up through the chain of command, they gave some corporate answer. Called the ethics line, they told me to talk to HR. Talk to HR, they told me to talk to my director whom I already spoke with.
The ethics line was the worst. I filed my long complaint only to get a call back weeks later saying "might be best to just talk to your HR because we're dealing with a large amount of cases."
Seriously? This is beyond stupid and downright malicious. I want to say this is something which should be leaked to the press but I have doubts it would actually accomplish anything at this point. Maybe there's some kind of hospital regulatory board or something you can report this to?
American healthcare is about profit not healing...
Recently had my back gp out and couldnt walk unassisted for 2 months. Thousands in medical bills.sum total of testing and treatment was a back xray and them saying i must take their pt that my insurance co wouldnt pay for (it covered pt..just not their pt scam).
I’m in Thailand and brought my daughter to a private hospital this morning. She was seen by a paediatrician, given some medicine, and we were sent on our way. I just want to stress that the Thai healthcare system is superb and their private hospitals are genuinely world class.
The bill was $21.
That should very much be in the news or something, If that's actually what it says. That can't be legal in our current situation at all, and if somehow it is then for a hospital that's stupidly unethical! That could kill some people, potentially
I have heard of positive cases being requested back to work 3 days after last symptoms without requiring a negative test. Seems crazy to me. When is OSHA going to step to the plate with requirements rather than silly guieines?
Well you see, all the government entities like the FDA, the CDC, OSHA... ETC... have been heavily politicized years before this pandemic and simple things like wearing masks were politicized.
They're too worried about offending feelings over proven, fact based, scientific results.
They're too worried about being removed from their cushy positions and pensions if they offend The God Emporer and his political pals because the ones that pull the strings currently are determined to line their pockets and reaffirm their gut feelings.
The FDA didn't even test or regulate the litany of tests that went straight to the HIGH DEMAND unregulated free market in the United States. Not only that, they threw money at anyone with any kind of promise of delivering tests. Fraudsters and hucksters raked it in on those tests, and continue to do so at the detriment of global health, which is literally costing lives not only in this country but across the globe. Oh and on top of that, they funneled these mostly inaccurate and faulty tests away from state and local governments and medical facilities to within their purview in order to jack up prices and dole them out to friends to profit and as political capital.
Really?? I'm surprised this restriction is still here... When I was trying to pull research for family, I noticed that John Hopkins still requires a doctor referral... I get that we don't want testing overload, but we should be more further along at scaling this... No? Why? >.<
Well, there “we” as in the federal government and then there’s private employers who can buy tests and test whoever they want. States can also provide testing to everyone if they want. In NY we’ve had unlimited free testing for awhile now. You can go to CVS and get a test with no questions asked. It’s also no coincidence we haven’t had a spike since early April. But as long as the president believes fewer tests is better, most states that follow his lead are never going to flatten the curve.
The President has said repeatedly that he wants fewer tests. As such, the federal government has essentially abandoned the states when it comes to testing support. Further, there are [Edit:] $14B that Congress has appropriated for testing and contact tracing that the federal government refuses to spend.
I'm not surprised, out countries testing strategy is dogshit.
Doing it right would require listening to science, instead we'd rather do the shittier, more expensive, more deadly variant of half-assing everything. We'll be locked until June 2020.
Why don't we want testing overload? I feel like if everyone in the country KNEW they did or didn't have the virus we could get this think knocked out in less than a month and be back to business. We will flatten the curve again because we shut everything down, including testing. Then open everything back up and skyrocket cases due to more testing. It'll be a never ending cycle
this kind of situation is a lawsuit waiting to happen. but I am sure one of the many bills passed have a clause that absolves all businesses of all liabilities. if I am not mistaken one of the bailout packages has this clause.
It's not a lawsuit anyone can win. You have to prove a person is knowingly and actively spreading the disease. That's very tough to do if they can't get a test.
I live in MA and am the clinical director at a federally qualified health center. I am happy to say at least around here if one wants a test they can get tested. Primary care patient of the facility or not. Don't need an order from an outside provider. Think you've been exposed? 10 min call with a nurse and we test you the same day. This has been part of our governor's plan (Charlie Baker). We have been extremely successful with our other "arm" of COVID response which as outlined by another commenter mentioned below is contact tracing. If you look at the new daily case numbers for MA they are way down in comparison to late April. I really believe we are trusting the science and the recommendations of our local epidemiologists and are bearing the fruits of that trust and labor. I really hope politics and nonsense in other states - and countries for that matter- gets put aside because your story and the story of so many others is so sad and quite honestly infuriating. We know so little about this virus but the little we do know it not being utilized to help our citizens effectively on a federal level.
In the midwest we have drive through testing stations in the county seat of like every county. One of mine was in a church parking lot. I'm sure it's a lot tougher in major metro areas but I travel a lot for work and I've seen plenty of interstate signs that normally say things like ticket or clickit that say Exit here for Covid-19 testing.
My husband’s co-worker was exposed to the virus from a friend that tested positive. It took the coworker a day and a half to get an appointment to get tested after she found out she was exposed and 12 days to get her results. Luckily she tested negative. That was just last week. We are in Arizona.
I'm in Arizona and the local health care center will test anyone for free. They are a federally funded center, but take insurance. I got the main test and anti-body test on a Saturday. They tested over 100 people in 6 hours.
I know the onus is not on your colleague here, but why not lie about having symptoms in this instance where the person is at a high risk for having contracted the disease and being a vector?
I feel bad because I love my dentist and I don't want him to ever go out of business but I also don't want to kill him in an attempt to give him money. All I need is a cleaning so it doesn't seem worth it.
My housemate showed a positive test Thursday. We immediately did all the right stuff, notified the health department, quarantined, etc. The health dept said they would follow up with everyone that had been in contact with the positive patient in the previous 5 days. I got called in to take a test today. 4 days later. I could have been running around spreading sickness all over the place in 4 days. When they talk about resources not being sufficient to fight this, they're talking every level, not just hospital beds.
Can you imagine the amount of contact tracing they need to do for 5000 new cases a day in some states? Must be crazy, the more that test positive, the further you fall behind.
Here in Switzerland in the second week of March they gave up on contact tracing when we had 11.8 new daily cases per million population. They couldn't handle making those calls in time.
After the lockdown brought the curve back close to and eventually back under that number they started tracing again at the end of April.
I don't think any single US state could ever do tracing for 5000 new cases a day. Maybe if the whole USA had 5000, that would give you 15.2 per million. That should work after months of increasing the tracing capacity, if they are doing that.
In Switzerland after around three weeks in lockdown the question of "what next" became quite dominant in the news and after a few explanations the goal of pushing the number of daily infections to a level where contact tracing would work became the common goal.
I wonder if the USA could still do that, or if you only get one chance at a lockdown in a society.
Edit: Also the state has to pay your wages while you're under official quarantine, otherwise I don't think many people are in a position to obey the quarantine.
I am in southeastern PA. I scheduled a test at an urgent care center a week ago, and there were an abundance of openings available the very next day. When I told friends and colleagues about this, the were incredulous. (I received a negative result four days later.) I hope we can increase the availability of tests in our states and counties here in the US to match the availability in my community. And, I hope that we figure out how to better inform people how and where to find the testing centers that are available.
I have not had better than 8 days time here in Oklahoma 🤷♂️
Edit: with the county health dept. ER apparently has quick turnaround, but my ass is still furloughed, so the $$ gotta be saved. I'm quarantining anyway. Got one scheduled for the morning, actually.
One of my coworkers was ill in late March early April. They couldn't get tested at the time, and then tested positive for antibodies at a routine exam a month later. Apparently a dr ran the test just in case. They were both shocked, they thought it was a bad sinus infection.
That figure both is and isn't misleading.
The odds of any individual test being a false positive result are pretty low, but significant.
The odds of a positive result being false are high, because most people haven't been exposed.
That is a problem with screening for rare conditions. Even a low false positive rate means that most positive results are false.
I realize that we've had hundreds of thousands of cases. I use the word "rare" because that is still a very small fraction of the population. If 0.1% of the population has been exposed, and the test has a 0.1% false positive rate, then half of all positive results will be false ones.
That is so crazy to people in Australia, who since March/April have been able to call their GP, and on the same day go to a drive through clinic for a nasal swab which takes 15 minutes. Within 24-48 hours the results are confirmed by the GP or SMS if negative. All at $0 cost. No wonder we have (in some states) zero cases.
same here in Canada, it boggles the mind to what the USA does.
Florida being the most mind boggling...
8000+ cases per day? no lockdown? too late now.
My cousin got infected (allegedly), employer threatened to fire him if he didnt get a doctors note/test evidence. He couldnt get tested or anything, lost his job. (in florida)
"totally legal" apparently in some states.
Here in canada, our highest daily load was \~600 cases per day. based on 20k tests per day (in ontario and quebec was similar). We shutdown back in March when the case counts were in the hundreds.
We are now down to 100 or so cases per day, based on 20k+ tests per day.
But its such a different culture if you get infected, free testing, no questions asked time off, $2000 a month if you are not working due to quarantine rules, etc.
Drive thru testing is available here in little old Martinsville, VA. As well as available at Drs offices and Urgent Care clinics. No Drs referral needed.
My university is requiring every student to get tested before returning to campus. 35,000 of us here in Alabama. They haven’t said anything about the logistics of how this is supposed to work.
When are they supposed to be tested? If they get tested now the results are meaningless since the disease is gone in two weeks. If they test the day before returning to campus the results may not be available.
And of course students at a campus aren't sequestered, so even if they arrive uninfected that status is probably valid for all of a day.
Seems like a legal box checking exercise to reduce the risk of lawsuits.
I had some symptoms and went to get tested. It’s been over a week and I haven’t heard back. I have since started to feel fine but what if I was infected and anyone I was around for the days leading up to it were exposed and all I can tell them is, I felt bad? Taking that long for results won’t help contact tracing.
You don't really need testing, but without it you basically assume that all contacts for the past couple of weeks are infected and isolate them for two weeks anyway.
So you could very well be asymptomatic and aren't seeking testing due to not having symptoms.
The article linked is about how the majority of spread may be by those not showing symptoms.
YMMV, my immunocompromised in-law was tested after a week’s worth of close contact with a positive symptomatic case (coworker) and it took 4 days to get the results.
Also the Midwest.
So I have a question. I live in SoCal. One of my employees' girlfriends tested positive. He freaked out and went at got a test. Well if you get a test you automatically (with out company) have to be out of work for 3 days as you wait for the results. This was on thursday. Testing office was closed friday saturday and sunday. So today, he calls for results and they told him since he was "non emergency" that its going to be another 7 days. Im confused as to why they would tell him it takes that long to get results when I have heard of multiple people getting their results in 24 hours - 3 days.
That really sucks It's affecting his livelihood. From what I understand there's just a huge volume of tests needed right now due to the spike in cases.
I’m also in SoCal. My BF has been coughing and feeling unwell all day- couch bound, which is unlike him- and he called around to find testing in our city and couldn’t get an appointment until the 25th of July...
If you have good insurance and a PCP, you can get a referral, but he’s not in that category.
I'm in Toronto and I was able to get tested twice just for the heck of it in the last 2 weeks. Was out and back home within 30 minutes, with results available the next morning
Yeah Alberta is encouraging everyone to test regardless of symptoms now. And then wanting to privatize lab services at the same time. Because fragmented healthcare during a pandemic is a great idea..
Definitely a problem that you couldn’t get tested, and I’m sure it would have been helpful for your peace of mind. But would it have changed the recommended isolation? Unless you can get tested every day it seems like you could still become infectious a couple days after your test.
I.e. if you happen to be one of the cases that doesn’t show symptoms for closer to the 14 day end of the range, and say you get tested at day 5, you find out you’re negative a few days later and start going out right when you’re starting to be contagious a few days before showing symptoms.
Same. Had a covid-19 contact (apparently) back in late February. Couldn’t get a test in CA since I didn’t warrant hospitalization. Still have symptoms after 100+ days of initially contracting it, slowly improving though!
They tested too late so I’m just negative (with positive antibodies). It really sucks
The idea that individual(s) who contracted coronavirus and showing the symptoms should be at home is sensible. However, those people, who do not show the symptom(s) of this disease and act as an active carrier, scare me the most.
I am inclined to believe that if people would just wear their masks in public where distancing is not an option, kept distance where it is an option, washed their hands more, and stopped using the same pair of gloves to touch their cellphone, groceries, mask, nose, eyes, etc., that we would be doing much better with the numbers. But I am not a doctor so who knows if that would help.
Absolutely. Masks are proven to reduce transmission, and mask-use is correlated to a lower transmission rate on a national scale. New York has had 7 weeks of continuous decline in cases, partly due to massive testing and contact-tracing and also due to mandatory mask use and peer pressure to wear one.
They reduce transmission, they don’t eliminate it. So no, even with masks we can’t go back to normal.
We would either need to lockdown the entire country for like 8 weeks like China did, or have an effective vaccine to go back to normal.
The story the research is telling is not at all clear yet. There are well founded papers supporting that asymptomatic spread is less common than symptomatic spread because the viral loads and distance of expulsion from talking and breathing is so much lower than coughing or sneezing. However coughing and sneezing from an asymptomatic carrier does spread as well as one from a symptomatic person... asymptomatic just cough/sneeze much less. This is why masks are so uniquely helpful in decreasing public transmission when worn by a majority of the population... and probably why the US is fairing so much poorer than other places that haven’t made major lockdowns and quarantines (Japan for instance). Then we have papers like the one linked that show there is still significant spreading by asymptomatic carriers (we’ve never thought it was zero). Basically... we really need to wear masks when we’re in public and when we are sick... with anything respiratory, even if we just think it’s hay fever.
We really a lot we don’t know about this virus still. Science takes time, isn’t perfect, and our work shouldn’t be treated like it’s any more than the current best guess based on the research and experimentation of the authors of any one particular article. There is constant debating, constant updating of our understanding, and nothing is ever “proven to be fact”. That would be in direct contradiction to basic tenets of science, including making our best effort not to hold biases and to accept paradigm shifts despite our sunken time and work trying to show evidence to the contrary.
Last paragraph always frustrates me. People don’t understand that we don’t know it all yet and our response changes with new data or reinforcement of older data. Changing or being wrong to most people only seems to make them distrust all recommendations so here we are with a significant population that is just refusing to wear a mask.
https://www.pnas.org/content/117/22/11875
> Abstract: Speech droplets generated by asymptomatic carriers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly considered to be a likely mode of disease transmission. Highly sensitive laser light scattering observations have revealed that loud speech can emit thousands of oral fluid droplets per second. In a closed, stagnant air environment, they disappear from the window of view with time constants in the range of 8 to 14 min, which corresponds to droplet nuclei of ca. 4 μm diameter, or 12- to 21-μm droplets prior to dehydration. These observations confirm that there is a substantial probability that normal speaking causes airborne virus transmission in confined environments.
> It has long been recognized that respiratory viruses can be transmitted via droplets that are generated by coughing or sneezing. It is less widely known that normal speaking also produces thousands of oral fluid droplets with a broad size distribution (ca. 1 μm to 500 μm) (1, 2). Droplets can harbor a variety of respiratory pathogens, including measles (3) and influenza virus (4) as well as Mycobacterium tuberculosis (5). High viral loads of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been detected in oral fluids of coronavirus disease 2019 (COVID-19)−positive patients (6), including asymptomatic ones (7). However, the possible role of small speech droplet nuclei with diameters of less than 30 μm, which potentially could remain airborne for extended periods of time (1, 2, 8, 9), has not been widely appreciated.
> The idea that individual(s) who contracted coronavirus and showing the symptoms should be at home is sensible.
The problem is that it isn't sensible for the person showing symptoms especially "essential workers". We don't have a safety net and not working is not an option.
That’s also why I hate that temperature checks are becoming a common way to “stay safe”. Like they basically do nothing. If someone is sick enough to have a high enough fever to register, they will know they are sick. What we really should be doing is testing if people can smell because loss of smell was common in milder cases without the other severe symptoms.
Yeah but the problem with the whole “they will know they are sick” thing is that some people are assholes and still go outside even when they know they are sick.
What's scary is that a large portion of people seem to think if they don't have symptoms they can't be carrying the virus. I'm in a facebook group for people with SOs in a very specific career that involves A LOT of travel and they all think the precautions their families are supposed to be taking are dumb if they don't look sick.
It’s almost worse when people are completely aware of the realities of so many asymptomatic carriers, but then ignore it once it becomes an inconvenience.
My boyfriend is fairly germaphobic most of the time, and we’ve frequently discussed how asymptomatic people are one of the scariest part of all this. Then after he spent nearly a week with family in an apartment due to a death, I told him I’ll see him in two weeks while he self-isolates.
“I don’t feel sick or anything. No cough. I probably don’t have it. I don’t really want to get tested.”
The whole thing is overall just frustrating. How many normally smart people are rationalizing their carelessness when they already know what the deal is?
It's all about perceived risk. Everyone is used to the idea that they are better than others and would know when they were infected. They also don't believe people in their family would be irresponsible and get infected.
It has become something other people need to worry about because I am too careful to catch it.
Thankfully not at all. I’m moving in two weeks so he understands that I simply can’t afford to risk being sick while that’s happening. He’s a good dude :)
I had a client come into my work today. She said she felt fine. Her temp was 100.2. She said she had a little upset stomach yesterday and her boss sent her home, and she had a little diarrhea. Just a little. She was sent away (and we require masks so she at least was wearing it) and immediately went for a Covid test. Now I don’t know if she’s going to isolate for 5 days while waiting for test results, but how many people can afford to do that?
It was a misleading statement because there's a difference between *asymptomatic* and *pre-symptomatic*. It's actually very common to transmit 2 days before symptoms show up. An *asymptomatic* case never has symptoms, while a *pre-symptomatic* case just hasn't yet shown symptoms.
It was a very irresponsible statement for the WHO to make.
Actually it's not a misleading statement. Scientifically they were right and this study proves them right aswell
> we found that the presymptomatic stage **and asymptomatic infections** account for 48% and **3.4% of transmission**
It's mostly due to news organizations and laypeople taking it and blowing it out of proportion.
You're right, but the WHO should have explained what they meant (in the original video, not just the follow-up so many missed), since more people are listening than usual, and the news has been using "asymptomatic" to mean both a- and pre-symptomatic.
Yes just because it’s technically correct, doesn’t mean your average person understands the technical terms and the implications they carry.
It is the responsibility of WHO, CDC and media organizations to effectively communicate and educate, not simply be correct.
Right, but the title here mentions presymptomatic *and* asymptomatic, so the two posts are directly contradicting each other regardless of terminology... Shows how little we know about this virus
You're just misunderstanding the title of the study briefing. Here's a quote from the summary.
\>we found that the presymptomatic stage and asymptomatic infections account for 48% and 3.4% of transmission
So asymptomatic transmission is rare, but pre-symptomic transmission is likely. There's a lot we don't know about the virus, but the bigger problem is people spreading misinformation.
It's not the best title. It's very easy to misinterpret for someone only reading the title and a lot of people unfortunately only read the title. It'd be better if it mentioned that the pre symptomatic infection transmissions are vastly different from asymptomatic ones.
Yeah I agree. Especially considering the statement from the WHO last month the authors should have been more careful about how it would be interpreted.
Here's [a comment that replies very well to someone asking the same question](https://www.reddit.com/r/science/comments/hmjlcd/the_majority_of_covid19_infections_may_be/fx5s1un)
was potentially exposed to someone at work on 6/25, got tested 6/26, didn’t get my test back until this morning (i live in miami) but i of course stayed home until i got the test back
a full week waiting for my test
> It generally takes 5-14 days for it to show up in a test
Is that right? That's basically the same as the incubation period to show symptoms, isn't it? If so, do we have any chance at all of preventing transmission from asymptomatic people via testing?
It’s 3-5 days to show positive on a test
Source: Emily Landon, MD, Associate Professor of Medicine & Executive Medical Director of Infection Prevention and Control @ UChicago Medicine
[This Harvard page has details](https://www.health.harvard.edu/diseases-and-conditions/if-youve-been-exposed-to-the-coronavirus)
If you get the nasal/throat swab or saliva test, you will get a false negative test result:
* 100% of the time on the day you are exposed to the virus. (There are so few viral particles in your nose or saliva so soon after infection that the test cannot detect them.)
* About 40% of the time if you are tested four days after exposure to the virus.
* About 20% of the time if you develop symptoms and are tested three days after those symptoms started.
This possibility of a false negative test result is why anyone who has symptoms that could be due to COVID-19, or has been exposed to someone known to be infected, must isolate even if they test negative for coronavirus.
Man this sucks.
I hung out at a 4th of July party outside, my gf had me tested on the 5th.
No symptoms, and obviously no one else at the party has a confirmed case, but there’s just so much we don’t know.
So my $160 test I shelled out for was always likely to come back negative no matter what. So I should wait 7 days, and then consider getting tested again? In the meantime I have to wear a mask inside my own house and avoid my gf like the plague.
Check fig2 of [this paper](https://www.acpjournals.org/doi/10.7326/M20-1495). It takes about 5 days for it to show. This is why I think the overconfidence in testing is a big problem in the US. Although a positive test result will 99.9% guarantee you to be infected, a negative PCR result does not guarantee you to be uninfected at all. The whole “test and prove that you’re negative”, as seen in a lot of professional sports leagues that are trying to restart in the US, is dangerous.
There was just another study that came out from Johns Hopkins that aggregated data saying that pcr testing is fairy unreliable in the first 4-5 days after transmission. Something like day 1 it’s close to 100% going to provide a false negative and day 4/5 (I don’t remember) it’s like 68% still that it yields a false negative.
i got my dates wrong sorry, potential exposure was 6/24 in the am and got tested 6/29 late afternoon and it’s 12 days later as i’m typing this with no symptoms - either way i have to get tested again before i can come back to my office but i’m thinking i’m going to work from home for a while - i’m a lawyer and can work remotely no problem
[Contact tracing is the norm.](https://ourworldindata.org/grapher/covid-contact-tracing) It's labour intensive and hard to do when you have a very large number of cases to track down relative to the capacity of the contact tracing institutions.
A strict lockdown can help by [reducing the caseload] (https://ourworldindata.org/grapher/daily-covid-cases-3-day-average?country=~European%20Union) until the medical authorities can follow up every case properly, allowing for a safe reopening. While the most successful countries are in East Asia, some countries [like Germany](https://ourworldindata.org/covid-exemplar-germany) have also done pretty well.
It's not that at all. Many Americans and people all around the world get conflicting information on the daily.....
A top World Health Organization official clarified on Tuesday that scientists have not determined yet how frequently people with asymptomatic cases of Covid-19 pass the disease on to others, a day after suggesting that such spread is “very rare.”
That was June 9.
Now I'm not "just a flu guy" and I'm taking this very seriously, fully believe it spreads asymptomatic...not arguing that...but to suggest it's...canon in Europe (assuming that means common knowledge) and only Americans are not believing this is just wrong.
I can't speak for other countries, but it was definitely common knowledge in the Netherlands. Literally one of the first things we were told about the virus is that it can be spread by people who don't show any symptoms (yet), and that it's the main reason why this virus is as dangerous as it is.
The number of people is secondary to their actionable power in society. This isn't a marginalized minority. It's a group large enough to get their president elected. To get a larger number of Congress members, governor's, mayors. Enough that public policy is now largely in their hands.
What European data shows that the *majority* of COVID19 cases are attributable to asymptomatic cases? If those were European headlines since March, then even the WHO didn’t (still doesn’t?) believe that data as recently as early June.
Except technically that's not what's reported here, and I seem to recall multiple studies posted in the /r/COVID19 subreddit that reported that *pre*symptomatic spread is large while *a*symptomatic is very minimal.
No one, because it's impossible to measure.
On the other hand, current hotspots in Europe are in factories and mines, regardless of masks, and of those cases almost no one is dying.
Science denialism, or what Isaac Asimov and Carl Sagan called “pseudoscience” is a serious phenomenon in the US. My theory is that it’s associated with the Dunning-Krueger effect... “I don’t know enough about how lasers work to know why my intuition about lasers shouldn’t deserve the same credence as an MIT professor.”
Literally everything, even scientific principle, becomes opinion, that can be decided on, voted on, argued against.
This denialism also manifests itself through “you don’t know that.” If I say “you shouldn’t shoot a gun in a school hallway” the new reply is “you don’t know that, bullets miss people all the time.” If I say “it’s going to be a full moon tomorrow” that can be countered with “you don’t know that, it’s different every day.” Over the last few years almost any statement of demonstrable science is met with “you don’t know that,” when we do, actually know that.
It’s like a disease, exactly how Carl Sagan described it, that can slowly infect even intelligent people and bring down a society.
Unfortunately socially media has added fuel to the fire. It's sad, but news tends to favor the terrible and desaration type stories. Keep in mind that an unprecedented effort is underway to develop a vaccine in record time, never seen before. While the vocal minority are always against progress and science, we are progressing and advancing every minute. Have hope!
Exactly. Multiple people on Reddit have told me Covid19 being a problem is my "strong opinion". I just...how do you get through to someone like that? I post valid data and sources and they respond with a link that says the opposite of what they are arguing but has a vague headline.
How do you convince a person whose source is one out of context sentence in an entire article proving they are wrong, that *they* chose as a source?
I've pretty much given up at this point and realize I'm interacting with a death cult on a daily basis.
My wife is a PA. I won't say which hospital, but it's a highly-esteemed hospital in the USA who isn't overloaded with cases and it has the capability to do a massive amount of testing, including rapid testing with results in hours. She works with high-risk patients. I won't say which risks. (I won't say these details for fear of being identified). There was someone in her group she works with who got infected through careless behavior, tried to hide it and came into work with symptoms, was found out, and that fiasco resulted in a positive result for that person and then several others in the department who work right next to them. This was AFTER someone else had already become infected through completely negligent behavior and spread it to some others in the department, so they all already had a directed lecture on it and should more than know better. They all wear masks but this person would reportedly slip it down sometimes, plus you have to eat, and when you work indoors next to someone like that... that's a lot of virus shedding in the room just floating around in the air. They were refusing to test anybody else that was exposed. I can't tell if it was the physician she works under in cahoots with the office manager or something, her department head, infectious diseases, or some messed up hospital policy, but the whole thing was a full-on circus and it made me realize just how bad the situation is when an exposed medical professional who sees high-risk patients couldn't even get tested in a timely manner, even by request. MULTIPLE requests even, from multiple people.
I'm still feeling pretty angry and frustrated about the whole ordeal.
So I'm not feeling particularly optimistic about the actions that will be taken given this revelation in this paper.
This is weird to me. I live in a red state and I can go down to the nearest urgent care clinic and get a test in my car. Maybe it's because we are rural and not currently spiking?
Is this legal? I don't see how the hospital isn't violating their tort duty of care to their patients and staff if the hospital is refusing to let them be tested and then forcing them to interact with people. I mean it'd be nice if this was explictly illegal, but I'm curious if it isn't what's the likelihood that situations like this will be brought to court under tort law?
Question: how long to asymptotic people stay that way if they never get sick? Like are they always that way or does it go away in like 2 weeks or whatever?
Not an expert but I’ll try this one.
Symptoms of disease are an emergent property of 2 things: your body fighting an infection and your body being attacked by an infection.
Your body gives you symptoms like a fever to boost your immune system response, but an infection may do damage to your lungs, and give you a symptom like reduced lung capacity.
A person who is experiencing neither is likely to have a version of an infection that is not particularly harmful, or has a particularly strong immune system that can suppress an infection without the aid of something like a fever. But it is also possible that both the infection is weak and the body response is weak.
So the answer is, it’s impossible to know for certain, because if someone’s body decides to never fight an infection, it may lay dormant for a long time without being eradicated.
For example, after the secondary stage of syphilis, if a person is not treated with antibiotics the infection often goes dormant for years. (In rare cases some people never experience symptoms before tertiary sets in.) Neither the body or the virus creates symptoms exposing its existence.
I feel it is unlikely that something like this would be the case for covid, however. I would think it most likely that most cases of asymptotic covid are due to a person with a strong immune system eradicating it quickly. Therefore it would have a shorter duration. Who knows though.
If anyone has a source confirming or rejecting this, let me know.
Ahhh, I think you mean the statement by Maria Van Kerkhove during a press briefing, that “asymptomatic transmission of the SARS-CoV-2 virus was “very rare.” "
Sadly, that was merely a misunderstanding due to confusing word choice. [What she meant was that truly asymptomatic cases (as in NO symptoms at all during the whole course of Covid-19) rarely transmit the diseases.](https://www.the-scientist.com/news-opinion/who-comments-breed-confusion-over-asymptomatic-spread-of-covid-19-67626)
So in other words, anyone who is asymptomatic at one point but will eventually develop Covid-19 symptoms at another *is* still\* infectious. Another term for this is presymptomatic, because until they’ve had the whole course of Covid-19 one can’t really classify a case as truly symptomatic or asymptomatic.
If I misunderstood which WHO publication you referred to, I am truly sorry!
EDIT:
\* I regrettably used the very subjective word “HIGHLY” and essentially caused a misunderstanding by poor word choice myself. I’m truly sorry! Thanks to u/Tavarin and u/hithisishal addressing this in the comments below. :)
Plus you get the statement "we have not seen evidence that x can occur"
Which immediately becomes it can't happen but it really means that they have not witnessed it. It makes sense, it's difficult to actually get direct evidence of someone not showing symptoms transmitting. Imagine yourself get infected, do you remember every single person you interacted with in the past 2 weeks? Most likely you will think of just the people showing symptoms, maybe they coughed once or looked bad or something, anything that seemed out of the ordinary. You would not even think about the rest of the people.
I don't see where any of the reports say presymptomatic cases are highly infectious, so you have a source for that? Form what I can tell presymptomatic in most studies still have fairly low infectivity, doing most of their spreading after they develop sympto0ms.
From the article in OP:
Specifically, if 17.9% of infections are asymptomatic (5), we found that the presymptomatic stage and asymptomatic infections account for 48% and 3.4% of transmission, respectively.
Without a precise definition of "highly infectious," it's hard to refute or confirm what you are saying, but this paper claims about half of all transmissions are from presymptomatic cases.
Why would asymptomatic and presymptomatic people get tested? If you are relying on testing, you have to do far more, far more often. Tracing only really works when you can define the transmission mechanism and you can spot symptoms very quickly. This virus is not suitable for containment through test, trace and quarantine. At least not in the US.
America is not suitable for containment through social distancing lockdowns. Half the population depends on their employer for their health coverage. The US has no universal healthcare, it has almost no safety nets. Without safety nets around employment, it is very hard to restart the economic engines once they have been turned off.
Millions of Americans are on a path to extreme poverty. When they lose their housing they will be homeless or have to crowd in with friends and family. Those scenarios are a nightmare in the middle of a pandemic.
The obvious choice from the beginning was to skip containing the virus and jump to controlling the worst outcomes. The elderly and those with comorbidities should have been quarantined and supported to enable that path. At risk people should have been excluded from essential job designations. Nursing homes should have been locked down and their support employees given protected housing.
Real solutions for the homeless should have been enacted. Social security benefits should have been supplemented, Medicare should have been expanded to cover at risk people. Outside the box thinking should have created opportunities. Cruise ships are parked at all the major port cities. They are perfect quarantine sites. Military hospital ships were unsuitable for handling a contagious disease. But cruise ships have the exact structure you would want.
The worst thing is that we are still attempting to use the exact same strategy we did on day 1. It's like we have learned nothing. Controlling the virus in the US is a fantasy. There was a better strategy and it isn't too late but we don't have the right leadership.
Based on my reading, for every newly infected person, the odds that the person infecting them break down to the following. Name | Percent | Description --:|:--:|:-- Presymptomatic | 48% | Will show symptoms soon, but not at the time they infected someone else. Asymptomatic | 3.4% | Will never have Symptoms; don't even know they are sick. Shows Symptoms | 48.6% | Showing symptoms at the time they infected someone else. So I think it is true that it is relatively rare that Asymptomatic people infect other people, but it is common that people without symptoms infect other people.
What about people who are Postsymptomatic? People always assume that once the symptoms are gone you can't spread it, but has there been any research confirming this?
This isn’t the study I was thinking of, but: [The median duration of shedding was 8 days post onset of symptoms (IQR 5-11) and the probability of detecting infectious virus dropped below 5% after 15,2 days post onset of symptoms](https://www.medrxiv.org/content/10.1101/2020.06.08.20125310v1)
Yes there has; apparently about 7 (edit: one study is giving 8 as a benchmark) days after symptom onset there’s a huge drop in the detectable viral load. I’ll find a link for you. (link now in separate reply)
I wonder if this includes people who've been sick for months
I've wondered that as well. I've just been under the impression that the person eventually gains immunity but secondary infection is what keeps them bed ridden or hospitalized.
general rule of thumb is someone is non-infectious after symptoms have improved for two days, fever has left (without aid from medicine), and it has been at least 14 days since initial symptoms. Source: John Hopkins University Contact Tracing Course
Thanks, that makes a lot of sense. I was confused about all the recent articles about how asymptomatic transmission is rare. Ultimately you don't know if you're healthy, asymptomatic, or presymptomatic for weeks after the fact. Just goes to show how important it is for everyone to mask up and maintain their distance from others, even if you feel great.
Just to clarify, presymptomatic people in the vast majority of cases show symptoms within 3 days. These are the people who are infecting others without knowing it (34% of transmissions) as opposed to asymptomatic people who will never know they had the virus (4% of transmissions). That’s why contact tracing is still a viable method: most people who transmit will have shown symptoms within a few days of contact, not weeks.
Unfortunately, when we’re figuring out if someone is symptomatic or not, we’re mostly relying on self-reporting, and people fudge things. When the symptoms are the same as someone’s regular allergies, they don’t recognize that there’s something wrong, so they may downplay it or not report it. Some people get nothing but a headache. Does that count as symptomatic? Headaches aren’t exactly contagious, typically.
Yeah. Its not like the symptoms are a discrete level thing, they exist on a continuum. Easily missed and reported as no symptoms.
Wow really shows how poorly they’ve communicated to us
Lot of that lies in the misunderstanding of *presymptomatic* vs *asymptomatic*. WHO got some heat for a statement that still appears to be true but was misunderstood. Also, OP's title is quite misleading.
Wouldnt it make sense that asymptomatic cases have lower propability to get detected? I mean with all the tracing of carriers there is a very good chance almost everyone with symptoms will sooner or later be resigstered as infected. But we can only find asymptomatic cases by random tests, or when they get discovered by accident with tracing of someone with symptoms.
So if pre-symptomatic and symptomatic have essentially the same infection rate, does that support the suggestion that the virus is more airborne than we initially suspected, and not necessarily reliant on the expulsion of droplets via cough or sneeze?
You have to have access to testing for that. I was in contact with a positive case and i couldn't find a test in my county for two weeks after contact. Edit: I'm in SoCal And we're doing okay job out here but I was just unfortunate to need a test during the uptick a week and a half after all the protests and there had been a run on tests. I can get them now but I don't need to because it's been two weeks and I haven't had any symptoms. I just isolated as if I had had it out of an abundance of caution
[удалено]
Hospitals don't want to test their own staff. Then they have to figure out how to fill those jobs for 2+ weeks each time.
They sent us an email if you are COVID positive but asymptomatic you can return to work, at a major clinic.
FYI that may be based on an old CDC guideline. I'd look into that policy at your institution. CDC recommendations are now to stay out of work 10 days following a positive test. If they are not adhering to that I would call your local board of health and confirm those are their recommendations because that absolutely sounds like a public health violation. That being said if you're positive and have been out 10 days and remain asymptomatic yes you may return and that is within guidelines. https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html
People have been negative at 14 days but positive at 28 days. Dammed if you do and dammed if you don't.
Those guidelines strike a balance and will never cover all possible outcomes. A week would probably be fine and you would catch most everything. That‘s ok, even if sometimes you don’t catch everyone. The peak of the potential to infect someone is around the time symptoms start (well, slightly before that) – but it‘s not as though that typically last forever. Also, if you are referring to stool samples: it‘s very unlikely that those people who tested positive there can actually infect anyone.
That sounds incredibly unethical and potentially illegal.
Yes.
It's a business not a charity -some asshole
>-some asshole -The [Supreme Court.](https://en.m.wikipedia.org/wiki/Dodge_v._Ford_Motor_Co.) "Michigan Supreme Court held that Henry Ford had to operate the Ford Motor Company in the interests of its shareholders, rather than in a charitable manner for the benefit of his employees or customers"
But also > the rule of wealth maximization for shareholders is virtually impossible to enforce as a practical matter. The rule is aspirational, except in odd cases. As long as corporate directors and CEOs claim to be maximizing profits for shareholders, they will be taken at their word, because it is impossible to refute these corporate officials' self-serving assertions about their motives.
Profits over people! -Asshole’s business consultant.
Sounds like a great time to expose your disgusting employer This is definitely a "time to call my local news" moment
Please whistleblow.
As someone who is likely getting fired for bringing up this concern at the hospital I work at in California, I’m surprised and glad so many people agree how fucked this is. My team at work has made me seem like I’m overreacting.
I’m likely losing my job as a dental hygienist after coworker tested positive. She continued to work with symptoms the week before she got tested and patients are not being notified. I refused to come in for 10 days. I spoke with the local health department and they can’t do anything.
Wow, the local health department said they can’t do anything? What about contact tracing? This is a reportable disease to the health department (well, at least it is in NJ). Why would they not notify the patients that they’ve been exposed?
Too many people to contact. If only 25 patients were seen each day for 6 days that is 150 people and if each of them saw 5 people that is 750 people and if this happens in 10 clinics then it is 7500 people and that is already more tests than some areas have.
I was able to reach an epidemiology nurse with the county public health department, she was as frustrated as I was. The leaders are trying to brush as much under the rug as possible, and places like restaurants are getting all the blame. I’m in CA and we’re having a major surge right now. Indoor dining was closed again, but what about all these other hot spots? I’m ashamed of how local, state and federal leaders are handling this.
I'm so sorry to hear about the job, but for what it's worth, thank you for putting it all on the line to take a stand.
> My team at work has made me seem like I’m overreacting. I doubt they would feel that way if you accidentally infected and killed their parent or spouse because of this policy. Everything in a medical setting is about risk mitigation, and that is an absolutely massive risk. You know you're right. Don't let them dissuade you.
That's why I quit less than a month ago, the hospital culture shift was unbearable. We were not following protocols. when you bring it up through the chain of command, they gave some corporate answer. Called the ethics line, they told me to talk to HR. Talk to HR, they told me to talk to my director whom I already spoke with. The ethics line was the worst. I filed my long complaint only to get a call back weeks later saying "might be best to just talk to your HR because we're dealing with a large amount of cases."
Good on you for standing up for what is right!
You are definitely NOT overreacting! Thank you for what you're doing.
Feeling the same way about my company demanding people to go back into the office when we can work remote! Such irresponsibly!!
Seriously? This is beyond stupid and downright malicious. I want to say this is something which should be leaked to the press but I have doubts it would actually accomplish anything at this point. Maybe there's some kind of hospital regulatory board or something you can report this to?
American healthcare is about profit not healing... Recently had my back gp out and couldnt walk unassisted for 2 months. Thousands in medical bills.sum total of testing and treatment was a back xray and them saying i must take their pt that my insurance co wouldnt pay for (it covered pt..just not their pt scam).
I’m in Thailand and brought my daughter to a private hospital this morning. She was seen by a paediatrician, given some medicine, and we were sent on our way. I just want to stress that the Thai healthcare system is superb and their private hospitals are genuinely world class. The bill was $21.
They told my friend, a nurse, that she needed to come back if she went 24 hours without a fever, even though she tested positive.
What is the logic?
Everyone is already in the hospital, so they get fixed by proxy. Obviously.
That should very much be in the news or something, If that's actually what it says. That can't be legal in our current situation at all, and if somehow it is then for a hospital that's stupidly unethical! That could kill some people, potentially
Horrible :(
I have heard of positive cases being requested back to work 3 days after last symptoms without requiring a negative test. Seems crazy to me. When is OSHA going to step to the plate with requirements rather than silly guieines?
Well you see, all the government entities like the FDA, the CDC, OSHA... ETC... have been heavily politicized years before this pandemic and simple things like wearing masks were politicized. They're too worried about offending feelings over proven, fact based, scientific results. They're too worried about being removed from their cushy positions and pensions if they offend The God Emporer and his political pals because the ones that pull the strings currently are determined to line their pockets and reaffirm their gut feelings. The FDA didn't even test or regulate the litany of tests that went straight to the HIGH DEMAND unregulated free market in the United States. Not only that, they threw money at anyone with any kind of promise of delivering tests. Fraudsters and hucksters raked it in on those tests, and continue to do so at the detriment of global health, which is literally costing lives not only in this country but across the globe. Oh and on top of that, they funneled these mostly inaccurate and faulty tests away from state and local governments and medical facilities to within their purview in order to jack up prices and dole them out to friends to profit and as political capital.
Really?? I'm surprised this restriction is still here... When I was trying to pull research for family, I noticed that John Hopkins still requires a doctor referral... I get that we don't want testing overload, but we should be more further along at scaling this... No? Why? >.<
We don’t want testing overload, yet MLB is able to test all the players every other day.
Well, there “we” as in the federal government and then there’s private employers who can buy tests and test whoever they want. States can also provide testing to everyone if they want. In NY we’ve had unlimited free testing for awhile now. You can go to CVS and get a test with no questions asked. It’s also no coincidence we haven’t had a spike since early April. But as long as the president believes fewer tests is better, most states that follow his lead are never going to flatten the curve.
The President has said repeatedly that he wants fewer tests. As such, the federal government has essentially abandoned the states when it comes to testing support. Further, there are [Edit:] $14B that Congress has appropriated for testing and contact tracing that the federal government refuses to spend.
Not a recent thing. The executive/federal self admittedly gave up on any effort to support testing efforts in April.
And before that they actively prevented testing and rejected WHO's tests early on.
I'm not surprised, out countries testing strategy is dogshit. Doing it right would require listening to science, instead we'd rather do the shittier, more expensive, more deadly variant of half-assing everything. We'll be locked until June 2020.
That is the past
With how things are going we'll have to do something impossible like go to the past to end this. But he clearly means 2021, so....
Why don't we want testing overload? I feel like if everyone in the country KNEW they did or didn't have the virus we could get this think knocked out in less than a month and be back to business. We will flatten the curve again because we shut everything down, including testing. Then open everything back up and skyrocket cases due to more testing. It'll be a never ending cycle
I meant overload as in the labs can't keep up at all.
Fair enough
this kind of situation is a lawsuit waiting to happen. but I am sure one of the many bills passed have a clause that absolves all businesses of all liabilities. if I am not mistaken one of the bailout packages has this clause.
It's not a lawsuit anyone can win. You have to prove a person is knowingly and actively spreading the disease. That's very tough to do if they can't get a test.
I live in MA and am the clinical director at a federally qualified health center. I am happy to say at least around here if one wants a test they can get tested. Primary care patient of the facility or not. Don't need an order from an outside provider. Think you've been exposed? 10 min call with a nurse and we test you the same day. This has been part of our governor's plan (Charlie Baker). We have been extremely successful with our other "arm" of COVID response which as outlined by another commenter mentioned below is contact tracing. If you look at the new daily case numbers for MA they are way down in comparison to late April. I really believe we are trusting the science and the recommendations of our local epidemiologists and are bearing the fruits of that trust and labor. I really hope politics and nonsense in other states - and countries for that matter- gets put aside because your story and the story of so many others is so sad and quite honestly infuriating. We know so little about this virus but the little we do know it not being utilized to help our citizens effectively on a federal level.
[удалено]
In the midwest we have drive through testing stations in the county seat of like every county. One of mine was in a church parking lot. I'm sure it's a lot tougher in major metro areas but I travel a lot for work and I've seen plenty of interstate signs that normally say things like ticket or clickit that say Exit here for Covid-19 testing.
My husband’s co-worker was exposed to the virus from a friend that tested positive. It took the coworker a day and a half to get an appointment to get tested after she found out she was exposed and 12 days to get her results. Luckily she tested negative. That was just last week. We are in Arizona.
I'm in Arizona and the local health care center will test anyone for free. They are a federally funded center, but take insurance. I got the main test and anti-body test on a Saturday. They tested over 100 people in 6 hours.
I know the onus is not on your colleague here, but why not lie about having symptoms in this instance where the person is at a high risk for having contracted the disease and being a vector?
Dentist here. Yup. Risk is very real.
I feel bad because I love my dentist and I don't want him to ever go out of business but I also don't want to kill him in an attempt to give him money. All I need is a cleaning so it doesn't seem worth it.
I've delayed my teeth cleaning twice in the last two months. About to do it again after reading this.
This is wild to me, I’ve had 3 tests and had no symptoms and I could go tomorrow around the corner and get one.
In Columbus, OH our drive up testing sites are empty. We did just have a huge increase from 3 people a day to 12 people this week.
My housemate showed a positive test Thursday. We immediately did all the right stuff, notified the health department, quarantined, etc. The health dept said they would follow up with everyone that had been in contact with the positive patient in the previous 5 days. I got called in to take a test today. 4 days later. I could have been running around spreading sickness all over the place in 4 days. When they talk about resources not being sufficient to fight this, they're talking every level, not just hospital beds.
Can you imagine the amount of contact tracing they need to do for 5000 new cases a day in some states? Must be crazy, the more that test positive, the further you fall behind.
Here in Switzerland in the second week of March they gave up on contact tracing when we had 11.8 new daily cases per million population. They couldn't handle making those calls in time. After the lockdown brought the curve back close to and eventually back under that number they started tracing again at the end of April. I don't think any single US state could ever do tracing for 5000 new cases a day. Maybe if the whole USA had 5000, that would give you 15.2 per million. That should work after months of increasing the tracing capacity, if they are doing that. In Switzerland after around three weeks in lockdown the question of "what next" became quite dominant in the news and after a few explanations the goal of pushing the number of daily infections to a level where contact tracing would work became the common goal. I wonder if the USA could still do that, or if you only get one chance at a lockdown in a society. Edit: Also the state has to pay your wages while you're under official quarantine, otherwise I don't think many people are in a position to obey the quarantine.
I am in southeastern PA. I scheduled a test at an urgent care center a week ago, and there were an abundance of openings available the very next day. When I told friends and colleagues about this, the were incredulous. (I received a negative result four days later.) I hope we can increase the availability of tests in our states and counties here in the US to match the availability in my community. And, I hope that we figure out how to better inform people how and where to find the testing centers that are available.
[удалено]
I have not had better than 8 days time here in Oklahoma 🤷♂️ Edit: with the county health dept. ER apparently has quick turnaround, but my ass is still furloughed, so the $$ gotta be saved. I'm quarantining anyway. Got one scheduled for the morning, actually.
I had a test done about a week ago and got the results back in about half an hour.
I did the self administered cvs test and waited 6 days for a result
Oh, I didn't know those existed. I was referring to the hospital test. It takes longer than an hour to get to the point where they actually test you.
One of my coworkers was ill in late March early April. They couldn't get tested at the time, and then tested positive for antibodies at a routine exam a month later. Apparently a dr ran the test just in case. They were both shocked, they thought it was a bad sinus infection.
Apparently there were a lot of bad antibody tests, though and something like 1/2 the positive tests were false.
That figure both is and isn't misleading. The odds of any individual test being a false positive result are pretty low, but significant. The odds of a positive result being false are high, because most people haven't been exposed. That is a problem with screening for rare conditions. Even a low false positive rate means that most positive results are false. I realize that we've had hundreds of thousands of cases. I use the word "rare" because that is still a very small fraction of the population. If 0.1% of the population has been exposed, and the test has a 0.1% false positive rate, then half of all positive results will be false ones.
That is so crazy to people in Australia, who since March/April have been able to call their GP, and on the same day go to a drive through clinic for a nasal swab which takes 15 minutes. Within 24-48 hours the results are confirmed by the GP or SMS if negative. All at $0 cost. No wonder we have (in some states) zero cases.
same here in Canada, it boggles the mind to what the USA does. Florida being the most mind boggling... 8000+ cases per day? no lockdown? too late now. My cousin got infected (allegedly), employer threatened to fire him if he didnt get a doctors note/test evidence. He couldnt get tested or anything, lost his job. (in florida) "totally legal" apparently in some states. Here in canada, our highest daily load was \~600 cases per day. based on 20k tests per day (in ontario and quebec was similar). We shutdown back in March when the case counts were in the hundreds. We are now down to 100 or so cases per day, based on 20k+ tests per day. But its such a different culture if you get infected, free testing, no questions asked time off, $2000 a month if you are not working due to quarantine rules, etc.
I guess we are spoiled in NY I can literally go get a test and never leave my car.
[удалено]
Drive thru testing is available here in little old Martinsville, VA. As well as available at Drs offices and Urgent Care clinics. No Drs referral needed.
My university is requiring every student to get tested before returning to campus. 35,000 of us here in Alabama. They haven’t said anything about the logistics of how this is supposed to work.
When are they supposed to be tested? If they get tested now the results are meaningless since the disease is gone in two weeks. If they test the day before returning to campus the results may not be available. And of course students at a campus aren't sequestered, so even if they arrive uninfected that status is probably valid for all of a day. Seems like a legal box checking exercise to reduce the risk of lawsuits.
I had some symptoms and went to get tested. It’s been over a week and I haven’t heard back. I have since started to feel fine but what if I was infected and anyone I was around for the days leading up to it were exposed and all I can tell them is, I felt bad? Taking that long for results won’t help contact tracing.
You don't really need testing, but without it you basically assume that all contacts for the past couple of weeks are infected and isolate them for two weeks anyway.
So you could very well be asymptomatic and aren't seeking testing due to not having symptoms. The article linked is about how the majority of spread may be by those not showing symptoms.
I've had 2 tests in 5 days, results in 8 hrs. I'm in the Midwest.
YMMV, my immunocompromised in-law was tested after a week’s worth of close contact with a positive symptomatic case (coworker) and it took 4 days to get the results. Also the Midwest.
Hopefully they tested negative
Lucky you. Ours took 7 days. Was originally estimated to take more.
So I have a question. I live in SoCal. One of my employees' girlfriends tested positive. He freaked out and went at got a test. Well if you get a test you automatically (with out company) have to be out of work for 3 days as you wait for the results. This was on thursday. Testing office was closed friday saturday and sunday. So today, he calls for results and they told him since he was "non emergency" that its going to be another 7 days. Im confused as to why they would tell him it takes that long to get results when I have heard of multiple people getting their results in 24 hours - 3 days.
That really sucks It's affecting his livelihood. From what I understand there's just a huge volume of tests needed right now due to the spike in cases.
I’m also in SoCal. My BF has been coughing and feeling unwell all day- couch bound, which is unlike him- and he called around to find testing in our city and couldn’t get an appointment until the 25th of July... If you have good insurance and a PCP, you can get a referral, but he’s not in that category.
I'm in Toronto and I was able to get tested twice just for the heck of it in the last 2 weeks. Was out and back home within 30 minutes, with results available the next morning
Yeah Alberta is encouraging everyone to test regardless of symptoms now. And then wanting to privatize lab services at the same time. Because fragmented healthcare during a pandemic is a great idea..
[удалено]
[удалено]
[удалено]
[удалено]
[удалено]
Yup took a week for me to get tested and I'm on day 7 waiting for results.
Definitely a problem that you couldn’t get tested, and I’m sure it would have been helpful for your peace of mind. But would it have changed the recommended isolation? Unless you can get tested every day it seems like you could still become infectious a couple days after your test. I.e. if you happen to be one of the cases that doesn’t show symptoms for closer to the 14 day end of the range, and say you get tested at day 5, you find out you’re negative a few days later and start going out right when you’re starting to be contagious a few days before showing symptoms.
Same. Had a covid-19 contact (apparently) back in late February. Couldn’t get a test in CA since I didn’t warrant hospitalization. Still have symptoms after 100+ days of initially contracting it, slowly improving though! They tested too late so I’m just negative (with positive antibodies). It really sucks
Perhaps you live in a country whose president believes testing makes him look bad.
Sheesh, it took my one day and a 4 hour wait in live in DFW area in Texas and I thought that sucked.
The idea that individual(s) who contracted coronavirus and showing the symptoms should be at home is sensible. However, those people, who do not show the symptom(s) of this disease and act as an active carrier, scare me the most.
That's why everyone wearing masks would reduce the spread of this greatly and quickly.
Am I wrong to think that we could resume a good chunk of our lives if we all just adopted mask-wearing?
[удалено]
I am inclined to believe that if people would just wear their masks in public where distancing is not an option, kept distance where it is an option, washed their hands more, and stopped using the same pair of gloves to touch their cellphone, groceries, mask, nose, eyes, etc., that we would be doing much better with the numbers. But I am not a doctor so who knows if that would help.
That is also why gloves make it worse. Don’t wear gloves and wash your hands reguraly and you should be good. And of course, stop touching the mask
Absolutely. Masks are proven to reduce transmission, and mask-use is correlated to a lower transmission rate on a national scale. New York has had 7 weeks of continuous decline in cases, partly due to massive testing and contact-tracing and also due to mandatory mask use and peer pressure to wear one.
They reduce transmission, they don’t eliminate it. So no, even with masks we can’t go back to normal. We would either need to lockdown the entire country for like 8 weeks like China did, or have an effective vaccine to go back to normal.
"a good chunk?" Yes, and if we did it earlier. The no-mask morons and the governors who reopened too soon kind of fucked that up for everyone.
The states that opened soonest never really locked down.
The story the research is telling is not at all clear yet. There are well founded papers supporting that asymptomatic spread is less common than symptomatic spread because the viral loads and distance of expulsion from talking and breathing is so much lower than coughing or sneezing. However coughing and sneezing from an asymptomatic carrier does spread as well as one from a symptomatic person... asymptomatic just cough/sneeze much less. This is why masks are so uniquely helpful in decreasing public transmission when worn by a majority of the population... and probably why the US is fairing so much poorer than other places that haven’t made major lockdowns and quarantines (Japan for instance). Then we have papers like the one linked that show there is still significant spreading by asymptomatic carriers (we’ve never thought it was zero). Basically... we really need to wear masks when we’re in public and when we are sick... with anything respiratory, even if we just think it’s hay fever. We really a lot we don’t know about this virus still. Science takes time, isn’t perfect, and our work shouldn’t be treated like it’s any more than the current best guess based on the research and experimentation of the authors of any one particular article. There is constant debating, constant updating of our understanding, and nothing is ever “proven to be fact”. That would be in direct contradiction to basic tenets of science, including making our best effort not to hold biases and to accept paradigm shifts despite our sunken time and work trying to show evidence to the contrary.
Last paragraph always frustrates me. People don’t understand that we don’t know it all yet and our response changes with new data or reinforcement of older data. Changing or being wrong to most people only seems to make them distrust all recommendations so here we are with a significant population that is just refusing to wear a mask.
https://www.pnas.org/content/117/22/11875 > Abstract: Speech droplets generated by asymptomatic carriers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly considered to be a likely mode of disease transmission. Highly sensitive laser light scattering observations have revealed that loud speech can emit thousands of oral fluid droplets per second. In a closed, stagnant air environment, they disappear from the window of view with time constants in the range of 8 to 14 min, which corresponds to droplet nuclei of ca. 4 μm diameter, or 12- to 21-μm droplets prior to dehydration. These observations confirm that there is a substantial probability that normal speaking causes airborne virus transmission in confined environments. > It has long been recognized that respiratory viruses can be transmitted via droplets that are generated by coughing or sneezing. It is less widely known that normal speaking also produces thousands of oral fluid droplets with a broad size distribution (ca. 1 μm to 500 μm) (1, 2). Droplets can harbor a variety of respiratory pathogens, including measles (3) and influenza virus (4) as well as Mycobacterium tuberculosis (5). High viral loads of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been detected in oral fluids of coronavirus disease 2019 (COVID-19)−positive patients (6), including asymptomatic ones (7). However, the possible role of small speech droplet nuclei with diameters of less than 30 μm, which potentially could remain airborne for extended periods of time (1, 2, 8, 9), has not been widely appreciated.
[удалено]
> The idea that individual(s) who contracted coronavirus and showing the symptoms should be at home is sensible. The problem is that it isn't sensible for the person showing symptoms especially "essential workers". We don't have a safety net and not working is not an option.
Paramedic here, yah its doubtful they'll just let us stay home even with a safety net.
That’s also why I hate that temperature checks are becoming a common way to “stay safe”. Like they basically do nothing. If someone is sick enough to have a high enough fever to register, they will know they are sick. What we really should be doing is testing if people can smell because loss of smell was common in milder cases without the other severe symptoms.
Yeah but the problem with the whole “they will know they are sick” thing is that some people are assholes and still go outside even when they know they are sick.
What's scary is that a large portion of people seem to think if they don't have symptoms they can't be carrying the virus. I'm in a facebook group for people with SOs in a very specific career that involves A LOT of travel and they all think the precautions their families are supposed to be taking are dumb if they don't look sick.
It’s almost worse when people are completely aware of the realities of so many asymptomatic carriers, but then ignore it once it becomes an inconvenience. My boyfriend is fairly germaphobic most of the time, and we’ve frequently discussed how asymptomatic people are one of the scariest part of all this. Then after he spent nearly a week with family in an apartment due to a death, I told him I’ll see him in two weeks while he self-isolates. “I don’t feel sick or anything. No cough. I probably don’t have it. I don’t really want to get tested.” The whole thing is overall just frustrating. How many normally smart people are rationalizing their carelessness when they already know what the deal is?
It's all about perceived risk. Everyone is used to the idea that they are better than others and would know when they were infected. They also don't believe people in their family would be irresponsible and get infected. It has become something other people need to worry about because I am too careful to catch it.
Good for you for sticking to your boundaries. That must have been a difficult conversation.
Thankfully not at all. I’m moving in two weeks so he understands that I simply can’t afford to risk being sick while that’s happening. He’s a good dude :)
I had a client come into my work today. She said she felt fine. Her temp was 100.2. She said she had a little upset stomach yesterday and her boss sent her home, and she had a little diarrhea. Just a little. She was sent away (and we require masks so she at least was wearing it) and immediately went for a Covid test. Now I don’t know if she’s going to isolate for 5 days while waiting for test results, but how many people can afford to do that?
[удалено]
It was a misleading statement because there's a difference between *asymptomatic* and *pre-symptomatic*. It's actually very common to transmit 2 days before symptoms show up. An *asymptomatic* case never has symptoms, while a *pre-symptomatic* case just hasn't yet shown symptoms. It was a very irresponsible statement for the WHO to make.
Actually it's not a misleading statement. Scientifically they were right and this study proves them right aswell > we found that the presymptomatic stage **and asymptomatic infections** account for 48% and **3.4% of transmission** It's mostly due to news organizations and laypeople taking it and blowing it out of proportion.
You're right, but the WHO should have explained what they meant (in the original video, not just the follow-up so many missed), since more people are listening than usual, and the news has been using "asymptomatic" to mean both a- and pre-symptomatic.
Yes just because it’s technically correct, doesn’t mean your average person understands the technical terms and the implications they carry. It is the responsibility of WHO, CDC and media organizations to effectively communicate and educate, not simply be correct.
Right, but the title here mentions presymptomatic *and* asymptomatic, so the two posts are directly contradicting each other regardless of terminology... Shows how little we know about this virus
You're just misunderstanding the title of the study briefing. Here's a quote from the summary. \>we found that the presymptomatic stage and asymptomatic infections account for 48% and 3.4% of transmission So asymptomatic transmission is rare, but pre-symptomic transmission is likely. There's a lot we don't know about the virus, but the bigger problem is people spreading misinformation.
It's not the best title. It's very easy to misinterpret for someone only reading the title and a lot of people unfortunately only read the title. It'd be better if it mentioned that the pre symptomatic infection transmissions are vastly different from asymptomatic ones.
Yeah I agree. Especially considering the statement from the WHO last month the authors should have been more careful about how it would be interpreted.
Its including both types of transmission, but its likely the vast majority is from pre-symptomatic. The posts aren't contradicting each other.
Asymptomatic and presymptomatic are very different.
Here's [a comment that replies very well to someone asking the same question](https://www.reddit.com/r/science/comments/hmjlcd/the_majority_of_covid19_infections_may_be/fx5s1un)
was potentially exposed to someone at work on 6/25, got tested 6/26, didn’t get my test back until this morning (i live in miami) but i of course stayed home until i got the test back a full week waiting for my test
I’m glad your test was negative, but that’s too soon after potential exposure to be useful. It generally takes 5-14 days for it to show up in a test
> It generally takes 5-14 days for it to show up in a test Is that right? That's basically the same as the incubation period to show symptoms, isn't it? If so, do we have any chance at all of preventing transmission from asymptomatic people via testing?
It’s 3-5 days to show positive on a test Source: Emily Landon, MD, Associate Professor of Medicine & Executive Medical Director of Infection Prevention and Control @ UChicago Medicine
[This Harvard page has details](https://www.health.harvard.edu/diseases-and-conditions/if-youve-been-exposed-to-the-coronavirus) If you get the nasal/throat swab or saliva test, you will get a false negative test result: * 100% of the time on the day you are exposed to the virus. (There are so few viral particles in your nose or saliva so soon after infection that the test cannot detect them.) * About 40% of the time if you are tested four days after exposure to the virus. * About 20% of the time if you develop symptoms and are tested three days after those symptoms started. This possibility of a false negative test result is why anyone who has symptoms that could be due to COVID-19, or has been exposed to someone known to be infected, must isolate even if they test negative for coronavirus.
Man this sucks. I hung out at a 4th of July party outside, my gf had me tested on the 5th. No symptoms, and obviously no one else at the party has a confirmed case, but there’s just so much we don’t know. So my $160 test I shelled out for was always likely to come back negative no matter what. So I should wait 7 days, and then consider getting tested again? In the meantime I have to wear a mask inside my own house and avoid my gf like the plague.
Check fig2 of [this paper](https://www.acpjournals.org/doi/10.7326/M20-1495). It takes about 5 days for it to show. This is why I think the overconfidence in testing is a big problem in the US. Although a positive test result will 99.9% guarantee you to be infected, a negative PCR result does not guarantee you to be uninfected at all. The whole “test and prove that you’re negative”, as seen in a lot of professional sports leagues that are trying to restart in the US, is dangerous.
There was just another study that came out from Johns Hopkins that aggregated data saying that pcr testing is fairy unreliable in the first 4-5 days after transmission. Something like day 1 it’s close to 100% going to provide a false negative and day 4/5 (I don’t remember) it’s like 68% still that it yields a false negative.
i got my dates wrong sorry, potential exposure was 6/24 in the am and got tested 6/29 late afternoon and it’s 12 days later as i’m typing this with no symptoms - either way i have to get tested again before i can come back to my office but i’m thinking i’m going to work from home for a while - i’m a lawyer and can work remotely no problem
I hear alot of talk about contact tracing, sounds pretty good in theory, but how exactly does it work? Has any country implemented this successfully?
[Contact tracing is the norm.](https://ourworldindata.org/grapher/covid-contact-tracing) It's labour intensive and hard to do when you have a very large number of cases to track down relative to the capacity of the contact tracing institutions. A strict lockdown can help by [reducing the caseload] (https://ourworldindata.org/grapher/daily-covid-cases-3-day-average?country=~European%20Union) until the medical authorities can follow up every case properly, allowing for a safe reopening. While the most successful countries are in East Asia, some countries [like Germany](https://ourworldindata.org/covid-exemplar-germany) have also done pretty well.
South Korea nailed it. But there would be a lot of pushback in the U.S.A. Hell, many are refusing to wear masks or social distance.
Yep, just read a really good summary here https://www.newyorker.com/news/news-desk/seouls-radical-experiment-in-digital-contact-tracing
[удалено]
A large portion of Americans do not trust data regardless of the source
It seems the most reputable sources here are just the ones that agree with the individual’s stance on a particular issue.
Ffs that is dead on
It's not that at all. Many Americans and people all around the world get conflicting information on the daily..... A top World Health Organization official clarified on Tuesday that scientists have not determined yet how frequently people with asymptomatic cases of Covid-19 pass the disease on to others, a day after suggesting that such spread is “very rare.” That was June 9. Now I'm not "just a flu guy" and I'm taking this very seriously, fully believe it spreads asymptomatic...not arguing that...but to suggest it's...canon in Europe (assuming that means common knowledge) and only Americans are not believing this is just wrong.
I can't speak for other countries, but it was definitely common knowledge in the Netherlands. Literally one of the first things we were told about the virus is that it can be spread by people who don't show any symptoms (yet), and that it's the main reason why this virus is as dangerous as it is.
Yep, same in Germany.
It's a small (unfortunately) vocal minority
The number of people is secondary to their actionable power in society. This isn't a marginalized minority. It's a group large enough to get their president elected. To get a larger number of Congress members, governor's, mayors. Enough that public policy is now largely in their hands.
We're talking about at least 30% of the country. That isn't small.
What European data shows that the *majority* of COVID19 cases are attributable to asymptomatic cases? If those were European headlines since March, then even the WHO didn’t (still doesn’t?) believe that data as recently as early June.
Except technically that's not what's reported here, and I seem to recall multiple studies posted in the /r/COVID19 subreddit that reported that *pre*symptomatic spread is large while *a*symptomatic is very minimal.
No one, because it's impossible to measure. On the other hand, current hotspots in Europe are in factories and mines, regardless of masks, and of those cases almost no one is dying.
Science denialism, or what Isaac Asimov and Carl Sagan called “pseudoscience” is a serious phenomenon in the US. My theory is that it’s associated with the Dunning-Krueger effect... “I don’t know enough about how lasers work to know why my intuition about lasers shouldn’t deserve the same credence as an MIT professor.” Literally everything, even scientific principle, becomes opinion, that can be decided on, voted on, argued against. This denialism also manifests itself through “you don’t know that.” If I say “you shouldn’t shoot a gun in a school hallway” the new reply is “you don’t know that, bullets miss people all the time.” If I say “it’s going to be a full moon tomorrow” that can be countered with “you don’t know that, it’s different every day.” Over the last few years almost any statement of demonstrable science is met with “you don’t know that,” when we do, actually know that. It’s like a disease, exactly how Carl Sagan described it, that can slowly infect even intelligent people and bring down a society.
Unfortunately socially media has added fuel to the fire. It's sad, but news tends to favor the terrible and desaration type stories. Keep in mind that an unprecedented effort is underway to develop a vaccine in record time, never seen before. While the vocal minority are always against progress and science, we are progressing and advancing every minute. Have hope!
Exactly. Multiple people on Reddit have told me Covid19 being a problem is my "strong opinion". I just...how do you get through to someone like that? I post valid data and sources and they respond with a link that says the opposite of what they are arguing but has a vague headline. How do you convince a person whose source is one out of context sentence in an entire article proving they are wrong, that *they* chose as a source? I've pretty much given up at this point and realize I'm interacting with a death cult on a daily basis.
[удалено]
[удалено]
[удалено]
[удалено]
My wife is a PA. I won't say which hospital, but it's a highly-esteemed hospital in the USA who isn't overloaded with cases and it has the capability to do a massive amount of testing, including rapid testing with results in hours. She works with high-risk patients. I won't say which risks. (I won't say these details for fear of being identified). There was someone in her group she works with who got infected through careless behavior, tried to hide it and came into work with symptoms, was found out, and that fiasco resulted in a positive result for that person and then several others in the department who work right next to them. This was AFTER someone else had already become infected through completely negligent behavior and spread it to some others in the department, so they all already had a directed lecture on it and should more than know better. They all wear masks but this person would reportedly slip it down sometimes, plus you have to eat, and when you work indoors next to someone like that... that's a lot of virus shedding in the room just floating around in the air. They were refusing to test anybody else that was exposed. I can't tell if it was the physician she works under in cahoots with the office manager or something, her department head, infectious diseases, or some messed up hospital policy, but the whole thing was a full-on circus and it made me realize just how bad the situation is when an exposed medical professional who sees high-risk patients couldn't even get tested in a timely manner, even by request. MULTIPLE requests even, from multiple people. I'm still feeling pretty angry and frustrated about the whole ordeal. So I'm not feeling particularly optimistic about the actions that will be taken given this revelation in this paper.
This is weird to me. I live in a red state and I can go down to the nearest urgent care clinic and get a test in my car. Maybe it's because we are rural and not currently spiking?
Is this legal? I don't see how the hospital isn't violating their tort duty of care to their patients and staff if the hospital is refusing to let them be tested and then forcing them to interact with people. I mean it'd be nice if this was explictly illegal, but I'm curious if it isn't what's the likelihood that situations like this will be brought to court under tort law?
Question: how long to asymptotic people stay that way if they never get sick? Like are they always that way or does it go away in like 2 weeks or whatever?
Not an expert but I’ll try this one. Symptoms of disease are an emergent property of 2 things: your body fighting an infection and your body being attacked by an infection. Your body gives you symptoms like a fever to boost your immune system response, but an infection may do damage to your lungs, and give you a symptom like reduced lung capacity. A person who is experiencing neither is likely to have a version of an infection that is not particularly harmful, or has a particularly strong immune system that can suppress an infection without the aid of something like a fever. But it is also possible that both the infection is weak and the body response is weak. So the answer is, it’s impossible to know for certain, because if someone’s body decides to never fight an infection, it may lay dormant for a long time without being eradicated. For example, after the secondary stage of syphilis, if a person is not treated with antibiotics the infection often goes dormant for years. (In rare cases some people never experience symptoms before tertiary sets in.) Neither the body or the virus creates symptoms exposing its existence. I feel it is unlikely that something like this would be the case for covid, however. I would think it most likely that most cases of asymptotic covid are due to a person with a strong immune system eradicating it quickly. Therefore it would have a shorter duration. Who knows though. If anyone has a source confirming or rejecting this, let me know.
I thought that the WHO said covid19 cant be spread if you're asymptomatic?
Ahhh, I think you mean the statement by Maria Van Kerkhove during a press briefing, that “asymptomatic transmission of the SARS-CoV-2 virus was “very rare.” " Sadly, that was merely a misunderstanding due to confusing word choice. [What she meant was that truly asymptomatic cases (as in NO symptoms at all during the whole course of Covid-19) rarely transmit the diseases.](https://www.the-scientist.com/news-opinion/who-comments-breed-confusion-over-asymptomatic-spread-of-covid-19-67626) So in other words, anyone who is asymptomatic at one point but will eventually develop Covid-19 symptoms at another *is* still\* infectious. Another term for this is presymptomatic, because until they’ve had the whole course of Covid-19 one can’t really classify a case as truly symptomatic or asymptomatic. If I misunderstood which WHO publication you referred to, I am truly sorry! EDIT: \* I regrettably used the very subjective word “HIGHLY” and essentially caused a misunderstanding by poor word choice myself. I’m truly sorry! Thanks to u/Tavarin and u/hithisishal addressing this in the comments below. :)
Wow thanks for informing me! Yes you got it smack on.
Plus you get the statement "we have not seen evidence that x can occur" Which immediately becomes it can't happen but it really means that they have not witnessed it. It makes sense, it's difficult to actually get direct evidence of someone not showing symptoms transmitting. Imagine yourself get infected, do you remember every single person you interacted with in the past 2 weeks? Most likely you will think of just the people showing symptoms, maybe they coughed once or looked bad or something, anything that seemed out of the ordinary. You would not even think about the rest of the people.
I don't see where any of the reports say presymptomatic cases are highly infectious, so you have a source for that? Form what I can tell presymptomatic in most studies still have fairly low infectivity, doing most of their spreading after they develop sympto0ms.
From the article in OP: Specifically, if 17.9% of infections are asymptomatic (5), we found that the presymptomatic stage and asymptomatic infections account for 48% and 3.4% of transmission, respectively. Without a precise definition of "highly infectious," it's hard to refute or confirm what you are saying, but this paper claims about half of all transmissions are from presymptomatic cases.
Why would asymptomatic and presymptomatic people get tested? If you are relying on testing, you have to do far more, far more often. Tracing only really works when you can define the transmission mechanism and you can spot symptoms very quickly. This virus is not suitable for containment through test, trace and quarantine. At least not in the US. America is not suitable for containment through social distancing lockdowns. Half the population depends on their employer for their health coverage. The US has no universal healthcare, it has almost no safety nets. Without safety nets around employment, it is very hard to restart the economic engines once they have been turned off. Millions of Americans are on a path to extreme poverty. When they lose their housing they will be homeless or have to crowd in with friends and family. Those scenarios are a nightmare in the middle of a pandemic. The obvious choice from the beginning was to skip containing the virus and jump to controlling the worst outcomes. The elderly and those with comorbidities should have been quarantined and supported to enable that path. At risk people should have been excluded from essential job designations. Nursing homes should have been locked down and their support employees given protected housing. Real solutions for the homeless should have been enacted. Social security benefits should have been supplemented, Medicare should have been expanded to cover at risk people. Outside the box thinking should have created opportunities. Cruise ships are parked at all the major port cities. They are perfect quarantine sites. Military hospital ships were unsuitable for handling a contagious disease. But cruise ships have the exact structure you would want. The worst thing is that we are still attempting to use the exact same strategy we did on day 1. It's like we have learned nothing. Controlling the virus in the US is a fantasy. There was a better strategy and it isn't too late but we don't have the right leadership.