Weak sauce and the spread of COVID-19.

This study is representative of the data that is driving public policy today. Let’s look at it. Before we start breaking it down, here is the exact wording of the “meaning” of the study, which is to say the author’s interpretation of the significance:

“High transmissibility of COVID-19 before and immediately after symptom onset suggests that finding and isolating symptomatic patients alone may not suffice to interrupt transmission, and that more generalized measures might be required, such as social distancing.”

Now let me be blunt: I don’t agree at all with the “meaning” in this study. In fact, I believe it makes flawed assumptions and the wording is totally inflammatory. I am going to walk you through and explain. And by the way, this is complicated, but it’s also kinda important, so please read. This is the thinking that is dictating our complete socioeconomic shutdown, so if it’s not based on fact, we are making some pretty massive mistakes.

This is a study performed in Taiwan between January 15 and March 18 on 100 confirmed COVID-19 patients. The intent was to look at how the virus spreads. The methods are solid, and we would be unable to duplicate it in the US due to differences in personal freedoms. Very detailed contact tracing was performed on all 100 patients starting 4 days prior to development of symptoms and continuing to every contact up to confirmation. The testing was RT-PCR – it is virtually 100% specific, which means if it’s positive, the patient does indeed have infection. The 100 primary cases were all identified by testing (this is going to be very important).

Nine of the patients were and remained asymptomatic, but their contacts were included in the study.   

OK, so now let’s look at these contacts: in-depth tracing identified 2761 that were considered close contacts. Think on that: that’s more than twenty-seven people per patient that were identified. Every single one of these people was quarantined – truly isolated – for 14 days. That’s a lot of people; even so, you were not considered a close contact without fifteen minutes of face-to-face contact. Let me say that again: twenty-seven hundred sixty-one people were painstakingly isolated and monitored who had been in right up in the grill for fifteen minutes of someone with confirmed COVID-19. Many of them had much more contact, like they lived in the same house.

If you passed them in the hall or the grocery store, you didn’t get a second look. If you touched the same railing in the building, no one cared. At the time, most regular people were not wearing masks. This is important: we are all wandering around concerned about getting within 6 feet of each other for ½ a second, and there is a big, big difference between engaging in a one on one conversation for a quarter of an hour.

So, what happened?

Of the 2761 isolated patients, twenty-two developed COVID-19.  That’s 0.7%, or 7 out of a THOUSAND people who had contact better than 15 minutes all up in there actually caught the virus.

Not one of contacts of the nine patients that were asymptomatic developed any symptoms or disease. Does this mean you can’t get COVID-19 from someone who is asymptomatic? Nope. In fact, I don’t think it means anything. Furthermore, they didn’t do additional testing on asymptomatic contacts unless they were high risk, so it’s possible that any number of them actually got infected but evaded detection. Nevertheless, we seem to have this idea that asymptomatic patients are not just potential culprits, they are in fact the most important, but, no one that had it with no symptoms led to another person becoming symptomatic.

Moving on, what can we learn from the people who actually got sick from being in contact with one of these 100 people?

One of the big questions has been: when in the course of the illness is a person most likely to spread the disease? This is a type of tracing study is much more powerful than mathematical models based on lab data like duplication rates, or even on viral load. There is more to being infective than just test results, and this type of study considers all of those real-world variables.

This is a really important chart, because this graph holds the evidence for pre-symptomatic infectivity that is shaping our lives now, and it can also demonstrate the flaws in the logic.

These graphs show the time the two cases were in contact based on the onset of symptoms. What we are looking for is when the people interacted: was it before they knew they were sick, was it about the same time, or was it later in the illness?

It’s worth mentioning that SARS has a different curve, and it seemed that sick patients are most infective about 10 days after developing symptoms. Not so much here… but it is worth noting that viral load studies (which are not the be all end all) suggest the highest infectivity with COVID-19 is about 5 days after onset of symptoms. Faster, yes, but still not pre-symptom.

And this data appears to confirm that COVID-19 patients are infective earlier in the disease as compared to SARS. However, the investigators here have focused very hard on the contact prior to symptoms.  10 of the 22 patients had significant contact with a primary case before the person was sick. What does that mean? 

Well, nothing really. That’s right, it doesn’t mean anything. And the authors know this, they even recognize it, but they don’t elaborate on it (partially because it calls into question a lot of things…)

First of all, 8 of those 10 patients had continuous contact both before and after developing symptoms, so there is no way to know. However: two patients only had contact prior to the primary case patient’s development of symptoms. So, there is no way to explain how these people could have gotten the disease any other way, right? Not so fast…

Allow me to introduce you to patient twenty-three.

Contact tracing actually discovered twenty-three patients, but number twenty-three was excluded. Why?

“One of the 23 cases was excluded from subsequent transmission-pair analysis because the documented day at exposure occurred after symptom onset of the secondary case.”

Read that again, then one more time. What they are saying is that the timing clearly showed the primary case was in fact a secondary case. In other words, the messed that one up, so they threw it out. But then they kinda ignored the fact that they might have the order wrong in other cases, too.

See, we can’t really say anything about the order of infection. Just because we identified these 100 patients as COVID positive in a lab, that doesn’t mean we know where they got it, or who got it first. Many of these people were close family, many living in the same house. They got it from someone, so it is just as likely a close contact got it from the same person.  We don’t know for sure if the primary cases are actually primary, or if they got it from a third person that gave it to the contact. And in at least one case the patient we identified as primary was clearly secondary, but this was never further acknowledged as a study limitation, because it would really screw up the data.

Now, no investigator likes to point out limitations in their study, but this is a pretty big deal. The idea of asymptomatic and pre-symptomatic spread is not just being consider as a possibility, it is assumed to be a major risk, and this fear has brought our world to a halt. Those fears are completely unfounded.

And here is where I really take issue with the author’s interpretation, so let’s look at it again:

“High transmissibility of COVID-19 before and immediately after symptom onset suggests that finding and isolating symptomatic patients alone may not suffice to interrupt transmission, and that more generalized measures might be required, such as social distancing.”

First, HIGH transmissibility? Fifteen minutes minimum face to face contact with an infection rate of 0.7% is HIGH?  But wait, in the body of the paper you said:

“In the contact tracing cohort, we observed a relatively low transmission rate of COVID-19.”

Well, which one is it?

I had to put my dad’s tax return in a box for 72 hours before the accountant would touch it, and I am still not allowed to carry my fathers’ belongings into his room, even if they clear the halls.

BTW, at the time of this study, the general population in Taiwan was neither wearing masks nor operating under any government recommendations of social distancing.

And then there is this word before, as in: transmission before symptoms.  That is totally unproven, and they know why, and they still say it.  BS. Before is not proven, and though I am sure it’s possible – most anything is possible – it is clearly not a scenario that should be driving public policy, and all of the damage done from these devastating mandates is clearly doing way more harm than any spread from asymptomatic or pre-symptomatic patients.    

So, one more time, and this time I put the fallacious interpretations in bold, because everything after that is dependent on this being fact: 

High transmissibility of COVID-19 before and immediately after symptom onset suggests that finding and isolating symptomatic patients alone may not suffice to interrupt transmission, and that more generalized measures might be required, such as social distancing.”

I am sorry, this is bad science. This virus is real, people are getting sick, it’s new, it’s weird. It’s also just not all that. And now we have scared the shit out of everyone, and we can’t undo it. The damage from shutting down society is at least an order of magnitude beyond the virus, and most of what we are doing to “fight” the virus is completely ineffective and unnecessary. We are chasing our own tails, many are afraid to speak up because they are painted as uncaring and reckless, others simply refuse to admit they made mistakes, and some are using this all for personal gain. Meanwhile the fear and fighting are fueled by social media, and we seem incapable of taking a few deep breaths and thinking this through.

How many times do I have to say it: shutting down the world is not an option, no matter what. Life is interconnected, and we are hurting and killing many more than we are saving, and the stuff we are doing that is the most damaging is also the least effective. Furthermore, many of us are at the end of our ropes, and you just don’t have a right to tell us how to live, especially when your rationalizations are dependent on this type of weak sauce.

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