Science – CHRIS DAEL

Crowded Beach/Federico Giampieri federicogiampieri / CC0

A few days ago, the WHO’s technical lead on COVID-19 Maria Van Kerkhove, caused quite a kerfuffle by suggesting that infected, asymptomatic people with COVID-19 very rarely spread the infection. The WHO and Dr. Van Kerkhove fairly quickly walked back those comments but not before her words raced through the internet and caused heated discussion everywhere.I thought it worth digging into a bit. What is the current science on asymptomatic spread?

First it’s important to understand that asymptomatic can mean at least two things with respect to COVID-19 and I think this is where some of the confusion arose with Dr. Van Kerkhove’s remarks. The first type of asymptomatic patient is the one who is infected and will never get sick with COVID-19. The second is the person who is infected, has not YET shown symptoms of the disease but will eventually become sick. We know a lot more about the second person than we do about the first. The second person is probably better described as pre-symptomatic. Studies indicate that the incubation period for COVID-19 is probably between 2 and 14 days with the average being 5 days. Studies largely out of Asia indicate that pre-symptomatic spread during those 5 days (2-14 days) almost certainly occurs enough to be a significant driver of the disease. Likewise, the a study from April confirmed that viral spread can occur well before symptoms and is likely responsible for up to 44% of secondary case infections. Overall, the data seems to clearly point to pre-symptomatic spread being an important factor in COVID-19 disease worldwide.

The amount of spread from truly asymptomatic individuals, those that never display signs or symptoms of the disease, is less well known but is likely to be less of a factor than for symptomatic and pre-symptomatic people. One preprint study (not yet peer reviewed) out of Australia attempts to quantify the percentage of individuals with COVID-19 who are asymptomatic and found from reviewing over 900 studies that this number is likely around 15%. Of all those studies only four looked at the forward transmission of virus from asymptomatic individuals and hand sufficient numbers of participants to draw conclusions. Those papers found that the rate of transmission ranged from 0-2.2% suggesting that asymptomatic spread occurs quite rarely.

Another study, however, out of Scripps published in the last week looked at specific closed cohorts from around the world (USS Theodore Roosevelt, Diamond Princess, Rutgers University Students, various nursing facilities and prisons to name a few) to examine the rates of asymptomatic spread. Three of the cohorts (from Iceland and Indiana) had representative samples of the population so they represent a better model for estimating true asymptomatic spread. In those cases the researchers found that the asymptomatic rate of infection was 40-45%. Numbers that high clearly indicated that asymptomatic spread could indeed be a very important driver of disease worldwide.

All of these studies have their problems. Many studies looking at asymptomatic spread have too few participants to draw strong conclusions. Others were unable to clearly distinguish between asymptomatic, pre-symptomatic and mildly symptomatic. It is clearly too soon to draw definitive conclusions from these studies or as scientists are wont to say, “more studies are needed.” That’s actually part of what Dr. Van Kerkhove said after discussing the possibility of low asymptomatic transmission rates in her media briefing several days ago but that tends to get lost in stories by the lay-press. When reporters hear a soundbite they know will draw in readers, viewers, listeners and clickers they are excited to report it because they know it’s a hot-button issue. They rarely focus on the cautionary parts of the scientist’s comments because, frankly, they’re a buzz-kill. But science doesn’t work that way. Simply put, it’s too early for us to know the answer to this question. Making policy decisions now with the evidence we have about asymptomatic spread would be utterly foolish. Science is a process that gradually and with methodical verification and re-verification, works slowly but surely closer to understanding the natural world around us.

These nuances are often lost on the lay-press when they report on science and medicine. They’re terrible at it because they want no part of the gray; they want only the black and the white. In the history of science there are only a relatively small handful of topics for which science has gotten anywhere close to the black and the white of it all. Even then, scientists work to reexamine and refine our knowledge of the best understood concepts in science. You can always know more and things can always change, even if incrementally. But when the press reports an informal statement by one very good scientist as potential gospel, only to have to report something different the next day because the first was off the mark, it does nothing but erode the public’s trust in science, medicine and public health.

I urge you to take stories from the lay-press with a gigantic grain of salt. The best studied concepts and theories in science have, in some cases, been examined and reexamined for hundreds of years. We’ve known about SARS-CoV-2 for six months. Think about that. Things will change; our understanding will change. That’s not a fault of science and medicine, the absence of dogma and science’s ability to change is what makes it the best tool humans have ever devised to understand our world and the threats to it.

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One of the really cool things about staying off of Facebook is that I’m not bombarded with conspiracy theories all day. One of the bad things about leaving Facebook is that I’m not bombarded with conspiracy theories all day. I, for instance, just found out that there’s a video called Plandemic spreading around the internet like a…well…pandemic (apologies), which is so rife with conspiratorial falsehoods it’s basically the holy grail of science blogging. I’m so late to the game on this that the video isn’t even around anymore to view. I was able to dig deeper into the bowels of the internet and find it but I’m so late to the game I’m not going to tackle it. Others have done an expert job of that already. If you’ve seen the video and found some of the points made therein to be compelling, you probably owe it to yourself to read If You Found that ‘Pandemic’ Video Convincing, Read This Too, by Beth Skwarecki of LifeHacker. I don’t think anybody could do a better job of point-by-point addressing the Plandemic video, certainly not me.

Instead what I’d rather do is provide a bit of a handy guide, a questionnaire of sorts, to help you know when you are at the greatest risk of believing a conspiracy theory. Let’s all answer a few questions about ourselves.

The Questionnaire

How helpless do you feel right now?

Do you feel completely powerless as life-altering decisions are made by people in suits miles and miles away from your reality?

How vulnerable do you feel right now?

Do you feel that there are imminent threats to your health, finances or freedoms?

How confused are you right now?

Do you feel overwhelmed by conflicting information and are finding it hard to know what to believe since information yesterday is different from today and one contradicts the other?

How threatened does your way of life feel right now?

Do you feel that there are people with ideologies counter to yours who are intent on changing the status quo to make your life worse or damage America irreparably?

How involved in political wrangling are you right now?

Do you engage in frequent arguments about politics with people who simply ‘don’t get it’ or do you frequently post memes and comments that denigrate people on the opposite side of the political spectrum?

How much social media are you consuming right now?

Do you find yourself increasingly drawn to social media platforms looking for some information that makes sense or for people who are similarly confused and frustrated with how things are going?

Discussion

If you answered, ‘a lot’ to some of these questions you’re probably at risk to believe in a conspiracy theory. The thing is, because of our current health and economic crisis almost every human on earth can answer ‘a lot’ to one or more of those questions and is probably at risk of believing conspiracy theories. That, frankly, is why there are so many flooding the internet these days.

Feelings of helplessness are commonly associated with a predilection for believing conspiracy theories. During the COVID-19 crisis many Americans feel like decisions that affect lives are being made by politicians and policy-people from hundreds of miles away. Elected and public health officials call all the shots and the average Joe has no say in the matter. The more helpless and out of control people feel, the more likely they are to try to find some measure of control. Often people try to find alternate explanations than those given by the people responsible for taking away control in the first place. Conspiracy theories provide that along with a comforting feeling that the believer is part of a select few who know the real truth.

Similarly, the anxiety that comes from vulnerability drives people to believe conspiracy theories. Millions of Americans have lost their jobs and face an uncertain future. Millions of small businesses are at risk of closing permanently because of the COVID-19 stay-at-home orders. For many, the stress of COVID-19 itself can be oppressive. Conspiracy theories can provide an explanation for the seemingly inexplicable change in peoples lives; life was completely normal four months ago and now it’s completely abnormal. Somebody or something had to be responsible for this dramatic turn of events.

The breakneck speed of COVID-19 and the response has led to unavoidable conflicting information from scientists, politicians and public health experts. Part of the fundamental nature of science is that it changes and is slowly fine-tuned or honed by additional data. This can produce an uncomfortable amount of confusion in the best of times, during the COVID-19 pandemic this has been difficult to process and keep up with for even the world’s foremost experts in virology and public health. For many, this confusion reaches a tipping point that leads them to conclude that events transpiring are simply too fantastical to believe. From there they seek alternative explanations and find many, much easier to chew than the science of pandemics, in conspiracy theories.

According to recent research, people who feel that fundamental societal values are under siege or directly threatened by those who believe differently are at an increased risk for believing in conspiracy theories. These individuals are likely to believe that there is an influential group of people who do not share the same values and are intent on disrupting the status quo. For people who feel this way, there is a common thread that nothing happens by accident; there is always someone or something at play to explain current problems or crises.

Studies show, the more politically entrenched a person is or the more they feel their way of life is threatened, the more likely they are to believe in conspiracy theories regardless of which end of the political spectrum they live. Generally, the politically preoccupied believe conspiracy theories that malign the other party and the people who belong to it. To make matters worse, the more someone overestimates what they know about politics or policy, the more likely they are to believe in clandestine, powerful agents acting against the common good. Having entrenched views and overestimating personal knowledge are particularly strong risk factors for belief in conspiracy theories.

The internet, in particular social media, provide people a perfect medium to spread unfounded ideas. The relative absence of gate-keepers gives free rein to conspiracy theorists to post their claims and allows them to find thousands of like-minded believers. This can give the group in question the gratifying feeling that they alone have the truth and that they share a secret that the rest of the world is ignorant of. In general, conspiracy theorists are far more active and share far more posts on social media than the people who debunk them. In part this comes from the belief that they have a secret truth that must be shared. Social media intensifies conspiratorial thinking.

The COVID-19 pandemic has created a perfect storm of risk factors for believing conspiracy theories. We’ve reached a point where almost every American has at least several of these risk factors and we’re seeing that play out on social media with an infectious spread of machinations designed to dupe vulnerable people into believing untruths. Honestly, I think it’s understandable; we all have doubts and we all want the truth so we go looking. It’s good to have an inquisitive and questioning mind. It’s vital though, to know when the answer to our inquisitiveness is devoid of real evidence. Most of us laugh when we hear someone bloviate about the “clear evidence” of a flat Earth or the undeniable “truth” that the moon landing was faked. For many of us, these ideas are so absurd that we ignore them and refuse to engage. It’s important to remember, however, that a belief in conspiracy theories, no matter how bizarre, is underpinned by a fundamental mistrust of science and expertise and the more pervasive these ideas, the more dangerous it is for society. We see this now with the conspiracy theories surrounding COVID-19; they are a direct threat to our personal health and the health of our economy (see On Bitter Pills). When society relies on every member to step up to protect the common good, it only takes a few to endanger the lives of millions. Since we all have some risk these days, it’s vital we steel our minds and take a moment, maybe several, before we post that potentially conspiratorial or highly political meme. Better still, take a break from social media or at least let’s clean up our social media feeds to remove the incendiary pages, and for the love of all that is good and holy, don’t ever look at the comments. No good can come from that.