Musings on Asymptomatic Transmission

Last week on the Ecosophia discussion board, someone asked a question about whether asymptomatic transmission of Covid-19 is real, and my response was that yes it is real but that doesn’t necessarily mean that we ought to behave as though it is real. Since writing that response, I have realized that this concept is at the core of the social panic that has gripped the world for the past two years, and that it deserves a great deal more unpacking.

It is important to understand that the idea that someone can be sick but not sick – which is to say infectious but not symptomatic – is rather new among human societies. Prior to antigen and PCR tests, one was either sick – in which case it was advised to maintain isolation – or healthy – in which case there was no concern. Disease carriers were recognized – as in the story of Typhoid Mary – but this was seldom extended to the point of suspecting that anyone might be infectious and ought to be regarded as such.

In the developing science of evolution, there was a spirited debate between the theory of “inheritance of acquired characteristics”, espoused by Jean-Baptiste de Lamarck, and the theory of natural selection espoused by Charles Darwin, which was eventually integrated with modern genetics. In the former, traits acquired by an individual, such as giraffe’s neck stretched a bit longer by a lifetime of reaching for leaves, would be directly passed on to offspring. In the latter, outcomes were determined only by genes, which were randomly reshuffled by sexual reproduction and which had nothing to do with traits acquired during an individual’s lifetime. Gene theory ultimately won this debate, but in recent years evidence has emerged in support of Lamarck’s ideas. The science of epigenetics has revealed that the experiences of parents directly influence the development of their offspring, by regulating patterns of gene expression such that – for example – children born into famine are physically different than children born into plenty.

In the world of infectious disease there has been a similar debate. “Terrain theory” or “host theory” postulates that the primary determinants of disease are internal – overall health, nutritional status, biochemical balance – and that pathogens will only cause illness in unhealthy bodies. “Germ theory” postulates that the primary determinants of disease are the pathogens themselves, and that health and lifestyle have a relatively small role to play.

Prior to the advent of PCR and antigen testing, our understanding was a sort of compromise: those who were ill were regarded as harboring germs and were advised to avoid contact with those at risk of severe illness. In the past forty or so years, however, culminating with Covid-19, germ theory has reigned supreme. Most people are now confident saying that someone is “sick” if they test positive for a disease, regardless of whether or not they feel ill, and furthermore that they are not sick if they test negative, even if they have significant symptoms. Research that would partially validate terrain theory – such as studies showing that severity of Covid-19 is strongly correlated with low vitamin D levels – is largely suppressed or ignored.

All of the Covid-19 control measures – the lockdowns, the mask mandates, the vaccine mandates – are predicated on the idea that anyone could be infectious at any time, which is to say that asymptomatic transmission is important and should be minimized at all costs. Regardless of whether one feels these measures are justified, it should be clear that the resultant fear of human contact and self-imposed isolation is not conducive to a joyful life or a healthy society. This then leads to the oft-asked question of whether asymptomatic transmission is real, but I want to propose that that is the wrong question to be asking.

In order for the last two years of Covid-prevention measures to be justified, three questions must be answered in the affirmative, and in our obsession with scientific reductionism we have focused only on the first.

(1) Is asymptomatic transmission real?

The answer to this question is quite clearly yes. Someone who tests positive for SARS-CoV2 but who is not showing symptoms can, on occasion, pass the virus on to others, some of whom become ill.

(2) Do efforts to reduce asymptomatic transmission improve public health outcomes?

In other words, does a focus on testing and contact tracing, social distancing, and masking of healthy individuals actually lead to a world in which fewer people get sick and fewer people die? The evidence here is much less clear. It seems, at least with this respiratory virus, that it spreads regardless of our interventions, and those places which have enacted strong measures do not, on the whole, have significantly lower rates of infection and death than those places which enacted few or no measures.

(3) Do the health benefits of behaving as if asymptomatic transmission is real offset the social costs?

This is more of a question of values than of science, but it is the responsibility of science to provide a reasonable estimation of the health benefits. By and large science has attempted to do this by providing a reductionist affirmative answer to Question 1 while largely ignoring the more holistic Question 2. Those who would speak for “The Science”(TM) furthermore insist on distorting the values involved, portraying this as a conflict between the value of human life, on the one hand, and selfish desires for individual freedom or greedy desires to keep the economy moving, on the other.

The truth is that we don’t have solid evidence that restrictive Covid rules lead to better health outcomes, in which case the reality of asymptomatic transmission becomes more of a biological curiosity than a driving factor for moralizing and political action. On the values side, the reality is that the conflict between individual freedom and collective safety, or between economic profit and employee well-being, fails to adequately describe the trade-offs. What is the cost of isolation for elders in nursing homes, in assisted living, in hospitals, who are not able to see their loved ones? Did anyone ask them whether they would prefer a decreased short-term risk of death over a continuation of their human connections? What is the cost to our society and to ourselves when we begin to see our fellow humans more as potential disease vectors than as friends, as dance partners, as loved ones, as family? Is this possibly offset by the longer lives we might have if we choose to isolate, to cancel the concerts and dances, to put off seeing our family for a year, and then another, and then another?

Facts do not, on their own, tell us anything about how we ought to live. We often pretend that they do, and thereby fail to consider the values, the stories we tell ourselves, that fill the space between the facts and the conclusions that we come to. Too often we claim that our differences are about facts vs. lies, when in fact they are about different value systems that make sense of the facts in different ways. When one side – usually the “Follow the Science” side – insists that its policy positions are based only on facts and not values, is it any surprise that many on the other side respond by denying the facts? Perhaps this is why we have climate deniers and Covid deniers. If we could begin to discuss our value differences, then it would be easier to agree on the facts.

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Let’s consider some examples of different stories that can be told based on the same facts. These are far from the only stories that can be told based on these facts, but they represent some of the more common stories that we tell ourselves.

Fact: All human beings eventually die.

Story 1: Because we will eventually lose everyone we know, it is best not to get too close to people. Loving others leads inevitably to pain and loss.

Story 2: Because our time on Earth is limited, we should live fully and love freely, as if each day might be our last or the last time that we see our friends.

Facts: 1% of humans are sociopaths, 6% of men are rapists, 25% of women experience abusive relationships.

Story 1: Anyone could be an abuser and no one can be fully trusted. It is best to keep to oneself, or to settle for an unsatisfactory life because the alternative could be far worse.

Story 2: Pain happens, our hearts and intuitions can fail us, and the world is not as we wish it might be, but it is still worth it to dive in, to trust others, to love, to heal and grow, even after abuse or betrayal.

Fact: We are descended from ancestors who have conquered and oppressed other humans, or who have been conquered and oppressed. This historical injustice remains a factor in distribution of resources and opportunities.

Story 1: This should understandably lead to feelings of guilt on the part of the privileged and resentment on the part of the oppressed. We must actively seek to compensate for historical injustice, and we must cast judgment on those who are not fully committed to this work.

Story 2: The past should be acknowledged, but the path to a more harmonious coexistence lies not through reopening of old wounds but through a commitment to acknowledge all humans as equally valuable and equally worthy of dignity and respect moving forward. Compensation for historical injustice may be pursued voluntarily but must not be coerced or enforced.

Fact: SARS-CoV2 and other infectious diseases (e.g. flu) can be transmitted by asymptomatic people.

Story 1: Because avoidance of disease and death should be prioritized over all other values, we should behave as though we, and anyone we encounter, may be infectious at any time. It is therefore reasonable to demand behavioral compliance from others and to enact public health regulations – gathering restrictions, occupancy limits, mask mandates, vaccination requirements – with the aim of minimizing disease transmission.

Story 2: Although there are environments (e.g. hospitals) in which minimizing the risk of disease transmission makes sense, we cannot live fulfilling lives in a world in which we view ourselves and others as disease vectors. It is therefore reasonable to reject the entire paradigm of fear, of asymptomatic testing, of contact tracing, of public health measures. In the novel world of genetic testing it is widely respected that most people would prefer not to know that they are likely to die of a particular condition earlier than normal. Similarly, perhaps it is better to simply accept that sometimes we will get sick, and some of us will die, and more of us will die in pandemic years, than to accept the isolating and anxiety-inducing consequences of behaving as if we might accidentally kill someone simply by breathing or singing or dancing together. It is better to stop asymptomatic testing and stop assigning blame or responsibility to chains of transmission that can only be uncovered by the new technologies of PCR or antigen testing.

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I was more or less on board with the imposition of public health measures for the first two months – March and April of 2020. It seemed that we might have a chance of driving the virus to zero, like SARS-1 before it, and thereby have our sacrifices pay off. But I was also aware that viral extinction might not happen, and that if it didn’t happen we would need to make an important choice.

I’ll close by quoting from that post written May 13, 2020, which included one of my father’s original songs:


In the morning the sun so gloriously greets the day
Brings the light, ends the night
And in the streets the people go the same old way
Without sight, without light
 
And how many days just pass us by
When we never really live and we never really die
And we never really laugh and we never really cry
And we never really know the reasons why
 
In the evening all the colors gather
In the sky, the western sky
Yet in the streets the people all would rather
Just get by, just get by
 
And how many days just pass us by
When we never really live and we never really die
And we never really laugh and we never really cry
And we never really know the reasons why

Ed Stone, sometime around 1980

In this case we know the reason why, and we are accepting a lesser life in the hope that doing so will lead to lesser death.  But perhaps that is always the reason why.  Perhaps we don’t really live and really laugh because our fear stops us short, tells us stories that keep us small, keeps us confined to the past and future, the virtual and the distant, while neglecting the miracle of the here and now. 

The latest guidance says that we won’t be singing together again, dancing together, crowding into stadiums again, until we have effective treatment or a vaccine.  That wording concerns me, precisely because it is conditional and not at all time-bound.  We might have a vaccine next year, or we might have one that is 40% effective like for the flu, or we might not ever have an effective vaccine at all, like for HIV.  It’s not like waiting until Christmas.  It’s more like staying in an unpleasant living situation because your scary roommate tells you they are probably moving out sometime in the next few years, and it feels safer and easier to stay put. 


Nearly two years and five billion injections later, Covid-19 cases are higher than ever and it is clear that we’re in the “might not ever have an effective vaccine at all” situation. Even as the public health narrative crumbles, many people cling to the idea of safety, wishing for the exhausted and flailing experts to tell them how to avoid catching or spreading a virus which – for most – will cause only a mild and brief illness. It is clear that asymptomatic transmission is real, but it is high time that we considered it an acceptable risk of being alive, that we stopped testing healthy people and identifying chains of transmission, that we stopped condemning ourselves and others for unknowingly spreading disease, and that we returned to physical closeness with our friends, our families, and our dance partners. It is time that we consciously erased the insidiously divisive and isolating concept that any of us might be lethally contaminated at any time.

Parts of the world are well on their way, and others have a long way to go. Unfortunately I’m in a “long way to go” community, but I see signs of recovery.

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5 Responses to Musings on Asymptomatic Transmission

  1. Cathie says:

    I’ve struggled with the idea of asymptomatic transmission since the beginning of the pandemic. I could not get my head around it!

    You have a gift for writing clearly, organizing complex material, and using examples to illustrate your points.

    You’ve brought some clarity to my understanding of this question, so thank you!

  2. Goran says:

    Hello Mark,

    Great post!
    Very refreshing perspective, that we should act as if asymptomatic people don’t spread disease. (Just like we have done throughout history, until PCR appeared.) I am all for this.
    I lived for a few years in China, some time back. There, people wore face masks when they had a cold, to reduce infection to other people. Very considerate. Face masks works to reduce aerosol distribution.

    A small side comment: I think that your comment regarding historical abuses is out of synch with the other ones. There is a lot of un-earned wealth, concentrated with families with shady pasts, and very much of that wealth is inherited to people who don’t really deserve it.
    If we are serious about “equal opportunity” we should tax inheritance much higher. Inheritance is the most unfair wealth transfer, imho.
    During the 1940-1980-period, it didn’t matter much, since most wealth buildup was through income. But these days wealth concentration is back on all-time-highs in most countries, and inheritance does matter a lot. (Piketty, Van Bavel, Graeber and others have written well about this.) “Reparations” of various kinds to those who don’t inherit anything could be very useful to level the playing field.
    Full disclosure: I come from a middle class background, not complaining about my own situation. I just observe how the increased wealth gap is destroying trust and democracy.

    Keep thinking! Keep writing!
    Goran

    • Mark says:

      Hi Goran,

      Thanks for your feedback and perspective!

      I’m not sure we actually disagree with regard to the inequity and unfairness of inherited wealth. See http://www.luterra.com/blog/?p=987

      “5. Wealth should not be inherited
      This is controversial as well, but necessary if we are to level the playing field. If we can agree that a person should not have privilege in life by virtue of being born white, then we should also be able to agree that a person should not have privilege by virtue of being born wealthy.”

      My attempt here, which may have fallen flat, is to point out that one approach to addressing historical inequality reinforces the differences between the oppressor and the oppressed (and tends to stoke feelings of guilt in the former and resentment in the latter), while another approach reinforces our shared humanity and a desire to live in a world in which these differences (race, culture, class, religion, etc.) no longer determine privilege in life or access to opportunity. It seems to me that by and large the modern social justice movement has chosen the divisive approach, to its lasting detriment.

      Mark

      • Goran says:

        Thanks!
        Indeed, your view on inheritance as expressed in that earlier post is very, very similar.

        I missed this part: “and we must cast judgment on those who are not fully committed to this work”
        Judgement and blame and outcasting is probably not useful. Better to just take the money.

        Goran

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