Are you infected without knowing it?

This post will attempt to answer the questions:

1. Can I be infected without knowing it?
2. If I don’t have symptoms can I still spread the disease?

One of the most challenging things with the COVID-19 pandemic is how rapidly information is changing. From one day to the next the recommendations seem to change making it almost impossible to keep up. At first this may seem like a flaw in the public health machine but often it is an unavoidable reality. The speed and extent of the spread of this virus is astonishing as you certainly have noticed. Decisions need to be made and interventions enacted on a global scale very quickly. This means that the decision makers have to decide what to do on the basis of imperfect and incomplete information. If they wait for more data to come in it may be too late. The downside is that the recommendations today may turn out to be wrong tomorrow as more research results come in.

Nowhere is that more evident than with the issue of asymptomatic spread and the recommendations for the general public to wear masks. Both the World Health Organization and the Centers for Disease Control and Prevention have repeatedly said that ordinary citizens do not need to wear masks unless they are sick and coughing.  This recommendation was partially driven by a fear of shortages of protective equipment needed in hospitals but also by an incomplete understanding of the numbers of asymptomatic carriers and how important they were in the spread of disease. This information is what drove the CDC and WHO only to recommend sick people wear masks

The problem is that more recent data has come in that shows a higher number than previously thought are infected with the coronavirus but have no symptoms. They are then spreading the virus around without realizing it. If everyone were to wear a mask this unknowing spread would decrease. On the Diamond princess cruise ship 18% of patients never had symptoms but could spread disease. A more recent study in Iceland was most concerning. They tested 10K people regardless of symptoms. Of the patients who had contracted the virus, half were asymptomatic.

The CDC may change its recommendations and recommend everyone wear a mask. I think this is a good idea. Most people think that they are wearing a mask to protect themselves from being infected by someone else. In reality the masks are to protect someone else from being infected by them.

This data also underscores the huge importance of mass testing. Mass testing without regard to symptoms would identify people who have contracted the virus without realizing it and allow them to take appropriate isolation precautions. This would prevent them from unwittingly spreading the disease. Ramping up of testing has been a massive failure here in the United States (I documented my personal experience here). Countries who are testing more can be less strict about their social distancing and isolation restrictions because they can focus all these energies on those who are actually infected as opposed to a our approach which is like hunting in the dark with a machine gun. You’ll likely hit the target but a lot of other things will get shot up in the process.

If you can’t get access to masks when you go out, this does underscore the importance of strict adherence to social distancing and quarantine recommendations. You may be infected without symptoms putting people around you at risk without realizing.

Hopefully more testing will become available in the United States. Regardless of what the President says, we are not testing nearly enough people nearly fast enough and it’s fueling the fire. Until testing becomes available, it’s probably best to assume you are an asymptomatic carrier and take appropriate precautions. You can check this link out to find out how to make a mask for yourself. Stay safe out there!