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A New Study Indicates Asymptomatic People are Still Highly Contagious

A daily Covid-19 update from Andy Slavitt, former head of the Centers for Medicare and Medicaid Services

There’s a new project called Covid Exit Strategy. The aim is to help states and the public see which steps have been taken towards protecting the public and opening the economy. It is brought to you by the amazing Ryan Panchadsaram. He was one of the key people on the Affordable Care Act turnaround team. He does in hours what armies of people take months to do.

Ryan, with a little help from United States of Care, accumulated the various metrics organizations have put together to make progress in the states. Progressed is calculated based on how many of the 20 identified interventions are being implemented. Most valuably, there is a layout of missing actions, and a process for states to report updates. This is by no means complete and there are already things that will need to be added as they are available. Check it out at covidexitstrategy.org.

There is more we don’t know than know about Covid-19. We are running so many hypotheses right now?

  • How many positive cases are there?
  • How many people are asymptomatic?
  • What accounts for severity of symptoms?
  • Who is most infectious? 
  • Which drugs work when?
  • How does immunity work?

 There are different kinds of people working on Covid-19: those who say they “know”, those who say they “think”, and those who say “we don’t know.” I’m excited to talk to Nate Silver about it this week on my podcast In the Bubble.

In the meantime we will be jumping on data and studies where we can find it. We don’t have time for peer review or double blind studies in a crisis. Here Scott Gottlieb points to a study on one of the major curiosity points — asymptomatic spreaders.

The picture of a large number of asymptomatic hosts is a chilling one. One asymptomatic spreader can spread Covid-19 to 9,537 patients in 40 days. (Using 10 generations & r0 of 2.5). If 40% of those people have no symptoms, the impetus for them to continue to stay home is lower.

With more asymptomatic people, some would argue that means it’s less deadly since the case fatality rates (CFR) is lower. I would argue that feature makes it more deadly. Cognitively when we come in to contact with asymptomatic people, we feel less reason to worry.

If the report is correct, asymptomatic people are just as contagious. To restate me earlier point, we don’t know. We just don’t. But it pays to prepare for the worst and that’s why all those measures on covidexitstrategy.org are so important.


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