Post #656: You are, in fact, most infectious before onset of symptoms

What prompts this post is a report from someone who went to the Merrifield Post Office yesterday.  Crowded, people standing in line, no masks, chit-chatting with one another.  Standing 6′ apart, of course.

Folks, in the case of a deadly pandemic, stupidity is going to be punished.  Even with our low testing rate, the US has more cases per capita now than any other Western nation.  And one of the main reasons for that is that a lot of Americans are just too damned dumb to take this seriously, until there are bodies piling up in the streets.

And if that’s what it takes, you know what?  That’s exactly what we’re going to get.

We already have by far the worst outbreak in the world  And yet, most people continue to treat this like it’s somebody else’s problem.  Which is a good part of the reason that we have the worst outbreak in the world.

With the last few days of case growth, we have managed to break the downward trend in daily growth in Virginia.  We are no long winning this battle, here, in our state.  If you look at the last 28 days, the trend in daily growth in cases was good.  For the last two weeks, it was good, but not as good.  But this week, it stalled at 8 percent per day case growth.

At that rate, Virginia as a whole overtops its health care system in about 2 and a half weeks.  That’s the point at which we’ll have 30,000 cases, which is my estimate of the case load that would consume more than every empty bed and ventilator in the Commonwealth.  And at that point, we start simply leaving people to die at home, because there’s no place to put them in the hospital.

Once again, a trend is a trend until it ceased to be a trend.  Our positive trend in case growth ceased this week.  Maybe that will change.  Maybe it won’t.

Yesterday, in Nature Medicine, there was a study published that tracked patients from infection through onset of symptoms.  They concluded that a) the typical individual is infectious for about three days before onset of symptoms, and b) they are most infections in the period just prior to onset of symptoms.  I don’t think anyone who has been tracking this was surprised, because transmission by asymptomatic individuals is the pretty much the only way you could explain the data.

The person you are talking to may be infectious, but not showing symptoms yet.  YOU may be infectious, but not showing symptoms yet.  The dumbest thing you can do is stand around talking to a bunch of strangers.   For no particular reason.  Just to pass the time of day.  (No, sorry, the dumbest thing is doing that without wearing a mask of some sort.)

People are not taking this anywhere near seriously enough.  It’s a good guess that something like 0.5% of the entire Fairfax County  population is walking around in an infectious state (Post #624, 4/12/2020).  (But that’s almost a week old, so … more like 1% now).  There are tons of people walking around with COVID-19 among the younger population who will never have significant symptoms (Post #632, 4/14/2020).  You can get infected via short-range aerosol transmission, which means just by being in the same office as somebody and talking to them (Post #631).

And, for sure, there have been instances of long-range (airborne) aerosol spread (Post #585).  I’d bet a large sum of money that the shutdown of meat packing plant after meat packing plant is occurring because those places a perfect storm of conditions promoting aerosol (airborne) spread, and that’s what explains the rapid and broad spread of disease there (Post #655).

At this point, my guess is that the CDC’s recommendation of “social distancing” alone is going to go down as the single biggest blunder in public health history.  Followed by their failure to recognize that short-range aerosol transmission (by talking with somebody) is a common route of infection.  Combine that with a population that STILL won’t wear masks in public (let alone at work), and governments that are too damned stupid to require them.  Add in a dysfunctional Federal government that is pressuring States to remove lockdown restrictions.  Sprinkle in a shoot-yourself-in-the-foot shortage of proper masks.

Folks, we have the worst experience in the world so far, and probably less than 1% of the total US population has been infected at this point.

Do the math.  We have 37,000 deaths so far.  Deaths, as I noted in earlier posts, are a lagging indicator, because it takes some weeks to die, on average.  But that’s from infecting just 1% of the population or so.  So, if it gets to 10%?  That’s 370,000.  And if it gets to 70%?  That’s 2.6 million.  In a typical year, we only have 2.8 million from all causes.

Somewhere in that progression, when the bodies start piling up, and they start digging and using mass graves, some Americans will probably figure out that they need to take this seriously.  To the point of, I don’t know, maybe at least wearing a mask in public.

This is a Darwin test for the USA.  And we appear to be flunking.

I’m not sure I’m going to post anything more about this.  I’m tired of being Cassandra.  I’m tired of emailing my elected representatives and getting nothing.  I’m tired of the magical thinking of people who believe that, somehow, this problem is going to solve itself.

I’m going to start putting my energy into getting good and hunkered down.  Maybe making a few high-quality aerosol-filtering masks for the couple of friends who asked for them.  And hoping like hell I’m still alive by the time they develop a vaccine.

We have an average daily case growth rate, this past week, that will put us over the capacity of the Virginia hospital system in just over two weeks.  And we have a President who is egging on those who call for removing the only tools we have in place, right now, to try merely to keep the rate down to that level.  Ain’t nothing I can do about it now except keep my head down and try to protect me and mine.

I’ll see you on the other side.  I hope.