{"id":186872,"date":"2021-06-14T12:01:20","date_gmt":"2021-06-14T11:01:20","guid":{"rendered":"https:\/\/www.transcend.org\/tms\/?p=186872"},"modified":"2021-06-13T04:46:53","modified_gmt":"2021-06-13T03:46:53","slug":"pre-symptomatic-transmission-is-very-real","status":"publish","type":"post","link":"https:\/\/www.transcend.org\/tms\/2021\/06\/pre-symptomatic-transmission-is-very-real\/","title":{"rendered":"Pre-Symptomatic Transmission Is Very Real"},"content":{"rendered":"
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Fact or fiction? Pre-symptomatic transmission of the coronavirus (MIT Medical, May 2020)<\/p><\/div>\n

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12 Jun 2021 – Pre-symptomatic transmission is real. But face masks still don\u2019t work.<\/em><\/strong><\/h3>\n<\/blockquote>\n

Because many authorities justified mask mandates with pre-symptomatic or asymptomatic coronavirus transmission, many skeptics and critics tried to argue against<\/em> the existence or importance of pre-symptomatic and asymptomatic transmission. But pre- and asymptomatic transmission is real for the same reason that face masks don\u2019t work: aerosols<\/strong>.<\/p>\n

In fact, numerous studies have shown that Sars-CoV-2 respiratory viral load<\/strong> peaks shortly before<\/a> or shortly after<\/a> symptom onset (see diagrams below). Once symptoms become apparent, it means the immune system has kicked in and viral load decreases rapidly.<\/p>\n

The idea that only symptomatic people spread viral particles, by sneezing or coughing, is based on the obsolete \u2018droplet model\u2019<\/strong> of virus transmission. In reality, transmission occurs primarily, and perhaps almost exclusively<\/a>, via inhaled aerosols produced when breathing, talking, singing, coughing, or whatever. Droplets, by definition, cannot be inhaled.<\/p>\n

Skeptics often point to a famous Wuhan study<\/strong>, published in November 2020 in Nature Communications<\/a>, that allegedly showed that asymptomatic transmission is a myth, as even a commentary in the BMJ<\/a> argued. In reality, the Wuhan study was a post-lockdown PCR study which tested 10 million Wuhan citizens in late May 2020 and found 300 who still<\/em> had a positive PCR test.<\/p>\n

But as the study notes, none of these people had positive virus cultures. Thus, these 300 cases were classic post-infectious high-CT PCR positives<\/a>, who obviously couldn\u2019t infect anyone anymore. In other words, the famous Wuhan study said nothing at all about pre- and asymptomtic transmission.<\/p>\n

(Another common misunderstanding about Wuhan is the idea that the city turned into a major coronavirus hotspot. In reality, antibody seroprevalence in Wuhan was only about 1% to 5%<\/a> by May 2020. At the same time, New York City had already a seroprevalence of at least 20%<\/a>.)<\/p>\n

Pre-symptomatic transmission is already well known<\/a> from influenza<\/strong>, and it would have been truly surprising if it had played no role at all in the case of the new coronavirus. Indeed, it looks like pre-symptomatic transmission is even more important<\/em> in the case of the new coronavirus, with estimates ranging between 30% and 60%<\/a> of all virus transmission.<\/p>\n

Pre-symptomatic or \u201cstealth\u201d transmission is also a major reason why Sars-Cov-2 could spread so rapidly and create a global pandemic<\/strong>. The real \u2018myth\u2019, or rather exception, might be sick people coughing straight into the faces of healthy people.<\/p>\n

In contrast to transmission by pre-symptomatic people (i.e. a few days or hours before symptom onset), transmission by people who remain fully asymptomatic<\/strong> is a bit more complex to evaluate, because this group includes some people with a low viral load, which makes them less contagious. In addition, fully asymptomatic people are much more difficult to detect. However, nobody knows beforehand if they will develop symptoms or not, and as a Swedish doctor recently showed<\/a>, even fully asymptomatic transmission has been documented in several carefully designed studies.<\/p>\n

In conclusion<\/strong>, pre-symptomatic aerosol transmission is very real and has played an important role in driving the coronavirus pandemic. For the very same reason, face masks, \u2018temperature screening\u2019, reactive lockdowns, and even \u2018contact tracing\u2019 (beyond the very early phase) have not worked.<\/p>\n

Scientific diagrams<\/h3>\n
A) Viral load and culture probability over time<\/strong><\/h5>\n

Rapidly decreasing viral load and (especially) infectiousness.<\/p>\n

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Viral load and estimated infectious virus shedding time series (Jones et al, May 2021)<\/p><\/div>\n<\/figcaption><\/figure>\n

B) Symptom onset compared to peak viral load<\/strong><\/h5>\n

Mean delay between peak viral load and self-reported symptom onset is 4 days.<\/p>\n

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Patient-reported onset of symptoms compared to estimated day of peak viral load (Jones et al, May 2021, Figure S15)<\/p><\/div>\n<\/figcaption><\/figure>\n

C) Temporal pattern of viral shedding<\/strong><\/h5>\n

Rapidly decreasing viral load (PCR ct value) after symptom onset.<\/p>\n

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Temporal patterns of viral shedding (He et al, April 2020)<\/p><\/div>\n<\/figcaption><\/figure>\n

D) SARS-1, SARS-2, MERS: Viral load vs. symptom onset<\/strong><\/h5>\n

SARS-2: Peak viral load near symptom onset \u2013 easy transmission. SARS-1 and MERS: Viral load increases only after symptom onset \u2013 poor transmission.<\/p>\n

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SARS-1, SARS-2, MERS: Respiratory viral load by day of symptom onset (Benefield, September 2020)<\/p><\/div>\n<\/figcaption><\/figure>\n

E) Aerosols: Respiratory pathogen transmission routes (2018)<\/strong><\/h5>\n

Aerosols as the primary mode of transmission, even at close range.<\/p>\n

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Respiratory pathogen transmission routes (Ian Mackay, 2018)<\/p><\/div>\n<\/figcaption><\/figure>\n

See also<\/h4>\n