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COVID-19 - How and Why the Virus Spreads Quickly
This is another in our series of coronavirus episodes of Scientific American’s Science Talk, posted on March 23, 2020. I’m Steve Mirsky.
In this two-part episode, our contributing editor W. Wayt Gibbs in Washington State—a state hit early and hard by COVID-19—reports on scientists’ fast-evolving understanding of this new coronavirus and the probable trajectory of this pandemic.
Today, in part one, he focuses on why the new coronavirus is spreading so quickly and is so difficult to control.
Check back in tomorrow for part two, when Gibbs looks at computer models that are predicting how long we’ll need to shut down large parts of society to prevent hospitals from being overwhelmed. He also looks at how emerging tests for immunity to the virus could pose thorny ethical issues in the months to come.
Wayt recorded this episode on March 22. The first voice you hear: Governor Jay Inslee of Washington.
JI: “It is not rhetorical or hyperbolic when I say that everyone needs to change their behavior, change the way that we live—temporarily—if we are going to prevent significant loss of life for the people we love in the state of Washington. And when I say everyone, I mean, frankly, everyone. Because we all are potential transmitters of this virus, and we all, to some varying degree, are potential victims of this virus.”
WWG: That was Governor Jay Inslee, pleading with people in my state on March 20 to stay home and stay away from each other. All around the U.S.—and around the world—governors and mayors and prime ministers are urging, begging—in many places even ordering—their citizens to shelter in place.
But it’s not easy to resist our hardwired desires to spend time with our friends, to visit our parents and grandparents, to go to work.
So here in Washington, like in lots of other places, compliance has been—kind of spotty. Traffic on some of the major highways here—a good proxy for human intermingling—is down only about 20 percent or so from normal.
But as scientists learn more about the SARS-CoV-2 virus and the COVID-19 pandemic, it’s becoming apparent that we’re facing a much more serious situation than most of us thought even a couple weeks ago.
Let me give you one example from here in Washington. On March 10, despite stern official warnings not to gather in groups, 56 people met for an event in Skagit County. All of them were apparently healthy at the time. But 10 days later, 43 of those 56 people have either been confirmed to have COVID-19 or are showing symptoms of the disease. Experts suspect that one or more people in the group was a so-called “supershedder,” someone who has yet to show symptoms but is transmitting lots of infectious virus.
In this two-part episode, we’ll look at several new research studies and new tests announced this week that may help answer four crucial questions.
Question 1: Can you catch this disease from someone who isn’t in the same room as you?
Question 2: Can you catch it from somebody who isn’t sick—and is there a way to test for that?
Question 3: What combination of shutdowns and closures will do the most to minimize the number of people who die from the pandemic? And how long will those tough restrictions need to continue?
And question 4: How will each of us know when we’re immune and no longer need to worry about catching COVID-19 or giving it to someone else? And what will we do with that information once we have it?
Let’s start with that first question: Do you have to come in contact with someone who has the virus—or with droplets they are spraying from a cough or a sneeze—to catch it?
Well, that’s almost certainly the easiest way to get it. So keeping your distance from others greatly reduces your risk of infection.
But in a study out this week in the New England Journal of Medicine, researchers at a Montana biohazard lab run by the National Institutes of Health confirmed what many experts had feared: this coronavirus can also be infectious outside of a living body—in some cases for days.
The other night I watched the 2011 movie Contagion, which certainly has some eerie parallels to the present. There’s a scene where Kate Winslet’s character, a CDC disease investigator, explains why that kind of durability is so troubling in a virus.
KW: “So at this point I think we have to believe this is respiratory—maybe fomites, too.”
“What’s that, fomites?”
KW: “It refers to transmission from surfaces. The average person touches their face 2- or 3,000 times a day—three to five times every waking minute. In between, we’re touching doorknobs, water fountains, elevator buttons and each other. Those things become fomites.”
WWG: The NIH researchers tested whether the SARS-CoV-2 virus can spread via fomites—which, by the way, is how you actually pronounce it. They sprayed infectious droplets onto cardboard, stainless steel and plastic. Then they checked the spatter as time passed to see how quickly the viral particles dried out and fell apart.
On cardboard, it took a good four hours before the amount of live virus started to fall significantly, and the surface remained quite infectious eight hours later.
So when an Amazon box appeared on my front porch a couple days ago, I was glad to see that the delivery man was wearing gloves. But after I opened the box, I still went to the sink and washed my hands.
On stainless steel—think railings, shopping carts, gas pumps, jungle gyms—the coronavirus remained infectious for more than a day.
And on plastic—so, our pens, our credit cards, our keyboards and keypads—it stayed viable for two to three days.
Here in the Seattle area, store managers and bus operators have been wiping down surfaces more frequently and making disinfecting wipes available at the door for customers to use. We now know that should be standard practice everywhere.
Inside that box I received from Amazon was a set of white cotton gloves that I had ordered for me and my family to wear when we go out.
Tests have shown that a standard face mask really doesn’t protect you from catching this virus because so much of the air you inhale leaks in around the edges rather than going through the filter. Wearing a mask is a nice courtesy, though, if you’re going to be around others who may be vulnerable.
But a pulmonary surgeon advised me to wear cotton gloves, as they do at his hospital, because the natural fibers trap the virus and it dries out and becomes inactive. Also, I find that wearing gloves helps me remember to avoid touching my face.
So we can get infected from people we never even see—from the fomites they leave behind.
But now let’s turn to that second question: Can you catch COVID-19 from someone who hasn’t tested positive or even from someone who may feel perfectly healthy?
Studies seem to confirm that the answer is yes. In a paper that appeared on March 16 in the journal Science, an international group of researchers analyzed data on the outbreak in China in January. They concluded that only 14 percent of COVID-19 infections were documented, meaning that 86 percent—that’s six out of seven cases—never showed up in the statistics as a confirmed case.
Here’s what Jeffrey Shaman of Columbia University, one of the authors of that paper, said about that in a news briefing last week:
JS: “These undocumented infections were about half as infectious per person as a documented case who has more severe symptoms and may be shedding more. Because, however, there are many more of these undocumented cases, it’s the undocumented infections that are driving the spread and growth of the outbreak.”
Shaman says these undocumented cases are mostly quite mild.
JS: “And so most people may not recognize that they may think they have another cold, or they may not even really recognize that they’re ill. If you were to project that number globally, given that we have 150,000 confirmed cases, it says that we’re approaching close to a million infections globally. Generally, you’re looking at about an order of magnitude more cases than have been confirmed.”
WWG: Of course, every day the count of confirmed cases rises. But the idea is that if you take the count today and multiply by seven, that’s a more realistic estimate of the number of infections to date.
So who is transmitting the virus? Obviously people who are very sick and have tested positive. Plus maybe seven times more people, many of them young, who have caught it but feel well enough that they wouldn’t think to get tested or to self-quarantine.
And then there’s a third group: the fast increasing numbers of people who are infected and who—five or 10 days from now—will fall ill and become a confirmed case but who feel perfectly fine at the moment.
In a preprint article published on March 18, researchers with the World Health Organization studied 94 COVID-19 patients in Guangzhou, China, to determine when they became infectious—and when they stopped shedding the virus. The scientists collected throat swabs from the patients as soon as they began showing symptoms and then tested them again every day for the following month.
They saw a lot of variation from patient to patient. But overall, the patients tended to become less infectious as their symptoms progressed. Through some calculations, the scientists concluded that these coronavirus patients shed the most virus, and were probably most infectious to others, up to two days before they started feeling ill. So these are people like Senator Rand Paul of Kentucky, who, we learned on March 22, has tested positive for COVID-19 even though he isn’t yet feeling any symptoms.
These WHO researchers estimate that around half of the people who caught this virus in Guangzhou got it from someone who was still feeling healthy at the time. And other studies from China have documented cases where patients have fully recovered from COVID-19 but continued to test positive for the virus for more than a week after their symptoms disappeared.
This phenomenon of presymptomatic and postsymptomatic transmission really complicates efforts to contain this virus, in particular because it will be a long time before we have enough coronavirus tests to check people who aren’t yet showing symptoms.
In a move to help ease shortages of coronavirus tests, the U.S. Food and Drug Administration last week gave emergency authorization to hospitals and labs to use a new automated test for COVID-19 that can detect infections in minutes rather than days. Cepheid, a biotech company in California, says it will start shipping the test kits this week.
The Cepheid test performs essentially the same real-time PCR process that existing tests do, just much faster, says Cepheid’s chief medical officer David Persing:
DP: “So what we’ve developed is a reference-lab-quality test that can be run at the point of care in about 45 minutes or less. You take a sample, put it into this new cartridge that we’ve developed and, about 45 minutes later, you’ll have the result. And that test can be run at the hospital as patients are being admitted. So the results are available much more quickly. And that means that those results will play into how those patients are managed: Who gets respiratory isolation. Who needs antibiotics? Who doesn’t need antibiotics? Those kinds of decisions can be made in real time.”
Persing says that while the test could be used for screening in the community—and may be sensitive enough to detect presymptomatic supershedders—initially it will be available only for hospitals to use on their patients and health care workers.
DP: “We think this will be a very important tool in being able to get rapid, actionable results to let patients know if they’re carriers even if they’re asymptomatic—to quarantine—and to know that they’re being quarantined for a reason, not because they may have hay fever or some other cause. But really give them a reason for quarantine.”
Faster, easier tests should help us get a better handle on the true extent of this pandemic. But these tests aren’t perfect. A number of studies, including one done by scientists at Wuhan University in February, have found that these RT-PCR tests we’re relying on today aren’t sensitive enough to reliably catch the infection in its early stages. So a negative test result is no guarantee that you’re not carrying the virus.
Nor does it tell you whether or not you are immune to the disease. But new tests for immunity are coming.
These characteristics of the new coronavirus—its ability to lie in wait on surfaces and to spread easily among people who feel fine or well enough—that is what make this virus so contagious and hard to stop, as Elizabeth Halloran of the Fred Hutchinson Cancer Research Center explained at a news briefing last week:
EH: “The basic reproductive number—that is, the average number of people that an average person infects at the beginning—is estimated to be about 2.5. And there are actually estimates that are higher.
“That’s before, of course, all this behavioral reduction and social distancing, which would reduce it. But it’s going to be difficult, even if it does go down somewhat seasonally in the summer, to bring that down necessarily below one.”
And until we can drag that reproductive number from 2.5 or so down to less than one, the pandemic will continue to accelerate.
In part two of this episode, we’ll look at how computer models of the pandemic are predicting when we’ll be able to emerge from our state of sequestration and start hanging out with each other again. Also in part 2, I’ll update you on antibody tests for immunity to the virus that are now emerging from research labs. And we’ll look at some tough ethical questions that society may confront as it uses this technology.
Until then, for Scientific American’s Science Talk, I’m Wayt Gibbs.
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