Understanding the Dark Matter of the COVID-19 Pandemic — Why Detecting Asymptomatic Cases Matters

The real dance — Tango in the streets of Buenos Aires

Disclaimerthis piece is intended as an exploration of the Deep OS of the COVID-19 pandemic. It is hoped that by more deeply understanding the dynamics of how humans process knowledge of the pandemic, we will more quickly and effectively restore civil society.

As we are now a solid six weeks into the COVID-19 pandemic, we still have a poor idea how all this is going to end. To read the papers, as well as listen to many experts, all of them are predicting 12-18 months, with most of this spent in lockdown. Essentially until a vaccine, which they also will predict will take 12-18 months to develop, is tested and deployed. This is a safe scientific position, predicated on past practice.

This is also a perilous socio-political position to take, because there is almost no way that a society, regardless of how you feel about the virus (conspiratorial scourge, or deadly threat,) will stay locked down inside our houses for that amount of time. What such predictions actually do is increase the potential of a loss of authority of government, where people will do whatever they think they should regardless of the consequences. This is ALREADY happening with more extreme elements of right-wing groups, like the Bundy family, who already faced down federal agents with guns over grazing rights adjacent to their land in Nevada. And I do believe that the impact of the pandemic will be far worse without coordinated action.

Additionally, I do believe that if we understand the dynamics of the pandemic, and how societies achieve larger herd immunity, we can manage impacts as we move along. One person who will continue to read the public mood will be our pathological narcissist-in-chief, who will pronounce whatever he feels needs to be announced to maintain his status with his base. As I’ve written before, narcissistic personalities have a super-radar that enables them to read the national mood. And while Democrats might feel ennobled sticking up for people like Dr. Fauci, and rational people SHOULD listen to him (I do) , with draconian timelines, there is a strong possibility that the Democrats will essentially throw the November election to Trump.

The correct, higher-level strategy to create has to leverage two things. One is a deep understanding of viral epidemics, and how populations achieve herd immunity through asymptomatic filling of populations in general, as well as this one in particular. The second is the need to adopt an Observe-Orient-Decide-Act (OODA Loop) strategy for particular actions in uncertain times. While it may appeal to offer short-term gain by announcing long-time reopening strategies — that they offer care and concern for citizens — the reality is that such long-term strategies actually offer lots of avenues for long-term failure and embarrassment. We are learning about how our modern society reacts to this type of situation as we roll along. And our top political figures need to learn how to embrace this. The minute we lose the ability to incorporate new knowledge along a moving timeline, not only the virus will beat us — but we’ll likely get four more years of Trump. And that would be disastrous on many fronts, especially for those of us wishing for a more coherent federal narrative.

There are many reasons for more optimistic timelines in reopening our society. People like Bill Gates are building simultaneous vaccine factories. There is the possibility of a better combination of anti-viral medications. But the biggest is the timeline of systemic evolution of the virus itself. And the largest part of that systemic evolution is our understanding of how populations with asymptomatic characteristics evolve immunity over time.

Why should you care about asymptomatic COVID-19 carriers? One thing that is coming to the fore, that I discussed in this past piece, is the effect of dose on whether one gets the full-blown Death COVID experience. A far higher percentage of health care professionals get the bad COVID and die. That we know. We also have immunocompromised individuals who also, when they get the disease, are far more likely to die. All this makes sense inside a larger narrative. Healthy people need a bigger dose to overwhelm their immune systems. Unhealthy people need a lesser dose.

What consists of a dose? No one can answer that question at this time. But once again, there are things we know. Coughing and spraying creates droplets that contain the virus. The bigger the droplets, the larger the number of viruses inside the droplet by a volume/cube law. What that tells us is that virus spreaders are primarily NOT asymptomatic. They’re coughing and spraying. And while you can certainly pick up stuff on your hands (wash your hands!) you’re far more likely to get this if you’re in the room with someone coughing. All of this stuff is probabilistic at this point. But there are obvious ways of decreasing your odds. Part of this is things you can do (avoiding exposure and dose.) Part of this are things that other people can do (wearing homemade masks.)

In the last couple of days, we have seen some very early, encouraging data-driven results regarding asymptomatic statistics for COVID-19. First one I saw was results from a Lombardy Italy blood bank that showed 70% COVID antibodies in all blood collections. Of course, this is anecdotal — but in general, people will not give blood if they think they are sick, or have been sick. Another paper here showed a preliminary retrospective on China that showed 80% of people were asymptomatic. I was sent another paper on influenza asymptomaticity — there, the numbers ranged from 18-25%, to a more likely 65-85% — the difference being the larger numbers were indicative of a more diverse/heterogeneous population.

Asymptomaticity, if the methods of spread are from aerosol or fluid droplet transfer, once again, are reasons to be optimistic. It means that the virus, much like cowpox inoculated against its more deadly variant, can spread and deliver immunity. And indeed, this is how many vaccines work. A weakened form of the virus is injected in a person, whose immune system kicks into gear and delivers protection.

Interestingly enough, this is not the first virus to deliver some level of immunity in a larger population after a death spike. I just finished reading Buddy Levy’s book, Conquistador, that documents how Cortes conquered the Aztecs. In the middle of the fight for the Aztec capital, Tenochtitlan, a Spanish slave carrying smallpox into an Indian household was the vector for the disease, which Levy and Jared Diamond document the plague as killing approximately 40% of the population. It is hard to pin down the exact percentage dead (Diamond says 40%) but the reality is that there were plenty of Aztecs left to wage a protracted conflict against the Spaniards. What that also means is that one of our deadliest scourges — smallpox — in an urban population, managed also to burn through a population, both symptomatically and asymptomatically, and deliver immune individuals out the other side. Enough to disrupt the dynamics of the epidemic. Asymptomaticity is a real thing.

That said, asymptomatic spread of immunity is NO reason to have chickenpox parties, or participate in anti-vaxxer nonsense. Rather, we need to understand asymptomatic behavior through a different lens — the physicists’ notion of Dark Matter. For those that don’t know what Dark Matter, it is the stuff the universe is made of that is relatively undetectable, but shapes, through gravity, our galaxies and star systems. And just like Dark Matter, asymptomaticity is out there, and we’ve done a poor job of measuring it. But if we understand it, we can use it to shape strategies for reopening our societies, in an incremental, OODA-loop manner.

First off is how social distancing and flattening the curve actually benefit spread of larger, society-wide immunity. On the surface, social distancing is cut-and-dried. You stay 6′ away from everyone, and regardless whether you have the virus, or someone else does, you’re 6′ away and can’t get the virus from them.

The reality is that social distancing works in a haphazard fashion. The 6′ distance number is kind of a guess, but not supported by anything resembling real science. But there is a primary benefit — it keeps high dose individuals, through public shaming, from circulating in society.

This was not always the case. During the week before Spring Break at my university (around the beginning of March) COVID was starting to rear its ugly head. We were called into a faculty meeting and told explicitly we were not allowed to tell any student displaying any COVID symptom to exit our classroom. By that time in my own classes, I had built enough social capital, and discussed the pandemic enough, that no sick students came to class. Yet it was eerie, even for me, as students started dropping out of my class — one that always had close to 100% attendance.

What social distancing actually does — causing quarantine of victims displaying active symptoms — is two-fold. As mentioned above, one is isolating high dose individuals from the population. But the other thing is that low dose individuals are far more likely to continue to circulate — and it gives them MORE TIME to do so. Asymptomatic individuals do indeed continue the spread of the virus. But as people wear masks, and wash their hands, it inherently reduces the dose of the virus they receive. That gives their immune systems more time to adjust and combat the virus.

This notion of measuring what isn’t there has confounded statisticians in the past. The best example in history of this involves one of my heroes — Abraham Wald. Wald was given the task of increasing bomber survivability for raids over Germany. People originally were looking at B-17s, and arguing for increasing armor over bullet holes in returning planes. It was Wald that argued a metacognitive opposite — we needed to look at the areas on the returning planes that had NO bullet holes, and armor those spots, as it was likely that the planes that had been shot in those areas were the ones that were NOT coming back. The problem with epidemiologists, similar to my hero, Abraham Wald’s work, with B-17 bombers in WWII, is that we have to reframe our efforts to measure the percentage of people who display no symptoms, instead of our current situation where we test people who already quite obviously have the disease. This also leads to the notion that the most important testing priority we can have has to be shared between active testing for the disease, as well as antibody tests to determine asymptomatic percentages.

What does this information inform? When confined to specific populations (like the police!) we can understand when population saturation of the pandemic has occurred. NYPD officers are reporting 20% of their population have active symptoms. What this really means is that, if the asymptomatic percentages are to be believed, that functionally every cop has COVID.

Such information is simply invaluable, because now we can create strategies to deal with people in our population who suffer from the fate that any dose is too large — the immunosuppressed. When you accept that every cop has COVID, one now generates protocols and testing for both the cops, as well as the immunosuppressed, to make sure, regardless of the circumstance, the disease is not spread to those it will kill. Needless to say, there are other subpopulations we can monitor within the context of protecting the immunosuppressed. And then this also leads us away from large-scale population monitoring for an indefinite future. Testing of the sick will still matter — there will still be a need for an “all clear” for a person coming out of quarantine. But getting a clean bill of health for most nominal circumstances (health care workers will still need to monitored somehow for dosing limits, which is NOT happening now) will allow a pretty dramatic reopening of society.

It also informs the weeks necessary for state-wide social distancing. Asymptomatic rates at a given level could then be mapped to herd immunity requirements, and then interdiction of individuals with the virus could be scaled back.

In a world without resource constraints, we might be able to have a meditative retreat for 12 months in our home. And if some of the more hyperbolic narratives are to be believed, the minute we come out of lockdown, the virus will explode again — so we have no choice but to wait for the one past fix we know can work — a vaccine.

But that then asks to sideline much of what we actually know about spread of the virus — that it mostly floats in aerosols and droplets. We also would have to realize that masks would make no difference — even though there is much evidence in a variety of countries that they do. And I’ve written this piece on the whole evidence stack for masks.

Until we have extensive antibody testing (Taiwan has already developed the test and is scaling production) we are stuck with the tools we have. But now, it may not be so stupid to stop travelers who display a high fever at the border, or in an airport. The deep insight of what was going on might not have been part of the decisionmaking process regarding COVID initially in Asian countries. But it turns out that luck was on their side.

And the other part of this — adapting an OODA-Loop philosophy — is also something we should consider. Singapore went back into lockdown a couple of days ago, with the intent of it lasting only a month. Yet at the same time, the Prime Minister of Singapore announced larger exemptions for critical industries. All lockdowns are not equivalent, and there is evidence Singapore is acting far more strategically — in line with the kind of logic I discussed regarding police above — than a “one size fits all” solution.

The political language then also has to change — from one of surety, which we most certainly do NOT have — to solidarity — we are all connected together, and we share a common fate. And we will manage this thing together so that the maximum number of us come out the other side. These are not strategies that necessarily require a vaccine. But they require the one thing we must strive to evolve to — a greater sense of empathy and connection in our population.

And if we focus thusly, we might find that other problems we struggle with greatly in our society may start to recede. We can’t know everything about an uncertain future. But we can know that we share a common future — as well as a sense of community and love.

PS — One of my favorite poems — advocating for an OODA perspective toward life and crisis, by Edgar Lee Masters — The New Spoon River

Robert Sincere

I built the house of my life

On the rock of invincible character,

Guarding it against the descending rains

Of regret for misspent days,

And against the floods of unrighteous living.

But an earthquake struck me:

The disaster of placing all confidence

In the integrity of man,

And in God’s moral governance.

Then I saw that I should have builded

On the shifting sands of selective prudence.

3 thoughts on “Understanding the Dark Matter of the COVID-19 Pandemic — Why Detecting Asymptomatic Cases Matters

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