The Diamond Princess was the cruise ship quarantined in Japanese waters after one person who disembarked in Hong Kong tested positive for COVID-19. The outbreak on the ship has been intensively studied, with almost all of the 3,711 passengers and crew being tested for the virus, some more than once. Scientists found that 700 of them were infected with the virus, with a substantial proportion – 18% – being asymptomatic (i.e. showing no symptoms). Like most cruise ships, many of the passengers were elderly and these people are more likely to develop severe symptoms when infected, whereas young people are less likely to do so. Therefore, it is suspected that the share of asymptomatic people in the general populace is likely higher than the 18% detected on the ship1.
Vò is a town of some 3,300 people in northern Italy which recorded the first COVID-19 death in the country. The University of Padua, assisted by the Veneto region and the Red Cross, tested everyone in the town, twice. The aim was to study the transmission dynamics of the virus, and the categories of people most at risk. This led to the discovery of the decisive role in the spread of the virus played by asymptomatic people. When the study began on March 6, a little over three weeks ago, there were at least 90 infected people in the town.
Andrea Crisanti, an infections expert at Imperial College London, who took part in the Vò project said: “We were able to contain the outbreak here, because we identified and eliminated the ‘submerged’ infections and isolated them.” That is what made the difference. The research identified at least six asymptomatic people who tested positive for the virus. If these people had not been discovered, they would probably have unknowingly infected other inhabitants. In a letter to the authorities, professor of clinical immunology at the University of Florence, Sergio Romagnani wrote: “The percentage of infected people, even if asymptomatic, in the population is very high” and “the isolation of asymptomatics is essential to be able to control the spread of the virus and the severity of the disease.”2
Iceland is a relatively small nation, with a population of about 364,000, but it has a strong social democratic ethos and a strong healthcare system. It was one of the few countries to send bankers to gaol after their nefarious dealing led to the Global Financial Crisis, whereas most other countries threw money at them; but I digress. In Iceland, there has been an intensive effort to test as many people as possible, and currently it has tested over 11,000 people which, on a per capita basis is more than any other country (i.e. about 28,000 per million). Its eventual aim is to test everyone. Most other countries are only testing people with symptoms and those who have been in contact with people who have tested positive. The testing is not yet complete in Iceland, but the indications are that about half of all cases are asymptomatic. While this indicates that the death rate is lower than the 3.8% suggested by the World Health Organisation, it also indicates that the virus has likely already spread much more than we are aware.3,4
South Korea is one of the countries which has done the best in controlling the spread of coronavirus, and it is pertinent to realise that as soon as they were able, they started on a mass testing regime, and with a population of about 51.5 million, they have undertaken 6,764 tests per million people whereas the US, with a population of 329 million, has tested 1,048 per million. This is despite both countries recording their first COVID-19 cases on the same day. The number of new infections in South Korea rose rapidly in February. But since then, the country has seen the number of new infections fall. About 9000 South Koreans are infected, and 120 of them have died. There are now less than 100 new infections per day. South Korean officials have put up numerous checkpoints and tents, where anyone and everyone can get tested for coronavirus free-of-charge. The country has tested nearly 400,000 people. Every day, a further 20,000 people can get tested, including at 40 drive-through coronavirus test sites5,6.
Currently (28/3/2020), there have been 3574 recorded cases of COVID-19 in Australia of which 14 have died7. Over 181,000 tests have been carried out (about 7,300 per million)8, roughly about the same level of testing as South Korea. There seemed to be a flattening in the daily increase in the number of new cases at around about 380, but it has now started to climb again7, and it looks like the rate of increase has slowed, although the evidence for that is still a bit slim. This slowdown seemed to be most evident in New South Wales, with the number of new cases apparently peaking at 210 a couple of days ago, while yesterday it was 190. However, the increase over the last 24 hours had risen again7.
Australia used to only test people who were symptomatic, and if you weren’t symptomatic, you’d be turned away without being tested. Also tested were those who were returned travellers and those with close contact with an infected person. But testing remains restricted and doesn’t go far enough. Like South Korea, we should also be testing people without symptoms. In the United States, asymptomatic spread has likely driven the undetected growth of an epidemic that was only realised when the health system began overloading. We’ve seen the same in most of Italy (except for Vò) and Spain, which also initially restricted testing.9
A week ago, Germany banned all gatherings of more than two people to cut the rate of progress of infection10, and a day or so later, the UK did the same11. Germany currently has about 58,000 cases, with 433 deaths, while the UK has about 17,000, with 1,021 deaths12. It makes you wonder how many cases there would be in these countries if they had done this earlier
To illustrate what a shambolic mess the Australian government response to this pandemic is, Richard Flanagan gives an example. His nephew is a school teacher, and he sent Flanagan a text message explaining that he is still allowed to teach a class of 30 children but if he dies from the virus caught while teaching, only 10 people can come to his funeral. If he remarried only 4 others could attend, but if he called it a boot camp, 10 could attend13. This government response is confused at best.
Morrison has stated that he wants the response to be ‘scalable’ by which he means that as the pandemic gets worse, more restrictions will be put in place14. This is the wrong approach. It is shutting the gate after the horse has bolted. If you want to keep the number of lives lost to a minimum, then you test, test, test and lockdown, lockdown, lockdown. Isolating the symptomatic is all very well if you can find them all; meanwhile, the asymptomatic may continue the spread of the virus unseen15. The people most assisting the spread of this virus in Australia are not the asymptomatic, but the federal government.