- The Washington Times - Wednesday, April 22, 2020

COVID-19 ranks as the Russian roulette of infectious disease: Some people get knocked out and others, such as Sen. Rand Paul, don’t feel a thing despite testing positive for the coronavirus.

The random nature of outcomes strikes at the heart of the challenge states and the federal government face as they attempt to reopen economies and try to root out asymptomatic people who might inadvertently spread the virus.

The White House coronavirus task force has pushed for a targeted approach, saying it’s best to inundate inner cities, nursing homes and other high-risk populations with testing instead of looking for a needle in a haystack.

“We went to the places where we thought it was most critical to find cases the earliest,” said Deborah Birx, the U.S. coronavirus coordinator.

States are moving in that direction. California announced plans this week to go beyond symptomatic people and prioritize homeless shelters, nursing homes and jails to root out cases hiding in plain sight.

Georgia is testing asymptomatic medical workers, law enforcement, first responders and residents and staff at long-term care facilities, as Gov. Brian Kemp starts to reopen gyms, nail salons and other businesses Friday.

Likewise, Michigan recently expanded its testing criteria to include essential workers who must report in person, whether they appear sick or not, and to all health workers and first responders.

“Obviously, looking for people who are vulnerable individuals is really important. That means health care facilities, nursing homes, assembly-line conditions, things like that,” said William Hanage, associate professor of epidemiology at Harvard T.H. Chan School of Public Health.

Pennsylvania says hunting down asymptomatic cases is a priority for the state, though it’s still a work in progress. It is expanding its testing program and “continuing to look at the latest science and research regarding asymptomatic individuals, and how we could work to better be aware of these cases,” health department spokesman Nate Wardle said.

The focus on asymptomatic people will be a key part of the next phase in the pandemic, as states try to reopen their economies while detecting those who might carry the virus in a shop, church or school without knowing it. Testing is limited, so states are picking their spots as they ramp up capacity.

Dr. Hanage said there may be clever ways to use digital apps that measure foot traffic and alert people if they had been potentially exposed to a known infected person.

“You’d be able to direct tests to those people — and if it was rapid enough, they would be able to figure out whether or not they were positive and currently asymptomatic themselves,” he said.

Most Americans know by now that older people and those with chronic conditions are at higher risk of landing in the hospital or dying from COVID-19, the disease caused by the coronavirus. For everyone else, it’s a complicated equation that starts with the “dose,” or how much virus a person was exposed to when infected.

“Usually, if you get a larger dose your incubation period is shorter and your illness is likely to be more severe,” said William Schaffner, an infectious disease specialist at Vanderbilt University. “You might just encounter a super-spreader. Some people simply put out more virus.”

Dr. Hanage said the mechanics of infection may explain some of the disparity between the rather sick and asymptomatic, citing reports of a choir practice that turned fatal.

Not only are the singers emitting the virus, but “the people who you are infecting are breathing very deeply, and it’s getting very deep into their lungs” he said. “So it could not only be a dosage effect but also something to do with the amount it gets into a particularly vulnerable part of the body.”

A person’s genes also play a part. Some people may be more vulnerable because of variations in the cell receptor where the coronavirus enters, while age and previous exposure to other coronaviruses could be a factor in how sick someone gets as the body attacks the virus.

“It’s a bizarre sort of situation that some people get very, very sick, even die from this, and some people get no symptoms,” Mr. Paul, the Republican senator from Kentucky, told “Fox & Friends” in an interview about his symptom-free bout of COVID-19. “There’s something about this illness that’s not just the illness but your immune response to it. And it may be some sort of genetic thing, that some people are genetically predisposed to an overwhelming immune response that ends up making the patient very sick, with their lungs filling up with fluid. And then other people like myself, get virtually no symptoms.”

Mr. Paul said he got tested because the virus was prevalent, and he had been traveling a lot. He attended a charity event in Kentucky in which an attendee later tested positive. The senator received his own positive test and quarantined in his basement.

“I had an extraordinarily mild case,” the senator said. “I had no symptoms, never had a headache, never had a body ache, never had a fever, never had a cough. I didn’t really have any symptoms.”

Massachusetts Gov. Charlie Baker on Wednesday said the share of asymptomatic persons could be far larger than anyone realizes, so it’s important to wear masks and maintain social distancing as his state tries to weather a surge in hospitalizations.

“We tested a nursing home — 98 people, 51% positive, nobody symptomatic,” Mr. Baker, a Republican, said at his Wednesday briefing. “I think it’s really important for people to recognize and understand here that one of the major reasons why distancing and why staying at home and why dealing with the consequences of all this is so important is because this is not like the flu. If you get the flu, you know it and everybody else knows it. But when it comes to this particular virus, there are a number of people who get it who don’t know it.”

Mr. Kemp, a Republican, is leaning on social distancing and hygiene to keep patrons safe as he lets gyms, nail salons and other business reopen in Georgia without ubiquitous testing to identify infected patrons.

“The fitness owners, I have great confidence in them spreading people out when they’re doing a workout,” Mr. Kemp told Fox News, when asked about asymptomatic spreaders. “Doing this additional sanitization that we’ve all learned how to do now and taking those precautions with hand sanitation, and having the folks working in the facilities wearing masks and other things.”

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