The World Health Organisation (WHO) is once again walking back one of its controversial statements, this time surrounding asymptomatic transmission of the coronavirus, reports The Hill.
A top WHO official, Maria Van Kerkhove, is walking back her earlier claims that the possibility of an asymptomatic carrier of COVID-19 transmitting the virus was “very rare”. The report says Van Kerkhove on Tuesday walked back on her Monday claims – which were met with stern scepticism from health officials throughout the world – saying that her original comment was based on just two or three studies and that it was a “misunderstanding” to say asymptomatic transmission is rare globally. “I was just responding to a question, I wasn’t stating a policy of WHO or anything like that,” she said.
The Hill reports that while this might seem just a subtle misstep to some, Van Kerkhove’s comments are the latest in a series of confusing policy implications coming from the WHO, which has previously flip-flopped on the effectiveness of healthy people wearing face coverings. And, by now, most all are in agreement that the organisation did not do enough to push Beijing to alert the world of the seriousness of the novel coronavirus.
The report says for the millions of Americans who have not been able to hug their parents or grandparents for months, who are out of work and struggling to put food on the table or who may be hesitant to join a protest for fear of being infected, Van Kerkhove’s Monday comments and subsequent walk-back are rightfully infuriating.
Deborah Birx, a key member of the White House coronavirus task force, has continuously highlighted the conundrum of asymptomatic carriers and, supposedly, asymptomatic spread was (at least part of the) basis for shutting down the economy and instituting social distancing requirements.
The Hill report asks with the WHO continuously contradicting itself on disseminating critical information on the virus to the international community, with disinformation spreading perhaps just as fast as COVID-19 on the internet and with the White House coronavirus task force all but eliminated from public view, where are we to turn for information we can trust?
Will it be organisations like the WHO, the White House, governors and mayors across the country? Or should we trust our own instincts and take it upon ourselves to protect our families and friends?
The report says the staggering lack of global leadership could very well have a more disastrous impact on the future of international cooperation and the global order than the virus we are all fighting.
The clarification comes after the WHO’s original comments incited strong pushback from outside public health experts, who suggested the agency had erred, or at least miscommunicated, when it said people who didn’t show symptoms were unlikely to spread the virus, reports Stat News. Some of the confusion boiled down to the details of what an asymptomatic infection actually is, and the different ways the term is used. While some cases of COVID-19 are fully asymptomatic, sometimes the word is also used to describe people who haven’t started showing symptoms yet, when they are pre-symptomatic. Research has shown that people become infectious before they start feeling sick, during that pre-symptomatic period.
At one of the WHO’s thrice-weekly press briefings Monday, Van Kerkhove noted that when health officials review cases that are initially reported to be asymptomatic, “we find out that many have really mild disease.” There are some infected people who are “truly asymptomatic,” she said, but countries that are doing detailed contact tracing are “not finding secondary transmission onward” from those cases. “It’s very rare,” she said. She added: “We are constantly looking at this data and we’re trying to get more information from countries to truly answer this question.”
Stat News says to some, it came across as if the WHO was suggesting that people without symptoms weren’t driving spread. Some studies, however, have estimated that people without symptoms (whether truly asymptomatic or pre-symptomatic) could be responsible for up to half of the spread, which is why the virus has been so difficult to contain. Isolating people who are sick, for example, does not prevent the possibility they already passed the virus on to others. Some modelling studies have assumed quite widespread asymptomatic transmission.
“The WHO created confusion yesterday when it reported that asymptomatic patients rarely spread the disease,” an email from the Harvard Global Health Institute said Tuesday. “All of the best evidence suggests that people without symptoms can and do readily spread SARS-CoV-2, the virus that causes COVID-19. In fact, some evidence suggests that people may be most infectious in the days before they become symptomatic – that is, in the pre-symptomatic phase when they feel well, have no symptoms, but may be shedding substantial amounts of virus.”
Their point: People not showing symptoms can spread the virus, whether they ultimately feel sick or not. That’s why wearing masks and keeping distance are so important to limiting transmission.
Van Kerkhove acknowledged Tuesday that her use of the phrase “very rare” had been a miscommunication. She said she had based that phrasing on findings from a small number of studies that followed asymptomatic cases and tracked how many of their contacts became infected. She said she did not mean to imply that “asymptomatic transmission globally” was happening rarely, because that has not been determined yet.
Stat News says that determining which routes of transmission are driving most of the spread of the virus is crucial so health experts can develop the right strategies to combat the virus. At the WHO event Tuesday, officials stressed that even as scientists are still learning more about the virus and how it spreads, countries have demonstrated that the best tactics to address the pandemic include isolating cases, contact tracing, and quarantining contacts — as well as hand hygiene and respiratory etiquette.
With those measures, “We won’t stop all transmission, but what we do is, we suppress transmission,” Mike Ryan, the head of WHO’s emergencies program, said Tuesday.
Other unknowns the WHO experts raised Tuesday include how asymptomatic or pre-symptomatic people are spreading the virus if they are not coughing – it could be that they still expel infectious droplets through singing, yelling, or even talking – as well as the percentage of all COVID-19 cases that are asymptomatic.
Based on what’s been seen so far, asymptomatic people tend to be younger and not have other health issues, Van Kerkhove said Tuesday, though she cautioned she didn’t want to generalise.
In addition to the studies about asymptomatic transmission that Van Kerkhove referred to, the WHO has also received data from member countries that “suggests that asymptomatically-infected individuals are much less likely to transmit the virus than those who develop symptoms,” according to WHO’s interim guidance on masks issued last week.
Stat News reports that outside experts have called on the WHO to release that data.
Both outside experts and WHO officials have acknowledged that detecting asymptomatic spread would be really difficult, and just because scientists haven’t seen something occurring often doesn’t mean it’s not happening. “Every question we answer, we have 10 more,” Van Kerkhove is quoted in the report as saying.
[link url="https://thehill.com/homenews/coronavirus-report/501877-coronavirus-daily-update"]Full report in The Hill[/link]
[link url="https://www.statnews.com/2020/06/09/who-comments-asymptomatic-spread-covid-19/"]Full Stat News report[/link]