I wanted to draw your attention to a piece at RealClearScience that I found thought-provoking. It’s long and a bit hard to excerpt meaningfully but bear with me. Written by a physician in Hawaii it takes as its point of departure this anecdote:
What most caught my interest back in April were the reports from some of the seemingly worst places to catch Covid-19 — prisons and meat processing plants — showing that well over 90% of those testing positive were displaying no symptoms whatsoever. How could this reconcile with a disease we were told had only a 40% asymptomatic rate? The question literally kept me up some nights; and finally I decided that it must have to do with “cafeteria settingsâ€: all these places shared the common feature of large congregate gatherings in big spaces with shared air.
Like many of the theories that have been cooked up by non-epidemiologists in the past six months, this one had holes in it. That was made clear to me last month in a disturbing outbreak in my home state. An airline training, with reports suggesting a median participant age in the 30s, held in a very large room, with appropriately distanced desks, and masks used during interactive sessions, resulted in at least 6 of the 8 positive cases being significantly symptomatic, with 1 of the 8 students hospitalized, and another dying. Why did this congregate setting lead to such severe disease?
Studying outliers can get an amateur statistician into trouble. However, when apparent outliers are not anomalies but rather quite common, it is time to adjust our perspective.
and is in essence a speculation about this:
…studying how asymptomatic outbreaks differ from severe outbreaks might point us towards the most important ways we can soften future waves of this pandemic. Covid-19 cases are going to happen. Manipulating them toward being mild cases could be our goal. Understanding the environments that have been associated with the highest rates of asymptomatic Covid-19 could allow Americans to gather together to work and study without the level of illness and death we have seen thus far.
Others might find it less thought-provoking than subversive or wrong-headed. I’ll be interested in reading the reactions of others.
As usual the inevitable question that came to me from the piece was, if true what are the policy implications? Of this I am unsure at this point but it certainly looks to me as though, if the author’s conjectures are true, we’ve been going in the wrong direction for some time.
The second question that frequently occurs to me is how would you go about disproving the author’s conjectures? I’ll be interested in getting some ideas about that as well.






