On the Pains of Testing and Contact Tracing. It’s Worse than Folly

The sociologist W.I. Thomas famously said, “If men define situations as real, they are real in their consequences.” We call this the “Thomas theorem” or the “definition of a situation.” Folks would do well to include the Thomas theorem in their manner of thinking about the world around them. Our present circumstances illustrate the theorem’s power as well as anything could.

After more than a week of testing, officials in Detroit are finding about a quarter of the residents and staff at the city’s several nursing homes are infected with SARS-CoV-2, the virus that causes COVID-19. Half of those tested are asymptomatic. The nursing home population is expected to have fewer asymptomatic cases than the general population given that the power of the immune system declines with age. The death rate for those in nursing homes is also expected to be higher because of immune system decline, as well as critical comorbidities, including type II diabetes and cardiovascular disease.

In a story published last night by the The New York Post, “Testing shows at least 200K in LA County may have been infected with coronavirus,” journalist David Aaro of Fox News reports that the estimated SARS-CoV-2 infection numbers are 28 to 55 times higher than the confirmed cases Los Angeles County reported at the time of the study in early April. Recall that the Stanford University study of Santa Clara residents found the rate of infection to be 50-85 times greater than confirmed cases. See the podcast above to hear my discussion of this finding.

A few days ago, when I ran a calculation to estimate the proportion of the population with antibodies to SARS-CoV-2, I applied a factor of ten to confirmed cases at the time (see “Future Containment of COVID-19: Have Authorities Done the Right Thing?”). I estimated 1.2 percent of the US population with antibodies and complained that, if the lockdown is keeping the number of infections at bay, it is at the same time interfering with the benefit society would derive from widespread immunity to the virus. The University of Southern California and the Los Angeles County Department of Public Health had found that 4.1 percent of Santa Clara adult population has antibodies to the virus in their blood. This is still nowhere near where it needs to be to approach herd immunity, but one can immediately see that the number of those with the virus is many times larger than those previously confirmed cases. This is powerful confirmation of the the argument I have been making for weeks.

For those who might have supposed that my estimates were overplayed in order to downplay the threat (since I am clearly not a supporter of hysteria and lockdowns, my extrapolations may be perceived as biased), my extrapolations have been very conservative. I said at least ten to twenty times actual infections to confirmed infections and then went with the lower number. To be sure, I am not an infectious disease expert, but I read and write science, grasp statistics, and have an understanding of epidemiological models. As soon as I learned that at least four out of five infections are asymptomatic or present with only mild to moderate symptoms, and, furthermore, based on a common sense assumption about human behavior in the United States, that many of those with flu-like illness don’t see a doctor or get tested (which is why the CDC estimates flu cases), I could see that the death rates were exaggerated. And I said so when it was unpopular to say so. The experts are not only confirming my point, but they’re indicating that governments, journalists, and even the experts got it a more wrong than I initially thought (I admit that I was using a rather small factor to err on the side of caution). Neeraj Sood, professor of public policy at the USC Price School for Public Policy said that the findings “suggest that we might have to recalibrate disease prediction models and rethink public health strategies.” You think? Maybe we need to recalibrate these lockdowns, too.

I am writing all this not to be immodest but to leverage the facts against the claim of testing and contact tracing is the way forward. Given what was obvious and now admitted to, how would authorities know whether any given infected person is the person from whom a sick person contracted the virus or, to put it another way, that those with whom a sick person has been in contact contracted the virus from them and not somebody else? If this thing is as highly contagious as they claim, in the absence of a vaccine to mitigate community spread, the virus is likely everywhere, and the reality of this means that this is not nearly the big deal governments have been making it out to be.

COVID-19 testing center in Hansen Dam Park in Pacoima, California.

In this context, mass testing and contact tracing risks witch hunts that stigmatize people who may or may not have rhinoviruses, influenza viruses, or other coronaviruses. A person gets sick and starts pointing to people he remembers as having the sniffles or a cough. A person who tests positive having to give up the names of everybody with whom he came in contact. I remember in high school getting that call from the Public Health Department asking me if and when I had sex with this or that girl. Given how serious people think SARS-CoV-2 is, we don’t think that will carry the same stigmatizing effect? What can tests show if, as Anthony Fauci said, a person who tests negative today but might have tested positive tomorrow since he actually has the virus? These tests depend on viral loads, which are highly variable across time and individuals. Coronaviruses are a significant part of the viral mix every flu season. There will be false positives and false negatives.

Contact tracing really only works for containment, which is feasible if the outbreak is small and traceable. Authorities use it for measles outbreaks, for example, because herd immunity has been established for this disease and measles is vanishingly rare and occurrences localized. Authorities also use the method in SARS-CoV cases. Most cases of SARS-CoV since the initial outbreak in 2003 are from laboratory accidents with a patient zero.* With SARS-CoV-2 probably having infected between forty and one hundred million people nationwide, testing and contact tracing is a useless method for determining whether to reopen society. Moreover, the same antibodies tests that have confirmed my argument will likely be used to decide who gets the privilege of living freely and those who will be shut in and shut out.

We test people who are sick to determine whether they have SARS-CoV-2 or influenza, etc., as an etiological matter to determine course of treatment or cause of death. Crucially, as I argued in “When a Virus Goes Viral” back in March, the causes of pneumonia are many, not all of them are even viral. If we want to know the cause of an illness, and there is a test for it, then we test for it. In fact, the CDC does not use mass testing to determine the extent of influenza but relies on epidemiological modeling. As a method of controlling community spread, testing is profoundly problematic. We don’t do it with influenza, which killed more people in 2017-18 than COVID-19 has so far this year—and that was with a vaccine.

While it likely won’t halt the spread of this virus, testing and contact tracing will have consequences for freedom and reputation. People will be reporting people who are coughing in public or around their child, and so on. When iPhone apps show the virus in one’s community, folks will shelter-in-place, paralyzed in fear. The consequences of sensory deprivation are devastating on the body and the mind. Fear raises cortisol levels in the blood, causing detrimental health effects. Fear can produce lasting trauma. The fear here is manufactured by a definition of the situation, not by the actual peril faced. In Brown County where I live, the media is reporting an “explosion” of cases (total tested cases are around one tenth of one percent). My friends and colleagues posts of panic are relentless. The fear in their words is palpable. The way their friends and colleagues encourage fear and paralysis is cringe-worthy. I see a lot of people with Stockholm syndrome.

We have to end this madness. Government pronouncements are simultaneously spreading paranoia and a false sense of security. People who test negative today but have the virus, or contract the virus tomorrow or the next day, will think they don’t have it when they do. Those who have had contact with an infected person will be subject to restrictions on their movements and interactions. Or they will self-restrict and self-loathe—leper colonies over a virus with an actual lethality rate more similar to the flu than the absurdly high numbers presented by authorities and journalists. (See “Asking Critical Comparative Questions About the Coronavirus Pandemic” and “We Should Stop Ciriting the Case-ethality Rate for COVID-19—or Start Using it for Influenza.”) We’re seeing in the hysteria the machinery of police and surveillance being emplaced to turn people into community pariahs and neighborhood spies. Now they’re talking about converting census takers into temperature takers. This is so insidious.

Finally, consider the practice of counting as COVID-19 deaths all these deaths from pneumonia that have no confirmed cause. The numbers of death jumped sharply on the change in defining who is a COVID-19 victim. Think about what is going on in the hospitals to make this possible. A person is brought in with pneumonia. The cause could be viral or bacterial or both (or something else). If viral, there are a number of viruses that could by responsible. Testing is so useful, even necessary at this point to determine what the patient has in order to determine the appropriate intervention. Yet these tests are clearly not being done since there are patients dying without tests ruling in or out SARS-CoV-2 infection.

This doesn’t make sense (or maybe it does and my brain won’t let me go there). We’re in the middle of a health crisis involving a novel virus and doctors aren’t concerned with finding out as much as they possibly can about what is making their patients sick? Even if it is to help them? I find this shocking. I tell my students in research methods class that, if they do not have a data point, then it is missing data. You don’t determine data points yourself. This risks shaping your findings towards a predetermined conclusion. Besides, it’s lying.

There is sinister. Given how the dire predictions surround SARS-CoV-2 didn’t pan out, adding pneumonia deaths of uncertain cause to the COVID-19 category gives government and health officials the death tolls they need to come back and say SARS-CoV-2 really was an unprecedented event and that therefore their actions upending our personal worlds and throwing the world economy into turmoil were justified. Including in the COVID-19 totals all pneumonia cases regardless of cause may get the numbers to a bad flu season. But it looks like authorities doing whatever it takes to rationalize throwing the world economy into a depression. Since famine is crouching in the corner, the leaders will need some cover. 

Endnote

* Insisting that this virus was not created in a lab is an uncharitable argument resting on the straw man that those who are talking about the P-4 labs in Wuhan are claiming that the virus was manufactured. While that is possible, that is not the claim. The claim is that the virus infected somebody at a lab. You can look this up but, since the first time around with SARS in 2003 (yes, the first SARS-CoV is a coronavirus), one source of infections has been lab accidents. That’s an established fact. So these labs do have various coronaviruses that they are experimenting with and, on more than one occasion, the virus has escaped containment and sickened people. You don’t have to claim SARS-CoV-2 was bioengineered to point to the labs experimenting with coronaviruses as the source of the pandemic. Moreover, China didn’t need to bioengineer a virus to wreak havoc on the world. It only needed to lie about the situation long enough to allow the virus to escape Wuhan and spread around the world and announce its coming with dire predictions of death and calamity. It’s easy to whack an enemy that is ready to cower in fear.

Published by

Andrew Austin

Andrew Austin is on the faculty of Democracy and Justice Studies and Sociology at the University of Wisconsin—Green Bay. He has published numerous articles, essays, and reviews in books, encyclopedia, journals, and newspapers.

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