Super-spreads exist, but do super-spreaders?

What does the term ‘super-spreader’ mean? According to an article in the MIT Tech Review on June 15, “The word is a generic term for an unusually contagious individual who’s been infected with disease. In the context of the coronavirus, scientists haven’t narrowed down how many infections someone needs to cause to qualify as a superspreader, but generally speaking it far exceeds the two to three individuals researchers initially estimated the average infected patient could infect.”

The label of ‘super-spreader’ seems to foist the responsibility of not infecting others on an individual, whereas a ‘super-spreader’ can arise only by dint of an individual and her environment together. Consider the recent example of two hair-stylists in Springfield, Missouri, who both had COVID-19 (but didn’t know it) even as they attended to 139 clients over more than a week. Later, researchers found that none of the 139 had contracted COVID-19 because they all wore masks, washed hands, etc.

Hair-styling is obviously a high-contact profession but just this fact doesn’t suffice to render a hair-stylist a ‘super-spreader’. In this happy-making example, the two hair-stylists didn’t become super-spreaders because a) they maintained personal hygiene and wore masks, and b) so did the people in their immediate environment.

While I couldn’t find a fixed definition of the term ‘super-spreader’ on the WHO website, a quick search revealed a description from 2003, when the SARS epidemic was underway. Here, the organisation acknowledges that ‘super-spreading’ in itself is “not a recognised medical condition” (although the definition may have been updated since, but I doubt it), and that it arises as a result of safety protocols breaking down.

“… [in] the early days of the outbreak …, when SARS was just becoming known as a severe new disease, many patients were thought to be suffering from atypical pneumonia having another cause, and were therefore not treated as cases requiring special precautions of isolation and infection control. As a result, stringent infection control measures were not in place. In the absence of protective measures, many health care workers, relatives, and hospital visitors were exposed to the SARS virus and subsequently developed SARS. Since infection control measures have been put in place, the number of new cases of SARS arising from a single SARS source case has been significantly reduced. When investigating current chains of continuing transmission, it is important to look for points in the history of case detection and patient management when procedures for infection control may have broken down.”

This view reaffirms the importance of addressing ‘super-spreads’ not as a consequence of individual action or offence but as the product of a set of circumstances that facilitate the rapid transmission of an infectious disease.

In another example, on July 21, the Indian Express reported that the city of Ahmedabad had tested 17,000 ‘super-spreaders’, of which 122 tested positive. The article was also headlined ‘Phase 2 of surveillance: 122 super-spreaders test positive in Ahmedabad’.

According to the article’s author, those tested included “staff of hair cutting-salons as well as vendors of vegetables, fruits, grocery, milk and medicines”. The people employed in all these professions in India are typically middle-class (economically) at best, and as such enjoy far fewer social, educational and healthcare protections than the economic upper class, and live in markedly more crowded areas with uneven access to transportation and clean water.

Given these hard-to-escape circumstances, identifying the people who were tested as ‘super-spreaders’ seems not only unjust but also an attempt by the press in this case as well as city officials to force them to take responsibility for their city’s epidemic status and preparedness – which is just ridiculous because it criminalises their profession (assuming, reasonably I’d think, that wilfully endangering the health of others around you during a pandemic is a crime).

The Indian Express also reported that the city was testing people and then issuing them health cards – which presumably note that the card-holder has been tested together with the test result. Although I’m inclined to believe the wrong use of the term ‘super-spreader’ here originated not with the newspaper reporter but with the city administration, it’s also frustratingly ridiculous that the people were designated ‘super-spreaders’ at the time of testing, before the results were known – i.e. super-spreader until proven innocent? Or is this a case of officials and journalists unknowingly using two non-interchangeable terms interchangeably?

Or did this dangerous mix-up arise because most places and governments in India don’t have reason to believe ‘high-contact’ is different from ‘super-spreader’?

But be personal and interpersonal hygiene as they may, officials’ use of one term instead of the other also allows them to continue to believe there needn’t or shouldn’t be a difference either. And that’s a big problem because even as the economically middle- and lower-classes may not be able to access better living conditions and amenities, thinking there’s no difference between ‘high-contact’ and ‘super-spreader’ allows those in charge to excuse themselves from their responsibilities to effect that difference.