Invisible epidemics: ethics and asymptomatic infection

Abstract

Interactions between microbes and human hosts can lead to a wide variety of possible outcomes including benefits to the host, asymptomatic infection, disease (which can be more or less severe), and/or death. Whether or not they themselves eventually develop disease, asymptomatic carriers can often transmit disease-causing pathogens to others. This phenomenon has a range of ethical implications for clinical medicine, public health, and infectious disease research. The implications of asymptomatic infection are especially significant in situations where, and/or to the extent that, the microbe in question is transmissible, potentially harmful, and/or untreatable. This article reviews the history and concept of asymptomatic infection, and relevant ethical issues associated with this phenomenon. It illustrates the role and ethical significance of asymptomatic infection in outbreaks, epidemics, and pandemics-including recent crises involving drug resistance, Zika, and Covid19. Serving as the Introduction to this Special Issue of Monash Bioethics Review, it also provides brief summaries of the other articles comprising this collection.

Keywords: Antimicrobial resistance; Asymptomatic infection; Carrier; Isolation; Microbial determinism; Quarantine.

Fig. 1

Public health tuberculosis screening programs in the USA (left) and Australia (right). Left: Image from the National Library of Medicine: http://resource.nlm.nih.gov/101451864. Right: Image courtesy Dr Alan King

Fig. 2

Potential consequences of infection with a microbe