by Michael J. Ainscough, MD, MPH
As the case numbers of coronavirus are now peaking in many large cities, nearly all states have started to relax restrictions and reopen sectors of the economy and society. Some localities are easing restrictions without meeting federal or state criteria.
Reopening carries a risk, but the impact won’t be immediate. The actual effect of loosening stay-at-home orders may take weeks to show up. It depends on how soon people start to socialize, the size of their social gatherings, and if asymptomatic contagious people attend events.
According to Governor Pritzker’s five-phase plan for reopening Illinois, gatherings of up to ten people are not even allowed until Phase 3, the “recovery” phase that can begin, at the earliest, May 29. After a lawsuit, an exception was made to allow worship services with up to 10 people.
On May 6, Governor Pritzker said he will continue to ban public gatherings of more than 50 people, including religious services, until a coronavirus vaccine or highly effective treatment becomes widely available. That may also be challenged in court.
Limiting crowd size does reduce the risk of spread. Larger social gatherings create higher risk.
The virus spreads best in crowded spaces. Those can be informal crowds like sporting events, concerts festivals, and public transportation (planes, trains, and buses), or more organized gatherings like church services, weddings and receptions. We have seen the results in residential settings (nursing homes and long-term care facilities (LTCF), and workplaces (factories and packing plants).
Because restrictions have been followed, no cases have been reported from St. Louis Cardinals games. No cases have been reported from schools, religious services, weddings, or receptions in Washington County because we haven’t had these gatherings for two months. If we had ignored restrictions, there most certainly would have been more cases.
Two examples were not local, but illustrate the point. Mardi Gras celebrations culminated on February 25. People from all over the world attended. By March 24, New Orleans had 567 confirmed positive cases and 20 deaths. Louisiana had 1,388 cases and 46 deaths. We may never know how many other out-of-state travelers took the virus back home with them.
That same week, a conference of 175 Biogen company executives gathered for two days of meetings at a Boston Marriott on February 26-27. By March 11, just twelve days later, 89 of the 175 attendees had symptoms. That’s 50 percent.
Workplace and residential examples exist in Illinois. In Chester and Steeleville, Gilster-Mary Lee Corp. shut down two baking mix plants because of virus outbreak. Smithfield Foods shuttered two meatpacking plants in Monmouth and St. Charles. Carlyle Health Care Center has had 67 cases, with 7 deaths. GreenTree LTCF in Mt. Vernon has had 62 cases, with 14 deaths.
All of these examples started with just one infected person joining an unsuspecting group of people. The virus doesn’t discriminate. Whether you are a reveler at a party, a worker at a factory, a churchgoer to a religious gathering, or a patron at a bar, the more people who are gathered, the more likely at least one person is contagious with the virus.
It’s springtime. People want to get out and be active. Large concerts and sporting events are still not allowed. People may resort to other informal gatherings.
High school seniors have missed most of their spring semester and important life memories like prom and graduation. Graduates will soon be going off in many different directions, so it is natural to want to have farewell gatherings.
Let’s propose a hypothetical gathering of teenagers. Let’s say about 70 teens decide to gather together at the same location out in the country. They have a good time for a few hours and return to their homes. A few days later one of the attendees begins to have symptoms of coronavirus. The person gets tested and is positive. In the clinical interview it is revealed the person works at a health care facility. The public health contact tracing identifies over 300 people potentially exposed by the other attendees going home to their parents and siblings. They all need to self-quarantine for 14 days.
This could turn out two ways. If the person who tested positive was not yet contagious at the gathering, every other person doesn’t get infected. We don’t know that for sure for 14 days. But if the person was contagious before symptoms showed, then many people start to get sick. Time will tell.
It may be two to three weeks before we’d see an increase in the number of cases. It takes 2 to 14 days after exposure for individuals to become contagious and for them to display symptoms. Some people may never develop symptoms.
When a person does start to have symptoms, it will take a few days to get bad enough for the person to get tested. The test results can take a few days to get reported. At each stage, there’s a lag time.
If this scenario actually happened, where did the system fail? How could 70 individual people not know the consequences and/or disregard the risk?
What can we do to prevent such gatherings of teenagers that could cause an outbreak? We need to better explain the reasons for group size limits to persuade young people to comply. Everyone needs to be aware that large gatherings can be rocket fuel for the spread of COVID-19. In a large gathering, you just don’t know who might have the virus. It only takes one person in the group.
This epidemic is a 100-year event. Schools were closed and church services were canceled for a reason. The virus is silent. It doesn’t tell you when it is arriving. The people who need to know aren’t reading this newspaper. Tell them. Please make sure your friends, your relatives, and especially your teenagers realize that choices have consequences and their actions matter.
Author’s note: Of the 16 people in Washington County who have tested positive for coronavirus, 8 were health care workers. During the epidemic, some jobs in health care include caring for coronavirus patients and involve risk. Despite wearing PPE and using best infection control practices, some health care workers do get infected. Workers must also use precautions to prevent spreading the virus to their families and friends. If medical professionals get the virus, why do amateurs think they won’t?