Public Protests in the time of covid19

DISPATCHES FROM HEALTHCARE’S FRONT LINES

Vol 1 Issue 2

If you like what you read, subscribe to DISPATCHES so you don’t miss any of them!

First and foremost, I want to express my outrage and sorrow about the tragic murders of George Floyd, Breonna Taylor, and Ahmaud Arbery. Many are reacting to these events with shock, but in actuality this carnage is devastatingly familiar; their deaths are only the latest in a constant series of atrocities that our country has committed against our African American brothers and sisters since its inception.

Today’s topic is the issue of large public protests, and how a coexisting pandemic may affect these large groups of protesters who are gathering in support of ending racial discrimination and police brutality in our nation.

We are seeing a predominantly peaceful outcry by a large number of concerned citizens speaking out about systemic racism and police brutality against communities of color in this country. Unfortunately, we are also in the middle of a pandemic the likes of which we have not seen for over 100 years. The irony of this overlap of events is stark: COVID19 disproportionately spreads quickly in lower socioeconomic groups. It is also more deadly for those populations, due to overcrowding, lack of access to healthcare, the pressure to return to work for financial reasons at high risk jobs, and a higher prevalence of the health conditions that lead to hospitalization and death. Mass gatherings may thus cause further suffering, since these rallies will undoubtedly spread COVID19, compounding the risks for communities of color.

So what are the facts about mass gatherings and the spread of infections?

Because COVID19 has never been seen before, there is limited data about COVID19 is transmitted in crowds.

We do have one fascinating historical parallel which occurred during World War I. During the (so-called) Spanish Flu of 1918, there were massive parades held to raise morale and to secure funding for war bonds. At one such parade, on sept 28th, 1918, 200,000 marchers stretched in a two mile procession through central Philadelphia.

Obviously, masks and social distancing were not part of the public health paradigm in 1918. Here’s what happened:

Within 72 hours of the parade, every bed in Philadelphia’s 31 hospitals was filled. In the week ending October 5, some 2,600 people in Philadelphia had died from the flu or its complications. A week later, that number rose to more than 4,500. With many of the city’s health professionals pressed into military service, Philadelphia was unprepared for this deluge of death.

Kenneth C. Davis, SMITHSONIANMAG.COM, SEPTEMBER 21, 2018 https://www.smithsonianmag.com/history/philadelphia-threw-wwi-parade-gave-thousands-onlookers-flu-180970372/

We do have more much more data on influenza in mass gatherings since the 1928 pandemic. A compilation of findings from a recent article showed that longer, more crowded rallies were more likely to transmit the flu. While being outdoors was better, any multiple-day event made things worse. This was especially true if attendees bunked together between events. Limitations on gatherings worked best early in any outbreak, and had less effects later, probably because the disease had already spread widely in the community.
https://www.cebm.net/covid-19/what-is-the-evidence-for-mass-gatherings-during-global-pandemics/

What are “Superspreaders”?

Superspreaders are people who attend a mass gathering and infect large numbers of people. (Up to 30% of COVID19 patients never have symptoms, and many patients are contagious several days before they develop symptoms, and so both groups unknowingly spread the disease.).

Why? Someone with COVID19 might spread it to several people at home or work. However, in a crowd, a contagious person might stand next to several hundred people in the course of a day, infecting a significant number of them.

A 2018 study of the London subway gave this concept more detail, as described in a National Geographic article titled “What’s the safest gathering size to slow the coronavirus? There isn’t one”:

“..Rates of illnesses were higher, they found, in areas where the subway system was busier.

But this uptick was not just because there were more people passing by. A likely explanation is that people passing through a crowded station move more slowly, Johansson and colleagues found in a separate analytical model. This causes them to spend more time in the station and come into closer contact with more people — much like the crowds who spent hours crammed into U.S. airports after new screening rules went into place.

“If it’s not crowded, it may take a few minutes to go through [subway stations], and if it’s really crowded, it may take 20 minutes or 30 minutes,” Johansson says. “You spend more time there and, in theory, are much more likely to pick up a disease”. (emphasis added)
https://www.nationalgeographic.com/science/2020/03/what-is-safest-gathering-size-coronavirus-wrong-question/

Statistically, with almost 2 million cases of COVID19 in the United States, the odds of there being at least one person in any crowd of 1000 people is > 95%. Bigger crowds, such as those found in the rallies going on at present, will mean more contagious people. Local areas like NY, DC or LA with higher rates of infection will have higher numbers of COVID19 patients in any similarly sized crowd compared to, say, Boise Idaho. Add in the concept of a superspreader, and one can easily see how hundreds of protesters could get infected with COVID19.

Other risks specifically present at protest gatherings

• By their nature, rallies have a lot of shouting, chanting, singing, and running around. These actions all increase the amount of virus droplets released into the air as “droplet clouds”, probably as forcefully or more so than sneezing. You will be exposed to many more viral particles (“viral load”) if the crowd is more vocal and active.
• When your mask gets soaked from all the sweat and poured/splashed water and singing and shouting, it becomes less effective, becoming another risk factor for you becoming infected.
• Peaceful, orderly gatherings may lower the risk for infection spread, with some participants at least trying to keep social distance. But actions taken by law enforcement have the potential to undo these precautions. Tear gas and pepper spray can cause sneezing, coughing and retching. Eye watering is common. Rubber bullets, baton assaults and other trauma will lead to screaming and crying, all causing more viral particles to be airborne and increasing everyone’s risk of contracting COVID19. Of course, social distancing becomes impossible under those conditions, worsening COVID19 spread.

But I am wearing a mask. Doesn’t that protect me at a protest gathering?

Certainly it protects you somewhat. The current recommendation is that masks be used when social distancing cannot keep people more than 6 feet apart.

There are lots of caveats to this. Masks have to fit properly, they have to be worn correctly (covering mouth and nose), they can’t be wet or contaminated, they have to be used continuously, and they have to be made of the proper material for air filtration. (N95 masks trap 95% of particles 5 microns or larger. A home made cloth mask may trap 50–75% of that, which is better than not wearing a mask at all.)

But what about everyone else? Mask really serve to protect others from you by trapping your infectious virus droplets. However, if others are not wearing masks, they may be exposing you, even if you are wearing a mask (which always allows in some unfiltered air). Look at this random snip of a London photo from a protest several days ago. Only 1/3 of people appear to be correctly wearing masks.

But the protests are outside- isn’t that supposed to be safe?

Outside is safer, but not risk free. Outdoors, air currents will dilute the viral “cloud” created when someone breathes or sneezes. But if there are hundreds of those clouds and you are close to some of them, you can still get infected. Recent data shows that COVID19 infectious particles may travel much longer distances than the 6 feet currently given as the “safe distance” guidance, and in many cases at a rally, you will not be able to maintain even the recommended 6 foot distance.

So what is going to happen?

Most experts expect a spike in reported COVID19 cases in 2–3 weeks, with rising hospitalizations 2–6 weeks afterwards. This may be on top of an already expected spike after the risky behavior we saw last Memorial Day when many states opened. It remains to be seen whether cities and towns have the health care capacity to manage all of this. Some areas with low background COVID19 infections will probably be OK if the demonstrations do not go on much longer; others who are already stressed like Montgomery, Alabama may reach a tipping point. If the demonstrations continue for weeks on end, all bets are off and we may be in for a national second wave far sooner and larger than we had been expecting.

So can I go to a rally or not?

The bottom line:

In my opinion, if you have risk factors for serious complications of COVID19, you should not go to a rally. The increased risk of catching COVID19 and having serious problems from it is too great. This includes anyone over 50, patients with hypertension, obesity, diabetes, or any chronic immune or lung disease. ALSO — DON’T GO TO A MASS GATHERING IF YOU HAVE COVID19 SYMPTOMS OR HAD CLOSE CONTACT WITH SOMEONE WHO DOES (or did within the last 2 weeks). You do not want to be a super-spreader and endanger many other protesters.

But let’s be real: if you are already going to 30 person barbecues in your neighborhood, hanging out at friends’ houses for drink night with 15 people, and not wearing a mask, don’t use your mild hypertension as an excuse to not follow your heart to a rally. If you do decide to go in spite of the risk, take the precautions outlined below.

If you decide to go to a rally, do your best to protect yourself and to protect others from you. (You could be an asymptomatic carrier!!) Follow as much of this advice as you can:

• Smaller rallies have lower risk due to less likely chance of having infected protesters near you
• If a smaller rally gets too big, you may consider leaving.
• Wear a mask. Make sure it fits.
• N95’s are now commonly worn by the public but OSHA requires them to be fit-tested to make sure they seal properly. If you have one without such a test, here is a cheat to test the fit… https://www.youtube.com/watch?v=05wyH1-mLGk …I do not recommend this, as it can give you a false sense of security without a formal OSHA-approved test, but I know many people who will wear these masks anyway. (The formal test involves inhaling a smelly substance and checking for penetration through the mask while under a hood. Do not try this at home.)
• Minimize your time at the gathering. This minimizes your exposure and preserves the functionality of your mask
• Maintain social distance as much as possible. This is best done at the sides and back of the crowd.
• Retreat in the event the crowds starts to compress in any direction that makes it hard to move freely, If everyone did this, the crowd would be well spaced out, less dense, and less contagious
• Wear eye covering. This is slightly controversial. In health care settings, eye glasses are not thought to be adequate to protect from COVID19; you have to have special eye coverings with side panels, or face shields. This might be overkill for an outdoor rally, but a pair of wrap around sunglasses can’t hurt.
• If possible and safe to do so, leave the scene as soon as violence erupts. As noted above, tear gas and other police methods increases the viral load in the air.
• BRING EXTRA MASKS. You may need them if yours gets wet or damaged, Give one to a stranger not wearing a mask as an act of caring. Tell them you are worried about them and want them to be safe.

If you are a law enforcement officer at a mass gathering:

• Please treat demonstrators with the kindness and compassion you would want if you were on the other side of the barricade protesting for a cause that was important to you.
• Almost any physical actions that you take against a crowd will increase COVID19 spread. You will be inflicting potential harm far away from the physical event itself. Please refrain, with your maximal effort, from using physical means of crowd control.

After attending a mass gathering:

• You should assume you have been infected. Monitor yourself for symptoms including fever, cough, muscle aches, and GI symptoms
• Technically you should quarantine at home for at least 7 days; 10–14 is better
• Seek out a COVID19 test 2–3 days after the rally, and repeat 2–3 days later if negative. Follow CDC guidelines if positive, and seek medical care if you feel short of breath, weak or very sick.

ABOVE ALL:
Use common sense. Be safe. Protect yourself and others. We are all in this together.

If you like what you just read, subscribe by clicking here so that you get emails with an announcement and summary of my posts, and click FOLLOW at the very top of this Medium article. Thank you for reading!

__________________________________________________________________

If you are a business owner or manager in need of assistance navigating the science and regulations around re-opening, get in touch with me and other COVID19 experts at www.backtoworkexperts.com

__________________________________________________________________