Small events can add up to a lot of COVID-19 cases
With the holidays ahead, experts fear more spread
Health officials spread the warning as holiday weekend approaches.
Images of packed beaches, lakes and bars have made the rounds on traditional and social media for much of the summer, drawing scorn from those concerned about the coronavirus spreading among those crowds.
Less prominent but also troubling are the growing instances of case clusters arising from smaller gatherings.
Contact tracing yields information about the sources of infections as the USA, by far the world leader in total COVID-19 cases and deaths, grapples with how to keep its population safe while propping up a flagging economy. More than 182,000 Americans have been killed by the disease.
The hasty reopening of businesses across much of the nation after the spring shutdown was largely blamed for a summer surge in infections, but social functions of various sizes among relatives, friends and co-workers may have been a contributing factor as well.
Public health experts sound the alarm as the Labor Day weekend approaches.
“People don’t think of it in the same way as the (President Donald) Trump rally in Tulsa, a bunch of people on the beach or in the bars, but these small events add up to a lot. It’s just invisible,” said Peter Chin-Hong, a professor of medicine at the University of CaliforniaSan Francisco who specializes in infectious diseases.
There’s no generally accepted definition of what’s a small gathering – it may range from five to 30 people – and the majority of these activities take place
“They may account for a much greater proportion of the cases than we think ...” Dr. George Rutherford, principal investigator for California’s contact tracing program, speaking of small gatherings
behind closed doors. That makes it difficult to garner hard data about them.
In late July, Maryland Gov. Larry Hogan said contact tracing revealed 44% of those testing positive for the virus in the state reported attending a family activity and 23% a house party, but the size of the events was not specified.
Plenty of anecdotal evidence supports the notion that getting together with people outside the immediate household, even in fairly limited numbers, can lead to a rash of infections. Chin-Hong said several of the COVID-19 patients he treated believe they caught the virus at barbecues.
Weddings have been troublesome, including a 100-guest event in San Francisco in early July that resulted in at least 10 people contracting the virus, among them the bride and groom.
Smaller events, such as family, office and graduation parties, have yielded COVID-19 cases as well.
In Alabama, eight of 11 relatives who went to a lake house together in July tested positive for the coronavirus.
In the Washington, D.C., area, the host of a backyard dinner in June for about 25 came down with COVID-19, as did some of her guests.
And in Houston, seven members of a family that went out for a Fathers’ Day meal developed COVID-19.
“Small gatherings are a concern because there’s so many of them. They may account for a much greater proportion of the cases than we think right now,’’ said Dr. George Rutherford, a colleague of Chin-Hong’s at UCSF and the principal investigator for California’s contact tracing program.
Rutherford emphasized the need for those planning to attend or host functions on Labor Day weekend to practice social distancing and wear masks as much as possible, but he’s even more wary of what may be in store after Thanksgiving.
Extended families traditionally convene on that holiday, often after traveling from far away, and sit around for long stretches, be it eating or watching NFL games on TV. The dinners are almost always held indoors, where limited ventilation makes it easier to contract the virus.
“Everybody’s going to be there with their belts undone and the top button off their pants, snoring and laying without masks on watching football in some tiny little den,” Rutherford said. “It’s not a pretty picture. There could be a lot of transmission. And Christmas is going to be exactly the same. It’s unfortunate, but this is not the year for family gatherings.”
Matt Lambert, an emergency room physician based in Washington, D.C., said he would advise against any gatherings bigger than 25 people, small enough for the hosts to inquire about symptoms before the event.
Those seeking to congregate for special occasions could take extreme measures, like a couple Lambert heard of who held their wedding at a zoo, where the staff enforced distancing regulations.
Even then, it’s hard to keep people apart.
“We’re not made that way,” Lambert said. “You get extended loved ones together, especially at a wedding, and there’s going to be some hugging going on.”
The Centers for Disease Control and Prevention and the World Health Organization posted guidelines for gatherings, and Chin-Hong said relatively safe barbecues can be held if the hosts and guests take precautions.
He pointed out that, besides mask usage, the main determinants of risk when people assemble are the size of the group, the type and duration of the activity, where it’s held (indoors or outdoors), whether alcohol is served, whether there is shouting or singing and how well participants know each other.
Chin-Hong suggested inviting no more than two or three groups, each from a single household, and having them stay in their own “pods,” at least 6 feet apart from the other participants. The event should be outdoors, hand sanitizer should be readily available, and either a host wearing a mask should serve the food, or the members of each pod could serve themselves while maintaining distance from the rest. Anybody using the bathroom should wear a mask.
“It’s fine to have a barbecue if you do it in a modest way and think about these risk aspects of keeping the pods apart from each other,” Chin-Hong said.