What do we do for fun this summer?
Here’s a question I am getting pretty often. "Dr. Katz, can we hold our [insert event here]? Everyone needs the opportunity to get out and we need the revenue?" These mass gatherings are mostly sporting and entertainment opportunities, with some religious observances thrown in. At least with the latter you can get a prayer for good luck. As usual, I have as many questions as answers.
Neither I nor the health department can prohibit events allowed in Governor Reynolds’ proclamations. We’ll review your plans and give you our opinions. The most recent relevant proclamation, on June 10th, defines a mass gathering as more than 10 people and requires that "the organizer must ensure at least six feet of physical distance between each group or individual attending alone", as well as other social distancing, hygiene, and public health measures. What’s to argue with? Sounds great on paper.
Here’s the problem, and it’s a hole you could drive a John Deere S-770 combine (or maybe sail a cruise ship) through. Section six of the proclamation states, "In conjunction with the Department of Public Health pursuant to Iowa Code 29C.18 and 135.35 all peace officers of the state are hereby called upon to assist in the enforcement of the provisions of this Proclamation". So, I ask you who thinks our constables should, can or will be responsible for surveillance at mass gatherings, making sure folks with coughs are screened and excluded, spreading the rest out, encouraging appropriate hand washing and making sure that when six feet is impossible masks are worn? What will be the response to "enforcement" of a crowd of beer drinkers in the stands at a baseball tournament or wine drinkers (more genteel music) or pot smokers (rock and roll) at a concert in a park or at a fair. Do we consider those three venues to be equivalent when evaluating a plan?
If not the cops, then whom? How effective will any "accountability" be when the president is holding a huge indoor rally in Tulsa (over the objections of local public health), is disparaging of both social distancing and mask use and is fudging or cherry picking case counts? For contrast, among Iowa and its border states only Missouri has not cancelled their state fair, and they will apparently maintain only their agricultural exhibits.
The CDC published a scary article in Morbidity and Mortality Weekly Report. Two people with mild COVID-19 attended church events on three days. They infected 35 of 92 attendees, with three subsequent deaths. Those 35 transmitted 26 additional cases in the community with one death. This was a "super spreading" event, the risk for which only increases with larger events. Consider an affair with several hundred thousand attendees over five days. See what keeps us up at night?
Are outdoor events different than indoor? The recent mass protests will be informative since we know the risk of transmission outdoors is less than that indoors. Right now I have insufficient understanding and guidance about relative risks to know how to alter safety criteria for outdoor vs. indoor gatherings.
I have reviewed event plans with a number of folks. Without exception they are busting their butts to put reasonable plans on paper. Every bone in my body wants to find a way to reward their efforts but I am failing. Plausible accountability for compliance with safety measures is missing, but not because they don’t "get it". It’s because we don’t have a handle on how to assure it during a pandemic that is politicized and polarized. Without the ability to effectively monitor and assure adherence to public health safety recommendations, it is my opinion that mass gatherings should not go forward.
Reopening has advanced (too fast) across the southern states and sunbelt. COVID-19 cases are climbing — not just test positives found with more testing, but hospital admissions that clearly reflect increasing illness. Our blood center is being asked to share COVID-19 convalescent plasma with our sister centers in Texas.
Moving into summer the compulsion to get out and play will grow. How much should we tempt fate? For what benefit? My priorities right now are to reach fall maintaining our current local control of COVID-19. Our hospitals will stay functional into the flu season and our kids can resume their education. I am going to live without the rest for now — I haven’t gone into a bar yet, much less to a mass gathering. My lovely bride finds it disorienting that I would channel Nancy Reagan, but I will "just say no" to attending any of these events for now. You should too, especially if, like me, you are at increased risk for bad outcomes from COVID-19 or are in contact with someone who is.
Louis M. Katz, MD, is medical director of the Scott County Health Department.
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