COVID-19 Interest Group

                                     June 7, 2020

                                                               CIG Bulletin #14

           A Pandemic, a Protest, a News Cycle and You, the Consumer of Covid-19 News

                                                    By Pate Thomson MD, FACC 

Covid-19 has dominated the headlines and news cycle since early March. It took an historic Coast-to-Coast protest against racial injustice and police brutality to displace it. As the protest winds down will the pandemic re-emerge as news cycle topic #1? My bet is that it will, when we scramble to contain the outbreak. What have we learned about transmission of this virus that leads me to this prediction?

 To begin with we know the SARS Co-V-2 virus is highly contagious and that it is most often transmitted by droplets and aerosols spewed into the air by breathing, talking, shouting, coughing, sneezing, singing, chanting. These tiny, mostly sub visible, air born particles, laden with virus, gain access to the new hosts respiratory tissues simply by the act of breathing them in. The viral load in the droplet can be large enough to infect. Or, if inhaled over time, a smaller repetitive viral load can accumulate and gain access to the respiratory cells where viruses enter and replicate at a rapid rate. If the host is weakened by age, for example, the infection may run rampant, overcome defenses, and a serious, lethal illness may ensue. This may also happen in younger patients but does so much less frequently. This story has become familiar to all of us.

 In the fall of 1918 there was a similar pandemic. As World War I was winding down the Liberty Parade was held in the streets of Philadelphia and crowds were packed in, cheek by jowl, to witness it. There, a virus lurked and it too was highly infectious. It also was transmitted by droplets and aerosols from breathing, talking, shouting, coughing, sneezing, singing, chanting, and it too invaded respiratory cells. Within a few days of the parade Philadelphia hospitals were overrun with sick patients, who had become victims of the Spanish Flu, the deadliest pandemic in history that ultimately infected two thirds of the population on earth and is estimated to have killed 20 to 50 million people!

 Fast forward to early 2020. The Covid-19 pandemic was well underway, ravaging our seniors as it did in China, Italy, Spain and in our densely populated New York City among other hot spots. The news cycle spoke of little else. People sheltered at home, with a shutdown economy and massive unemployment, as evidence emerged of disproportionate covid-19 infection rates and higher mortality among our black and brown communities. In the midst of signs of failure by our government to prepare and manage these crises, a shocking video emerged. The world witnessed the suffocation death of a black man named George Floyd at the hands of Minneapolis police. This symbol of racism and police brutality caused people to pour into the streets all across the nation in a stunning action of protest. The crowd was multicultural and geographically widespread. Initially there was looting and destruction of property but as days unfolded masses gathered to protest, to breath, to shout, sing, cough, and sneeze. Anger was incited and respiratory passages were irritated by tear gas, pepper spray and aggressive assault of the protesters. Despite this, wide spread support continued to grow for the demands for racial justice and for an end of police mistreatment of our black and brown community. In an amazing turn of events the violence melted away and was replaced with peaceful protests. It was a watershed moment. A change in the wind, a multicultural recognition of the injustice alongside a sense that this might be a new day and that meaningful steps might soon be taken to address the injustice of it.

 Looking at photos from 1918 through the lens of Covid-19, understanding of methods of spread, I was struck by the similarities of the two crowds and by the risks to both of transmission and infection. The major difference was that there are many more masks being worn in the contemporary photos. Early in the 2020 demonstrations with the crowd shouting, singing and chanting, there were quite a few unmasked faces. As the weeks progressed more masks are worn. We know SARS Co-V-2 was lurking and folks were gathered cheek by jowl, with little opportunity for social distancing. My assessment was that the risk of transmission was high.

 If history repeats itself a resurgence of Covid-19 cases traceable to the protests will occur and we will learn of it from front-page news. My hope is that masks and youthfulness will protect, but I fear that I am engaged in wishful thinking. With respect to this, no news would be good news and once again the flaws in my ability to predict will be exposed.


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