How to not become a Corona Super Spreader

I started writing this article sitting in an Airbus A380, en route from Copenhagen, Denmark to Dubai, United Arab Emirates. The seating capacity of the plane is 615 passengers, but on this particular flight all of us onboard had a whole row of seats to ourselves, with plenty of empty rows to spare. No one wanted to be on this flight unless they had to.

I wasn’t planning on being onboard this flight until the night before when the Danish Government decided to close its borders for 4 weeks. I thought I would have limited options to return to my home in Australia if I didn’t act fast, so I left on the first available flight.

In the previous few days the Danish Government had watched the number of COVID-19 cases rise steadily while they took measures to reduce the spread, including:

• All public employees working in non-essential functions must stay at home for two weeks. Private sector employees are encouraged to work from home where possible.
• Day-care, primary, secondary and tertiary educational institutions will be close for two weeks. Visitors are banned from entering nursing homes for the foreseeable future.
• Public and private gatherings of more than 100 people are banned. As a result, sporting and cultural events are cancelled and cinemas, gyms, restaurants, night clubs and other night life have shut up shop.

How did things come this far for Denmark in just a few days?

The answer is a Super Spreader event.

A Bartender Serving Corona

Danes truly love skiing, but Denmark is mostly flat as a pancake so skiing requires people to travel to more mountainous destinations.

One particularly popular destination is in Austria, called Ischgl. Ischgl is located in the European Alpes, close to the borders of Switzerland and Northern Italy. In Ischgl there is an equally popular after-ski bar called Itzloch. The bar is usually tightly packed with lots of warm-bodied, heavy-breathing skiers knocking back way too many J?gerbombs.

In this bar worked a bartender. He had Coronavirus but he didn’t know it yet. The bartender – like all the other bartenders working at Itzloch – was a guy who knew how to start a party. He had a whistle to attract attention and would let the guests blow into it regularly. As he walked through the venue with big trays full of drinks, he would blow the whistle to move people along. The whistle would spray little particles of saliva into the air and any nearby drinks.

At the start of the week, everyone was having fun. By the end of the week, most had COVID-19. Over the weekend of 7 March, 139 Danes returned home from Ischgl with COVID-19. However, before they got diagnosed and quarantined, these people managed to infect friends and family. The chart below shows the result.

(I got the chart from this page, which is a great source of information about COVID-19. You can easily customise charts with data from any region of interest.)

The bartender at Itzloch was a Super Spreader. One guy in the wrong place, doing the wrong thing has led to thousands of infections across Europe (the number of direct and indirect COVID-19 infections stemming from this particular venue is unknown). It also put Denmark in a situation where extreme measures were necessary to prevent a meltdown of the health care system, like it has happened in Wuhan and Italy. The trade-off is serious financial impediment for the country as a whole and complete carnage in tourism and entertainment related industries, which will send ripples through every corner of the economy.

Luckily the infected ski tourists were generally fit and healthy, so the COVID-19 death toll in Denmark is still very low at 3 (as at 16 March 2020). Things don’t go so well when there is a Super Spreader amongst more vulnerable parts of the population. An example is the nursing home in Kirkland, Washington where a mass infection has taken the lives of 27 residents (as at 14 March).

Similarly, South Korea’s early response to the Corona outbreak was very effective, based on the previous experience with SARS. That is, until the infamous Patient No. 31 spread the virus amongst 1,000 of her closest friends at church. South Korean authorities say 1 in 5 cases in the country can be linked to her. Again, one Super Spreader pushed things into chaos for an entire population.

The moral of the story is of course: don’t be a Super Spreader! In a Corona-aware world we can all see why the events at Itzloch were a clear recipe for disaster. However, once you look a little closer at your own daily activities you will soon realise that most of us encounter situations where we can unwillingly set off a Super Spreader event.

Just consider the following hypothetical scenario. Yesterday you got infected with COVID-19, but you don’t know it yet. After all, it takes five days on average to show. You work in an office with 200 colleagues and you all share the same staff kitchen. Just before lunchtime you go to the kitchen to get a glass of water from the tap. Right before touching the tap, you cough into your hand. The handle now has Coronavirus on it.

Shortly after, the lunchtime peak ensues and your colleagues are in and out of the kitchen, washing their fruits and vegetables and touching the water tap as they go. At the end of the day, 12 of your colleagues have contracted COVID-19, but they won’t find out for another five days on average.

The next day, your long-standing and very popular colleague Bob has his 25th working anniversary with the company. In the afternoon, there is a celebration of Bob’s tenure and everyone in the office attends. After the formalities are over everyone wants to congratulate Bob in person. One of your infected “dirty dozen” is particularly friendly and gives Bob a wet kiss on both cheeks. Another of your unknowingly infected colleagues is less affectionate, but still gives Bob a good old handshake. Five minutes before the handshake, the colleague had coughed into his right hand. Bob is now a vector for the disease because he has Coronavirus on his hands and face.

Throughout the afternoon, a continuous stream of colleagues take turns in congratulating Bob, using hugs, kisses and handshakes to do so. Of course, there are plenty of nibbles to go around too, if you don’t mind using your fingers.

On day five, you call in sick. The next day, the dirty dozen all call in sick. The day after that, another sixty people from the office call in sick. But that’s not all. In the five days of incubation, everyone infected has managed to infect an average of 2 to 4 people in their social circles. Several hundred people have now been infected in about a week and these people are out there infecting another big bunch. By the time the infection in your office is identified it’s already out of control.

The potential for mass contagion is everywhere and there are so many ways to spread this virus if basic hygiene recommendations aren’t followed. For instance, you could easily infect a big number of people by leaving your germs on door handles, elevator buttons or public transport handrails being used my many people throughout the day.

Luckily, the general recommendations for hygiene and social distancing can do a lot to prevent these sorts of events from occurring. They are:

1. Cough or sneeze into your sleeve (upper arm)
2. Wash or disinfect your hands regularly and thoroughly
3. Avoid close contact with others such as shaking hands, kissing or hugging
4. Regularly clean surfaces at work and at home
5. Don’t gather in large groups.
6. And might I add another recommendation: that petri dish called your phone should be cleaned with disinfectant a couple of times a day.

Why is it so important to stop this virus in its tracks?

The problem with COVID-19 is fourfold:

1. It’s reasonably contagious (like the common flu).
2. It takes five days on average to show (compared to three days for the common flu). This gives the virus plenty of time to spread before it’s detected.
3. Many are asymptomatic and therefore unaware that they are infected with COVID-19.
4. No one has immunity.

So far, a few hundred thousand of a potential 7.5 billion people have been infected. We are only at the very beginning of the pandemic. We hear a lot about “flattening the curve” which is important. However, in reality no health care system is well-equipped to handle a large spike in hospitalisations and if/when that occurs, more deaths and serious isolation efforts will follow, like we’ve seen in Wuhan, South Korea and Italy. If 10%-60% of the population catch this virus over the next 12 months, every health care system in the world will get severely tested and possibly beyond capacity.

Therefore, it’s every human’s duty to do their bit to stem the flow of this virus through appropriate hygiene and social distancing.

For more context on why “flattening the curve” is important but maybe not enough, read this excellent article.

Some Other Thoughts on the Pandemic

Coronavirus is potentially life-threatening, but it also puts the livelihoods of millions of people at serious risk. Just think of the economic impact of travel bans, and partial or complete shut-down of public gatherings. It affects big business and the poorest people on a global scale. Systemically important industries like airlines and hotels are at imminent risk of bankruptcy, but so are the poor families sustaining their lives by selling coconuts on exotic beaches. When the situation allows for it, we must return to our local restaurants, go to the dentist and support other businesses that have suffered immensely from this virus outbreak. 

Finally, seeing the human race uniting to fight this virus fills me with a lot of hope for the future. It is my hope that this mass experiment in Stoicism will make us all realise what really matters in life, which is not the newest gadget or latest Instagram like. Across the world we’re seeing some fantastic examples of love and compassion for others and a general sense that we need to look after each other. When humans have won the war against COVID-19 (which we will), wouldn’t it be amazing if we could transfer our newfound sense of community to other global issues such as climate change, poverty or environmental pollution?

Comments are welcome, please share your thought below.