What a Live Event During an Epidemic Looks Like

There are decades where nothing happens and there are weeks where decades happen. While we watch the horrors of the largest war since WW2 unfold before our eyes, there is still the ever-present war against COVID-19. It has killed more Americans than the Civil War and has seemingly turned modern science and public health policy into a battlefield. There's an assortment of articles arguing that we are moving from a pandemic to an endemic so I'll split the difference and call it an epidemic.

It's been roughly a week since I returned from the ETHDenver conference. As a founder who's relatively new in the crypto space, it was a great opportunity to learn from and connect with other builders. I got a sneak peek into the future and I returned with so much clarity and conviction around what we're building at Fairo. I knew that attending an event with over 10,000 people for a week basically guaranteed that I would come across COVID exposure despite the organizer's best efforts. It's hard to go up against the law of large numbers.

I'll start by ripping the band-aid off: it's clear now that a COVID-19 outbreak did occur at the ETHDenver conference. This is not some singular indictment against the conference but just an attestation to the realities of how large-scale events work now. It's also a reflection of where public health policy sits today. We are lifting mask and vaccine mandates across the country not because the spread of the virus has slowed down significantly but because the latest variant is now a manageable disease since it's not overwhelming hospitals.

It's clear that we're not returning to mandatory lockdowns. The Super Bowl had over 100,000 attendees. Coachella is back this year. Live events are back. In this new normal, we should arm ourselves with as much real-time data as possible. Testing, reporting and contact tracing are the most potent tools left in our arsenal today and could actually introduce a new modality to slow the spread of all airborne diseases in the future.

One silver lining that came out of the pandemic was a collaboration between Apple and Google that resulted in a contact tracing framework and protocol now known as Exposure Notifications. The way it works is that users who opt-in to the tool broadcast a temporary key via Bluetooth that rotates every 10 minutes to other opted-in devices around them. These keys are stored for 14 days. In that timeframe, if someone tests positive for COVID, they can then share their keys so that people who have been exposed can be alerted. My personal data demonstrates that COVID is ever-present now but only a small number of all exposures are actually meaningful enough to trigger an alert. Epidemiologists working with Apple and Google have done an amazing job developing models that filter the signal from the noise. When COVID was raging through SF this past December, a COVID exposure alert gave me a day to prepare for my battle with the virus. It goes without saying that if you see this alert, get tested!

Testing

A negative COVID antigen test was required for a wristband that granted entry to ETHDenver. The entire conference ran from February 11th to the 20th with the core conference happening between the 17th and the 20th. The event was reminiscent of SXSW since it had venues across 3 blocks in Denver. Official parties on the schedule required the wristband for entry so this helped preserve the COVID-negative bubble somewhat. However, as the week went on there were also many unofficial gatherings and parties that didn't require the wristband and this probably helped introduce a vector for spread since many people came into town without a conference pass. Those who arrived on the 17th for the core conference did have to endure 3-hour lines in the cold to get tested, which is probably why many large-scale events don't currently implement this mechanism due to the bottleneck it introduces.

While vaccinations have proven durable against hospitalization, their effectiveness against getting infected fades over time. Research shows that those who aren't boosted effectively have no immunity against the omicron variant. Event organizers who are trying to use vaccination status as a proxy for being COVID-negative should probably factor in the booster and the correlation may very well be tenuous at best.

Schmoozing

A negative test provided the opportunity to go unmasked and the overwhelming majority of us did. Some venues were packed throughout the conference but once the core conference was in full swing, the density was really concentrated at specific venues such as the Sports Castle. Once COVID-positive people entered the mix, this was probably a core vector for spread. I sat next to a TIME reporter at the Sports Castle who later confirmed his positive diagnosis after the conference ended.

Reporting and Tracing

My personal COVID exposure data shows that the COVID-negative bubble for the event mostly held up until around the 18th. The two ways to look at this is that the bubble held for a week full of pre-conference events and also that it held for a day of maximum density. One other thing to note about the data is that the exposure counts (blue area) are time delayed. As a quick refresher, an exposure is defined as being in the proximity of someone who later tested COVID-positive for less than 10 minutes. The dramatic spike you see starting on the 21st corresponds to the spike in COVID-positive tests coming in on that date but the actual exposures occurred 3 - 5 days before, which corresponds to the time of maximum density at the conference. Confirmed exposures are mapped to the day when they occurred. While I received 4 different exposure alerts (presumably mapping to 4 different people), I only knew the date of the earliest exposure. Subsequent exposure dates were not revealed.

The Gambit

Attending a live event during these times requires a personal risk assessment. Realizing that my vaccine immunity to omicron was near zero with only two shots from >6 months ago, I decided to to boost up and take the flu vaccine ahead of the conference. Along with the natural immunity that I had obtained in December, I now had "super immunity." I did come into contact with 4 people that triggered an alert out of the ~180 confirmed exposures that I racked up during the conference. It was only after the alert came in that I started to realize why I was feeling really sluggish and it was followed by a day of chills afterward. The chills were less severe than the ones I had experienced after the booster and flu vaccines so I believe that my body was generating an immune response to virus exposure. In any case the viral load was too low to register on an antigen test. The fact that my immune system fought off 4 serious exposures with minimal downtime was impressive.

The Data

I am certain that the total number of COVID exposures that I had were at least double what I recorded on my device. That's because we have a broken contact tracing infrastructure in the US that doesn't cross state lines well. In fact, it's not available in most states! I was lucky that I traveled between two states that had Exposure Notifications enabled. COVID doesn't respect state lines and we need to enable a national registry to recognize that reality. Recent reports state that only 3% of cases in California were reported through the system since launch, though I will add that self-reporting options were non-existent until a recent update on iOS. I am convinced that the availability of at-home tests is leading to severe underreporting of infection data. The lack of adoption of such a powerful tool is also saddening.

A New Modality

We now have the tools to properly trace and potentially stop the spread of airborne diseases. It's clear that preventative measures such as always-on masking and social distancing are not sustainable long-term solutions. However, deploying a privacy-preserving contact tracing protocol would be a great a public good. If we voluntarily report airborne illnesses through the protocol, alert others, mask up and self-quarantine (if possible) until an incubation period has passed or symptoms disappear, we can dramatically reduce the spread of any future airborne disease.

Whether we like it or not, we're in a new normal now. Data can help us live our lives without fear and provide us with the tools to manage our way forward.

I am the founder of Fairo, a startup focused on protecting Web3 communities from hackers and malicious transactions.