{"id":34418,"date":"2020-09-16T15:31:38","date_gmt":"2020-09-16T21:31:38","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=34418"},"modified":"2024-05-13T09:34:59","modified_gmt":"2024-05-13T15:34:59","slug":"how-to-prevent-superspreader-events-this-fall-and-winter","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/how-to-prevent-superspreader-events-this-fall-and-winter\/","title":{"rendered":"How you can prevent &#8216;superspreader&#8217; events this fall and winter"},"content":{"rendered":"<div style=\"margin-top: 0px; margin-bottom: 0px;\" class=\"sharethis-inline-share-buttons\" ><\/div><figure id=\"attachment_34428\" aria-describedby=\"caption-attachment-34428\" style=\"width: 600px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-34428\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2020\/09\/16114603\/social-distancing-with-masks-sized-e1600278827259.webp\" alt=\"to prevent superspreader events, wear masks, avoid creeds, stay apart and gather outside. Some women wearing masks sit at an outdoor table.\" width=\"600\" height=\"401\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2020\/09\/16114603\/social-distancing-with-masks-sized-e1600278827259.webp 600w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2020\/09\/16114603\/social-distancing-with-masks-sized-e1600278827259-300x200.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2020\/09\/16114603\/social-distancing-with-masks-sized-e1600278827259-150x100.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2020\/09\/16114603\/social-distancing-with-masks-sized-e1600278827259-200x133.webp 200w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><figcaption id=\"caption-attachment-34428\" class=\"wp-caption-text\">Wearing masks and meeting people outdoors are two strategies for preventing superspreader events. Photo: Getty Images.<\/figcaption><\/figure>\n<p>Superspreader events \u2014 where a person with COVID-19 inadvertently infects multiple other people at the same time and place \u2014 are likely to increase as we head into fall and winter.<\/p>\n<p>But, you can prevent superspreader events if you follow these relatively simple guidelines from <a href=\"https:\/\/www.uchealth.org\/provider\/daniel-pastula-md-mhs-neurology\/\">Dr. Daniel Pastula<\/a>, a\u00a0<a href=\"https:\/\/www.uchealth.org\/\">UCHealth<\/a>\u00a0neuro-infectious disease expert and a neurohospitalist at <a href=\"https:\/\/www.uchealth.org\/locations\/uchealth-university-of-colorado-hospital-uch\/\">UCHealth University of Colorado Hospital:<\/a><\/p>\n<ul>\n<li>Stay home when you are sick.<\/li>\n<li>Wear masks as much as possible.<\/li>\n<li>Avoid crowds and limit the number of people at events.<\/li>\n<li>Stay at least six feet away from people.<\/li>\n<li>Maximize \u201cclean\u201d air by holding events outdoors or with good ventilation indoors.<\/li>\n<li>Wash hands and frequently touched surfaces as often as possible.<\/li>\n<\/ul>\n<p>\u201cThe risks of transmission aren\u2019t the same across all events. There are some events or circumstances that are very risky for widespread COVID transmission. These are what we call superspreader events and they are largely preventable,\u201d said Pastula, who is also an\u00a0<a href=\"https:\/\/www.cumedicine.us\/providers\/neurology\/daniel-pastula\" target=\"_blank\" rel=\"noopener noreferrer\">associate professor of neurology, infectious diseases and epidemiology for the University of Colorado School of Medicine<\/a>\u00a0and the\u00a0<a href=\"http:\/\/www.ucdenver.edu\/academics\/colleges\/PublicHealth\/Pages\/default.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Colorado School of Public Health<\/a>.<\/p>\n<p>Over the course of the pandemic, researchers have learned that the virus that causes COVID-19, SARS-CoV-2, likely spreads both through respiratory droplets and possibly via short-range airborne aerosols. These infectious particles can be very dangerous in poorly ventilated, crowded indoor environments and can lead to superspreader events.<\/p>\n<p>Pastula doesn\u2019t want to single out specific types of businesses or events, but people should be very careful if they work or spend concentrated time in crowded indoor environments.<\/p>\n<p>Concerns about airborne aerosols prompted health experts at the <a href=\"https:\/\/www.colorado.gov\/cdphe\" target=\"_blank\" rel=\"noopener noreferrer\">Colorado Department of Public Health and Environment<\/a> to issue new guidance in recent days about <a href=\"https:\/\/drive.google.com\/file\/d\/1oNUhQx2CCwSsMrbSklOreAN1Yjp62sYd\/view\" target=\"_blank\" rel=\"noopener noreferrer\">how to properly ventilate indoor areas<\/a> as well as <a href=\"https:\/\/cdphe.colorado.gov\/covid-19\/businesses-organizations\" target=\"_blank\" rel=\"noopener noreferrer\">how employers can prevent outbreaks in workplaces<\/a>.<\/p>\n<h3><strong>A new understanding of how the virus spreads<\/strong><\/h3>\n<p>While health experts and government officials are worried that coronavirus cases are going to spike throughout the fall and winter, Pastula said he\u2019s actually quite hopeful because experts now have a much better understanding of how the virus spreads.<\/p>\n<p>\u201cSince we have a much better handle on how and why superspreader events happen, we have some good strategies to prevent them,\u201d Pastula said.<\/p>\n<figure id=\"attachment_30046\" aria-describedby=\"caption-attachment-30046\" style=\"width: 166px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-30046\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2020\/03\/19061359\/Dr.-Dan-Pastula.webp\" alt=\"Dr. Dan Pastula\" width=\"166\" height=\"205\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2020\/03\/19061359\/Dr.-Dan-Pastula.webp 166w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2020\/03\/19061359\/Dr.-Dan-Pastula-121x150.webp 121w\" sizes=\"auto, (max-width: 166px) 100vw, 166px\" \/><figcaption id=\"caption-attachment-30046\" class=\"wp-caption-text\">Dr. Dan Pastula.<\/figcaption><\/figure>\n<p>The newest theories about the spread of COVID-19 are actually quite groundbreaking, Pastula said.<\/p>\n<p>\u201cTypically, with respiratory illnesses, we usually think of droplets as acting like ballistic projectiles. We previously thought that coronaviruses only spread through these droplets,\u201d Pastula said.<\/p>\n<p>Droplets are relatively heavy. So, when a person sneezes or coughs, the \u201cprojectile\u201d droplet is pulled down by gravity within six feet or so and shouldn\u2019t infect people who are farther away. That\u2019s why social distancing \u2014 or staying at least six feet apart from other people \u2014 is so important. Those who are infected also can sneeze or cough onto their hands, then touch a surface and spread the virus through objects and surfaces.<\/p>\n<p>But, increasing evidence shows that COVID-19 also may travel from person to person via aerosols, much smaller particles that can stay suspended in the air for minutes or hours, and in turn, infect additional people who may be farther away than six feet.<\/p>\n<p>\u201cAerosols can float. Measles is the classic disease that spreads through the air. It\u2019s so infectious that you don\u2019t need to be exposed to many viral particles to get sick,\u201d Pastula said.<\/p>\n<p>\u201cWe\u2019ve always thought there\u2019s been a dichotomy. An illness either spreads through droplets or through airborne transmission. But, with this outbreak, we are learning that it may not be black and white. It\u2019s likely that SARS-Co-V-2 may be transmitted through both infectious droplets and short-range aerosols in high enough concentration to cause infections,\u201d Pastula said.<\/p>\n<h3><strong>How a choir practice became a superspreader event<\/strong><\/h3>\n<p>Pastula said lessons learned from two particular superspreader events have been critical to boosting knowledge and preventing other events.<\/p>\n<p>\u201cNow that we know more, we have a much better handle on how this virus has spread,\u201d Pastula said<\/p>\n<p>One of the <a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/69\/wr\/mm6919e6.htm\" target=\"_blank\" rel=\"noopener noreferrer\">first known superspreader events in the U.S. occurred in Skagit County, Wash. on March 10<\/a>, where a choir practice at a rented church hall led to mass infections.<\/p>\n<p>\u201cThere were 61 people. One of them had a mild respiratory illness that turned out to be COVID-19. This was early in the outbreak, so no one was wearing masks,\u201d Pastula said. \u201cPeople were seated close together. They were indoors. They were singing and they were together for about two-and-a-half hours.<\/p>\n<p>\u201cOne person is thought to have infected 52 other people in those two-and-a-half hours,\u201d Pastula said. \u201cThat\u2019s a secondary attack rate of 87%.\u201d<\/p>\n<p>Since few people knew then exactly how COVID-19 spread, the choir members didn\u2019t know to stay apart from one another. They didn\u2019t know that singing could be especially dangerous, as could speaking loudly, coughing, sneezing and laughing forcefully. All of those actions could cause an infected person to expel more virus particles farther than they would otherwise. Not everyone who attended the choir practice came into direct contact with the sick person. Therefore, researchers believe the virus also spread through airborne aerosols that floated and traveled throughout the multi-purpose room. Ultimately, two choir members died after contracting COVID-19.<\/p>\n<p>Learning from this tragedy can help prevent other tragedies as long as people remain vigilant, Pastula said.<\/p>\n<p>\u201cWe know that there are some activities that aerosolize particles more than others. For instance, we think that quiet breathing or talking with mask wearing is unlikely to generate as many infectious droplets or aerosols. However, speaking loudly and singing, shouting and coughing and sneezing all can generate more infectious droplets and aerosols, especially when masks aren\u2019t used,\u201d he said.<\/p>\n<h3><strong>Avoid spending concentrated time inside poorly ventilated public spaces<\/strong><\/h3>\n<p>This is where Pastula\u2019s simple guidelines for preventing superspreader events come in.<\/p>\n<p>If the choir member who was sick had stayed home, it\u2019s possible no one else would have gotten COVID-19. If the members had been wearing masks, practiced outside, kept their distance from one another or avoided singing in close proximity, the practice also might not have turned into a superspreader event. But again, not as much was known about COVID-19 transmission back in March.<\/p>\n<p>If fewer people had attended the practice or they had been around one another briefly, rather than for an extended period of time, it\u2019s also possible that some might not have gotten sick.<\/p>\n<p>Pastula said people generally need to be exposed to a sick person for at least 15 minutes in order to get infected, though that time may be shorter or longer depending on the intensity of the exposure.<\/p>\n<p>\u201cThe longer you spend in proximity to an infected person, the more opportunity you have to inhale infectious particles, whether they be droplets or aerosols,\u201d he said.<\/p>\n<h3><strong>Can asymptomatic people trigger superspreader events?<\/strong><\/h3>\n<p>A <a href=\"https:\/\/wwwnc.cdc.gov\/eid\/article\/26\/7\/20-0764_article\" target=\"_blank\" rel=\"noopener noreferrer\">second superspreader event that has been well studied<\/a> occurred in January in China and provided evidence early in the pandemic that asymptomatic people still can spread the virus.<\/p>\n<p>A family traveled from Wuhan \u2014 where cases of the new coronavirus originated \u2014 to a restaurant in Guangzhou. One family member had no symptoms, but later than day, experienced the onset of a fever and cough. Two other families who sat at nearby tables at the restaurant also became infected with COVID-19.<\/p>\n<p>\u201cOne person who was pre-symptomatic infected nine other people in an hour. There was no mask wearing since this was very early in the outbreak,\u201d Pastula said.<\/p>\n<p>The air conditioning was running in the restaurant, so the flow of air could have spread droplets and aerosolized particles from one table to the next. But, the restaurant was large and not everyone there got sick.<\/p>\n<p>The way air particles move is complex. Pastula said it\u2019s possible that the air conditioning system caused aerosolized virus particles to pool in an eddy near the tables where the infected person was sitting. That may be why it didn\u2019t affect everyone else in the restaurant. Or, it\u2019s possible that there wasn\u2019t a high enough concentration of aerosols further away to cause infection at other tables.<\/p>\n<p>Researchers are continuing to learn more about airborne aerosols, but <a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/nejmc2004973\" target=\"_blank\" rel=\"noopener noreferrer\">a study in the spring by researchers from the National Institute of Allergy and Infectious Diseases lab in Hamilton, Mont.<\/a> found that aerosolized virus particles could stay aloft for about three hours.<\/p>\n<p>\u201cThis was an experiment in a lab, and might not completely translate to human transmission in the real world. We\u2019re continuing to watch what happens,\u201d Pastula said.<\/p>\n<p>But evidence thus far shows that droplets and potentially short-range airborne aerosols can both be dangerous.<\/p>\n<h3><strong>How to stay safe and prevent superspreader events<\/strong><\/h3>\n<p>So, what\u2019s the best way to stay safe and not attend or host superspreader events?<\/p>\n<p>Some of the earliest advice still holds true: wash your hands frequently, avoid touching your face, and by all means, stay home if you have any symptoms of COVID-19, which range from a fever and cough to headaches, body aches, digestive symptoms, loss of taste and smell and in less common cases, swelling of extremities.<\/p>\n<p>Social distancing is also vital because you want to stay at least six feet away from people who are potentially infectious (as droplets usually fall to the ground within six feet and the concentration of aerosols also goes down as a function of distance).<\/p>\n<p>Wearing masks is also absolutely essential, Pastula said. (To see research about wearing masks, click <a href=\"https:\/\/cdphe.colorado.gov\/covid-19\/faq\" target=\"_blank\" rel=\"noopener noreferrer\">here<\/a> and scroll to the bottom. Then click on Science of universal mask-wearing.)<\/p>\n<p>\u201cWe know that if the infected person is wearing a mask, the mask serves as a control of the source. If they are talking, sneezing, coughing or shouting, the mask catches a lot of infectious particles and prevents them from going as far as they otherwise would,\u201d Pastula said.<\/p>\n<p>Masks also help people who are not sick.<\/p>\n<p>\u201cIf you are around someone who is infected, and you are wearing a mask, that may cut the viral dose that a person may get. It\u2019s not 100% effective, but there\u2019s increase evidence that mask wearing helps.\u201d<\/p>\n<p>Pastula said <a href=\"https:\/\/www.kgw.com\/article\/news\/health\/coronavirus\/pacific-seafood-outbreak-increases-to-124-covid-19-cases\/283-ffeb0712-76c0-45ea-b6c8-b7644def0ad1\" target=\"_blank\" rel=\"noopener noreferrer\">a study from a seafood processing plant in Oregon provided interesting evidence about masks and infections<\/a>. All workers at the plant were required to wear masks. When there was an outbreak at the plant, universal mask wearing seemed to reduce the severity of infections. Among those who tested positive for COVID-19, all of whom had been wearing masks, 95% were asymptomatic. Researchers believed the masks protected the workers from getting severely ill. They have theorized that they might have been infected with lower doses of the virus and their bodies were able to fight the infection.<\/p>\n<p>\u201cUntil we have a vaccine, masks might function as a crude way to help our immune systems recognize and respond to the virus before the body gets overwhelmed,\u201d Pastula said.<\/p>\n<h3><strong>How to make indoor air as \u2018clean\u2019 as possible<\/strong><\/h3>\n<p>Along with wearing masks, being mindful about ventilation is absolutely essential.<\/p>\n<p>\u201cIt\u2019s important to \u2018clean\u2019 the air as much as possible. How do we do that? First, if you can hold an event outside, that\u2019s best. There\u2019s so much ventilation outside. With wildfires, that may not be possible, but when air quality and weather allow, gathering outside is always better.\u201d<\/p>\n<p>When inside, it\u2019s also possible to keep air as clean as possible. Whenever possible and safe, open a window to keep air moving.<\/p>\n<p>Heating and cooling systems also can provide help. Most furnaces and air conditioning units have filters.<\/p>\n<p>Change your filter as recommended, and use the highest level of filtration which is compatible with your system. Click here to see <a href=\"https:\/\/www.epa.gov\/sites\/production\/files\/2018-07\/documents\/guide_to_air_cleaners_in_the_home_2nd_edition.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">a guide from the Environmental Protection Agency<\/a> on how to keep indoor air safe at your home.<\/p>\n<p>Pastula recommends using filters that are rated at MERV 13 or higher. He also suggests running your heating and cooling system in a way that brings outdoor air inside as much as possible.<\/p>\n<p>You can also keep your system running all the time.<\/p>\n<p>\u201cThere\u2019s a circulation setting on most HVAC units. You\u2019re not heating or cooing, but running it in the background,\u201d Pastula said. \u201cRunning it at a low level all the time, rather than turning it on and off allows the air to continuously run through your HVAC filter.\u201d<\/p>\n<p>Managers of commercial buildings also must be mindful about the safety of indoor air and many are making adjustments as the seasons change.<\/p>\n<h3><strong>Until the pandemic eases, avoid crowds<\/strong><\/h3>\n<p>Along with working to keep air cleaner, in order to prevent superspreader events, we are all going to need to keep avoiding crowds.<\/p>\n<p>\u201cThe highest risk of a superspreader event would be lots of people from different households gathering indoors for more than 15 minutes, not wearing masks, with a lot of loud talking and poor ventilation,\u201d Pastula said.<\/p>\n<p>\u201cThis fall and winter, we\u2019re going to have to keep being adaptable. Be really smart,\u201d Pastula said.<\/p>\n<p>\u201cCOVID-19 is still circulating. We are not out of the woods yet.<\/p>\n<p>\u201cGather with fewer people. Try to be outdoors if you can. If you can\u2019t be outside, make sure the ventilation is good indoors. Wear masks, except when actively eating and drinking. Spread out. And make sure anyone who is sick stays home.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Superspreader events \u2014 where a person with COVID-19 inadvertently infects multiple other people at the same time and place \u2014 are likely to increase as we head into fall and winter. But, you can prevent superspreader events if you follow these relatively simple guidelines from Dr. Daniel Pastula, a\u00a0UCHealth\u00a0neuro-infectious disease expert and a neurohospitalist at [&hellip;]<\/p>\n","protected":false},"author":2123,"featured_media":34428,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[8],"tags":[4859,4860,392,162],"class_list":["post-34418","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","tag-coronavirus","tag-covid-19","tag-infection-prevention","tag-infectious-diseases"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>How to prevent &#039;superspreader&#039; 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