How to spread COVID

      "An 83-year old man who tested positive Nov. 25 died Dec. 1 at Rogue Regional Medical Center, pushing the local death toll from the disease to 38."

          Medford Mail Tribune newspaper today

That death was one of 2,857 yesterday, and 2,885 the day before and 2,610 the day before that.

Joe Biden is announcing he plans a new national approach to COVID. Do more, not less. Break the trajectory of COVID infection now to stop the rising hospitalization and death count. Vaccines are on their way, but don't let up just yet, he says. He announced that Dr. Anthony Fauci has been re-upped and promoted. Biden announced plans for a 100-day national mask mandate.

In states, cities, and counties, elected officials have been shutting down restaurants and bars for everything but take-out. It is controversial because people dispute whether it is well-targeted and effective, because it is inconvenient for the general public, and devastating for the hospitality industry. 

Conservative opinion leaders have an easy target and talking point. One say perfunctory things about the tragic loss of life, and then go to the safe harbor of criticizing the irritating on-the-ground mechanisms for stopping the virus. No one likes freezes and shut-downs and masks. In states with Democratic governors or mayors, criticize them. If there is a Republican governor, criticize Biden.

"This Thanksgiving is when we need each other more than ever before," a Fox Business host said on Fox & Friends. "I think people are going to revolt. Not an in-your-face revolt, but you know what, if you've got 15 people coming over, they're coming over, period." 

Americans got mixed messages on masks and shutdowns. They see people at the White House having mask-free indoor gatherings and they hear stories of Democrats like Speaker Nancy Pelosi, California Governor Gavin Newsom, and now the Mayor of Austin, Texas, being outed for failing to observe their own rules. The conservative media pounces. Hypocrites! The net result is that many people feel justified and righteous in doing what they want to do anyway, live their lives as if COVID is not a problem. Gather, eat, drink.

Bar and restaurant owners feel particularly aggrieved. In Michigan a restaurant owner protested, saying his business is being destroyed, and restaurants aren't the real problem. "You know, my business has been going through this for nine months and we have not had any cases."  He complained the real spread takes place in informal private gatherings, at homes and private parties, not in restaurants.

We have some data on how COVID spreads in a restaurant.

COVID appears to spread through air droplets, whether at a family birthday party or in a restaurant or bar. 

There is a big element of chance on catching the virus. Six feet of distance does not provide safety. Droplet movement depends on ventilation and air flow. A South Korean study took a close look at transmission in a 1,000 square foot restaurant, without windows, but with two air conditioning units circulating air: Click: Journal of Korean Medical Science

There are few enough cases in South Korea that exposures to any infected person is rare, so the study authors feel confident they know who spread the infection to whom. In South Korea cell phone location data was able to trace back the contacts people had. Closed circuit TV showed where patrons sat at tables, the distances of patrons in the restaurant, the times they were in proximity, whether masks were worn, exactly where people sat, and where the air conditioning units were.  People fifteen and twenty feet away caught it. People closer did not. 

Several people very near the infected person did not catch COVID, including people right behind the Patient A, the original infected person. Nor did people at the same table. The people who caught it were people  in the air flow direction of the air conditioning. 

Some activities are apparently more dangerous than others.  Sitting quietly, but closely is apparently not as dangerous and talking with volume or singing. 

The notion that only the very vulnerable catch the disease is belied by the circumstances of the Skagit County Choir. The spread was not hit and miss between the fragile and the hardy. Both got it. Fully 87% of the people in the singing group caught the infection after a single session of choir practice. The key element appears to be projection of droplets in the air within an enclosed space or where ventilation allows the droplets to circulate. The Skagit event suggests that if airborne droplets circulate to you, you probably catch the disease. A person who visits a bar or restaurant, or a gathering where people project their voices, and who then goes home to family, is a person of at risk of having and spreading the disease. Thanksgiving or Christmas dinners are dangerous. 

The infected person in both studies were a-symptomatic at the time they spread it.

Note: the data in this study, and others, are repeated in more readable form in this article: https://zeynep.substack.com

Summary: Indoor restaurants and bars are inherently places where COVID spreads. People are maskless to eat. People project their voices to be heard. This behavior also happens at parties, at Thanksgiving dinner, at parties. People responsible for protecting public health are not illogical or un-scientific in targeting indoor restaurants, bars, family gatherings, and assemblies where people talk, worship, chant, or sing. They are reasonable in saying that masks and social distance matter. They would be following the science. 

They shouldn't expect to be thanked for it. They are bearing unwelcome news, taking an action people would prefer not to take. The smart, but cynical politics is to tsk-tsk about how terrible COVID is, and then criticize tyrants who presume to tell people what to do, where to eat and drink, and whether to see one's family.