Tulsa, Okla., Is about to host an event that scientists call a “natural experiment.” It can provide important clues to one of the most confusing features of the COVID-19 pandemic: the undetected spread of the novel coronavirus by people who do not appear to be sick.
At least 20,000 admirers of President Trump are expected to gather at the city’s Bank of Oklahoma Center, where they will be tightly packed for several hours. Once inside, they sing, cheer, and scream – all as a highly efficient means of getting the coronavirus into the air where it can be sucked in by people nearby.
Health professionals are confident that the potentially deadly pathogen will travel from infected people who have no external signs of disease to others who have entered the arena virus-free.
If the recent trends in Oklahoma continue, 2.1% of those who get sick enough to be diagnosed with COVID-19 will die. And 41% of Oklahomans are at risk of becoming seriously ill if infected because of their age or underlying health conditions.
Bruce Dart, Tulsa County’s Chief Health Officer, expressed concern about “our ability to protect anyone attending a large indoor event.” The Trump campaign said that each attendee would be offered a hand sanitizer and mask, but none of these would be required.
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Although the infectious events in Tulsa will be invisible, they will take place in full view of a national audience. But only with time, testing, and careful tracing of contacts can researchers see the dynamics of the virus’ spread and determine its ultimate toll.
Released in the breath droplets of an infected person, the coronavirus that causes COVID-19 has become firmly established in and around Tulsa. In Tulsa County, infections confirmed daily have increased since late May, reaching 130 per day in a community of approximately 650,000 people. Nearly 15% of confirmed patients end up in the hospital, and 65 people there have died from COVID-19 to date.
Even so, between Friday and Sunday this weekend, tens of thousands of people will leave their homes and make their way to a variety of mass gatherings.
Some of those attending the president’s rally on Saturday night are sure to wear face-coverings that can hinder both the projection of breath droplets and their inhalation by nearby people. But many will not be ready to offer such protection. Indeed, the event headliner has long derided wearing face masks. (On Thursday, Trump claimed that some have taken the practice to express their disapproval against him.)
Participants must queue for hours and undergo temperature checks as they enter to rule out those with active infections. Much will be missing: somewhere between 25% and 50% of those infected do not have a fever or other notable symptoms. However, several studies have shown that many can and do infect others.
On the contrary, the coronavirus does not seem to recognize political tendencies. So, thousands of others in Tulsa become guinea pigs and gather at events to protest Trump, fight back against racism and remember Juneteenth, the anniversary of the learning of enslaved Texans about their emancipation.
These subjects in the city’s natural experiment will also join forces in the area of the spread of the breath droplets. However, they mostly collect outdoors, where virus-filled droplets fall out of the air more quickly and therefore spread less efficiently.
While their ages and ethnicity will vary widely, they will likely be younger and more African American and Latin American than the crowd that it turns out for Trump. Experts predict many, but not all, will wear masks at the urging of public health officials.
Once reconstructed and analyzed by researchers, this weekend’s events, and the aftermath beyond, could help them unlock some secrets about an epidemic that caused nearly 120,000 deaths in the United States and 458,000 deaths worldwide.
Asymptomatic spread has emerged as one of the most surprising and confusing challenges of the pandemic. Emerging patterns of spread have defied the expectations of epidemiologists, who are now wondering whether the COVID-19 outbreak will be a historic first: a pandemic triggered by spreaders who have no idea they are sick.
In January, Dr. Anthony Fauci, Director of the National Institute for Allergies and Infectious Diseases, said the spread of viruses through people without symptoms was historically “never the driver of outbreaks”.
That was then, that is now, he said recently.
“If you look at the data and the percentage of people who are not symptomatic – between 25% and 50% – it’s likely that they play a role, and possibly a significant role, in transmission,” Fauci said.
Several studies indicate the likelihood of infection from people who are infected but either don’t get sick or have not yet developed symptoms.
A Chinese study published in the journal Nature found that people infected with coronavirus are likely to shed it for almost two and a half days before their first signs of illness appear, the scientists found. Contagion from an infected person peaks about 18 hours before a fever, body ache, or cough begins.
Another Chinese study published in the Journal of Infection tracked a single 22-year-old man who returned to Anhui Province from Wuhan at the start of the pandemic. He passed the virus on to eight others in the two days before he noticed the first signs of his own illness: itchy eyes and a fever.
Other studies have pointed to the prospect that asymptomatic transmission is significant. When the Theodore Roosevelt pulled into Guam for an emergency medical stop and all staff aboard the aircraft carrier were tested, it was found that approximately 1,000 out of 4,800 were infected. They were reported to be far fewer sick, suggesting the virus could be easily transmitted in people with few or no symptoms.
Researchers who want to study the dynamics of virus transmission in Tulsa have not yet come up with a plan, said William Hanage, an epidemiologist at Harvard. Uneven access to tests – either to diagnose an infection or to detect a previous infection – will make it difficult for any team to come up with a reliable solution to the issue, he said.
To better manage asymptomatic transmission, “very intense contact tracing” needs to be carried out on a population that is both limited and limited, Fauci said. He suggested that close monitoring and scrutiny of people in nursing homes, prisons, and on board ships like the Roosevelt could help epidemiologists understand just how much “silent spreaders” are responsible for the growth of the pandemic.
One such research project at Rutgers University examines 500 healthcare workers who are regularly exposed to the coronavirus and 540 of their household members. All are questioned and tested regularly for several months. Their transmission rates and trends are compared to a group of non-healthcare workers.
Another study, launched in April, could help clarify how the way you talk, shout and cheer at rallies and protests is contributing to the spread of the coronavirus, and how a mask can help suppress such spread.
Researchers from the National Institutes of Health will have 60 subjects with probable or confirmed infections, but no symptoms will participate in a masked and unmasked speaking exercise. The droplets they produce are collected and analyzed, and participants are followed to see if and when they develop symptoms.