The Washington Post - USA (2020-11-13)

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A4 EZ RE THE WASHINGTON POST.FRIDAY, NOVEMBER 13 , 2020


the coronavirus pandemic


BY KARIN BRULLIARD

A record-breaking surge in U.S.
coronavirus cases is being driven
to a significant degree by casual
occasions that may feel deceptive-
ly safe, officials and scientists
warn — dinner parties, game
nights, sleepovers and carpools.
Many earlier coronavirus clus-
ters were linked to nursing homes
and crowded nightclubs. But pub-
lic health officials nationwide say
case investigations are increas-
ingly leading them to small, pri-
vate social gatherings. This be-
hind-d oors transmission trend
reflects pandemic fatigue and
widening social bubbles, experts
say — and is particularly insidious
because it is so difficult to police
and likely to increase as tempera-
tures drop and holidays ap-
proach.
The White House coronavirus
task force has been urging states
that are virus hot spots to curtail
maskless get-tog ethers of family
and friends, saying in reports that
asymptomatic attendees “cause
ongoing transmission, frequently
infecting multiple people in a sin-
gle gathering.”
On Thursday, the nation passed
another grim milestone in the
pandemic, setting records for cas-
es and hospitalizations, with
more than 153,000 new cases and
more than 66,000 people hospi-
talized. In Chicago, the mayor
said that starting Monday, resi-
dents should leave home only to
go to work or school, or for essen-
tial needs, such as seeking medi-
cal care or getting groceries.
This week, New York Gov. An-
drew M. Cuomo (D) announced a
10-person limit on gatherings in
private homes, calling them a
“great spreader.” Similar restric-
tions have been imposed in states
including Ohio; Utah; Connecti-
cut; Colorado, where one recent
cluster involved seven people in-
fected while playing the dice
game bunco; and Rhode Island,
whose governor has pledged to
fine violators. Oregon last week
announced a “pause” in hard-hit
counties on most groups larger
than six people.
“Earlier in the outbreak, much
of the growth in new daily cases
was being driven by focal out-
breaks — long-term care facilities,
things of that nature,” said Nirav
Shah, director of the Center for
Disease Control and Prevention
in Maine, where cases have soared
in the past two weeks. “Now, the
kitchen table is a place of risk.”
In Maine, as in other states,
case investigators are seeing a
new and related pattern: People
who are infected list more close
contacts than they did earlier,
making the work of contact trac-
ers more time-consuming and


complicated. From March
through September, the average
number of contacts identified in
Maine coronavirus investigations
was 3.5. In October, that rose to
5.8.
“We’ve all gotten used to our
bubbles, but I don’t think we’ve
really asked whether someone
who’s in our bubble is also in
another person’s bubble,” Shah
said. “People’s bubbles are getting
big enough to burst.”
For months, the danger of large
events has been a focus of state
and local restrictions and of me-
dia coverage. Experts say less at-
tention has been paid to the peril
of small gatherings among family
and friends, who may appear
heal thy and take similar precau-
tions to avoid the virus.
But each additional contact in-
creases a person’s risk, said David
Rubin, the director of PolicyLab at
Children ’s Hospital of Philadel-
phia, which warned in a blog post
last week that small indoor gath-
erings create “perfect conditions
for a virus that can spread among
people who are crowded into a
poorly ventilated space.” Rubin
said a person’s “bank” of risk
should be even lower in winter
because respiratory viruses like
the coronavirus are more stable in

dry, colder air.
“Often, they’re with people we
know really well,” Rubin said of
these gatherings. “We let our
guard down .”
Amber Calderon now knows
she did that in October. The 24-
year-old was excited to see some
of her relatives for the first time in
months at her nephew’s birthday
party — a nd she felt safe. The
Conroe, Tex., resident knew her
relatives wore masks and socially
distanced in their day-to-day
lives, she said, so she “trusted
everyone.”
About 25 people attende d the
party at a house, and Calderon
said just one person wore a mask
— her 81-year-old grandmother.
Calderon started to feel ill a few
days later, and she tested positive
for the coronavirus on Oct. 20. Ten
other people who were there also
got sick, she said, including her
grandmother.
“When I tested positive, I w as
mad at the situation I put myself
in,” Calderon said. “I should’ve
never attended that party that
day. None of us should have. I
knew better.”
In some places, the sheer vol-
ume of cases is so great that public
health departments cannot con-
nect the dots between them or

discern whether a gathering at-
tended by one infected person is
the same as one reported by an-
other.
In Minnesota, which reported a
single-day record of nearly 6,
cases on Sunday, the state’s infec-
tious-disease director, Kris Ehres-
mann, described what she called a
“circular” problem: Social gather-
ings are leading to more commu-
nity spread, and more spread is
making those events ever riskier.
“It’s getting more and more
difficult to really tease out an
interpretation of these data, be-
cause our community transmis-
sion just keeps going up,” said
Amy Westbrook, the public health
director of St. Louis County, Minn.
In h er county, she said, 30 per-
cent of people who test positive
say they don’t know where they
caught the virus, and a rapidly
gro wing number haven’t even
spoken to overwhelmed conta ct
tracers. Westbrook said she is
stepping up public education ef-
forts, but she knows residents are
somewhat numb to messages
about masks, handwashing and
staying home. And local law en-
forcement agencies, she said,
have other matters to focus on
than dinner parties.
“Once there’s community

transmission that’s so wide-
spread, there’s not a lot of good,
targeted interventions,” West-
brook said.
Timothy McDonald, public
health director in the Boston sub-
urb of Needham, said he is consid-
ering a campaign centered on the
idea of a “social budget,” remind-
ing residents that, according to
guidance from the Centers for
Disease Control and Prevention,
they should avoid spending more
than 15 minutes within six feet of
most other people in a 24-hour
period.
McDonald said he hopes that
might help with an alarming wid-
ening of social groups and casual
encounters, particularly among
youths. In-school transmission is
not the problem, he said. Instead,
spread is happening after school
— at play dates, sleepovers, and,
especially, socializing and car-
pooling connected to youth
sports, he said.
“If your son or daughter is play-
ing on a town soccer team and a
travel soccer team, plus lacrosse,
and is also on an ice hockey team,
they’re exposed and in close prox-
imity to dozens of other kids,”
McDonald said. “Instead of count-
ing the contacts on single digits,
it’s now getting to two or three

dozen in some cases. And those
are only people who are defined as
close contacts.”
Beyond gathering caps and
public pleas, of ficials and experts
say it is unclear what can be done
to persuade pandemic-weary
Americans to tighten their circles.
Capacity limits in bars or mask
requirements in stores can be en-
forced through fines and closures.
Cracking down on baby showers
or poker nights in private homes
is another matter.
Connecticut Gov. Ned Lamont
(D) last week announced a 10-per-
son limit on all indoor and out-
door gatherings, saying informal,
private gatherings were “where
we’re seeing ignition taking off in
terms of the infection rate.” But he
acknowledged that enforcement
would be “on the honor system.”
In neighboring Rhode Island,
Gov. Gina Raimondo (D) has for
weeks admonished residents to
shrink their bubbles and skip
casual gatherings. Some people
have reported 50 close contacts,
she said at a b riefing in mid-Octo-
ber. A high school slumber party
involving at least 20 youths led to
at least five infections and put
hundreds of people in quarantine,
she said as she announced a 10-
person limit on social gatherings
Oct. 30.
Raimondo said she would not
hesitate to fine hosts of gather-
ings found to fuel transmission
$500 for each person over the
limit. No such fines have been
issued yet, a state health depart-
ment spokesman said Tuesday.
“Of course you want to have a
birthday party for your kid. Of
course it’s your friends who you
have over, so you want to give
them a hug,” Raimondo said. “It’s
human. It’s understandable. It’s
got to stop.”
Calderon now agrees. Her bout
with covid-19, the disease caused
by the coronavirus, involved a
litany of symptoms: loss of taste
and smell, devastating head-
aches, a cough, congestion, stom-
ach pain, muscle aches, fatigue.
Calderon came out of it feeling
lucky. She and all of her relatives
recovered. Her grandmother was
hospitalized for a week but is on
the mend.
Calderon said she also came
out of it with renewed resolve to
remind others to be vigilant —
and tell them “that the party they
are about to have is not a good
idea.”
Everyone is tired of leading
hemmed-in lives, Calderon said.
But she views her experience as a
painful reminder that “this virus
spreads, and it spreads fast,” she
said. “And if you continue to ig-
nore it, it will catch up to you, just
like it did me.”
[email protected]

Transmission surges, fueled by parties and game nights


ANDREW KELLY/REUTERS
Little League players gather in October on Staten Island. Many health officials have pointed to the widening of social groups, particularly
in youth sports and other after-school activities, as a major driver in the recent surge of coronavirus infections nationwide.

BY BEN GUARINO,
LENA H. SUN
AND ARIANA EUNJUNG CHA

When the White House coro-
navirus task force first recom-
mended mask-wearing April 3,
officials emphasized that this was
not about you. It was about oth-
ers. Your mom, dad, other family
members. Friends. The older
woman who always smiles at you
at the grocery store, the immuno-
compromised dad coaching your
kid’s basketball team.
Now, a g rowing body of science
suggests that by wearing a mask
to prevent spreading the virus,
you may be protecting yourself,
too. It is further evidence that
know ledge about masks, and
their be nefits, continues to evolve
— much as does understanding of
the pandemic more broadly.
The Centers for Disease Con-
trol and Prevention publicly ac-
knowledged that for the first
time, writing in a scientific bulle-
tin posted to its website this week
that “the benefit of masking is
derived from the combination of
source control and personal pro-
tection for the mask wearer.”
Masks are neither completely
selfless nor selfish — they help
everyone.
John Brooks, chief medical of-
ficer for the CDC’s coronavirus
response, told The Washington
Post there was an urgency to
explain this clearly, because the
widespread wearing of face cov-
erings can help prevent the need
for national lockdowns.
The CDC published this scien-
tific brief to fix what the agency
saw as the lack of “a concise
summary of the powerful scien-
tific evidence demonstrating the
benefit of masking,” he said. The
bulletin marks the start of the
agenc y’s renewed push to bolster
public messaging as infections
surge to their highest-ever levels
in many U.S. regions. The agency


is now updating all its communi-
cations about masks to include
the new information. CDC is also
preparing material with details
about the data and science for its
partner groups, including state
health departments.
Because the CDC cannot im-
pose mandates, the agency wants
the public to understand masks
are “good for them,” Brooks said.
The new document attempts to
dangle a persuasive carrot of
information before the public: A
“likely complementary and possi-
bly synergistic” relationship ex-
ists between controlling the
source of infection for others and
being protected yourself, the
agency said. Put another way, the
more people wearing masks in
the community, the greater the

individual benefit.
“Wearing a mask blocks you
from inhaling potential virus-
containing particles in the air,”
Brooks said. “But most of the
benefit to a mask is to block
particles coming out of people
who don’t know they are infected
from exposing others.”
Masks create a barrier that
stops some of the droplets from
flying outward when someone
breathes, talks, sings or coughs. A
study released last week showed
that, in experimental conditions,
simple fabric masks blocked
about three-fourths of the parti-
cles expelled by coughing volun-
teers.
But it was a logical hypothesis
for researchers to investigate,
too, whether masks might also

block incoming particles. And
laboratory tests in recent months
indicated that masks can filter
out the types of incoming parti-
cles able to carry virus, Brooks
said.
The CDC official added that
personal protection for the mask-
wearer is not absolute. “The real
benefit is when all of us do it,
that’s how we bring down the
viral load of covid-19 in commu-
nities,” Brooks said.
In the nine months since the
virus hit the United States, the
CDC has come under increasing
criticism that its guidance on
mask protection has not been
sufficiently clear because it con-
flated scientific data with a con-
cern over mask availability.
During the first wave of the

pandemic, surveys indicated a
majority of both Democrats and
Republicans wore masks, though
Democrats were more likely to.
But a few Americans were strong-
ly skeptical. This opposition be-
came so pronounced in the sum-
mer that online shops sold fake
“mask exemption” cards, labeled
with stolen Justice Department
imager y, by the hundreds.
By midsummer, Republican
memb ers of Congress were en-
couraging face coverings. Senate
Majority Leader Mitch McCon-
nell (R-Ky.) said in late June
putting on a mask was the “single
most important thing you can do”
until vaccines were available.
But President Trump rarely
insisted Americans wear them.
He often described masks as op-
tional and once, misleadingly, as
a “double-edged sword” because
people might touch the fabric and
then their faces.
Images of the president cover-
ing his face were scarce until he
tweeted a photo of himself in a
mask in July.
“Overall, this seems like a win
in terms of messaging that would
appeal to Republicans,” said
Katherine White, an expert in
consumer behavior at the Univer-
sity of British Columbia. She said
this was because conservatives
are strongly motivated by a per-
sonal responsibility to care for
themselves.
Brooks, who oversaw the publi-
cation of the new bulletin, said
the language went through
lengthy vetting to make sure
there was agreement on the best
evidence. In this case, laboratory,
epidemiological and population-
based studies all showed “very
substantial benefits” of mask-
wearing, he said.
An evolution of scientific
thinking about masks in the Unit-
ed States occurred amid the pan-
demic. Monica Gandhi, an infec-
tious-diseases expert at the Uni-

versity of California at San Fran-
cisco, said science suggests face
coverings “of higher thread
count, more than one layer, and
those that employ ‘electrostatic
filtration’ like surgical masks”
provide the best protection.
“Messa ging that allows the
public to know that masks pro-
tect you as well as others will be
more powe rful in convincing
skeptics that masks are impor-
tant in public spaces to slow
down spread and disease from
covid-19,” Gandhi said.
It is less clear whether masks
— by potentially stanching some,
but not all, incoming viral parti-
cles — might also lessen the
severity of illness. On Sept. 8,
Gandhi and her UCSF colleague
George Rutherford suggested the
dose of virus that people are
exposed to may affect the serious-
ness of disease. The scientists
said face coverings could filter
enough droplets to lead to asymp-
tomatic or mild illness in some
cases — and lead to some immu-
nity.
On Oct. 23, a group of other
prominent experts — including
Columbia University’s Angela
Rasmussen and George Mason
University’s Saskia Popescu —
argued in a letter to the editor
that the science is preliminary
and that it is only a hypothesis
that mask-wearers inhale small
amounts of virus.
The CDC did not address this
theory in the bulletin released
this week. The agency empha-
sized this update did not reflect a
change in the agency’s recom-
mendation to wear masks.
“Our guidance is still the
same,” Brooks said. “This is more
data in support of that, and it
highlights that there is personal
protection that we want to make
sure people know about.”
[email protected]
[email protected]
[email protected]

A mask isn’t just about protecting others, CDC says. It can help you, too.


KIM RAFF FOR THE WASHINGTON POST
A patron a t Nostalgia Café in Salt Lake City on Monday. Coronavirus cases are spiking in Utah,
prompting new restrictions on gathering and mask-wearing.
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