A Tale of Coin Flips, Luck, and a Dangerous Decision in California
This week many news outlets reported on an early January Covid-19 policy change in California. Contrary to CDC guidance, the California Department of Public Health no longer requires a person who tests positive for Covid-19 to isolate if they do not exhibit symptoms. This means that infected people may attend schools, places of work, religious services, and other crowded locations like health care facilities. The change represents a continued erosion of protection for people with vulnerable health conditions and for everyone in society. In the last year many have grown accustomed to ignoring the exposure risk that they create for others. To understand how large this risk can be I offer a story of my own from the onset of the Covid-19 pandemic in the U.S.
Four years ago this week, I sat in my office on Fordham University’s Rose Hill Campus in the Bronx. During the day I traded text messages with a friend and fellow economist named Jason. The first U.S. infection of the Covid-19 pandemic had been diagnosed just days earlier. As Jason and I corresponded, things were not yet as heavy as they would become. Sirens didn’t yet echo throughout New York City streets and alleys. As we now know, that day would soon be upon us.
Even though the full force of the pandemic had not arrived, Jason and I had concerns. We, along with additional colleagues, had organized a late February economics workshop in a Boston hotel. Our workshop would host about 30 people. It was a small part of a larger conference that hundreds of people would attend. Was it wise for us to hold our two-day gathering of thirty people while an epidemic raged in China and perhaps soon would envelope the world? That was the question we were asking each other. Many of our attendees would travel from across the U.S. and others would be arriving from Asia and Europe. My individual decision was easy – even though I had helped to organize the workshop, I had a family event that prevented my attendance. Yet, I felt a responsibility to do the right thing for our attendees and society at large. So did the other organizers. But we didn’t know what the right decision was. At the time, there was no guidance against holding events such as this. In the end, we decided to move forward and hold the workshop but we did so with uncertainty. To the best of our knowledge no one was infected. However, we now know that our decision was unwise. We got lucky. How do we know this?
Two days before our workshop, an international biotechnology company named Biogen held a meeting at another Boston hotel.* This hotel was only two miles from the site of our economics workshop. The Biogen meeting contained about 175 people; like our workshop it too contained several international participants. However, Biogen was not as lucky we were. An outbreak occurred at their meeting. Initially 28 cases were identified among participants and their direct contacts. It grew to 99 infections as people returned home and cases were tracked to Indiana and North Carolina. In late February 2020 we were not yet measuring daily infections in the thousands or millions as would occur later in the year. When the meeting started, there were fewer than 100 known cases across the entire U.S. For the time the Biogen outbreak was very large. It would grow to be much, much larger.
The specific strain of the virus, CT2416T, that caused the Biogen infections was unusual. It had only been found in two French patients before its appearance at the Biogen meeting. The uniqueness of the strain allowed Boston area researchers at the Broad Institute (a partnership between M.I.T. and Harvard) to track the spread outward from the meeting at the Boston waterfront hotel. People throughout Boston, including many in Boston shelters, became infected with the same strain. Likely, no one at the meeting introduced the virus into the shelters directly. But as I wrote in a newsletter last week, when someone is infected, their exposures ripple outward in waves like those created from a pebble tossed in a pond. Some of those waves reach the vulnerable. How far did the waves from Biogen spread?
Researchers continued tracking the unique strain of the virus. By May 2020, there were around 50,000 cases linked to the Biogen outbreak. By November 2020 the estimated number of cases linked to Biogen totaled 249,000. This number made up approximately two-percent of all known U.S. cases at the time.
Since the identification of the outbreak, many have criticized Biogen. Was it unwise for them to hold their meeting? In many ways, yes. However, their blame should be shared. Biogen is no more to guilty than me. The workshop that we held could just as easily have been the source of an outbreak that infected hundreds of thousands and killed many. There were many other similar sized events in Boston that week. More events like this occurred in New York, St. Louis, Seattle and every other city across the country. A Biogen-like outbreak could have been sparked at any one of thousands and thousands of locations. Biogen got an unlucky flip of a coin. The others were simply more lucky, or happened to go unnoticed.
When the Biogen meeting was held, the wider population of the world did not understand the risk of Covid-19 super spreading events like we do today. Now that we hold this knowledge, we need to consider it alongside the exposure risk that we create for others in our day to day lives. When someone gets a lucky coin flip and their infection doesn’t spread to many others, they can’t sit back and say, “there’s no need to take precautions.” Instead, they need to recognize their luck. Further, we all need to create more luck by testing and isolating if found positive. We need to alert others if we accidentally expose them. The new guidance in California ignores this responsibility. We need to recognize that the risk that we create for others could explode. It takes only one unsafe visit to a concert, restaurant, church or school to create a Biogen like event. It takes only one unlucky exposure to create a ripple that reaches a vulnerable person and causes lifelong disability or death. This is why the decision in California is so dangerous. It is another shift in responsibility away from those infected and toward those who need protection the most. And now, those most vulnerable can’t be confident that the person next to them on the bus, the hospital waiting room, or the school classroom is safe. We’ve turned the world over to flips of a coin. And, some of those flips won’t come up the way that we hope. The California Department of Public Health is complicit in each and every one of these bad outcomes. They have made a policy choice that guarantees more infection, disability, and death.
*The details of the Biogen super spreading outbreak were taken from this New York Times article. Many additional stories have been written about it.
Troy Tassier is a professor at Fordham University and the author of the forthcoming book, The Rich Flee and the Poor Take the Bus: How Our Unequal Society Fails Us during Outbreaks.