Clusters of cases of COVID -19 have been common worldwide. In several countries, big ones marked the beginning of the national epidemic.
In France it was the international gathering of the Christian Open Door Church at Mulhouse from 17-24 February, with 2,500 linked cases. In South Korea it was the meeting of the Shincheonji Church in late February with 5,212 confirmed cases (amounting to almost 50% of all cases recorded in the country). In New Zealand its second biggest outbreak (96 cases – the biggest was a wedding with 98) started in March at the Marist College girls school in Auckland.
And the first outbreak we know about in Scotland (but only thanks to investigative journalists) occurred at the Nike Conference on 26-27 February when 70 international delegates met at the Hilton Carlton Hotel in Edinburgh, leading to 25 confirmed cases.
Details of this outbreak have not been officially published. In other countries they write them up and publish more rapidly. In South Korea, for example, we know from the Korean Centres for Disease Control and Prevention report that the virus was busy at a Zumba dance workshop in late February and early March, where three instructors infected 50 students between them; and the US Morbidity and Mortality Report has described in detail a choir practice on 10 March at Skagit County in Washington State which led to 33 confirmed infections among the 61 attending members.
Shout it out
A feature common to all these outbreaks was the expulsion of breath by those involved much more vigorously than in normal conversation. Evangelical religious gatherings have decibel levels many orders of magnitude greater than Quaker meetings. Zumba dancing and choir practices speak for themselves, as does the alleged Nike haka in Edinburgh and the fiafia night in mid-March at the Marist College in New Zealand, as well as a St Patrick’s Day celebration at a bar and eatery in Matamata in the same country (77 cases) when the participants were encouraged to get themselves “Shamrocked”.
Heavy breathing helps but is not necessary for virus transmission. There were 712 cases on the Diamond Princess cruise liner moored off Yokohama. And more than 40% of care homes for adults in Scotland have had two or more probable COVID 19 cases. Neither setting surprises. Before COVID -19 struck I was regularly instructed by lawyers acting on behalf of travellers who had fallen ill on holiday and sought to sue the travel organisers. I have prepared microbiological expert witness reports on infections on 21 cruise ships, 18 caused by a virus.
And a quote from a prescient paper entitled “Influenza in long-term care facilities” by authors from Nottingham University and the WHO published in 2017 (doi:10.1111/irv.12464) says it all: “Long-term care facility environments and the vulnerability of their residents provide a setting conducive to the rapid spread of influenza and other respiratory pathogens. Infections may be introduced by staff, visitors or new or transferred residents, and outbreaks of influenza in such settings can have devastating consequences for individuals, as well as placing extra strain on health services”.
COVID -19 press conferences hinge on the R0 number. But another quantity is very relevant to understanding the epidemic. It is k, the overdispersion parameter, a measure of how many cases occur in clusters. The smaller it is, the more the cases cluster; in other words, the greater the number of superspreader events in which one infected person has gone on to infect many individuals. Without doubt, k is small for COVID -19. In New Zealand, which has set the standard for openness about its epidemic’s epidemiology, 41% of its cases have occurred in 16 clusters of 13 or more cases, five of them in care homes. In Scotland more than 400 care homes have had two or more cases, and many have had big outbreaks.
Pareto – and Sturgeon’s Law
It looks as though the Pareto principle, the 80/20 rule, may be in operation, where most cases are getting their infection from a few infectious individuals. Pareto derived his 80/20 from the distribution of income in Italy at the beginning of the 20th century, when 80% of the wealth was held by 20% of the population. It has been suggested that even fewer than 20% of initial COVID -19 cases might be the crucially important initiators of big outbreaks.
It is possible that Sturgeon’s Law may be in operation. Sturgeon (Ted, the science fiction author, not Nicola) said – referring to the genre at a Science Fiction Convention in 1953 – that 90% of everything is crap, but it’s the 10% that isn’t crap that is important. The good news is that if Pareto and Sturgeon are operating, preventing superspreader events will cause R0 to tumble in a very big way. Contact tracing will test this hypothesis. The sooner we get on with it the better!
Further reading: UK suffers highest death rate, FT, May 28; South Korea reimposes restrictions, Guardian, May 28;
Featured image: Shincheonji church in Daegu via Yonhap; Christian Open Door Church via porte-ouverte.com
Keith Macdonald says
Hugh may well be onto something here and clearly potentially highly dangerous gatherings should be tightly restricted. Contact tracing should help to identify “super-spreaders” though I think it would be more effective and economically more efficient if it were followed by testing and not just isolation.
A vital part of the process of recovery, once the immediate threat has passed, will be a full independent enquiry into what has happened. That will help us get to the bottom of what happened at the Nike conference and why so many of the most vulnerable elderly died in care homes.
You would have thought that the First Minister would have made an early commitment to such an enquiry rather than leave a mess of unresolved issues to fester for years. Yet she seems very reluctant.
Last week in the Scottish Parliament Jackson Carlaw questioned her again about the very death rate in care homes. He had to remind her of her apparent support for an enquiry earlier in the week and her response seems to be “of course there will be enquiries but really this is nothing to do with me” (the latter part is implied rather than stated).
This is simply not good enough and means that much energy goes into dragging out basic facts rather than a joint effort to save lives. Most people do not yet understand that we almost certainly have a much higher death rate in elderly care homes than England and that we are still not collecting an important statistic about this which is available in England.
We need to be prepared for a second wave later in the year as well as future pandemics. That requires openness from our government, difficult and painful though that will be. It is not good enough just to point to Boris Johnson and say that at least we are not as bad as him and, on care homes, that may not even be true.
Me Bungo Pony says
I have rarely read such politicised drivel wrapped up as “science”. The Nike conference seems to have given the Unionist Right a desperately desired bone to gnaw on regarding the Scottish govt’s response to the pandemic. We all know there was no cover up, the cases were recorded (they were not even the first confirmed cases in Scotland) and it would not have made the slightest difference to anybody’s behaviour had it been trumpeted from the ramparts of Edinburgh Castle, but hey, they need something to take a pop at the FM with and distract from the shambolic UK govt response, so they just bash on regardless.
Similarly with Care Homes. There is as yet no definitive evidence that they have been harder hit in Scotland than in England as the latter has been grossly under reporting deaths while the former has been meticulous in their reporting. But then again, the Unionist Right must make hay while the Sun shines and will attempt to smear the Scottish govt with anything that can be spun in a negative way.
It is all so transparent (sic).
Fay Young says
I think you are missing the point of this article. Professor Pennington does not anywhere say that Scotland’s Care Homes are harder hit than those in England (that’s a matter for future expert analysis). Instead he points out that care homes are especially vulnerable breeding grounds, as indicated by earlier research on the impact of influenza in care settings [‘Influenza in long-term care facilities’].
As Prof Pennington points out: “In New Zealand, which has set the standard for openness about its epidemic’s epidemiology, 41% of its cases have occurred in 16 clusters of 13 or more cases, five of them in care homes. In Scotland more than 400 care homes have had two or more cases, and many have had big outbreaks.”
This point is also tragically illustrated in today’s excellent BBC Scotland story about Shetland’s rapid, and effective, response to the outbreak, Shetland acted quickly, far ahead of the rest of Scotland and, indeed, the rest of the UK. But despite rapid lockdown and effective contact tracing, care homes were among the hardest hit.
Writes BBC Scotland’s Jon Kelly: “According to National Records of Scotland (NRS), the first death of a person in Shetland with Covid-19 took place some time between 30 March and 5 April. Five more came the following week; a sixth the week after that. On 6 May, another death was announced; there have been no more since then. Tragically, five of the seven were in a single care home.” A cluster of islands: How Shetland locked down early and stopped the virus in its tracks https://www.bbc.co.uk/news/stories-52823510
As Scotland’s FM has openly acknowledged we need to learn from our mistakes in order to be better prepared for future (inevitable) epidemics. Understanding who is at greatest risk, how to protect them – and why we have failed to do so in this pandemic – is not a tribal blame game. It is about human compassion and courage. Competent governance requires honest self-appraisal.
Me Bungo Pony says
While not disagreeing with any of the bones of your post, I think it is you who is missing the point of the article. The article says nothing that advances our understanding of the virus. It simply cites two obscure theories, that have nothing to do with combating the virus, in order to sow seeds of doubt in people’s mind regarding the Scottish govt’s response to the crisis.
If this is not the case, why insert the little gem, “but only thanks to investigative journalists”, into the article? The author wants to give the impression of a cover up without actually saying it “out loud”. Similarly with the line, “New Zealand, which has set the standard for openness about its epidemic’s epidemiology”. The implication the author wants us to draw from this is that the Scottish govt has not been open.
And let’s not forget the “theories” being used as the basis of the article. The first, “Pareto’s”, is only cited to justify the use of the second, “Sturgeon’s”. The idea that this theory “just happens” to share the same name as the FM is laughable. The article seeks to sow doubt about the FM’s performance so her name has to be front and centre …. without actually accusing her of anything you understand.
I was taught that when you read a source you have to know who wrote it, when they wrote and why they wrote it. Prof Pennington is an extremely active member of anti-independence, reflexly anti-SNP, right wing groups. Something not mentioned in his bio above. It is in that context that the article must be read.
Keith Freeman says
I am a barrister now retired and many cases were trying to defend government who were less than open to say the least
My wife is a GP trying to cope with Care Homes: she raised get alarm on care homes (Leeds) in February but was ignored
Keith Freeman says
Ad hominem arguments are particularly unwelcome
Hugh is simply pointing out that the basis for treating Covid as a flu virus is wrong
He is surely right to focus on k
And get local clusters dealt with by local track and trace
No one is suggesting removing social distancing or handwashing or nit having good PPE: my question is why are care homes not being tested every week at least with a quick turnaround of results
david black says
I was informed by a medic friend that it is suspected the virus arrived in Scotland on or around 23rd January, when several Chinese students with links to Wuhan were admitted to hospital with symptoms, but then recovered and were discharged without a firm diagnosis. Some also seem to believe that a number of the Chinese student population in Edinburgh were almost certainly a-symptomatic super spreaders who were simply not aware that they might be a source of infection. This suggests that the Nike meeting was not the first point of contact.
Is this true? A colleague in the US indicates that Americans who caught the flu in the winter of 1997 had contracted h3n2 A/Wuhan/359/95; that is, a virus with No. 3 hemagglutinin, No. 2 neuraminidase, which was the three-hundred-and-fifty-ninth sample isolated from the Wuhan area of China in 1995. I haven’t a clue what any of this means, of course, but I’m sure Professor Pennington will have an informed view.
Also with this issue shouldn’t we be separating the political from the scientific? Unionism v Independence is not relevant. Politics do, of course, influence the science, as in the case of the UK government’s lunatic appointment of a Conservative peer who was lobbying for the non-cancellation of the Cheltenham Festival as England’s track and trace supremo.
Me Bungo Pony says
It is impossible to determine the exact point when Covid-19 entered Scotland. “Patient-0” will never be identified. It is likely they would have been asymptomatic anyway. The “rumours” about Chinese people are more likely to be hind-sight fuelled paranoia touched with a smidgen of xenophobia.
I too believe the scientific should be separated from the political on this issue. However, this article does not do that. It uses “pop theories” (not much better than “Catch-22”) to take a pop (sic) at the Scottish govt. It’s purpose was political, not scientific. Prof Pennington is a brilliant microbiologist undoubtedly capable of producing a purely scientific response to Covid-19. This was not it.