Minimizing risk of flu and coronavirus in social dance

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Mar 112020
 

(It may be that in a few weeks this post will be moot as we cancel all CI events big or small, either due to legitimate concern or critical mass of panic.  I write it in case we have a bit more time, and if not, it will still hopefully be useful for thinking about dancing during the annual flu season.
Also, this article was written when it was unclear how aggressively the coronavirus would spread and  has advice on what to do to minimize virus transmission through social dancing.  However, i assuredly do not mean this to encourage any local group specifically to continue dancing through looming health warnings.  Please do pay attention to local dynamics and advice/orders from local health authorities.  There are some very good public health reasons to be extra cautious and practice strong social distancing quite early in the epidemic process.)

Social dance is incompatible with suggestions to social distance that comes along with coronavirus precautions.

At some point, we very likely will want to cancel social dance events due to the coronavirus, specifically when it is in localized free transmission in the community or for larger events that involve people traveling from many locations.  This is already happening for some events in many places.  While some people will reasonably decide to not attend  social dance events and to completely practice social distancing very early, others will reasonably wait to different points to adopt these measures. In between the point of it being overkill and it being clearly necessary is a zone of personal judgment call. Until we decide to not attend or to not host social dance events, we can think of how we can minimize the transmission of viruses via social dance.  I think that this will be useful not just for coronavirus but for thinking about best health practices around dancing, particularly during the annual flu season.  It is worth considering.  Also, to avoid panic, it is likely good to familiarize yourself with what the impacts are. At the bottom are some useful links.

As i write this, i do not write as a medical virus specialist, but as a trained ecologist and producer and teacher of social dance who works with epidemiological models and knows his way around scientific literature on transmission dynamics.  While I have done my best to be thorough with my research on this, I would love to hear from any specialists who think i got something wrong or something should be updated based on new findings.  Our understanding of the coronavirus particularly continues to develop.

How is the virus transmitted?

We are still learning about the coronavirus, but so far it seems to parallel the transmission pathway of the flu.  It is transmitted via saliva.  Primarily we get it either via inhaling the micro-droplets from an infected person’s breath, cough, or sneeze, or we get it by touching surfaces on which those micro-droplets have landed and then touching our nose, mouth, or eyes. With regular breathing, these micro-droplets can travel up to 2 meters and farther with a cough or sneeze. That is why there are the important behavioral advisories to always cough into your arm, to wash your hands frequently, and to not touch your face. Also, as one author put it, if you can smell what they had for lunch, you are breathing in those micro-droplets.

When they talk about physical contact transmitting the virus, they don’t mean that it goes from your skin through my skin and into my body. The virus is NOT transmitted through sweat and not through the skin.  It is transmitted  via saliva and through a mucous membrane. What happens is that an infected person will get micro-droplets of saliva on themselves (usually their hands from touching their face or coughing into their hands), then two people will touch (for example, shaking hands), and the other person will touch their mouth, nose, or eyes.

The majority of transmissions so far are traced back to someone who was symptomatic at the time, but some transmission has been documented when the person was still in the “incubation time” or was otherwise asymptomatic. The incubation time is usually less than 5 days, but has been documented up to 14 days.  There is concern that someone can spread the virus without feeling particularly sick, but the most important measure is to self-quarantine once you do feel symptoms, for either flu or coronavirus.

When should we cancel events?  

Recommended precautions from governments have been coming in stages, based on how advanced the spread of the virus is through a region and how aggressively cautious the government is.  At very early signs of the virus in the region, there will be warnings for very large events.  For example, as of a few days ago, Denmark had about 17 cases of coronavirus and there was a warning about attending events over 1000.  However, as Dr. Abdu Sharkawy points out, a moratorium on social events  before there is localized transmission is overkill and smaller local events should be unproblematic with reasonable flu precautions until there is clear local transmission.  As social dance events by their nature involve a lot of physical contact, this is a concern. Of more concern would be larger events and most especially those that involve people traveling long distances from multiple locations. This context would create the ideal transmission vehicle.  Probably many of us who have been in a social dance world for a while can think of examples of the flu spreading through such large gatherings during the winter. Of less concern are smaller events oriented primarily for a local community.

So, what does that mean, exactly, “localized transmission” and how do i know when this is the case?  This is explained in many of the links below, but it is when new cases appear who were infected by others in the local community, not traceable directly to someone from abroad.  How do you know if you are there?  Hopefully you should just be able to google “Local transmission of coronavirus in (my city)” or “free transmission of coronavirus in (my city)” and find out.  If you can’t find this information, my guess is that without digging too much, if you find 100+ cases in your city and there are already documented deaths, I think you can assume that you are there.  Of course another important measure would be fraction of the population with the virus.  At what percentage should you act?  This may be decided for you by authorities, but there is something of a judgement call depending on your target for slowing down the virus and your hospital capacity relative to the population. Ironically, it is likely that places with more hospital capacity are also those that will also act earlier and with better testing capacity.

A reasonable policy might be better a bit too early than a bit too late.  Once there is localized transmission, it will be spreading fast.  If we reasonably assume 10 times as many cases as reported and with doubling of 6 days and as fast as two days (as was reported for a while in Italy), localized transmission with 10 known cases could mean over 10,000 actual cases in two weeks… surely 800 (with less being reported).

Of course, before preemptively canceling upcoming festivals in the summer, you might want to wait, if you have the luxury of being able to do so.  The epidemic spread of the SARS virus was halted by hotter summer weather.  We don’t know how the new coronavirus will respond to upcoming warmer weather in the northern hemisphere, but we may be lucky and find that the problem abates dramatically after the spring.

How long should we stop events until?

First, the point of social distancing measures is not to eliminate the virus or stop its spread. It is to slow it down.  A few of the links below do a wonderful job explaining this in pictures. Despite all of these measures, you are probably going to get it at some point… maybe not if  you are lucky and maybe not those whom we protect the most (as we should do with our elders), but probably you will get it.  By slowing it down, we keep our health system from being overwhelmed with a spike of infections and we decrease the overall number of those eventually infected and the overall number of deaths.

Recognizing this, it seems that once we get to the point of cancelling events, we would want to hold off on them until rates of new infection are clearly dropping.  At this point, it is no longer as important to slow down the infection as a critical mass of people will have already gotten it and be immune, and we will be nearing something like herd immunity or something like a more steady rate of the virus in the populations.  I suspect there will be much talk about this as we all start to get there.  There is some talk of peaking based on early spring beginnings of many local epidemics sometime  in the summer.  Of course, maybe this will be aided by moving into summer in the north.

What to do to make the events we attend safer for ourselves and others until the moment when we do cancel them?

Now, if we are still going to an event, assumedly we think that the chance of someone coming there having the virus is quite low. Recognizing that it is not zero risk, we want to minimize transmission risk, in case there is someone there asymptomatic but potentially transmitting a virus. In considering making an event that is happening safer, we should think about how the virus is actually spread and adapt common recommendation to the circumstances.

  • Self-quarantine. The very most important thing we can do to minimize flu or coronavirus transmission is to self-quarantine as appropriate.  If we are symptomatic for either, we should avoid social dance events if we want to minimize passing it on.  For the coronavirus, the going recommendation is also that if either 1)we have been in potentially transmitting contact with someone with the coronavirus in the last 14 days or 2) we have traveled from someplace with widespread local transmission of the virus in the last 14 days, we should self quarantine until those 14 days are up or until we get tested and are negative.  The usual incubation period is about 5 days, but the 14 day window should catch the overwhelming majority of cases.
  • Minimizing Face to Face.  We often face each other in social dances and bring our faces relatively close. Remember, if you can smell what they ate, you are breathing in micro-droplets from their saliva and thus potentially exchanging viruses. Perhaps more than usual, we might want to not breathe directly in each others’ faces and maintain a bit more face distance, including by turning the head a bit to face away from their face.  As the micro-droplets are dispersed with distance, just a bit of face-distance and orienting faces away can go a long way to minimize transmission.
  • Washing hands. It’s all about your hands. This is why you see people promoting these other forms of physical contact social greeting, like the elbow bump or the foot shake. Remember, since the virus is spread not directly through contact or through sweat, the risky part of physical contact is getting virus from the hands to the face.  We can pick these micro-droplets up on our hands by coughing or breathing on them and also by touching surfaces on which someone else has coughed or breathed.  If we wash our hands thoroughly before dancing, we minimize the risk of transmitting the virus from surfaces outside of the dance space.  We also reduce transmission risk from ourselves in case we have the virus but are asymptomatic.  If we wash our hands after a dance, we minimize the risk of transmitting from the person we danced with to ourselves or to someone else.
  • Don’t touch the face.  Remember, physical contact transmits the virus not via the skin, but by virus on the hand passing the virus to a mucous membrane on the face.  Try not to touch your or your partner’s face. As demonstrated in a recent video from the CDC, where a health professional gave an announcement about the importance of not touching your face and then proceeded to unconsciously touch her face, this is actually quite hard.  However, if we do it a bit less, it will cut down on transmission significantly.  And of course, if you wash your hands before touching your face, better.  Some dance forms also get a lot more freeform, with the face coming in contact with various surfaces  of the partner’s body (head on shoulder, etc).  You would want to minimize that and probably a good idea to wash your face after.
  • Wash everything when you get home. Take a shower.  Throw your clothes in the laundry.  This will minimize the chance that you will touch some part of yourself or your clothes that have picked up a virus and then touch your face.
  • Avoid larger gatherings in favor of smaller gatherings.  The larger the event, the larger the possibility that someone will have the virus and then the more people they might transmit to.  The hazard of a dance event goes up non-linearly with size.  Think… a group double the size is four times the risk.  It might even be a good idea to eschew meeting in open groups with lots of mixing and make dates for one-on-one practice instead.

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These actions will not eliminate the risk of viral transmission of flu or coronavirus, but they will very significantly reduce it. In a context where we are feeling it is still appropriate to meet for social dancing but where we want to be cautious, maintaining these measures will help reduce concerns that are still there.

Helpful Links

Here are a some links that I have found useful for further reading.

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image from CDC

 

 

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