IPC on Tour: Reflections from the big apple

This is a slightly odd blog post as it’s mostly linked to a podcast (included below) that Mr Girlymicro and I did whilst on holiday in New York last month.

As we still top over 50000 cases of SARS CoV2 per 7 day period and face increasing numbers of hospitalisations due to Influenza and RSV, it seemed timely to post some of the things that struck me from visiting elsewhere. This doesn’t mean that I think we are anywhere in the same situation we were in at this time last year, but it’s tough out there, and respiratory viruses are back with a vengeance.

There was still an encouragement to test

When we arrived at JFK we were greeted by a CDC sign that encouraged us to pick up 2 free tests so we could test on days 3 and 5 post arrival. There were also free testing booths on every other street. I’m no claiming this is perfect, universal across the states, or anything other than driven by the way their health service is set up. It was nice to know that after a higher risk of exposure process (breathing recirculated air for 7 hours) we were supported in our choice to test. The signage around all of these opportunities emphasised just that, testing is a choice. They then went on to have quite a useful education campaign to support that so it was an informed choice. Sometimes, I think that is what we have missed since the dictates went away, which said you just test. If you want continued engagement with the process you then have to also talk about the why.

Certain events continued to SARS CoV2 precautions seriously

I enjoyed the Late Show with Stephen Colbert before I went to New York, but now I LOVE the Late Show. Is it because of the great guests and the fact that he makes me laugh, well yes, but mostly it’s because I adored both his SARS CoV2 policy, and the fact that it was actually enforced. This is a show where people come from all over the states, as well as other part of the world to see it being filmed. It’s filmed in an old off Broadway theatre, with exactly the ventilation you would expect from an old building that is underground and enclosed. You then throw into the mix that this population will sit in there laughing for 4 hours, and you can see why you might be at high risk of a transmission event occurring. Now, I’m sure most of this is set up to protect the team running the show and to minimise reputational and financial risk, but it doesn’t change the fact that I loved it.

Everyone had to sign up to a set of behaviours before you got issued your ticket, which included that you would wear a mask throughout. You also had to declare whether you were vaccinated. On the day, unlike when we have been to other places in the UK or New York, you were actually followed up on your pre-submission information. If you did not have a mask you were issued one, it had to be a mask and not a face covering. You had to show your vaccination records and ensure that you were symptom free, anyone who couldn’t was given a lateral flow test and observed whilst it was undertaken. Once inside the venue and seated mask wearing was monitored throughout. Production assistants kept an eye on the rows and anyone removing their mask or wearing it incorrectly (i.e. not covering mouth and nose) was asked to correct. From a compliance point of view, it was a thing to behold.

There was also a surprising amount of nonsense

The flip side of the coin is that there was a lot of nonsense that was still being sold/communicated in relation to transmission risk. Everything from supplements and using ‘energy therapy’ to prevent infection, to this TV remote that was in my hotel room and has an antimicrobial coating. You can easily see why some of these things feel like a sensible approach……..what’s wrong with an antimicrobial remote? Well, any coating is only going to impact (even if it’s great) the organisms in direct contact with it, so in a monolayer. Sadly, in the real world, bacteria don’t get inoculated into lovely monolayers, they get deposited in clumps, often at high loads. The only way to manage these therefore is via removal, which requires cleaning. It requires an action not a passive approach. It is easy to sell the idea that you can maintain the equivalent risk control by having something that does not require an actual response, but sadly it just isn’t the case. If it’s too good to be true, it usually is. (I’m not even going to comment on what I think about ‘energy therapy’)

Sometimes places making individual risk assessment can work

I therefore saw both good and bad on my travels. The key take home message for me though, was that individual risk assessment at scale can work, but only if you put the continuous resources into the conversation to make it work. Single interventions, single conversations don’t work. This was about having stands on every street corner, stands that are accessible and meet the needs of diverse populations. Testing that is free and accessible to support informed decision making. In the UK we are in the middle of a winter where SARS CoV2 rates are again up, with little community testing available, with many co-circulating viruses that cause similar symptoms. This is in the context of vaccine and SARS CoV2 fatigue where having the conversation is becoming increasingly challenging. The step away from a national response without sufficient embedding to support individual risk assessment makes these conversations even more challenging. The constant discussion about resource allocation is however important and ongoing. With the ITU admissions linked to SARS CoV2 still low, how much resource do we allocate to this? The thing that saddens me most however, is this was a real opportunity to evaluate and establish ways to embed scientific conversations and how we have them, both nationally and within communities. What has actually happened is that we’ve told people to make their own choices and their own risk assessments without continuing to support the conversations and build the structures to enable this to happen well. As always, there’s so much learning yet to do.

All opinions on this blog are my own

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