Emergency physicians like us have seen the worst of Covid-19, from children gasping for breath to death on an unimaginable scale. So you might expect us to be cautious about attending large public gatherings and set a standard by establishing careful guidelines for organizing them.
You’d be wrong.
During the second week in May, the Society for Academic Emergency Medicine (SAEM), a large medical organization, held its annual meeting in person in New Orleans after canceling the event in 2020 and holding it virtually in 2021. The meeting brought together emergency physicians, residents, fellows, medical students, clinical researchers, and corporate exhibitors from across the U.S. at a time when the country was enduring yet another Covid-19 surge, this time from the Omicron BA.12.1 subvariant.
Organizers of the conference reported expecting more than 3,000 attendees, one of the largest events the society had ever hosted, and social media images from conference events showed large, closely packed indoor crowds in close contact and without masks on.
With cases and hospitalizations rising in many parts of the country, including New Orleans, and a community vaccination rate of around 50% for the host city, attending a large, multi-day, indoor meeting with after-hours socializing in the community posed numerous safety risks. In fact, a computing conference held in New Orleans the prior week was under scrutiny as a high transmission event. Yet the SAEM’s Covid policy was not modified to reflect contemporaneous public health data. Nor did the organizers implement a vaccine verification system, require boosters, or incorporate a Covid-19 testing strategy. Masks were “welcome” but optional. No information was provided about ventilation and there were no efforts to minimize indoor crowding. No standards were suggested about minimizing spread in social gatherings.
The three of us did not attend the conference in person, and are grateful for making that decision.
The week after the conference, news of Covid-19 cases began circulating among our colleagues. Some shared stories of becoming ill, others described how they were pulled in to cover the shifts of others who were struck by Covid.
To come up with a back-of-the-envelope estimate, we reached out informally to 15 emergency medicine programs across the country to see how many of their attending physicians, fellows, residents, and research staff attended the conference and how many cases were thought to have resulted from the conference. Among the 11 programs that responded, the number of attendees ranged from five to more than 50, and Covid-19 case rates ranged from 18% to 67%. While there are many caveats to the data (it’s a nonrandom, convenience sample, the data are self-reported estimates), they suggest that this single academic event was responsible for many hundreds of cases.
A number of attendees at the annual meeting of the Society for Academic Emergency Medicine (SAEM), May 10-13, tested positive for COVID-19 after the event which brought thousands to a hotel in New Orleans amid an uptick in cases.
— Mr Graham (@1val1richy) June 8, 2022
Do these cases matter? We believe they do, as there is the continued risk of severe disease, long Covid, and significant impact on training and careers, increased burden on already-strained health systems, and the exposure of untold numbers of other travelers in planes that no longer have mask-wearing rules, family members, patients, and others, some with increased vulnerability to severe disease due to underlying illnesses.
This certainly isn’t news. Conferences have been shown to have massive potential as superspreader events over the last two years. In February 2020, Biogen held a conference in Boston where 175 executives in attendance were infected, subsequently traveling home and carrying a specific genome of Covid-19 to tens of thousands of individuals in Australia, Singapore, and the United States, including some people in Boston’s homeless shelters. An estimated 20,000 cases resulted from this single event.
Just weeks after SAEM’s event, the American Society of Clinical Oncology (ASCO) hosted its annual meeting in Chicago with additional mitigation strategies including daily rapid antigen testing. Despite this, there are reports that a significant number of attendees contracted Covid-19.
Good news: A ton of you who attended #ASCO22 are taking #COVID19 rapid tests.
Bad news: A ton of you are testing pos.
Entertaining news: You’re all texting ME the pics. I’m not a contact tracer, but 👀patterns are emerging. Please tell each other too, not just me, #OncTwitter
— Tatiana Prowell, MD (@tmprowell) June 8, 2022
SAEM’s Covid policy did require attendees to be vaccinated (unless medically exempt), but no reliable vaccination verification system was employed and the policy did not specify whether boosters were included in the definition of vaccinated. Despite rising case levels in Orleans Parish, where New Orleans is located, wearing masks was not recommended for the indoor conference events. The Centers for Disease Control and Prevention currently encourages the use of masks indoors in areas with high hospitalization rates, but some consider this akin to shutting the barn door after the horse is out. The meeting did not employ screening efforts using rapid tests. In essence, bare minimum Covid-19 mitigation strategies were in place.
But with surging cases nationwide and in New Orleans, meeting planners and attendees could have embraced a higher level of safety precautions to mitigate potential spread of Covid-19, particularly when the organizers advertised that “the health and safety of our attendees, exhibitors, and speakers remains priority number one.”
With such a high concentration of the U.S. emergency health care workforce gathered in one place, people with vast collective expertise on how to protect themselves and two-plus years of closely following rigorous safety protocols in their clinical environments, we have to ask: Why did so many eschew restrictions in the face of surging Covid? And if medical professionals don’t gather safely, how can other professionals, not to mention the general public, be expected to do that?
The argument for individual responsibility has been increasingly present over the past few months: Informed individuals can decide to add layers of protection as they see fit. It’s hard to argue that a group of academic emergency physicians isn’t well informed about the dangers of Covid, as well as about the best measures to mitigate risk. Yet the majority of attendees did not layer in mitigation strategies, ask the conference organizers to consider changing their policies, or cancel their trips to the conference after witnessing the minimal protections in place.
It is easy to blame individuals for taking high risks. But most people have personally witnessed how easy it is to fall in step with the lowest level of mitigation — even when they know better. Instead of blaming individuals, the focus should be on the systems in place that encouraged “throw caution to the wind” decision-making at events. Organizations should work to protect their members by requiring mitigation strategies, providing the appropriate technological and material resources, and making safety the norm. It is much harder for the individual to make the right choice when it entails increased effort and there is no incentive to be responsible.
No set of measures can completely eradicate the risk of contracting or spreading Covid-19. That said, public health experts agree that risk can be maximally mitigated by embracing good policies, and for conferences and meetings we further recommend:
- Ensuring that everyone is vaccinated and boosted (no exceptions)
- Reviewing the local prevalence of Covid-19, as well as whether the number of cases is rising or falling, and informing attendees about this information
- Requiring a negative Covid-19 test within 24 hours of attendance, or daily testing if there are settings where masks are not worn
- Mandating the use of high-quality medical-grade masks in indoor settings
- Ensuring proper building ventilation and using outdoor spaces whenever possible
- Reducing the number of attendees at sessions and the duration of sessions
- Providing suggestions for the safest places to hold events, including outdoor venues
- Engaging those with expertise in infection control and those who are immunocompromised or otherwise at high risk for infection and severe disease in planning the event
Live medical conferences play an important role in academic development, advancing ideas, research collaboration, and professional development. Each of us has benefited in our careers from these assemblies. However, the organizations planning them bear a responsibility to protect their members and, in terms of medical conferences, a responsibility to the public to protect the health care workforce.
To avoid past mistakes, conference planning committees should have groups dedicated to creating safe environments during this pandemic and future ones. Embracing the measures outlined above is a start, but these organizations must be agile in order to shift policies based on an ever-changing situation. Further, failures to keep attendees safe from infection should be acknowledged directly and a subject of open discussion to give the organization the best chance of making a feasible and adequate plan in future years’ events.
Anand Swaminathan is an assistant professor of emergency medicine in New Jersey. Jessica Smith is a professor of emergency medicine and clinician educator in Rhode Island. Esther Choo is a professor of emergency medicine at Oregon Health & Science University and co-founder of Equity Quotient. All three are emergency medicine physicians.