Last week, a report from the Chicago Department of Public Health described an outbreak that happened at a Chicago gym. When I first started arguing on behalf of prevalence measures to inform policies, I used the example, admittedly from May, of gym goers in Oslo, Norway who weren’t getting COVID-19 from the gym, for the obvious, if often ignored, reason that, when very few people are infected, you’re unlikely to be infected anywhere (the Yogi Berra school of epidemiology). Of course, the converse also is true: when COVID-19 is common, you’re (far) more likely to contract it–again, that’s obvious, but you wouldn’t know it based on the decisions most U.S. policy makers have made through the pandemic.

The discussion of the Chicago gym outbreak seems to have missed something very important from the article:

Twenty-two (40%) attendees with COVID-19 attended an exercise class on or after the date of symptom onset, including three (5%) who attended on the same day or after they received the positive test result.

While it’s possible that all nineteen* untested people attended class before they developed symptoms, I think that’s highly unlikely, especially considering up to three people might have attended after they tested positive for COVID-19.

You might want to re-read that last sentence again. Multiple people with symptoms, as well as three people who, at best, thought they might be infected–and, at worst, knew they were infected with a potentially lethal virus–decided to go to a gym class.

This should not happen–and it wasn’t just one or two idiots. Something went really, really wrong with our public health outreach. But don’t worry it gets worse! Let’s mull this section for a bit:

During August 24–September 1, 2020, an exercise facility offered four to eight high-intensity indoor classes daily. All classes were held at ≤25% capacity (i.e., 10–15 persons). Mask use, temperature checks, and symptom screenings were required on entry; however, patrons were allowed to remove masks during exercise.

How do we reconcile the boldface part with the likely reality that multiple people attended the class while having symptoms. It’s possible that all 22 people had symptoms that the gym didn’t screen, or that everyone’s symptoms onset after attending, not before.. It seems much more likely that either some of the patrons or the gym lied (or, of course, both).

This is very disturbing when we consider things like quarantine and isolation**. If people are willing to mistate their health status over a stupid gym class (or businesses are going to be exceptionally lax), then we’re really screwed. While I’m as much a structuralist lefty-type as anyone, even I will admit that infection control is nearly impossible if people with symptoms–or who FUCKING TESTED POSITIVE–decide to go out and about. That’s the bare minimum. And, again, this wasn’t someone choosing between rent or food and quarantining. It was a stupid gym class.

This seems very relevant to why we have failed to control COVID-19 and what we need to do for the next few months to get to the other side of this horror.

*I suppose this should really be eighteen out of nineteen.

**One thing that hasn’t really been discussed is how ineffective these essential procedures have been in the U.S.