On the intersection of racing and public health

Today certainly did not go as I thought it would.  Out of all the conflicting news reports and constant updates on sports leagues shutting down or schools closing their doors, I found myself at an odd crossroads of my racing life and my education---one that I did not anticipate intersecting.

For those who don’t know, I completed my master’s degree in Public Health a few years ago, specifically studying Community & Behavioral Health and Epidemiology, the latter of which studies how diseases move through populations.  I have worked in various parts of the public health field since I graduated, and it’s something I’m very passionate about.

Combining this with my love of racing, I felt it important that I put up some sort of blog post to add some perspective to this whole bizarre situation that unfolded today in Australia.  And to be honest, I’m still a bit confused and disappointed over how it devolved to this.

For those who hadn’t followed along, today’s roller coaster of a “Will they or won’t they” began earlier when a member of the public tested positive for COVID-19.  That person shared the same hotel as several Formula 1 team members, one of whom turned out to have contracted the virus.  This set off a chain reaction of fear and assumed responsibility which culminated in prolonged radio silence from F1, teams packing up and leaving, mixed media messages and frustrated racegoers.

Teams waited by the paddock, unsure whether their job would be to compete for a Grand Prix victory or pack everything up.  Fans at the track stood in queues at closed gates as the screaming V10 of the F1 two-seated lapped Albert Park. 

As I’m sure you know, the race was eventually canceled, and I imagine more Grands Prix will fall in the aftermath.  But from a public health perspective, what on Earth just happened?

Before we delve too deeply into this, I want to define a few things.  These are all questions I’ve been asked online and in-person, and it helps put this decision into perspective.

At its broadest, people around the world are getting very sick from a virus that is spreading quickly all over the place.  It has killed scores of people in China, the Middle East, Italy and elsewhere.  New cases are popping up constantly, and you’re seeing cancellations as a result.

Why this is such a big deal revolves around the culprit to all of this:  a novel coronavirus.  Coronaviruses aren’t new.  The name describes a known shape or type of virus, “haloed” by glycoproteins and attachment proteins (which help the virus grab onto cells).  But this particular one is new.  And that’s a problem.

When we follow diseases through populations, monitoring is good enough that we can track how these sicknesses evolve.  We can usually discern when one mutates and creates another dominant form.  It’s why and how we predict flu strains for the yearly flu shot (since influenza mutates like crazy, always changing its attachment proteins).  But this particular kind of coronavirus didn’t evolve from something else, it literally popped up.

Specifically, epidemiologists can trace it to a market in Wuhan, China, where the first cases arose.  Whether it jumped to humans from bats or from another animal, we know that this was not originally a human disease.  From there, the race began to try to identify it.

That’s where the next definition comes in.  Given the symptoms that accompanied infection with this virus, scientists classify this as a SARS virus, which stands for “Severe acute respiratory syndrome.”  Yes, that’s the same general SARS that made news a few years ago, but this time the thing that is causing it is a lot more potent.  Because this virus causes a form of SARS, it is classified as SARS-CoV-2 (COronaVirus).  This is only the second time a SARS-causing virus has arisen in modern times.

The disease that CoV-2 causes goes by the name COVID-19, or COronaVIrus Disease (first documented in) 2019, and its attack is a bit unique.

Unlike more common diseases, this new-to-science coronavirus is quite contagious.  Very small viral loads seem to be necessary to transmit it (in other words, you don’t need to be exposed to a lot of virus particles to get infected).  People spread it effectively, although we still don’t totally know how its transmitted (or if it’s different than the usual hitching a ride on droplets coughed out or sneezed).  It seems to be able to survive for long periods of time in the air and on surfaces.  And more worryingly, people seem to be contagious for a long time both before and after they show symptoms of the disease.

For those that do get sick, there are further concerning differences here.  More susceptible populations seem to get hit by COVID-19 really hard.  Their rates and lengths of hospitalizations are higher than the usual flu or colds, and of those hospitalizations, a higher percentage require placement in the Intensive Care Unit.  And a large number end up dying.

It’s an odd mixture of a disease that our body isn’t prepared to fight, that we don’t know a ton about, and that we aren’t ready to treat.  And because there’s still so much science doesn’t know, there’s palpable concern.  How long are we contagious before symptoms set in?  How much exposure do you need to get sick?  On and on.

It would be one thing if this were fairly localized, but COVID-19 spread rapidly.  Usually in an epidemiological setting we talk about a troubling disease doubling its number of cases every six days or so.  Start with 100 cases, then six days later you have 200, then 400, then 800, then 1600, then 3200, then 6400, then 12,800 and so on.  All in a month and a half.

But in the worst-hit parts of this outbreak, doctors saw a doubling every two to three days.  In the above example, your 100 cases turn into 12,800 in a little over two weeks.  Add in two more weeks, and you’re at nearly half a million.  Add in six more days, and you’re just shy of a million.  All in a month from just 100 cases (which, for example, could be a small close-knit group like the F1 paddock).

It can be easy at this point to think that everyone is freaking out and saying we’re going to die, but this is an important distinction to make, especially when you keep that quick, exponential increase in mind.

This disease is not massively lethal---at least in certain populations.  For most healthy and young people, this will seem like a bad flu, if that.  Then they’ll be done with it.  But the problem is, all the time they’re sick, and for quite a while before, they’re still contagious.  They’re still spreading this virus to others (and remember, it doesn’t take much).  But while those young people may be fine, older people are absolutely clobbered by COVID-19.

People who have weakened immune systems are sitting ducks for this disease.  People who have breathing difficulties may not survive a sickness that includes extremely severe breathing problems.  

When we talk about the lethality of this disease, it’s not for the average person, it’s for vulnerable populations.  In fact, the very nature of public health doesn’t deal with the individual patient, it deals with the public as a whole.  So this is not crying wolf, it’s recognizing that people may get this disease through no fault of their own, and it may kill them.

That’s where we start to get back to the racing bit.

Think about what a Grand Prix is from a human standpoint.  You have people from all around the world gathering in a central location.  You have a hundred thousand potential carriers, some of which may be actual carriers who are in the stage of the disease where they’re not showing symptoms, but they’re still a flamethrower of viral particles.  You have a finite number of bathrooms where people funnel through, cramming into high humidity environments and close quarters even for the briefest of times.  Then they all leave and go back to where they’re from, all over the globe.  Hopefully given what you now know about this virus, you can start to see the issues.

So when the decision had to be made, it wasn’t to protect the people in the stands, per se, it’s to look at the broader picture of what happens next.  Epidemiologists don’t think the entire crowd in Melbourne will get sick.  They don’t think they’re all going to die.  But they know that even if a tiny subset of attendees harbor this virus, it’s only a matter of time and math before you get a massive spread across loads of populations---some of which don’t have any cases of COVID-19 yet.

Others may point to the fact that this disease will spread regardless, but there is still a big benefit in actions like this.  Take a look at Italy right now as an example of what can happen in an unprepared population:  Cases are exploding, hospitals are well over capacity, triage doctors are losing patients who are fighting for extremely limited resources.  This isn’t a knock on Italy, but they’re a prime example of why preventive measures and “flattening the curve” are so important.

Imagine a classic bell curve, which is highest in the middle and tapers off at the edges.  Now imagine another curve that stretches much wider than that bell curve, but it’s not near as high.  Then imagine a dotted line that is just above the lower curve’s peak and well below the peak of the higher one.  This dotted line represents the total capacity of all of the hospitals and doctors in a given population.

Unabated, the disease swells quickly and has a tall peak, well above that dotted line.  As a result, there are far more who need care than the hospitals can accommodate, because all of these cases are happening at once.

If, however, you can flatten that curve, the peak always stays below that full capacity line.  Cases will still happen, but they’re so spread out, there are never overwhelming to the healthcare industry.

That’s what these types of delays and postponements do.  They stop those easy ways for the virus to spread.  They keep populations apart from each other for as long as possible, which lets the inevitable cases play out while the preventable ones are delayed.  Even so, some of those people may get the disease anyway, but if they do, it will be at a later date when the number of cases may not be as high.  Or it may happen at a time when we have better treatment options or possibly even a vaccine.

Public health can be frustrating in this way, since we so often deal with risk rather than concrete guarantees.  People want to know whether or not they’ll get it, not that their risk is lower or higher in certain situations.  They will point to exceptions to the rule, or they will outright not believe what they’re being told.  But actions like the cancellation of the Australian Grand Prix are the right thing to do from a public health standpoint.  And remember, public health isn’t about the individual, it’s about the bigger picture.  In other words, it isn’t about you.  Nor should it be.  The healthcare system is for “me,” but public health deals with “us.”  It deals with prevention instead of treatment.

Thankfully, and perhaps scarily, the world is perched on the edge of the transition between prevention and mitigation, from saying “We have to stop this” to saying “We’ll just have to manage the inevitable.”  And ideally, we want to keep it that way for as long as possible.  Seeing sports canceled can be frustrating and heartbreaking as a fan and a consumer, but we’re trying to do something now that will pay dividends later.  You, as a healthy fan, might have been fine either way.  But by delaying now and flattening the curve of cases, your older loved one might actually be around next season to watch your sport of choice with you.  A friend at work who may be immunocompromised because of a medication he or she is taking may not die unexpectedly in two or three months.

We can’t know the benefits of doing this now, but we can sure see the frustration and the immediate shock waves that these decisions sent through the sports world.  We can see the disappointment and the amount of money lost on tickets that won’t be refunded, and it can be easy to fixate on that.

But the public health professional in me is heartened by the fact that so many leagues and organizations worldwide stood united today and took sweeping, definitive, preventive action.  They saved lives today, and we don’t (and won’t) even know it.  They did what was right, no matter how much I was thrilled to get F1 and IndyCar back this weekend.  F1 may have had an awful time doing it, they may have dropped the ball on countless occasions today, and they were woefully unprepared, but in the end,  they made the right decision.

So while I may be some random person rambling on the internet, please take this disease seriously.  Do your research.  Ask me any questions you’d like.

It may be frustrating to you in the here-and-now, but those most at-risk for developing this disease will thank you later.  Whether it’s your grandparent, your aging neighbor, a friend fighting cancer, or in my case, my own mother, these are the medically vulnerable people we’re trying to help.  And believe it or not, delaying events like this helps us do that until SARS-CoV-2 passes (and it will pass eventually).  So let’s do our part now, and later we can watch all the races and games with them that we want.