Physicians Study Their Own COVID-19 Outbreak

A team of physicians performed double duty as scientists and research subjects for a recent study that cautions against prematurely resuming social activities during the pandemic.

April 13, 2021
Aparna Nathan
Physicians Study Their Own COVID-19 Outbreak

On March 11, 2020, 73 clinicians and their companions gathered in Edmonton, Alberta for a four-day event with colleagues from across Western Canada. That same day, the World Health Organization deemed COVID-19 a global pandemic. Within weeks, more than half of the event’s attendees tested positive for SARS-CoV-2. 

Now, these clinicians have published a study in the Canadian Medical Association Journal Open about their own experience as a cautionary tale for a world that, one year later, still clamors for a return to normalcy.

“Every time you do a study, it always feels a little personal,” said Bonnie Meatherall, a physician and clinical associate professor focusing on infectious disease at the University of Calgary and the senior author of the study. “But this one was obviously quite different.”

It all started with an annual curling competition. “I know, it’s so Canadian!” Meatherall added.

On the ice, the doctors vied to take home the 63rd Annual Western Canadian Medical Bonspiel trophy. But socializing with colleagues off the ice was also important, said Kelly Burak, a professor of medicine at the University of Calgary and first author of the study. Burak is a 20-year veteran of the bonspiel and a former organizer of the event. The 2020 event included buffet lunches in the lounge, evening outings, and even a championship banquet, where the victors were ushered in by bagpipes, an homage to curling’s Scottish origins.

At the time, the risks of the event were hazy. Alberta had fewer than 20 known COVID-19 cases; masks weren’t yet a wardrobe staple; and only gatherings of more than 250 people were banned. After discussions with public health officials, the festivities proceeded under a cloud of anxiety, albeit with a smaller crowd than usual—likely due to COVID-19 concerns, said Meatherall. The customary handshakes before and after a game were quashed, curling stones were disinfected between games, and hand sanitizer was plentiful. Off-the-ice activities included watching daily COVID-19 updates from Alberta’s Chief Medical Officer of Health. Some bonspiel competitors dropped out of the tournament when they started to feel ill, while others, like Burak and his wife, avoided large social events.

Three days after the event, the first bonspiel attendee tested positive for SARS-CoV-2. The next day brought another positive test. Burak was in the midst of moderating a recurring panel of infectious disease experts dubbed “COVID Corner” when he received the news of the second case. He leapt into action, contacting the bonspiel attendees and encouraging them to isolate and get tested. As positive tests kept rolling in, he called the province’s top health official to report the outbreak and recommend stricter restrictions.

Within days, everyone isolated and more people tested positive (including Burak and Meatherall). As the infected colleagues shared their symptoms in an email thread, they noticed bizarre patterns.

“A lot of us were saying, ‘It feels a little bit strange saying this, but I don’t think I can smell properly,’” Meatherall said, and they soon learned they weren’t the only ones.

Sensory loss is now widely recognized as a harbinger of COVID-19, but at the time, symptoms were poorly characterized, making the group uneasy. “That’s what a lot of us found kind of frustrating and scary, and ultimately what led us to do the study,” Meatherall said. 

Burak’s epidemiology training kicked in as he recognized this opportunity to learn about COVID-19 through careful self-documentation of symptoms—something that, as medical doctors, they were trained to do. 

“That’s kind of the silver lining of an event like this,” Meatherall said. “It almost turns itself into a scientific experiment.”

For Meatherall, the study was a welcome distraction from the growing anxiety of fighting COVID-19 in isolation, which was taking a physical and mental toll on both her and Burak. With a research assistant, the pair designed a symptom survey. Even while isolated at home, they found the perfect subjects for a test run: Meatherall interviewed Burak’s wife about her symptoms, and Burak interviewed Meatherall’s partner. Once the survey was ready, all 73 bonspiel attendees—including 55 health care workers—agreed to participate in interviews with Burak and Meatherall.

The interviews paint a detailed picture of the diversity of COVID-19 experiences. Forty attendees tested positive for SARS-CoV-2 by RT-PCR, but many of them never experienced the fever or shortness of breath that were initially testing criteria. Instead, unexpected symptoms repeatedly popped up, such as diarrhea and loss of smell and taste, prompting the researchers to recommend expanding testing criteria to avoid missing infections in people with unconventional symptoms.

Curling might not have even been the riskiest activity: although all attendees spent similar amounts of time on the ice, people who eventually developed symptoms were more likely to have attended the buffet lunches. Meanwhile, the sole team that avoided all social events had zero cases.

Burak and Meatherall published their study in February of 2021, almost one year after the event, but Burak emphasized that its findings are relevant as reopening plans take shape despite rising case counts and infectious SARS-CoV-2 variants in Alberta. Still reeling from his “awful experience” treating COVID-19 patients in an overstretched hospital this January, Burak hopes that this study will alert people to transmission risks.

“It is hugely concerning that our public health officials are trying to ease restrictions,” Burak said. “We’re screaming ‘please don’t do this!’”

In the immediate aftermath of the bonspiel, media coverage spurred some criticism about the physicians’ judgement. Many attendees felt guilty, Meatherall said, but she believed that it was crucial to share these stories to help reduce stigma, while acknowledging that doctors are imperfect human beings. 

Fortunately, the group had no severe cases or deaths, both researchers noted.

“It was a crazy time, but everybody was very giving of their time and everybody was willing to learn from this,” Burak said. “I’m proud of my colleagues.” 

Burak is a long-time curler, who honed his skills at international competitions like this pre-COVID bonspiel in 2016 in Forfar, Scotland. (Photograph by Kelly Burak)

Reference

Burak et al. CMAJ Open. 2021 Feb 9;9(1):E87-E95.

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