Mass Gatherings Series: Health and Infectious Disease at Occupy Camps

Last Friday, Nov. 11 2011, the Fulton County Health department in Atlanta, Ga. confirmed cases of single-drug resistant tuberculosis at the Occupy Atlanta camp. The protestors have occupied an area near a homeless shelter, where the cases were reportedly first identified.

In San Francisco, dogs at the Occupy camp at Justin Herman Plaza are testing positive for parvovirus, a highly contagious virus that can be fatal for dogs.

At Occupy Boston, doctors and nurses are volunteering at free health clinics, dispensing influenza vaccines for whoever shows up.

Acute, or crowd, diseases are characterized by early and brief periods of symptoms (if at all) and rapid onset of disease. In acute viral infections, the virus begins reproducing in the host very quickly, allowing for its spread to other hosts.

Chronic diseases, such as cancer, are diseases with a long progression, making them easier to identify and prevent. Hepatitis B and C, as well as AIDS, can begin with acute infections, but often turn into chronic or lifelong infections.

Public health officials and medical practitioners are more concerned with acute diseases in mass gatherings because these diseases thrive in crowds. In fact, the pathogens causing acute infection depend on crowds to survive. In a piece for Discover Magazine in 1992, Jared Diamond explains how pathogens causing acute infections work. These pathogens, he says, “actively modify the anatomy or habits of their host to accelerate their transmission.” Take influenza, for example. The influenza virus replicates quickly inside our cells. After replication, the virus causes us to sneeze, which launches copies of the virus into the air, ready to infect any one standing close enough. Influenza viruses can last up to a few hours on certain surfaces, making it possible to infect more than those who happen to be around for just a sneeze.

Without others in close range, the virus is not able to reproduce in another host. The virus will eventually fall victim to the immune system and/or antiviral medications, and the infection won’t spread.

However, when you have groups of people living in close quarters, it is easy for the flu virus, or tuberculosis, cholera or whooping cough bacteria, to continue to spread. The rapid onset of disease makes it difficult to treat these infections in their early stages; we rely more on our healthy immune systems to fight the pathogens.

These factors are important in the consideration of disease spreading at Occupy camps. As Dr. Buddy Creech from the Vanderbilt Vaccine Program explains to Elizabeth Cohen from CNN, the coming of winter, the lack of sleep, the crowding and poor sanitation, could create a “nightmare” for public health departments. Sleeping in tents and the strain of the winter weather could impact the immune system’s capability to fight off infections. During the snowstorm that hit many east coast cities at the end of October, Occupy protestors were asking the homeless for cold survival tips, as they braved the freezing rain and snow.

The Occupy movement does not lack organization. As has been reported numerous times, the silent system of communication and feedback (raising hands and fingers to indicate yes or no so as not to disturb residents with shouts or bullhorns) is impressive. After visiting several different Occupy websites, it is clear that certain measures have been taken to protect the health of protestors.

On the #HowToOccupy website, several resources are listed to educate protestors about anything from basic first aid to combat medical care. Occupy Providence has a Medical Working Group website with an email address and an invitation to visit the medical tent for training in health care skills. They even have a Facebook page that offers a contact telephone number and a truck for transportation of people or medical supplies. The Sanitation Working Group posts minutes from their meetings on its website.

At Zuccotti Park, the basic first aid tent was open 24 hours a day and staffed by medical professionals. In the event of serious injury or condition (severe cuts, appendicitis and drug overdose were all mentioned), patients were referred to nearby hospitals. There are also reports of Occupy camps providing aid for mental health problems because, as one protestor states, “The distress of sleeping on the street and experiencing sleep deprivation can lead to a whole series of medical issues.”

Local health departments are doing sanitation checks on campsites to ensure that there is no need to shut down the camps. In late October, Multnomah County Health officials inspected Occupy Portland and reported that there were no “actionable” violations.

But that’s not all. Many four legged friends are joining their owners at Occupy camps. Apparently veterinarians who support the Occupy movement did free check ups once a week for dogs at Zuccotti Park. Though, in some cases, like San Francisco, the veterinary help came too late.

Parvovirus is often a problem in animal shelters because it is resistant to many disinfectants (and can last on fomites such as clothing, hands, food and water dishes) and can be shed in feces for up to two weeks after initial infection. According to the American Society for the Prevention of Cruelty to Animals (ASPCA), prevention of parvovirus necessitates quarantining the infected animals and the cleaning and disinfection of the entire facility the infected canine was in. Something that isn’t exactly possible at an Occupy protest.

Are the Occupy campsites mass gatherings? It isn’t exactly clear. The definition of a mass gathering, as stated in a previous piece in this series, is “any occasion, either organized or spontaneous, that attracts sufficient number of people to strain the planning and response resources of the community, city or nation hosting the event.” In some instances, the Occupy camps probably don’t have numbers sufficient to strain city or state resources.  At Burnside Park, where Occupy Providence is taking place, there are roughly 100 tents.  

But perhaps labels aren’t important. The principle risks are the same at a spontaneous crowd gathering and at a planned event. What is important is that the Occupy protests create crowds of people and increase the risk for infectious disease spread. Clearly, there are efforts to diminish these risks, but protestors and public health officials alike should be on high alert. Spontaneous gatherings, like Occupy or other political protests, lack some of the foundational work that goes in to preparing for planned mass gatherings such as surveillance systems and vaccine stocks.  

David Scales MD PhD, research fellow at HealthMap, points out that these sites are all unified by an idea. While there is no empirical evidence to support this yet, he asks whether or not the risk of disease spreading quickly through Occupy camps might be higher than expected. Are activists close enough that perhaps they travel from one camp to another?

It is true that these camps are nowhere near the size of the crowds at Hajj or the World Cup. However, any infections that might be brewing there could have traveled with one of the 40 protestors who left Providence last week to rally at the White House.

Looking at the Occupy camps in the context of mass gatherings and infectious disease spread provides an interesting picture for protestors and public health officials. It becomes clear that regardless of the classification of a gathering of people, the risk of the spread of infectious disease changes and should be prepared for and reacted to accordingly. Check back next week for more on mass gatherings with some words from experts in the field.

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