Q’s With Dr. Danielle Ompad: NYU Infectious Disease Epidemiologist Talks Coronavirus And Concert Industry

Paul Kane / Getty Images – Audience of None
Violinist Renaud Capuçon performs Beethoven, Schubert and Mozart to empty seats at Lausanne’s Salle Métropole March 4. Swiss public radio and television broadcast the unattended shows.

As the coronavirus disease (COVID-19) proliferated across the U.S., the live events industry responded accordingly to slow the disease’s spread. Major spring concert events, including Coachella and Pearl Jam’s upcoming arena tour, were postponed to protect the public.

Local and state governments soon acted, with states including New York and California restricting large public gatherings. Quickly, Live Nation and AEG suspended larger shows for the coming weeks, as did indie promoters like I.M.P. and Another Planet Entertainment. At press time, artists from Billie Eilish to Chris Stapleton had postponed tours.

Though such drastic measures may have initially seemed premature, experts agree that they were prudent, and will likely help slow the disease’s spread.

“There’s no reason to panic right now, but it is important to take this seriously,” says Dr. Danielle Ompad, an associate professor of epidemiology at New York University’s School of Global Public Health who specializes in infectious diseases. “I understand that people are very dedicated to music and to the bands they want to listen to. I get it. But sometimes, we have to take one for the team, and in this case, the team is the vulnerable people in our communities. Avoiding these venues for the near future is probably a good idea, as disappointing as it may be.”

Ompad connected with Pollstar to discuss how coronavirus spreads and what fans and industry observers might expect next.

Pollstar: How does a virus like COVID-19 spread, and how might that be intensified at large gatherings?
Dr. Danielle Ompad: This is spread via droplets. Somebody coughs, sneezes or talks, and moisture comes out of their mouth and it ends up on other people. It can get into your nose, your mouth, your eyes. It also resides on surfaces, so if you touch a surface and then you touch your face or mouth or your nose, then you could transmit it that way as well.

What happens when you’re at a concert, and particularly certain concerts that may be outdoor or have a pit or something like that? You have a lot of people really close together, singing along, often with the performers, in each other’s faces. There’s a potential for quite a bit of transmission. That’s why people are so concerned about big events, and particularly concerts and festivals.

We have flu season every year. Why does this virus pose such a threat?
It seems to be a little bit more contagious. It seems that the mortality rates increase as people age, meaning that the older you are, the more likely you are to have serious illness or potentially die. What we call the case-fatality rate, it’s not as high as Ebola, but it’s still substantial. That’s of concern. [World Health Organization data places Ebola’s case-fatality rate around 50%, and SARS’ around 11%. Current estimates place COVID-19 close to 2%, which is substantially higher than the 0.1% rate typical of seasonal flus.]

One fear with coronavirus is that asymptomatic patients can still transmit it. How prevalent might patients be who aren’t displaying symptoms?
I’m not sure that we know quite yet what proportion of people [are asymptomatic]. Remember, in the U.S. in particular, there aren’t enough tests [being conducted]. In order to know that someone is asymptomatic, you have to know that they’re infected. [A Chinese Center for Disease Control and Prevention study of 72,314 cases found that only 1% of COVID-19 patients are asymptomatic.]

Austin’s South By Southwest and Miami’s Ultra Music have been cancelled. Coachella was postponed. Some think that, given the relatively small number of confirmed cases in the U.S., those decisions were premature. Is postponing or canceling events weeks or even months in advance reasonable?
In terms of public health, what we saw in China is that the spread was actually quite rapid. And it went down substantially once they instituted the isolation and the quarantine. Basically, if we can reduce transmission, we may be able to reduce the number of cases overall and not have as big of a peak as in China. It’s probably a good idea, at least for the next month or two, to really consider whether or not these big events need to happen. My mom has tickets to go see The Rolling Stones. Some of our performers are older adults as well, and at risk. So, we want to protect the performers as well as the concertgoers. I don’t necessarily want my mom and my stepdad at a big Rolling Stones concert. People are excited, they’re talking. There’s a high probability for transmission in those crowded, closed-in spaces.

Coronavirus has already been in the U.S. for a few weeks. Is the reason we haven’t seen more cases that there’s a limit to how fast even fast-spreading viruses can be transmitted?
In the beginning, transmission is usually slow, because there’s only a few cases. But as more cases present themselves, the likelihood of getting infected increases. You tend to get logarithmic growth. To be less technical, you get dramatic growth the more cases that there are.

Does weather or heat have any bearing on how this might spread?
It’s unclear right now.

Fabrice Coffrini / AFP – The Best Medicine?
After Australian health officials discovered that a woman who had attended Perth Concert Hall had tested positive for coronavirus, Russell Brand’s sold-out March 9 show at the venue was canceled.

There’s uncertainty now about concerts not just in March and April and May, but in June, July, August. Is it plausible that, if not contained, coronavirus could continue to spread and intensify for that length of time?
It’s possible. We just learned about this particular virus in December. We’ve learned a lot in about three months. But this is new. We have some experience with SARS and MERS and with influenza that can help us think about what’s going to happen, but to some extent, we don’t know, and the evidence is still being collected to help us really understand what these epidemics are going to look like. You feel uncertainty because there is uncertainty. It’s not because of lack of effort; it takes time to accumulate the scientific knowledge.

We’ve lived through SARS and MERS. How does this compare?
From the current understanding, which obviously is going to evolve, the death rate is lower for COVID-19. It took some serious interventions to get SARS to stop. If we don’t take it seriously now, I think cases could increase. People struggle with what isolation means and what quarantine means. When people think they’re isolating, they’re staying home from work, but maybe they’re still going to the grocery store. Well, that’s not really isolation. If you do it right, isolation and quarantine are going to be very inconvenient to the individuals doing it, but it has a huge impact on public health. That’s where public health kind of struggles, is that we ask people to do things that may be inconvenient to them to help the wider population.

Beyond just the increased statistical probability that you might be in contact with somebody who is infected, is the transmission risk any different at large venues compared to smaller ones?
I’m not sure that size matters. Maybe it does, but you’re still at risk if you’re in a smaller venue with a lot of people.

Justin Bieber moved his tour from stadiums to arenas, reportedly citing coronavirus. Is holding events in arenas safer than holding them in stadiums?
No. If you’re thinking about how people interact with each other, the transmission is happening within three feet. Unless the concert is sparsely attended and there is a chair or two between people and they stay in their chairs, then maybe – but that’s not how it works. [In COVID-19 literature, the WHO advises “social distancing” of three feet, while the Centers for Disease Control and Prevention advises six feet.] 

Are high-energy crowds riskier for transmission than more stationary ones?
It’s about proximity. With people moving around and talking and dancing and yelling, there may be more opportunity for transmission, but that doesn’t mean that sitting next to somebody who is symptomatic is not risky. Again, it’s the social distancing that doesn’t happen at concerts that’s the issue.

Keeping yourself isolated is probably best, but if events are still taking place, what can venue staff do to reduce transmission?
I would wipe down all surfaces on a regular basis with something that would be able to kill the virus, so not just water. Changing gloves on a regular basis. Don’t touch their face. Be careful about what they’re touching when they go to the bathroom. I would constantly ask them to wash their hands thoroughly. You know, pick your favorite song. Mine is the hook from “You’re All I Need to Get By,” Mary J. Blige and Method Man.

I still think it’s a risk. If I had free front-row tickets to Wu-Tang right now and I would be able to meet them backstage, it would be really hard for me to say that I shouldn’t go – but I shouldn’t go. And the feeling I have for Wu-Tang is deep and real! I’m not trying to go to concerts right now. It’s just not a good idea. It’s not about me getting sick, that’s the thing. A lot of concertgoers are young, so even if they get coronavirus, they may not get sick or they may have mild symptoms. They probably won’t end up in the hospital. But it’s the people in their communities that are at risk.

People are saying, “The people who go to Coachella are young and fit and healthy. What’s the big deal for them?” But it’s that they could come into contact with it and increase its logarithmic spread.
Yeah, to their friends, their families, their co-workers. To people in their community where they go shopping, that kind of thing. It’s not all about you. It’s about the wider community, and we have a responsibility to protect the most vulnerable, even if it’s inconvenient.

If a fan paid an arm and a leg for Wu-Tang tickets and can’t refund or sell them, what could they do to reduce transmission, if they went to the show?
Oh, gosh. That is so not what I would recommend. Let’s just make that clear. I would take the hit on the ticket, honestly. But I would be very careful about touching my face. I would wash my hands all the time. I would be very careful about sitting next to people who are coughing. If I could spread out a little bit, I would try to be at least three feet away from people, but I know that’s difficult. I would not be pushing my way to the front in the crowd of people, as much as I want to shake Method Man’s hand or say hi to RZA. I would be trying to stay in my seat.