Will spring breakers become super-spreaders?

Hansel Tookes, public-health physician at University of Miami’s medical school

11-14 minutes

People gather on Clearwater Beach during spring break despite world health officials' warnings to avoid large groups on March 18 in Clearwater, Florida. | Mike Ehrmann/Getty Images

TALLAHASSEE, Fla. — As Florida officials move to expel the hundreds of thousands of spring breakers who ignored calls for social distancing, public-health specialists are nervously wondering what will happen once the party’s over.
For much of this week, revelers continued to cram four and five to a hotel room, swarm beaches over hundreds of miles of coastline, and then gather shoulder-to-shoulder in bars and clubs – almost a model process for spreading contagious diseases.
Now, with their campuses likely shuttered, most spring breakers will return to hometowns across the country where any exposure to coronavirus could set off a contagion, public-health experts warned. They called for greater vigilance in those communities and sharply criticized Florida authorities for their slowness in closing beaches and nightspots.

“What is happening in Florida with spring break partying-on by students oblivious to the epidemiological implications of their actions is nothing short of tragic,” wrote Gregg Gonsalves, a professor of epidemiology at the Yale School of Public Health, in an email. “While many of us have been hunkering down to try to break the chains of infection in our communities, these young people have decided the pleasures of the moment are worth bringing back the coronavirus to their friends and family.”

Justin Lessler, a professor of epidemiology at Johns Hopkins University’s Bloomberg School of Public Health, said the crush of swimsuit-clad students consuming large amounts of alcohol could create so-called “super-spreading events” that worsen the pandemic.

“The students who are going and partying at spring break potentially are feeding into a world where they are stuck in their houses for weeks on end later on,” he said. “So I think they should keep that in mind."

There is some precedent for resort communities being slow to wake up to epidemics. The Austrian village of Ischgl, an Alpine ski destination and party hotspot, was slow to close down its establishments even as other nations issued travel warnings of potential coronavirus exposure. Thousands of revelers returning from vacations in Ischgl spread infections across much of Scandinavia. On Tuesday, Norway said 40 percent of its then-1,400 infections were traced to Ischgl.

The outbreak has prompted accusations that authorities there acted too slowly out of a fear of harming the local tourist economy.

Unlike other states, Florida did not initially impose strict controls on crowds and left it up to local officials to take action.

On Tuesday, Gov. Ron DeSantis ordered bars and nightclubs to close for 30 days and directed restaurants to cut their seating capacity by half. That same day he said that beaches could remain open but that groups of more than 10 people would not be allowed in one place.

The edict wasn’t enforced. Aerial pictures of hundreds of thousands of beachgoers hit the national airwaves and shocked people in other states where even major thoroughfares were empty.

Forced to explain his decision, DeSantis said he did not want to do a statewide order because there were places where the virus had not yet spread. People were on “edge,” he said, and he wanted them to be able to go outside.

Some local officials stepped in. Those in Miami Beach, Fort Lauderdale, Naples and Clearwater moved to shut their beaches down.

On Friday, DeSantis ordered restaurants to shut their doors, except for takeout and delivery. He told gyms to shutter and closed the beaches and other “non-essential” businesses in Fort Lauderdale and Palm Beach at the urging of local officials. This action came a day after Miami officials closed many businesses.

Miami Beach Mayor Dan Gelber told POLITICO on Friday that the city is finally getting spring breakers to leave after a month of revelry. Gelber ordered beaches shut on Thursday, and posted photos of the empty sandscape on Facebook on Friday.

Hotels will “substantially close” by Monday evening, Gelber announced in a late-Friday tweet.

Gelber predicted the measures would reduce the transmission of coronavirus but, at this point, he didn’t know how much. Florida spring break went on for weeks before anyone took action, when the virus seemed less threatening.

“This is about risk management,” Gelber said. “It might have been too late a month ago, frankly.”

Miami Beach spokesperson Melissa Berthier said there have been no confirmed spring break coronavirus cases reported in the city.
But Hansel Tookes, a public-health physician specializing in infectious diseases at University of Miami’s medical school, said no one knows how much the coronavirus has spread among spring breakers because of a lack of testing. Had there been enough tests, the students could have gone to clinics, and the sick ones could have isolated themselves in Florida before going home.
“If there was testing, they could be isolated in say, a hotel or a place where they could remain alone until they were no longer infectious,” he said. “Younger people have more social interactions. There’s more transmission amongst them. Most people are infectious before they are symptomatic.”

Indeed, researchers at the University of Texas at Austin have found that the virus also spreads quickly even among people who are asymptomatic. Ten percent of patients are infected by someone who has no symptoms.

So far, there’s no sign of a spring break surge in Florida's safety net hospitals, which would potentially be more likely to take in a struggling spring breaker. But it’s also too early. Infected Florida spring breakers are still incubating the illness, spreading the disease. And, state officials don’t know if there will be a surge in other parts of the country because they’re not tracking anyone who has left Florida without symptoms.

“There’s the strong possibility that we could start to see cases popping up after the incubation period. And if it’s not the spring breakers, their parents and grandparents are at high risk as well,” said Nitesh Paryani, an oncologist in Lakeland, who said his cancer specialty doesn't mean anything amid the public health crisis. “Everybody is treating coronavirus, whether we want to or not. All physicians are being pulled into this fight. It’s an all hands on deck situation.”

Ironically, the risk of returning spring breakers carrying the virus has already manifested itself in Florida. In the city of Gainesville, home to the University of Florida, four students have tested positive. One of the students had returned from Portugal while on spring break, according to local media. The Gainesville Sun reported that one student was a dentistry student who worked in a clinic after returning.

The revelation that there was positive tests among university students played into the university system’s decision to scrap in-person classes for the rest of the semester. Initially, schools planned to delay opening campuses after spring break and resume classes in early April. DeSantis admonished university students this week for returning to fraternity houses to party instead of going home.

Florida State University President John Thrasher, whose college was on spring break this past week, said that he is hopeful that many of the school’s 41,000 plus students will stay away, even those who live off-campus locally.

“We are doing everything we can to discourage them from going back,” Thrasher said.

But while Florida schools contribute to the spring break crowds, students also stream in from the rest of the South and even the Midwest. And it’s not quite clear how many came to the state – and where they are going now that the bars, restaurants and many of the beaches have shut down.

“I would think it next to impossible to track that many people and potential exposures,” said Craig Fugate, the former head of the Federal Emergency Management Agency who also led Florida’s emergency management agency when the state dealt with back-to-back hurricanes. “This may end up being tracked by spring breakers if they get sick here or once they get home and working backwards.”

Visit Florida, the state’s tourism marketing arm, does not have figures for this year, but says that more than 32 million visitors come to the state in March through May. An average of 2.7 million students come to Florida each year, the group estimates.

DeSantis acknowledged Thursday — at the opening of a South Florida mobile testing site — the unintended consequences of a March 11 directive that he and the State University System Board of Governors worked together on. They told students to delay returning to campus from spring break for two weeks.

“We were thinking, don’t come back yet,” DeSantis said. “Instead, they all went back, and they were drinking at the bars every night.”
Despite the clear risks, experts said that several factors might mitigate the threat posed by the spring breakers.
“It certainly has the potential to cause spread, but it may not be as dramatic as some people might think," said Lessler, the Johns Hopkins professor. Young people are more likely to be asymptomatic, and might therefore be less contagious, he said.
Lessler also cited the short duration of spring break, which lasts about a week for most revelers. The generation time of the virus ranges from four to eight days, weighted towards the higher end, he said. That means that infected spring breakers could spread the virus to one other person, but there might not be enough time to pass the virus on again before heading home.
Still, all public-health officials who were interviewed warned that returning spring breakers could easily bring the virus to new parts of the country, as the disease continues its relentless spread.
“Students on spring break are likely to introduce [coronavirus] into communities that have not yet been exposed to the virus, especially in quieter less well-connected parts of the country,” said William Hanage, professor of epidemiology at Harvard’s T.H. Chan School of Public Health, in an emailed statement. “However this does not change the fact that the virus is well established and community transmission is widespread. Once this has happened, limits on travel become much less important.”

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