Interesting story from Wisconsin - social distancing

wasn't practiced and masks weren't used, especially when eating or

drinking... need  I say more...

......

USA (Wisconsin): ice fishing

Date: Mon 15 Feb 2021

From: Blaise Vitale <bvitale@burnettmedicalcenter.com> [edited]

Ice fishing is a popular pastime in northern Wisconsin and Minnesota.

Makeshift villages show up on area lakes every winter and remain there

most of the winter. This may be the 1st documented outbreak of

COVID-19 associated with ice fishing.

During my regular clinic on Friday [29 Jan 2021], I was assigned to do

COVID-19 testing. Our small clinic at a Critical Access Hospital

allows asymptomatic people to be tested by laboratory personnel but

symptomatic people are supposed to be seen by a provider. The 1st 2

patients were a couple in their 30's who requested testing as they had

found out on [28 Jan 2021] that someone with whom they had been ice

fishing during a family outing on [23 Jan 2021] with 3 ice houses on a

lake in northern Polk County, Wisconsin, had tested positive. Both of

the members had started to develop mild upper respiratory symptoms on

[27 Jan 2021]. Rapid antigen testing (Quidel) was positive for both

patients. The family then brought multiple other members to our clinic

over the course of the day and 9/9 tests were positive. The patients

ranged in age from 4 to 67. No one reported sharing beverages but

several meals were consumed in the ice houses. In total, 11 people

were affected (including the presumed index case who was tested early

in the week with a PCR test at another clinic). 3 patients were

pediatric (2 of whom were asymptomatic). Subsequently, all 9 positive

rapid antigen tests were confirmed positive by a send-out PCR test.

When I saw the 67-year-old, I alerted her to the availability of

administering monoclonal antibodies to mitigate the risk for severe

disease. Her 69-year-old husband had tested positive at a drive

through site in Polk County, WI on [28 Jan 2021] but was not notified

about the availability of treatment. He then came into the office and

was evaluated as well. He did have a symptomatic hypertrophic

cardiomyopathy but was otherwise healthy. After receiving an exam,

being provided with the appropriate educational material, and a

discussion of risks and benefits, the 67- and 69-year-old received

infusions of bamlanivimab on the same day.

The 69-year-old did report some low grade fevers overnight as well as

chest pain such that he presented to our Emergency Department the

following day. Because of an abnormal EKG and a mildly elevated

troponin, he was transferred to the Twin Cities for evaluation but was

discharged after an overnight period of observation without any

intervention. The 67-year-old had complete resolution of her symptoms

within 2 days.

While preparing this report, our clinic subsequently found a 2nd

outbreak associated with ice fishing on a Burnett County lake.

These may be the 1st reported outbreaks of COVID-19 associated with

ice fishing. As demonstrated by this report, while ice fishing is

usually thought of as a safe outdoor activity, fishing within the more

comfortable ice houses currently on the market does represent a

potential unrecognized hazard.

Additional information

On follow-up, 40 people participated in 7 different ice houses. Most

of these were very nice RV [recreational vehicle) like structures with

heaters and several of them had bathrooms. About half of the people

had been there the night prior. There was food in most of the houses

but individual meals were largely served within family groups. There

were a total of 14 new positive cases traced back to this event. 5

people at the event had already been infected and recovered from

COVID-19. One person had already been vaccinated. The older couple

described were there only for about 3-4 hours. The index case worked

at a dental office and was thought to have been infected at work. When

she became mildly symptomatic, she was tested, but because she didn't

think she had it, she did not quarantine. There were no additional

medical complications and everyone has completely recovered.

I was told that everyone visited multiple houses and socialized

throughout the day. The 10 patients I saw were associated with 3 ice

houses and the index case apparently visited all 3.

I would also doubt that windows were opened. In my experience, the

only reason that would occur while ice fishing is if the house

overheated. Windows are usually built into houses for getting in

natural light rather than for increasing ventilation. With multiple

people moving around (including multiple children) I suspect the doors

opened often enough that windows were not necessary to prevent the

houses from overheating (and some of these fancy RV-like ice houses

can keep the temperature regulated at a certain height. I do know that

masks were not worn as they thought this was a safe "outdoor"

activity. The only other information was that 2 additional children

did have mild flu-like symptoms around the time of this outbreak but

their parents elected to not get them tested.

--

Blaise Vitale, MD

<bvitale@burnettmedicalcenter.com>

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