In Reply to “A Symptom-Driven Mitigation Protocol for SARS-CoV-2 in a Wilderness Medicine Elective”

To the Editor:

Thank you for giving us the opportunity to reply to the letter ¹ about our paper entitled “Evaluation of Safety Measures at a Medical Summer Camp during the SARS-CoV-2 Pandemic.” ² First, we’d like to thank Dr Hill et al for highlighting potential limitations of generalizability within our manuscript to the editor so we can respond to them and clarify the points made in our manuscript. Our paper was strictly a description of a multifactorial nonpharmaceutical intervention risk mitigation strategy. Ultimately, we want to commend the letter authors for their insightful thoroughness in developing, implementing, and analyzing the effectiveness of a symptom-driven testing protocol for a wilderness medicine elective during the SARS-CoV-2 pandemic.

The letter authors express concern about mandatory asymptomatic SARS-CoV-2 testing in their population and environment since their participants are young and healthy in an environment with sufficient natural ventilation.

Our manuscript differs in that we were evaluating a medically complex population who were spending significantly more time indoors compared to the wilderness medicine elective population. The inherent risk of severe complications from SARS-CoV-2 infection in this population heavily affected our more conservative approach in requiring asymptomatic viral testing. ³ Also, our data was only collected in the early phases of the SARS-CoV-2 pandemic when routine vaccination was not readily available for everyone and natural immunity was not as prevalent. ⁴ Our population was larger than the wilderness medicine elective population but similarly was underpowered to draw any sweeping conclusions on the effectiveness of any intervention.

Upon reflection, keeping in mind recent advancements in SARS-CoV-2 immunizations, natural immunity rates, and natural history of viral characteristics, we hope to implement a risk mitigation strategy that is in line with the letter authors. We agree with the letter authors that it is difficult to draw conclusions on the effectiveness of specific risk mitigation strategies given the design of the manuscripts. Similar to the letter authors, we are very interested in the assessment of various non-SARS-CoV-2 infection risk mitigation strategies on the health care and societal costs in the outdoor activity group settings.