#15,273
A week ago, in MMWR Early Release: COVID-19 Superspreading Event In A Church Choir, we looked at a large cluster of COVID-19 cases linked to attendance of a church choir practice in Skagit County, Washington, in early March. See summary below:
Following a 2.5-hour choir practice attended by 61 persons, including a symptomatic index patient, 32 confirmed and 20 probable secondary COVID-19 cases occurred (attack rate = 53.3% to 86.7%); three patients were hospitalized, and two died. Transmission was likely facilitated by close proximity (within 6 feet) during practice and augmented by the act of singing.We also looked at several other church based COVID-19 clusters in South Korea and Singapore, all of which show how easily a novel respiratory virus can spread in a crowded, enclosed environment.
Yesterday the CDC's MMWR released another cautionary tale, this time involving 94 attendees of a rural Arkansas church during the week of March 6th-11th, which resulted in 35 COVID-19 infections, and 3 deaths.
An additional 26 people in the community who reported contact with an infected member of the congregation were also infected, resulting in 1 death.While church gatherings appear to be highly conducive to COVID-19 transmission, they are not alone. We've seen outbreaks in crowded nursing homes, hospitals, restaurants, funerals, and at family gatherings, all of feature a large number of susceptible people in an enclosed space.
As we reopen our economy, our biggest challenge will be in finding effective ways to curb transmission of COVID-19 in these types of settings. As this report illustrates, a cluster which emerges from a specific event, or location, can easily spill out into the greater community.The CDC offers advice on their Community and Faith-Based Organizations webpage, but each state appears to be providing their own guidance. How good that advice is, and how well it is followed, will spell the difference between success or failure.
The full MMWR report is lengthy, but worth reading. I've only excerpted the summary and discussion section, so follow the link to read it in its entirety.
High COVID-19 Attack Rate Among Attendees at Events at a Church — Arkansas, March 2020
Early Release / May 19, 2020 / 69
Allison James, DVM, PhD1,2; Lesli Eagle1; Cassandra Phillips1; D. Stephen Hedges, MPH1; Cathie Bodenhamer1; Robin Brown, MPAS, MPH1; J. Gary Wheeler, MD1; Hannah Kirking, MD3
Summary
What is already known about this topic?
Large gatherings pose a risk for SARS-CoV-2 transmission.
What is added by this report?
Among 92 attendees at a rural Arkansas church during March 6–11, 35 (38%) developed laboratory-confirmed COVID-19, and three persons died. Highest attack rates were in persons aged 19–64 years (59%) and ≥65 years (50%). An additional 26 cases linked to the church occurred in the community, including one death.
What are the implications for public health practice?
Faith-based organizations should work with local health officials to determine how to implement the U.S. Government guidelines for modifying activities during the COVID-19 pandemic to prevent transmission of the virus to their members and their communities.
(SNIP Detailed Outbreak Summary)
Discussion
This investigation identified 35 confirmed COVID-19 cases among 92 attendees at church A events during March 6–11; estimated attack rates ranged from 38% to 78%. Despite canceling in-person church activities and closing the church as soon as it was recognized that several members of the congregation had become ill, widespread transmission within church A and within the surrounding community occurred. The primary patients had no known COVID-19 exposures in the 14 days preceding their symptom onset dates, suggesting that local transmission was occurring before case detection.
Children represented 35% of all church A attendees but accounted for only 18% of persons who received testing and 6% of confirmed cases. These findings are consistent with those from other reports suggesting that many children with COVID-19 experience more asymptomatic infections or milder symptoms and have lower hospitalization rates than do adults (4,5). The role of asymptomatic or mildly symptomatic children in SARS-CoV-2 transmission remains unknown and represents a critical knowledge gap as officials consider reopening public places.
The risk for symptomatic infection among adults aged ≥65 years was not higher than that among adults aged 19–64 years. However, six of the seven hospitalized persons and all three deaths occurred in persons aged ≥65 years, consistent with other U.S. data indicating a higher risk for COVID-19–associated hospitalization and death among persons aged ≥65 years (6).
The findings in this report are subject to at least four limitations. First, some infected persons might have been missed because they did not seek testing, were ineligible for testing based on criteria at the time, or were unable to access testing. Second, although no previous cases had been reported from this county, undetected low-level community transmission was likely, and some patients in this cluster might have had exposures outside the church. Third, risk of exposure likely varied among attendees but could not be characterized because data regarding individual behaviors (e.g., shaking hands or hugging) were not collected. Finally, the number of cases beyond the cohort of church attendees likely is undercounted because tracking out-of-state transmission was not possible, and patients might not have identified church members as their source of exposure.
High transmission rates of SARS-CoV-2 have been reported from hospitals (7), long-term care facilities (8), family gatherings (9), a choir practice (10), and, in this report, church events. Faith-based organizations that are operating or planning to resume in-person operations, including regular services, funerals, or other events, should be aware of the potential for high rates of transmission of SARS-CoV-2. These organizations should work with local health officials to determine how to implement the U.S. Government’s guidelines for modifying activities during the COVID-19 pandemic to prevent transmission of the virus to their members and their communities (2).(Continue . . . )
