Arkansas church link to new cluster of coronavirus cases is proof religious gatherings can be super-spreaders

Among 92 attendees at a rural Arkansas church during March 6-11, 35 people developed Covid-19 and three died


                            Arkansas church link to new cluster of coronavirus cases is proof religious gatherings can be super-spreaders
(Getty Images)

President Donald Trump wants churches to open in the US, but more evidence has emerged on how church services can turn into super-spreading events.

Two people infected with Covid-19 spread the virus to at least 30 people during church gatherings before the first case was diagnosed in Arkansas, according to the report. Among 92 attendees at a rural Arkansas church during March 6-11, 35 (38%) people developed Covid-19 and three died. An additional 26 cases linked to the church occurred in the community, including one death, shows the report by the US Centers for Disease Control and Prevention (CDC).

(CDC)

Super-spreading events exist in many infectious diseases, but with Covid-19 they are especially dangerous because the virus has a longer incubation period in which patients show no symptoms but can infect others. An earlier analysis of a choir practice showed how one person, who did not show any symptoms, led to 87% of the choir members developing Covid-19 in Washington, US. Accordingly, the latest findings are important as the report shows how rapidly the new coronavirus can spread to others involved in faith-based organizations and may have implications for places of worship as churches nationwide figure out how to reopen safely.

According to a study, avoiding mass gatherings until a vaccine is developed or herd immunity emerges could be an effective way to prevent the spread of Covid-19. The research team from Denmark used computer simulations to model what would happen to the pandemic trajectory under various scenarios. "In comparison to mitigating in the 'home' and 'work/school' sector, mitigating the 'other' sector has a profound impact — it halts the epidemic. This finding suggests that limiting diffuse/random social contacts such as that occurring in transportation, gatherings, weddings, religious meetings, and frequent trips to shops, bars, and restaurants is what drives the Covid-19 epidemic. This dramatic finding only obtains when super spreaders are in the model," the pre-print study concludes. 

Super-spreading events exist in many infectious diseases, but with Covid-19 they are especially dangerous because the virus has a longer incubation period in which patients show no symptoms but can infect others (Getty Images)

What did the research find?

Detailed investigations show that on March 16, 2020, the day national social distancing guidelines were released, the Arkansas Department of Health (ADH) was notified of two cases of the new coronavirus from a rural county of approximately 25,000 people. These cases were the first identified in this county. The two cases occurred in a husband and wife. The husband is the pastor at a local church (church A). During March 6-8, church A hosted a three-day children's event which consisted of two separate 1.5-hour indoor sessions (one on March 6 and one on March 7) and two, one-hour indoor sessions during normal church services on March 8.

The couple (the index cases) attended church-related events during March 6-8 and developed non-specific respiratory symptoms and fever on March 10 (wife) and 11 (husband). Before his symptoms developed, the husband attended a Bible study group on March 11. Including the index cases, 35 confirmed Covid-19 cases occurred among 92 (38%) people who attended events held at church A during March 6–11, and three patients died. According to the researchers, the age-specific attack rates among people aged 18 years and below, 19-64 years, and 65 years or above were 6.3%, 59.4% and 50.0%, respectively.

"The husband and wife were the first to be recognized by ADH among the 35 patients with laboratory-confirmed Covid-19 associated with church A attendance identified through April 22; their illnesses represent the index cases. During the investigation, two symptomatic persons (not the husband and wife) during March 6–8 were identified. These are considered the primary cases because they likely initiated the chain of transmission among church attendees," says the report. "Additional cases included those in persons who attended any church A events during March 6-11, but whose symptom onset occurred on or after March 8, which was two days after the earliest possible church A exposure," it adds. 

According to the researchers, the age-specific attack rates among people aged 18 years and below, 19-64 years, and 65 years or above were 6.3%, 59.4%, and 50.0%, respectively (Getty Images)

During contact tracing, at least 26 additional confirmed Covid-19 cases were identified among community members who reported contact with one or more of the 35 church A members with coronavirus as an exposure. These people likely were infected by church A attendees. Among these 26 people, one was hospitalized and subsequently died. As of April 22, 61 confirmed cases (including eight or 13% hospitalizations and four or 7% deaths) had been identified in people directly and indirectly associated with church A events, shows analysis. 

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.

Based on their findings, the researchers say that this outbreak highlights the potential for widespread transmission of SARS-CoV-2, the virus that causes Covid-19, both at group gatherings during church events and within the broader community. The authors write that these findings underscore the opportunity for faith-based organizations to prevent Covid-19 by following guidelines regarding modification of activities to prevent virus transmission during the coronavirus pandemic.

"High transmission rates of SARS-CoV-2 have been reported from hospitals, long-term care facilities, family gatherings, a choir practice, 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 US government’s guidelines for modifying activities during the Covid-19 pandemic to prevent transmission of the virus to their members and their communities," the team recommends.

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