As states decide how and when to reopen churches amid the novel coronavirus pandemic, a new federal report analyzing a cluster in Arkansas shows how easily the virus can spread in faith communities—even when they take precautions.
The analysis from the Centers for Disease Control and Prevention (CDC) details how one couple—a pastor at a local church and his wife—contracted the virus and unwittingly may have helped spread it to 26 others, which ballooned into a cluster of 61, of which four people died. The analysis mirrors past reports detailing—with painful precision—how just one case of COVID-19 can quickly spread within communities or cities, like at a funeral and birthday party in Chicago.
But this latest report comes as states and localities move to reopen from COVID-19 lockdown—and served as a stark warning amid a rush to fashion rules and regulations for large gatherings.
Before the Arkansas couple developed respiratory symptoms and fever, the 57-year-old pastor attended a Bible study group on March 11 at his church. During subsequent contact tracing, local and federal public health authorities determined that dozens of others were likely infected by the pair, highlighting “the potential for widespread transmission” of the virus “both at group gatherings during church events and within the broader community,” according to the report.
On March 12, after learning that members of their congregation had developed symptoms, the pastor and his 56-year-old spouse closed the church “indefinitely.” They were the first two confirmed cases of the virus in the county, the report states. They were likely infected between March 6 and 8, and “the husband might have then exposed others while presymptomatic” during the March 11 Bible study event.
He and his wife were officially diagnosed on March 16, after their test results came back positive.
The Arkansas case report was largely consistent with the details of an outbreak reported at a church in Greers Ferry, Arkansas, north of Little Rock, though as with other CDC reports of this nature, individuals’ identities were obscured. And though the deacon publicly cautioned congregants to take the virus seriously in that case, public health authorities have sparred with pastors and other religious leaders over social distancing, sometimes resulting in criminal charges.
Of course, the novel coronavirus pandemic is not the first time that public health has been at loggerheads with religious practices, according to Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University and an expert on U.S. readiness for pandemics.
He cited the conflict between those in West Africa who passionately fought to maintain religious burial traditions during an Ebola outbreak and even Orthodox Jewish communities in New York City, where measles outbreaks flared last year. (Tension between the ultra Orthodox community and New York City Mayor Bill de Blasio has escalated amid reports of well-attended funerals and school sessions in recent weeks.)
“There are people whose entire lives center around going to a mega church every Sunday,” said Redlener. “This is to be expected, in a way, because of very strong religious beliefs that often do override concerns about health and safety.”
But the Arkansas case is perhaps more concerning because the church closed indefinitely as soon as the pastor and his wife learned that congregants had developed symptoms. What’s more, the couple cooperated with the investigation, generating a list of 94 church members and guests who had registered for or might have attended related events. Those March events included a 3-day children’s event beginning on March 6 with indoor sessions, singing, and church services led by guests from another state and involving hand-to-hand contact during offerings. On March 7, food prepared by church members was served in a buffet.
Of the total of 35 cases related to the church through April 22, the investigation by the Arkansas Department of Health identified the pastor and his wife as the index cases. But another two people who were symptomatic on earlier dates were found to be the “primary cases… because they likely initiated the chain of transmission among church attendees.” Those two people lived locally, reported no travel or contact with any confirmed cases, and were linked only through the church.
“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,” according to the CDC report.
Of this group of 94 church event attendees, 92 were contacted, and 38 percent of that group contracted the virus. Of the 45 people who were tested, 78 percent received positive test results. Among the 35 church event attendees with laboratory-confirmed COVID-19, seven—or 20 percent—were hospitalized, and three—or 9 percent—died. No children suffered severe infection. Six of the seven hospitalized persons and all three deaths occurred in persons at or over the age of 65 years.
But those 35 people appeared to spread the virus to another 26, including one person who died, leading to a total of 61 confirmed cases either directly or indirectly associated with the church. To be clear, the report notes that there could have been additional cases that were not detected “because they did not seek testing, were ineligible for testing based on criteria at the time, or were unable to access testing.”
As Redlener pointed out, while other clusters around the country have involved so-called “super-spreaders” who may be more contagious than the average patient, the virus itself is infectious enough to be easily spread by anyone—even if they have mild or no symptoms.
“We don’t even need super-spreaders to create a significant outbreak because the rate of transmission is so high,” he said. “This disease is very infectious, and unless we have thorough contact tracing, it’s going to be hard to control.”
This matters a great deal when states discuss how and when to reopen churches and other public gathering spaces, Redlener argued. Churches all over the country have said they are working to determine what makes sense after weeks of Zoom services. In New York at least, Gov. Andrew Cuomo has said that churches will be among the last spaces to reopen.
“People can go to church and become infected and then spread it into their larger communities, and with an infection like SARS-CoV-2, this could really promote a major secondary or tertiary wave of infection in the larger community,” Redlener said. “It’s not just limited to the people who attend these services.”
“This is an unresolved issue,” he added. “There’s a threat to the larger community.”